Depression and Hearing Loss

young-depressed-man-cartoonThe National Council on the Aging has published a study emphasizing the need for treating hearing loss, no matter how “minor”. Dr. James Firman, the President and CEO of the National Council on Aging reports that untreated hearing loss can lead to serious consequences.

According to Dr. Firman, “The survey of 2,300 hearing impaired adults age 50 and older found that those with untreated hearing loss were more likely to report depression, anxiety, and paranoia and were less likely to participate in organized social activities, compared to those who wear hearing aids.”

Dr. Firman further states, “This study debunks the myth that untreated hearing loss in older persons is a harmless condition.” This is not new information to audiologists who regularly see patients with untreated hearing loss. Many first time hearing aid users report an increase in socialization and family interactions. Being able to be part of a conversation is refreshing and relaxing. Family members report a renewed interest in outside activities once their loved one is fit with hearing aids.

There are over 38 million Americans with hearing loss. Hearing loss is just not for older Americans. About 7% of American teens have permanent hearing loss due to noise exposure. Fortunately, many teens are “turning the volume down” on their personal listening devices. But, for some the damage is already done.

Also, fortunately, Baby Boomers are recognizing the need for hearing tests and the necessity for hearing aids. Physicians are requesting patients have a baseline hearing test at age fifty. Many Baby Boomers are finding the need for understanding conversations in meetings and social situations. They are finding that with a high frequency hearing loss they are having trouble understanding speech in a noisy situation. They often report they are withdrawing socially because it is too difficult to follow the conversations.

Depression is real. Hearing loss is real. See an audiologist and have a hearing test. If you need hearing aids, find a way to purchase them. Do not let a treatable problem rule your life.

Written and Submitted by Loleata Wigall, M.S. CCC-A, FAAA

President of Atlantic Audiology, Inc.

781-246-0305

lwigall@gmail.com

 

 

 

How to Select a Hearing Health Care Provider

female_audiologist_postcard-r2147302d1ca64d8bbfec49ea325d8ed6_vgbaq_8byvr_324You’ve finally decided to move ahead and try to improve your communication skills. You’re excited about wearing hearing aids but don’t know how to get started. Choosing an appropriate hearing health care provider is as important as your choice of physician. Your audiologist is the hearing professional trained to evaluate and manage your hearing disorders and your concerns….so where to begin????

While a recommendation is very useful, it’s important to understand that one person’s success may not translate into success for you. Each person’s hearing loss is different and requires individual attention, not only to your hearing disorder, but to your lifestyle and your hearing requirements. Your doctor may have the names of qualified audiologists and this may be a good place to start. Asking a friend or relative is also helpful in terms of knowing the style and personality of the practice.

1. Choose a practice that adheres to the industry’s standards of “best practice”

2. Choose a practice where you will be seen by the same individual practitioner so there is continuity of service

3. Choose a practice that is not corporate in design so that decisions can be made by the audiologist managing your needs, and not by corporate protocols

4. Choose an audiologist who will listen to your needs and your concerns

5. Choose an audiologist who has state of the art equipment

6. Choose an audiologist who adheres to infection control recommendations, using disposable items when indicated

7. Choose an audiologist who is willing to make changes and corrections to the recommended hearing aid if it is not satisfactory

8. Choose an audiologist who takes the time to survey your hearing problems before you make hearing aid decisions

9. Choose an audiologist who offers many manufacturers’ brands of hearing aids

10. Choose an audiologist who incorporates multiple follow up appointments in order to assure your success

11. Choose an audiologist with appropriate university degrees

12. Choose an audiologist who has outcome measures to validate the hearing aid fitting

13. Choose an audiologist who is state licensed and abides by the state rules and regulations, and explains the state’s law for the trial period.

14. Choose an audiologist with a helpful staff for making insurance claims and answering questions

15. Choose an audiologist who will forward reports to your primary care physician

16. Choose an audiologist who will refer you to an otologist if your tests indicate the need for medical intervention

17. Choose an audiologist who you LIKE…you will be spending hours with this person which makes it even more important to put your trust and your confidence in a professional who is pleasant and accommodating and makes you feel relaxed and comfortable.

