Exercise

Listen!  Here's one more reason to get moving.  We all know the benefits of exercise: working out helps us manage our weight, boost our energy, stay heart-healthy, and enhance our mood.  And now, research at the University of Florida is suggesting that exercise may help prevent age-related hearing loss, so far, at least in mice.

The researchers divided mice into two groups: the mice in one group each had an exercise wheel, but the other mice did not.  They found that the sedentary mice lost important structures in the auditory system at a much higher rate than their exercising counterparts. According to their results published in the Journal of Neuroscience this resulted in a 20% hearing loss in the sedentary mice but only a 5% hearing loss in the active mice - that's huge!

Age-related hearing loss affects about 70% of adults age 70 and over, and is associated with loss of hair cells, capillaries and spiral ganglion in the cochlear (inner ear) system. These are the structures that sense sound, feed the hearing system with oxygen, and send the sound from the ear up to the brain.

The inner ear is a highly metabolic organ - it is always "on" and processing sound. It needs a lot of energy molecules.  To generate energy molecules the system must be well-fed with oxygen.  Researchers compared the running mice with the non-running mice to test how exercise affects the inner ear structures.  While it's fun to visualize tiny Fit-Bits, they researchers  monitored the exercise wheels to see how far the mice ran.

It's thought that age-related inflammation damages the capillaries and sensory hair cells, and that exercise protects against inflammation.  They found that the runner mice had about half the markers of inflammation than the couch potato mice.  We already know that there is a link between exercise and hearing loss, but this is the first study to show that regular exercise can actually prevent age-related hearing loss in mice.

This is likely to translate to people.  New studies are beginning to look for molecules that are released by exercise that protect biologic function in humans.  According to Dr. Christiaan Leeuwenburgh, a co-author of the UF study exercise likely releases some growth factors yet  to be discovered that maintain capillary. Exercise may also attenuate negative factors such as inflammation.

So, tie up your sneakers, put on some music, and move it!

Cognitive Ability and Hearing Loss May Go Hand in Hand

Did you know that there are links between untreated hearing loss and a decline in cognitive skills? Studies have shown that adults with untreated hearing loss experience a 30-40% faster decline in cognitive abilities compared to peers with aided hearing. 

Cognitive abilities are brain-based skills required to accomplish any task from the simplest to the most complex.  Basically, cognitive abilities affect how a person understands the world and interacts in it. Core aspects of cognition are visual and spatial processing, language, motor skills, memory, attention and perception.

Scientists believe that extra effort exerted by the brain to listen and comprehend redirects resources from the part of the brain used for memory and decision making. In fact, MRI’s of people with hearing loss have shown the part of the brain responsible for sound and speech shrinks faster than normal, likely due to atrophy from lack of stimulation.

A recent study in the Journal of the American Geriatrics Society compared the trajectory of cognitive decline among older adults who were using hearing aids and those who were not. While the study found no difference in the rate of cognitive decline between a control group with no reported hearing loss and people with hearing loss who used hearing aids, untreated hearing loss was significantly associated with lower baseline scores on the Mini-Mental State Examination.

If you have concerns that yourself or a loved one is experiencing hearing loss leading to a decline in overall health, please reach out to our team at McGuire’s. We provide the highest level of audiological evaluations and hearing aid services in a warm, private setting.

Smart Phones and Hearing Apps

Years ago, before there were Made for iPhone hearing aids, I kidded that one day our professional jobs would be taken over by our smartphones. I was kidding, but little did I realize the role that technology would assume in helping us with our amplification.

The Hearing Center audiologist Chris Herget explains, "Yesterday’s hearing aids needed constant tweaking and handling from professional clinicians, to make everyday noises sound natural. Today’s hearing aids are the opposite. Most modern hearing aids do the adjustments automatically based on your environment (reducing distracting noise around you to help you speech better, decrease wind noise while outside), and allow you to even make adjustments on the fly with a smartphone. Imagine yourself listening to your loved ones at a loud party but can’t quite make out what they are saying. In an instant, you can make the noise around you quieter and hear your family more clearly. This is not to say that professional clinicians don’t need to set the default settings and monitor your hearing but today’s hearing aids definitely are patient focused. From smartphone apps, to automatic settings, to noise reduction and environmental identification, modern hearing aids are the future of hearing healthcare."

