Blog

Dr. Dana Day was featured in Heather Lindsey’s article,Sports-Related Concussions: Call for Hearing Healthcare to Get in the Game in the February 2014 Volume of the Hearing Journal, you can access the article online here as well…

Audiologists have a key position to play in managing athletes who sustain a concussion.

Missing the diagnosis of concussion’s audiologic consequences may delay return to play, work, or other daily activities, as well as increase the risk of depression, sleep disturbances, anxiety, and change in mood or behavior, said Dana Day, AuD, managing member of Arizona Balance and Hearing Associates (ABHA) and an audiologist with Banner Concussion Center and the Central Arizona Center for Therapeutic and Imaging Services (CACTIS) Foundation, which is creating a concussion management program in Phoenix.

Unfortunately, awareness and understanding of the auditory and vestibular side effects of concussion, which can include benign paroxysmal positional vertigo, hearing loss, tinnitus, noise sensitivity, and auditory processing problems, is “still in its infancy,” Dr. Day said.

This information gap may not come as a surprise, given that data on sports-related concussions are lacking overall, especially in younger populations, as noted in the Institute of Medicine–National Research Council (IOM–NRC) report on Sports-Related Concussions in Youth: Improving the Science, Changing the Culture released Oct. 30, 2013.

Approximately 1.6 million to 3.8 million “sports- and recreation-related traumatic brain injuries (TBIs), including concussions and other head injuries, occur in the United States each year,” the report authors noted, citing a 2006 article from the Journal of Head Trauma Rehabilitation (21[5]:375-378 https://journals.lww.com/headtraumarehab/pages/articleviewer.aspx?year=2006&issue=09000&article=00001&type=abstract). However, because athletic concussions are likely underreported, these figures may be higher, they added.

Awareness of the issue has increased, though, and is partly behind a rise in the incidence of sports-related concussion over the past decade, according to the report. For example, the reported number of people age 19 and younger treated in U.S. emergency departments for concussions and other nonfatal, sports-, and recreation-related TBIs increased from 150,000 in 2001 to 250,000 in 2009.

Generally, concussions are more frequent among high school athletes than college athletes in football, men’s lacrosse and soccer, and baseball, according to the IOM–NRC report. Concussion is also more common during competition than practice, except when it comes to cheerleading.

Sports with the highest incidence of concussion include football, ice hockey, lacrosse, wrestling, soccer, and women’s basketball. Concussion rates also appear greater for youths with a history of concussions and among female athletes.

LESSONS FROM MILITARY RESEARCH

While data on the auditory side effects associated with sports-related concussion are limited, Dr. Day noted, audiologists can learn a lot from TBI research in military personnel.

Tinnitus and hearing loss are two of the most widely reported audiologic consequences of traumatic brain injury, said Paula Myers, PhD, chief of the Audiology Section at the James A. Haley Veterans’ Hospital in Tampa, FL, whose comments for this article are based on her research of injuries from blasts or motor vehicle accidents.

In a report on veterans of the Iraq and Afghanistan wars who were evaluated for traumatic brain injury, 59 percent experienced sensitivity to noise, and 66 percent reported hearing difficulty (Brain Injury2012;26[10]:1177-1184) https://informahealthcare.com/doi/abs/10.3109/02699052.2012.661914. Another study of military personnel with TBI found that up to 38 percent complained of tinnitus (J Rehabil Res Dev 2007;44[7]:921-928) https://https://www.rehab.research.va.gov/jour/07/44/7/page921.html.

Following TBI, audiologic sequelae may arise from debris, tears, or external bleeding in the ear canal; a ruptured tympanic membrane or ossicular damage in the middle ear; cochlear damage with or without eighth nerve complex injury; disruption of the membranous labyrinth; or vascular compromise in the inner ear, Dr. Myers said. The temporal bones and central auditory nervous system pathways may also be affected.

A standardized approach to audiological management of TBI patients does not exist because peripheral and central function; speech perception abilities in quiet and degraded conditions; cognition; and emotional, behavioral, and physical health all vary greatly in this population, Dr. Myers said.

However, audiological assessment of mild TBI should begin with a comprehensive case history that includes pre- and post-injury information about physical and cognitive functioning, visual ability, dizziness, and hearing, including tinnitus and exposures to loud noise, she recommended.

Information gathering about traumatic brain injury should focus on the nature of the injury, use of protective gear, loss of consciousness at the time of injury, history of prior head injuries, and current medications, she said.

