Dementia: Can You Decrease the Risk?

A new study suggests that a number of factors,
including mid-life hearing loss, could contribute
to some types of dementia.

There are no guarantees against dementia, but a major international study just published in the esteemed journal Lancet, reports it is possible that one in three cases of dementia could be prevented if more people looked at their brain health throughout life.

According to the researchers, there are life style factors that may make the brain more vulnerable to problems with memory and thinking as we age. Dementia is diagnosed later in life, but changes in the brain begin to develop many years earlier.

Here are 9 factors that contribute to the risk of some types of dementia:

• mid-life hearing loss (9%)
• failing to complete secondary education (8%)
• smoking (5%)
• failing to seek treatment for depression (4%)
• physical inactivity (3%)
• social isolation (2%)
• high blood pressure (2%)
• obesity (1%)
• Type 2 diabetes (1%)

While I have been aware of each of these, I was surprised by the degree (9%!) to which hearing loss factored in. There is much that is still unknown about just how hearing loss is connected to cognitive decline. Maybe hearing loss adds to the cognitive burden of a vulnerable brain, or leads to social disengagement or depression, or is related to systemic age-related microvascular changes.

It's also not proven for sure if use of hearing aids eliminates hearing loss as a risk factor. However, it is likely that if amplification fosters social connection and reduces the effort needed to listen, that addressing hearing loss proactively is a big plus. (And, it makes life better, for sure!)

The take home message is the number of people with dementia is increasing globally, although it is decreasing in some countries. Quoting the Lancet: "Be ambitious about prevention. We recommend active treatment of hypertension in middle age and older people without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity might have the potential to delay or prevent a third of dementia cases."

It is a hopeful message: although we cannot totally control our future, there are modifiable risk factors that make an enormous difference, and these addressing them proactively are good for overall health, making good choices a win-win situation.

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.

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.

We Would Love to See Our Family Physicians Incorporate Hearing Screening into Routine Primary Care

When new Medicare recipients see their doctor for their Welcome to Medicare visit, the doctor may or may not ask about hearing. So far, hearing health has not been given an "A" rating, which is a flat-out recommendation to provide service. The doctor may be speaking loudly in a small room one-to-one setting, and so a hearing issue may not be on his/her radar.

But, the evidence is mounting to support early intervention for hearing loss. Early detection and appropriate intervention holds the key in reducing disability and maintaining independence. Last year's PCAST (President's Council of Advisors on Science and Technology) endorsed access to appropriate hearing technology especially for people with mild to moderate hearing loss. Research finds that hearing aids, when indicated, boost social engagement, reduced caregiver and family stress, and reduced symptoms of depression, all factors important in positive health outcomes and quality of life.

As we have reported in the past, there are independent associations between hearing loss and an array of broader health issues, including cognitive decline, functional dependence, falls, social isolation, diabetes, cardiac problems and patient-physician communication.
Physicians, asked to be experts in so many health areas, may not be aware of the array of current treatment options available for hearing help.

So, if you or a loved one has concern about ease of hearing:

• Difficulty understanding family members
• Difficulty understanding health care providers
• Difficulty with group conversation
• Difficulty hearing in noise
• Difficulty hearing on the phone
• Communication is tiring or hearing loss interferes with easy flow of conversation…

Ask your doctor for a referral for a diagnostic hearing evaluation. We will make some measurements with you, and then educate and inform you about the results. We always send a clear report to your physician to explain the results.

Remember that communication is key to a full and joyous life at any age. Never say "at my age….…" I thought of this recently at holiday services when a 102 year old lady – a choreographer by training – led the congregation in beautiful body movements to accompany a prayer. 102! And still reaching up and out, and living strong. Remember: at the end of the day – what we have is connection and communication.

The Journey of a Recycled Hearing Aid

Renew Reuse Recycle is a mantra in my family.  Toys and clothes get passed along to anyone who might enjoy them.   Often my hearing aid patients ask what can be done with hearing aids that are no longer being used.  We mention the “Donate Now” button on our website that connects them to Hear Now, a program run by the Starkey Hearing Foundation.

Here is what happens when you send your hearing aids to Hear Now. 

Your hearing aid goes on a journey that results in providing hearing help for a person in need.  Here is how your hearing aid goes from you to someone in need:

1. The original owner ships to hearing aid to Starkey Hearing Foundation, ATTN: hearing aid recycling, 6700 Washington Avenue South, Eden Prairie, MN 55344
2. The donation is received and documented, and a letter of acknowledgement is sent to you.
3. Aids are sorted by make and model.
4. Everything gets used: components are removed and salvaged for rebuilding.
5. Hearing aids are rebuilt to specification – both custom (in the ear) and behind the ear models.
6. Custom shells are cleaned and buffed. Ear hooks are fitted for over the ear styles.
7. Each aid goes through the Quality Assurance process so the new owner is assured of accurate and appropriate amplification.
8. Aids are packaged and made ready for missions.
9. A person in need is fit with hearing aids.   The Starkey Hearing Foundation is changing lives, one at a time.

