Winter 2010 Hearing Health

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The Ultimate Consumer Resource on Hearing



Hard-Hitting Nice Guy Washington Redskins’ Reed Doughty

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Opening Lines

HEARING HEALTH Volume 26 Number 1, Winter 2010 Publisher

Deafness Research Foundation Andrea Kardonsky Boidman, Chief Operating Officer Editor-in-Chief

Donna Lee Schillinger Art Director

Devorah Fox, Mike Byrnes and Associates Associate Editor

Jamie Morrison Medical Director

George A. Gates, M.D. Staff Writers

Amy Gross; Amy Morrison; Nannette Nicholson, Ph.D. Advertising

866.454.3924, Contributors

American Speech-Language-Hearing Association; John Ayers; Jianxin Bao, Ph.D.; Brenda Battat, Ph.D.; Daniela Bermudez Gardea; Tim Creagan, Ph.D.; CTIA-The Wireless Association; Ashley DeLaune; Spc. Opal Hood; Matthew W. Kelley, Ph.D.; GengLin Li, Ph.D.; Alan G. Micco, M.D., FACS; Michael Ream; Janice Schacter; Self-Advocacy Solutions, North Dakota; Beverly Shay; Elizabeth Stump; Dawn O’Brien Taylor, M.A., M.Ed.; Kim Waters Council of Scientific Trustees

Patricia M. Chute, Ed.D.; Noel L. Cohen, M.D.; Robert A. Dobie, M.D.; Judy R. Dubno, Ph.D.; Bruce J. Gantz, M.D.; George A. Gates, M.D.; Stefan Heller, Ph.D.; Matthew W. Kelley, Ph.D.; Anil K. Lalwani, M.D.; David Lim, M.D.; Cynthia Morton, Ph.D.; Yehoash Raphael, Ph.D.; Steven D. Rauch, M.D.; Allen F. Ryan, Ph.D.; James C. Saunders, Ph.D.; Sam Selesnick, M.D.; Robert V. Shannon, Ph.D.; Peter Steyger, Ph.D.; Jennifer Stone, Ph.D.; Debara V. Tucci, M.D.

Exciting developments that could significantly reduce a chief cause of hearing loss among our military personnel and the general public are underway. “Hearing Loss: No. 1 Diagnosis for U.S. Soldiers in Afghanistan” (p. 7) takes us to the front lines where soldiers make a daily choice to either hear their best or protect their hearing against the unexpected acoustic trauma from an improvised explosive device. While the military and the private sector are working to improve wearable hearing protection, another type of hearing protection is on the horizon. In “Take Two of These and Hear Me in the Morning” (p. 12), learn how the “allied forces” of public, private and military researchers are attacking the formidable foe of noise-induced hearing loss through a pharmaceutical prophylactic. For those of us who have already been exposed beyond remedy to toxic noise, there is potential hearing restoration through biological means. Beginning in the 1980s with the discovery that chickens could regenerate their lost hair cells in the ear – something humans cannot do – multiple lines of research have made huge strides in the effort to regrow the all-important hair cells in our inner ears that are necessary for healthy hearing. In “Recent Advances in Biological Restoration of Hearing” (p.18), Matthew W. Kelly, Ph.D., of the National Institute on Deafness and Other Communication Disorders, reviews the progress and outlines what remains to be done to realize this amazing breakthrough that could renew hearing lost through noise trauma as well as via the aging process. As we approach the holidays, we could all use some great gift-giving ideas. If that special someone with hearing loss is also the hardest person on your list to shop for, check out our third annual Holiday Gift Guide (p. 22) for some practical gift ideas for loved ones of every age. For the person who has everything, please consider making a gift of hearing in his or her honor by donating to the Deafness Research Foundation to advance hearing and balance research.

A publication of

Warm regards,

Rebecca Ginzburg 641 Lexington Ave., 15th Floor New York, NY 10022 Phone: 866.454.3924 TTY: 888.435.6104 E-mail: Web:

Rebecca Ginzburg Deafness Research Foundation Chair, Board of Directors

Deafness Research Foundation is a tax-exempt, charitable organization and is eligible to receive tax-deductible contributions under the IRS Code 501(c)(3). Federal ID # 13-1882107.

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HEARING HEALTH Volume 26 Number 1

On the Cover Hearing Loss #1 Diagnosis for Troops in Afghanistan ............................................ 6 17 Misconceptions About People with Hearing Loss ............................................40 Hearing Restoration: Are We There Yet?...................................16 Hard-Hitting Nice Guy Washington Redskins’ Reed Doughty........................36

Cover Photo: U.S. Marines with 2nd Battalion, 8th Marine Regiment in Afghanistan. DoD photo by Sgt. Pete Thibodeau, U.S. Marine Corps. Below: Reed Doughty, photo courtesy of The Washington Redskins


Winter 2010

Features HEARING HEALTH ---------------------------------------------------------- 7

Hearing Loss: No. 1 Diagnosis for Soldiers in Afghanistan Spc. Opal Hood It’s Not Rocket Science – Smart Veterans Seek Better Hearing Michael Ream NOISE-INDUCED HEARING LOSS ----------------------------------- 12

Take Two of These and Hear Me in the Morning Elizabeth Stump RESEARCH ----------------------------------------------------------------- 18

Recent Advances in Biological Restoration of Hearing Matthew W. Kelley, Ph.D. LIFE-CHANGING TECHNOLOGY -------------------------------------- 28

Hearing Aids and Cell Phones – More Compatible than Ever American Speech-Language-Hearing Association

LIFE WITH HEARING LOSS --------------------------------------------- 36

Dr. Defense / Mr. Nice Guy Amy Gross MANAGING HEARING LOSS ------------------------------------------- 40

17 Misconceptions About People With Hearing Loss Janice Schacter COCHLEAR IMPLANTS -------------------------------------------------- 48

It’s Never Too Late for Better Hearing Beverly Shay The Digital Conversion...In the Ear Jamie Morrison

18 Next Issue Summer Fun: Camps Directory D/HH on Facebook, Who Would Know? The Audiogram Explained

Hearing Health (ISSN: 0888-2517) is published four times annually by Deafness Research Foundation. Contact Hearing Health for subscription or advertising information at: info@drf. org or 866.454.6104. Copyright 2010, Hearing Health. All rights reserved. Articles may not be reproduced without written permission from Hearing Health. In no way does Deafness Research Foundation nor Hearing Health magazine endorse the products or services appearing in the paid advertisements in this magazine. Further, while we make every effort to publish accurate information, Deafness Research Foundation and Hearing Health are not responsible for the correctness of the articles and information herein. USPS/Automatable Poly

Small region of the inner ear at the cellular level.

Departments Opening Lines -------------------------------------------------------------------------3 Have You Heard? ---------------------------------------------------------------------6 The Doctor Is In --------------------------------------------------------------------- 21 Trends---------------------------------------------------------------------------------- 22 DRF Centerstage ------------------------------------------------------------------- 26 Mother Nurture ---------------------------------------------------------------------- 35 Applause ------------------------------------------------------------------------------ 44 Marketplace -------------------------------------------------------------------------- 46

Have You Heard? Sign Language Goes High-Tech Learning American Sign Language (ASL) could become easier for both kids and adults, thanks to research developed at Southeastern Louisiana University, funded by a $390,000 “Steppingstones of Technology” grant from the U.S. Department of Education. Researchers Robert Hancock, Ph.D., and Becky Sue Parton, Ph.D., attached radio frequency identification (RFID) tags to an initial set of 500 common objects. When the object is waved in front of an RFID reader, it signals a computer to display a brief video of an interpreter signing the word for the object, along with several photos or clipart pictures of the object. Other enhancements can be displayed as well, like variations of the object – both red and green apples, for instance – along with the written English word “apple” for print recognition and an audio pronunciation for hard of hearing children. Since many parents of deaf children don’t know sign language and struggle to learn it, their children can fall several years behind in language acquisition. Hancock and Parton’s system enables children to pick up ASL vocabulary directly, as a supplement to peer and teacher interactions. It can be used with children both in a classroom setting and at home.

Will Healthcare Reform Fix This? Now both blind and deaf, Holly Alonzo of Piggot, Ark., has written a book called Never Giving Up Hope, an inspiring story of perseverance amidst daunting health problems. The 22-year-old mother suffers from neurofibromatosis, a chromosomal defect that causes noncancerous tumors to grow, impeding the proper functioning of the nervous system. Tumors that grew in her brain during childhood compressed the brainstem. At age five, her right leg was weaker than her left and she suffered from poor vision, her thick glasses inviting mockery from other kids. Surgery at

age 13 saved her life but left her irreversibly blind. A new brain tumor has now rendered her deaf but an auditory brainstem implant (ABI) would partially restore hearing. Sadly, Medicaid refuses to pay because they consider Alonzo too old; however, surgeons have offered to work pro bono, and Alonzo has raised one-third of the $30,000 needed for the actual implant on her own by selling raffle tickets, among other things. Her book conveys measures a person will, and apparently, must take to restore this vital sense. Proceeds from the book will be used for purchasing the ABI. Learn more at or call 870.324.1454. Limbaugh Puts Money Where His Mouth Is Conservative radio talk show host Rush Limbaugh gave $500,000 to the House Ear Institute in Los Angeles, in memory of Antonio De la Cruz, M.D., who died on July 31, 2009, at age 65. After experiencing sudden hearing loss in 2001, Limbaugh received diagnosis and treatment for autoimmune inner ear disease, including a cochlear implant that restored most of his hearing. “Dr. De la Cruz literally saved my career and got me my life back with that surgery,” Limbaugh recently told the Los Angeles Times. ■

Photo courtesy of

Hot Tips & News Clips The Alexander Graham Bell Foundation for the Deaf and Hard of Hearing received a $150,000 grant from the Oticon Foundation (The William Demant and Wife Ida Emilie Foundation) to support AG Bell’s Parent Advocacy Training program. Learn more at Oticon recently received FDA approval for the Ponto bone-anchored hearing system, the company’s first bone-anchored hearing instrument. Advanced Bionics (AB) has launched Processor Direct to streamline replacing a sound processor. Audiologists log on to a secure Web site to upload their patient’s unique program file. AB then loads the customized program into a replacement device and ships it directly to the patient. AB also recently announced it will be acquired by Sonova Group, of which hearing aid manufacturer Phonak is also a division. AB will remain an independent division under the parent company. Learn more at British charity RNID has released a helpful document on how to make induction loops more widely available to customers with hearing loss: Researchers at the House Ear Institute have found a gene, GRM7, they believe may be associated with agerelated hearing loss. Next up: developing a laboratory model to test pharmaceuticals for possible treatment. ■ 6 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION


Hearing Loss No. 1 Diagnosis for U.S. Soldiers in Afghanistan

A U.S. Army soldier with 1st Battalion, 32nd Infantry Regiment, 10th Mountain Division, fires at insurgents attacking from the hills surrounding the remote village of Barge Matal during Operation Mountain Fire, in Afghanistan’s Nuristan province, July 12, 2009. During the operation, U.S. and Afghan National Security Forces quickly secured the tiny mountain village, which was overwhelmed by insurgents several days prior. Photo by U.S. Army Sgt. Matthew C. Moeller, 5th Mobile Public Affairs Detachment BY SPC. OPAL HOOD, 5TH MOBILE PUBLIC AFFAIRS DETACHMENT


hen gearing up for a mission in Afghanistan, a service member wouldn’t dream of forgetting their helmet, gloves, weapon, eye protection or body armor. But what about hearing protection? According to Air Force Staff Sgt. Lee Adams, an ear, nose and throat (ENT) technician at Bagram Air Field, more than 50 percent of the patients seen in the ENT walk-in clinics are there for hearing-related issues. “The first question I ask a patient who comes in with a hearing complaint is, ‘Were you wearing hearing protection?’” says Air

Force Col. Joseph A. Brennan, the ENT doctor at Bagram. “Since I arrived here in May, I have not had one service member answer yes to that question.” Deployed service members are exposed to many dangers while in combat zones. According to Brennan, many troops do not use hearing protection while out on missions because they feel that the hearing protection negatively affects their ability to do their job and complete their missions. “I was in Iraq in 2004 and 2005 in Fallujah, with the Marines and the Army’s 1st Infantry Division and we just couldn’t get folks

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to wear their hearing protection,” says Brennan. “We understand. It’s like the old Army helmets: soldiers were complaining they couldn’t shoot with them. So even though they offered better protection, which as a doctor is what I care about, the fight is most important.” While in Iraq, Brennan saw more than 600 outpatients in an ENT clinic, and hearing loss was the No. 1 diagnosis there, just as it is today in Afghanistan. When service members are exposed to loud noises such as improvised explosive devices (IEDs) – the primary cause of hearing loss in both Iraq and Afghanistan – they are at risk of either conductive or sensorineural hearing loss and tinnitus. Conductive hearing loss can usually be fixed surgically, with the causes ranging from damaged ear bones to wax in the external canal of the ear. In sensorineural hearing loss, the nerve in the inner ear has been damaged.There is no way to surgically fix this and the only treatment is hearing amplification. Tinnitus is another form of hearing damage. It is a ringing or whining inside a person’s ear that can result from damage to the nerve. There are two forms of tinnitus: objective and subjective. If a person has objective tinnitus, the sound inside the ear can be

measured with a device used by ENTs. With subjective tinnitus, only the person with tinnitus can hear the sound - it is not measurable in any way. There is no cure for tinnitus. Tinnitus can be “masked,” however. A tiny device, a type of hearing aid, replaces noise caused by tinnitus with a less annoying, more natural sound inside the ear, according to Brennan. Another common problem is blown-out eardrums, which can heal on their own. A hole in an eardrum is considered a form of conductive hearing loss. This means that sound is not reaching the nerve in the inner ear that transmits sound to the brain. “In Iraq in 2004, there was a soldier who was in two IED blasts. The second explosion really blew out his eardrums and he could not hear a thing,” recalls Brennan. “The soldier’s sergeant and his fellow soldiers were on a rooftop in a firefight. The bullets were buzzing by his head. His sergeant had to tackle him to get him out of the line of fire, because the soldier couldn’t hear his comrades yelling for him to take cover.” According to Brennan, this story demonstrates why hearing protection is so important to soldiers. A hearing-impaired soldier not only puts himself in danger, but also his fellow soldiers.

U.S. Army Spcs. Patrick Wilson (left) and Evaristo Garcia fire a 120 mm high-explosive mortar round during a coordinated illumination exercise at Forward Operating Base Mizan, Afghanistan, on Sept. 2, 2009. Both soldiers are from Alpha Company, 1st Battalion, 4th Infantry Regiment, U.S. Army Europe. DoD photo by Sgt. Kris Eglin, U.S. Army.


