Hearing Solution Guide

Marie-Josée Taillefer Ambassador of Lobe Clinics and Hearing Health

It’s a pleasure for us to offer you this guide containing the different hearing solutions that are available to you or a loved one with hearing loss.

Hearing health professionals will be happy to analyze your audiogram with you, then determine your listening and communication priorities, and verify if you’re eligible for RAMQ, CNESST, Veterans Affairs programs or others.

This hearing solution guide was made possible with the help of hearing health professionals practicing in the Lobe clinics.

Because every moment deserves to be heard.

Congratulations!

You have taken the first step towards better hearing health. You are now among those who have chosen to take care of their hearing. You must be proud! It is when you are deprived of a sense that you realize the best its importance. A healthy hearing is a gift, let’s not forget it!

All my love,

Marie-JoséeTaillefer

Your Audiogram Analysis

Now that you’ve had a hearing assessment, it’s time to analyze it.

Low frequencies are responsible for the understanding of 20% of words

High frequencies are responsible for the understanding of 80% of words

Anatomy and Physiology of Binaural Hearing

Collects sound from the environment

Binaural processing of the auditory information Functions

Sound Reception Area Outer Ear

Mechanical transmission

Conversion into nerve pulse

Middle Ear Inner Ear

Brain Auditory Areas

Oval Window

Cochlea

Binaural processing of the auditory information Functions

Brain Auditory Areas

Conversion into nerve pulse

Mechanical transmission

Collects sound from the environment

Outer Ear Middle Ear Inner Ear

Sound Reception Area

Who Is Eligible to Open a CNESST File?

According to the statistics available, there are 3.1 million workers in Quebec. More than 400,000 of these workers are exposed to potentially harmful noise levels in the workplace. Prolonged exposure to such sound levels can lead to occupational noise-induced hearing loss, sometimes with tinnitus.

Each year in Quebec, approximately 1,500 new cases of occupational hearing loss are recognized and compensated by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST).

If a worker is suffering from hearing loss and has a history of exposure to noise in the workplace, he or she may file a claim with the CNESST for compensation. The worker must meet the following conditions:

– Have a hearing loss that is consistent, in whole or in part, with occupational hearing loss.

– Have worked for many years in noisy environments, mainly in Quebec.

– Have contributed to the CNESST plan.

Note that retired workers can file a claim with the CNESST to have their hearing loss recognized as work-related, no matter how long ago they retired. The same goes for people who worked for companies no longer in business. It is also possible for workers to file claims with the CNESST even if they did not wear hearing protectors (e.g. earplugs) during their careers.

Once a worker’s hearing loss is recognized as workrelated, the CNESST covers the costs for one or two hearing aids every five years, as well as hearing aid cleaners and batteries. Depending on the worker’s needs, the CNESST may also cover the costs for assistive listening devices (ALDs), such as television listening systems and amplified telephones.

- LAROCHE, C., M. VALLET and D. AUBRÉE (2003). Bruit, in Environnement et santé publique – Fondements et pratiques, p. 479-497, Edisem / Tec & Doc, Acton Vale / Paris. Online. dsest.umontreal.ca/documents/24Chap18.pdf References

- INSTITUT NATIONAL DE SANTÉ PUBLIQUE DU QUÉBEC (2004). Étude exploratoire de la relation entre l’exposition au bruit en milieu de travail, la perte d’audition permanente et la sécurité routière. Online. www.inspq.qc.ca/pdf/publications/341-BruitMilieuTravailSecuriteRoutiere.pdf

- INSTITUT NATIONAL DE SANTÉ PUBLIQUE DU QUÉBEC (2007). Le bruit en milieu de travail : une analyse des coûts pour le régime d’indemnisation. Online. www.inspq.qc.ca/pdf/publications/712-BruitMilieuTravail.pdf

Here are the steps for opening a CNESST file:

1 The process starts with a free* hearing consultation, including a brief evaluation of your hearing. This service is offered within the Lobe clinics. This first meeting will be with a hearing health professional, who will take the time to discuss your career with you. They will then be able to determine which aspects of your daily life could be affecting or have affected your hearing. They will also test your listening and communication abilities and briefly assess your hearing.

2 If they detect hearing loss, you will be referred to an audiologist for a complete hearing assessment. Depending on the results of this assessment, the audiologist may confirm that the hearing loss could be work-related.

3 You will then meet with an ENT (ear, nose, and throat) specialist to obtain a medical certificate. The CNESST requires this certificate to analyze your application.

4 Once you have obtained the medical certificate, you will then be redirected to a specially trained resource person who will help you open a file with the CNESST. Among other things, they will help you fill out the necessary forms for your claim (the “Worker’s Claim” and “Appendix to the Worker’s Claim” forms).

