When is a hearing aid more than a hearing aid?

With its newly launched Livio A.I. device, Starkey is reinventing the humble hearing aid for the machine learning generation. Not only does the Livio hearing aid enhance your ability to hear things, but it can also automatically translate foreign languages, and even track physical and mental well-being. Think of it like the babelfish from The Hitchhiker’s Guide to the Galaxy — only with some extra cool tech thrown in there for good measure!

“I believe Livio A.I. heralds the hearing industry’s iPhone moment,” Dr. Achin Bhowmik, Starkey’s chief technology officer, told Digital Trends. “The mobile phones prior to the iPhone were single-purpose devices, allowing us to make phone calls. In contrast, today’s smartphones are multipurpose devices. Hearing aids have so far been single-purpose devices as well, helping people hear better by amplifying sound. We are changing that with Livio A.I. With embedded sensors and artificial intelligence, we are turning the hearing aid into a multifunction health-monitoring and multiuse device that will help us lead better lives in many more ways. This is driven by our mission to improve human lives through technology.”

Current Perspectives on Traumatic Brain Injury

Hearing Deficits and Traumatic Brain Injuries

 

TBI as a Health Problem

According to  American Speech-Language-Hearing Association https://www.asha.org/Articles/Current-Perspectives-on-Traumatic-Brain-Injury/ an approximate 1.5 million Americans survive TBI each year, and approximately 230,000 are hospitalized for the condition. About 50,000 Americans die each year following TBI, representing one third of all injury-related deaths. Leading causes of TBI are falls (28%), motor vehicle accidents (20%), struck by/against events (19%), and assaults (11%). More than 1.1 million patients with mild TBI are treated and released from emergency departments each year. The vast majority (75%–90%) of cases involve mild TBI; these individuals experience few if any ongoing symptoms, and the cases follow a predictable course without requiring special medical treatment. Only a small subset of TBI patients (about 10%) experience any persistent post injury symptoms.

Not all individuals exposed to an external force will sustain TBI. Severity of TBI may range from “mild” (a brief change in mental status or consciousness) to “severe” (an extended period of unconsciousness or amnesia after the injury). About 80% of TBI cases are classified as mild, 10% are moderate, and 10% are severe.

At a minimum, TBI produces a diminished or altered state of consciousness. TBI results in a diverse, idiosyncratic constellation of cognitive, neurological, physical, sensory, and psychosocial symptoms.

DoD/VA Common Definition

TBI is a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by the onset or worsening of at least one of the following clinical signs, immediately following the event:

  • Any period of a loss of or decreased level of consciousness
  • Any loss of memory for events immediately before or after the injury
  • Any alteration in mental state at the time of the injury (feeling dazed, confused, disoriented, thinking slowly, etc.)
  • Neurological deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient
  • Intracranial lesion

While no standard definition or diagnostic criteria for mild TBI currently exist, there are well-established diagnostic criteria for stratifying the level of brain injury at the time of the injury. DoD and VA jointly developed a definition based on existing TBI definitions and current clinical experience with blast injuries.

Mild TBI is defined as a traumatically induced structural or physiological disruption of brain function as the result of an external force that is indicated by the onset or worsening of at least one of the following clinical signs immediately following the event:

  • Loss of consciousness lasting less than 30 minutes
  • Alteration of consciousness or mental state lasting up to 24 hours
  • Posttraumatic amnesia up to 24 hours
  • Glasgow Coma Scale (best available score during the first 24 hours) of 13–15

This definition has been widely used by the Congress of Rehabilitation Medicine, American Academy of Neurology, Centers for Disease Control and Prevention, and the World Health Organization for more than 10 years and is widely accepted as the “gold standard” for defining mild TBI. It is important to understand that meeting these diagnostic criteria does not predict functional or rehabilitative outcome. The level of injury is based on the status of the patient at the time of injury based on observable signs such as level of consciousness, posttraumatic amnesia, imaging, and coma scaling (see Table 1).

Table 1-Severity of Brain Injury Stratification

Mild Moderate Severe
Normal structural imaging Normal or abnormal structural imaging Normal or abnormal structural imaging
LOC=0–30 minutes LOC > 30 minutes and < 24 hours LOC > 24 hours
AOC=a moment up to 24 hours AOC > 24 hours. Severity based on other criteria
PTA=0–1 day PTA > 1 and < 7 days PTA > 7 days
GCS=13–15 GCS=9–12 GCS=3–8

Note: AOC=alteration of consciousness/mental state; LOC=loss of consciousness; PTA=posttraumatic amnesia; GCS=Glasgow Coma Scale. For purposes of injury stratification, the Glasgow Coma Scale is measured at or after 24 hours. This stratification does not apply to penetrating brain injuries where the dura mater is breached.

Mild TBI or concussion generally involves loss of consciousness that lasts 30 minutes or less, posttraumatic amnesia less than 24 hours, and Glasgow Coma Scale of 13–15. Concussion can be further graded according to loss of consciousness and posttraumatic amnesia (see Table 2).