Air Force Col. Joseph Brennan (l.), the ear, nose and throat doctor at the U.S.-run Staff Sgt. Heath N. Craig Joint Theater Hospital demonstrates how the portable hearing test machine works with the help of Air Force Staff Sgt. Lee Adamsan, ear, nose and throat technician. Photo by Spc. Opal Hood, 5th Mobile Public Affairs Detachment

Even if a person suffers hearing loss in only one ear, they can still be a danger, says Brennan. Their hearing directionality is impaired, and they will not be able to tell which direction a sound – like a whizzing bullet – is coming from. Since hearing damage affects the safety of military personnel and others around them, soldiers with hearing loss can be discharged from the military or forced to re-classify into a different job specialty, where they won’t be exposed to loud noises that could further damage their hearing. Active-duty personnel who have combat-related hearing loss receive hearing aids, and after they leave the military, the Veteran’s Administration provides the service members with hearing aids as needed, Brennan says. With IEDs being the No. 1 problem for Coalition forces in Afghanistan, it is no surprise that IEDs are the No. 1 reason for hearing loss among service members. Service members need to protect themselves from this very real problem and new technology is always being developed to help in the fight against hearing loss. “The best kind of earplug, which the military is actually working on at the Air Force research lab on Wright-Patterson Air Force base in Ohio, uses what is called active hearing protection,” Brennan says. “A person would wear this device on the inside or outside of their ear. For instance, if you were walking through the woods, this earplug would amplify the sounds around you, but the moment the noise reached a harmful level, the earplug would protect your ear and eliminate the sound, essentially plugging your ears.” This new form of earplug is ideal because it increases a person’s awareness, but also protects the service member’s ears. Normal earplugs employ what’s called passive hearing protection. They have the same effect as plugging your ears with your fingers, according to Brennan. Hearing protection is just as important to a U.S. military service member’s safety as their body armor and helmet. A soldier who suffers severe hearing loss could find his career ending as quickly as if he had suffered other combat-related injuries. Military personnel should listen to their leadership about wearing proper hearing protection … while they can still hear the warnings. ■

It’s Not Rocket Science Smart Veterans Seek Better Hearing BY MICHAEL REAM

E Even as the military hopes to develop more effective hearing protection, the noise of war – in particular, blasts h ffrom improvised explosive devices (IEDs) – can still easily sshatter eardrums and cause hearing problems. Many veterans who were fortunate enough never to be in the line of fire are nonetheless finding, years after b ttheir service is over, that healthy hearing was part of their ssacrifice for our country. One such veteran is Stephen Franklin, 59, who served on active duty for 20 years after F graduating from the Air Force Academy in 1972. Franklin g currently works as an engineer at United Launch Alliance, c a Colorado-based company that helps launch spacecraft. He is part of an eight-person team that puts together test H llaunches and addresses every potential problem with an upcoming launch. u Franklin is also representative of many veterans because, with intervention such as wearing hearing aids and using w aassistive listening devices, he has been able to improve his hearing, enabling him to function better in his job, enjoy h ttime with his family and have better quality of life. Franklin recently spoke to Hearing Health about dealiing with his hearing problems: “It was a gradual thing. When I was in the Air Force, I w was around loud planes, loud cars and even louder mussic. Typical young man stuff. I think all that together just w wore my hearing down. There was no specific incident tthat caused my hearing loss. “I flew for 10 years in a KC-135. It’s an aerial refueling aaircraft. I traveled a great deal and had a lot of fun! We aalways had headsets and we also wore those little foam earplugs. But that jet was very loud. I don’t know the nume bers but I know it was one of the louder jets, based on the b ffact that it was pretty much hollow inside except for the ffuel tanks. So it was a loud plane. “When I was in my 30s, about the time my career was finishing up, passing the flight physicals was a bit more of a challenge. I had to really struggle to make sure I could pass the hearing test. p “In a conference-type setting, when I was in a large rroom and someone would be speaking from across the rroom, sometimes I didn’t hear every word that was said aand I’d have to have them repeat it or speak up, or embarrrass myself by responding to what I thought I heard. Not a good thing to do!” Franklin noticed hearing problems at home as well. “The first thing I noticed was, sleeping on my right side vversus my left side, the ambient noise in the room was diffferent. I noticed that when I slept with my right ear down, iit was quieter. That became more pronounced as I got iinto my 40s. By that time, I was wrapping up my Air Force

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Stephen Franklin, retired Air Force navigator turned rocket scientist, provided engineering oversight for the rocket that launched the Lunar Crater Observation and Sensing Satellite, or LCROSS, which made impact with the moon on Octboer 9 of this year to search for water ice on the moon.

being treated and I found that bothersome. “My hearing problems were a little bit worse but I just dealt with it – which was selfish thinking. Conversations at home with my wife and television volume had to be much louder than were comfortable for her, because it was hard for me to hear. I would sit about twice as close to the television as she did. These are the things I had to do to cope.” Franklin switched to his current hearing aids in early 2009. “I use Siemens Pure 700 now – it’s also behind-the-ear. My new hearing aids are much easier to personalize – shaping the spectrum of sound that’s augmented by the hearing aids – to a much greater degree than my previous hearing aids. The range of coverage is different. Rather than just treating the middle range, which is where the majority of sound comes through, the upper and lower ends (of the range) are addressed as well. “It’s much better at work, too. I was in a conference room for a large meeting and I was sitting at a table in the center of the room. People were behind me talking and I couldn’t hear them very well, because we were set up for music and surround-sound, so I had my hearing aids set to that. Suddenly, a person who was far behind me spoke. I could hear clearly; I didn’t have to turn around and focus on them. I thought that was pretty neat!” ■

Michael Ream is a freelance journalist.

Photo courtesy of the Boeing Company

career and I was no longer flying; I was doing commandand-control-type work. “I think it was just a progressive change as I got into my 40s; the higher range of hearing was noticeably missing. I was turning the television up and I noticed I had to focus on people’s faces a lot more when they were talking.” After suffering from hearing difficulties for several years, Franklin consulted an audiologist. He was diagnosed with high-frequency hearing loss in both ears. “In 2002, I think, when I was living in California, I saw an audiologist, knowing that I did have a problem, but just to verify how bad it was. I was surprised that both ears were impacted. Since I didn’t have any information to go on, I thought it was just one-sided. “When I saw the results of the hearing test, I tried different types of hearing aids and I did not like the in-thecanal type because of the sensation it gave me. So we settled on a pair with behind-the-ear design. They were much more comfortable to wear and maintain.” Franklin stopped wearing hearing aids in 2006. “I really wasn’t happy with the performance, so I was wearing them less and less and then I stopped wearing them altogether. Looking back, it was just correcting a narrow band of hearing so that the full spectrum wasn’t


Reduced-Cost ALDs for Vets Williams Sound, a global manufacturer of wireless listening technology, has teamed with the Military Audiology Association to offer the Retiree Assistive Listening Device (RALD™) program to retired and active-duty military service members and their families. The RALD program was created to provide these veterans and service men and women access to assistive listening devices (ALDs) at a reduced cost, along with free personalized telephone support. ALDs are devices to help individuals with hearing difficulties hear more clearly in a wide array of social situations, whether those needs are specific to listening on the phone, to a television, in a group setting or during one-on-one conversations. An ALD is designed to pick up sounds from the sound source and bring it directly to the listener’s ear, without the distraction of background noise. For more information visit www.williamssound. com/rald and ■

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Answers for life. *Offer valid on your purchase of pair of Siemens Pure® 700 or 500 BTE models only. Valid with original Siemens voucher on hearing aid purchases made from 12/15/09-3/15/10 in the USA only. Cannot be combined with other offers. Not valid on purchases made by consumers via the internet or on prior purchases. Available at participating Hearing Care Providers. Hearing instruments help individuals hear better but results may vary. **The Bluetooth® word mark and logos are owned by the Bluetooth SIG, Inc. and any use of such marks by Siemens AG is under license. Other trademarks and trade names are those of their respective owners. Copyright © 2009 Siemens Hearing Instruments, Inc. All rights reserved.



Take Two of These and Hear Me in the Morning BY ELIZABETH STUMP


drug to cure hearing loss? It is not yet available in your local drugstore, but scientists are optimistic about what the future holds. More than 36 million Americans have hearing impairment due to aging, disease, ototoxic drugs, noise and genetics, and the number is increasing each year, according to the Hearing Loss Association of America. And the increase is not all due to aging baby boomers – anyone can suffer permanent hearing damage from excessive and repeated exposure to loud noise. Upwards of 30 million people in the United States regularly face dangerous levels of noise at work, in such industries as construction, mining, agriculture, aviation, manufacturing and transportation. In fact, hearing loss is among the most common forms of disability among military veterans, according to the 2005 Institute of Medicine’s report, “Noise and Military Service: Implications for Hearing Loss and Tinnitus.” Small wonder then that, during this past decade, there has been mounting interest in the development of drugs to prevent and treat hearing loss and, in particular, noise-induced hearing loss (NIHL). For more than 15 years, Richard D. Kopke, M.D., CEO of the Hough Ear Institute in Oklahoma City, Okla., has studied NIHL with the aim of developing a preventive treatment. “Despite decades of hearing conservation, which has been needed and helpful, NIHL is still one of the most common causes of deafness,” says Kopke. Drug treatments are necessary because hearing protection can be “uncomfortable, inconvenient, impair hearing acuity and can often be only partially effective,” Kopke says. Even the most sophisticated earplugs cannot dampen noise received through the skull. “The skull easily transmits very loud, damaging noise directly to the cochlea where damage occurs,

bypassing earplugs,” Kopke explains. Loud noise causes the release of toxins, called free radicals, in the cochlea (the inner ear organ of hearing), which in turn causes

Hough Ear Institute The Hough Ear Institute (HEI) in Oklahoma City, Okla., bills itself as “the only ear institute in the world that has contributed to the research and invention of all of the following:” cochlear implants; implantable devices for nerve deafness; implantable devices for conductive deafness; and standard hearing aids for developing countries. It is a Christian nonprofit research, educational and humanitarian service institute which provides hearing resources to individuals throughout Oklahoma and in more than 60 countries. On its campus are a cochlear implant clinic, a hearing enrichment language program facility, the Otologic Medical Clinic, Inc. and Audio Recovery, Inc. HEI collaborates in research with the University of Oklahoma, the Oklahoma Medical Research Foundation and Oklahoma State University. Among HEI’s firsts are: the first cochlear implantation of a child under three years of age, the first successful cochlear implant in a completely deaf and blind patient and the first human implantation of an electromagnetic implantable hearing device for sensorineural hearing impairment. As a part of Integris Health, Oklahoma’s largest nonprofit health organization, further information on HEI can be found at by clicking on Services, then Hearing Health, then Hough Ear Institute. ■

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the structures of the inner ear. Now with the discovery of the role of free radicals comes the possibility that a pharmaceutical could be formulated to neutralize them. Kopke and Henderson collaborated on the exploration of two classes of drugs to prevent – and, to a limited degree, treat – free radical damage, thereby preventing NIHL. “The first class of drugs is antioxidants, which are related to the body’s normal antioxidant protection system,” Henderson says. Antioxidants are nutrients found naturally in the body, in fruits and vegetables and in vitamins A, C and E, and they basically eliminate free radicals, according to Henderson. The researchers discovered that repeated exposure to nontoxic noise increased the levels of antioxidants in the inner ear. “The logic is that if free radicals are normally neutralized by antioxidants, and if noise greatly increases free radical formation, augmenting the ear’s antioxidant supply helps prevent serious damage.” SRC-inhibitors are the second class of drug Kopke and Henderson explored. These drugs block the cell death process (apoptosis).While these drugs have worked well in laboratory studies with mice, rats and chinchillas, there is limited data on their efficacy with humans in noisy environments, says Henderson. Studies from Henderson’s lab show that the SRC protein tyrosine kinase (PTK) may be involved in initiating both metabolic and mechanically induced apoptosis in sensory cells of the cochlea. In research published in Hearing Research in 2005, chinchillas were given SRCinhibitors on the round window membrane of their inner ears and a type of placebo was Capt. Christine Yarbrough fills a prescription of ibuprofen in the 379th placed on the other ear. The chinchillas were Expeditionary Medical Group’s pharmacy in Southwest Asia, Feb. 19, 2009. then exposed to noise. Twenty days later, Capt. Yarbrough is an active-duty member deployed from Nellis Air Force analysis of their cochleae showed that all three Base, Nev. Hearing loss is among the most common forms of disability among of the SRC-inhibitors under trial (KX1-004, military veterans. Scientists are hopeful about developing a pharmaceutical KX1-005 and KX1-174) provided protection treatment. from noise at 106 decibels. Additional tests, Photo by Senior Airman Domonique Simmons, courtesy U.S. Air Force varying the noise exposure, were conducted with the most effective drug, KX1-004. For all conditions, results suggested an active role for SRC-PTK in damage to the delicate hair cells and nerve endings in the cochlea NIHL. Henderson’s research on SRC-PTK inhibitors to prevent and leads to the death of irreplaceable sensory cells needed for NIHL is ongoing. hearing. The loss of these cells proceeds in a predictable pattern called “apoptosis,” says Donald H. Henderson, Ph.D., professor of comNAC Shows Promise municable disorders and sciences at the Center for Hearing and In 2004, Henderson and Kopke performed a significant human Deafness at the University at Buffalo, in Buffalo, N.Y. clinical study on the safety, tolerability and effectiveness of NBefore it was discovered that NIHL is largely caused by the acetylcystine, or NAC, a relatively safe antioxidant compound, as production of free radicals, NIHL was thought to be caused pria hearing protection drug for Marines in battle. (NAC was approved by the FDA over 25 years ago for treating liver damage marily by intense vibrations, produced by loud noises, that tear


from overuse of acetaminophen.) NAC had been studied for more than eight years in the laboratory and tested successfully in mice and chinchillas for hearing loss, but this was the first study on humans. In the pilot study, approximately 650 military personnel – all of whom used earplugs – were given either low oral doses of dissolvable NAC or a placebo during training. NAC was found to be safe and well tolerated, with the same side effects as the placebo, and it appeared to reduce the incidence of hearing loss by 25 percent compared to the placebo, reports Kopke. These preliminary results are currently under peer review. “Because of the initial encouraging results, two more clinical studies were initiated in the military. The first study is a repeat of the previous study with weapons noise using a higher dose of NAC. The second study looks at using NAC to reduce NIHL on an aircraft carrier,” Kopke says. NAC has several beneficial effects, says Kopke. “It neutralizes the toxins, it helps the injured tissue to repair itself and it prevents some of the injured cells from dying.The result is a substantial lessening of permanent deafness than the noise would have normally caused. It is most effective if given before noise exposure and then continued during noise exposure but it can also be somewhat effective if given shortly after loud noise exposure.” The NAC antioxidant compound is currently available as a dietary supplement under the name The Hearing Pill by American BioHealth Group in San Diego, Calif., which used the patent from Kopke’s studies and acquired the license to develop the drug into an easily usable form. According to the Web site (www.the, the pill is “indicated for helping the remediation of the mechanisms that lead to permanent hearing loss, either before or shortly after noise trauma, after diagnosis by a qualified physician.” The site urges those taking the pill to also use external hearing protection. But this isn’t a patent for a miracle cure, experts caution. NAC is still not FDA-approved as a treatment for NIHL. Rigorous scrutiny and further testing in humans is warranted before it is safe to expect that the supplements or any pill on the market can prevent NIHL. The FDA determined that NAC in a small dose is a nutraceutical – a name for foods claimed to have a medicinal effect on human health – rather than a pharmaceutical, and did not need regulatory approval to be sold. Unlike drugs, nutritional supplements aren’t subject to FDA regulation. Compared with the dosage of SRC-inhibitors, a higher dosage of NAC is required, says Henderson. In Kopke’s Oklahoma City lab, research continues on the development of drug approaches for the prevention and treatment

National Hearing Conservation Association Conference The National Hearing Conservation Association, whose mission is “to prevent hearing loss due to noise and other environmental factors in all sectors of society,” is convening its 35th annual Hearing Conservation Conference, from February 25-27, 2010, in Orlando, Fla. The conference, with the theme of “Explore the World of Hearing Loss Prevention,” will feature H.W. Davies, Ph.D., associate professor at the University of British Columbia School of Health, presenting “Noise and Cardiovascular Disease: Can Hearing Conservation Programs Prevent Heart Attacks, Too?”, and Christine Harrison, M.Sc., occupational audiologist, WorkSafeBC, presenting “Have Hard Hat, Will Travel — Hearing Conservation in the Great White North”. For more information, visit www. or call 303.224.9022. ■

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of NIHL. “Although initial results with NAC are encouraging, the damage and cell death mechanisms involved in noise-induced deafness are very complex,” he said. “Therefore we have been performing additional studies with a combination of NAC and other safe antioxidants including a nitrone.We have found that the combination treatment is considerably more effective, allows the dose of medicine to be lowered, and increases the time window for giving the medicine after noise exposure from four to 24 hours.” It may only be a matter of time before protective drugs for people exposed to dangerous noise levels become a possible solution, echoes Henderson. These drugs could take the form of a pill or nutritional bar and act as a supplement to boost the defenses of anyone, but especially industrial workers, soldiers and musicians.