When it comes to your hearing, which is an integral component of your overall health, choose a hearing care professional who is patient and caring and provides counseling and aural rehabilitation to facilitate the adjustment to hearing instruments. Hearing aids are a process, not a product, and the relationship you build with your audiologist should be meaningful and built on a foundation of trust.

Hears to happy hearing and healthy living!

Stefanie Wolf, Au.D.
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094

What’s the Buzz About?

imagestinnitusAn estimated 37 million Americans suffer from ringing, buzzing, humming or hissing in the ear known as tinnitus. Tinnitus, by definition is the conscious perception of sound in the absence of an externally generated sound source. Tinnitus can be a combination of sounds and for many people may vary in tone, character and loudness. It may remain consistent and persist or may subside or at times seem to disappear. For some, stress and diet exacerbate it. Others have difficulty determining what makes it better or worse.

And while tinnitus is perceived in the ear, and may, in some cases be generated in the middle ear space, most scientists will agree that in most cases, the sound perceived in the ear is occurring in the brain. Yes, that’s right, tinnitus is perceived in the ear, but occurs in the brain. This explains why many patients with severed auditory nerves will lose all ability to hear from the severed nerve ear, but will still experience tinnitus.

Scientists disagree over the causes, origins and models for how tinnitus originates and becomes weaved into the neural pattern, but what they do agree about is the fact that many different types of tinnitus exist. A popular theory suggests that damage to the peripheral auditory structures send disrupted, abnormal neural signals to the brain which subsequently causes persistent abnormal activity in the central auditory pathway (Nageris, et al., 2010; Jastreboff & Hazell, 1993).

While tinnitus can occur for individuals with normal hearing, 85% of those with tinnitus do have some degree of hearing loss. (Simpson & Davies, 2000). This makes sense when we think about how damage to the ear can result in disrupted and abnormal signals to the brain.

For many patients, simply acknowledging the presence of the tinnitus and understanding that it is a result of damage to the auditory mechanism is enough for them to accept the noise intrusion. Others find their tinnitus more debilitating and seek other avenues for help.

For many tinnitus sufferers with hearing loss, a properly fit hearing aid will help to reduce the perception of tinnitus in over 60% of cases. Some find that use of amplification can suppress tinnitus. But for most, decreased awareness of tinnitus is either a result of a complete or partial masking of the sounds or a reduced contrast between silence and the tinnitus, or because of a more structured neural pattern, among other possible occurrences that contribute to diminished awareness of the presence of tinnitus.

For others, amplification alone will be insufficient to help deal with the effects of tinnitus. Stress management and counseling or cognitive behavioral therapy is often extremely useful when used alone or in conjunction with amplification therapies.

Certainly, one with tinnitus should know that there is help. An appointment with an audiologist can help identify whether there is hearing loss, need for medical referral and design an approach for dealing with tinnitus.

Hears to Healthy Living!

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

“Like” us on Facebook!
https://www.facebook.com/AudiologyofNassauCounty

Sources

Jastreboff, P., & Hazell, J. (1993). A neurophysiological approach to tinnitus:
clinical implications. British Journal of Audiology, 27, 7-l7.

Nageris, B., Attias, J., & Raveh, E. (2010). Test-retest tinnitus characteristics in patients with noise-induced hearing loss. American Journal of Otolaryngology–Head and Neck Medicine and Surgery, 31, 181-184.

Simpson, J., & Davies, E. (2000) A review of evidence in support of a role for 5-HT in theperception of tinnitus. Hearing Research, 145, 1-7.

Hearing for the holidays and life

family-meal-free-clip-artIt’s that time of year once again. The days are shorter, the air is colder, we shop too much, we eat too much, and we make plans for more. For most of us the best part of the season aside from the delightful treats and seeing little ones open their presents, is reconnecting with family and friends. Gathering around a table or a fireplace reminiscing, recollecting and sharing is what the holidays are all about.

Yet, for the 48 million Americans that have some degree of hearing loss, the holidays may be a time of great struggle. For those with untreated hearing loss, get togethers with friends, family and colleagues in noisy party settings is often stressful and uncomfortable. Conversation connects us with people and even a mild hearing loss affects the ability to converse in the presence of background noise.

Untreated hearing loss can also lead to social isolation and depression. People decline invitations because they feel like they can’t participate in conversation in a meaningful way. Many feel that they look “stupid” if they can’t properly answer a question (it’s difficult to answer a question that you can’t hear). Depression can result from prolonged isolation.