This is not a new program – Starkey has been doing this work for many years.  But only recently did I realize that each and every hearing aid can be put to use for the benefit of people in need. I’m proud that we work with Starkey/Audibel, a company that has a core belief in changing lives in the U.S. and around the world. To date, more than 560,000 hearing aids have been recycled – AMAZING!

Patients and their Families are the Real Experts

Hearing loss impacts everyone involved in the life of someone with hearing challenges, especially family and loved ones. In healthcare overall, and in hearing healthcare in particular, we are learning that treatment outcomes are better when families are involved, increasing overall patient satisfaction.

We support a holistic approach to healthcare - one that considers the person receiving services and his/her family to be active partners in the planning, executing, and monitoring of treatment.  The Institute of Medicine offers the following description:

Family-centered care provides care to patients and family members that is respectful of and responsive to individual patient and family preferences, needs, and values, and ensures that patient and family values guide all clinical decisions.

Sure, we perform our tests and make our measurements to quantify hearing ability and determine what areas of the auditory system are involved. But these measures offer a starting point, and do not dictate how we proceed.  

We have learned that each person is unique, and not every hearing loss can be treated the same way. I am a guide, so that we may explore options based on lifestyle, perceptions and preferences of the individual.

We encourage our patients to invite a family member along to the audiology appointment. The family member is great for support, encouragement, and "reality check".  Sometimes the patient has one perception of his communication abilities, but his significant other may see things a bit differently. Interestingly, both views may be aspects of the same story!

We welcome active participation by family members.  Familiar voices help to assess how a hearing aid is perceived, and helps us tweak the settings to best serve the patient.  

We consider the individual patient and his family to be the experts. They (not we) live with that hearing loss every day. Nobody knows you as well as your family! Everyone in the family has a role in setting goals. We get the best picture when we see it from all sides.  The patient may say: "I want to hear TV more comfortably." A son or daughter may have another concern: "I need to know he will hear the phone when I call so I don't worry." Likewise, both the patient and the family members contribute to assessing success and/or need for adjustment.

Finally, another pair of hands and set of eyes can make things easier so any problems can be addressed quickly by the "team" and the family can get on with good, stress-free communication. When you hear better, you (all of you) live better.

Helping Single Sided Deafness

Some people have little or no usable hearing in one ear, and either normal hearing in the other ear, or a hearing loss that can be helped with amplification. There is a solution for this situation, and current technology makes it better than ever!

Single sided deafness (SSD) involves significant damage to hearing in one ear. People with SSD can have trouble understanding speech because they can’t separate background noise from the sounds they want to hear, and they can’t hear from one side – making it difficult to locate sounds.

In addition, these people need to strategize when they are in a car, walking in the street, or sitting at a meeting, in each case being sure that the speaker they are trying to hear is on the “good” side. This is not easy.

The technology that addresses single sided deafness is called CROS (when the better ear is normal) and BICROS (when the better ear has an aidable hearing loss.) Here is what happens:

CROS hearing aid systems wirelessly transmit sound from the deaf side to the better ear via a small sleek transmitter, which is placed behind the deaf ear. The transmitter picks up sound and wirelessly transmits it to a receiver hearing aid on the normal-hearing ear. This solution is discreet and highly effective.

BiCROS is similar to CROS, but is made for those who are deaf in one ear and hearing impaired in the other ear. Here, the receiver hearing aid also amplifies sound on the better ear.

People who have lost their hearing in one ear and begin to use a CROS or BICROS system often light up with delight as they realize they are picking up sounds from the “bad” side. It is truly an “oh, wow!” moment.

Today’s CROS/BICROS instruments use the latest fashionable wireless instruments. They not only look good, but take advantage of the newest sound processing.  Battery life is surprisingly good.  Some units have a volume control so the sound from both sides can be adjusted.

Finally, patients with tinnitus (ringing in the ear) often get relief because of the additional sound enrichment.

If you or someone you know has single sided deafness, we would we happy to discuss this option with you.

CaptionCall - a Free Service to Assist With Phone Calls

If you have trouble hearing easily on the phone there is a technology that can help you.   Even with hearing aids, sometimes it is difficult to hear soft or high-pitched voices. Sometimes names or numbers are hard to hear, and sometimes the phone connection is simply not good.