For now, head to your local drugstore – for earplugs. Minding the risk factors for hearing loss and taking preventative measures like wearing ear protection and limiting noise exposure is still your best defense. ■

Elizabeth Stump is a medical writer and assistant editor at Springer Publishing in New York City. She is also the editor-in-chief of the Hearing Loss Association of America, Manhattan Chapter monthly newsletter. In addition to writing, Elizabeth enjoys reading, sports and fitness and exploring New York City.

Anti-epileptic Drugs May Help Prevent Noise-induced Hearing Loss Yet another drug-based plan of attack against noiseinduced hearing loss is coming from the Washington University School of Medicine in St. Louis, Mo. Research there, headed by Jianxin Bao, Ph.D., research associate professor of otolaryngology and head of the Central Institute for the Deaf’s Presbycusis and Aging Laboratory, has found that two anti-epileptic (anticonvulsant) drugs can prevent permanent hearing loss to a significant degree in mice exposed to loud noises. “The military has a tremendous need for preventing noise-induced hearing loss,” Bao says. “But others would also benefit. For example, many hunters have hearing loss on the side where they hold their gun and pilots are especially prone to hearing loss because of the noise in airplane cabins. Protective equipment or earplugs aren’t always appropriate and right now no drug on the market can prevent or treat noise-induced hearing loss.” Bao’s laboratory is dedicated to the study of both agerelated and noise-induced hearing loss. He and his colleagues found that if they exposed mice to loud sounds and then gave them trimethadione (Tridione®) or ethosuximide (Zarontin®) — anticonvulsant medications used to treat epilepsy — they could prevent a significant amount of permanent hearing loss. When mice got the medications before noise exposure, only trimethadione, not ethosuximide, significantly reduced subsequent hearing loss. These two anticonvulsant drugs have already received FDA approval and so could be used right away in clinical trials that study hearing loss. The experiments in mice showed that the drugs could reduce by about five decibels the permanent threshold shift that can occur after noise exposure. For example, if


the softest sound the mice could hear before the noise was 30 decibels, after the noise it might take a louder, 50-decibel sound for the untreated mice to hear, but only 45 decibels for the treated mice. “In people, a five-decibel difference in hearing ability can be important for [understanding] everyday speech,” Bao says. “We will continue our investigations of these kinds of drugs to see if we can improve the results. One possibility is to combine an anticonvulsant with an antioxidant to increase the protective effect.” Both drugs tested are T-type calcium channel blockers, which inhibit the movement of calcium ions into nerve cells. In the ear, calcium may play a role in causing damage to hair cells and the nerve cells that connect the hair cells to the hearing centers of the brain. These anti-epileptic drugs can unfortunately have some unwanted side effects, such as dizziness and sleepiness. “The drugs’ side effects would be detrimental in certain situations,” Bao admits. “But lowering the dosage and combining them with other drugs may be effective. Newer versions of anti-epilepsy drugs have fewer side effects and it may be possible to modify the structure of the drugs so that they don’t cross into the brain, which could avert some side effects.” The strongest conclusion of Bao’s work is that continued research in the area of pharmaceutical prevention of noise-induced hearing loss merits support. ■

Read more in Hearing Research, Dec. 31, 2006: “Prophylactic and therapeutic functions of T-type calcium blockers against noise-induced hearing loss” by Shen H, et. al.

F A Q on


What is noise-induced hearing loss (NIHL)? Every day, we experience sound in our environment, such as the sounds from television and radio, household appliances and traffic. Normally, we hear these sounds at safe levels that do not affect our hearing. However, when we are exposed to harmful noise — sounds that are too loud or loud sounds that last a long time — sensitive structures in our inner ear can be damaged, causing NIHL. These sensitive structures, called hair cells, are small sensory cells that convert sound energy into electrical signals that travel to the brain. Once damaged, our hair cells cannot grow back. What sounds cause NIHL? NIHL can be caused by a one-time exposure to an intense “impulse” sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a woodworking shop. Sound is measured in units called decibels. On the decibel scale, an increase of 10 means that a sound is 10 times more intense, or powerful. To your ears, it sounds twice as loud. The humming of a refrigerator is 45 decibels, normal conversation is approximately 60 decibels and the noise from heavy city traffic can reach 85 decibels. Long or repeated exposure to sounds at or above 85 decibels can cause hearing loss. The louder the sound, the shorter the time period before NIHL can occur. Sounds of less than 75 decibels, even after long exposure, are unlikely to cause hearing loss. Although being aware of decibel levels is an important factor in protecting one’s hearing, distance from the source of the sound and duration of exposure to the sound are equally important. A good rule of thumb is to avoid noises that are “too loud” and “too close” or that last “too long.” What are the effects of NIHL? Exposure to harmful sounds causes damage to the hair cells as well as the auditory, or hearing, nerve. Impulse sound can result in immediate hearing loss that may be permanent. This kind of hearing loss may be accompanied by tinnitus — a ringing, buzzing or roaring in the ears or head — which may subside over time. Hearing loss and tinnitus may be experienced in one or both ears,

and tinnitus may continue constantly or occasionally throughout a lifetime. Continuous exposure to loud noise also can damage the structure of hair cells, resulting in hearing loss and tinnitus, although the process occurs more gradually than for impulse noise. What are the symptoms of NIHL? When a person is exposed to loud noise over a long period of time, symptoms of NIHL will increase gradually. Over time, the sounds a person hears may become distorted or muffled and it may be difficult for the person to understand speech. Someone with NIHL may not even be aware of the loss but it can be detected with a hearing test. Can NIHL be prevented? NIHL is 100 percent preventable. All individuals should understand the hazards of noise and how to practice good hearing health in everyday life: Know which noises can cause damage (those at or above 85 decibels). Wear earplugs or other hearing protective devices when involved in a loud activity (special earplugs and earmuffs are available at hardware and sporting goods stores). Be alert to hazardous noise in the environment. Protect the ears of children who are too young to protect their own. Make family, friends and colleagues aware of the hazards of noise. If you suspect hearing loss, have a medical examination by an otolaryngologist (a physician who specializes in diseases of the ears, nose, throat, head and neck) and a hearing test by an audiologist (a health professional trained to measure and help individuals deal with hearing loss). Where can I get more information? The National Institute on Deafness and Other Communication Disorders maintains a directory of organizations that can answer questions and provide printed or electronic information on NIHL. Please see the list of organizations at ■ Source: National Institute on Deafness and Other Communication Disorders: hearing/noise.asp

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This image illustrates a small region of the cochlea, including hair cells and supporting cells. At the top of each hair cell is a specialized structure called a stereociliary bundle. In the image, each stereociliary bundle is bright green and has a shape somewhat like “V” or a “)”. Movement of the stereociliary bundle allows a hair cell to detect a sound. There are many different types of supporting cells within the cochlea as well, and one of these types, the pillar cell, is labeled in red in this picture. Photo courtesy of Matthew W. Kelley, Ph.D.

Recent Advances in Biological Restoration of Hearing BY MATTHEW W. KELLEY, PH.D


earing loss can occur in people of all ages, from newborns to the elderly.While the initial causes of hearing loss can be diverse, including viral infections, genetic mutations and long-term exposure to loud noise, in most cases, what ultimately occurs is damage to or death of the cells located within the cochlea, the snailshaped portion of the inner ear, resulting in hearing loss. Inside the cochlea are four or five rows of specialized cells referred to as mechanosensory hair cells. These cells change the


sound waves that enter the cochlea into small bursts of electricity, or signals. These electrical signals are carried into the brain through a specific type of nerve cell – spiral ganglion neurons. In addition to hair cells, the cochlea also contains rows of cells that support and surround the hair cells. While these cells do not play a role in the detection of sound, their presence and normal function is required for hair cell survival. Hence their name: supporting cells. Usually in cases of hearing loss due to toxic noise, infection or drug treatments, the hair cells are damaged or destroyed. How-

ever, in some forms of inherited deafness (i.e., deafness caused as a result of an abnormal change in a gene), the supporting cells are initially affected. But since hair cells cannot survive without functioning supporting cells, the effect is the same – they also die and hearing loss results. For reasons that are not understood, once humans lose their hair cells, they do not grow back, like skin cells do. However, when the spiral ganglion neurons are not damaged, as is often the case, the hearing loss may be partially restored with hearing aids that increase the activation of the remaining hair cells, or with a cochlear implant, a device that replaces the hair cells entirely. While both hearing aids and cochlear implants often provide good recovery of hearing function, the development of a biological method to induce the production, or regeneration, of new hair cells has the potential to completely restore normal hearing without any type of prosthesis. It is a mystery why humans, or any other mammals for that matter, cannot regenerate their hair cells. Studies in other animals, including birds, fish and reptiles, have demonstrated that they can regenerate their hair cells over and over again. The same studies have also shown that these regenerated hair cells develop from surrounding supporting cells. In contrast, in mammals, hair cells are only formed during a brief period in prenatal development. Because of this observation, several researchers have examined mammalian embryos to try to find the genes that are “turned on”

in cells as they are forming into hair cells. In particular, researchers have searched for specific kinds of genes, referred to as transcription factors, because these genes “turn on” (express) other genes. Several years ago, a gene called Atonal Homolog 1 (Atoh1) was found to be turned on (expressed) in developing hair cells. When the Atoh1 gene was specifically removed from a developing mouse, no hair cells formed in the mouse’s cochlea. By contrast, if cells within an embryonic mouse cochlea were forced to express Atoh1, then those cells would develop as hair cells even if they would normally have developed as supporting cells. Moreover, studies of certain species of birds indicated that the avian version of Atoh1 is turned on during hair cell regeneration.Together, all of these results suggested that if Atoh1 could be “turned on” in cells within an adult mammalian ear, then this might force those cells to develop as new hair cells. The first step toward testing this idea was taken when a combination of drugs was used to deafen adult guinea pigs by killing most of the hair cells in their cochleae. Following this treatment, the Atoh1 gene was expressed in one cochlea of each animal using a type of therapy in which a specially-designed virus transports the gene to where it needs to go to be effective. After two months of recovery, the hearing of these animals was tested. Many of the animals actually showed some restoration of hearing function in the cochlea that had received the Atoh1 gene therapy. Moreover, an examination of the cochleae of these animals revealed cells that

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This image shows a cross-section through the cochlea of a mouse. Different kinds of cells are illustrated in different colors. Mechanosensory hair cells are blue and supporting cells are either green or red. Photo courtesy of Matthew W. Kelley, Ph.D.

looked similar to immature hair cells. In a similar series of experiments, hair cells located in regions of the inner ear that regulate balance were destroyed and gene therapy was again used to introduce Atoh1 into the remaining supporting cells. As was observed in the cochlea, some of these animals demonstrated a partial recovery in balance function. While these results are exciting, important follow-up experiments still must be done before it can be concluded that expression of Atoh1 is all that is required to make a new hair cell in an adult ear. In addition, independent confirmation of the results from other laboratories, a crucial step for any experimental result, has not yet been reported. While progress is being made, the use of this type of gene therapy in a clinical setting remains highly experimental. These results are encouraging and supportive of the idea that expression of Atoh1 may have the ability to initiate growth of new hair cells. Nevertheless, we are a long way from the development and application of an Atoh1 gene therapy-based treatment for hearing loss in humans. Unlike those of birds, fish and reptiles, the supporting cells within the cochleae of adult mammals appear to have lost the ability to change into different types of cells. However, studies have shown that the supporting cells in the cochleae of prenatal mice can change into hair cells under certain circumstances. This suggests that an unknown aspect of the aging process causes supporting cells to lose their transformative ability. Whereas gene therapy to force the cells to change into a different cell type is a possibility, another option might be to introduce entirely new cells that behave like young cells that still have the ability to develop into different types of cells. Cells with these abilities are referred to as stem cells. The stem cells that play a role in the early development of an organism – embryonic stem cells – are perhaps the best known types of stem cells but many other stem cell types also exist, including bone marrow and nervous system stem cells. In fact, a study published a few years ago even identified a small number of inner ear stem cells in the ears of adult mice. In addi-


tion, researchers are close to being able to make stem cells from skin cells, meaning that it might be possible to make stem cells for any person who needs them. Regardless of where the stem cells come from, one approach to restore hearing might be to surgically place stem cells within the cochlea in such a way that they would fuse with the remaining cochlear structures and develop and function as hair cells. Depending on the type of stem cell, it might be necessary to treat the stem cells chemically and/or biologically to increase the likelihood of these cells becoming hair cells once placed in the ear. Ongoing research suggests that it is possible to increase the probability that a stem cell will become a hair cell, and in some cases cells that look very much like hair cells have been produced in the laboratory. But, as is the case for gene therapy, a number of challenges remain with a stem cell strategy to hearing restoration. For reasons that are not completely understood, even when stem cells have been delivered to the correct part of the ear, most of them have failed to incorporate into the cochlea. Moreover, in addition to the many types of potentially useful cells that stem cells can turn into, stem cells can also form tumors. So, while improving the techniques for introducing stem cells into the cochlea is an important requirement, it will also be imperative to ensure that these cells can be safely introduced with no risk of causing cancer. The criteria for biological hearing restoration treatments have changed considerably in the last 10 years. Prior to the development of the cochlear implant, the restoration of any hearing through biological methods would have been considered a success. But, when we consider how well cochlear implants work for most of the people who receive them, the criteria must be adjusted such that a biologically-based therapy for hearing restoration meets or exceeds the benefits that can be expected from a cochlear implant. This will probably require the ability to regenerate a much more complete cochlea, including specific types of hair cells as well as adequate supporting cells. It is possible that the use of gene therapy to introduce a single gene, like Atoh1, might be sufficient to restart the entire process of cochlear development, leading to regeneration of a normal cochlea, but it is also possible that we will need more direct control of multiple aspects of the regenerative process in order to regenerate a cochlea that can provide an understanding of speech and an appreciation of music. The new discoveries described above illustrate how biomedical researchers are rapidly developing a much more complete understanding of the genetic and cellular processes that will need to be manipulated to initiate a biologically-based treatment for restoring lost hearing. Hopefully, ongoing research will continue to identify specific genes that regulate key aspects of hair cell and supporting cell formation. At the same time, research with stem cells offers the potential to be able to introduce a completely new set of young hair cells into a damaged or elderly ear. While we are still several years from a biologically-based treatment for hearing loss, this is an exciting time for hearing research and the potential for major breakthroughs has never been greater. â– Matthew W. Kelley, Ph.D., is chief of the Developmental Neuroscience Section of the National Institute on Deafness and Other Communication Disorders, National Institutes of Health, in Bethesda, Md.

