Hq august 15 issue

HQ

Aug - Nov 2015

hearing

For all your hearing options

Cochlear Implant Diary From decision day and surgery to 'switch on' and beyond

TECH REVIEW It's crunch time for Apple Watch

WATCH OUT! Use your eyes to hear well

ALL ABOUT:

Meniere's Disease

Ask the Experts: • The best earplugs • Sound-saving surgery • How often to change your hearing aids

REAL PEOPLE

An audiologist with a first hand understanding of how her clients feel

PLUS...

news, innovations and things you need to know now

Fleetwood Mac's

STEVIE NICKS

living life to the max with hearing loss

editorial advisory board Emeritus Prof William Gibson AM

Prof Gibson held the Chair of Otolaryngology at The University of Sydney until August 2013 and was head of ENT at The Royal Prince Alfred Hospital. He is the founder and director of the Sydney Cochlear Implant Centres, and still sees patients privately. He is also currently undertaking research into Meniere’s Disease.

Assoc Prof Robert Cowan, CEO HEARing Cooperative Research Centre Principal Research Fellow of Melbourne University, A/Prof Cowan has researched and published extensively in the fields of audiology, cochlear implants, sensory devices and biomedical management. He holds the '06 Denis Byrne Memorial Orator Award.

contents contents FEATURES

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STEVIE NICKS - LIVING LIFE TO THE MAX

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COCHLEAR IMPLANT DIARY - PART 1

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I SEE HOW TO HEAR

Sharan Westcott Clinical Manager, SCIC

Former principal audiologist for Australian Hearing, Sharan Westcott has provided audiology services to children and adults for more than 40 years and now coordinates a team of surgeons, audiologists, speech pathologists and social workers at SCIC.

The Fleetwood Mac star makes an Australian comeback tour despite suffering hearing loss - plus pioneering treatments promising to restore lost hearing.

In the first of a three-part series, young-at-heart grandma Liz Efinger bravely decides on a cochlear implant in her 80s.

Life coach Deb Maes (MA Deafness and Communication) explains how we use our eyes to hear.

Adjunct Prof Harvey Dillon Director of Research, NAL

Dr Dillon has researched many aspects of hearing aids, effectiveness of rehabilitation, auditory processing disorders and methods for preventing hearing loss. He has designed hearing aids, authored over 160 articles and his text on hearing aids is used worldwide.

Alex Varley, Chief Executive Media Access Australia

MAA focuses on identifying practical, realworld solutions for people with disabilities to access audiovisual content to empower people to be independent. They provide advice to government, industry, educators and individuals.

Dr Neville Lockhart

After 45 years of profound deafness Dr Lockhart received a cochlear implant in 2005. His involvement in the cochlear implant support group CICADA and his technology background (retired senior CSIRO scientist) led him to become editor of CICADA Magazine (now Hearing HQ).

Cover image: Keith Mayhew / Alamy

REGULARS

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NEWSBITES

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ALL ABOUT

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ASK THE EXPERTS

Research, innovations and things you need to know.

Meniere's Disease.

Professional advice on readers' questions and concerns.

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REAL PEOPLE

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PRODUCTS & SERVICES

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HERE TO HELP

After cochlear implant surgery, audiologist Helen Court has a new lease of life.

Information at your fingertips.

Organisations providing advice and support.

Olivia Andersen, Founder/Director Hear for You

Profoundly deaf from birth, Olivia Andersen started Hear For You, a not-for-profit organisation to help young deaf people achieve their life dreams. The birth of her first child prompted her decision to have a cochlear implant.

Published by The Tangello Group Pty Ltd Editor Rebecca Barker editor@hearingHQ.com.au Contributors Liz Efinger, Deb Maes, David Becconsall, Helen Court Experts Ass. Prof. Melville da Cruz, Emma Scanlan, Roberta Marino, Jawan Sayed Advertising Sales Executive Sally Davis sally@tangello.com.au 0438 177 036 Magazine Distribution distribution@hearingHQ.com.au Publisher Lucinda Mitchell lucinda@tangello.com.au Printed by Offset Alpine 4

Hearing HQ Aug - Nov 2015

SUBSCRIBE Personal orders: for just $22 each year, receive 3 issues Multiple copies - Small: $30/year for 3 issues (5 copies of each issue) Multiple copies - Large: $50/year for 3 issues (45 copies of each issue) For all orders you can subscribe - online at www.hearingHQ.com.au

- post the form on page 24 to the address below - email subscriptions@hearingHQ.com.au Hearing HQ, PO Box 1054, Lane Cove NSW 1595

HQ hearing

The Editorial Advisory Board provides guidance and expertise on a voluntary basis. They may not review every article and make no warranty as to the scientific accuracy of the magazine.