Table 2-Classification of Mild TBI (Concussion)

Grade Cantu (1992) Colorado AAN
1 No LOC; PTA < 5 minutes No LOC; confusion without amnesia Transient confusion; no LOC;
Concussive symptoms resolve < 15 minutes
2 LOC < 5 minutes;
PTA > 30 minutes
No LOC; confusion with amnesia Transient confusion; no LOC;
Concussive symptoms last > 15 minutes
3 LOC > 5 minutes;
PTA > 24 hours
Any LOC Any LOC either brief (seconds) or prolonged (minutes)

Note: Colorado=Workers Compensation Board, State of Colorado; AAN=American Academy of Neurology; see “Practice Parameter” (1997).

 

Diagnosis and Treatment

Diagnosis of mild TBI can be difficult because of the subjective nature of complaints and significant overlap with other conditions. Focal neurological signs for mild TBI are frequently mild or transient. Imaging is usually negative. The natural history of mild TBI is less predictable than for more severe TBI, but the majority of patients follow a predictable course, experience few, if any, ongoing symptoms, and do not require special medical treatment. Specificity of injury sequelae is less predictable than for more severe forms of TBI, and sequelae often overlap with other noninjury conditions, such as stress disorders.

Most of what we know about mild TBI is based on sports injuries and acceleration/deceleration injuries (e.g., motor vehicle accidents). Research is lacking on blast-induced brain injuries. The symptom persistence and long-term implications of blast-related mild TBI and multiple mild TBI are unknown. However, there is no reason to conclude a priori that high-energy blast-related mild TBI has the same pathophysiology and natural history as sports injuries.

Because of the uncertainties regarding mild TBI, the focus should not be on diagnosis. Diagnosis, or rather misdiagnosis, can lead to inappropriate treatment. Furthermore, the diagnosis may carry unintended stigma. For example, under current coding rules, a cognitive deficit (e.g., memory problem) resulting from TBI would be coded as a nonpsychiatric mental disorder due to organic brain damage. Many service members and veterans and their families object to this diagnosis because they feel the symptoms are due to a neurological brain injury. For these reasons, the focus should be on recovery and treatment of persistent symptoms using an interdisciplinary approach to care. Mild TBI can be transient in nature, but it can also cause significant disruption in employment, education, and relationships, and it should not be minimized. Audiologists should also note that auditory manifestations of TBI can significantly affect treatment and rehabilitation outcomes and are the reason that audiologists should be part of an interdisciplinary approach to TBI care.

TBI Symptoms

There is no single TBI symptom or pattern of symptoms that characterize mild TBI. Symptoms may resolve quickly, within minutes to hours after the injury event, or they may persist longer. Some TBI sequelae may be permanent. Most signs and symptoms will manifest immediately following the event. However, other signs and symptoms may be delayed from days to months. These delayed symptoms are particularly difficult because there may have been significant untreated impact on the patient’s physical, emotional, behavioral, social, or family status. Attributing these delayed symptoms to the injury event can be problematic. Signs and symptoms may occur alone or in varying combinations and may result in a functional impairment.

The key factor in attributing these signs and symptoms to TBI is that they are not better explained by preexisting conditions or other medical, neurological, or psychological causes, except in cases of an exacerbation of a preexisting condition.

In the case of hearing loss, for example, peripheral hearing loss due to noise exposure needs to be ruled out, and central auditory manifestations of TBI may be due to preexisting conditions.

TBI symptoms generally fall into one or more of the three following categories:

  • Physical: headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia, dysphagia, dysarthria, apraxia, balance disorders, disorders of coordination, or seizure disorder.
  • Cognitive: problems with attention, concentration, memory, speed of processing, new learning, planning, reasoning, judgment, executive control, self-awareness, language, or abstract thinking.
  • Behavioral/emotional: depression, anxiety, agitation, irritability, impulsivity, or aggression.

(Note that these signs and symptoms are typical of each category but are not an exhaustive list of all possible signs and symptoms.)

The following are typical symptoms seen in TBI:

  • Dizziness
  • Loss of Balance
  • Poor coordination
  • Headaches
  • Nausea
  • Visual disturbance
  • Poor concentration
  • Forgetfulness
  • Difficulty making decisions
  • Slowed thinking
  • Fatigue
  • Insomnia
  • Light sensitivity
  • Hearing difficulty
  • Noise sensitivity
  • Body/extremity numbness
  • Altered taste or smell
  • Appetite change
  • Feeling anxious
  • Feeling depressed
  • Easily irritated
  • Poor frustration tolerance

The symptoms listed above are frequently interdependent and often exhibit complex, subtle and overlapping manifestations. Some symptoms are obvious (e.g., amputations, burns, or scars), but some TBI symptoms are “invisible” injuries, as listed below:

  • Mild TBI (concussion)
  • Auditory manifestations (peripheral and central auditory disorders, tinnitus)
  • Cognitive and memory impairments and executive function disorders
  • Visual manifestations (vision loss and visual disturbances)
  • Emotional/behavioral disturbances
  • PTSD
  • Pain
  • Fatigue
  • Memory impairments
  • Musculoskeletal disorders
  • Small embedded fragments

Audiologists should note that auditory and vestibular complaints (hearing loss, tinnitus, balance disorders, and central auditory manifestations of TBI) are particularly common. Tinnitus and hearing loss (auditory complaints) are the most common service-related injuries in OEF/OIF veterans.