Every hearing aid manufacturer is now offering an array of apps - some apps allow the listener to enhance the listening experience by working directly with the hearing aids.  For example Audibel's Trulink app answers calls and streams phone calls and music directly through your hearing aids. You can personalize and geotag hearing aid settings to best suit your environment. You can control volume and memory settings with your iPhone.  You can have as much or as little control as you like.

Other apps have specific functions, such as the Relax app for tinnitus management.  The listener may browse among a selection of "relief" sounds and select the most helpful for his individual preferences, and then stream the sounds to his wireless hearing aids.  We have learned that tinnitus is best managed by a comprehensive program of tinnitus education and sound therapy.  

McGuire's hearing aid dispenser Michael Burke has a patient who has used hearing aids with tinnitus masking for many years, but found that these instruments allowed little control over the tinnitus stimulus available to him.  But with his latest hearing aids and Relax app, he has blossomed into a "techie" and through the app he now decides whether he wants a (virtual) walk through the woods, along a sandy beach, or to sit and listen to birdsong all through the magic of his Relax iPhone app!

Another type of app is the listening exercise exemplified by Hear Coach or LACE. These programs allow the user to train their listening systems (ear to brain) to practice discerning speech in a variety of challenging listening environments.  As we tell our patients, better hearing is not just about making things louder, but also about filtering the sounds that we don't need and home in in on the ones with the information we want.  These games may be thought of as Physical Therapy for the ears!

Study States Fibromyalgia Patients Have Higher Risk of Hearing Loss

According to a recent study done by Norwegian researchers (published by Fibromyalgia News Today), patients suffering from fibromyalgia are 4.5 times more likely to suffer from hearing loss.  Fibromylagia, a musculoskeletal pain disorder that causes chronic pain, affects the central nervous system and may be associated with an overall dysregulation of the nerves. 

Hearing loss appears to be more common for those afflicted with fibromyalgia, and other musculoskeletal disorders, for a long period of time. The loss is attributed to the damage to the inner ear auditory nerve pathways to the brain. The prevailing theory is that all fibromyalgia-related symptoms result from an alteration in the central neural processing of perceptive stimuli.

Fibromyalgia is frequently associated with feelings of “ear fullness,” earache, and tinnitus.  

Our team at McGuire’s specializes in treatment of these symptoms, so please contact us today so we can help you recover any loss or relieve discomfort.

Listening: A Work in Progress

Our listening system is quite amazing.

Imagine you are at a party and there is a group of people chatting. You may be talking to one person for a while, and then you may shift your focus to another. You're still standing in the same spot, but you are able to home in on one conversation at a time. While listening in noise may be tough, we are able to tune in to one speaker while the other becomes part of the background sound.  We have known about this for a long time - it's called the "cocktail party effect" and it's one of the cool things about our amazing hearing system.

A similar process is being studied at the University of California at Berkeley. We've all had this experience, too: initially someone's thick accent seems indecipherable, or you can't make out the lyrics of a song.  You listen again and again, and voila!  The meaning of garbled words pops out.

Recent work suggests that the brain is actually retuning itself to perceive speech information. The UC Berkeley neuroscientist have seen this process in action by recording activity from the surface of a person's brain as the words of a previously unintelligible sentence suddenly pops out. The retuning happens in less than a second!

The researcher Chris Holdgraf says "We believe that this tuning shift is what helps you 'hear'  the speech in that noisy signal. The speech actually pops out from the signal." Co-author Frederik Theunissen adds "Something is changing in the auditory cortex to emphasize anything that might be speech-like, and increasing gain for those features," making the speech more audible in noise.

Another co-author Robert Knight adds "It is unbelievable how fast and plastic the brain is. In seconds or less, the electrical activity in the brain changes its response properties to pull out linguistic information."

Hearing in noise is a challenge for all, and especially for those with hearing loss. But, it is exciting to know that our brains do work to direct our attention and facilitate pulling the message out of the noise. And as we continue to listen, a signal that initially unintelligible may well become clear. Listening is literally a work in progress. If you have hearing aids to help catch more sound, be sure to wear them on a full time basis, and keep listening.

We are Learning More about “Hidden Hearing Loss.”

It may happen once or twice a week:  Someone comes into the office saying they are having difficulty hearing at times when the people with them are not having problems. They may miss the punchline of a joke, or struggle to follow a conversation at a noisy restaurant.  They are not sure if they have normal hearing or not.   We do our testing, and find that the audiogram – the gold standard test of hearing sensitivity – is normal.

