Month: November 2019

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New Guideline Updates On What You Need To Know About Sudden Hearing Loss

As we age, we often conclude that our hearing has gotten worse over time. Age-related hearing loss is an incredibly common result of the natural aging process, and most of us understand that our hearing will depreciate as we get older. But what happens when hearing loss comes on all of a sudden without years of build-up? Sudden Hearing Loss (SHL) can be a terrifying symptom for those suffering unexpectedly. Affecting up to 27 for every 100,000 people and over 66,000 new cases in the US annually, understanding what may cause SHL, what signs to look for, and when to seek treatment can help dramatically improve your quality of life and improve hearing recovery.
For these purposes, The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published new updates to their SHL guidelines, hoping new information will make a difference according to Seth R. Schwartz, MD, MPH, the methodologist for this update, “Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and quality of life. That is the overarching objective and purpose of this guideline update.”

What Is Sudden Hearing Loss?

Defined as a “rapid-onset subjective sensation of hearing impairment in one or both ears”, SHL can manifest in three ways: Conductive Hearing Loss (CHL), Sensorineural Hearing Loss (SNHL), or a mixture of both occurring in the same ear. CHL occurs when problems transferring sound waves through the outer ear arise, while SNHL is attributed to damaged cochlear sensory cells. Though Conductive Hearing Loss may be brought on by an abnormality in the ear canal, “eardrum”, or middle ear, both types of hearing loss can be brought on by many causes ranging from neurological disorders or infections, to head trauma or exposure to certain medications.
With many risk factors and variables involved, SHL can be a frightening condition to undertake for many patients with lifelong ramifications. If left untreated, an average of 25 to 30% of patients with SSNHL will achieve some level of spontaneous improvement, although not always back to their normal hearing level. If treatment is sought immediately, recovery rates improve to 50% or even more in some cases.

What Updates Have Been Made?

Knowing the importance of early detection and treatment, updates to the AAO-HNSF’s SHL guidelines were vital. Though the 2012 guidelines were crafted with the most current research at the time, medical science is constantly advancing, opening up room for improvement when it comes to treatment. Improvements such as addressing the need to distinguish SSNHL from CHL in patients who have shown initial signs of hearing loss, as well as clarify the need to identify “rare, nonidiopathic, sensorineural hearing loss” to help separate those patients from others who suffer from Idiopathic Sensorineural Hearing Loss (ISSNHL), a target population that this update addresses. Schwartz hopes that these updates will better suit the medical community when treating SHL, concluding “While the original guideline was a big step, this update provides an opportunity to improve diagnostic accuracy, facilitate prompt intervention, reduce unnecessary tests, and improve hearing and rehabilitative outcomes for patients.”

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Is There a Connection Between Harsh Sounds and Brain Disturbance?