The Doctor Is In

DRF Centurions — At the Forefront of Our Cause In 1963, the nation’s leading ear, nose and throat specialists came together with a simple but important goal: to advance the research crucial to their fields, knowing that their practices and patients would directly benefit from this work. This innovative group became The Centurions – champions and supporters of Deafness Research Foundation (DRF). The Centurions now enjoy the support of more than 1,800 physicians, researchers and other professionals in fields related to hearing and balance sciences. Under the leadership of President David S. Haynes, M.D., and Secretary/Treasurer John L. Dornhoffer, M.D., The Centurions play an essential role in promoting DRF. To learn more about The Centurions, how to become a member or identify Centurions members in your area, please contact DRF at 866.454.3924, 888.435.6104 (TTY), visit our Web site at or e-mail In each issue, a member of The Centurions fields questions about hearing health and related issues. In this issue, questions were addressed by Centurion Alan G. Micco, M.D., FACS, who is chief, Section of Otology and Neurotology and associate professor, Departments of Otolaryngology and Neurological Surgery, at the Northwestern University Feinberg School of Medicine in Chicago, Ill. A couple of years ago I was experiencing tinnitus and dizziness. Results of an MRI suggested that a small vestibular schwannoma (VS) may have formed. A year later I had another MRI which revealed that the VS is not growing. Oddly, my tinnitus has gone, but I am still prone to some dizziness if I move my head abruptly. This dizziness has increased recently and I have been experiencing strong nausea. Is it possible that the nausea is related to VS? James M. via One of the inner ear’s main functions is to detect head motions so that the brain can appropriately coordinate eye muscle movements so that the eyes see as the head moves. Vertigo is caused when an unbalanced signal from the inner ears reaches the brain, and eye movements are not in sync with head motions. This will give a perception that the world is spinning.

This pathway from the inner ear to the brain goes through a center in the brainstem called the reticular formation where nausea is triggered, as when one becomes ill on an amusement park ride. It is also possible that a person can have multiple types of vertigo at once. Vertigo triggered by head motion or position change is called benign paroxysmal positional vertigo and is caused when the crystals from the inner ear organs move into the balance canals. This is the most common form of vertigo and is frequently associated with other types of ear problems, from ear infections to hearing loss. This type of vertigo can cause nausea as well and is usually treatable. Nausea can be associated with any inner ear problem, even a VS. Sometimes it can be the only sign of an inner ear problem. It is always recommended, however, that a patient have a check-up with a gastroenterologist to make sure there is no gastrointestinal problem causing the nausea.

Got a question you would like one of the nation’s leading ear, nose and throat doctors to answer? E-mail it to

Has there been any research on whether the sound of a food affects our opinion of it? We hear how the taste, texture, appearance and smell of food are appealing in various ways, so I was wondering if foods such as chips or Rice Krispies are more appealing because of their crunchy sounds and if they might not appeal equally to people who can’t hear those sounds. Eric Brady via There has been no specific research on this topic. However, it is well known that sounds do affect emotions and stimulate memories. It is these types of memories that one can create and associate with experiences. For instance, one can hear a song and remember the situation when he or she first heard it. If one lacks a sense such as hearing, other types of memory are associated with the experience, such as color or smell. While a hearing individual may associate the sound of certain foods with their taste quality, another person can do it with color, smell or feel. Therefore, a hearing loss should not affect one’s appetite or desire for certain types of food.■

The Centurions help ensure that clinical research continues in the field of hearing and balance science. To learn more about The Centurions or how to contribute to the Centurion Clinical Research Award, please visit www. or e-mail

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olidays bring opportunities for celebrating and relaxing with family and friends – or at least that seems to be the intention each year. More often, however, I’m rushing from one engagement to the next and usually making at least one long-distance trip. This holiday routine has inspired our selection in this year’s gift guide. Here are some great gift ideas for the stressed-out holiday traveler.

First, A Deep Breath Research has shown that, for people with hearing loss, listening is stressful

and fatiguing – even more so during the holidays. Recently, relaxation has been receiving more attention in research literature for its ability to ease the stress of chronic conditions such as hearing loss. The best gifts you can give a person with hearing loss are patience and kindness – and how about a new way to relax? We recommend a short but profound book, Yoga Nidra, by Richard Miller, Ph.D., available from Sounds True (www. for $19.95. It comes with a CD with two meditative practices. Another CD with four short relaxation practices, entitled “Guided Yoga Relaxations”


by Rolf Sovik, Psy.D., is available for $14.95 from the Himalayan Institute Press ( Or if just 20 uninterrupted minutes away from parenting a twoyear-old is all you really need, try Kidwinks, a three-DVD set with words and songs, spoken and signed, that has been “specifically created to support speech and language growth by using simple repetitive phrases with definite rhythms that help stimulate your child’s creativity and intelligence,” according to Watching the trailer on the Web site, you might not think Kidwinks is anything


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special – certainly no competition for Barney – but the effect on two-year-olds is hypnotic – the Teletubbies phenomenon all over again. Time to Travel Leaving home for the holidays? The last thing you need is a hearing aid malfunction. To keep hearing aids and hearing devices in top working order, take a travelfriendly Dry & Store® hearing aid and implant conditioning system (, which reduces moisture, dries earwax, kills germs, deodorizes hearing instruments and extends battery life. If your travel includes a tight schedule, oversleeping could ruin your whole holiday. So give these gifts in advance to heavy sleepers: vibrating/flashing wrist watches or alarm clocks. The VibraLite 2 wristwatch (about $50) features two alarm settings with vibration or beep alarm and a stopwatch. The VibraLite 3 ($60-$80) comes in a rainbow of colors and includes an auto-reload countdown timer,



while the VibraLite 8 ranges in price from $80 to $160 and features eight alarm settings, a countdown timer, stopwatch, backlight for use in the dark and a large digital display. These watches are available through Harris Communications (www., Hitec (www.hitec. com) and The Shake Awake alarm (www. is great for traveling, since it is compact and has a strong vibrating motor. The front cover folds under to become a stand on your tabletop or closes to protect the buttons when traveling. It has a light for nighttime viewing and a convenient chain strap with a clip for attaching the clock to a pillow, bed or chair. It’s reasonably priced at $30, AA battery-operated and has a plug-in for a lamp. It can also be used with the Visi-Bel®, a AA battery-operated visual flashing LED or strobe light, available for $40. The VisiBel Strobe can also be used to alert you to telephone calls. Purchased together, the Shake Awake and Visi-Bel are about $65 from Harris Communications.


The Shake N Lite® travel alarm has both a crescendo audio alarm and a vibrating alarm setting and costs about $25 from Harris Communications or Hearmore ( Tuck the Hydas Under Pillow Alarm® under your pillow to awaken to a gentle vibration. Available for less than $20, options include sound, sound and vibration, or vibration alone and it can be set for two different alarm times.Visit http:// and search for “under pillow alarm.” For those who need a big wake-up call, check out the Sonic Alert Sonic Shaker ( No gentle, soothing vibration for this portable vibrating travel alarm, which features a powerful bed shaker and extra-loud (90-decibel), pulsating alarm, available for $30. If you need an alarm that’s even more substantial, Sonic Alert’s Sonic Boom has a large, easy-to-read display, a bedshaker, hi/low dimmer switch, a loud 113-decibel alarm, adjustable tone and volume controls and battery back-up. For the holiday traveler who is on the go year-round, the portable Gentex Smoke Detector/Alarm (www.gentex. com) has a bright candela strobe and a 90-decibel alarm that will wake you when a regular smoke detector can’t. No hard wiring is necessary: whether staying in a hotel or with family and friends, simply pack it and plug it in! It also has a back-up battery. A great gift for those with hearing loss and/or vision problems, this device can be ordered for $130 to $180 from Harris Communications, HearMore, Harc Mercantile ( or SoundBytes (



Entertainment on the Go Travel during the holidays offers such a range of opportunities for making memories with family and friends. For example, a simple tool to allay the bored child is a portable DVD and/or CD player which can be used in the car as well as in grandma’s playroom. Imagine the travel games you can play using sign language. Baby Signing Time ( includes four DVDs and provides


a simple vocabulary of first words. Signing Time Series One was T ddeveloped for children aages one to eight and cconsists of 13 DVDs te teaching single-word signs through episodes si such as Playtime Signs, su ABC Signs, Family A F Feelings and Fun aand The Zoo Train. Signing Time Series Two, with 13 more DVDs, was developed for older children and introduces sentences through episodes such as Nice to Meet You and Happy Birthday. In addition, flash cards and four music CDs are available for purchase individually or in sets. When it’s time to travel, a good book is usually in order for everyone (except the driver!). Get ready for a long drive or settle down on a cozy couch on a wintry afternoon with inspirational stories reflecting the feelings and experiences of people with hearing loss and the challenges they face. Hidden Frustrations, by Maureen Mann, chronicles her journey as a hard of hearing student in a mainstream school setting. Her story has a happy ending, as she counsels hard of hearing public school students, inspiring them to reach for their own goals. Hearing Health’s own Elizabeth Thompson authored Day by Day: The Chronicles of a Hard of Hearing Reporter, blending memoir with the best of her Suburban News Publications columns. She shares about her experiences with hearing aids, FM systems, alarms and training her dog Snert to serve as a hearing guide dog. For younger readers, Deaf Child Crossing, by Marlee Matlin, is a story about nine-year-old Megan, who is deaf, and her excitement when Cindy, who is hearing, moves into her neighborhood. Cindy learns sign language and the two quickly become inseparable, although they face some bumps in the road as they learn the true meaning of friendship. These picks, as well as others, are available from Harris Communications and Amazon. com, among other booksellers. A popular way to while away the hours for tweens, teens and young adults is listening to music on an MP3 player. Able Planet’s LINX AUDIO™ sound isolation earphones or Clear Harmony behind-the-head earphones deliver music with amazing clarity, thanks to their innovative noisereduction technology. Ear/headphones can be purchased online from Able Planet (, from online hearing

healthcare retailers or stores such as Best Buy, Costco, Staples or Wal-Mart. Connect MP3 players to hearing aids and cochlear implant sound processors using direct audio input cords available from your audiologist, device manufacturers or online hearing healthcare retailers such as Harris Communications, Hearmore and SoundBytes. Did we miss someone on your list? Visit the archives at www. and check out the holiday gift guides from previous years for more great gifts for people with hearing loss. Also see the many product reviews in our Showstoppers articles, in the summer issues of our archived magazines. ■


Nannette Nicholson, Ph.D., is an sssistant professor and the director of Audiology in the Department of Audiology and Speech Pathology. She has a joint faculty appointment at the University of Arkansas for Medical Sciences and University of Arkansas at Little Rock, and a clinical staff appointment at Arkansas Children’s Hospital. E-mail her at Dawn O’Brien Taylor, M.A., M.Ed., ECSE, is an Au.D. student at the University of Bloomsburg, Penn. The authors would like to express their appreciation to Ashley DeLaune, B.S., an Au.D. student at the University of Arkansas for Medical Sciences, Little Rock, Ark., for her assistance.

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DRF Centerstage

‘Tis the 2009 Giving Season


etting ready to make your year-end charitable gifts? Consider making a gift to Deafness Research Foundation (DRF). DRF works to make healthy hearing possible for everyone through quality research and education. In addition to being the leading national source of private funding for research in hearing and balance science, DRF publishes Hearing Health magazine. Your support ensures that we can continue finding successful treatments to help those living with hearing loss and balance disorders and to protect those at risk. You may provide your charitable gift online at or by mail: Deafness Research Foundation 641 Lexington Ave., 15th Fl. New York, NY 10022 IRA Charitable Rollover Tax Incentive The economic turmoil of late resulted in a bit of good news for individuals aged 70½ and older. Congress extended the IRA Charitable Rollover tax incentive as part of the Emergency Economic Stabilization Act of 2008 (H.R.1424), signed into law on October 3, 2008. The IRA Charitable Rollover tax incentive allows individuals aged 70½ and older to donate up to $100,000 from their individual retirement accounts (IRAs) and Roth IRAs to public chari-

ties without having to count the distributions as taxable income. Only contributions made between January 1, 2008, and December 31, 2009, are eligible for the enhanced tax benefit. Donors must be 70½ or older when the distribution is made. A donor’s total combined charitable IRA rollover contributions cannot exceed $100,000 in any one year. Charitable contributions from an IRA must go directly to a public charity. Not 70½ Yet? General Gifts: Gifts to DRF can provide seed funding for exciting new research, support programs and enable us to continue our work in the years to come. Tribute Gifts: Consider making a donation in honor or memory of a friend or loved one, or for a special occasion, such as the holidays, a birthday or an anniversary. Matching Gifts: Many employers offer programs that match charitable contributions made by their employees. Employer matching gift programs may also be available to you if you are the spouse of an employee, a retired employee or the spouse, widow or widower of a retiree. This is a great way to enhance your gift to DRF. Gifts of Stock: Donating shares of a publicly traded company is an excellent means of giving to DRF. Your gift of stock that has appreciated in value over time may provide you with a greater tax benefit than giving cash. Your charitable income tax deduction is equal to the fair market value of the stock. You may also avoid paying capital gains tax on any increase in the current value over the original cost of the stock.Your broker can assist you in making a gift of stock by a direct transfer to DRF. Planned Gifts: When you name DRF in your will, you create a legacy of hope for people with hearing loss and balance disorders. With a gift through your will or living trust, you retain full use of your gift, preserving current income, during your life. Bequests and gifts through living trusts can be any size and may be of cash, securities, real estate or other property. In addition, such gifts can reduce estate taxes. Are You a Federal Employee? The 2009 Combined Federal Campaign (CFC) concludes on December 15. Funds raised go to support nonprofit organizations providing health and human services throughout the world. Please support DRF – CFC number: 11853 – through your CFC payroll deduction plan. For more information, e-mail or call 212.328.9480. ■ Deafness Research Foundation is a nonprofit organization with IRS 501(c)(3) designation. Your donation is tax-deductible to the full extent of the law. Note: This article is provided for informational purposes only and is not intended to serve as legal or tax advice. Please speak with your tax professional and/or attorney to determine the best fit for your philanthropic plans.