Many are in denial about their hearing loss, often because it is a gradual process and are truly unaware that there is a problem. Others are concerned that admitting to a hearing loss will make them look “old.” The alternative, which is suffering in silence as the world whirls about is it really is painful for the person with hearing loss and their loved ones.

The silver lining is that hearing aids DO HELP. Most hearing losses can be assisted with hearing aids that are discrete and have a remarkable ability to process sound clearly and naturally. Don’t spend another holiday season in silence. Motivate yourself or your loved ones to have a hearing evaluation. There is little more precious in life than enjoying the company of those we care about. Make the most out of your time together. Hearing enables us to connect and is too precious a sense to be ignored.

Take care of your health, hearing and enjoy the spirit and sounds of the holiday season!

Stefanie Wolf, Au.D.
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094

I Can Hear but I Can’t Understand

images (1)The auditory mechanism is an astoundingly complex and brilliant design. It is truly amazing how sound waves or vibrations in the air, initiate a chain reaction that starts with vibrations to the eardrum and concludes with a neural signal to the cortex. Our physiological reaction, this delicate chain of vibration, pulsation, displacement, conduction, that occurs in response to sound is what allows us to communicate, participate and enjoy music, and the sounds of the world that surrounds us. This design is so fascinating, and so intricate that a slight interruption along this pathway, either occurring at the peripheral or central level, can result in tremendous difficulty with hearing, understanding, or both.
Hearing and understanding are not always codependent. One must be able to hear to capture a spoken message, but hearing alone does not necessitate that the message was understood. The ability to understand an auditory signal ultimately depends on the brain’s capacity to receive and interpret a complete and synchronously fired neural message.

For many older adults who suffer from sensorineural hearing loss, damage to the peripheral auditory system passes incomplete messages to the brain. More than 50% of adults over age 65 have some degree of presbycusis or hearing loss in the higher frequencies. These adults often have difficulty hearing certain higher pitch sounds such as a bird chirpings , certain phones ringing and particular letters of the English alphabet. Because our alphabet is comprised of a combination of vowels, which are lower in frequency, and consonants which are higher in frequency, an individual with high frequency hearing loss, might remark that they can hear, (because they can indeed hear ) but they didn’t understand because they didn’t quite receive all of the information due to the brain’s inability to receive a complete message. In English, consonants envelop vowels to give meaning to speech and hearing only vowels and limited consonant sounds offer opportunities for misunderstanding. “Fifty” and “sixty” sound somewhat alike for someone with presbycusis, especially in noise.

Hearing aids offer tremendous help for most individuals with hearing loss by bringing the inaudible sounds into the range of audibility and offering the brain complete messages. Yet, there are individuals who have difficulty understanding, despite being able to hear. For some, damage to the auditory nerve results in its inability to fire synchronously, delivering an unclear signal to the brain. Some listeners with auditory nerve damage may have normal hearing (when it comes to detecting tones) but cannot interpret speech because the signal sounds distorted or unclear. For many who suffer from a lack of clarity, assistive listening devices in conjunction with aural rehabilitation often result in tremendous improvements in listening.
If you or a loved one has difficulty hearing OR understanding , a hearing evaluation is a first step. There is help for most hearing loss. No one should suffer in silence. Schedule an appointment at an audiologist today.

Stefanie Wolf, Au.D.
 
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
[avatar user=”blog” size=”thumbnail” align=”center”]

Hearing Loss and Driving: Safety on the Open Road

 

While an estimated 43% of adults over the age of 65 have hearing loss, roughly only 25% wear hearing aids. Many are in denial about their hearing loss, often because it is a gradual process and are truly unaware that there is a problem. Others are concerned that admitting to a hearing loss or assisting it with amplification will make them look “old.” Although, untreated hearing loss has been known to lead to social isolation and depression and recent studies have correlated a decrease in auditory stimulation to dementia, untreated hearing loss poses safety issues as well, especially for drivers.