Researchers from Massachusetts Eye and Ear have, for the first time, linked difficulty with speech understanding in noisy settings with evidence of a condition known as “hidden hearing loss” in people with normal hearing sensitivity. 

Hidden hearing loss refers to damage to the connections between the auditory nerve fibers and the sensory cells in the cochlea.  This damage precedes the loss of the sensory cells themselves.  Reduced connections likely contribute to problems understanding speech in noisy or reverberant environments, even when the audiogram indicates “normal” hearing.  Lost connections may also play a part in the onset of tinnitus (ringing in the ear) or hyperacusis (sensitivity to loud sounds).

We know that these difficulties do not show up on our routine tests. The researchers at Mass Eye and Ear set out to develop better measures to test for cochlear synaptopathy, that is, damage to the sensory-neural connections.

Diagnostic tests for hidden hearing loss are important to fully assess damage to the inner ear, especially damage induced by noise exposure.  This would give us a more comprehensive understanding of the basis of the problems our patients are reporting.  We can then discuss preventive strategies going forward, and offer assistive technology options such as remote microphones.  Better diagnostic tools are also important is developing future therapies to repair inner ear nerve damage. Research is being done on animals that offer hope that one day connections between sensory cells and auditory nerve fibers can be successfully restored!

This is a work in progress.  Researchers are looking at whether Speech-in-Noise testing or auditory nerve tests can pick up early inner ear damage even before there are audiometric changes.   Clear definitive answers are not here yet, but this is an exciting direction that may lead to better understanding and future solutions.

Meanwhile, protect your ears from excessive sound levels, as we are sure that noise is in part the culprit for inner ear damage, and stay tuned as we learn more.

Dr. Kathleen Campbell: A Career Dedicated to Protecting Ears

When I first read about Dr. Kathleen Campbell's work about 15 years ago, I was blown away. She was testing the use of an anti-oxidant called D-methionine (D-met) in protecting the inner ear from the damaging effects of needed but toxic chemotherapy agents. So often our patients ask if there is a pill to take away their tinnitus or repair their hearing loss, and most of the time the answer is no. There is no FDA approved drug to prevent or treat hearing loss or tinnitus. Dr. Campbell has made her life's work studying ototoxicity (poisoning of the hearing and balance mechanism) and the potential of pharmaceuticals in preventing and managing hearing loss.

Soldiers are exposed to a barrage of potentially damaging noises, and so hearing loss and tinnitus are among the most common injuries sustained in military service.

Ototoxicity has many sources, including chemotherapy medications such as cisplatin, IV aminoglycoside antibiotics and excessive levels of noise. What if we could provide "ear armor" ahead of time to protect against the damaging agents? What if we could treat the ear immediately following exposure and "rescue" the ear from permanent damage?

Imagine the people that might be helped!

• How wonderful it would be if cancer patients could be protected from potential treatment side effects of hearing loss or balance problems, at a time they so need to be able to communicate.
• Do no harm! But sometimes treatments do unavoidable harm. It would be amazing if the heavy-duty IV antibiotics used to treat tuberculosis and cystic fibrosis could be stopped from doing collateral damage to the ear.
• Exposure to intense noise is ototoxic. Soldiers are exposed to a barrage of potentially damaging noises, and so hearing loss and tinnitus are among the most common injuries sustained in military service.

Bringing oto-protective medication to market is a work in progress. Dr. Campbell has been testing protocols and collecting data for many years. Studies thus far show that D-met can provide almost complete protection for cisplatin-induced hearing loss. Important to note, it shows no anti-tumor interference with the cancer therapy. The idea is that oto-protection must protect normal cells, but not cancer cells.

Noise-induced hearing loss is an enormous problem in the military. The Department of Defense and Veterans Affairs spend somewhere between $2 and 4 billion a year on noise related hearing injury. Soldiers with hearing loss have trouble locating where the enemy is coming from and communicating in high background-noise levels. It's the most common disability in the military. It is not surprising that the DoD has funded Dr. Campbell's clinical trials to assess the safety and efficacy of D-met in protecting ears from long term hearing damage.

At this time we cannot walk into our pharmacy with a prescription for oto-protective medication. But it is exciting to know what's in the works, and will soon help patients in treatment, soldiers protecting us, and even ordinary citizens exposed to high levels of sound.

Dr. Campbell has dedicated her career to protecting ears – it is exciting and incredibly useful work.