5 Once your hearing loss has been recognized as an employment injury by the CNESST and that the ENT specialist has recommended hearing aids, you’ll meet with an audioprosthetist who will assess your needs and suggest hearing aids that best suit your lifestyle and type of hearing loss.

6 Finally, you will have your hearing aids adjusted. At this stage, you’ll have an appointment with the audioprosthetist and a specialized educator. These two hearing health professionals will help you readjust to the world of sound and share communication strategies and tips for using and maintaining your hearing aids. They’ll also help you choose assistive listening devices as needed.

If you would like to start the process to have your occupational hearing loss recognized, don’t hesitate to book a free* hearing consultation, including a brief evaluation of your hearing. This service is offered within the Lobe clinics.

* Permanent offer. 18 and over.

Why Must I Wear Two Hearing Aids?

People with bilateral hearing loss to whom we recommend wearing two hearing aids frequently ask questions: “I know someone who only wears one hearing aid, so why should I wear two? Can I start with one ear and see about the other one later?” There are good reasons why humans are born with two ears. Both are essential for determining where a given sound is coming from and to understand speech, particularly in noisy places.

Speech Comprehension

When the brain receives sound through both ears rather than just one, it has a greater selection of acoustic information to process. Decoding words thus becomes easier, particularly in loud settings.

Advantages of Wearing Two Hearing Aids

Wearing only one hearing aid is rarely satisfying, even with top-of-the-line hearing aids.

With binaural amplification (wearing two hearing aids), we maintain the natural advantages of binaural hearing.

It allows both ears to receive sound at the same time, meaning that you pick up sounds and speech coming from both your left and your right. This leads to more balanced sound quality, which in turn makes it easier to understand speech.

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs.

With binaural amplification (wearing two hearing aids), we maintain the natural advantages of binaural hearing.

Better Sound Quality

Having two hearing aids instead of one increases the range of sound perception from 180° to 360°. Sound is richer in tone and feels more natural.

Sound Localization

Sound localization refers to the human auditory system’s ability to pinpoint the location or origin of a detected sound through a range of physical cues including interaural time difference or ITD.

Sounds reach each ear at slightly different times and amplitudes: tiny differences that tell us whether the sound is coming from the right, left, front or rear. This information is vital in many situations. For example, in traffic, it’s what lets the driver determine which direction the blast of a horn from another vehicle is coming from.

Bilateral Hearing Loss

Hearing loss in both ears is said to be bilateral (hearing loss in one ear called unilateral). The most common type is presbycusis (caused by natural aging of the ear), followed by occupational deafness and congenital deafness (from birth).

Sensory Deprivation

Depriving oneself of hearing has consequences on the entire auditory system, from the ear to the brain, which is called sensory deprivation. In the presence of hearing loss, there’s a decrease in the amount and quality of messages sent to the brain. The risk of Alzheimer’s disease is 2.5 times higher in people with hearing loss who are not treated.1

Our two ears are precious, let’s be attentive to their needs!

Reference

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs.

Presbycusis

Why Deprive Oneself of the Joys of Hearing?

Presbycusis is the leading cause of hearing loss in humans. It is the slow, gradual loss of hearing. Hearing acuity, the capacity to hear sounds at a normal level, decreases in time and years, in different intensities and rhythms depending on people.

This decrease of hearing acuity can be explained by degeneration of nerve cells in the inner ear (cochlea) responsible for sound selection. This phenomenon is comparable to vision (presbyopia). The people who have this type of deafness realize that it is much more difficult to hear what a woman is saying, while men’s voices are still audible. These difficulties become even more pronounced when there is a great deal of background noise or when several people are talking at once. Similarly, it can become harder and harder to hear the television (lack of sound clarity, even when the volume is turned up).

The energy (power) behind speech comes from low frequencies, which people with presbycusis are capable of hearing rather well. The person then continues to understand speech and easily hear when someone talks.

However, they will struggle to understand the words themselves, which are produced at higher frequencies (consonants).

This is why it can be so difficult to carry on a simple conversation if, say, the refrigerator, whose sound is still audible, is making noise in the background—it’s hearing without understanding.

The person will struggle to understand the words themselves, which are produced at higher frequencies (consonants).

Sensory Deprivation

It is common for people with hearing loss to underestimate this problem, in light of the embarrassment they may endure as a result of existing prejudices. Individuals with hearing loss wait an average of seven years before seeking professional help. Not only does that long wait force them to struggle with daily hearing difficulties, but depriving themselves of proper hearing also has repercussions on their entire auditory system, from the ear to the brain. This situation is called sensory deprivation.