The open road is a dangerous place. Anyone getting into a car and turning on the ignition has a tremendous responsibility; the life of the driver, passengers, pedestrians and other motorists is in many senses in a heighten state of vulnerability. Careful driving requires engagement of visual and auditory senses to make informed often, very quick decisions to navigate safely.  Hearing loss can greatly impair an individual’s ability to hear important safety cues such as a horn honking, a siren, or another vehicle accelerating nearby.   Street noise outside the car and the hum of traffic can make it difficult for normal hearing drivers to detect signals, for those with hearing loss, background noise presents an even greater challenge.

Hearing loss alone provides significant safety concern on the road.  Hearing loss combined with the ordinary distractions of driving makes for an even riskier environment.  A study of older adults with hearing loss published in the Journal of the American Geriatrics Society entitled Hearing Impairment Affects Older People’s Ability to Drive in the Presence of Distracters found that there was a significant correlation between hearing impairment and driving performance in the presence of distracters. The study concluded that older adults with hearing loss had greater difficulty driving safely in the presence of distracters than older adults with normal hearing.  Because distractions such as conversation, reading street signs, listening to the radio, using a mobile phone or navigation system are a present day reality for all drivers, those with hearing loss face an even greater challenge when confronted with distraction.  This study, which references similar studies of adults with hearing loss suggests that the additional effort of listening to a degraded auditory signal detracts one’s resources from other cognitive tasks, making it more difficult to attend safely to the road.

Good hearing is essential to good driving. But drivers with hearing loss needn’t necessarily hang up their keys, instead they should seek help. If you suspect you or a loved one has a hearing loss, see an audiologist for an audiologic evaluation.  If you have a diagnosed hearing loss, see your audiologist annually to monitor for changes. If hearing aids are prescribed, they should always be worn when driving.  Finally, make responsible decisions; if your senses are impaired, your driving ability can suffer, especially for older adults.  When on the road, be smart, be courteous, and remember, your safety and that of others is at stake.

Stefanie Wolf, Au.D.
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094

Hickson L, Wood J, Chaparro, A, Lacherez, P, Marszalek, R. Hearing impairments affects older people’s ability to drive in the presence of distracters. Journal of the American Geriactrics Society, 2010; 58:1097-1103

 

Marketing Predators: The EAR-ie Truth

I wish I had a nickel for every time a patient came to my office with a mailer they received promising a vacation, a kitchen appliance, or even a Thanksgiving turkey as a gift for trying a hearing aid. Mailers like these are nothing new. Such inducements have become common practice in condo time shares and car dealerships, but they have no place in health care.

 

These mailers are sent by hearing aid dispensers or audiologists who purchase a list of specific demographic targets in order to lure prospective patients to their offices with promises of gifts and discounts.  These practices expect that, in order to receive their “gifts”, the patients will book an appointment and splurge for hearing aids. The mailers will often arrive in an 8 x 10” envelope marked “urgent” with the appearance of an authorized document, with emboldened warnings such as “time sensitive information” and “for recipient only.” Others state that the recipient has been “selected to be part of a special test market.” These mailers are often outsourced and arrive from a third party marketing company to present the appearance that it is not the practice’s own marketing. Is it legal, yes. Is it ethical, who knows. Is it tasteful, definitely NO!

While there is nothing wrong with advertising a clinic – after all, how else will people be made aware of the practice – I have a particular distaste for letters and publicity designed to mislead people. What is particularly troubling is that most of those who are targeted for these mailers are over the age of 65. A December 2012 article published on NPR’s website entitled Why It’s Easier To Scam The Elderly reported findings from psychologist Shelley Taylor at UCLA. Her study suggested that older adults have decreased activity in the area of the brain that detects risk and danger, making them more susceptible to respond to unsavory types of marketing. The article also reports a finding from AARP that the average age of fraud victims is 69, and states that this age bracket is “most inclined to believe those too-good-to-be true promises.” A more recent article, entitled Psychological Vulnerable Older Adults Are More Susceptible to Fraud,  published by Science Daily in April 2013, suggests that psychologically vulnerable individuals, characterized by depression and ”low level of social needs fulfillment”, were most likely to become victims of fraud. Because hearing loss is so pronounced in this age demographic, and because untreated hearing loss leads to social isolation and depression, the inevitable obvious conclusion is that the target audience for the hearing aid gimmicks are those who are most psychologically vulnerable.