There are also many emotional/behavioral problems associated with TBI, including depression, apathy, anxiety, irritability, anger, paranoia, confusion, frustration, agitation, sleep problems, and mood swings. Problem behaviors may include aggression and violence, impulsivity, acting out, noncompliance, social inappropriateness, emotional outbursts, childish behavior, impaired self-control, impaired self-awareness, inability to take responsibility or accept criticism, and alcohol or drug abuse/addiction. Some patients’ personality problems may be so severe that they are diagnosed with personality disorders. Symptoms associated with PTSD may overlap with symptoms of mild TBI. Differential diagnosis of brain injury and PTSD is required for accurate diagnosis and treatment.

Cognitive deficits are also particularly prevalent in TBI and include problems in thinking, reasoning, problem solving, information processing, and memory. The most common cognitive impairment among severely head-injured patients is memory loss. Higher level, executive function deficits include problems in planning, organizing, abstract reasoning, problem solving, and making judgments, and can have a significant impact on quality of life and return to preinjury work activities. Patients with moderate to severe TBI tend to have more problems with cognitive deficits than patients with mild TBI. Many service members and veterans have been exposed to multiple injury events (e.g., repeated blast exposures). These multiple mild TBI events may have an additive effect, causing cognitive deficits equal to more severe degrees of injury.

The important message to audiologists is that persistent symptoms such as emotional/behavioral disturbances, attention problems, memory loss, and executive function deficits can have a significant impact on auditory and vestibular evaluation rehabilitation.

Auditory and Vestibular Symptoms

Audiologists may see a wide variety of symptoms related to TBI:

  • Ear aches
  • Aural fullness
  • Tinnitus and hyperacusis
  • Dizziness and vertigo
  • Loudness sensitivity
  • Distorted hearing
  • Hearing impairment
  • Central auditory manifestations TBI

The ear is the organ most affected by blast. Injuries may include rupture of tympanic membrane (most frequent), dislocations/fractures of the ossicles, or damage to the cochlea. Blast overpressure is too rapid to be compensated by air escape through the eustachian tube.

Because the ear is particularly susceptible to blast, damage may be a sign of blast exposure. The extent of ear damage from the blast depends on factors such as size of the blast, distance from the blast, orientation of ear canal to the blast, and the environment (e.g., reflective surfaces or enclosed spaces). Tympanic membrane perforation is the most common otologic injury. The tympanic membrane ruptures during positive phase of the blast and occurs in about 50% of adults at about 175–185 dB peak pressure level (5 PSI) depending on the blast characteristics.

Primary blast waves can send small fragments of the squamous epithelium into the middle ear cavity. Therefore, audiologists should be on guard for cholesteatomas. Careful surgical debridement is necessary for removal and close follow-up, as 10%–20% of cholesteatomas recur. If there is a history of eardrum perforation, follow-up is important.

Ossicular damage ranges from 4% to 33% of eardrum perforations. The most common ossicular injury is disruption of the incudomalleal joint. Disruption of the ossicles may absorb some of the incoming energy of the blast wave, sparing the structures of the inner ear.

Immediately following blast injury, patients may experience hearing loss and tinnitus. Hearing loss may be transient, lasting for minutes to hours, or permanent, with symptoms of tinnitus and hyperacusis. Inner ear damage caused by explosions results from a combination of the blast wave and the following impulse sound.

Balance disorders are common symptoms of TBI. These symptoms can be transient or persistent, and should be evaluated in consultation with an otolaryngologist. Head trauma is the most frequent cause of benign paroxysmal positional vertigo (BPPV), and there are also cases of traumatically induced Ménière’s disease. Dizziness from TBI can be caused by injury to the ear, peripheral neuropathies, whiplash, musculoskeletal injuries, vascular disorders, oculomotor disturbances, and diffuse multimodal central nervous system injuries. Eardrum injury secondary to blast exposure can also be accompanied by perilymph fistula, labyrinthine damage, and otolith damage.

Perspectives on Central Auditory Manifestations of TBI

TBI patients frequently have auditory complaints of difficulty hearing or listening that cannot otherwise be explained by basic audiometric findings. Problems may include difficulties in sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of sound (e.g., integration, discrimination, ordering, and masking); auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (American Speech-Language-Hearing Association [ASHA], 2005b). These TBI-related auditory manifestations may coexist with other disorders such as depression, anxiety, insomnia, hypervigilance, and stress disorders.

There is ongoing debate as to the nature of these auditory manifestations, which are sometimes diagnosed as central auditory processing disorders ([C]APD). Broadly defined, (C)APD refers to the efficiency and effectiveness by which the central nervous system utilizes auditory information (ASHA, 2005a). Narrowly defined, (C)APD is a deficit in the processing of information that is specific to the auditory modality (Cacace, 2009; Cacace & McFarland, 1998; Jerger & Musiek, 2000; McFarland & Cacace, 1995).

