Could a cochlear implant help you?

 

A cochlear implant can be the answer for many people who find that despite their well-fitted hearing aids they are struggling to hear in daily life. Some may have also been added in wireless accessories such as the Phonak Select/Pen system which works by enabling wireless streaming of phone calls, conversations from one or multiple speakers, and TV programs. 

1.Hearing difficulties

Read the following list – if you answer yes to any or all of the questions, it might be time to head to your nearest Attune clinic to get a comprehensive hearing test.

−Are you relying more on lip-reading than your hearing aids?

−Do you need people to repeat themselves often?

−Have you stopped using the telephone?

−Is speech hard to understand even when talking 1:1?

−are you feeling increasingly isolated due to not hearing?

−Do you have difficulty communicating in groups?

−Is your job in jeopardy due to hearing loss?

−Can you no longer hear the birds, your children / grandchildren's voices, the microwave beep?

−Is TV hard to follow even with captions?

−Do you feel unsafe in the world because you can't hear?

−cannot hear at all out of one ear?

2.Quality of life

A cochlear implant can help you when your hearing difficulties become so much that they affect the quality of your life. You may have noticed or others may comment that you seem depressed and avoid joining in on social activities such as family BBQs or going out to dinner with friends. Your personal relationship with your partner may be strained as they struggle to communicate with you in daily life, and you withdraw as it becomes ever more frustrating. Friends you had may have stopped calling around or asking you out for a meal/drink at the local club, or a round of golf, or a game of footy as they know that you can't hear them and that you don't join in anymore. You avoid going out anyway as it makes you so tired of trying to hear conversations and join in with the laughs at the right moment. It has been years since you were able to hear well on the phone and so you stop making calls and just text or email instead. This is hard if you have family who lives away or overseas and would like to hear your voice. Using the Phonak Roger Select/Pen system has helped a lot but you can still feel embarrassed that you have to carry a few devices around with you. 

3.Current hearing option/s

Wearing hearing aids is all you have known for a number of years now. From your very first pair of hearing aids to your current Phonak Audeo hearing aids, you have been a regular wearer putting them both on every day from early morning to night time. The Audiologist you see has reviewed your hearing every 12mths and checked your hearing test results to see whether any adjustments are needed to your Phonak aids. Your hearing aids have also been reviewed every 12mths and sent back to Phonak as needed for service and repairs. Still, you struggle with a hearing speech clearly and just can't have any background noise as it competes too much with a conversation. Getting a Phonak Select/Pen system did help you to hear a bit more in meetings and groups with not too many people. Adding this Phonak wireless accessory has been a good supplement to your  Phonak hearing aids. However, you know that more is needed and that there are other hearing options out there. You have read about cochlear implants and wonder would a cochlear implant help you?

4.Cochlear implant

You discuss with your Audiologist the possibility of a cochlear implant. They agree that a cochlear implant may help you to hear better as your Phonak hearing aids despite being top-level technology still have limitations given your severe degree of hearing loss. The Audiologist provides you with some basic information about cochlear implants (what they look like, how they work, how you would still use a hearing aid in the other ear, and be able to use your Phonak Roger Select/Pen system with the cochlear implant processor and the remaining Phonak hearing aid). They recommend that you see your GP and get a referral to an ENT (Ear, Nose & Throat) surgeon so that you can discuss the medical aspects of getting a cochlear implant and whether you would benefit from such surgery. The ENT Implant surgeon will then send you to an Implant Audiologist who will assess and support you through the entire cochlear implant process from pre-implant to post-implant and beyond.

5.Cochlear sound processor

The Implant Audiologist explains that if you do get a cochlear implant then you can use both the cochlear sound processor and the Phonak hearing aid to give you hearing from both ears. Also that the Phonak Roger Select/pen system can be set up for both devices and allow stereo streaming which will greatly improve what you can hear in groups and background noise. You will be able to use it for TV streaming and also taking mobile phone calls. Being able to hear through two ear devices is always so much better than hearing from one ear alone. It is good to know that getting a cochlear implant still allows you to use wireless accessories such as the Phonak Roger Select/Pen system.

6.So can a cochlear implant help me?