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Cell Phones and Hearing Aids



aving a hearing aid shouldn’t keep you from enjoying the convenience of a cell phone. Although incompatibility of the two technologies is still an issue, cell phones and hearing aids are getting along better than ever. The following edited podcast, one in a series from the American Speech-Language-Hearing Association (ASHA), taps the expertise of Hearing Loss Association of America Executive Director Brenda Battat and U.S. Access Board Senior Accessibility Specialist Tim Creagan to discuss the compatibility of cell phones and hearing aids. This podcast was moderated by Joseph Cerquone, director of Public Relations for ASHA.

ASHA MODERATOR: Brenda, how many people currently wear hearing aids and are expected to need them in the future? And how big of a decision is it for someone to purchase and wear a hearing aid?

BRENDA BATTAT: Today there are about six-million-plus people who actually are using hearing aids, a very small number. It’s


estimated that about 80 percent of people who could actually benefit from them don’t get them. And that’s for a variety of reasons. First of all, we all know that there’s still a level of embarrassment about wearing a hearing aid and about admitting that you have hearing loss. Another issue is sometimes people will take the step and then they find out it’s quite expensive. It’s an out-of-pocket expense for many people. So it’s a big decision and it’s impacted by

several factors, but the end result is many more people could actually get help for their hearing loss than do. ASHA: On the question of compatibility with things like cell phones, what do you hear from your constituents?

Hold the Line! More on Hearing Aid Compatibility of Cell Phones

BB: It’s actually quite positive; things are getting better. There was a survey done recently by Georgia Tech; they found that satisfaction level is increasing but still it’s a little difficult for people to find [cell phones]. And I think that’s an educational process – they need to know what to look for and where to look.

The Better Hearing Institute has compiled a list of more than 70 cell phones available in the U.S. that carry the highest rating of M4/T4, and are thus more likely to be compatible with hearing aids: www.betterhear

ASHA: You say that matters have improved. What helped bring about a positive change?

“How to Buy a Cell Phone When You Have a Hearing Loss” by Hearing Access Program Chair Janice Schacter has become the Better Hearing Institute’s most-downloaded article because of the practical information it packs, such as: an explanation of M and T ratings, and how compatibility is affected by style of hearing aid and geographical coverage areas. Available online through a link at enews/em030809.html.

BB: The hearing aid manufacturers really got quite aggressive and they worked on this problem and were able to increase the immunity significantly in hearing aids. So on that side there was action, and then on the phone industry side, as a result of FCC [Federal Communications Commission] regulations, phones are rated to know what kind of performance you can expect. And so with those two things going on, on the phone side and the hearing aid side, we’ve had great improvements. ASHA: Tim, where there is a compatibility problem between a hearing aid and a cell phone, what could the problem be? And how does one go about finding phones that are compatible? TIM CREAGAN: Typically the problem with hearing aids and cell phones [is] an issue of what’s called interference, and it’s an interaction between the hearing aid and the cell phone, which can produce an electronic buzz or a hum. The closest example I could provide, for someone who does not wear hearing aids, would be the sound that a fluorescent light makes when it’s about to burn out. That’s a very similar sound to what a hearing aid user experiences when using an unshielded phone and [it] is often worse when the hearing aid is being used on telecoil setting. What happens is the faceplate of the phone and the antenna may generate interference with the hearing aid, and so you’re experiencing the sound being drowned out by this noise. In August 2003 the Federal Communications Commission required that the telecommunications industry and its members work to reduce interference in cell phones, requiring them to produce at least two [models of] cell phones which had minimized interference. When it comes to looking for a phone, what I’m looking for is a rating called M for microphone, or T for telecoil switch on the box, and the ratings are from one to five, with the higher numbers being better. Most phones are rated three or four. ASHA: You mentioned a telecoil. How does one know whether a hearing aid has a telecoil to begin with? TC: Typically it’s something that would have been offered as an option at the time you were purchasing a hearing aid. And it’s something that hopefully would be discussed with you, or if the audiologist doesn’t bring it up, it’s certainly something that you

FCC Consumer Facts “Hearing Aid Compatibility with Wireless Phones and Services Frequently Asked Questions,” wireless.html. Explains FCC requirements for hearing aid compatibility of digital wireless telephones; labeling and testing requirements; and how to file a complaint with the FCC if you have a problem using a hearing aid with a digital wireless phone that is supposed to be hearing aid-compatible. “Connectivity: Early Steps Point the Way Toward Wireless Wonders to Come,” by Sara Bloom, addresses wireless connectivity issues that impact not only cell phone use but also MP3 players, movies, television and more. Published in Hearing Journal, October 2009, and viewable online at HearingJournal/article_detail.asp?article_id=2288. The Center for Hearing Loss Help has an excellent article, “Finding Hearing Aid Compatible Cell Phones” (, for better understanding the concept of hearing aid immunity and how these ratings work in tandem with cell phone ratings to produce the best possible outcome for a happy coupling of hearing aid and cell phone. “Hearing Aid Compatibility: Choosing a Cell Phone That Works For You” A new video series by CTIA–The Wireless Association® and Wireless RERC about what to consider when choosing a hearing aid-compatible wireless device, from discussions with a certified audiologist to the in-store “try and buy” process. Video series available at ■

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should bring up because it makes a big difference in your daily operations. BB: I’d just like to say one thing and that is the FCC actually has a minimum rating requirement, which is three or four, so you are not going to see ratings below three. However, if you have a highimmunity hearing aid, there’s a chance that it actually might work fairly well with a phone that is not rated. It’s really hard to predict, even with a rated phone, how it’s going to perform. And certainly if somebody doesn’t know exactly the immunity of their hearing aid, it could be hard to predict whether or not they’d be able to use an unrated phone. So we always say, “Try before you buy.”You can narrow down the search by first looking for a phone that’s rated three or four, but if that’s not working out, just try any phone that’s out there and see how it goes. ASHA: “Try before you buy” is easy to remember and very good advice.With respect to the M and T ratings, where would those ratings appear on the packaging? Where should one look? BB: On the box, which is not very helpful because you all know when you buy the cell phone, the box is probably the last thing you see. And I’m talking now about company-owned stores, not big-box stores.The reason I’m referring to company-owned stores is that I would encourage people with hearing loss to try to purchase their phones from company-owned stores because they are required by the FCC to let you try them out before you take them home. Also, they train the salesperson to help you find something to go with your hearing aid. So on the box, in the call-out cards, and then also on the Web site. I strongly recommend people go to the Web and do a little research before they go shopping; it’s going to make it easier to dialogue and communicate with a salesperson if you’ve already done your homework. ASHA: If someone cannot find a phone that’s going to work for them in terms of compatibility, what would be the first step for them? BB: I’d be surprised if they can’t find one, but it really depends on what we’re talking about here. If it’s that they can’t find one because they keep getting interference, I would just keep trying and try a lot of different phones. There is a difference between the operating system GSM and CDMA. CDMA, because of the nature of the signal, tends to cause much less interference than GSM. So one thing I would do in that case is default to a CDMA operating system, although we do have situations now where some phones offer both systems. So that’s getting a little more complicated than it used to be. If it still is not working, then you could look for hands-free accessories that enable you to get the phone away from the hearing aid, so there’s less interference. In this day and age, it wouldn’t be interference that would stop somebody from being able to find a phone they can use. It might be that their discrimination is not good enough, that they can hear but they can’t understand. That might be a situation where they want to think about moving to using a caption phone, where you have the benefit of some text to back up what you’re hearing. The other thing to be aware of


is that there are certain form factors in a phone that will make a difference. For instance, a flip phone gets the interference further away from the hearing aid versus the candy bar [style] – people do better with a flip phone. The bigger the screen size, the more potential for interference, so with some phones, iPhones and phones with big screens, it may be a little more difficult to find a compatible one. Also, now we’re getting into an age of metallic is sexy. Metallic casings are a lot harder to make compatible than the plastic ones that we used to have. Avoiding casing materials that are metallic, looking for screen size that is not so big, and a flip versus a candy bar – these all make things a little more likely to be compatible. TC: I’ve certainly found it to be true that the flip phone, for instance, is more likely to be compatible with hearing aids, because once you open the phone, there’s a greater distance between your microphone that you’re speaking into and where the antenna on the phone is. The more miniaturized the phone is, the more difficult it is to find something that will work with your hearing aid. Not that it would be impossible but it would be more difficult. ASHA: I think the question’s been answered to some degree already, but have advances in hearing aid design obviated the need to be concerned about compatibility with cell phones? TC: One of the things we do is work on design standards for electronic and information technology, which includes telecommunications products. Our guidelines would then be reviewed and adopted by the FCC as a basis of design standards for telecommunications products. One of the issues we look at is whether or not telecommunications equipment is compatible with hearing aids. And, as Brenda talked about, the GSM or the candy bar phones, which are very popular right now, are not accessible either in a visual or hearing aid setting. The manufacturers are working on that and they’re making progress. But it’s one of these situations where just because it’s a new product, you shouldn’t automatically assume that accessibility features have been integrated. I think Brenda can speak to this, but a few years ago, cordless phones, which had traditionally been analog, were required to be hearing aid-compatible. But then, when they switched from analog to digital service, some people were finding that cordless phones were not compatible; something had changed and the compatibility had been lost. That was an issue that had to be addressed through consumer input. And I believe that was successfully addressed, isn’t that right Brenda? BB: Yes, that’s absolutely right. Something else with the new technology in cell phones is that you’ve got companies coming along who have never made phones before. And there’s a requirement in the FCC regulations which says if you don’t have more than a certain number of products, then you’re not held to the requirement of making the phone hearing aid-compatible. So if you have a computer company suddenly come out with a phone, all of a sudden they only have one product and they’re actually, for the moment, not held to that regulation. And that is a real problem. The iPhone wasn’t hearing aid-compatible and [Apple] can actually


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It’s the cold and flu season but your hearing aid’s immunity won’t help you stay heathly. High immunity in a hearing aid can mean better compatibility with cell phones though. Your hearing aid’s immunity rating is the degree to which it is resistant to radio frequency interference, such as that which cell phones generate. Immunity ratings use the same scale as cell phone compatibility: M1-M4 and T1-T4. About the best you can find at present in hearing aids is a rating of M2/T2 – and more expensive and newer does not always mean higher immunity. Most hearing aid manufacturers list immunity ratings on their Web sites. Ask your hearing healthcare professional for the immunity rating when considering new hearing aids and if you’re a cell phone user, work with your healthcare professional to get a hearing aid with the highest immunity possible. ■

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claim exemption because they only have one [cell phone] product. And that’s an issue that we are quite concerned about. ASHA: How is it being addressed? BB: We filed a complaint with the FCC, we’re working one-onone and talking to the company involved. We have asked the FCC for clarification on that and we did not get what we were hoping for. We didn’t feel that the [exemption] was meant for a large company that has tremendous assets and just happened to come out with a new product. I think the company is trying hard to work on being compatible but it didn’t come out that way in the beginning. ASHA: Tim, along these lines, are more rulings or policy developments anticipated that could further foster compatibility? TC: The Access Board works on standards and guidelines to promote accessible electronic and information technology. We’re currently involved in a renewal of the design standards and guidelines under both Section 508 of the Rehabilitation Act and Section 255 of the Telecommunications Act. We’re looking at the current design standards for telecommunications products to revise them. In April 2008 our advisory committee submitted a report to us, which can be found on the Access Board Web site at, in which the committee made recommendations to the agency suggesting that we amend our current standards and guidelines to address some of the telecommunications design issues currently out there. Among the recommendations they made were that we look to standards for voice over Internet protocol [VoIP] phones, that we continue to insist on hearing aid-compatibility and that we do further work in that area.

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The Jitterbug cell phone is hearing aid-compatible. Photo courtesy of

Trends Picks for Telecommunication The Jitterbug Gifting Program ( is a convenient and flexible way to introduce a hearing aid-compatible cell phone to aging or grandparents. Jitterbug has a patented ear cushion that parents o reduces background noise and a powerful, loud and clear speaker. It work works with or without a T-coil and has big backlit buttons and bright text that is easy to see. Live, friendly Jitterbug operators are available 24 hours a day to make calls for you, provide a directory assistance and add names to your phone list. The direc new Jitterbug J sells for $147 while monthly plans range from $14.99 $14. to $79.99. Call 866.638.9211 for more information.

A cell phone with built-in navigation capabilities? The Garmin nüvifone® fully integrates the world’s bestselling GPS navigator with voice, data and mobile Web, available via AT&T (www. f $299. Shopping for for smartphone The Garmin applications? For $99.99, you can nüvifone® fully make a one-time lifetime purchase of integrates the world’s bestGarmin Mobile® for BlackBerry®. selling GPS With this downloaded application, navigator with a BlackBerry (www.blackberry. voice, data and com) and a wireless data mobile Web. plan, you get spoken, turn-byPhoto courtesy of turn directions to millions of destinations (www.garmin. com/mobile/garminmobile). Hark the herald land-line rings! It’s the Geemarc Ampli600 telephone, featuring a 50-decibel incoming amplified signal, caller ID, speaker phone, super-loud 95-decibel adjustable ringer volume, amplified input jacks, hearing aid compatibility and emergency connect features – and we’re not talking just dialing 9-1-1. In the event of a fall or emergency, the wearer presses the emergency button on the phone or on the transmitter worn on the wrist or on a lanyard aaround the neck. Six preprogrammed e emergency contact numbers are then d dialed automatically. ■

T Geemarc Ampli600 amplified The emergency telephone is available from e Harris Communications. H Photo courtesy of P


The Access Board is currently working on the revision of the standards and we anticipate that we may be able to issue an advance notice in which we will have draft text for review on our Web site at some period during this fall. ASHA: We’ve been talking about consumers and vendors and manufacturers with respect to this issue of compatibility with technology. I’m wondering what role audiologists can play to help educate consumers about the compatibility question. TC: I’m a long-time user of hearing aids and I have to tell you that, up until four years ago, I was actively discouraged by my audiologist from getting a telecoil in my hearing aid, and the reason I was given was because they don’t work very well and it’s not worth the hassle. Now since I’ve gotten one, I’ve found that to be absolutely not true. I’ve found that the T switch in the hearing aids is certainly a valuable asset and it measurably improved my quantity and quality of use of the phone. So I think that hearing aid dealers and audiologists should be aware of the issue, and that they should, when they’re meeting with their patients, make an effort to find out what their telephone usage is like and tell them about this information. BB: That’s right and I would like add one thing. I’ve had a hearing loss now for many years and I’ve been tested and evaluated in four different countries by audiologists and never once have I been asked the question how am I going to hear on the phone. And I’m not just talking about cell phones; I’m talking about land-line phones long before cell phones ever came to be popular. I think there’s too much emphasis on being able to hear face-to-face in a soundproof booth or a quiet office. Once we leave that office, we go out into a busy, bustling world and we have to function, and one of the ways is on the phone.There needs to be enough time given to making sure that whatever hearing aid is prescribed is going to be able to be used on the phone by that individual. And I think [audiologists] need to know the immunity of the hearing aids that they are selling to people so that they can give them some idea of what to expect when it

comes to interference potential with using other electronic devices. There’s a video available on [with] all of the information that we’ve been talking about today. It’s good both for them and for their patients. Cell phone usage and land phone usage is a big part of our lives and if it’s not taken into consideration when fitting the hearing aid, then we leave only half-prepared to deal with the world.