Patients with mild TBI should then receive an audiologic evaluation with otoscopy, pure-tone audiometric thresholds up to 12,000 Hz or the frequency limits of the individual’s hearing, speech recognition testing in quiet and in noise, a complete immittance battery, otoacoustic emission testing, evaluation for central auditory processing disorders, and electrophysiological evaluation with appropriate referrals to otolaryngology, Dr. Myers said.

Reassessing patients with TBI six months post-injury and annually thereafter—sooner if subjective changes are noted—is advisable due to the potential for latent sequelae, she added.

INVISIBLE INJURIES

One of the greatest challenges for audiologists addressing sports-related concussion is that both audiological problems and brain injuries are not readily visible, Dr. Myers said.

Another difficulty is that auditory symptoms are only one of many sensory problems seen in these patients, Dr. Day said. Testing in a well-lighted room may not be possible due to light sensitivity. Additionally, the optokinetic stimulus itself may induce motion intolerance.

“The audiologist must be able to adjust testing on the fly at times to get the diagnostic information needed,” Dr. Day said.

Lack of awareness is another obstacle to care, she added. While audiologists know mild TBI can cause ossicular bone dislocation, they’re not as familiar with the cognitive and oculomotor aspects of concussion. Consequently, they may assume patients are “not giving their best effort” during diagnosis.

In her clinic, Dr. Day most often sees the audiologic sequelae of tinnitus, noise sensitivity, hearing loss, and auditory processing difficulties.

“These complaints are likely explained by damage to the outer hair cells of the cochlea, damage to the ossicular chain, cognitive deficits in the speed at which auditory information is processed, attention to auditory information, and memory,” she said.

Dr. Day also commonly sees dizziness, vertigo, headaches, and sensitivity to light in her patients.

To provide the best possible evaluation and management of sport-related concussion, audiologists should work with a multidisciplinary team, she said.

This approach is especially useful in patients who continue to experience symptoms beyond a three-month follow-up period. Some individuals “do not get better on rest alone,” she said.

MULTIDISCIPLINARY APPROACH

At Banner Concussion Center and the CACTIS Foundation, the multidisciplinary team includes a physician trained in sports-related injuries and concussions; neuropsychologists familiar with neurocognitive testing; professionals experienced in comprehensive neurovestibular assessment and therapy; providers of vision services, including optometric evaluation and treatment; and audiologists who conduct a comprehensive evaluation.

Protocols for working with concussion patients at Arizona Balance and Hearing Associates involve a complete medical history and the performance of tests for high-frequency distortion-product otoacoustic emissions, ultrahigh-frequency (12,000 Hz to 20,000 Hz) hearing thresholds, ipsilateral and contralateral acoustic reflex thresholds, and speech in noise, which, if abnormal, may require full evaluation for a central auditory processing disorder.

The center also conducts videonystagmography (VNG), with a well-defined protocol for ocular motor testing. “Our clinic prefers to utilize water calorics whenever possible to assure the most accurate caloric findings,” Dr. Day said.

She and her colleagues may consider other tests such as ice water calorics, rotary chair testing, computer dynamic posturography, and cervical vestibular-evoked myogenic potential with or without ocular vestibular-evoked myogenic potential.

Video head impulse testing is still being evaluated by the practice for use in patients with a concussion.

“I believe [its] greatest value may come in testing the pediatric patient, but the final verdict is still out,” Dr. Day said.

GETTING A BASELINE

Arizona Balance and Hearing Associates is working with the CACTIS Foundation to offer baseline testing services to its youngest patients and athletes, who are 6 to 14 years old.

“We hope that by gathering this information prior to injury it will offer an objective measure for making the critical return-to-play decision,” Dr. Day said.

At a minimum, an audiogram and VNG need to be conducted to assure a baseline measurement in case tinnitus or dizziness present as late-onset symptoms, meaning three to six months after injury, Dr. Day said.

In addition to testing, audiologists at Arizona Balance and Hearing Associates directly manage several concussion-related sequelae, such as sensorineural and conductive hearing loss and benign paroxysmal positional vertigo, Dr. Day said.

Tinnitus can be the most challenging condition to address because therapy must be personalized to the patient, she said.

Appropriate medical and psychological referrals should be made for tinnitus, Dr. Myers added.