If you have answered yes to any or all of the questions at the beginning of this article then a cochlear implant could potentially help you. Seeing an ENT Implant surgeon for medical review and then an Implant Audiologist will help give you information about whether you are a suitable candidate for a cochlear implant. Will, you still be able to use your Phonak hearing aids – yes you can still wear one in the other ear and hear with two different devices. Also that the Phonak Roger Select/Pen system can be used for stereo streaming with the two devices. It is good that you now know that you have other hearing options to consider to assist in improving your overall quality of life for hearing and communication. So jump on board and talk with your Audiologist or G.P. soon – we all need to be able to hear, communicate, and connect with our family and friends. Life can be different with a cochlear implant!

Summary

A cochlear implant can assist when hearing aids are no longer enough and other assistive devices such as wireless accessories e.g. Phonak Roger Select/Pen system have also been tried. The process of assessment for a cochlear implant will be through a referral from a G.P. to an ENT Implant surgeon and seeing an Implant Audiologist. Using a hearing aid in the other ear will allow hearing with two different devices but give more benefit than hearing from one ear alone. Adding in wireless accessories like the Phonak Roger Select/Pen system will not only be possible but will give enhanced hearing with stereo streaming. Call up Attune Hearing today to ask about booking in for a comprehensive hearing test. 

Understanding your hearing test results

 

Why have a hearing test?
There are many reasons to have a hearing test. The most obvious is a self-referral when a hearing loss is suspected and a hearing test is needed to confirm the suspicion. Others need hearing tests as part of their employment if working in environments that may be hazardous to hearing. Others will be referred to an Audiologist by a Doctor to investigate symptoms, prior to certain medical treatments begin such as chemotherapy, or to obtain a baseline hearing test result before seeing an Ear, Nose, and Throat specialist.

An Audiologist will conduct a series of hearing tests to determine the nature and extent of the hearing loss. Accurately understanding hearing test results is important. It will help you understand why you are having trouble in certain situations, such as having difficulty in a noisy environment while hearing well in one on one conversations. Alternatively, you may find that you can hear words but often misunderstand what is said. Understanding your hearing test results will make it easier to understand any recommendations made by your Audiologist, as well as improving your understanding of what your Audiologist is aiming to achieve with hearing aids. 

Pure tone Audiometry
Pure tone Audiometry is the main test used to assess hearing. This is a behavioral measure and relies on a patient responding (usually by pressing a button) to a series of tones varying in intensity and pitch. The softest sound that can be heard at each pitch or frequency tested is then depicted on a graph known as an Audiogram.

How to read an Audiogram
An Audiogram is basically a visual representation of your hearing ability. Across the top of the audiogram are the different frequencies (or pitches) from a low frequency at the left side of the audiogram, becoming increasingly high frequency across to the right side. Frequencies are measured in Hertz (Hz).
Down the left side of the audiogram is the sound level, which is measured in decibels (dB). Which ranges from very soft at the top of the graph to very loud at the bottom.
The responses recorded on the graph are the softest tones that can be heard at each frequency. The right ear is recorded as O and the left as X .
The Audiogram will also have other symbols to indicate how well you hear through bone conduction (a part of testing which bypasses the middle ear, which instead sends vibrations to the inner ear). These hearing test results are used by the Audiologist to determine the nature of the hearing loss.
The loss can be sensorineural, meaning it is a permanent loss caused by damage to the inner ear. Or it can be conductive, caused by damage to the outer or middle ear. A conductive loss when treated, can in some circumstances result in the hearing being improved or completely restored.

The closer to the top of the graph, the better the hearing is. The closer to the bottom of the graph, the greater the hearing loss.

An Audiogram often has horizontal sections identified to help explain the results.
The top section from -10dB to 20dB represents normal hearing.
The second section from 20dB to 40dB represents a mild hearing loss.
The third section from 40dB to 70dB represents a moderate hearing loss.
The fourth section from 70dB to 90dB represents a severe hearing loss and the final section from 90dB+ represents a profound hearing loss.

Word recognition testing
Testing is conducted to test your brain’s ability to understand words and to determine the optimum performance i.e. what is the best-case scenario with adequate volume?

Tympanometry
Tympanometry is a test of the middle ear function. By testing the mobility of the eardrum and middle ear structures, information can be obtained which can help in the diagnosis of middle ear problems.