Our nervous system, including the brain, has the capacity to adapt and change the way it organizes its functions. This is referred to as brain plasticity. The more information the brain receives from a specific part of the body, the more effectively it processes that information. So if a part of the human body begins sending fewer messages than before, the nervous system’s ability to process that information correctly diminishes.

When a person experiences hearing loss, the quantity and quality of the messages sent to the brain is effectively reduced, and in turn, the auditory system’s pathways from ear to brain are used less frequently.

Sensory deprivation leads to a decline in the brain’s ability to recognize and understand speech, a problem that can grow worse over time. This condition can affect people of any age, and is found in individuals with hearing loss who don’t wear hearing aids, as well as in those with hearing loss

in both ears who wear only one hearing aid. In the latter case, sensory deprivation is experienced in the unfitted ear.

Solution

If diagnosed and treated in time, comprehension difficulties can be alleviated, which is why it is critical not to wait until hearing problems become unbearable before taking action. To improve speech intelligibility, stimulation of the auditory system must be increased as soon as possible.

Hearing aids limit the effects of the auditory system’s sensory deprivation in two ways. In the short term, they improve speech intelligibility through better audibility, by amplifying words. Then, in the long term, they improve sound representation thanks to perception. Hearing aids continuously solicit auditory system pathways, helping maintain their effectiveness.

When a person experiences hearing loss, the quantity and quality of the messages sent to the brain is reduced.

Remember, your ears work all day long. Even when you are asleep, they continue to send messages to your brain. In this fashion, amplification helps recreate the wealth of auditory input we receive every day.

Obviously, brain plasticity cannot be regained overnight with auditory stimulation: it’s a gradual process that varies from person to person. Bear in mind that people have an average of seven years of sensory deprivation to make up for, since they wait an average of seven years before seeking professional help.

Hearing aids continuously solicit auditory system pathways, helping maintain their effectiveness.

- ARLINGER, S. Negative consequences of uncorrected hearing loss – a review, International Journal of Audiology (2003); 42(2), 17-20.

- CORNA, L. et al. Corrected and uncorrected hearing impairment in older Canadians, Gerontology (2009); 55, 468-476.

- FRISINA, R. and J. WALTON. Age-related structural and functional changes in the cochlear nucleus, Hearing Research (2006); 216-223.

- KAPPEL, V. et al. Plasticity of the auditory system: theoretical consideration, Brazilian Journal of Otorhinolaryngology (2011); 77(5), 670-674.

- PALMER, C. et al. The functionally and physiological plastic adult auditory system, Acoustic Society of America (1998); 103(4), 1705-1721.

- PHILIBERT, B. et al. The auditory acclimatization effect in sensorineural hearing-impaired listeners: Evidence for functional plasticity, Hearing Research (2005); 131-142.

Table of Technologies

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Here is a table that summarizes the benefits of different technologies.

Parties and social gatherings

Restaurant Family dinners Outdoor activities

Meetings

Plays and concerts

Oneto-one

*These scenarios assume good speech recognition abilities and the use of binaural hearing aids. Premium level Mid-Advanced level

A New Technology Featuring Artificial Intelligence

New, versatile hearing aids provide exceptional sound quality while also allowing users to track their physical, mental and cognitive health. This technology stands out from all currently available hearing aids, helping users improve their listening experience while sharing important health information with their audioprosthetist.

Body and brain monitoring

These hearing aids are the first in the world to use artificial intelligence to help people of all ages adopt a proactive approach for their overall well-being. 3D motion sensors that detect movement, activity and gestures are integrated in every hearing aid. These sensors provide information on physical and mental health. Users can easily view and manage this information with an app on their smartphone. They can also see the progress of their physical activity, as well as the benefits that wearing hearing aids can have on their mental health.

Natural user interface with touch control

The user interface can be programmed to start or stop audio streaming from a TV or a remote microphone. You just need to double-tap on a specific area of the hearing aid to use this feature.

Translation

A hearing aid feature helps users communicate with people who speak another language—27 languages—thanks to a translation tool in the mobile app.

Fall detection

These hearing aids are also able to detect falls and send emergency alerts.

Connectivity

Connectivity accessories make it possible to broadcast TV programs and music directly in the hearing aids.

Ask your audioprosthetist if these hearing aids suit your needs.

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs.

Types of Hearing Aids

Invisible-in-the-Canal

Nearly invisible hearing aids are very discreet and lie far in the ear canal. They require good manual dexterity and are not recommended when earwax production is abundant.

In-the-Ear

In-the-ear (ITE) hearing aids lie in the ear canal.

Completely-in-Canal

Completely-in-canal (CIC) hearing aids lie deep in the ear canal. They’re discreet. They require good manual dexterity and are not recommended when earwax production is abundant.

Receiver-in-the-Ear

Receiver-in-the-ear (RITE) hearing aids have a discreet case that sits behind the ear pinna and a receiver that goes inside the ear canal with a thin wire.