Sudden-onset tinnitus, with or without hearing loss, requires same-day assessment by otolaryngology and audiology, she said. If the condition is causing severe distress or challenges with coping, referrals should also include psychology.

COLLEGE-LEVEL CONCUSSION MANAGEMENT

To provide better care for its student athletes with potential concussion, Lamar University in Beaumont, TX, implemented a program in the fall of 2013 that uses cognitive and vestibular tests to assess students.

“Usually a concussion will show up as a cognitive problem or a balance problem,” said program developer Vickie B. Dionne, AuD, who is also associate professor and program director of audiology at the university.

“We’re worried about the player who comes off the field and says he was hit hard and then, the next day, has a headache, or everything is blurry, or he can’t process what you say. These symptoms don’t show up right away.”

Currently, the Balance Error Scoring System (BESS) is widely used to assess balance deficits indicating concussion, Dr. Dionne said. It requires a trainer to subjectively evaluate a variety of the athlete’s stances to see if the body sways.

“This is a test that a lot of teams are using from middle school up through college,” she said.

In addition to BESS, a pencil-and-paper test for cognition such as the Standardized Assessment of Concussion is commonly used.

“It consists of questions about the day, year, and the athlete’s name; immediate recall; concentration; and delayed recall,” Dr. Dionne said.

However, given that only three versions of the paper test are available and athletes have been taking the tests for years, subjects often have responses memorized. “It’s no longer a true test,” she said.

UPDATED TESTING

After a heavy overhaul of Lamar’s National Collegiate Athletic Association (NCAA) concussion management plan, Dr. Dionne and colleagues studied 400 student athletes using updated concussion assessment technology, including computerized dynamic posturography (CDP). CDP provides vestibular evaluation of concussion through the assessment of balance, postural sway, and weight bearing.

In addition, researchers used the computerized ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Since the test is randomly generated each time it’s given, athletes can’t memorize it, Dr. Dionne said.

She and coinvestigators acquired baseline CDP and ImPACT assessments from athletes before practice or play and then tested them after a head injury was sustained.

“We thought we were going to test athletes within 24 hours of concussion, but we found a lot of symptoms didn’t show up until 48 to 72 hours later,” she said.

Athletes were not allowed to play until both tests were back to baseline. “We benched quite a few players throughout the year for up to two to three weeks,” she said.

Most people recover from concussion within seven to 10 days, said Richard E. Gans, PhD, founder and CEO of the American Institute of Balance, which has eight clinics in the Tampa and Orlando, FL, areas.

When patients don’t recover within that time frame, they may then move into a post-concussion syndrome profile. Vestibular rehabilitation is being used to treat many of these patients, he said.

RAISING AWARENESS

As part of future research, Dr. Dionne would like to conduct hearing evaluations in student athletes with concussion and evaluate how long any identified cognitive or auditory processing disorders take to resolve.

Testing for auditory processing disorder would be a valuable addition to the program because such deficits could mean students are functioning poorly in class.

Further studies comparing different approaches to diagnosing and treating the audiologic consequences of concussion would be welcome, as would registries tracking the results of patients seen for mild TBI, the testing performed, and subsequent outcomes, Dr. Day said.

The audiology community also needs to establish best practices for assessing mild TBI and monitoring recovery.

“We need to continue to increase audiologists’ awareness of the diverse sensory and communication disorders that may result from a TBI so that a team-oriented, patient-centered rehabilitation plan can be formulated and implemented efficiently, thereby enhancing the likelihood of improved outcomes,” Dr. Myers said.

For More Information

The government, the American Speech–Language–Hearing Association (ASHA), and other organizations offer resources on the diagnosis and management of concussion, including the auditory and vestibular side effects.

* Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury (TBI): https://bit.ly/TBI-CPG.

* Traumatic Brain Injury Veterans Health Initiative: https://bit.ly/TBI-VHI.

* Centers for Disease Control and Prevention on Concussion and Mild TBI: https://bit.ly/TBI-CDC.

* ASHA Gives Current Perspectives on Traumatic Brain Injury:https://bit.ly/TBI-ASHA.

* ASHA on Tinnitus Evaluation and Management Considerations for Persons with Mild Traumatic Brain Injury: https://bit.ly/mTBI-ASHA.

* Brain Injury Association of America: https://www.biausa.org.

© 2014 by Lippincott Williams & Wilkins, Inc.