Acoustic Reflexes
Acoustic reflex testing measures the contraction of a small muscle in the ear in response to a sound stimulus. This provides information that, when combined with other test results, can contribute to a diagnosis.

Interpreting the Audiogram
You now understand the hearing test and know how to read the Audiogram but what does that really mean?

• Is there a hearing loss present? If all the symbols on your audiogram ( < / > [ / ] , O / X ) are in the top section of the graph (-10dB to 20dB), there is no hearing loss present.
• If some or all the symbols are in the other sections, there is hearing loss present and your Audiologist will discuss whether you would benefit from a hearing aid or further investigation.
• If the bone conduction scores ( < / > [ / ] ) are better than your air conduction scores ( O / X ) then you have a conductive hearing loss and your Audiologist would advise further investigation.

It is important to realize that hearing losses are rarely “flat”. Quite often the pattern is sloping, with the low frequencies being in the normal range and the middle and high frequencies sloping to a mild or moderate loss. The hearing difficulties that are noticed in daily life relate to the specific frequencies that are affected by an individual's hearing loss. Sometimes speech sounds and common environmental noises are shown on the audiogram, indicating their frequency and decibel level and giving a clear visual representation of which sound you can hear and which you miss.

What next?
It is now time to use the information gained at the hearing test to understand how a hearing loss is impacting your life and how to manage it.
The most common pattern of hearing loss is a sloping high-frequency hearing loss. Often the low frequencies are at normal or close to normal levels which means that you can hear quite well. However, because there is hearing loss present in the higher frequencies, the consonants may not be heard. Consonants give clarity to speech so this explains the common complaint “I can hear, I just can’t understand” or “I can hear people speaking but they seem to be mumbling”. If the loss is mild, the brain can fill in the gaps, and hearing loss may not even be noticed. However, as the loss progresses, listening can become exhausting and can negatively impact daily communication and socialization. 

At Attune , an Audiologist will inform you if the loss is aidable and it is then time for action! There are a large number of options available in terms of hearing aids and listening devices and your Audiologist can help you to find an option that suits you and your individual lifestyle and circumstances. 

The early fitting of hearing aids often means an easier adjustment, as the brain only needs to adapt to a small increase in volume. Hearing aids are programmed to suit your individual pattern of hearing loss, they are discreet and highly effective. To better understand changes in your hearing, book a hearing test with Attune today. Why miss out on anything if you don’t have to!

     

A Guide to Coping With Hearing Aid Feedback

Those that have had experience with older family friends or grandparents with hearing loss and hearing aids may be familiar with the unpleasant squealing noise (hearing aid feedback) that hearing aids can make. Squealing hearing aids can be embarrassing for those with hearing aids if they are aware of the hearing aid feedback. Hearing aid feedback may be equally embarrassing if the people wearing the hearing aids are unaware of the feedback despite feedback being audible to others. People with significant hearing loss may fail to hear the feedback noise emanating from their hearing aids. What is hearing aid feedback? When might hearing aids produce feedback? Why do hearing aids produce feedback and how can hearing aid feedback be avoided? Has technology advanced sufficiently to address the problem of hearing aid feedback? Or is it fair to predict the feedback from today’s hearing aids based on past experiences with older generations of hearing aids? Which hearing aids have access to the technology that suppresses hearing aid feedback? These are the questions we will address.

What is hearing aid feedback?

The feedback or squealing sound that hearing aids can make is as a result of a sound loop.  The sound which the hearing aid speaker releases into the ear is recycled back into the hearing aid via the hearing aid microphone and passes through the amplification process again and again in a loop generating a whistle or squeal.

 

Why do hearing aids produce feedback and how can hearing aid feedback be avoided by people with hearing loss?

1.Hearing aid feedback may be heard if an object is too close to the hearing aid microphone. Examples of potential “objects” include people leaning in for hugs, hats, and pillows. Feedback can be avoided by increasing the distance between the hearing aid and the person coming in for the hug or other encroaching object.

2.There may also be feedback if the hearing aid is not inserted into the ear correctly and firmly enough or is not a good fit (This will allow sound to escape from the ear of our friend or relative with hearing loss back to the microphone producing feedback loop). Feedback can be avoided by ensuring that the hearing aid is correctly fitted in the ear and is a good fit. A tighter fit can be achieved by increasing the length of the earpiece that goes into the ear and by using a softer material for the earpiece. Bear in mind that these adjustments may make insertion of the hearing aid(s) more challenging.