They are not responsible for any errors published and do not endorse advertised products. If you have any questions about editorial content, please direct them to editor@hearingHQ.com. au. If you have questions about product suitability for your specific needs, we recommend you consult an audiologist or doctor. Any person with health issues or medical concerns should first take advice from a health professional.

Now a broader range of hearing aid wearers can experience the outstanding performance binax has to offer.

In a world first, wearers are now able to experience binaural directionality in instruments with a single microphone.

Wearers can experience enhanced speech intelligibility and sound quality, even in challenging listening situations.

AH0685 05072015

As seen on Channel 9

Make an appointment to trial the latest technology, or check if you are eligible for Australian Hearing service today.

Call 1800

826 500 or visit hearing.com.au

1800 826 500 hearing.com.au Hearing HQ Aug - Nov 2015

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ed's letter It is with great passion and enthusiasm that I take up the editorial reins at Hearing HQ. Having worked with adults and children with auditory issues, I am constantly amazed at the pace of science and technology in this area.

In the run-up to August’s Hearing Awareness Week (August 23-29), it is incredible to note that we are so close to curing deafness and hearing difficulties for many people for good (see our feature story on Fleetwood Mac’s inspirational singer Stevie Nicks – how she has embraced technology and lived life to the max despite personal setbacks and hearing loss). With her indomitable spirit in mind, I am committed to bringing you the latest hearing news, reviews, events, equipment and support to help you achieve your best ever hearing experience for years to come.

Enjoy the issue and drop me a line. I would love to hear from you.

Rebecca Barker Editor

newsbi newsbite Big splash

A team of seven inspirational hearing-impaired athletes represent Australia in the fourth World Deaf Swimming Championships in Texas , USA, this month. Craig Morgan, 26 (above), Sam Greatorex, 15, Ben Robins, 14, Alex Kirchner, 12, Teneale Houghton, 23, Jade Wellstead and Hannah Britton, both 21, have been named as the Australian Deaf Swimming Team for the event which runs from August 17 to 22.

With no allowance in Paralympic funds for deaf athletes, the team and fundraisers needed to raise around $50,000 to participate in the championships as they were not eligible for Federal Government funding from the Australian Institute of Sport.

Youngest team member Alex, who has moderate to severe hearing loss and began lessons aged just two, is thrilled to be representing his country. “It made me feel really proud that I qualified for that event. I may be deaf but that still gives me a range of new opportunities like getting to go to Texas and being able to swim in able-bodied competitions as well,” Alex told the Herald Sun newspaper.

The World Deaf Swimming Championships, first held in 1995, take place every four years and two years apart from the Deaflympics. www.wdsc2015.us/home.html.

To have your say contact: editor@hearingHQ.com.au Hearing HQ Magazine is published by The Tangello Group Pty Limited 'The Tangello Group' (ABN 38 155 438 574) PO Box 1054, Lane Cove NSW 1595 and is subject to copyright in its entirety. The contents may not be reproduced in any form, either in whole or part, without written permission from the publisher. All rights reserved in material accepted for publication unless specified otherwise. All letters and other material forwarded to the magazine will be assumed intended for publication unless clearly labelled “not for publication”. Text, photographs and illustrations received in hard copy must be accompanied by a self-addressed envelope stamped to the appropriate value (including registered or certified mail if required) if return required. The Tangello Group does not accept responsibility for damage to, or loss of, submitted material. Opinions expressed in Hearing HQ Magazine are those of the contributors and not necessarily those of The Tangello Group. No responsibility is accepted for unsolicited material. No liability is accepted by the publisher, the authors or members of the editorial advisory board for any information contained herein. All endeavours are made to ensure accuracy and veracity of all content and advice herein but neither Hearing HQ Magazine, its publisher, contributors or editorial advisory board members is responsible for damage or harm, of whatever description, resulting from persons undertaking any advice or purchasing any products mentioned or advertised in Hearing HQ Magazine or its website.

