There’s a pocket of air sealed in the inner ear. Rapid change in temperature can equal a painful change in airpressure. This change is pressure can be very painful if you are congested because the eustachian tubes (which regulate the pressure) get blocked. Keep you ears and head covered when you head out into a Canadian winter. If you do get an ear ache, deal with it the same way as on a plane: yawning, chewing hard, swallowing, and warm compresses.
Noisy Holidays
The new list is out that states which toys are too loud and could cause damage. Check out this link to see if you purchased any of these toys:
http://www.sightandhearing.org/news/healthissue/archive/hi_1111.asp
If you have purchased some of these toys, it is important to diminish the sound when children play with them. Most of them reach dangerous sound levels that can damage hearing in less than 15 minutes. Putting a piece (or several pieces) of duct tape over the speaker will help in making the toy safe, but the best way to ensure safety is to not buy or return this toy.
The holidays are a time of great fun, but there shouldn’t be consequences for children when they play with their toys.
Happy Holidays!
Advanced Hearing Group of Clinics
Protect Your Ears From Noise
Here are some tips on protecting your ears when you are exposed to noise:
Monitor your exposure time to sounds over 85 dB and take periodic 15-minute “quiet” breaks. the maximum time to safely be exposed to 100 dB is only 15 minutes.
Avoid hazardous sound environments. If you have to raise your voice to be heard, you are in a potentially hazardous environment for your hearing.
Wear hearing protection, such as pre-molded, custom earplugs, or earmuffs in noisy environments. Look for products with noise-reduction ratings (NRR) of at least 9dB.
Move away from on-stage monitors or amplifiers.
If you suspect hearing loss or notice sudden changes in your hearing or have ear pain, consult a hearing healthcare professional and have your hearing tested by a licensed audiologist.
What Does it All Mean?!
Anytime you come in to one of our clinics for the first time, you will be given a hearing test. This test requires you to sit in a sound proof booth with either headphones or foam inserts in your ear and press a button when you hear a tone that will change in pitch and volume. The goal of this test is to see how much volume you require to hear that certain frequency or pitch. There will be word tests done where you will be asked to repeat words back and a bone conduction test that will check what happens if we bypass some of your ear right to the inner ear. Included in the gambit will also be a test that checks how well your eardrum moves and how flexible your reflexes are around the bones (ossicles) of your middle ear.
So lets break down what we as clinicians are actually doing. First let’s look at the ear, so you have a good understanding of the terms Outer Ear, Middle Ear, and Inner Ear.
Outer Ear
The outer ear consists of the external part of the ear that people can see and the ear canal. The function of this part of the ear is to funnel in sound and direct it to the eardrum.
Middle Ear
The middle ear consists of the eardrum and the three tiniest and most delicate bones in our body, called the ossicles. The eardrm, or tympanic membrane, is a thin piece of skin that is at the end of our ear canal that is stretched tight like, well, a drum. It vibrates when the collected sound from the outer ear reaches it and this vibration makes that sound louder. Attached to the eardrum is the malleus bone. This bone is the first in a series of three that carry on the vibration from the eardrum and make it more powerful. The malleus is known as “the hammer”. Next is the incus, which is known as “the anvil”, and finally the stapes which is know as “the stirrup”. The malleus vibrates from the drum and causes the incus to vibrate, making is stronger, which then makes the stapes vibrate. The stapes is attached to the cochlea, our organ of hearing, and the vibration from the stapes must be powerful enough to push through the liquid this organ contains.
Inner Ear
The inner ear is the cochlea, mentioned above. Sound comes into the inner ear as vibrations and enters the cochlea , a small, curled tube in the inner ear. The cochlea is filled with liquid, which is set into motion, like a wave, when the ossicles vibrate. The cochlea is also lined with tiny cells covered in tiny hairs that are so small you would need a microscope to see them. They may be small, but they are incredibly important. When sound reaches the cochlea, the vibrations cause the hairs on the cells to move, creating nerve signals that the brain understands as sound.
The cochlea transforms sounds into action potentials in auditory nerve fibers. This process is known as mechano-electrical transduction. Vibrations of the tympanic membrane are finally transmitted to those of basilar membrane in the cochlea through the perilympth. The organ of Corti sits on the basilar membrane, and it consists of sensory cells such as outer hair cells, inner ear cells and many other kinds of cells. Every sound makes a different vibration of the basilair membrane.
Air Conduction
The atmospheric transmission of sound to the inner ear through the external auditory canal and via structures of the middle ear.
(The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.)
The test that has you wearing headphones or inserts listening for different pitches at different volume levels is testing what your ear does naturally. It searches for the softest sound audible to an individual at least 50% of the time. With this test, we are not bypassing any step in an individuals hearing. The test shows us what the outer ear, middle ear, and inner ear are capable of on their own.