Feelings of vertigo, dizziness, and loss of balance are more prevalent than most people realize; 42% of the United States population (ninety million people) experience this at least once during their lifetime, and for many the condition becomes chronic. In the elderly, dizziness is the most common reason that people over seventy five visit a doctor, and for people over sixty five, falls resulting from a loss of balance are the number 1 cause of serious injury and death.Most (75 percent) of these cases are caused by peripheral vestibular disorders in the inner ear; examples of these conditions include Ménière’s disease, labyrinthitis, perilymphatic fistula, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis, acoustic neuroma. These disorders cause abnormalities in the delicate areas of the inner ear that disrupt our ability to maintain and control our sense of balance. Most of the cases of dizziness and vertigo occur in adults, but these conditions can affect children as well, with even greater impact because they are often involved with athletics or playground activities in which a sense of balance is key.These conditions can be treated with surgery and drugs, but there is another treatment methodology that uses physical therapy to stimulate and retrain the vestibular system and provide relief – Vestibular Rehabilitation Therapy (VRT). The Vestibular Rehabilitation Therapy exercises are individually prescribed for each patient’s symptoms and complaints, but in general they consist of head movements, eye exercises and gait training designed to reduce symptoms and improve stability. VRT cites its goals as seeking to improve balance, decrease the experience of dizziness, improve patients’ stability when walking or moving, improve coordination, minimize falls, and reduce anxiety.VRT has been shown to be effective in reducing symptoms for many people suffering from the conditions mentioned above, and for those with other forms of bilateral or unilateral vestibular loss. The effectiveness of VRT in patients suffering from these conditions who did not respond to earlier treatment methodologies has been proven in several clinical trials. It is not as likely to be beneficial if a patient’s symptoms are the result of transient ischemic attacks (TIA), anxiety or depression, low blood pressure or reactions to medications, migraine headaches.Because the specific exercises in a regimen of VRT vary according to the patient’s symptoms and conditions, it is not easy to give an overview of them. But are all taught by trained Vestibular Rehabilitation Therapy therapists, and often involve movements of the head, eyes, and body that enable your brain and body to retrain themselves and regain control over their equilibrium and balance, compensating more effectively for the incorrect information sent to them from their inner ear. If you have experienced long-term symptoms of dizziness or vertigo, consult a balance specialist and ask for more information. You may also want to contact the Vestibular Disorders Association and take advantage of many of their short publications and resource materials.

Tinnitus (ringing in the ears) is a well-known problem among adults, but there are no age restrictions associated with this disorder. Many children also experience the symptoms of tinnitus. While adults can usually determine that the sounds they are hearing are abnormal, many children assume the noise is a regular part of life. If your child shows signs of tinnitus it is important to look into it to rule out any underlying condition.Tinnitus is caused by a number of different conditions in both adults and kids. The disorder is linked to wax build-up in the ear canal, problems in the circulatory system, misaligned jaw joints, noise-induced hearing loss, and head and neck trauma. Slow-growing tumors on nerves in the face and ears can also cause tinnitus. Bring your child to your family doctor to rule out any specific ear problems. If there are not any obvious issues, you will likely be referred to an ear, nose, and throat specialist or audiologist for further investigation.If the examination uncovers a specific reason for your child’s tinnitus, the issue can usually be alleviated by addressing the underlying problem. Unfortunately, many incidences of tinnitus are not associated with a specific issue. In this case, there is no way to eradicate the problem, so your focus should shift to helping your child cope with the sounds he or she is hearing.Your child may find that his or her tinnitus makes concentration difficult. Background noise is an effective way to fight back against this problem. Consider playing soft music or running a fan when your child needs to concentrate. Hearing aids can be helpful for kids with hearing loss by helping them filter out distractions and focus on important sounds.Tinnitus can cause some kids to experience psychological distress. In this case it is important to be supportive and reassuring about the condition. Make sure your child understands that tinnitus is a common problem that affects many other children. Ask your audiologist about how you can explain tinnitus to your child in a way that makes sense to them.Some kids find that their tinnitus gets worse when they are under stress, so work with your child to find ways to manage stressful situations.Always keep in mind that many kids outgrow their tinnitus without intervention, so it may cease to be an issue. While it may be a nuisance now, with time your child can overcome it.