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Hearing HQ Aug - Nov 2015

After reports this year of a Canberra student with autism confined in a cage-like structure, there were urgent calls for an inquiry into the treatment of children with disabilities in Australian schools. Around 83 per cent of Australian students who are deaf or have hearing impairments attend mainstream schools. In a bid to make immediate improvements for these students, Media Access Australia (MAA), is urging teachers to use captions on all video content in classrooms as part of its Cap That! campaign. “Providing captions on all video content creates an additional medium or method for these students to understand and engage with lesson support materials and information,” says MAA CEO Alex Varley. For more information or resources visit: www.capthat.com.au.

ites s ARTS

EXTRA Sydney writer Pauline Findlay (below right) set out on a journey to raise awareness about deafness through film after experiencing the shock of hearing loss herself seven years ago. She has created two movies on the subject, her debut feature film LOLA, about a deaf musician and the short film Blue Mist about a deaf woman who goes missing on a bush walk in the Blue Mountains, New South Wales. Partly funded by the American crowd-sourcing website Kickstarter, the film stars actress Susie Porter (left), from the TV shows Underbelly and Puberty Blues. Findlay hopes to take Blue Mist to local and international film festivals to highlight the impact of hearing loss on everday living.

i

Sound of music

Country music star Troy Cassar-Daley is on track to support at least two hearing-impaired children through school from the proceeds of his new song, I Can Hear You Now. Inspired by Australians who have lived with hearing loss and can hear again or are hearing for the first time, the single aims to fund an academic award to put at least one primary school child and one high school student with auditory difficulties through their studies.

Cassar-Daley is the ambassador for the country’s largest provider of Government-funded hearing services, Australian Hearing.

The successful candidates will be announced in August’s Hearing Awareness Week.

Tackling tinnitus head on In a world first, medics have mapped signals in the brain as a person is experiencing tinnitus - the condition that causes ringing or buzzing sounds in the ears. The findings, noted in the journal Current Biology, were taken from a 50-year-old epileptic man with tinnitus who was being monitored prior to surgery due to seizures. Two weeks before his operation, 164 electrodes were placed on the left side of his brain to trace the incidence of fits. At the same time, researchers were able to compare brain activity when tinnitus was loud compared to when it was quiet. The results show activity in more areas of the brain than previously thought and could change medical approaches to the disorder.

“A number of models - and therefore treatment approaches - have aimed to pinpoint a particular part of the auditory cortex that relates to the frequency being heard, either by targeting it physically in the brain or with sounds at that frequency. But our results suggest that it’s a much wider part of the auditory cortex and the brain that’s implicated in tinnitus, so these strategies might have to be revised or reconsidered a bit,” the study’s co-author William Sedley, a UK doctor and neuroscientist told BBC News.

Listen up!

One in six Australians are believed to be hearing impaired.

This number is expected to rise to one in four by 2050.

To raise awareness of the despair and disconnect that often goes hand-in-hand with hearing difficulties, the Deafness Forum of Australia launched Hearing Awareness Week, which runs from August 23 to 29 this year.

It aims to inform, support and encourage the hard of hearing and help them to reconnect with loved ones and achieve their best auditory outcome by receiving a free hearing check and expert advice from participating audiology clinics across the country.

Details of events can be found at www. hearingawarenessweek. org.au.

Hearing HQ Aug - Nov 2015

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newsbites newsbites FALLING ON DEAF EARS

Linked:

hearing loss and SIDS

Research suggests that babies who die from Sudden Infant Death Syndrome have a hearing deficiency in their right ear.

This incredible finding, reported in the Herald Sun newspaper, is being used in the race to develop the first screening test to identify infants at risk.

The revelations come after US paediatric anaesthetist and researcher Daniel Rubens looked into the deaths of 31 babies who died from SIDS over 15 years in Rhode Island, America. The newborn hearing screening test showed that they all had hearing issues in their right ears. Doctor Rubens believes that this inner ear damage may prevent babies making movements they need to take a breath of air when their breathing becomes compromised due to illness or sleeping position.

The findings follow the same pattern in studies on mice with one-sided inner ear damage, which appear to be unable to move their heads to take a lifesaving breath when oxygen levels are compromised. “The stimulus to make those survival movements is the drop in oxygen,” explains Dr Rubens. “But when you run into problems in sleep, like if they have a cold or the baby tucks its head into its chest, you’d also get the build-up of carbon dioxide. It’s the mixture of carbon dioxide preventing them from waking up,” he says. “If you take carbon dioxide out and they just have a drop of oxygen, the ones with inner ear damage can still make the movements,” says Rubens.

