The Road to Change

I’ve lived in the same house since 1978, and I’ve had the same job since 1985, so you can see that I don’t make changes lightly! Making decisions and implementing change can be tough. I have surely found myself thinking: “On one hand….but on the other hand…” I get it!!!

Yet, changing habits is fundamental in hearing health care. When we recommend something to you, we are asking you to change some habits. Implementing change is often a journey. When people change habits psychologists have found they follow a well-recognized pattern. Let’s look at this pattern and see how we can use these stages to describe the journey to better hearing health:

Pre-contemplation: At this stage the person does not realize or believe that there is need for change. Someone else may have initiated the appointment such as a physician or family member. The person may be surprised by the perceptions of others, and may make excuses for missing conversation, such as “other people mumble” or “I wasn’t paying attention.” The audiologist listens and offers information, but he or she may not be ready for intervention.

Contemplation: There may be ambivalence at this stage. The person may still be comfortable with the status quo, but may be beginning to explore the consequences of doing nothing. At this point, we acknowledge ambivalence, and start to explore the person’s experiences with communication and hearing. We begin to offer advice about options for improving the situation.

Preparation: As the person moves on to the preparation stage, they reach a tipping point and decide to act on the hearing loss. Now the person is motivated, and is looking for information on the best path forward. We are here to offer advice about what it takes to facilitate communication. There are always a variety of options and so it’s important that both the person, the family, and the professional are open to listening and exchanging ideas that make the most sense for this particular situation.

Action: A person in the action phase is moving ahead. Having resolved the initial ambivalence, the person feels positive. This is the point where the decision that had seemed daunting now feels less difficult than anticipated. This is the time to focus on the anticipated benefits of improved hearing and communication. As in any decision we make, it’s so much easier once we are on the path to action.

Maintenance: This is the stage that moves from a place of stress to a place of contentment. The person is now taking advantage of amplification and better communication strategies. The goal of this stage is to feel successful and comfortable with the new behavior (amplification and communication strategies). These new habits are fully integrated into his or her lifestyle. The person is now using amplification confidently…and we continue to be there for support and assistance as needed.

Of course, not every decision is a step-be-step process for every person. Sometimes it’s a journey, and sometimes it’s a slam dunk. Either way, change involves a little adjustment. But before you know it, you’ll have a “new normal” - you’ll be in a better place, wondering why you didn’t get there sooner.

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.

Ear Infections

This is happy news!

Ear infections are uncomfortable for both the babies who have them and their parents whose nights are disrupted, but new research shows that fewer American babies are getting ear infections compared to 20 years ago.

The researchers followed 300 newborns through their first year. Almost half of them had at least one infection during that year. This is a big drop since the 1980s and 90s. The number of babies with ear infections during the first three months of life dropped by two thirds. Good news indeed.

This decline did not surprise lead researcher Dr. Tasnee Chonmaitree. Here’s why:

VACCINES: There is a vaccine that’s been available for a few years (the pneumococcal conjugate vaccine) that protects against several strains of bacteria which can cause serious illness such pneumonia and meningitis. These bacteria are also major causes of children’s middle ear infections.

Also, annual flu shots are now recommended for babies and children. These may help too, as ear infections may arise following a viral infection like the flu or common cold.

So it may be that these recommended vaccines have an additional benefit of driving down the rate of ear infections in babies and children.

BREAST FEEDING: Exclusive breast feeding during the first six months helps lower the rate of ear infections. There are a few reasons: Breast milk contains antibodies that can protect the babies against infections. Also, breast fed babies spend less time feeding from a bottle while on their backs. That position may make some babies more vulnerable to infections. The author said “breast feeding is good and should be encouraged to do it if they can.”

CIGARETTE SMOKING: Smoking cigarettes is down, and although the number of babies in the study is too small to clearly implicate second hand smoke, the researchers believe that the impressive reduction in smoking in the last few decades has had a positive effect on reducing the incidence of ear infections in young children.

Mild Hearing Loss

A few weeks ago I had a bout of garden-variety external otitis, or “swimmer’s ear.”  I ignored it for about a week, and when my home remedies did not help, I sought treatment by an otologist.   It resolved quickly after that, and now I’m back in the pool and hearing fine.  But I learned a lesson during the time that my hearing was muffled.  While my hearing was off I had perfectly normal hearing in my left ear, and a mild conductive (plugged-up) hearing loss in my right ear.  That doesn’t sound bad, does it?  But, it was more tiring than I would have anticipated.