3.If there is a big ball of earwax in the ear in front of the hearing-aid-speaker, the wax can reflect the sound back out of the ear toward the microphone into the sound loop that generates the feedback. Feedback can be avoided by ensuring that the person with hearing loss keeps their ear canals clear of earwax.

4.There may also be feedback if the earpiece of the hearing aid is inappropriate given the loudness of the sound the hearing aid produces. The louder the sound, the greater the risk that enough sound will escape to form a feedback loop. The greater one’s hearing loss the more likely it is that there will be feedback. Your hearing care provider is responsible for providing the most suitable fit in the ear to prevent sound leakage that can cause feedback. This is determined by how snugly the earpiece fits in the ear and by the size of its ventilation “shaft”. It can occasionally happen that a hearing loss is so significant that the amplification required is so great that there is still some feedback even when the earpiece is an excellent fit and the ventilation “shaft” is absent. However, this will not be a common problem for all people with hearing loss.

Technological advances that address the problem of hearing aid feedback for those with hearing loss.

Modern hearing aid software provides multiple avenues of support to eliminate hearing aid feedback for people with hearing loss. 

●Hearing aids possess automatic feedback cancellation technology which constantly scans for hearing aid feedback and cancels it out. 

●Hearing aids also possess frequency lowering technology. This technology works by converting a high squeaky sound to a lower-pitched sound. This is helpful when individuals with hearing loss have significant hearing loss in the highest pitches (for high squeaky sounds) and require significant amplification of those high pitches.  By converting very high-pitched sounds to lower pitches where individuals with hearing loss may have better hearing, the need for amplification is reduced. Lowering amplification lowers the risk of hearing aid feedback.

●Your hearing care professional can also run a feedback manager which measures the hearing aid’s response to sounds and reduces hearing aid amplification in the pitches that cause hearing aid feedback. 

Which hearing aids suppress hearing aid feedback for people with hearing loss?

People with hearing loss that have investigated the potential financial cost of acquiring hearing aids would be aware that different levels of hearing aid technology are available at different prices. Simple hearing aids are more affordable than more sophisticated hearing aids. The question arises as to whether less sophisticated, lower-cost hearing aids still support individuals with hearing loss by providing feedback suppression technology. Fortunately, there is consensus amongst hearing aid manufacturers that hearing aid feedback is a problem that no one with hearing loss should have to face.  Hearing aid feedback suppression technology is generally available across the board across all hearing aid levels regardless of the cost of the hearing aids.

Knowing what hearing aid feedback is and when and why hearing aids produce feedback is helpful. Hearing aid feedback can be avoided using practical strategies and relying on technological advances in hearing aid feedback suppression software. Technological advances in modern hearing aids are so effective, that hearing aid feedback will be a problem very rarely encountered by folks with hearing loss. This is true regardless of the cost of hearing aids. Only those with very significant hearing losses requiring significant amplification can expect to continue experiencing feedback from their hearing aids.  Most of us that carry unpleasant childhood memories of grandparents’ hearing aids squealing can rest assured that those embarrassing experiences will remain in the past. Make sure to book a hearing test at Attune Hearing to get your hearing evaluated. The qualified Audiologists are able to help you manage your hearing loss and find solutions, like hearing aids, that will enable you to enjoy life and hear every sound. 

Ear Plugs: What is Available To Buy?

There isn’t a one-size-fits-all ear plug that can do it all. So, what is available and how do you know you’re using the right ear plugs?

Ready-Fit versus Custom Earplugs There are two main categories that earplugs fall into, ready-fit plugs sold over the counter or custom earplugs. Ready-fit plugs are a standard one-size-fits all or may come various sizes – usually available from pharmacies or online. Custom ear plugs are custom made to fit your ears, so it is best to be fitted by a hearing professional. An impression or mould of the ear needs to be obtained which is a delicate process that should only be carried out by a trained professional. While custom ears plugs are costlier, ranging from $50-$200 for a pair, they are more durable, and custom made to ensure you are receiving proper protection with the best comfort.