The pioneering researcher is now starting a bigger study involving 100 British babies who died from SIDS and 400 healthy infants. Rubens completed his medical training in Australia and his work has been partly funded by a charity called River’s Gift, set up by Victorian parents Alex Hamilton and Karl Waddell from Geelong who lost their four-month-old son to SIDS in 2012. www.riversgift.com.au.

Osteoporosis - the condition that weakens bones and makes them break easily especially during falls - has been shown to trigger an increased risk of sudden deafness, say medical experts in the Journal of Clinical Endocrinology & Metabolism.

Researchers say that women who suffer from osteoporosis or brittle bones have almost double the risk of developing sudden deafness compared to those who do not suffer from it. They now believe that as the bones thin and weaken other systems in the body can be affected, such as hearing abilities. Sudden sensorineural hearing loss or sudden deafness is an unexplained, rapid hearing deterioration that usually happens in one ear. Many people later regain their hearing but it is believed immediate treatment with steroid drugs may help.

Around 85 per cent of people treated for the condition recover some hearing but the rest do not. The study included 10000 people with osteoporosis and was led by researchers at the Chi Mei Medical Center in Taiwan. The paper’s co-author Doctor Kai-Jen Tien says: “A growing body of evidence indicates that osteoporosis affects not only bone health but the cardiovascular and cerebrovascular systems.”

Robert Henry, CEO & Founder of Hear for Less, is leading a team of six people through Tough Mudder this October in a bid to raise $10,000 towards Deaf Children Australia's recreation program.

Tough Mudder, a team-oriented 18-20 kilometre obstacle course, is designed to test physical strength and mental grit. The gruelling event puts camaraderie over finisher rankings and is not a timed race but a team challenge that allows participants to experience exhilarating, yet safe, world-class obstacles they will not find anywhere else.

For more information on the event and how to sponsor visit www.justgiving.com/HearforLess.

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Hearing HQ Aug - Nov 2015

watch this space Better Hearing for a Sound Future Better Hearing Australia is holding its 67th national conference in Perth on October 16-17. At this twoday event expect thought-provoking speakers and sessions. For details and registration information email:bhawa2015conference@gmail.com. Registrations close on August 31.

GOOD

vibrations

A new vest could be the key to communication for the profoundly deaf, say researchers at Houston’s Rice University. Their pioneering, low-cost creation, called the VEST – or Versatile Extra-Sensory Transducer, comprises a vest fitted with sensors that vibrate in specific patterns in response to words related through a smartphone app.

The prototype has been designed in collaboration with Baylor College of Medicine by Scott Novich, a doctoral student in electrical and computer engineering, and a team of undergraduates, who work in the laboratory of neuroscientist David Eagleman.

Novich says both hearing and deaf people have tried the vest, which requires a period of brain-training to learn to translate the vibrations into words. “As they (people) use the vest more, they get feedback, and know whether they are right or wrong and start to memorise patterns. People are able to identify words they have never encountered before,” says Novich.

To watch David Eagleman's TED talk explaining the vest visit: www.ted.com/ talks/david_eagleman_can_we_create_new_senses_for_humans.

Source: http://www.futurity.org.

i

Touted as the latest must-have tech-accessory, Apple’s slick new smartwatch has been hailed an asset for the hearing impaired community.

But after four months on the market, not to mention a price tag of $499 to $24,000, is it really worth the investment?

Linked to an iPhone (iPhone 5 or newer), the watch is readily accessible and allows the user to remain handsfree. It features the in-built advisor Siri, makes speakerphone calls, presents incoming texts, Twitter and Facebook notifications, pays bills and can feature a range of simple apps.

Without the iPhone, it holds selective apps, allows flight check-ins, plays music and tracks fitness metrics.

But the most useful feature for people with hearing difficulties appears to be its new ‘taptic engine’ which allows wearers to set vibrations for various alerts or send messages via taps to other users.

One deaf and blind British reviewer says she has been able to program her watch to navigate maps around London by setting a certain number of taps to activate at junctions.

Meanwhile, the idea of sending taps to people in meetings, conferences and group situations, where hearing is most challenged, is a bonus. This, however, means at least one other person in the room will need to wear the new technology making it an expensive exercise.