A hearing aid can be an effective way to offset hearing loss. Every year hearing aids become more advanced and offer additional features and functions that were not previously available. The directional microphone is one of these new features. Many of today’s hearing aids incorporate this device, allowing the wearer to enjoy a more natural hearing experience.The traditional standard for hearing aids was the omnidirectional microphone. When this style of microphone is in use, sound is amplified from all directions in equal measure. While this method works well in a quiet setting such as a living room, it is not conducive to noisier environments (such as a restaurant). In order to compensate for this, directional microphones focus closely on sounds emanating from the front. This allows you to hear what is being said in front of you while blocking out unimportant noise from the rest of the room.Because both types of microphones have their own advantages, many hearing aid designers will incorporate both into their devices. Directional microphone usage varies from hearing aid to hearing aid. In some cases users can manually switch back and forth between microphones, usually through a small switch. Other devices can pick up on which microphone is most useful in a given situation and will automatically switch back and forth.A third type of hearing aid microphone is the adaptive directional microphone. This device offers variation in the direction of amplification, automatically picking up on speech signals and focusing in on the direction they are coming from. Adaptive microphones can be troublesome in crowded environments where many speakers are present, but the user can usually switch to a forward only mode in these situations.Hearing aids designed for kids sometimes utilize directional microphones, but caution is needed when using these devices. Because kids develop much of their language skills from listening to the people around them, a directional microphone may cause them to miss out on an important developmental experience. Children may also have difficulty hearing traffic with this type of microphone. Parents should make sure that their child’s hearing aid has an on/off switch for the directional microphone and make sure it is only turned on when appropriate.The advantages of the directional microphone outweigh its flaws, allowing it to dramatically increase its wearer’s ability to hear.

Completely-in-canal (CIC) hearing aids are the smallest of all the hearing aid options and different than other possibilities because they are custom fitted to the inside of your ear canal to amplify sounds in individuals with mild to moderately-severe cases of hearing loss. CIC hearing aids offer several pros for the wearer, as well as a couple of cons that you should be aware of before getting one.Pros:This type of hearing aid is small and comfortable, which provides both cosmetic and listening benefits to the wearer.Because of their small size, it’s difficult for others to notice a CIC without looking for it and it works automatically without extra knobs and buttons to control. The custom fit of the device may make this a more comfortable choice because they are molded to the shape of your inner earYou can wear some completely-in-canal brands around the clock for up to several months at a time, so there is no need to insert and remove it every morning and night. Models that cannot remain in the ear are equipped with a tiny string for easy removal. Because the device is inside the ear, your outer ear keeps away wind noise and allows you to use the telephone with ease. Additionally, the natural anatomy of the ear helps guide sound to the instrument, which improves the directionality of the sound.Cons:Because the completely-in-canal hearing aids are small, they are generally less powerful and go through batteries faster than larger ones. They are generally the more expensive option because they are custom fitted to the wearer’s ear. Additionally, their tiny size doesn’t leave room for extra features, so you won’t be able to adjust the volume or experience directional sound (the sound in front of you appears louder than one that coming from somewhere else). Moreover, CICs are not powerful enough for people with major hearing loss.

Excerpt: “Arizona Balance & Hearing Associates’ Audiologists want to help parents narrow the range of hearing aid options for their children by explaining the pros and cons of various hearing aid styles for kids.”Read full press release at:https://www.prweb.com/releases/phoenix/hearing-aids/prweb11456331.html

Finding the hearing aid that’s right for you or your loved one can be overwhelming, especially considering the variety of hearing aid choices available. The next few paragraphs will describe more about one of the most popular hearing aid styles: open fit hearing aids.Open fit hearing aids share many similarities with behind-the-ear devices. This type of hearing aid consists of a plastic case that rests behind the ear and a small tube that connects the case to the ear canal. However, open fit hearing aids are considerably smaller than their behind-the-ear counterparts.Better ventilation to the ear is probably the largest differentiating factor of the open fit hearing aid. The open fit design allows low frequency sounds to enter the ear without being amplified. This offers a more comfortable and natural experience to those with mild to moderate hearing loss that are able to hear low frequency sounds without amplification. It also prevents wearers from hearing their own chewing, coughing, and speaking, reducing distraction and adding further comfort.Another major advantage of open fit hearing aids is their small size. Many users are able to disguise these devices, making them a favorite among listeners who are self-conscious about having to use a hearing aid.Open fit hearing aids do have downsides, particularly for users who have deep hearing loss. At high levels of amplification (required for individuals with severe hearing losses) the open fit devices often suffer from feedback noise. The hearing aid’s small size can also work against it, as people who do not have fine motor skills often find it difficult to operate such a small device. Additionally, this small hearing aid type requires very small batteries that will need to be changed or charged regularly.Open fit hearing aids may have their flaws, but they are still a great choice for many users. Consult with your hearing professional to determine if the open fit type of hearing aid may be the best for your unique hearing needs and lifestyle.