Bone Conduction
The process by which sound waves are transmitted to the inner ear by the cranial bones without traveling through the air in the ear canal.
(The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.)
Once we have a good idea what your whole ear system is capable of doing, we then check the inner ear itself to check if there is a large difference recorded. If the inner ear responds much better than the outer and middle ear, we know where the problem lies and often you are sent to an Ear, Nose, and Throat Specialist to see if there is a surgical or medicinal option to help you attain better hearing.
Word Recognition Score (WRS)
This test is done to check the amount of words a person can get out of a possible 25 at their Most Comfortable Level (MCL). This level is found before the test is presented. The WRS is a series of monosyllabic words presented via a CD recording, so that the test can be standardized. The result is a percentage that should correlate with the hearing loss presented, as long as the hearing loss isn’t due to another medical issue. The WRS is very useful in determining how successful hearing aids will be. If the person’s WRS is spectacular once the volume is turned up, it shows that they will be very successful wearers. If the opposite is true, then we have to look into their specific needs and counsel them on realistic expectations.
Speech Reception Threshold (SRT)
This test determines the lowest intensity level at which the patient can correctly identify 50% of common two-syllable words such as: baseball, airplane, mushroom. It is presented on each ear seperately through a pre-recorded CD and the client will repeat the words that they hear. If they repeat them correctly, the volume is turned down and another word is presented until we reach the level where they can just make out the word. The results of this test should correlate with this patient’s Pure Tone Average, which is the average dB needed to hear taken from 500, 1000, and 2000Hz of the patient’s Air Conduction test. This test tells the hearing healthcare professional the degree of hearing disability a person may be experiencing.
| SRT (dB) | Degree of Disability |
| -10 to 15 | None |
| 16-25 | Slight |
| 26-40 | Mild |
| 41-55 | Moderate |
| 56-70 | Moderate-severe |
| 70-90 | Severe |
| 90 up | Profound |
Impedence
Impedence is performed to check the function of the middle ear, and the overall health of the eardrum. You will asked to sit very quietly and still with two different tips in your ears. One tip will record all the results, while the other tip will just be there to administer certain sounds. First, you feel some pressure on the ear being tested as air is sent into the ear canal to check the elasticity of the eardrum. If there is fluid or pressure behind the eardrum, this test will record it so that the hearing healthcare professional gets a visual representation on a graph. Then you will hear a series of beeps on either side that will tell us how your reflexes are working and if sound can travel from one side to the other. This test helps us see if there are any medical or otologic issues further to just a hearing loss. This test is performed on both ears.
The End Result
All of these results are recorded on your audiogram. The air and bone conduction are recorded on a graph with the x axis being decibels and the y axis being frequencies. The word testing and impedence are located on the same form and give the hearing healthcare professional an overview of your hearing and ear health. This overview will help us make a decision on the next steps that are right for you.
Book your hearing test today at one of ThAdvanced Group of Hearing Clincs, either 1663 Carling Ave or 296 Metcalfe Street.
-Angie Prudhomme, HIS
(613) 728-4327
It’s Not Easy Being Green…
A lot of the time when people come in to see me, they tell me that it is their wife or husband or group of friends that have noticed that they have a hearing loss. Often this is followed with the statement “But I don’t think I need them, they just need to speak clearer.”
This statement is the first step in the grieving process. I know that this idea that people grieve for their hearing is odd, but it is completely common place. We as human beings have a wide range of emotional responses to our everyday life and that is what makes us truly unique as a species. It is perfectly normal to grieve the fact that we can no longer hear the way we used to; that meetings become more difficult, restaurants and bars are frustrating and even just hearing a loved one from another room can end up in a misunderstanding and possible argument.
This post aims to look at the grieving process from both sides, that of the hard of hearing person and that of their family and friends. It is an extremely frustrating process on both sides, but the most successful hearing aid wearers are those who are surrounded by people that completely understand their role in the process as well. Not only that, but the hearing aid wearer understands that they, themselves, must also make changes for their loved ones.
Grieving Stages
Denial:
If the hearing loss is gradual, people develop coping mechanisms to get by in every day life. Therefore they may not perceive the loss as much as those around them. So they state that they hear perfectly fine, that they have no problems.
For the family and friends this stage may be the most frustrating. Not only are they trying to help the hard of hearing person but they feel it would make their life easier as well. Especially when the person is with you everyday, they notice that life is becoming more and more difficult. They may ask the hard of hearing person to do something and it doesn’t happen. Often, they cannot believe that the hard of hearing person is denying that they have a loss and this stage causes some issues in the relationship. Honestly, though, the question must be asked, if you felt you were perfectly fine, would you wear a hearing aid?