These are some of the problems I noticed:

I had trouble telling where sounds were coming from, as the hearing symmetry was off-kilter.

I was missing some of the soft high frequency consonant sounds that define words – I found myself almost reflexively asking “what?”

When the pace of the conversation was fast, I had even more trouble.

As an audiologist I speak with different people all day long – it is important to me that I hear my patients accurately so that communication is accurate, and I don’t need to interrupt the conversation to ask for clarification.  Even with this little degree of hearing loss I was guessing and straining.  I found my brow was wrinkling up as I worked to hear.

Soft and distant sounds were challenging to hear.  By the end of the work day I was ready for the quiet of my home.

If you doubt this degree of difficulty, you can try this at home.  Insert one (or two) foam ear plugs, and ask someone to recite a list of short words: fish, dish, six, fist, fifth, sits, sit, etc.  How did you do? Try it again with the radio or TV on. More challenging?  Next, try it without the visual help you get from looking at the speaker.  Now with another speaker also reading some words… this can be really difficult. 

Imagine you are listening like this all day long, every day.  It can be done, but you would be using effort better spent on enjoying and responding to what you are hearing.

My lesson is that even what I think of as a mild hearing loss can significantly interfere with ease of communication.  Some patients with mild hearing loss may not perceive day-to-day challenges. But many do, as I did,  and they are real.  Each patient is unique, and for many people with even mild hearing loss, there is a simple appropriate solution to make every day communication easier, more accurate, and fun.  

Normal Audiogram, but…

From time to time, a patient comes to the office noticing they are struggling with conversations, especially in challenging listening environments.  Sometimes they come in after a big birthday – maybe 40, maybe 50.  They ask, “Is it me?”  They want a baseline, and an explanation of why they are have difficulties when other folks seem to be following the conversation or getting the joke.  So I perform our standard audiometric measures, and often find myself saying “Good news – your audiogram is normal, you understand words clearly in quiet, your middle ear is functioning properly, even the inner ear response is fine – in fact, if you were a baby you’d pass the newborn hearing screening.”

And yet, and yet….   They are still not hearing well in noisy environments.  What is going on?  Perhaps my “Good news” is not so reassuring, as it raises the question of “Well, then, why can’t I hear like I used to?”  This was addressed nicely in a recent article in the ASHA Leader (Koehnke, Lister, and Wambacq).  

Although undetectable with audiometric testing, changes in hearing ability begin in our 40’s and 50’s.  A growing body of research suggests that while hearing acuity may be normal, complex auditory processing at the central (brainstem and brain) level is not what it was in our 20’s and 30’s.  

Remember, there is so much more to accurate hearing than raising the volume.  There is a set of skills we use in listening that are complex and quite amazing:

• Temporal processing is the ability to follow rapid changes in speech and music, and affects our ability to discern the consonants and vowels that define a word.  Temporal processing declines with age.
• Information from speech rhythm and emphasis is also clearly affected by age, and affects ease of communication.
• Separating out one stream of conversation from another (at a restaurant or party) becomes more challenging with age – to me, it is a miracle that we can do this at all!
• Subtle changes in hearing may interact with changes in memory, attention, and processing speed.  One study found that speech “babble” (background speech) adversely affects middle aged people’s ability to retrieve words from working memory.

So – there are “normal” changes in the auditory system as we age that may interfere with listening, especially in background noise.  Hearing thresholds may be normal, so hearing aids are not called for.  Here are some strategies (mostly common sense) for easier listening if normal age-related changes in auditory processing are impacting on daily communication:

• Turn off the radio or TV that interfere with your understanding another’s speech.
• Position yourself and your conversation partners to best see and hear each other.
• Ask conversation partners to speak more loudly, slowly, clearly (whatever would help).
• If other conversations are happening simultaneously, try to relocate.   Separating will help you focus your attention on the conversation of interest.

We may not know exactly which of the many age-related changes may affect our individual auditory systems.  We do know that there are normal changes that occur.  They may affect each of us differently, but if you are not hearing quite as easily as you used to, I hope it is reassuring to know that you are not alone! 

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.