Conductive hearing loss sufferers have problems hearing due to a problem with their ear’s capacity to conduct sound waves. This variety of hearing loss arises from a blockage in the ear canal, but it also may be due to a congenital absence or malformation in the ear. In many cases conductive hearing loss can be treated, fully restoring normal hearing ability.Quite a few congenital problems may cause conductive hearing loss. For example, someone may be born with an ear canal that isn’t fully open, or their ear canal may not have developed at all. Deformation of inner ear components can inhibit optimal hearing. A number of these congenital problems can be addressed via surgery. Others may be best addressed with a hearing aid. Congenital problems are among the less frequent reasons behind conductive hearing loss.One of the more common causes of conductive hearing loss is a buildup of fluid or wax in the outer ear. Wax buildup and infections of the ear can lower a person’s hearing ability. Ear infections can be cured with prescription antibiotics while cleansing the ear might be sufficient for eliminating ear wax buildup.Buildup in the middle ear can also result in conductive hearing loss. This issue is most often caused by the accumulation of fluid. Frequently attributable to ear infections, this issue is widespread in kids. Sinus pressure from the common cold or allergies can exert pressure on the middle ear, putting a damper on a person’s ability to hear. A uncommon reason for hearing loss in the middle ear is tumors.Perforated eardrums or foreign bodies in the ear canal are other problems that may be responsible for conductive hearing loss. Conductive hearing loss principally happens on its own, however it can coincide with other forms of hearing loss. Consult with a hearing care specialist right away if you experience any unexplained hearing loss. In many cases complete hearing can be recovered with appropriate treatment.

There are countless drug and medication commercials nowadays with seemingly endless lists of negative side effects. Did you know certain medications can cause balance problems or hearing loss? These medications are in wide use, and they’re called ototoxic medications. Ototoxic drugs are over-the-counter (OTC) and doctor-prescribed medications that can damage your hearing and alter your balance. You can find more than 200 recognized ototoxic drugs that are in common use according to the American Speech-Language-Hearing Association (ASLHA). Quite a few of these ototoxic medications are used, and you’ve probably heard of them and might even be using them.

• Loop Diuretics – Loop diuretics are sometimes used in the management of certain kidney conditions, high blood pressure, and heart failure. Loop diuretics have been shown to cause tinnitus and hearing loss, which is sometimes only discovered during a hearing test.
• Salicylates – Salicylates are commonly found in everyday pain relievers such as aspirin and in aspirin-containing medications. Tinnitus and hearing loss are known to be caused by high daily doses (8 or more tablets per day) of medicines containing salicylates. Fortunately, when drugs containing salicylates are discontinued, the ototoxic side effects will go away on their own.
• NSAIDs – Nonsteroidal anti-inflammatory drugs(known as NSAIDs) can result in temporary hearing loss and a ringing in the ears in large quantities.Some easily recognized NSAIDs include ibuprofen and naproxen.
• Aminoglycoside Antibiotics – There are numerous categories of aminoglycoside antibiotics used to treat bacterial infections, including streptomycin, kanamycin, neomycin, gentamicin and amikacin. Complications come up when these medications produce free radicals, which do damage to the inner ear. Expectant mothers should be mindful of possible congenital deafness from using aminoglycosides during pregnancy.
• Chemotherapy Drugs – Cancer treatment drugs, such as bleomycin, carboplatin, cyclophosphamide and cisplatin can cause permanent hearing damage. If you have any hearing or balance changes while taking your chemotherapy drugs, speak to your oncologist.

Increased dosage and/or mixing of these ototoxic medications can increase the risks, but always consult your physician before adjusting or stopping any prescription drugs. To safeguard your ear health, talk to your doctor for alternatives to known ototoxic medications; if they cannot be avoided, make sure you are taking the correct dose precisely as directed.