CaptionCall is similar to captioned TV, but it is only available to people with hearing loss.  It displays written, almost instant easy-to-see captions so that you can listen and read the captions simultaneously.   Twice the information allows you to communicate with better understanding and less stress.

Moreover, it is FREE!  Captioned Telephone Service is a federally funded program administered by the FCC as a benefit of the Americans with Disabilities Act.  There are no costs associated with this service.  The telephone itself is provided by CaptionCall at no cost.

In the words of one of my patients – a dynamic professional woman with a tough hearing loss and a wonderful way with words:  “Thanks to CaptionCall there’s no more ‘processing’ time interrupting my conversation.  I can answer spontaneously.  Without the help of CaptionCall it takes a pause to get the contextual meaning.  But now I can have a true dialogue.  It provides another layer of ability, not disability!”

To qualify for a CaptionCall service you must have a hearing loss, and a signed form from a qualified health professional affirming that you need a captioned phone because of your hearing loss.  Once you submit your form by FAX to 1-888-778-5838 a CaptionCall representative will contact you and arrange for: free phone, free delivery, free installation, free in-home training, and free captioning service.

You will be able to communicate with confidence!  Caption Call is familiar – calls are dialed and answered like any regular phone.  The phone is hearing aid compatible if the hearing aids have telecoils available.  The sound of the phone can be customized - the ringer, handset volume and frequency balance can be optimized to meet your hearing configuration.

Three things are needed to get started:

• hearing loss that requires the help of a captioned phone service
• high-speed internet connection 
• standard home phone connection

Be empowered!  Accurate and easy telephone use is important for staying in touch with family and friends, obtaining needed information, knowing you are communicating with accuracy, and staying well-networked.  My patients who have obtained this service are delighted with the help.

McGuire's Featured in Suffolk Time's Article on Hearing Health

The December 3rd edition of the Suffolk Times included an article by Rachel Young ("Don't take your hearing for granted") that featured McGuire's Owner and Help America Hear founder David Carr. Click here to read the article.

Our Senses Connect Us to Our World

What sounds are you thankful to hear?

As Thanksgiving approaches, gratitude is on my mind. Our senses connect us to our world, and also remind us of past experiences. One sense connects to the next…the sound of sizzling bacon together with its aroma is a mouth-watering sensation. Take a few minutes to imagine your favorite sounds.

I love when my patients who are new to hearing aids are aware of sounds previously unheard. Often the first, in my office, is: I can hear the secretaries in the waiting room! (yes, I can too – that’s a good thing.)

Here are some sounds that come back into the “soundscape” when audibility is enhanced:

• Ice cubes cracking in a drink
• Toaster oven clicking off
• Patter of rain on the window
• Children laughing in pure joy
• Crackling fire
• “thwonk” of a well-placed tennis ball
• Tinkling of teaspoon stirring coffee
• Crunch of crisp apple
• Wind chimes in a light breeze
• A cello solo
• Crunching footsteps on fresh snow
• Baby’s first babbling
• Waves breaking rhythmically on the beach
• Choir singing a joyful song
• Birds chirping in early spring dawn
• Far away train
• Leaves rustling in the wind
• Applause

We are told to stop and smell the roses. True! I am so grateful for all our senses! Take a few minutes today to listen, look, smell, touch and taste. What sounds are you thankful to hear?

Calling All Grandchildren!

Hearing aid technology has made phenomenal advances, and is highly interactive with the soundscape so that the listener has a better chance than ever to hear well and comfortably. And yet, hearing aids are only part of the prescription for better hearing. Good listening strategies and strong, kind family support are as important as ever.

If you are lucky enough to have grandchildren in your family scene, you have a built-in resource to help in the adjustment to hearing aids. I say this on the basis of years of observations of the families I see in my practice.

Children are, by nature, proactive, matter-of-fact, curious, intuitive, and quick to “get it.”

Here are a few tips on how the young ones in your family can facilitate good benefit from amplification:

• Learning to actively listen is essential. Let your little ones read a book or tell a story. When we really want to hear, we put extra effort into listening.
• Kids like to get close. Remind them that it’s easiest to listen when face-to-face.
• Children are endlessly curious. It’s OK to ask questions: Why do you have trouble hearing? What happened to your ears? How do our ears work? Do the hearing aids help? It’s a great opportunity to educate your children, and at the same time clarify the very same questions the adults may also be thinking about.
• Changes in hearing often come with aging, but older people do not need to struggle with hearing impairment. Hearing aids and good listening strategies can make it much easier to listen.
• Motivation is so important to maximize hearing aid benefit. Often children’s voices are especially difficult for hearing impaired people to hear because they are soft and a bit treble. So these young precious voices are just the ones that will benefit from being amplified. This is an opportunity for the hearing aid benefit to shine.
• If you don’t hear the child, don’t pretend you did. Children are straightforward. You can say: My ears didn’t hear you – please tell me again.
• Kids can be your best “hearing ally.” In the words of one of my patients, if she’s observed to be missing things, her grandchild says: Grandma, do you have your ears on? If it’s the grandchild who asks, it is never nagging!