When to use earplugs?

Noise plugs (industrial) – For those who work in construction or around heavy machinery for prolonged periods of time it is essential that hearing protection is a part of your everyday uniform. Prolonged exposure and even sudden loud sounds will have a lasting, long-term effect on your hearing. Even if you are using power tools for a few seconds – these few seconds of noise exposure cumulate and over time will damage your hearing. Foam plugs are effective only when used properly. If you find foam plugs uncomfortable, custom ear plugs will ensure maximum comfort so you are able to wear them all day. Custom earplugs will also provide the highest level of noise protection (up to 40dB!). Doubling up on hearing protection is more than welcome, wearing earplugs with earmuffs on top.

Noise plugs (general) - If your partner snores and you’ve just about had enough, ear plugs may be able to assist. Ready-fit ear plugs should suffice for this purpose however if you find they keep falling out during sleep a custom pair may be helpful to keep the plugs in and snoring out. Ready-fit plugs can also be helpful when on aeroplanes or in situations where you need to concentrate in a noisy area and just need a minor reduction of surrounding sounds.

Musician ear plugs – Your ears are extremely important for music! If you play in a band, love your heavy metal music or are an avid concertgoer, loud instruments and music in such close proximity will cause permanent damage to your hearing. Any deterioration in hearing can cause sounds to sound different or distorted. Retaining your normal hearing should be a priority and this is best achieved through protecting your hearing and wearing hearing protection. Maximum noise reduction is not always optimal as this can affect the quality of music thus, over the counter ear plugs are not ideal as they offer a flat attenuation of sound. Ear plugs made specifically for musicians allow different levels of attenuation allowing reduction of sounds evenly to maintain clear and natural sound. Musician earplugs can be sold in standard sizes however for the best retention and attenuation a custom-fitted earplug would be best.

Swimming ear plugs – If you are an avid swimmer or surfer and prone to getting surfers/swimmers ear or ear infections you should strongly consider custom ear plugs. Over the counter plugs just don’t cut it as even a little bit of water can get through the nooks and crannies if not inserted properly. Custom swimming plugs will allow the best fit and seal to keep water out. They are made from a strong durable soft acrylic which will allow prolonged life span and use. If over the counter plugs are your only option make sure they are made from a strong, water-resistant material; foam plugs are a no go for this situation!

What can I customise?

Shape - Some earplugs sit deep in the ears while others fill-up the whole outer portion of the ear. Ready-fit earplugs come in assorted shapes to help with retention to keep the earplugs in securely. Custom earplugs are made to fit the shape of your ears seamlessly as they are made based off a mould of your ears.

Size - Depending on the manufacturer, ready-fit plugs can offer only one size while others offer larger variety. It is important to find an earplug that fits properly and snug especially when using for hearing protection as sound only needs a hole the size of a pin to travel through! The size of custom earplugs will depend on the shape and size of your ears.

Material: Ready fit earplugs are generally made of a soft, pliable material like foam so that it is easily manipulated to fit your ears. Custom earplugs are typically made from a soft acrylic, but this is customisable depending on the manufacturer. If you are allergic to ready-fit materials or acrylic you can opt for silicones, latex or poly-vinyl and request for hypoallergenic coatings to reduce irritation.

Venting: For some earplugs – like for divers, the earplugs cannot block up the ears completely as they require ventilation to equalise – custom plugs allow customisable venting. If you feel uncomfortable with the ears completely blocked up and like to use them for sleeping or general noise reduction, having a vent through the plug will allow air to flow through and aerate the ears.

Attenuation: Ready fit plugs can offer up to 25dB of attenuation but only when used correctly. With custom ear plugs you can customise how much noise the plugs can reduce. This will depend on your purpose for using the plugs.

Caring for your ear plugs Most ready-fit ear plugs should be durable enough to used multiple times however, if there is a tear or the material is not as pliable as it was then it’s best to use a new pair. Custom ear moulds will last years but they still get a bit of wear and tear and it is possible for the shape and size of your ear canals to change. If the custom plugs are broken, chipped or falling out of the ears easily then it’s time to get some new moulds made. Be gentle when inserting and removing custom earplugs, especially if they are made of a softer material. Wipe them down with warm, soapy water or an alcohol swab but make sure they are completely dry before using them again.