Adding to this, battery life is short (around 18 hours) compared to rivals such as the Pebble watch, which runs for up to 7 days and is compatible with iPhones and android phones.

On the bright side, apps are being developed that will allow quick and easy sign language to be sent to fellow watch-wearers – utilising a form of communication that already feels familiar to them.

While still in its infancy, the Apple Watch shows signs of making life easier for people with hearing loss.

But will these people embrace it?

See review of the Apple Watch on page 17. If you have recently purchased a smartwatch, please tell us about it at editor@hearingHQ.com.au.

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Hearing HQ Aug - Nov 2015

STEVIE NICKS Live with Fleetwood Mac at the Xcel Energy Center, Minnesota, USA

LIVING LIFE TO THE MAX

hearing loss with

Photo by Matt Becker /melodicrockconcerts@gmail.com

When it comes to age-related hearing loss, you can go your own way…or embrace life and its many miracles, just as Fleetwood Mac’s Stevie Nicks has writes Rebecca Barker.

In an incredible music career spanning four decades, Fleetwood Mac’s Stevie Nicks has battled relationship break-ups, drug addiction, the death of her mother and more recently, hearing loss.

Though not widely known, her auditory issues started more than 10 years ago - a common health concern for long-time musicians due to noise damage and age-related wear and tear (presbycusis). But at the age of 67, the legendary tambourine-shaking matriarch of one of the world’s most iconic bands is preparing to tour Australia - for the first time as a full five-piece band since 1998.

In the band’s 1980s heyday, cocaine and prescription drug use overwhelmed the shawl-clad singer but it was hearing loss that threatened to halt her greatest love - singing.

Nicks told Canadian lifestyle magazine Zoomer that she noticed her hearing was deteriorating when she started to lose the higher frequency sounds, which

are often the first to go due to age and noise-related damage. But, rather than let it get her down, she began using hi-tech headphones to sharpen up the listening experience. “I’ve lost a lot of my highs. So I personally am much better off listening on a pair of really good studio headphones…because I can hear all those amazing guitar parts and keyboard parts and all of those just amazing instrumental parts that kind of go by me when I’m listening to it on kick-ass big speakers,” she says.

Unfortunately, in today’s hi-tech world, noise-induced hearing loss is becoming more prevalent, particularly with the rise of phone, tablet and earbud use. Over time, prolonged exposure to loud music (continuous noise of 85 decibels or more) without ear protection damages the inner ear cells that transfer vibrations to the cochlea, auditory nerve and brain. To put this into perspective, 85dB is about the sound of heavy, Hearing HQ Aug - Nov 2015

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Fleetwood Mac still draw massive crowds today

Photo by Sgt. 1st Class Jim Greenhill

Inspired by her visits to wounded soldiers, Stevie Nicks speaks at the USO of Metropolitan WashingtonBaltimore's annual awards dinner last March

passing traffic.

Nicks’ former lover and band cofounder Mick Fleetwood also suffers from the condition following years of drum-playing on tour. But the pair have channelled their experiences in positive ways. Fleetwood has backed hearing loss awareness campaigns while Nicks refuses to let it get her down, making every effort to stay proactive, youthful and upbeat. “I have a good state of mind – just keep moving, keep working, keep singing, keep creating, keep hanging out with great people,” Nicks told Zoomer before her tour here in October and November.

Australian Hearing reports that more than half the population aged between 60 and 70 has hearing loss and this increases to 70 per cent for those over 70. But it is not all doom and gloom. By all accounts, attitude, diet, exercise and staying social are hugely important when it comes to maximising your hearing potential and living a full life.

A US survey by the National Council on Ageing including 2300 hearing impaired people aged 50 and over found that those with untreated hearing loss were more likely to report depression, anxiety and paranoia and were less likely to participate in organised social activities compared to those wearing hearing aids. On top of this, a study by researchers at Sweden’s Stockholm University (BMC Public Health Journal) reveals that hearing issues are more

The rumours are true - touring as a five-piece for the first time since 1998, Fleetwood Mac will play a selection of shows in Australia this Oct - Nov

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Hearing HQ Aug - Nov 2015

Fleetwood Mac (from l-r) Mick Fleetwood, Stevie Nicks, Lindsey Buckingham, John McVie, Christine McVie

common in times of stress, like the threat of redundancy, poor sleep and ill health.