To our patients who are disgusted by these mailers, I want to say “Thank You” for reading between the lines. To our colleagues who remain committed to avoid this path, it’s wonderful to see so many taking the high road to preserve the caliber of our profession. To our professional organizations that have not yet sanctioned these tactics for being unethical, hopefully soon you will reach the same conclusion that I have and re-evaluate your ethics standards and guidelines.

Most importantly, to recipients of these mailings, please remember for yourself and for your loved ones – especially the elderly who may not be able to read the subtle cues or fine print – that there really isn’t a special prize, special discount or special test audience, as advertised. These are simply devices to get people intrigued. The gifts for valentines chocolates aren’t REALLY chocolate, rather a $15 online certificate where you have to spend a certain amount to activate the coupon. If a practice promises $500 off a price of a hearing aid, more often than not, the price is first INCREASED $500 so the spender can feel good about using their coupon. Or, my personal favorite is the 50% off the manufacturer’s suggested retail price, which of course is artificially doubled by the practice so that it can be cut in half. Read carefully, be smart, and advise those you care about to do the same.

When it comes to your hearing, which is an integral component of your overall health, choose a hearing care professional who is patient and caring and provides counseling and aural rehabilitation to facilitate the adjustment to hearing instruments. Hearing aids are a process, not a product, and the relationship you build with your audiologist should be meaningful and built on a foundation of trust. Certainly professionals who use tricks to get you to their door could be initiating a relationship that prays on your vulnerabilities. Don’t let yourself or your loved ones fall victim to marketing predators. Isn’t it better to find honest professionals and buy your own Thanksgiving turkey?

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

“Like” us on Facebook!
https://www.facebook.com/AudiologyofNassauCounty

http://www.npr.org/blogs/health/2012/12/06/166609270/why-its-easier-to-scam-the-elderly
http://www.sciencedaily.com/releases/2013/04/130425132441.htm

When Louder isn’t Always Better: Tips for communicating with someone who is hearing impaired

 

Communicating with someone with hearing loss is often very frustrating for all parties.   The inability to hear normally and effectively communicate leads to emotional consequences such as a loss of self-esteem, social isolation and a lack of participation in social settings. While there is currently no cure for sensorineural hearing loss, hearing devices prove a powerful and life changing tool.

While I (and most of my colleagues and patients) regard hearing instruments as “tiny little miracles”, simply wearing hearing aids alone may not be enough to maximize communication.   Both the listener and speaker should understand that in order to receive the most benefit from hearing aids, there are additional strategies that can be employed concomitantly.

The Hearing Loss Association of America (HLAA) recommends three core points to maximize communication with a person who is hard of hearing: set the stage, get the point across, and establish empathy with the audience.

When setting the stage, the HLAA recommends facing the listener directly, spotlight your face (avoiding backlighting), avoid noisy backgrounds, get the listener’s attention before initiating speech, and ask how you can facilitate conversation (often the listener knows just what to recommend!).  When the acoustics are poor, emphasize visual cues.

The HLAA outlines several pointers on how to best “get the point across”.  First, don’t shout. Speaking louder doesn’t necessarily result in a clearer acoustic signal.  The ideal way to deliver your message is by speaking at a moderate pace, clearly, without overemphasizing words. Use facial expressions or gestures when appropriate and don’t hesitate to rephrase if you are not understood. Finally, remember the hearing impaired rely heavily on visual cues. Chewing, facial hair such as a heavy beard or mustache, or turning your head while speaking may not result in communication breakdowns for someone with normal hearing but may cause interruptions for a hard of hearing listener.

To establish empathy with your audience the HLAA recommends being patient.  Speak directly to the hard of hearing individual (not about him or her to another person), show respect and maintain a sense of humor, stay positive and relaxed.

Even with the best intentions however, communication breakdowns are bound to occur.  If your listener did not appropriately understand what you said, try repeating the message noting your delivery speed. If your message was still not understood try rephrasing the message. If “that’s right” was not understood try, “that is correct.” Another approach is to repeat a key word to indicate the topic of conversation. If “Sue came home” was not recognized try, “Sue. Sue is home.” Simple alterations in word choice and order often have a significant impact on your intelligibility.

In summary, when communicating with individuals with hearing loss , share in the responsibility of effective communications.  While there are certainly strategies for the hearing impaired listener to maximize communications (a topic for a later post), exercising some of these strategies can yield a positive impact on your relationships.