Whether you are using ear plugs for noise protection, swimming, music or sleeping it’s important to consider the shape, size and material that is most suitable for your intended use. If you’re not sure what is best for you, reach out to your local Attune Hearing clinic for guidance.

How to read my audio-gram? Interpretation and results

An audiogram is the graph plotted by an Audiologist when a hearing test is performed.  Quite simply, it shows the softest sounds you can hear.  As there is often a lot of information given during the initial test appointment (test results, coming to terms with the fact you have a hearing loss and may need a hearing aid, hearing aid information itself, financing or funding options for hearing aids) it’s no wonder it can be hard to remember what everything means!

For a quick hearing test or screening, this audiogram may be the only information gathered about your hearing.  If you have a more comprehensive assessment there may be other information as well including speech test results and middle ear results.  Some clinics are happy to provide you with your audiogram, whereas others may request you obtain this through your GP if you have had a medical referral for a hearing test.

If we look at the basic audiogram, it is a graph with two axes.  Top to bottom is the volume of sound going from soft up the top to loud down the bottom.  Sound is measured in decibels relative to hearing levels, or dB HL, where 0 is the threshold of normal hearing (Interacoustics, March 2016).  Although 0 is where normal hearing starts, the normal range of hearing is actually from 0 to 20, and this normal range is the same no matter what age you are.

Across the graph from left to right is frequency or pitch of sound.  This is measured in Hertz (Hz) or Kilohertz (kHz) for the higher frequencies.  Think of a piano keyboard that goes from bass to treble if you sweep your finger left to right – the audiogram is effectively the same.  Most speech sounds fall between the range of 500-4000Hz and the frequency range for a hearing test is usually 250-8000Hz.  In rare cases either lower frequencies (down to 125Hz) or higher frequencies (up to 12kHz) may also be tested depending on the purpose of the test. 

The audiogram should have a table nearby explaining what the symbols plotted on the graph mean.  Circles indicate the right ear, crosses indicate the left ear.  If your audiogram is in colour: red is for right and blue for left.  A basic hearing screening will only have these symbols, but a comprehensive test will also have other symbols such as < or >, [ or ] or Π, sometimes there are even letters printed on the audiogram! What do they all mean?

Circles and crosses (even filled in circles and crosses) are air conduction results, which are from headphones or earphones.  These indicate how loud you can hear sound when it goes through all 3 parts of your ear (outer, middle and inner) and is the primary measure of the softest sounds you can hear.

The different types of brackets indicate bone conduction which was the tight headband you may have worn that sat behind your ear – this bypasses the outer and middle ears and sends the sound directly into the cochlea in your inner ear.  Bone conduction is normally performed during a comprehensive hearing test and indicates what part of your ear the hearing loss is in – and can often help your Audiologist to know whether any medical treatment should be considered rather than just a hearing aid.  As a rule if the bone conduction is much higher on the audiogram than the air conduction this could indicate a conductive or mixed hearing loss, and medical referral should be undertaken to investigate the cause and any treatment, especially if a hearing aid is being considered.

On your audiogram there might be different letters printed, or a banana shape or shaded area.  This area is where the different speech sounds occur, and each letter is actually a speech sound  - so you can see for yourself what sounds you can hear and which you can’t – at a normal conversational volume.  This can help you make sense of what your audiogram actually means!  If your hearing levels (circles and crosses) are above the letter then you can hear it well, if your hearing is below the letter then you can’t hear that sound well unless it is made louder in volume.  You may see that your audiogram is a mix - some speech sounds you can hear well (typically vowels and sounds like M, N, D) and some you may not hear well (typically F, S, TH). This is why people frequently say “I can hear but not understand” as they are not hearing all the sounds they need for speech to make sense. 

As mentioned above, the range of normal hearing is from 0 to 20dB.  If any results fall below 20 this indicates a hearing loss. Below normal hearing is graded by the terms mild, moderate, severe and profound. Mild is down to 45, moderate to 70, severe to 90 and profound below this. Hearing is not explained using a percentage which is a common misunderstanding, it will be described using these terms (for example mild to moderate, moderate to severe etc).

