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.

Shark Tank Host Discusses His Hearing Lossby Brenden Gilewski, Hearing Healthcare Liasion

Instantly recognizable from ABC's "Shark Tank," Daymond John is an entrepreneur extraordinaire. But did you know that Daymond  (@thesharkdaymond) suffers from hearing loss and wears Starkey's Hearing Technologies' Halo 2 hearing aids?

In a recent Instagram post, Daymond set out to combat hearing aid stigma and help others live life to the fullest, overcoming what is a common but often hidden issue.  Daymond is not a paid sponsor of Starkey, but wanted to share his experience and reach out to those that may literally be suffering in silence.

Here is Daymond John's recent Instagram post:

“I love music!  I have been partying, attending concerts and wearing headphones while listening to music way too loud ever since I was a child. So like many of us, my hearing is not what it should be. 3 years ago I started wearing @StarkeyHearing Halos because they not only amplify my hearing, but I can also connect them to my iPhone and listen to my music, audio books and anything else quietly.

Once I started wearing them, I was shocked at how many people approached me about them. Many of the people clearly knew that they or a loved one had a loss of hearing but were too embarrassed to wear a hearing device because they were afraid of what people would think. That makes absolutely no sense to me. Why would you ever miss all the beautiful sounds of life because of what somebody else thinks? I decided that I want to be somebody that helps break the stigma that only seniors need these type of devices. Especially when today's technology allows you to do so much more with them by connecting to your smartphone. So I asked Starkey to hook me up with a special pop color pair that didn't blend in with my skin like my brown pair did. I want to make sure people noticed them when they see me.

Today my brand new red Halos came in and I'm ready to rock!! So if you have somebody in your life that is afraid of what people think if they wear hearing devices, then use me as an example. When you see them on me, tell them to get with the times.

To be clear, I have a great relationship with Starkey, but I have absolutely no ownership and I am not getting paid for this post. If you choose not to buy a Starkey product, that's ok. The point here is to share with the people you love with hearing loss that life is way too short to not enjoy all the beautiful aspects of it to the fullest. Push them to get their hearing checked and let them know that what other people think should be the last thing they should ever listen to! Pun intended:-) DJ”

This world renowned entrepreneur has built brands into global powerhouses including a six billion dollar brand in FUBU, which he founded.  In addition to being the Presidential Ambassador of Global Entrepreneurship and a co-star on "Shark Tank," Daymond is also a celebrated pioneer in the fashion industry, a best-selling author, and a highly sought after motivational speaker.

Daymond recently spoke at the Starkey Hearing Innovation Expo to talk about the "power of people" with Starkey's research and development team. He reminded the team why they are dedicated to investing in their people and their purpose.

The Hearing Innovation Expo is a global event hosted by Starkey Hearing Technologies, America's premier provider of hearing healthcare.

Use and Optimize your Awesome Hearing Resource

The things we don’t think about!  This week the New York Times reported on Lee Duck-hee.  He is an 18 year old who is ranked 143rd in the world in tennis, a sport in which listening to the ball is crucial.  Lee is the best player in South Korea, and he is also deaf.  In tennis, seeing the ball is thought to be insufficient at the top level of play.  Hearing the ball enables the quickest responses.  Even milliseconds make a difference in a game with super-fast serves and powerful groundstrokes.

Each spin has a slightly different sound as it comes off the racket.  Martina Navratilova explains that “You first hear the ball. Then you respond to the speed and spin according to the sound.” Studies have shown that people react more quickly to auditory stimuli than visual ones. At this level of play, every fraction of a second is significant.  Andy Roddick noted that at Wimbledon his first reaction to the shot comes from hearing. He explains “I think you need to hear the ball pretty clearly to play at your highest level.”

Hearing is so important that some players struggle with crowd cacophony – at this year’s U.S. Open even the pounding rain caused some players to find it hard to hear the cues that informed them about their opponents’ strokes.

In his book “The Inner Game of Tennis” W. Timothy Gallwey preached attention to the sounds of the sport, and described a feedback loop created by close attention to the sounds of one’s strokes in order to replicate the “crack” of a successful shot. The body learns to repeat the movements that produce that wonderful sound.

So – how remarkable it is that Mr. Lee, a deaf player, could do so well without the benefit of critical auditory information!  Paige Stringer, founder of the Global Foundation for Children with Hearing Loss, suggested that people born deaf may have a stronger sense of intuition in general, and are more tuned in to the subtle clues in face and body language than people with normal hearing.

This led me to thinking:  We know that hearing loss is a risk factor for falls; we suspect contributions of the inner ear balance system, medications and other health issues, and perhaps decreased awareness of the environment.  I thought this article raised a related issue: that auditory cues are quicker than visual cues – for the tennis player this may mean quicker access to information about where the ball is coming from.  Likewise ordinary people deprived of acoustic feedback in the form of footsteps, maybe even echoes, may be at a disadvantage in keeping their balance.

I shared this with Dr. Frank Lin, a Johns Hopkins otologist with expertise in the field of hearing and cognition, and he offered this thought:

“Yes—I fully agree with you about the role of subtle environmental cues in helping maintain balance. Importantly, for many older adults, balance is dictated by lots of things—strength, vision, cardiovascular output, proprioception, etc. I don’t think hearing is one of the dominant risk factors but for an older adult who already has multiple ‘hits’ affecting their balance (e.g., diabetes and peripheral neuropathy, poor eyesight, etc.), hearing could be a key additional ‘hit’ that may in fact be modifiable/treatable unlike the other risk factors.”

My conclusion: use and optimize your awesome hearing resource! Whether for your best possible tennis game….or treasured everyday communication with your friends, coworkers, and family.