Central auditory manifestations of TBI have significant overlap with other auditory, cognitive, and emotional/behavioral disorders:

  • Peripheral hearing loss
  • Noise-induced hearing loss
  • Hearing loss secondary to otologic trauma
  • Cognitive and memory deficits
  • Executive function disorders
  • Language impairment
  • Attention deficits
  • Emotional disorders
  • Motivational concerns
  • PTSD

Audiologists should exercise caution in making a diagnosis of (C)APD in TBI cases, especially blast-induced TBI. Most of what we know about (C)APD is based on developmental data, sports injuries, motor vehicle accidents, and discrete lesions. We should not expect a priori that high-energy blast-induced brain injuries or any traumatic injury to the brain will result in auditory-specific lesions. These auditory manifestations could be due to true modality-specific (C)APD, multisensory central processing disorders, or supramodal (attentional) disorders.

According to ASHA (2005b, p. 2), “any definition of (C)APD that would require complete modality-specificity as a diagnostic criterion is neurophysiologically untenable; however, one should expect the sensory processing perceptual deficit in (C)APD to be more pronounced, in at least some individuals, when processing acoustic information.” The ASHA working group concluded that (C)APD “is best viewed as a deficit in neural processing of auditory stimuli that may coexist with, but is not the result of, dysfunction in other modalities” (p. 2). Unless we know otherwise, central auditory manifestations of TBI should be not be labeled as (C)APD. However, uncertainty about the diagnosis should NOT delay or prevent evaluation using available auditory, multisensory, and neuropsychological techniques.

Further information on this topic was found in an article posted on www.hearingreview.com   http://www.hearingreview.com/2015/07/traumatic-brain-injury-tbi-primer-hearing-healthcare-practitioner/ which says in part:

TBI and the Ear

TBI can cause a range of problems related to the ear, including hearing loss, vestibular effects, and central auditory problems.

Hearing loss. Because of the sudden and violent nature of the injury, TBI may cause concurrent damage to the auditory pathway. Damage can occur at any point within auditory pathway, from the outer ear to the cortex, which can result in a variety of complex symptoms.

Impairment due to trauma can produce conductive and sensorineural hearing loss, central auditory processing deficits, vestibular impairments, and tinnitus. The tympanic membrane, middle ear, and cochlea are the most common sites of peripheral injury as they are often directly in the line of trauma. Disruption of the oval and the round window can occur, as can displacement of the basilar membrane. The hair cells are the most vulnerable elements of the cochlea and, when damaged, can produce sensorineural hearing loss and tinnitus.

Clinical and experimental studies have shown that there are numerous sites of pathology ranging from TM perforation, ossicular discontinuity, degeneration of the organ of corti, and ischemia of the 8th cranial nerve.

Vestibular effects. Dizziness is thought to occur in 40-60% of individuals with traumatic brain injury. It is usually of peripheral as opposed to central origin. Most common causes include labyrinthine concussion or benign postural positional vertigo (BPPV), which is due to the dislodgement of calcium carbonate crystals from sensitive nerve endings at the macula of the utricle. Less common causes of labyrinthine injury include perilymphatic fistula resulting from the rupturing of the oval or round window membrane. Symptoms may include vertigo, tinnitus, hearing loss, chronic nausea, and exertion headache.

Central effects. The effects of damage to the central auditory system have not been systematically examined in humans, but animal studies have revealed much about the architecture of the system. The shearing or the stretching forces from trauma can disrupt the parallel organization of the brainstem and reduce the ability to localize sound or to make the minute frequency and temporal distinctions in the presence of competing stimuli. This reduction in binaural processing can undermine the ability of the auditory system to distinguish between multiple sound sources or to maintain speech recognition ability in the presence of back ground noise.

In summary, the most common otological complaints immediately following head trauma are otalgia, tinnitus, aural fullness, dizziness, loudness sensitivity, distorted hearing, and hearing impairment. Hearing loss may improve following the period of traumatic exposure, but in other cases it may persist or progress.

The underlying symptoms of vestibular, peripheral, and central auditory damage can overlap those of other conditions such as post-traumatic stress disorder (PTSD), concussion, and mild TBI. These deficits are particularly challenging in the TBI population, as symptoms can be mistaken for PTSD, mental health issues, and cognitive deficits.

Discussion

Patients with TBI present a distinctive and challenging population for the hearing healthcare practitioner. In addition to hearing loss, patients endure years of disability, as TBI often prevents a return to work, disrupts family relations, and causes increased social isolation, mood disorders, and even suicide. The variety of symptoms associated with the condition can include headaches, seizures, motor disturbances, and insomnia, as well as changes in cognition, memory, and speech.

The treatment and rehabilitation of auditory and vestibular injury associated with TBI will require a collaborative approach between otolaryngology, audiology, speech-language pathology, neuropsychology, mental health, and physical and occupational therapy. Audiologists and allied professionals should be prepared to modify treatment protocols, incorporate new disciplines in the treatment process, and work in consultation with allied health professionals.