Anger:
Once a person is told that they have a hearing loss and are showed concrete proof via the audiogram graph, they will move from denial to anger. This anger is not really directed at anyone in particular (though it feels as though it is). They are angry that they have lost their hearing and will project that onto the people that have brought them in to be checked or have told them that they have a loss and a great deal of resentment is projected.
Family and friends have to understand that if their loved one is experiencing this stage, that they cannot take it personally. Often, this anger stage can be the worst one for children of the hard of hearing person. If the parent is older, they feel as though they are losing control of their lives and decisions as the children help out more. Add onto these changes a loss of hearing and need for aids and the parent can feel that their children are meddling or becoming overbearing. This stage will pass, but it is the most difficult one.
Bargaining:
Once the initial shock wears off, baragaining begins. Often this is the stage I see, as most people keep their personal struggles private. I am asked if there is a surgery that can be performed to bring back the hearing, will the hearing aids restore their natural hearing, can they wear the hearing aids only part time.
On both sides, hard of hearing person and family and friends, this is the stage that they can agree on. Both sides want things to be better and the way they originally were. So they both wish that something can be done to just make everything better.
Depression:
For a select group of people depression can be the fourth stage. When denying an issue exists hasn’t worked, getting angry about it hasn’t worked, and bargaining hasn’t helped, some people may fall into a depression. The hard of hearing person will remove themselves from social events, even those involving family.
Any type of depression is difficult for the person’s family and friends. It is extremely difficult to help someone who is feeling this way. All the loved ones can do at this stage is be positive, supportive and aware. If they feel it is getting out of hand, family and friends will be the ones to seek help. As I mentioned above, though, this isn’t overly common. Only a slight amount of depression may occur in most people.
Acceptance
Once the hard of hearing person has reached this stage, they are ready to wear hearing aids. This moment is exciting and daunting at the same time. On one hand they will be able to hear better, but on the other hand they will be hearing differently. At this point, it is my job to ensure that they are counseled properly on usage and realistic expectations.
For the family and friends, this stage is the best. Their loved one has finally accepted the help they have been trying so hard to give. This change, however, is only the start.
Hard of hearing people and those close to them, once it is accepted that they need help, have to undergo changes. The family and friends have to learn that they still need to look at the hard of hearing person directly to get the greatest amount of the message across. Hard of hearing people have to learn some patience in themselves and those around them. After the grieving process comes the learning process for everyone involved.
The main thing it is important to know is wearing hearing aids has to be the PATIENT’S choice, not that of their family or friends. If someone is not ready for hearing aids, they will not be motivated to wear them and, as noted in our previous post, will result in them feeling as though the aids are too loud or too distorted in some way because their brain is not acclimatized. It will also result in friction in relationships, and this is the time when hard of hearing people need the most support.
-Angie Prudhomme, HIS
(613) 728-4327
Room Acoustics and Hearing Aids
Often, after being fit with a new hearing aid, people are surprised and frustrated that they cannot hear their television or radio better or they are lost in a crowded room setting. They arrive back in their hearing clinic asking for their new hearing aid(s) to be changed and reprogrammed for this sole purpose. As clinicians, we discuss with the client that amplification is not the only step that must be taken in order for these situations to be clearer. One must also consider their room acoustics in order to have the most benefit from their aids.
Some of the first items that must be considered are the overall layout of the room and its furnishings. The sound that you hear in any room is made up of two different types of sound, direct sound that goes directly from the source to your ears, and reflected sound that bounces off the walls, ceiling, floor, furniture and windows before some of it reaches your ears. Reflected sounds can add spaciousness to your overall listening experience, adding fullness when watching television or movies. This sound for the hard of hearing person, however, can take away from their understanding of the sound as they need as much of the information as possible.
Speech is a complex sound that does not happen over only one frequency. As individuals we require the full spectrum of frequencies, from low to high, for intelligibility, loudness, and quality. If a room is badly planned, we lose certain frequencies due to exterior noise and reflection and therefore lose our ability to fully understand what is being said. Hearing aids are designed with directional microphones and noise reduction that helps immensely with this, but they may not be enough. If you are watching television in a room with hardwood flooring, non covered windows and a high ceiling, the aids can only work to amplify the sound, but suffer as your natural ears would to get enough direct sound for comprehension.
Some solutions could be to watch television or listen to the radio in a room that has a rug or carpet, cover your windows with drapes and to move the television or yourself closer. Placing bookcases filled with books in the same room can diminish the amount of sound that bounces off the hard surfaces of the room. In the end, if redesigning is not an option, the use of an Assistive Listening Device for the television is highly recommended. Used with your aids, you will get nothing but direct sound to your ears and will have a greater understanding of what is being said.