Congrats. In an effort to hear your favorite television shows without annoying family members, you went out and purchased a hearing loop. Although it may have been a challenge to find the best system from all the fantastic options out there, it should be much easier for you to install your hearing loop after you get it home and out of the box. Fortunately, a professional is not needed to install a home hearing loop, because the steps are quite straightforward.Before you begin. Nearly all home hearing loop systems have four major pieces — an amplifier box, the loop cables, the product you want to hear more clearly (for example the TV) and the sound receiver (typically your hearing aid or a separate device packaged with your system). Just like any home project, it is a good idea to ensure you have all the correct tools and equipment on hand before you begin configuring your new system. Dependant upon the particulars of the system you’re installing, a few additional tools, such as an industrial stapler and a screwdriver, will make your installation much easier.The steps involved. The first thing to do is to position the amplifier in a suitable location close to your sound source (normally a TV set or telephone), being certain to follow any directions the manufacturer provides for using special tape or screws to attach the amplifier to a piece of furniture or a wall. The subsequent step is to plug your amplifier into a power outlet and to connect your amplifier’s input jack to the audio output jack of your sound source. The last is to place the wire loop along either the edge of the ceiling or floor and secure with staples or tacks.And, your done!Just follow the hearing loop manufacturer’s directions to modify the volume and any additional settings your system might have. The volume controls can be located on the amplifier itself or on a standalone remote depending on the hearing loop’s design.Caution. Never position any electronic equipment in or around water, or in areas where moisture may accumulate. Never spray cleaning solution on the amplifier; instead, wipe it with a dry cloth. Moreover, keep the system away from sources of heat, such as a heater, fireplace or stove. Be sure your home hearing loop is placed in an area with plenty of ventilation to avoid overheating it.

Public health officials estimate that approximately 26 million people across the U.S. are impacted by noise-induced hearing loss (NIHL). NIHL can be temporary or permanent, caused by exposure to unsafe sound levels above 85 decibels (dB). By way of comparison, repeated exposure to traffic noise in cities may reach this decibel level, while guns, motorcycles and fireworks all have decibel levels in excess of 120. Luckily, there are several styles of hearing protection products sold at your local sports or hardware store to match the different noise levels in a variety of conditions.The rating system for hearing protection. In the US, all products are given a Noise Reduction Rating (NRR) based on a standard system for assessing the amount of protection they give the wearer. NRR is measured a decibel scale of 0 to 33 with the level of protection rising with the rating number.

Deciding Between Earmuffs and Earplugs

Electronic earplugs

Electronic earplugs are small devices placed inside the ear to block extremes in external noise, while still allowing you to hear normal sounds in your vicinity. On top of that, they respond and adapt to deaden unexpected noises, such as a shot from a gun or a cymbal. Some kinds of electronic earplugs can allow lower-decibel sounds such as speech to pass while at the same time blocking dangerous noises. Electronic earplugs are particularly valuable in situations where earmuffs could be too cumbersome and get in the way.

Electronic earmuffs

Electronic earmuffs cover the entire outer ear with a cushioned insulating material and, while many models are similar in appearance to non-electronic earmuffs, they are actually very different. Some earmuffs are made specifically for people who encounter firearms on a routine basis, such as soldiers, police or hunters. Other earmuffs designs include a built-in radio system to enable conversation between people working in noisy environments. You can even find certain earmuffs that let you listen to the radio when you are in a noisy spot, which is wonderful when blowing leaves or mowing the lawn.

When it’s time to select a new hearing aid, you will find that there are many types and styles from which to select. Although every style of device has its own advantages and disadvantages, behind-the-ear (BTE) hearing aids are one of the more popular options.If you’re thinking about investing in hearing aids for yourself or for a loved one, the facts in this article may help you decide whether a BTE hearing aid might be a sensible choice.Of the various types of hearing aids on the market, behind-the-ear designs are usually the easiest to identify. The very first thing you’ll recognize is a compact, curved plastic case that sits behind the ear and is attached to another section placed inside the ear. The hearing aid itself is housed in the case section of the device. The battery, the electronics, and many of the controls for operating the hearing aid are safeguarded by this casing. The part that sits inside the ear is called the ear mold. Ear molds are custom-made using the unique form of each wearer’s ears, which helps to ensure that they are comfortable to wear and that sound is transmitted effectively.There are a number of advantages associated with wearing a behind-the-ear hearing aid. The larger casing fits larger batteries, which can provide additional amplification and longer battery life. The larger size of the BTE also allows for more features, including directional microphones, telecoil and Bluetooth. On top of that, the larger casing makes BTE hearing aids easier to handle than more compact ones, which makes swapping batteries and cleaning the device less difficult for people with more limited dexterity and eyesight.In terms of drawbacks, the biggest criticism of BTE hearing aids is their appearance. It’s extremely tough to conceal the fact that you are wearing a hearing aid if you opt for a BTE. Users who are sensitive about the aesthetics can select cases that complement their skin coloration to help them blend in. Noise from wind can also be a problem with BTE hearing aids, though most of them now have hardware and software features available to reduce or eliminate this concern.If it sounds as though pros of BTE hearing aids outnumber the cons, you may have found the right to suit your needs. Consider talking to your audiologist to find out more.