Do the screams of a siren or the shrill cry of a peacock send you into flight or fight mode? Does the sudden honk of a vehicle make you jump? If so, you are not alone. The effects of harsh sounds can seem intolerable to some people. In fact, this is the reason most alarms are so annoying.
Alarm manufacturers intentionally use tones with fast-paced, repetitious sounds that have the effect of putting us on alert. Neuroscientists at the University of Geneva (UNIGE) as well as Geneva University Hospitals (HUG) in Switzerland have spent time researching the reactions that people have to a varied range of sounds.
With a goal of identifying the point that test subjects determined these frequencies to be objectionable, scientists explored the areas of the brain that reacted to different frequencies. By having them listen to sounds repeatedly from 0 to 250 Hz at intervals closer together each time, researchers at UNIGE asked participants to determine the point where the sounds went from several intermittent sounds to a solid, continuous one.
With the responses they got, the scientists found that at around 130 Hz participants heard only one continuous sound. This prompted the question of why the brain determines harsh sounds as obnoxious. Keeping that in mind, they requested that the test participants listen to different frequencies. They were instructed to categorize them from 1 to 5, with 1 being tolerable and 5 being obnoxious.
According to Luc Arnal, who is a researcher at the Department of Basic Neurosciences at UNIGE’s Faculty of Medicine, “The sounds considered intolerable were mainly between 40 and 80 Hz, i.e. in the range of frequencies used by alarms and human screams, including those of a baby. That’s why alarms use these rapid repetitive frequencies to maximize the chances that they are detected and gain our attention.”
Armed with this knowledge, neuroscientists worked to figure out why the brain reacts to these as sounds as intolerable. Pierre Mégevand, a neurologist and researcher in the Department of Basic Neurosciences in the UNIGE Faculty of Medicine and at HUG reported, “We used an intracranial EEG, which records brain activity inside the brain itself in response to sounds.”
For sounds that are detected as one long continual sound, the intracranial EEG showed that there was activity in the auditory cortex, which is located in the upper temporal lobe. Mégevand stated, “This is the conventional circuit for hearing.”
The sounds that participants determined were intolerable (such as the ones they reported between 40 Hz and 80 Hz) resulted in a constant reaction that also involved a number of cortical and subcortical areas that are not normally involved in the traditional auditory system.
To this, Arnal responded, “These sounds solicit the amygdala, hippocampus, and insula in particular, all areas related to salience, aversion, and pain. This explains why participants experienced them as being unbearable.” He was reportedly surprised about the fact that these regions had something to do with sound processing.
Researchers were unable to find previous data that supported their findings that sounds between 40 Hz and 80 Hz had ever been determined to drive these same neural networks, though for many years these same frequencies have been used in various alarm systems.
According to Arnal, “We now understand at last why the brain can’t ignore these sounds,” says Arnal. “Something in particular happens at these frequencies, and there are also many illnesses that show atypical brain responses to sounds at 40 Hz. These include Alzheimer’s, autism and schizophrenia.”
Neuroscientists anticipate that further research into the topic will show why these areas are motivated by this specific range of frequencies. They hope to learn if early detection is possible for illnesses such as Alzheimer’s, autism, and schizophrenia.
According to a study listed online at PMC US National Library of Medicine National Institutes of Health loud noises can bring about certain neuropsychiatric responses like the following:

  • Anxiety
  • Emotional stress
  • Psychiatric disorders

These can be responsible for changes to the hypothalamic pituitary axis (HPA) which is associated with how the body reacts to stress. Sudden, loud, harsh noises can create stress, which our body responds to almost instantaneously in the sympathetic nervous system. It begins the process of secreting epinephrine and norepinephrine, which are responsible for the changes you would normally experience when frightened or stressed such as an increase in heart rate and excess perspiration.
Within seconds the HPA axis is alerted and the hypothalamus reacts to signals such as raised norepinephrine levels. It then begins the secretion of corticotropin, a hormone released during the stress response. The pituitary gland responds by secreting adrenocorticotropic hormones which in turn triggers the release of cortisol.
Cortisol is known to increase the blood pressure as well as the cardiac output which provides more blood to your muscles in the event the stressor needs to result in physical exertion, such as running for your life.
When considering that the sound of sirens on emergency vehicles, tornado sirens, or even alarm clocks are designed to alert and potentially raise attention, it’s easier to understand why. When armed with this information, people can gain a better understanding of the reasons behind the discomfort and even fear that surrounds these loud and intolerable sounds.

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Communicating Better With People Who Have Hearing Loss

You might believe that hearing aids are enough for communicating with people with hearing loss. Although hearing aids are beneficial in many circumstances, sometimes they are not enough. When talking, remember that a conversation involves two people: a speaker who sends the message, and a listener who receives the message. So, as a member of this communication pair, it is essential to communicate your message clearly to those with hearing loss. Here are a few approaches to help you do it better.

Get Their Attention

Try to gain a listener’s attention before you begin speaking. You might say the person’s name, or gently touch their arm or shoulder to gain their attention. These actions will allow the listener with hearing loss to prepare, so they do not miss the first part of your conversation.