As a grandparent myself, I am so aware that communication with my young grandchildren is a joy beyond words. Harness this energy - it’s beneficial to both grandparents and grandkids.

Removing the Hurdles to Getting Hearing Aids

Jane Brody, Health and Science write for The New York Times, published her second article about seeking treatment for hearing loss.  Read Article

Among the points she made were:

Be sure to discuss options (style, technology, cost) with your audiologist that best match your requirements.  Hearing aids are not one-size-fits-all, and there may be a variety of options for your preferences and hearing needs.

Fine-tuning hearing aids may take a few visits.  Work with your audiologist.  Communicate where you are seeing improvements, and where you hope for better results.  While hearing aids do not restore normal hearing, with patient, careful, expert programming, they can be tweaked to provide you with the most comfortable hearing possible.

Practice!  Benefiting from amplification not only requires adjustments by your audiologist but learning to make good use of the sounds by the listener.  Be patient, this may take a little time.  It is well worth the effort.

Hearing Loss Costs Far More Than Ability to Hear

Last month we posted an article about how hearing ability and general health are very much interrelated. So, I was delighted this week to read Jane Brody’s Personal Health column in the New York Times on the same topic.  

Ms. Brody is a highly esteemed Science writer for the Times, and this article is the first of two being published on hearing loss. Generally she writes about a different health topic each week in Tuesday’s science section, but she recognizes that this topic is so important it warrants a two articles!  

Click Here to read Jane Brody’s column:

It’s not just people with hearing loss that have a tough time enjoying conversation in noisy restaurants.

Certainly, folks who don’t hear well have an especially difficult time hearing conversation when the sound level is high, but even those with perfect hearing find it a strain to hear and be heard when the acoustic environment is noisy and reverberant.

The tide may be turning.  In the past, it seemed to be a badge of “cool” for a restaurant to have a sonic pandemonium that spilled out into the street.  But, as reported this week in the New York Times, restaurant architects are listening to customers’ requests, and with their greater understanding of acoustics, are creating listening environments that allow conversation to take place more comfortably.

They are creating the soundscape that they want.  They have found that if the sounds are too muffled, then every spoon clink may be a distraction.  But, as is more often the case, if the sounds are amplified by lots of hard reflective surfaces, then comfortable conversation is impossible.

Restaurant designers have become more precise and scientific, working to create areas of talk at each table without losing the sound sensation of activity that makes to room feel alive.  There needs to be a balance of soft and hard components, and the right mix of bass and treble.

One New York architect describes it like this:  “You want to amplify the good noise and reduce the bad noise.”  He describes bad noise as the tinny high-pitched squall that moves through the restaurant.  Good noise is not just the audible conversation at each table, but the pulse of excitement from the front and back of the room.  Conversation should be easily audible but there can still be a “buzz.”  The idea is to make it a really comfortable acoustic environment.

How is this goal attained?  In a variety of very high-tech and very low-tech ways – ranging from combining specific sound absorbing materials in strategic places with visually pleasing but more reflective materials, to sound systems that place tiny microphones and speakers throughout the restaurant with software that then controls the noise levels, to instructing the staff not to clink the forks when placing them on the table.

So – if you have a hearing loss, live with someone who does, or, just are tired of yelling during your dinner date, choose a restaurant that has been thoughtfully designed.

Balance in Older Adults May Improve with Hearing Aid Use

A small study published in the well-respected journal Laryngoscope suggests that older people with hearing loss may have better balance when they use their hearing aids.  This supports the idea that treating hearing loss may help decrease the risk of falls.

In this study 14 adults (aged 65 and up) were given standard balance tests both with and without their hearing aids on. Patients performed better on the balance tests with their hearing aids on.  This is the first study to demonstrate that sound information contributes to maintaining the body’s stability, and suggests that use of amplification may reduce the risks of falls in older people.

Lead researcher Dr. Timothy Hullar believes that not only do the hearing aids increase alertness, but the participants were using the sounds coming through their hearing aids as auditory landmarks to help maintain balance.
 