Rechargeable Hearing Aids

In-the-Canal

In-the-canal (ITC) hearing aids lie in the ear canal.

Behind-the-Ear

Behind-the-ear (BTE) hearing aids lie behind the ear, as their name suggests. A tube is attached to the earmold in the ear.

Rechargeable hearing aids are gaining popularity. After all, they do have many benefits, such as ease of use for people with visual or motor issues and the environmental benefits of reducing the number of discarded batteries.

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs. The model is chosen according to the degree and configuration of the hearing loss, as well as other criteria specific to the user.

Listening and Communication Strategies

People with hearing loss and their friends and family frequently face communication problems. Listening and communication strategies can help improve comprehension. People with hearing loss and their conversation partners share the responsibility for using these strategies.

Advice for Friends and Family

1 Make sure you’re in the same room as the person with hearing loss when speaking.

2 Get the person’s attention before speaking (e.g. by calling their name, tapping their shoulder, etc.).

3 Stand near the person and face them to make lip-reading easier.

4 Speak slowly and clearly, but don’t overdo it.

5 Do not shout.

6 If certain words are misunderstood, repeat using different words.

7 Turn off any background noise sources (TV, radio, dishwasher, music, etc.).

8 Make natural gestures and avoid covering your lips.

9 Indicate the topic of conversation and clearly signal a change in topic.

10 Ask questions.

Advice for People With Hearing Loss

1 Wear your hearing aids.

2 Let it be known that you have difficulty understanding.

3 Look at the person you are speaking to and watch their lips. Observe them as they speak.

4 Turn off any background noise sources (TV, radio, dishwasher, music, etc.).

5 Ensure that the face of the person you’re speaking to is well lit.

6 Ask about the topic of conversation.

7 In a meeting, ask people to speak one at a time.

8 Ask people to speak slowly.

9 Ask questions.

Strategies might be helpful!

– It’s important to tell your discussion partners about your hearing loss. They will then make sure you understand well.

– Moving closer (one or two meters from discussion partner) reduces communication problems. Indeed, sound loses intensity when crossing obstacles in its path.

– Talking face to face facilitates lip-reading and helps understanding emotions through facial expressions.

– Your conversation partners should never speak with a hand in front of their face

– It’s important to pronounce well, without exaggerating, which may alter lip movement.

– Yelling is not recommended since it alters pronunciation. The auditory system may also distort words, due to hyperacusis. Just raise your voice slightly.

– Speaking slowly makes it easier to follow lip movement and to understand speech.

– Well-lit places help to see the face better.

– The person talking to a person with hearing loss should never stand against the light, back to a window for example, because it creates a shadow on the face.

– Ambient noise is the enemy of communication, so it is essential to reduce it. For example, background music at a dinner party may affect the understanding of a person with hearing loss. Turning the dishwasher or range hood off is another way to facilitate communication.

– Choosing the place where you sit may also facilitate communication. At the restaurant, ask to sit at a table close to a wall. Upholstered benches also absorb noise. If you are one-onone, face each other. If you are with a group, make sure to see as many faces as possible, or sit near the people most likely to talk to you.

– Prioritize private rooms in restaurants.

– To improve your understanding or reduce your discussion partners’ impatience, avoid words like “What?” or “Sorry?.” Instead, mention the part that you understood or ask to repeat using other words.

Hearing Protection

Our ears are precious! Let’s protect them from loud sounds with custom earmolds or earmuffs. Here are the different types of earmolds to meet all needs.

Adaptors for Earbud Headphones or Custom-fit Audio Monitors

A good solution if your earbud headphones are causing your ear canal discomfort or if your ears are simply too small for these types of devices.

Swim Earmolds (post-myringotomy earmolds)

Silicone earmolds that prevent water from getting into the ear canals when swimming, showering or bathing. Recommended following the insertion of CIC tubes or for those prone to ear infections.

Earmolds are available in a range of colours, based on type.

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* Combination of two colours

Earmolds for Workers in Noisy Environments

Silicone earmolds that greatly reduce all types of ambient noise. Recommended for loud workplaces or high-decibel recreational activities.

Musicians’ Earmolds

Earmolds with a special filter (9, 15 or 25 dB attenuation) that reproduce the ear’s natural amplification. The sound quality is similar to what you hear without them, but much softer. Perfect for musicians and concertgoers!

Sleep Earmolds

Earmolds that reduce ambient noise when sleeping. A good solution for light sleepers!

Earmuffs

Earmuffs that protect hearing in noisy environments such as concerts or festivals.

Hearing health speaks to everyone.

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Marie-Josée Taillefer Ambassador of Lobe Clinics and Hearing Health