Eye Contact

Please face the person with hearing loss and make eye contact. It is your facial expressions and body language that provide critical information to the message you are delivering. It is easy to see excitement, joy, confusion, and frustration on a person’s face.

Keep Hands Away From Face

When you are speaking, try to keep your hands away from your face. Doing this will allow you to deliver a more explicit speech while allowing your listener to pick up on visual clues by watching your mouth and face. Remember that speechreading depends on a listener being able to see your face, which improves their perception of the message.

Use Natural Speech

Try to keep your speech distinct, but do not exaggerate. There is no need for shouting, as it will only distort the message. Avoid mumbling and speak at a reasonable rate. Use pauses instead of slow speech, which will give the listener time to process your speech. Try to provide clues when you are changing subjects or state that you are changing topics.

Rephrase Instead Of Repeating

If your message is not clear, repeat it one time. If your listener is still having difficulty understanding what you are saying, try to rephrase your message differently. Make use of different words that have the same meaning. You may also ask your listener what part of the message they did not understand and repeat only that phrase or word.

Avoid Background Noise

Please try to reduce environmental noise as much as possible when communicating. Turn off the radio and television and move to a quiet place. When going out to a restaurant, request a table away from the kitchen, server station, or large groups of people.

Lighting

Good lighting on your face is essential for a person who is speechreading. When you are at a social gathering, sit where the light is good, and your face is visible. Poor lighting causes shadows on your face, and intense lighting from behind may cause difficulty from the bright light.

Consider An App For Translation

Several apps are now available that will allow you to speak into a smartphone and have your words appear on the screen for the person with hearing loss to read. Texting is another useful tool for communication.

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Protect Your Hearing Aids This Winter

Temperatures are dropping, and storms are becoming more frequent in many parts of the country as we dig deeper into fall on the way to Winter’s freeze. For many, these changes bring to mind snow tires and scarves, hot chocolate and cozy socks to combat the cold days. If you use hearing aids, you’ll also want to take steps to protect them from the colder temperatures and changes in weather.
Protect your hearing health investment
If you have hearing aids, you’ve made a smart investment in your hearing health. Chances are you got started with a hearing evaluation then worked with your hearing healthcare provider to select the best hearing aids for your needs.
From there, you probably went through fittings and one or more adjustments to get them working just right for your unique hearing loss. Finally, you learned how to clean and maintain them. You have probably spent time each day removing and drying them, replacing batteries and cleaning them to prevent wear and tear and lengthen their life, even taking them in for professional cleanings once or twice a year. All of this to protect your investment.
During the year, however, you’ll want to take extra steps to keep your hearing aids humming along in top shape. That includes during these colder winter months when the elements can take a toll.
Winter considerations for hearing aids
During colder fall and winter months, keep these things in mind when it comes to your hearing aids:

  • Keep the stormy weather out – Moisture from the elements is a big concern this time of year. It can damage the inner workings of the hearing aid reducing its effectiveness. Moisture from rain and snow can also affect the battery and reduce its life. Carry umbrellas, wear rain and snow jackets with hoods or a protective hat and use similar protection from the elements.
  • Be aware of condensation – Going from the cold of the outdoors to the warmth of inside can create condensation inside your hearing aids that leads to damaged connections and hearing aid batteries. This is especially true when you are moving between the temperature extremes repeatedly during the day.
  • Protect against sweat – shoveling snow, covering ears with a hat or earmuffs, and even winter sports can leave you a little sweaty even in sub-freezing temperatures. When this sweat seeps into hearing aids, it can be just as damaging as the snow and rain. Consider wearing a hearing aid “sweatband” or even removing hearing aids during strenuous activity.

Winter hearing aid worries often revolve around moisture and its damaging effects on the devices and their batteries. To help minimize damage and protect hearing aids, remove and open them whenever they’re not in use to allow extra moisture to escape. When you are away from home, do carry a small cleaning toolkit and extra hearing aid batteries if your batteries do become a victim of the elements.
Are you looking for more information on how to protect hearing aids during the winter months? Contact our office for tips and advice.