There are no regulations that cover video anywhere else. So right now there’s a coalition of hundreds of organizations working to pass the 21st Century Video Accessibility Law, making sure that video over the Internet would be captioned. The other big issues are things like Skype with captioning. Any audio signal now that’s relayed on the computer or cell phone needs to be accompanied with captioning.

ASHA: Tim, hasn’t your agency produced materials for hearing health professionals?

TC: One of the concerns that we have had, which has been actually addressed in recent months, is the ability of media that’s posted, for example, on YouTube, to be captioned. Government agencies, under section 508, are required to post multimedia which contains synchronized captioning and also synchronized audio description. YouTube has recently added a feature so that it’s possible for people posting on YouTube to post synchronized captioning with the material. This is something that we’re going to be paying very close attention to so that when we release the new design requirements we make sure to address the issues of embedded captioning in visual and auditory media. ■

TC: We’ve produced information on our standards and guidelines on On our first page, on the left-hand side of the page, there’s a heading called Communications and underneath that are two provisions, one is Section 508 and one is Telecommunications. If you click on the link for Telecommunications it will take you to both the standards, as well as some links for additional information and guidance. ASHA: Well, we’ve been talking about hearing aid and cell phone compatibility, but as we know, the popularity of audio technology continues to increase, I wonder where that leaves people with hearing loss. Are there other issues besides cell phone accessibility? BB: Absolutely, and the big one is the proliferation of video everywhere – video on your cell phone, video on the Internet. Right now you have FCC regulations governing video and TV.

Visit to see the full list of ASHA podcasts. Other items of interest include “Infants and Hearing Aids,” “The Value of Early Intervention for Late-Talking Children,” and “Protecting the Hearing of the Young,” with the Director of the National Institute on Deafness and Other Communication Disorders, James Battey, Jr., M.D., Ph.D. A new podcast is added monthly. Listen to individual episodes, download transcripts or subscribe to the feed and receive new files automatically through an aggregator program like iTunes.

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FAQs about Hearing Aids and Wireless Phones Who manufactures wireless devices that have been approved as hearing aid-compatible (HAC) by the FCC? All major handset manufacturers are required to offer HAC-compliant devices and may also offer hands-free accessories to improve usability. What does an “M3” or “M4” on the label mean? “M” refers to the device’s radio frequency emissions level and means the device is intended for use with hearing aids in microphone mode. The higher the “M” rating number on the device, the more likely you will be able to use the device with your hearing aid on the microphone setting. What does a “T3” or “T4” on the label mean? “T” refers to the device’s telecoil coupling ability and means the device is intended for use with hearing aids in telecoil mode. The higher the “T” rating number on the device, the more likely you will be able to use the device with your hearing aid on the telecoil setting. What is a telecoil? A small device that is built into some hearing aids for use with the telephone as well as assistive listening devices. To use the telecoil, generally either the hearing aid is switched to the “T” position or a button on the hearing aid is pushed to select the telecoil program. Some newer hearing aids will automatically switch to telecoil mode when using a phone. The telecoil picks up magnetic fields generated by telephones and converts these fields into sound. Are devices rated HAC more expensive than devices without hearing aid compatibility? No, the range of features and functions of wireless devices will impact the price but hearing aid compatibility will not. I already have a wireless device. May I trade it in for a hearing aid-compatible device? You will need to consult with your service provider. What if I cannot find a wireless device that works with my hearing aid? You can check with your hearing healthcare professional to determine if there is a hearing aid option for you that may work better with wireless devices. Some


telecoil users may find that accessories such as neckloops may further assist with their use of wireless devices. How can I be “hands free” while using my wireless device? If you use a telecoil, you may be able to use a neckloop. If you use the microphone mode in your hearing aid, you may be able to use the speaker phone function available on some wireless devices. If there is a Bluetooth accessory for your hearing aid, it may be able to work with Bluetooth-enabled wireless devices. What does HAC mean for hearing aids? This standard measures and rates the hearing aid’s immunity to the typical electromagnetic outputs from wireless devices. An M1 or T1 is the poorest immunity rating, and an M4 or T4 is the best immunity rating. How do I know if my hearing aids will work with a particular cell phone? If your hearing aid is rated for HAC, like many wireless devices are, then there is a method for prediction: just add the rating of your hearing aid to the rating of the wireless device. A hearing aid rated M2 and a wireless device rated M3 combine to a give an M rating of 5 and would likely provide “normal” use. An M rating combination of 6 would likely provide “excellent performance.” The same would be true of T ratings. The higher the combination, the better the user experience is likely to be. Every individual’s hearing loss is unique so ratings do not guarantee performance. Does HAC compliance apply to cochlear implants also? Cochlear implants are not regulated by the FCC and therefore are not rated. However, devices rated for HAC may make it more likely that a cochlear implant user will be able to use a cell phone with minimal interference either on the M or T setting. ■

Excerpted with permission from AccessWireless.Org, a publication of CTIA-The Wireless Association®. Visit for developments in accessible wireless services, products and features and a new consumer education video series: “Hearing Aid Compatibility: Choosing a Cell Phone That Works For You.”

Mother Nurture

The Squeaky Wheel BY KIM WATERS


hen my son Jay was four, his wish list for Santa included items such as a pony or a baby sister. His father and I thought it was just a passing phase – until the following year, when those items were still on the list. Although my husband and I had already decided that our family was complete with just one child, I began to think about how much a sibling would enrich Jay’s life. Friends will come and go throughout life but a sibling is forever – someone with whom to share everything, from the joy of having children to the grief of losing a parent. Also, a baby eats considerably less than a pony and is easier to clean up after! So a week after his sixth birthday, Jay welcomed his long-anticipated baby sister, Megan. From the beginning she was as much his as ours and he adored her. I knew the minute I saw the two of them together that expanding our family had been the right decision. In 2001, when Jay was born, universal hearing tests for newborns were not yet routine. So Jay’s hearing impairment was not discovered until just after his fourth birthday. We were determined not to go without such a vital evaluation with our second child, so Megan was screened right away. After what seemed like an impossibly long wait, the doctor came in beaming and announced that Megan had passed her newborn hearing screening. My whole body sagged with relief. Like any parent, I wanted my baby to start out her life with as many advantages as possible but I was surprised at the tiny bit of disappointment I felt as well. I realized that, deep down, a small part of me had almost wanted Megan to have a hearing impairment like her brother. Then Jay

Jay Waters delights in his baby sister Megan. Photo courtesy of Kim Waters

would have someone who would truly understand him and I would worry less about him feeling alone. I felt guilty for harboring such thoughts – as if I had been willing to throw my daughter under a bus for the sake of my firstborn, my own modern-day “Sophie’s Choice.” It was just a fleeting thought though; the other 99 percent of me was elated that Megan had normal hearing. That was not the last time, however, that my concern for Megan would be secondary to my conscientiousness in regard to Jay. There is some of the normal secondchild syndrome – marked by a dramatic decrease in photos and memorabilia compared to the firstborn – but I worry that more of my attention will be focused on Jay because I know that success will not come as easily for him. “Megan will be fine. No need to worry over her,” I’ve caught myself thinking many times. I take it for granted that things will fall into place for her and yet I feel anxious over Jay’s future. And, of course, that’s not fair to either of them. Then there are times when I feel guilty because of how much less effort I put into parenting Megan. In part, it’s because I’m just more at ease with the second child

but a lot of it has to do with how easy it is to communicate with her. What a difference spoken language makes! I know that sounds like the understatement of the year but I am amazed daily at my daughter’s expanding vocabulary – it seems to grow exponentially. The words that come out of her tiny mouth just leave me dumbfounded. But what really strikes me is her receptive language. It’s such a surprise to be able to give her directions and watch her follow them. What a contrast to the frustration we experienced with Jay. Now I realize how delayed Jay was at that age and I mourn the fact that, as inexperienced parents, we didn’t recognize his hearing loss sooner. I’m sad that we didn’t get to fully enjoy those years with Jay. What a treat it is to sit quietly and read my two-year-old daughter a book, to whisper silly thoughts back and forth. These moments are bittersweet when I realize what I never shared with Jay when he was that age. A friend once told me that some children tickle our hearts, others warm them. I’m sure that any mother with more than one child would say that her love for each child is unique, and yet equal. I hope that I will be able to maintain the balance within our family, even though the child with special needs sometimes requires more attention. I want both children to feel equally valued and loved. If not, I suppose I can always re-create the scene from “The Prince of Tides,” where the mother takes each of her children aside and utters the words many before her have said,“You know I love you the most, right?” ■ Contact Kim Waters through her blog, “A Little Less Conversation” at

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Dr. Defense


ashington Redskins safety Reed Doughty is humble and affable. A gentleman. The quintessential Mr. Nice Guy. Flip on ESPN during a Redskins game, however, and it will occur to you very quickly that there’s a whole other side to this guy. “As a safety, I get the chance to get my hands on the ball once in a while,” Doughty explains. “But I also get to hit.” And it is clear that #37 relishes every tackle. Doughty is a lot tougher than he looks. From the time he was in high school, playing varsity football and earning straight A’s, Doughty struggled with a significant hearing loss. Now 27, he estimates that he has about a 30 percent hearing deficiency in each ear and it appears to be progressive. He started wearing hearing aids in college, though he admits he wished he had started wearing them sooner. “I was always great one-on-one,” says Doughty, “but in a loud setting, I wasn’t always able to hear people talking to me. I wasn’t as outgoing sometimes because I worried about not being able to catch what others were saying. If I’d [been wearing hearing aids], I would have been more confident and direct, and maybe people might have thought I was nicer.” Could that be possible of


this handsome, blue-eyed, mild-mannered husband and father of two? The hardest part about being a Reed Doughty fan must be reconciling Mr. Nice Guy with Dr. Defense, who spends fall and winter Sundays vigorously tackling 200-pound running backs. While many kids dream of being professional football players, Doughty never once entertained the thought of turning pro. In his senior year of college, Doughty realized he might have a chance at playing for the NFL when he was named a candidate for the Draddy Trophy (often referred to as the “Academic Heisman”). Although he didn’t win the Draddy that year, in 2006 Doughty was drafted straight out of the University of Northern Colorado by Washington as a free safety. He is now in his fourth season with the Redskins - an incredible accomplishment for anyone, and even more so for a person with hearing loss. In college, Doughty says he was forthcoming about his hearing loss with his professors and coaches and did what he could to maximize communication with his teammates. He would sit up front in class so that he could read the lips of his professors and he paid close attention to his coaches during practice. However, when Doughty found himself in the pros, it suddenly occurred

Left: Reed Doughty, Washington Redskins #37, takes down an opponent for a tackle. (Photo courtesy of the Washington Redskins) Right: Doughty picks up his son for a family snapshot. (Photo courtesy of Reed Doughty)

Mr. Nice Guy to him that his hearing loss might be more of an issue. “I wasn’t trying to hide it,” says Doughty, “but I wasn’t jumping up, either. I had a new job that was predicated on my physical abilities. My coach noticed I would be staring intently at him – really listening to him – way more than the other guys. He finally said to me, ‘Reed, I think you may have a hearing loss.’ And I said, ‘Coach, I know I have a hearing loss.’” Doughty says his teammates take his hearing loss in stride and he gets a lot of good-natured ribbing about it. But it is clear his fellow players respect him and are glad he’s on their side. In 2008, Doughty was voted by his teammates the Redskins’ winner of the Ed Block Courage Award. Named for the late Baltimore Colts trainer, the award goes to a player on each team who is a source of courage and inspiration to his teammates. No doubt, Doughty knows about courage. Doughty and his wife Katie had their first son, Micah, in 2006. Born prematurely, Micah suffered chronic kidney failure as an infant and received a kidney transplant. Micah’s first few years were a tumultuous and uncertain time for the Doughtys. Reed had just started playing for the Redskins and Katie’s life revolved around

her son’s trips to the doctor and countless medications. At the urging of his wife, Doughty had actually started wearing hearing aids in college, though he admits that he only wore them sporadically. It was the chaos of having a new baby – particularly one with a significant health issue – that made Doughty realize he needed to be wearing them all the time. “My son would be crying and my wife would be trying to talk to me in the dark,” he says. “I couldn’t read her lips and I couldn’t hear her.” These days Doughty wears Siemens® behind-the-ear hearing aids, with good results. For safety reasons, however, he can’t wear them while playing football. So Doughty says he’s considering Lyric® in-the-ear aids because he would be able to leave them in to play and because they are compatible with his iPod®. Until the day when he can wear hearing aids on the field, Doughty relies on other tactics to do his job. “We use a lot of hand signals in football to begin with, which helps,” Doughty explains. “Fortunately in my position, I anticipate instead of react. And playing defense, I don’t have to listen to a count – I just have to see the guy coming at me.” But on those occasions when he needs to hear a play called or take direction

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from a coach, Doughty still has to lip read, which isn’t easy when there’s a facemask blocking his view. Even coaches today sport horizontal headsets on the sidelines, which almost entirely obscure their mouths. So how ‘bout them Redskins, anyway? At press time,Washington was 3-6, making it very unlikely that the team will be heading to the playoffs. “It’s been a frustrating season,” Doughty says. “We have a lot of talent on the team but we’re not playing particularly well.” For a guy who spent the off-season recovering from a back injury which kept him out of play for most of 2008, his team’s lack of synergy this year is clearly disappointing. But even if his team goals aren’t coming together the way he’d like, being completely healthy now and able to play almost every game this season is something for which he’s grateful. In the world of professional sports, gratitude can be hard to find. It’s easy to get caught up in self-promotion, but Doughty credits his father, who also has a significant hearing loss, with not overinflating him as a youngster. “He kept me humble,” Doughty explains. “With my dad, it was all about hard work and ethics and about how you play the game. For both of us, integrity means a lot.” Doughty brings that integrity to his off-field endeavors, too. Because of his first-hand experience with hearing, back and kidney issues, earlier this year Doughty served as honorary chairman of the Hearing Loss Association of America’s Washington, D.C. Walk4Hearing; the Washington-area Kidney Walk; and Spinal Research Foundation’s “We’ve Got Your Back” Walk. He and Katie also support Kidney Kids, a needs-based organization that helps families make payments and improve their well-being when a child is undergoing kidney treatment or surgery. It would be easy to assume that Doughty’s life revolves entirely around physical matters: his hearing loss, athleticism and medical

issues. Nothing could be further from the truth. “My wife and I are very blessed and we trust God in every aspect of our lives,” says Doughty. “To me there’s nothing better than coming home and having dinner with my family after a game. My kids give me a break from football.” Although they’ve lived in Washington, D.C., since he started playing for the Redskins, Reed and Katie bought a house “back home” in Colorado last year, in the hopes of perhaps indulging in hobbies they both enjoy that have taken a backseat to football. As his sons grow up, Doughty would love to introduce them to fly fishing, snowshoeing, hiking, camping, cycling – all those things that keep him a Colorado boy at heart. Doughty’s sons both appear to have perfect hearing and that’s another blessing for the family. Micah’s kidney transplant was successful and he’s doing well, though as Doughty says, a transplant is not a cure because transplanted kidneys only last three to 20 years. More transplants are certainly in Micah’s future and the Doughtys hope they will still have the NFL’s excellent health insurance when that time comes. The “Dr. Defense” Reed Doughty knows he has many seasons left in him to make hits on the field that would knock the average guy senseless. But after the game, a strange transformation always occurs in the locker room and out walks Mr. Nice Guy. Doughty realizes that he is an inspiration to young athletes – with and without hearing loss – and takes the job of mentor very seriously. He recently received an e-mail from a young man who asked his advice about playing football with a hearing impairment. “With younger kids, a hearing loss can be seen as a social stigma,” says Doughty. “But I tell them what I wish someone had told me: It’s better to be able to communicate than to be perceived as cool. I just tell [those kids] to be forthcoming with their coaches about their hearing loss, to put their best foot forward and try hard.” ■

Reed Doughty, “Dr. Defense,” on the field. (Photo courtesy of the Washington Redskins) And Reed Doughty, “Mr. Nice Guy,” with wife Katie and sons Micah and Caleb. (Photo courtesy of Reed Doughty)


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17 Misconceptions About People with Hearing Loss BY JANICE SCHACTER


isconceptions about people who are deaf or hard of hearing are commonplace – some are antiquated stereotypes, others just incorrect assumptions. It’s easy enough to get the wrong idea, as hearing loss can be an invisible disability – unlike the wheelchair that signals a mobility challenge. Whether it’s a total stranger trying to make small talk in sign language or an over-articulating coworker or relative, it’s time we initiated the conversation that will correct misconceptions and remove the stigma associated with deafness and hearing loss.This list of the more common misconceptions – and there are many more – can be a good starting point for that conversation.