Those patients with cognitive impairments will require additional time and attention in order to maximize the benefits of rehabilitation. Behavioral issues are also common in patients with TBI, and TBI can precipitate problems that require treatments involving emotional management and impulse control.

Mood disorders and psychiatric disturbances are common after traumatic brain injury and may include depression, anxiety, bipolar, psychosis, obsessive-compulsive disorder, and PTSD. In such cases, referral for psychotherapy and medical management would certainly be indicated, as the majority of these patients will benefit from a combined multidisciplinary approach.

References

  1. Tun C, Hogan A, Fitzharris K. Hearing and vestibular dysfunction caused by blast injuries and traumatic Brain Injuries. Hear Jour. 2009:62(11):24-26.

  2. Bigler ED. Traumatic Brain Injury: Mechanisms of Damage, Assessment, Intervention, and Outcome. Austin, Tex: Pro-Ed;1990:13-20.

  3. Koshimori Y, Johns K, Green R. A guide for hearing healthcare providers to characteristics of traumatic brain injury. Hear Jour. 2009: 62(11):17-23.

  4. Ylvisaker M, Turkstra LS, Coelho C. Behavioral and social interventions for individuals with traumatic brain injury: A summary of the research with clinical applications. Sem Speech Lang. 2005;26(4):256-267.

  5. Khan F, Baguley IJ, Cameron D, Rehabilitation after traumatic brain injury. Rehab Med. 2003;178(17): 290-295.

  6. Fausti SA. Auditory and Vestibular Dysfunction Associated with Blast-Related Truamatic Brain Injury. J Rehab Res Devel. 2009;46(6):800-809.

  7. Kushner D, Mild traumatic brain injury: Toward understanding manifestations and treatment. Archi Intern Med. 1998;158(15):1617-1624.

  8. Oleksiak M, Smith BM, St Andre JR, Caughlan CM, Steiner M. Audiological issues and hearing loss among veterans with mild traumatic brain injury. J Rehab Res Devel. 2012;49(7):995-1004.

  9. Lew HL, Jerger JF, Guillory SB, Henry JA. Auditory dysfunction in traumatic brain injury. J Rehab Res Devel. 2007;44(7):921-928.

  10. Scherer M, Schubert MC. Traumatic brain injury and vestibular pathology as a comorbidity after blast exposure. Phys Therapy. 2009;89(9):980-992.

  11. Luethcke CA, Bryan CJ, Morrow CE, Isler WC. Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast versus nonblast-induced traumatic brain injury. J Intl Neuropsychol Soc. 2011;17:36-45.

  12. Myers PJ, Wilmington DJ, Gallun FJ, Henry JA, Fausti SA. Hearing impairment and traumatic brain injury among soldiers: Special considerations for the audiologist. Sem Hearing. 2009;30(1):5-22.

American Speech-Language-Hearing Association.(2005a). (Central) auditory processing disorders [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association.(2005b). (Central) auditory processing disorders-the role of the audiologist [Position statement]. Available from www.asha.org/policy.

Cacace, A.T.(2009, March). Repercussions of blast-related traumatic injury on peripheral and central auditory function . Paper presented at Joint Defense/Veterans Audiology Conference, Mesa, AZ.

Cacace, A.T., & McFarland, D.J.(1998). Central auditory processing disorder in school-aged children: A critical review. Journal of Speech, Language, and Hearing Research, 41, 355–373.

Cantu, R.C.(1992). Cerebral concussion in sport: Management and prevention. Sports Medicine, 14, 64–74.

Department of Veterans Affairs Office of Quality and Performance and Department of Defense Quality Management Directorate, U.S. Army Medical Command.(2009). VA/DoD clinical practice guidelines for management of concussion/mild traumatic brain injury . Retrieved on June 8, 2009, from www.healthquality.va.gov/mtbi/concussion_mtbi_full_1_0.pdf [PDF].

Hall, J.W.(2009, January). TBI and auditory processing disorder (APD) . Paper presented at Effective Practice of Audiology and Speech-Language Pathology for Traumatic Brain Injury (TBI) Conference, Washington, DC.

 

Jerger, J., & Musiek, F.(2000). Report of the consensus conference on the diagnosis of auditory processing disorders in school-aged children. Journal of the American Academy of Audiology, 11, 467–474.

Practice parameter: The management of concussion in sports (summary statement).Report of the Quality Standards Subcommittee. (1997). Neurology, 48, 581–585.

lyric hearing aids

Lyric Hearing Aids

What are Lyric Hearing Aids?

They are the first extended wear hearing device that is 100% invisible. They are comfortably placed in the ear canal by a Lyric  trained hearing professional and can be worn 24 hours a day, seven days a week, for up to 4 months at a time. No surgery or anesthesia is required.

Unlike many other hearing aids, Lyric Hearing is positioned completely inside the ear canal, so it uses your ear’s natural anatomy to funnel sound to your eardrum. This unique design and placement helps reduce background noise and feedback and provides exceptionally natural sound quality. Because it remains in the ear canal 24/7 for months at a time, you don’t need to worry about daily hassles like putting the device on or taking it off, or changing batteries, so you can forget about your hearing loss and spend time connecting with friends and loved ones.