Judy Rasin

We know that people sway more when they try to balance in a darkened room. Our eyes help to orient us in space. The more information we take in through our hearing and vision senses, the better able we are to keep balanced.

Dr. Hullar notes that the results are statistically significant even though there were not many people in the study.  He plans to replicate the study with a larger group of people. Meanwhile, we think these results are exciting. Reducing the risk of falls while at the same time enhancing communication ability is a win-win benefit. 

Judy Rasin is a licensed New York State Audiologist and hearing aid dispenser at The Hearing Center at Pelham. You can contact Judy at (718) 822-4100 or visit their website

How Does the Brain Respond to Hearing Loss?

Did you know that our brains are continually reorganizing themselves?  Our brains grow and prune their connections as a result of our experiences.  This is called neuroplasticity.

Sometimes this is helpful – about 15 years ago researchers in England found that taxi drivers, who are required to memorize the entire street map of London, actually expanded their hippocampus – a part of the brain involved with memory.

Recently, researchers at the University of Colorado have found that the brain areas devoted to hearing can become reorganized – reassigned to other functions - with even mild hearing loss.  They discovered that areas in the brain that process visual information can take over brain areas which normally process sound.

So, if there is a decrease of stimulation coming in through the ears, the corresponding brain areas that process sound may be “reassigned” to handle stimulation coming in through the eyes.  This is called “cross-modal” cortical reorganization and reflects how the brain actively responds to changes in the environment.

Judy Rasin

The group's work suggests that the portion of the brain used for hearing can become reorganized, even in earliest stages of age-related hearing loss.  These compensatory changes increase the overall workload on the brains of aging adults.

"One in three adults over the age of 60 has age-related hearing loss," researcher Anu Sharma noted. "Given that even small degrees of hearing loss can cause secondary changes in the brain, hearing screenings for adults and intervention in the form of hearing aids should be considered much earlier to protect against reorganization of the brain."

Further studies will be needed to determine if use of hearing aids will prevent cortical reorganization.  Stay tuned!  But it is logical to think that if the auditory parts of the brain continue to receive lots of sound stimulation, the corresponding brain areas will keep active as well.  Use it, so you don’t lose it!

Judy Rasin is a licensed New York State Audiologist and hearing aid dispenser at The Hearing Center at Pelham. You can contact Judy at (718) 822-4100 or visit their website .

Talking with a Loved One About Hearing Loss

by Judy Rasin

Hearing loss is a family affair.  

When someone has difficulty hearing it is not their problem alone - the entire family is affected.  The need for repetition interrupts the flow of communication and may be a source of frustration for all.  Watching a loved one withdraw from conversations and enjoyable activities is heartbreaking.  You can make a difference for your loved one.

Convincing your loved one to seek professional help may take a bit of courage!  It is the right thing to do, yet it may not be easy.  Hearing loss often comes on so gradually that the person with the loss is the last to be aware there is a problem.

A spouse with the best of intentions may become the “ears” for the person who is not hearing well.  While this is surely helpful in the moment it may prevent the person from realizing how much communication they are missing or mis-hearing.

Here are some things you can do to get the conversation going:
Talk to your loved one about their hearing concerns.

• Raise their awareness by pointing out when you “translate” for them.

• Suggest a visit to an audiologist to get a professional evaluation and gather information.  Offer to schedule an appointment and join them at the consultation.  There is nothing to lose and may be a great deal to gain.

Your suggestions may be met with some push-back.  Don’t be surprised – we often hold on to our preconceived ideas.  Unlike vision, when hearing loss develops people are not as quick to address it.  Many wait years before seeking treatment.

Your loved one may think that if he had a real hearing loss his family doctor would have diagnosed it.  But, fewer than 20% of doctors routinely screen for hearing loss.  A one-to-one talk in the doctor’s office may not point up the difficulties that a slightly more challenging conversation in a little background noise would, so the physician may not notice real-world hearing difficulties.

Some people are concerned about how hearing aids look.  Today’s hearing aids are sleek and “tech-y.”  They are the tools to get the job done.  And, remember hearing aids are less noticeable than mis-hearing conversation and responding inappropriately.

Some folks say that a little hearing loss is not so bad – “I’ll wait till it gets worse.”  But we have learned that even mild hearing loss leads to effortful listening, stress, social isolation, and even reduced earning power.  Acclimatization to hearing aids is easy – especially with family support, motivation, and a little patience.

Share in your loved one’s hearing care.  Hearing wellness involves the whole family.  There are so many ways in which we can help you on this journey.

Judy Rasin is a licensed New York State Audiologist and hearing aid dispenser at The Hearing Center at Pelham. You can contact Judy at (718) 822-4100 or visit their website.