If you are attending a meeting or party in a larger room with many people, you often get drowned in noise versus clarity. What we have to take into account is where you are standing and what the room looks like. If you stand directly in the middle of the room, with several people around you, you are not going to have an easy time. Though the hearing aids are equipped with noise reduction and directional microphones, there is too much reflective sound all around you, not just behind. It is important to accept that hearing aids help, but you must make some changes as well. Pulling someone off to the side, away from the main noise will help you understand them much better. Preferably near a wall, as there will be less reflective sound. This reflective sound issue is the reason so many people have issues hearing in their place of worship. Most of these buildings are designed to be grand with large ceilings and lots of room, which makes for very little direct sound.
At the Advanced Group of Hearing Clinics, we understand what may need to change in your environment, and would be more than happy to discuss options with you.
-Angie Prudhomme, HIS
(613) 728-4327
Wear Your Hearing Aids…no seriously
As a clinician, I am responsible for helping you choose the proper technology for your hearing loss. It is my job to ensure that the technology chosen is set specifically for your needs and that your hearing and ears are healthy. I am expected to follow up with you and complete the proper paperwork so that you get back refunds and grants. The most important part of my job, though? Ethically, it is to let you know what will happen with your hearing if you do not wear your hearing aids.
The technical term for the process of your hearing getting worse if you do not stimulate the auditory pathway is AUDITORY DEPRIVATION. This means that you are starving your brain for sound and the brain is not being stimulated the way it should. Your brain will, inevitably, get lazy and your hearing will continue to decrease. The worst part being that with your hearing , your understanding of speech can also decline. That’s the saddest issue of hearing loss in my opinion. Yes, it is very important to hear sounds, especially for localization, but speech enhances our quality of life. It is important to maintain a good word recognition score so that you will be able to hear your grandchildren, friends, family, lectures, television, etc. If you only wear your hearing aid sparsely, you are not consistently stimulating your brain and you may end up sitting away from the crowd because you cannot understand anyone.
Other issues arise as well. If you do not bombard your brain with the hearing aids, your brain will never get used to them. It is like this with most things, your brain has to acclimatize itself to the new technology and adapt. If you only wear them once a week, the sound quality will be off every time. They may sound too loud, create an echo, or you may find that you cannot understand people because your brain cannot adapt to hearing aids in hours, it takes days, weeks, sometimes even months. Every brain is different, and there is no actual “normal” amount of time for adaptation.
Often I hear from people that they are worried that if they wear hearing aids, they will become dependent on them, or that their hearing will decrease even further. Let’s look at the latter first, your hearing will stabilize with hearing aids. The reason that your hearing decreases over time without the use of amplification is your auditory pathway is not being stimulated. With the use of aids, we give that pathway a workout and make it stronger. Another way to look at it is like a bad shoulder. If you hurt your shoulder, it is highly advisable that you move it, or work it out, otherwise it will get very stiff and will be much harder to deal with if it has not been moved. The brain and the auditory pathway are the same. Hearing aids are like a workout to make them stronger so they work to the best of their ability.
Similarly, if you choose to put off attaining hearing aids for many years, you will have poorer outcomes as the auditory system becomes less and less activated and the auditory nervous system degenerates. Do not wait until you NEED hearing aids, let the clincian, your friends and your family guide you to your decision. Hearing aids can only help when you have the available neural material to help you hear better and adapt more quickly.
Are you going to be dependent on your hearing aids? To a certain degree, yes, you ,will. Very much like glasses, we adapt to having hearing aids, because they make us better. Glasses help us see; the people who wear them, need them in order to function day to day. Hearing aids are the same. We get used to having them and they become a part of our daily routine. Like glasses, however, you do not HAVE to wear them every hour of the day, you can give yourself a rest every now and then for a couple of hours.
My final thought is this: You paid good money for your hearing aids and it would be an awful shame to waste that money. If you are having issues, come and see us at one of our locations, either 1663 Carling Ave or 296 Metcalfe Street, and let us help you. That’s our job. You are not being a bother or a nuisance, we only want our patients to be successful, no matter how often we have to see them.
-Angie Prudhomme, HIS and Sean Lennox, Audiologist
(613)728-4327
Welcome
Welcome to the Advanced Hearing Group of Clinics blog. It is our goal as a hearing healthcare facility to provide our clients with the most up to date information on their hearing health. We are also aware that we are now in the 21st century and, as such, must change along with the times. This awareness has brought with it a new social networking phase to our business. We have joined Facebook (Advanced Hearing Group of Clinics page), Twitter (@AdvancedHearin1), and have posted cleaning and care videos on YouTube (AdvancedHearingGroup channel). Now we have added a blog. Here we can give you up to the minute information on not only hearing issues, but also on our clinics’ events and up -to-the-minute news. We hope that you enjoy this new stage of our development!
(613) 728 4327