What are the Benefits of Lyric Hearing Aids?

  • They are 100% invisible.
  • They produce clear, natural sound.
  • They provide effortless all-day hearing.
  • Lyric Hearing Aids can be worn for months at a time without taking them out.
  • The deep placement directs sound into the ear canal naturally for reduced background noise and exceptional sound quality.

How do They Work?

 Lyric Hearing is not appropriate for all patients. See a trained Lyric Hearing professional to determine if it is right for you.
lip reading

A Look into Lip Reading

What is Lip Reading?

Lip reading allows you to “listen” to a speaker by watching the speaker’s face to figure out their speech patterns, movements, gestures and expressions. Often called “a third ear,” lip reading goes beyond simply reading the lips of a speaker to decipher individual words. Some also refer to it as Speech Reading.

Learning to lip-read involves developing and practicing certain skills that can make the process much easier and more effective.

Skills Involved in Lip Reading

  • Watching the movement of the mouth, teeth and tongue
  • Reading facial expressions
  • Paying attention to body language and gestures

Facts About Lip Readinglip reading

  • Consonant shapes (p, f, sh, w) are:
    • Hard to hear
    • Easy to see
    • High-frequency sounds
  • Vowel shapes are:Easy to hear
    • Hard to see
    • Low-frequency sounds

Lip Reading Involves:

  • Hearing some of the sounds
  • Recognizing and interpreting facial expressions, body language and gesture.
  • ‘Putting two and two together’ and guessing words that you can neither lipread or hear by using the context and common sense to help you.

Did you know that sentences are easier to lipread than individual words and long words are easier to lipread than short words?

For more information on Lip reading, check out these resources:

Lipreading.org

HearingLink.org

cochlear implants

The Benefits of Cochlear Implants

What are the Benefits of Cochlear Implants?

What is a Cochlear Implant?

Cochlear implants are a means of surgical amplification for patients with severe-to-profound sensorineural hearing loss. There is an internal and external device as part of the implant. Appropriately-identified adults and children with severe to profound hearing loss can be implanted starting as early as 12 months of age.

Cochlear implants are used in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the damaged organ of hearing and convert sound into electrical impulses that can directly stimulate the hearing nerve. The implant has of an external portion worn on the ear like a hearing aid or on the body. This device, called the sound processor, is comprised of a microphone, power compartmcochlear implantsent and external coil. The internal portion, which is typically made of ceramic or silicone, consists of an electrode array and must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and the electrode array, which is inserted into the organ of hearing, or the cochlea. The electrical signals are programmed by the audiologist to maximize speech perception and are controlled by the speech processor. The brain interprets these electrical impulses as sound.

To find out more about cochlear implants, please refer to our blog titled; Cochlear Implants.

The Benefits Include:

  • The majority of adults benefit immediately. Once the initial tuning sessions have been completed, they will continue to improve for about 3 months. After that, performance will continue to improve, but at a slower rate.
  • The ability to perceive loud, medium and soft sounds. The majority of people report that they can perceive different types of sounds, such as footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the tea kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on.
  • Understand speech without lip-reading. Even if this isn’t possible, the implant will help with lip-reading.
  • The ability to watch TV more easily. This will also improve if the user is able to see the speaker’s face. However, listening to the radio is often more difficult as there are no visual cues available.
  • Most are able to make phone calls.  Some good performers can make normal telephone calls and even understand an unfamiliar speaker. However, not all people who have implants are able to use the phone.

Want to know about Cochlear Implants? Check out the links below:

FDA.gov

BettterHearing.org

MayoClinic.org

 

Children and Hearing Loss

What Causes Children to Have Hearing Loss?

There are several possible causes for children and hearing loss, whether it’s congenital or acquired. Hearing losses in children can also be conductive, sensorineural or mixed. It’s children and hearing lossimportant that parents, caretakers, physicians, teachers and others know the signs of and addresses hearing loss in children because early hearing loss – especially that which is undiagnosed – can cause significant development and emotional problems for children that have long-lasting effects.

Congenital Hearing Loss

What does “congenital hearing loss” mean? This means that the hearing loss was present at birth. There are many causes of congenital hearing loss, some are not as easily identified. There are non-genetic and genetic factors that could lead to hearing loss.

Non-Genetic Factors:

  • Birth Complications: this includes the presence of Herpes, Rubella Cytomegalovirus, Toxoplasmosis or any other serious infection. Another complication that can arise is a lack of oxygen to the baby.
  • Premature Birth: a baby that is born smaller than 3 pounds and or that require certain life-sustaining drugs for respiration are at a higher risk for hearing loss than a full-term sized baby.
  • A Nervous System or Brain Disorder
  • Usechildren and hearing loss of Ototoxic Medication By the Mother During Pregnancy: Ototoxic medications are not usually illicit substances – medications like various antibiotics and NSAIDS can potentially cause damage to the auditory nerve or other hearing structures of the fetus.
  • Infection of the Mother During Pregnancy: infections such as toxoplasmosis, cytomegalovirus, herpes simplex or German measles can lead to children and hearing loss.
  • Maternal Diabetes
  • Drug or Alcohol Abuse by the Mother During Pregnancy

Non-genetic factors only account for about 25% of all congenital hearing loss. Experts agree that genetic factors – meaning the hearing loss is hereditary – cause more than 50 percent of all hearing loss in children, whether the loss is present at birth or manifests later in life (Mroz).