 

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

“Like” us on Facebook!
https://www.facebook.com/AudiologyofNassauCounty

Johnson, C., Danhauer, Guidebook for Support Programs in Aural Rehabilitation. Singular Publishing Group, San Diego,1999.
Montano, JJ. and Spitzer, J.B. (Eds.) Adult Audiologic Rehabilitation Plural: San Diego (2009).
Tye-Murray, N.: Foundations of Aural Rehabilitation Singular: San Diego (1998).
http://www.asha.org/public/hearing/disorders/types.htm
http://www.earaudiology.com/hhie.pdf
http://www.hearingloss.org/LEARN/index.asp#50
http://www.isu.edu/csed/profile/sac.shtml#

In Case your Doctor Forgot to Mention…

Often patients express surprise when I share some very basic information about hearing and ear health and hygiene. Either some of these topics are neglected at a physical exam or they are forgotten by the patient. Keeping our ears safe and healthy is an essential aspect of overall health. Hopefully, for most, the information below will serve as a friendly reminder and not new information.
Here are a few basics when it comes to taking care of your ears:

1) DO NOT USE Q-TIPS IN YOUR EARS! The best thing you can do with your Q-tips is to break them in half and toss them in the trash! Ear wax is a good thing. EAR WAX IS NOT DIRT! Ear wax is anti-bacterial, anti-fungal, a natural bug repellent and it is there for a reason! Q-tip users who complain about itchy ears have itchy ears BECAUSE of Q-tip use. Scrubbing the natural oils from the ears depletes the canals of essential moisture causing itching and dryness. Stop the Q-tips, stop the itch. Remember nothing smaller than your elbow should ever go in the ear canal!

2) Protect your ears from noise ALL THE TIME! Both young and old should take care to protect the delicate hearing mechanism. Noise exposure damages the fragile hair cells that reside in the cochlea that are responsible for detecting sound. Damage to the hair cells can result in hearing loss. This can happen after one encounter with something extremely loud or over time with repeated exposures. Consider ear protection for home, on the job or for concerts or loud events.

3) Tinnitus or ringing in the ear should always be evaluated. If you or someone you know reports that they experience tinnitus, an audiometric evaluation should be performed by an audiologist. Often tinnitus is caused by damage to the auditory mechanism. An audiologist can also recommend different treatments to help manage tinnitus annoyance and when indicated can refer to the appropriate otologist.

4) Changes in hearing should receive prompt attention. Sudden changes in hearing such as ‘sudden deafness’ is considered a medical emergency and should receive immediate attention.

5) Dizziness or a sense of disequilibrium should be discussed with your physician or audiologist.

6) Hearing loss should be addressed as an important health issue. Untreated hearing loss has been linked to depression and social isolation. Recent studies have also linked untreated hearing loss to dementia.

7) There IS help for the hearing impaired. Speak with your audiologist and learn about your options for better hearing and hearing protection.

 

Stefanie Wolf, Au.D.

Caught in the CROS Hears

Every now and then there are moments from the work day that stay with us long after the last patient has departed, computers turned off and the office locked for the evening; moments that we replay in our heads and hope we will always remember. This week we experienced such a moment as we fit a patient with a very particular hearing instrument for the first time.
Hearing loss presents itself in many different configurations. For some, hearing may be diminished in both ears, some in one, and for others the auditory mechanism is so damaged that the ear provides no audibility and is referred to as a “dead ear”. For patients with one normally hearing ear and one “dead ear”, there is a special type of hearing system called a CROS fit which stands for Contralateral Routing of Signal. For this particular type of fit a patient wears a microphone on the “dead ear” and a receiver on the hearing ear. Sound from the “dead ear” side is routed to the hearing ear, offering patients a fuller, more robust picture of their acoustic environment.

This week we were privileged to have the opportunity to fit an upbeat woman with a radiant smile with a wireless CROS hearing system. We became choked up as we watched her reaction to hearing her boyfriend on her “dead ear” side. Overwhelmed with emotion she began crying as she wirelessly received auditory information from the side that she had never heard from. She repeatedly thanked us as she fanned the tears in her eyes telling us that she has never heard him from that side of her head before. Social activities such as dining in restaurants were always more effort for her because she had to carefully plan her seating to ensure that the person she wanted to hear was seated next to hear hearing ear. Now, for the first time, she has the acoustic information from both sides of her head and it left her speechless. Imagine the limitations of seeing with only one eye and then suddenly being able to use the one eye to capture the visual field from both sides.