The most common shape for a hearing loss is where it slopes downwards towards the right, meaning that higher pitched (treble) sounds are harder to hear. This is typically what happens with age and exposure to loud noise. Hearing loss does vary from person to person with some people having flat hearing losses and others having a reverse slope where the deeper sounds are worse and the audiogram slopes upwards from left to right.  Often left and right ears are similar on the audiogram, but if one ear is worse, then that line will be below the other on the audiogram. 

If you were given a speech test where you heard a man’s voice say words you then had to repeat, then this will be the percentage you were given, which is often confused with your hearing levels.  This percentage score is called speech discrimination and what this actually means is how clearly you can hear speech when the sound is made loud enough for you.  The volume that you hear the words is usually dependent on your audiogram therefore for some people these words may be at a normal conversational speech volume, whereas for others the volume of speech may be made quite loud.  This score is a good indicator of your overall hearing ability, and if you have a hearing loss then it can indicate how well you are likely to do with a hearing aid. 

As hearing is complex and not about simply turning up the volume, if you have average speech discrimination then a hearing aid won’t be the answer to your hearing difficulties by itself.  For example, if you have a severe hearing loss and your speech discrimination for amplified speech is only 60%, then even with a hearing aid you will still have difficulty understanding what people say.  Unfortunately, generally the poorer your hearing is the worse your speech discrimination is; and the longer your leave your hearing loss untreated (without a hearing aid) the worse your speech discrimination is likely to get in the long run.

So how do you know whether you actually need a hearing aid?  Generally if your audiogram shows you are missing many or most of the speech sounds, or you are well below the normal hearing range (20dB or lower on the graph) a hearing aid may benefit you.  

There has been abundant research into early intervention for hearing loss and fitting hearing aids to people even with a mild hearing loss.  The biggest finding has been from The Lancet International Commission on Dementia Prevention and Care, where untreated hearing loss in middle age was found to be the single biggest modifiable risk factor for cognitive decline later in life (Livingston, et al., 2017).

Even for a mild hearing loss a hearing aid can make a big difference to your communication and levels of fatigue by the end of the day.  Certainly if the hearing loss is more than mild a hearing aid should be considered as an option.  As technology improves, hearing aids are becoming smaller in size, and there are even completely invisible shower-proof hearing aids available!

Your Audiologist can discuss suitable hearing aid options with you based on your hearing ability, your individual ear, and your needs and lifestyle.  It is also important to have realistic expectations of what hearing aids can and cannot do, so you know what to expect.  Your Audiologist can also discuss finance and funding options available for hearing aids.  Many clinics have interest free finance packages available and many private health funds offer a rebate on hearing aids if you have extras cover.  In Australia, if you are on a pension or DVA funded you may be eligible for hearing aids through the Hearing Services Program.

Understanding your own audiogram is easy, and is an important step to help you take control of your communication needs, especially when considering a hearing aid.  If you have any questions when looking at your audiogram or other results, or want to discuss hearing aid options, your Audiologist at Attune Hearing will be more than happy to help.

References

Interacoustics. (March 2016). The Variety of Decibel - Basics. Retrieved from https://www.interacoustics.com/guides/basics/the-variety-of-decibel-basics

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S., Huntley, J., Ames, D., & al, e. (2017). Dementia Prevention, Intervention and Care. The Lancet, 390(10113), 2673-2734.

Are Diabetics twice as Likely to have a Hearing Loss?

It is not uncommon for hearing loss and health problems to go hand in hand. On the face of it this may seem obvious but even though we may readily acknowledge this fact, we don’t automatically link specific diseases to hearing loss or recognise that we may have a hearing loss.  It is thought that approximately 1 in 6 Australians have a hearing loss and the health causes of hearing loss are still being researched. Furthermore, recent studies have shown that diabetes, a prevalent health condition which is on the rise, may be linked to hearing loss. Approximately 1.7 million Australians have diabetes (www.diabetesaustralia, 2018), and studies recognize that “As diabetes becomes more common, the disease may become a more significant contributor to hearing loss.” (Dr Catherine Cowie NIH, 2008). Cowie also identified that the likelihood of adults with diabetes having a hearing loss doubled. This finding is also supported by various other studies all of which have indicated that hearing loss is in fact twice as likely to occur with the disease, diabetes. 

What is the Connection?