Genetic Factors:

  • Autosomal-Recessive Hearing Loss – This is the most common type of genetic congenital hearing loss – autosomal recessive accounts for around 70 percent of all genetic hearing loss cases. What this means is that neither parent has a hearing loss, but each parent carries a recessive gene that gets passed to the child. Parents are usually surprised when their child is born with this type of hearing loss because people typically aren’t even aware they have the recessive gene.
  • Autosomal-Dominant Hearing Loss – This type of hearing loss accounts for around 15 percent of genetic hearing losses, according to the American Speech-Language-Hearing Association (ASHA). In autosomal dominant hearing loss, one parent carrying a dominant gene for hearing loss passes it to the offspring. This parent may or may not have hearing loss, but he or she might have other symptoms or signs of a genetic syndrome.
  • Other genetic syndromes include; Usher syndrome, Treacher Collins syndrome, Waardenburg syndrome, Down syndrome, Crouzon syndrome and Alport syndrome.

Acquired Hearing Loss

children and hearing lossWhat does “acquired hearing loss” mean? This means that the hearing loss occurred after birth. Causes of acquired hearing loss include:

  • Perforated Eardrum
  • Otosclerosis or Meniere’s Diseases (progressive)
  • Infections such as; Meningitis, Measles, Mumps, or Whooping Cough
  • Taking Ototoxic Medications
  • A Serious Head Injury
  • Untreated / Frequent Ear Infections

Transient Hearing Loss

What does “transient hearing loss” mean? This is the hearing loss caused by an excess number of Middle Ear Infections (Otitis Media)

At least 75 percent of children have had one episode of otitis media by the time they are three years old. This type of infection is very common in children because of the Eustachian tube position during childhood. The Eustachian tube, which allows for air pressure equalization between the middle ear and the nasopharynx, is smaller and more horizontal during development. Thus, it is very susceptible to blockage by fluids or large adenoids (Mroz).

Transient hearing loss due to an ear infection can occur when fluid inhibits the vibrations of the tiny middle ear bones, making efficient sound transmission difficult. Thankfully, this type of hearing loss is usually temporary and resolves itself. However, frequent, untreated middle ear infections can cause cumulative damage to the bones, eardrum or auditory nerve, creating a permanent, sensorineural hearing loss (Mroz).

Screenings for Children and Hearing Loss

children and hearing lossIt is routine for hospitals to perform hearing screenings on infants in the first 24-48 hours after birth. If an infant fails the initial screening, he or she is usually scheduled for a second screening a few weeks later. However, sometimes infants who pass the hearing screening at birth may exhibit signs of hearing loss as they age.

 

 

What Kind of Treatment is there for Children and Hearing Loss?

Hearing Aids

Hearing aids are just one kind of device that can help children with hearing loss hear clearly again. There are many advanced models, including high-powered aids for children with profound hearing loss, that offer high-quality hearing assistance. Many solutions for children include special coverings and other accessories to ensure that young children don’t remove or misplace their hearing aids. There are several models of devices to choose from, including behind-the-ear hearing aids or those that are almost entirely in the ear canal and very discreet.

Cochlear Implantschildren and hearing loss

Cochlear implants are surgically implanted devices that directly stimulate the auditory nerve in the inner ear with electrical stimulation. Cochlear implants also have an external device, and many companies make kid-friendly devices that can be held on with a soft headband. Cochlear implants work for infants and children who cannot benefit from hearing aids.

Speech Therapy

For children who have had hearing loss that has affected their speech, he or she might need speech-language therapy after getting hearing aids or a cochlear implant to help him or her catch up on speech delays.

Assistive Listening Devices

Many hearing aid manufacturing companies offer assistive listening devices such as FM systems that are discreet and work well in a classroom situation in conjunction with the child’s hearing aid or cochlear implant. FM technology helps overcome the poor acoustics of classroom settings or other venues with lots of background noise. Essentially, the teacher wears or has a discreet microphone in front of him or her that transmits his or her voice directly to the child’s hearing aids or cochlear implant.

To read more about children and hearing loss, click HERE.

Made for iPhone Hearing Aids

Hearing Aid Accessories

Batteries

Batteries are perhaps one of the most important hearing aid accessories; without them, the hearing aid wouldn’t have any power.

Hearing aids come in many different sizes and styles and with different power needs. Larger hearing aids require larger batteries. Additionally, hearing aids for people with severe or profound hearing losses typically require more power and larger batteries.

hearing aid accessories There are five sizes of hearing aid batteries available on the market. The sizes from smallest to largest are; 5, 10, 312, 13 and 675. Size 5 hearing aid batteries are rarely used. The four most common hearing aid battery sizes are all smaller than the diameter of a dime:

  • Size 10 – 5.8 mm wide by 3.6 mm high
  • Size 312 – 7.9 mm wide by 3.6 mm high
  • Size 13 – 7.9 mm wide by 5.4 mm high
  • Size 675 – 11.6 mm wide by 5.4 mm high

Because size differences may be hard to notice and difficult to remember, battery packaging is color-coded so finding and purchasing the correct ones is easier.