A large number of new types of hearing aids are equipped with Bluetooth capabilities; maybe yours already has it. Bluetooth is most often associated with hands-free cellular phone use, but it is also commonly found in mp3 players, TVs, computers and home phones. Hearing aids equipped with Bluetooth give you brand new ways to use and manage these products, which makes them more flexible and convenient, and offering you a superior sound experience.Nearly all hearing aids use a small, easy to use external device to control their Bluetooth features. The controls are generally worn around the neck or carried in a pocket. Whenever you wish to obtain Bluetooth signals, the controller will receive the sounds and wirelessly transmit them to your hearing aid. This allows you to hear your television, phone, or other Bluetooth-compatible device without having to turn the volume up high. You can even use Bluetooth to listen to telephone conversations in both ears, making it even easier to hear.Bluetooth controllers are designed to be user friendly. In many cases all you will need to do is press a button that is assigned to the device you wish to listen to. Talking on a mobile phone or listening to an audio player that uses Bluetooth is just as straightforward – just push a button to activate and press it again to stop. Depending upon the particular type of Bluetooth-enabled hearing aids you have, you may even be able to manage other features as well.Hearing aids with a Bluetooth feature can help keep seniors with mobility issues safe and comfortable. Newer designs allow you to be up to 30 feet away from your phone when making a call, allowing you to get in touch with your loved ones without having to leave your seat. This functionality can be potentially lifesaving during an emergency.Choosing to buy a hearing aid with Bluetooth capabilities allows you to enjoy a clear, crisp listening experience which is hard to achieve through any other means. This mix of clear sound and simple-to-use makes Bluetooth a terrific way to strengthen your hearing and delight in experiences that may have felt out of reach.

The canals in our ears are lined with hair follicles as well as glands that produce an oily wax called cerumen, or ear wax. This wax coats the inner surface of the ear canal and protects it by attracting and gathering foreign debris like dirt and dust, bacteria, and various microbes. A further purpose of ear wax is to protect the delicate skin of the ear canal if it is exposed to water; Thus, the creation of ear wax is both normal and healthy.Ordinarily, ear wax makes its way to the opening of the ear, where it comes out by itself can be removed when we rinse out our ears. But, the glands in certain people’s ears produce more wax than usual. As a result, the wax accumulates and may harden, blocking the ear canal and preventing sound waves from getting to your inner ear. For that reason, the buildup of excess ear wax is, for people of every age, one of the most common causes of hearing difficulties.Signs of ear wax blockage normally include earaches, a sense that the ear is closed up, a persistent ringing noise (tinnitus), and partial loss of hearing, which seems to get gradually worse. This is a form of conductive (rather than sensorineural) hearing loss, where the sound waves are blocked from getting to the eardrum. Hearing loss brought on by excess ear wax, happily, can be easily diagnosed and treated.If the symptoms listed above sound familiar to you, see us in our clinic where any of our team members can do pain-free assessments to see whether you do in fact have an excess accumulation of ear wax. If it is, an excessive build-up of ear wax is readily treated, either at home or at the office.If an audiologist says that you have excessive ear wax that is blocking your ear canal, you can take steps to remove it by yourself at home. One of the things not to attempt, however, is to use a Q-tip or cotton swab, which tends to just compact the ear wax, not get rid of it. A much better home treatment is to add drops of mineral oil, glycerin, baby oil, or commercial ear drops to each ear, let them loosen the wax build-up, and then wash it out using water at body temperature. (Hot or cold water can cause feelings of vertigo or dizziness.) Drug stores offer small bulb-like syringes which you can use to flush the ear after the wax has been loosened, assisting the process. Do not try to use a WaterPik or other jet irrigator created for the teeth because the force of the spray could harm the eardrum, and do not try any form of irrigation at home if you know that your eardrum has been punctured.If this doesn’t seem to work to clear up the accumulation of ear wax, come visit us.