E 1Hearing . loss spans across a spectrum from mild to completely VERYONE WITH HEARING LOSS USES SIGN LAN GUAGE AND READS LIPS

deaf and not all people with hearing loss communicate the same way. Communication depends on a variety of factors, such as the degree of hearing loss, whether a hearing aid or cochlear implant is used, the age at which the person lost his hearing, the level of auditory training received and the nature of the listening situation. The majority of people with hearing loss do not use sign language but it is still important to those whose communication depends on it. American Sign Language is a visual language with its own syntax and grammar that is quite different from spoken and written English. Sign language varies by country as well. A person with some knowledge of sign language is not a substitute for a qualified interpreter who is trained to transmit what is said clearly and accurately. Some people with hearing loss read lips and others do not. Lip reading, also called speech reading, is most helpful as a supplement to residual hearing, even though many speech sounds are not visible on the lips. It does help to face the person with hearing loss when speaking. Many people can pick up visual clues even if they are not proficient at lip reading.

T 2Increasing . the volume is only part of the solution; clarity is also


important.And there is a point where increasing the volume begins to distort the quality of sound. To obtain sufficient clarity, people with residual hearing may require sound to be transmitted from a microphone directly to their ear via an assistive listening system.


Sitting close to the speaker can assist the listener (it facilitates lip reading) but is not a substitute for an assistive listening system. Yelling and over-articulating does not help because these distort the natural rhythm of speech and make lip reading more difficult. A person who can hear normally cannot determine whether the sound is adequate for a person with hearing loss.

3A Hperson does not obtain “normal” . hearing by wearing a hearEARING AIDS AND COCHLEAR IMPLANTS RESTORE HEARING TO NORMAL

ing aid or cochlear implant. These are not solutions for hearing that are equivalent to wearing glasses to correct poor eyesight. Hearing aids increase the volume but only slightly enhance clarity by raising the volume in certain frequencies. The improvement a cochlear implant makes can vary from providing near-normal hearing to only gaining an awareness of environmental sounds with no comprehension of what they mean. Results depend on such factors as the individual’s hearing history, length and onset of deafness and age of implantation. People with hearing loss may be able to understand and respond correctly many times by listening intently but they can miss important information. Furthermore, it can be tiring to listen intently for a prolonged period.



People with hearing loss have the same range of intelligence as the general hearing population. People with untreated, or inadequately treated, hearing loss may respond inappropriately since they may not have heard what was said. Some people with hearing loss can speak and others cannot; again, there are many factors at play. A person who speaks well doesn’t necessarily hear well. And it can be frustrating or upsetting when others remark on how well they speak – and even more so if the remark is directed to a bystander, rather than directly to the person with hearing loss. People with hearing loss are fully employable but may need certain accommodations for effective communication, as required by the Americans with Disabilities Act. It is always best to ask the person what type of accommodation is needed. When conversing via telephone and using a relay service, there may be delays for interpreting or transcribing. People who are not familiar with relay services may wrongly assume that the lag time reflects on the level of intelligence of the person with hearing loss.




Access or accessibility

Handicapped or disabled services

People with developmental disabilities He has an intellectual disability

The mentally retarded He’s retarded

My son has autism

My son is autistic

She has Down syndrome

She’s a Downs kid, a mongoloid

He has a learning disability

He’s learning disabled

I have paraplegia

I’m a paraplegic

She has a physical disability She has a mobility impairment

She’s crippled

He’s of short stature

He’s a dwarf (or midget)

She has an emotional disability

She’s emotionally disturbed

He uses a wheelchair

He’s wheelchair bound or confined to a wheelchair

5OfPthe 36 million people with some. form

A typical person or a person without a Normal and/or healthy person disability

of hearing loss, only 30 percent are 65 or older.

He receives special education services He’s in special education




Hearing loss is a characteristic, like the color of one’s eyes. It does not define a person. The “person” should be listed first, for example, “a person who is hard of hearing,” “a person who is deaf,” or “a person with hearing loss.” (See “People First Language”).

7ThisH assumption . at least partly explains AVING HEARING LOSS IS SHAME FUL

why many people with hearing loss will not purchase or use hearing aids. According to the National Institute on Deafness and Other Communication Disorders,“Only one out of five people who could benefit from a hearing aid actually wears one.”

Congenital disability

Birth defect

Accessible parking, bathrooms, etc.

Handicapped parking, bathrooms, etc.

She has a need for. . .

She has a problem with. . .

REMEMBER, PEOPLE FIRST, so… R • Do not refer to a person’s disability unless it is relevant! • Use “disability” rather than “handicap” to refer to a person’s disability. • Avoid negative or sensational descriptions of a person’s disability. • Don’t use “normal” to describe people without disabilities; instead say “people without disabilities” or “typical” if comparisons are necessary. • Never assume that a person with a communication disorder also has a cognitive disability such as mental retardation. • Don’t portray people with disabilities as overly courageous, brave, special or super-human. ■ A Adapted with permission from Kathie Snow,, and Self-Advocacy Solutions, North Dakota. N

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It’s frustrating to people with hearing loss not to have something repeated when they miss part of the conversation. Saying, “It wasn’t important” compounds the frustration because now not only did they miss part of the conversation but the conversation is also being edited.The person with hearing loss wants to decide for himself or herself what is important.


9If a person with hearing loss interrupts a conversation, it is WITH HEARING LOSS ARE RUDE AND

ter imply a deficiency in the person rather than removal of barriers. However, as access is not limited to mobility impairments, business Web sites, brochures and promotional materials should provide information for people with hearing loss, visual impairments and cognitive disabilities as well.

13ManyHpeople with hearing loss. ’are so accustomed to there’being EARING ACCESS ISN T NEEDED BECAUSE IT S SO RARELY REQUESTED

no accessibility accommodations that they don’t inquire about it unless it is publicized. Access, when made available and publicized, is usually used.

probably because they didn’t hear the speaker, not because they are rude. People with hearing loss may position themselves toward the front of a group or in a room so that they are closer to the speaker, making it easier for them to hear and lip read. This behavior is sometimes incorrectly interpreted as pushiness.

14 PPeople who are blind read Braille. B . P 15Hearing . access is less expensive than most people think. Many

P 10 . Hearing loss can affect anyone and does not discriminate. Peo-

solutions exist for just a few hundred dollars. Obtaining price estimates is advisable.

ple with hearing loss spend time with family or friends who may or may not have hearing loss. They do not want to be relegated to special seats away from the rest of the people they are with.

16 “D.“



11Ear buds and ear bud-style headsets require people with hearing


aids to remove their hearing aids. Headsets typically do not work for people who wear behind-the-ear hearing aids nor for many people who have more than mild hearing loss because the sound output is insufficient. People who have cochlear implants or T-coils in their hearing aids can receive signals directly through their hearing aid or cochlear implant when an induction loop is used. They can also access FM or infrared signals directly to their hearing aid or sound processor by using a neck loop receiver or an attachment (boot) to their aid or sound processor. The neck loop can be plugged into headphones but most one-piece headphones lack jacks.

T 12The wheelchair . symbol does not represent people who are deaf, HE WHEELCHAIR SYMBOL REPRESENTS UNIVER SAL ACCESS

hard of hearing, visually impaired or who have cognitive disabilities. Using the wheelchair as a symbol of universal access makes it more difficult for appropriate access to be obtained for other disabilities, since mobility is the only disability portrayed by this symbol. It is also important to use the appropriate hearing loss symbols to specify the kinds of access being provided. There are different symbols for interpreting, assistive listening devices and systems and open and closed captioning (see “Symbology”). Many companies provide access information under the heading of “Access” or “Accessibility,” which is preferred to terms such as “Disabled Services” or “Handicapped Services,” since the lat-







The umbrella term for the category is “people who are deaf or hard of hearing.” “Deaf ” denotes a profound loss of hearing and can also be used to refer to the community of people who are deaf and share a language, such as American Sign Language, and a culture. “Hearing impaired” is not a preferred term.

17 C


When hiring an access coordinator, it is critical to investigate the person’s experience. A person can be an expert in one area of access, such as mobility impairments, but may not understand access issues for people with hearing loss, visual impairments or cognitive disabilities. Also, hiring a person with hearing loss does not guarantee that the person has knowledge of effective access for people with hearing loss or for the full range of hearing loss. ■

Janice Schacter is an accomplished advocate across the hearing advocacy and related political spectrum. She founded the Hearing Access Program in 2002. It is the only organization dedicated to helping the world’s corporations, cultural and entertainment institutions, government agencies and mass transit organizations improve their accessibility for people with hearing loss. Contact Janice at This article was developed in consultation with people and organizations representing people with hearing loss.


Below are the official symbols that identify the type of access available. This information and the Disability Access Symbols* were produced by the Graphic Artists Guild Foundation with support and technical assistance from the Office for Special Constituencies, National Endowment for the Arts. Visit to download high-resolution images of these symbols for use in printed material and in signage.

Access (Other than Print or Braille) for Individuals Who Are Blind or Have Low Vision This symbol indicates access for people who are blind or have low vision, best used in places such as a guided tour; a path to a nature trail or a scent garden in a park; and a tactile tour or a museum exhibition that may be touched. Symbol for Wheelchair Accessibility The wheelchair symbol indicates access for individuals with limited mobility, including wheelchair users. Remember that a ramped entrance is not completely accessible if there are no curb cuts and an elevator is not accessible if it can only be reached via steps. Audio Description People who are blind or have low vision may enjoy performing arts, visual arts, television, video and film that offer live commentary or narration (via headphones and a small transmitter) of visual elements provided by a trained Audio Describer. An adapter for nonstereo TVs is available through the American Foundation for the Blind, 800.829.0500. Telephone Typewriter (TTY) This device is also known as a text telephone (TT), or telecommunications device for the deaf (TDD). TTY indicates the presence of a device used with the telephone for communication with and between people with hearing loss and speech impairments. Volume Control Telephone This symbol indicates the presence of telephones that have handsets with amplified sound or adjustable volume controls. Assistive Listening Systems These systems transmit amplified sound via hearing aids, headsets or other devices such as a neckloop. It is recommended to indicate the devices available under the symbol. Sign Language Interpretation The symbol indicates that sign language interpretation is provided for a lecture, tour, film, performance, conference or other program.

Accessible Print (18 pt. or Larger) Large print is indicated by the words: “Large Print,” printed in 18 point font or larger text. In addition to identifying large print versions of books, pamphlets, museum guides and theater programs, you may use the symbol on conference or membership forms with large print. Sans serif or modified serif print with high contrast is important, and special attention should be paid to letter and word spacing. Induction Loop Symbol An induction loop system utilizes an electromagneteic coil to create a magnetic field. The hearing aid wearer switches the hearing aid to the T-coil setting to receive sound directly to the aid. The symbol also indicates hearing aid-compatible devices such as audio guides or phones. Closed Captioning Closed Captioning (commonly known as subtitles) enables people who are deaf or hard of hearing to read a transcript of the audio portion of a video, film, exhibition or other presentation. As the video plays, text captions transcribe (although not always verbatim) speech and other relevant sounds. Open Captioning This symbol indicates that captions, which translate dialogue and other sounds in print, are displayed on the videotape, movie, television program or exhibit audio. Open Captioning is preferred by many people with hearing loss, as well as people whose second language is English. Braille Symbol This symbol indicates that printed material is available in Braille, including exhibition labeling, publications and signage. Web Access Indicates the Web site was designed with accessibility features. The symbol should always be used with the following alt-text tag: Web Access Symbol (for people with disabilities).■

*Hearing loop symbol courtesy of Web symbol courtesy of

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T ilbl Trailblazer off the h Y Year T Tate T Tullier lli ((center)) accepts a check h k ffrom P Purple l C Communications’ i i ’B Brandon d A Arthur h (l (left), f ) vice i president id of marketing communications, and Dan Luis, chief executive officer. Photo courtesy of Purple Communications

Blazing a Trail to Bigger Dreams


hroughout this past summer, Purple Communications, a leading provider of text and video relay and on-site interpreting services, has honored deaf citizens around the U.S. as Trailblazers – people who have positively impacted the deaf and hard of hearing (D/ HH) community. As part of the company’s “Dream Bigger” Campaign, 10 Trailblazers were honored for making a difference in such areas as sports, civil rights, politics, business, language, community, medicine, the arts and education. Each Trailblazer received $1,000 on behalf of the organization of their choice and was then eligible to win the Trailblazer of the Year award, chosen exclusively by online voting at Purple’s event Web site, “Purple specifically focuses on breaking down communication barriers through our hardware and software products. So it’s fitting for us to honor those in the deaf and hard of hearing community who have broken down barriers in their

respective fields, paving the way for future deaf and hard of hearing citizens to reach their dreams,” commented Dan Luis, Purple’s chief executive officer. “From city to city, we have watched communities come together to honor the individual Trailblazers, inspired by their passion to go out and serve their community in hopes of eliminating the challenges that face the deaf community.” On October 17, in Washington, D.C., Luis pronounced Tate Tullier of Louisiana Trailblazer of the Year. A professional photographer who began his career at the age of 12 using the Louisiana landscape as his inspiration, Tullier graduated from Gallaudet University in 2003. He pursued a photography career in New York City and then returned to the South in 2005. He has grown his business through a combination of online and “word of hand” marketing in the D/HH community, where he is heralded as a creative leader for deaf youth. “I am overwhelmed and overjoyed that so many in the deaf community saw


something special in me and selected me as their winner,” said Tullier. “The outpouring of support I have received from the deaf community has been amazing. In winning the award, I want to challenge the deaf youth of tomorrow to reach for their goals, dream bigger and know that anything is possible with hard work and dedication.” As Trailblazer of the Year,Tullier won an all-expense-paid vacation to the destination of his choice. An additional $10,000 was also awarded in Tullier’s name to the organization of his choice, Louisiana School for the Deaf in Baton Rouge, which serves 500 D/HH youth. Donna Alleman, interim director of Louisiana School for the Deaf, was ecstatic to hear about the donation to the school. “We are all so proud of Tate and are pleased to accept this donation to Louisiana School for the Deaf from him. The money will be used to fund an afterschool program to foster creativity in the areas of art, drama, photography and dance for our students.” ■

Regional Trailblazers and the Organizations They Selected to Receive $1,000 M.J. BIENVENU, PH.D. BALTIMORE, MD. ABUSED DEAF WOMEN’S ADVOCACY SERVICES Bienvenu, an educator, activist and American Sign Language (ASL) advocate from Washington, D.C., has spent a lifetime seeking bilingual education for deaf students. A nationally recognized ASL advocate, she has tirelessly pursued government-recognized legitimacy of ASL, while teaching students the language’s beauty and its central role in deaf culture.