Hearing is a precious sense that connects us to our environment. It enables us to communicate with friends and loved ones and feel in touch with our world. The absence of hearing, even in one ear, can severely impact an individual and render everyday communication a struggle. We are so grateful to the acoustic engineers and all of those who work for the hearing aid manufacturers who allow us to achieve what was once thought of as impossible. How wonderful it is to be able to make a difference in someone’s life, by providing them access to one of life’s precious senses.

Diapers, Cookies and Hearing Aids??

On a recent outing to my beloved Costco for life’s necessities, I found myself paying more attention to the Hearing Aid Center than I had ever in the past. Hearing aid departments at box stores such as Costco are nothing new and I had seen this particular Hearing Aid Center countless times. But as I waited on the checkout line to pay for my diapers, cookies, laundry detergent, paper towels and the rest of my purchases, I found myself keeping a watchful eye on the booth and recalled an article that I had recently read in Bloomberg Businessweek. The article reported 26% growth of hearing aid sales per year on average for the past four years. As an audiologist and hearing aid dispenser, it begs the question…Really?

Of course I am not at all surprised that box stores sell hearing aids. They sell everything else and often at great value with fantastic customer service for their products. But knowing what I know about the process of diagnosing hearing loss and providing appropriate amplification, verification, handholding and counseling, it was indeed startling to read the article. My only rationalization for this is just an overall lack of awareness and understanding from the general public about hearing impairment, hearing aids, and practitioners who work with these issues.

I think that while most people may be aware that a hearing aid can provide benefit for hearing loss there is still so much unknown about audiology, hearing aids and the process of hearing aid fittings. To illuminate on this, audiologists are professionals specializing in disorders of the auditory and vestibular systems; audiologists diagnose and treat hearing and balance problems. Audiologists, most of whom hold a doctoral degree, have the foremost skills and education to evaluate hearing, have been trained to recognize when medical referrals are required, fit hearing aids and provide the critical services that are required for patient success. Otolaryngologists, are medical doctors who are trained to diagnose and treat diseases of the ears, nose, and throat and cancers of the head and neck. Otolaryngologists are specially qualified with at least 5 years of surgical residency training following a medical education. Many otolaryngologists work closely with audiologists who administer hearing evaluations and work with hearing aids. Finally, a hearing aid dispenser, or hearing instrument specialist, is a professional licensed to work with hearing aids. Although requirements vary from state to state, hearing-aid dispensers generally have from six months to two years of supervised training or a two-year college degree and in most states must pass licensing tests.

Some box store hearing aid centers may have audiologists on staff, but most are run by hearing aid dispensers. The Bloomberg Businessweek article reported that Costco in particular is running a program to help their employees obtain hearing aid dispenser licenses. The goal of a hearing aid dispenser is not to provide a thorough diagnostic analysis of the auditory mechanism, but rather a quick hearing screening and a hearing aid sale if a candidate presents. It doesn’t seem possible to service the volume of patients they are reporting and to provide the follow-up verifications all of which are recommended by our industry’s “best practice.” In several attempts at calling two such box stores to find out a little more about their hearing aids and practice, the phone went repeatedly to voicemail, during their stated working hours. When I eventually got through to them, they did confirm their hearing evaluation and follow-up process which, to say the least varies greatly from what we do at our practice.

Sales of hearing aids at box stores and “wanted for a test market trial” mailings that promise steaks, turkeys and pull out all sorts of tricks (which, stay tuned, will surely be a post at a later time), diminish the experience of being diagnosed in a professional setting. In order to put patients first, time is needed, hand holding is needed.

So if, convenience if your thing, (believe me, I get it), and you like to shop under one roof, and are tempted by the signs next to the hot dogs, take a moment to think. First, remember hearing aids are a process, not a product. Do you really want to take shortcuts with your hearing? Finally, ask yourself what are you (or mom, or grandpa) really getting from purchasing hearing aids where you buy tomato sauce?

HEARS to healthy, safe and SMART hearing,

Stefanie Wolf, Au.D.