The precise link between hearing loss and diabetes is not yet fully understood, however, it is thought that having a high blood sugar level seems to increase the likelihood of developing hearing loss by as much as 30% (Dr Catherine Cowie NIH, 2008). This finding pertains to anyone who is either diabetic or in the process of developing the disease. It is not clear why this is the case, however, the most likely hypothesis considers what is already known about the damaging effect of having high blood glucose levels. When this happens the sugar or glucose levels become toxic. This glucotoxicity begins to break down different parts of your body’s organs including your nerves, arteries and blood vessels. The body’s healing reaction to fight this breakdown is to form plaque which can build up in your arteries. Of all the organs in your body, your kidneys are the most vulnerable to the effects of glucotoxicity. This is because your kidneys have to work extra hard to remove the glucose from your blood. The excess of glucose gradually destroys the kidney’s, which leads to dialysis. How all this relates to your hearing is still being researched, however, since the glucotoxicity effect from high blood sugar levels is known to damage blood vessels, nerves, arteries and organs, it is thought that this must therefore almost certainly apply to the blood vessels of the organ of hearing, known as the cochlear or inner ear; damaging the vessels and nerves and the nerve pathway from the inner ear to the brain (Lorenzi, 1992). The link between hearing loss and diabetes is clearly present and how this affects the hearing is also still being researched. However, studies around the world in Brazil, the United States of America, Australia and Asia have all had supporting results to strongly suggest that there is a very strong association between diabetes and hearing loss. 

Know the signs

It is important to arm yourself with a good knowledge of the disease if you are either a diabetic, or if you think that you may be pre-diabetic. If this is the case, it is important to understand that you may be at risk of hearing loss as a complicating factor of diabetes disease. In particular, there seems to be an increased risk of high frequency hearing loss (Vasilyeva et al, 2009). If you have not already done so, book an appointment with your audiologist. If you have never had a hearing test, or only recently been diagnosed with diabetes, or are pre-diabetic, it is very important to establish a base-line of your hearing, so that your hearing can be monitored over time. Make sure that you have regular hearing tests so that your audiologist can tell you if there are any changes in your hearing thresholds. This is very necessary so that, should you start to develop a hearing loss, your audiologist can discuss rehabilitation options with you before your hearing loss deteriorates too much (Vasilyeva et al, 2009).  

Prevention is better than Cure

The most common diabetes in adults is Type 2 and it is possible to avoid the onset of this disease and even reverse the condition, especially if pre-diabetic. It is important to know what the relationship is between your lifestyle and the onset of this disease and take active steps to avoid diabetes, which in turn will lower the risk of complicating factors such as hearing loss (www.nih.gov). The causes are varied but if you remember that disease is due to high blood sugar levels, we can look at a few things that trigger this. Diet is primary; carbohydrates increase your blood sugar levels, so try and reduce or avoid foods high in carbohydrates such as pasta and potatoes and sugary foods like sweets. Eating a healthy diet is essential and you can easily do this by introducing more vegetables and foods high in fibre. Other big risk factors for diabetes is obesity, being sedentary, and high blood pressure. Exercise is vital for good health and well being and also for keeping trim. Reducing alcohol intake and Regular exercise assists you in losing weight and will also help you to maintain a healthy blood pressure. If you smoke, try to reduce it until you have given it up. People who smoke greatly increase their risk for diabetes.  

Summary

The number of diabetes cases is increasing and it is known that if you have diabetes you double your chances of hearing loss. The reasons why having diabetes contributes to the complication of a hearing loss so significantly are not completely clear, however, we do know that very high blood sugar levels lead to glucotoxicity which breaks down the nerves, arteries, blood vessels and organs of the body. It is thought that in the same way glucotoxicity may very likely damage the blood vessels and nerves of the delicate mechanism of your inner ear, which will cause hearing loss. Taking positive steps to prevent this disease and even reverse it involves not only changing your lifestyle, but also to regularly check your hearing with your audiologist. You can do this every year just as you have an annual check-up with your general practitioner.

If you’re looking to get your hearing tested, trust Australia’s only hearing healthcare provider, Attune Hearing. With clinics nationwide, visit one of our friendly Audiologists for a professional hearing test to determine your level of hearing loss or to manage your hearing health. Contact Attune Hearing today.