ELLA MAE LENTZ OAKLAND, CALIF. THE DEAFHOOD FOUNDATION Lentz is an ASL poet, author and advocate. A graduate of Gallaudet University, Lentz coauthored a bestselling book and video on ASL and video collections of original ASL poetry. She is one of the nation’s leading advocates for the concept of Deafhood, a celebration of individual and collective journeys.

HOWARD A. ROSENBLUM CHICAGO, ILL. MIDWEST CENTER ON LAW AND THE DEAF Rosenblum, a civil rights attorney with Equip for Equality, strives for equal access for people with disabilities, primarily in Illinois but also across the U.S. He founded the Midwest Center on Law and the Deaf, a nonprofit that seeks to make the legal and judicial systems accessible to thousands of D/HH across the Midwest.

ANITA BUEL MINNEAPOLIS, MINN. PINK DEAFIES Buel is a community organizer who survived a first, then a second bout with cancer, fighting along the way to make healthcare – and cancer education – more accessible to people with hearing loss. She co-founded Pink Deafies, a support group focused on providing comfort, hope and education to D/HH individuals with cancer.

TAYLER MAYER LOS ANGELES, CALIF. KODAWEST A Southern California technology luminary and e n t re p re n e u r, Mayer founded the seminal deaf blog/vlog aggregator and the online video community DeafVIDEO.TV. Mayer has spent much of his professional career seeking new ways to apply technology to connect the deaf community online while achieving entrepreneurial success.

CAROLYN STERN, M.D. ROCHESTER, N.Y. DEAF HEAL Stern is a physician and lecturer in Rochester who has spent her life treating and educating deaf patients on health issues; training interpreters for interpreting in medical settings; educating other doctors, hospitals and allied healthcare professionals on accessibility; and ensuring that national continuing medical education programs are accessible for D/HH.

ASHLEY FIOLEK ST. PETERSBURG, FLA. HEARING LOSS ASSOCIATION OF FLORIDA Fiolek,an XGames national champion motocross rider, is the only woman, and the only deaf person, ever to ride on a factory racing team. Seeking to be the fastest woman motocross rider in the world, Ashley is dispelling stereotypes about people with hearing loss and women everywhere she races.

KEVIN NOLAN BOSTON, MASS. AMERICAN ASSOCIATION OF PEOPLE WITH DISABILITIES Nolan, the nation’s first borndeaf person to be elected to public office, launched a political campaign near Boston that unseated a seasoned political insider who had held the office for more than 20 years. Nolan’s tenacity cleared the path to elected office for deaf people everywhere.

JEREMIAS VALENCIA SAN DIEGO, CALIF. DEAF SPORTS ACADEMY Valencia is the founder of Deaf Sports Academy in Riverside, Calif. A former professional basketball player,Valencia pushes players to “never give up on their dreams.”Valencia’s Deaf Sports Academy provides accessible coaching and encouragement, opening the world of sports and competition to more than 20 teams of kids, from preschool through grade eight. ■

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Dedicated to Healthy Hearing

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Ear Technology Corporation’s hallmark is innovation with a purpose, and with uncompromising quality. Our history is made up of practical, real-world solutions to unmet needs in the hearing healthcare industry. Our future is bright: Helping people hear better every day.; e-mail:; 866.844.4327

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It’s Never Too Late for Better Hearing BY BEVERLY SHAY


ince the age of 25, John Ayers has suffered varying degrees of hearing loss, in part due to a genetic condition which affects males in his father’s family line. By the time he was in his early 50s, he was wearing hearing aids. Then in 2004, while working outside, he instantaneously lost all hearing in his left ear and had severe vertigo. A virus was the culprit. Ayers began diligently pursuing a more effective treatment for his hearing loss. He found a cochlear implant (CI) surgeon, Robert Peters, M.D., in Dallas, and received his first implant in October 2005. Unlike hearing aids that only amplify sound, CIs use speech processors to convert sound into digital signals, which are then processed through the nervous system to provide hearing. A cochlear implant is an electronic device, surgically implanted to provide hearing for the deaf or profoundly hard of hearing. To implant the device, a small metal plate is first inserted in the scalp behind and slightly above the ear; this plate is magnetic and holds a dollar coin-sized computer chip. The doctor then drills through the mastoid to the cochlea. An electrode array is inserted into the cochlea next to the nerve endings found within the cochlea. The processor itself is worn behind the ear and is similar in appearance to certain hearing aids. It contains batteries, a miniature computer processor and has a magnetic lead, which attaches to the plate in the scalp. Following a six-week healing process, the recipient is “activated” – the chip is turned on, and via computer, programmed. “It’s like having a child in your head who does not know what he is hearing,” Ayers described the period of time involved in “mapping” the signals into sounds that make sense. “What most people don’t realize is your eyes and ears act in tandem to provide

hearing. “It’s something you do without thinking about it.” The next few years became a journey of hearing restoration for him. Ayers’ delight in his recouped hearing has led him to participate in research that will most likely benefit others more than himself. Having successfully received an implant in his right ear in February 2007, at age 73, Ayers was asked to apply for a position as a test subject at the Binaural Hearing and Speech Lab at the Waisman Center, University of Wisconsin-Madison, under Ruth Litovsky, Ph.D. The center was originally funded in the 1960s by the late Joseph Kennedy, due to his family’s personal interest in disabilities. “I immediately became excited about the prospect of reversing roles – from being on the receiving end of help and care, to the possibility of being a giver,” Ayers recalled enthusiastically. For three-and-a-half days, two doctoral candidates, Smita Agrawal and Gary Jones, performed rigorous tests involving 25 speakers and panels of 100 words shown on a computer. Ayers was asked to identify sounds and locate where they were coming from in noisy environments. The tests were designed to provide data that would lead to the improved ability of CI users to identify sound location, as well as isolate and discriminate between speakers. Ayers has since participated in three such research projects. Ayers quickly found that the better he did on the tests, the more they tested him, increasing the complexity of each progressive test. “I was told they wished to get the best set of data obtainable by pushing [us to our] limits,” Ayers remarked, indicating that all he wanted to do once the day was over was sleep! The advanced tests worked on hearing focus. People with natural hearing can automatically tune out or ignore those sounds they do not wish to hear in order to focus their attention on those they want to listen to. Being quite familiar with the challenge of hearing in crowded rooms, Ayers was eager to give the testers every last bit of data he could. In another research project, Ayers wore a SPEAR 3 research speech processor directly connected to the lab computer. This time they observed the mapping control of Ayers’ speech processor by enabling him to better “center” the sounds to the left, center or right of his forehead and to handle and identify more than one sound arriving simultaneously. Under examination was the stereophonic hearing our brains naturally provide. Following his time with the University of Wisconsin, Ayers received a call from the University of Texas at Dallas (UTD) in

John Ayers speaks to a health support group about hearing loss. Photo by Jack Chamblee


From left: Philip Loizou, Ph.D., director of the University of Texas at Dallas Electrical Engineering Lab; John Ayers, bilateral cochlear implant recipient; and doctoral candidate Lu Yang. Photo courtesy of John Ayers

Richardson, Texas. The UTD electrical engineering department has been developing equipment to program CIs with algorithms to more accurately process sounds. Kostas Kokkinakis, Ph.D., a postdoctoral research associate at UTD, working in the cochlear implant and speech processing lab of Philip Loizou, Ph.D., states, “The aim of my work is the development of signal processing strategies that can improve speech recognition of cochlear implant users in noisy social settings and reverberant environments.” Ayers has been a part of this research, which includes electrical stimulation, as well as implementation and evaluation of the CI algorithms for efficacy in speech processing. Participating in these research projects has inspired Ayers to become more involved in hearing loss education at churches, schools, hospitals and service clubs.“I find many people are reluctant to talk about hearing loss,” he says. By informing them of resources and

progress, as well as research going on in the field, along with his own testimony and obviously improved hearing, Ayers desires to bring awareness and hope to those with similar hearing loss. He reflects: “The Lord is so good to humankind to give people the desire and know-how to devise such marvelous equipment in order to restore hearing for those with deafness.” ■ Beverly Shay is a freelance writer, copy editor and community editor for local magazine SouthwestNOW serving Cedar Hill, DeSoto and Duncanville, Texas.

It’s Never Too Late to Win an Oticon Focus on People Award Either Few people can say they’ve worn hearing instruments for 86 years. Having just celebrated his 100th birthday, Julius Barthoff of Needham, Mass., a winner of the 2009 Oticon Focus on People Award, has been an inspiration to countless individuals with hearing loss, with perfect hearing and everyone in between since 1923. He has developed buttons – “Speak up, I’m Hearing Impaired!” – and index card-sized instructions – “I am profoundly hearing impaired. We can communicate by following these simple rules…” – that he happily shares, providing a practical resource to the many people with hearing loss he has encountered over the years. More recently, Barthoff successfully lobbied for his local library to install a TTY telephone and advised fellow senior citizens on hearing loss and hearing aids. Barthoff is a widower who lives on his own and continues his commitment to doing a good deed daily. Each morning, he delivers the newspapers to each apartment door in his senior residence – propping them up “just so” so that when a resident opens the door, the paper falls neatly in. Oticon also honored Paige Stringer of Seattle, Wash., for advocacy; Kristin Grasberger of Mechanicsburg, Pa.,

100-year-old Julius Barthoff, a winner of the Oticon Focus on People Award, celebrates with his audiologist, Eve Adler (l.) and his ENT, Rebecca Stone. Photo courtesy of Oticon Inc.

a freshman at James Madison University for her academic achievement; and David Woodruff, Au.D., of San Diego, Calif., for his charitable audiology work. ■

The Digital Conversion…In the Ear BY JAMIE MORRISON, ASSOC. EDITOR

In February, when the U.S. television industry converted fully from analog to digital, some individuals had to obtain converter boxes to enable their older analog TVs to convert the digital signal to analog. Each time a sound

makes its way through the ear canal to the inner ear, a similar, though reversed, conversion occurs in the cochlea, as analog sound is converted to digital. And it’s the job of Geng-Lin Li, Ph.D., to find out more about how

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Geng-Lin Li, Ph.D. Photo courtesy of Geng-Lin Li, Ph.D.

this works. Li, a research assistant professor at the Oregon Health and Science University (OHSU) in P tl d studies t di the th first synapse in the auditory system, Portland, which converts electrical voltage fluctuations in hair cells into spikes in auditory afferent fibers. This conversion is necessary because a spike is a better format for carrying information across a long distance – i.e., from the inner ears to the brainstem – when compared to voltage fluctuation. “Digital TV broadcasting can transmit 20 million digits per second,” says Li. “But the auditory nerve fiber can send only about 1,000 digits per second because of biological limitations. So the synapse has to handle the conversion very intelligently so that it passes enough information to the brain without missing anything crucial. I’m trying to discover the synapse’s conversion algorithm.” Li’s research involves recording synaptic responses while applying voltage stimuli to auditory hair cells in the inner ears of bullfrogs. Li’s approach: “We know how hair cells’ voltage changes in response to a sound stimulus. We apply the same voltage change to hair cells and then monitor the spike response in the auditory nerve fibers.” Understanding this conversion could lead to improvements in the quality of hearing for people with cochlear implants (CIs). CIs restore a considerable amount of lost hearing in people with profound hearing loss, but it is difficult to interpret tone and pitch. “I hope my research will help us enable CI-users to enjoy hearing just like people with typical hearing,” Li says. Li’s research was funded by the Deafness Research Foundation (DRF) in 2008 and again in 2009. “After we accumulated some preliminary data,” he says, “my mentor encouraged me to apply for a National Institutes of Health (NIH) grant. With the DRF grant, I had enough funding to conduct my initial research. So I was able to convince the NIH review panel that I could do what I proposed.” Originally from central China, Li has been at OHSU since 2003. He studied at Beijing Normal University and earned his Ph.D. from the Shanghai Institutes for Biological Sciences. Though he’s far from home, Li loves Oregon. “I wouldn’t want to live any other place in the U.S.,” he says. When he’s not in the lab, Li sometimes finds time for a 30-minute jog or a few games of badminton. And with their two-year-old boy, Sennan, Li and his wife Xiaoli have their hands full. Li will work for two more years under his current mentor at OHSU and then his NIH grant will enable him to start his own lab and fund it for three additional years. And where might that lab be? Portland sounds good to Li, but he loves his research and is ready to move anywhere a decent academic job takes him. ■


If you just can’t hear on the phone... Ask your Audiologist about Hamilton CapTel® and the new CapTel 800i®. The CapTel 800i is as simple to use as a traditional telephone, with one important addition: it displays captions of what is being said to you on the phone. Simply use your existing phone service combined with a high-speed Internet connection* to receive captions on incoming and outgoing calls. • Free Captions • Easy to Use • Available Nationwide See what they say with Hamilton CapTel and the CapTel 800i.

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Copyright © 2009 Hamilton Relay. All rights reserved. • CapTel and the CapTel 800i are registered trademarks of Ultratec, Inc.

We’ve Been in Your Shoes Advanced Bionics has answers for helping you hear your best.

You want to hear better in noisy settings, enjoy the wonderful harmonies and melodies of music without missing a note, and easily converse with your friends, family, and colleagues. Cochlear implants can bring the rich world of sound to you for deeper connections with loved ones and a more complete hearing experience. With Advanced Bionics’ Connect to Mentor program, you can learn about cochlear implants and have all your questions answered by someone who’s really been there—an actual cochlear implant recipient or one of our trained professionals.

Connect to a mentor of your very own and receive a free Bionic Ear kit by visiting or calling the Bionic Ear Association at 866-844-HEAR (4327)