  • Size 5 batteries – red label
  • Size 10 batteries – yellow label
  • Size 312 batteries – brown label (most common in the U.S.)
  • Size 13 batteries – orange label
  • Size 675 batteries – blue label

Hearing Aid Care

Listening Tube – Listen to the hearing aid every day. Using a listening tube, you can listen to the hearing aids to be sure that they sound clear and not weak or scratchy. Your audiologist will teach you how to listen for intermittency and internal feedback.

Forced Air Blower (not a hair dryer) – Check for dirt and grime. Earmolds can be removed from the hearing aids and cleaned with a mild soap solution. Dry them carefully using a forced air blower (not a hair dryer!). Be sure they are dry before reattaching them to the hearing aids.

Hearing Aid Drying Container – This is important for proper function. A hearing aid drying container will help keep moisture from building up inside the hearing aids and will lengthen their life. Be sure to take the batteries out of the hearing aid before placing them in the storage containers.

Hearing Protection

Volume Limiting Earphones – ETY-Kids safe-listening earphones are engineered to limit sound output while maintaining sound quality. By controlling the earphones, it is nothearing aid accessories necessary to restrict the volume setting on the player and sound coming through ETY-Kids earphones will not exceed safe levels. The main reason listeners of all ages turn up the volume is to block out distracting background noise. ETY-Kids earphones seal the ears with close fit ear tips so volume levels stay safer. With an adequate seal plus the sound output-limiting of ETY-Kids earphones, parents are assured their kids are listening safely.

Tubing, Domes & Tips

Hearing Aid Tubing – All Behind The Ear (BTE) hearing aid tubes harden and should be changed at least every six months. Many people find it beneficial or necessary to change them more frequently. BTE hearing aids become uncomfortable and more difficult to wear as the tubes become progressively stiffer. Also, it is claimed the sound transmission through hearing aid tubes deteriorates as the tubes harden.

Hearing Aid Domes – A hearing aid dome is the small plastic bell-shaped piece at the end of the tube. This is the actual physical piece that is inserted in your ear. A proper fitting dome can make a huge difference in both comfort and quality while wearing your hearing aid.

Hearing Aid Tips – Soft and comfortable Eartips can be used on behind the ear hearing aids, in the ear hearing aids, and pocket hearing aids.

New Advances in Hearing Aids

New advances in hearing aids are constantly improving; with new technology being developed daily.

But, what are the most recent advances that we have seen and how do they help people who use hearing aids? We decided to find some of the newest advances and share them with all of you!

new advances in hearing aidsOpen Acoustic Fittings are improving the way people hear with a virtually invisible hearing aid! With Open Acoustic Fittings, the ear canals remain free, which can then preserve their natural ability to amplify sound. 

Multi Programs are the different programs that come with most hearing aids. They allow you to manually select what you hear by choosing a program that best fits the environment you are in. The main benefit to these is the fact that they can simplify adjustments and the add convenience to the wearer. 

Noise Reduction Feature is a recent feature which allows the user to personalize their hearing aids to disable the many unwanted background noises. 

Automatic Volume Control is an advancement to hearing aids which allows the wearer hands-free volume control. Changes to hearing aids will be automatically updated, depending on the environment. 

 

 

A Study on Hearing Loss and Falls

Have you ever took a moment to consider the relationship between hearing loss and falls? We feel like it is an important topic to discuss with our readers, so we did our research. The main research hearing loss and fallswe came across was a study which was done a couple of years ago at Johns Hopkins by Researcher, Dr. Frank Lin and Dr. Luigi Ferrucci of the National Institute on Aging.

The Study

The “Hearing Loss and Falls Among Older Adults in the United States” study consisted of 2,017 participants ranging from the ages of 40 to 69 years old. The researchers used some the health data which was gathered from the 2001 to 2004 cycles of the National Health and Nutrition Examination Survey. During those specific years, the 2,017 participants had their hearing tested and answered questions relating to whether or not they had fallen in the past year. The participants also had their vestibular function, a measure of how well they kept their balance, tested.

The Results

In the end, Dr. Frank Lin and Dr. Luigi Ferrucci concluded that there is a special link between hearing loss and falls. They found that the participants with a 25-decibel hearing loss (also known as Mild Hearing Loss) were three times more likely to have a history of falling. Dr. Lin explained that “every additional 10-decibals of hearing loss increased the chances of falling by 1.4 fold”. Throughout the study, the results stayed consistent even when the researchers took into consideration other factors such as; age, sex, race, cardiovascular disease and vestibular function.

Why is There a Relationship Between Hearing Loss and Falls?

Dr. Lin suggests that a possible explanation for this is due to the fact that people with hearing loss may not have a good awareness of the environment around them. They may not be paying direct attention to obstacles that could be in their way.

 

For more information on this study CLICK HERE.