So to make the most of residual hearing, it is important to find a professional audiologist, get your hearing tested and ‘seize the day’. With technology and research constantly evolving, a vast array of life-enhancing hearing aids, implants and listening devices are now at your fingertips. Even more exciting is the news that many types of hearing loss could be cured in the near future through ear protection, gene therapy and ear hair cell regeneration.

NEW DISCOVERIES In the last century, the focus has been on developing hearing aids and cochlear implants to transform lives in the deaf and hearing impaired community. But the technology is imperfect and now scientists are close to finding a cure for many types of hearing loss through biological means, such as restoring damaged aural hair cells. In a groundbreaking statement earlier this year, Claire Schultz, chief executive officer of America’s largest private hearing research funder, Hearing Health Foundation, said: “The question is not if we will regenerate hair cells in humans, but when.”

Australia is at the forefront of this research with work being conducted at many of our labs including Victoria’s Bionics Institute, under Professor Rob Shepherd and the University of Melbourne’s Department of Otolaryngology, where Dr Bryony Nayagam has made strides in stem cell technology and regeneration of the auditory nerve.

Researchers at the University of New South Wales’ Translational Neuroscience Facility (TNF) in Sydney have been working alongside colleagues at Harvard and Auckland universities to find new ways to tackle noise and age-related hearing difficulties. “Our hearing is extraordinary. We can hear the very quietest sounds like a pin drop to hearing loud sounds relatively safely as well,” says Professor Gary Housley, of UNSW’s TNF. “The challenge of hearing across a lifetime is maintaining that incredible range of sound, also the complexity and colour of that sound,” says Housley, who explains hearing loss is much more complicated than simply losing aural

hair cells. It also involves deterioration of nerve fibres and cells in the ear and brain and the subsequent loss of cerebral function through lack of use.

Every person is born with around 20,000 hairs within each ear that help us detect and locate sound and transfer vibrations from the cochlea to the auditory nerve and brain. There are two types – hair cells that transmit sound information to the brain and those that act as amplifiers. Over time, through illnesses, the use of certain drugs, loud noise and ageing some, or all of these hairs, are permanently damaged. Recent research has gone some way to explaining why we usually lose higher frequency sounds (consonants, particularly ‘s’ sounds, birdsong, women’s and children’s voices etc.) first as we age.

Hair cells in the basal or lower part of the cochlea deal with high frequency sounds. “We don’t understand what makes the basal part of the cochlea vulnerable to hearing loss… but it is likely to do with the large proportion of hair cells in the basal region. We also know that nerve fibres connecting outer ear as well as to the brain start to be lost progressively as people age,” explains Housley.

Scientists have already grown hair cells in the laboratory while Housley’s team has been using a method of delivering gene therapy to the inner ear to stimulate the growth of auditory nerves. It is known that auditory nerves

regenerate if neurotrophins – a naturally occurring family of proteins crucial for the development, function and survival of neurons – are delivered to the auditory part of the inner ear – the cochlea. The team at UNSW propose using electrical impulses delivered via a cochlear implant’s electrodes (during implantation surgery) to deliver gene therapy directly into the area most needing it. “This research breakthrough is important because while we have had very good outcomes with cochlear implants so far, if we can get the nerves to grow close to the electrodes and improve connections between them, then we’ll be able to have even better outcomes in the future,” says Jim Patrick, chief scientist and senior vicepresident of Cochlear Ltd. The findings will also help to fine-tune hearing devices. “People with cochlear implants do well with understanding speech but their perception of pitch can be poor, so they often miss out on the joy of music,” says Housley. “Ultimately, we hope that after further research, people who depend on cochlear implant devices will be able to enjoy a broader dynamic and tonal range of sound, which is particularly important for our sense of the auditory world around us and for music appreciation,” says Housley, who has also examined the way ears relate to each other and the brain to localise, amplify or reduce incoming sound.

“In the future cochlear implants could include a way of responding to each other that may help in the very natural

Professor Gary Housley with the UNSW’s Translational Neuroscience Facility team

Get Smart: Assisted Listening Device (ALD) Review Our readers and experts try out some of the latest assistive listening technology.

What is it: Sennheiser RS 180 digital, wireless headphones with rechargeable batteries and TR 180 transmitter.

‘This equipment enhances sound from the television and other audio devices in the home.

A clear, easy-tofollow instruction manual allows you to set up in a few minutes and the headphones are adjustable and comfortable.

‘I have bad hearing in each ear and a different degree of deafness on either side.

But this is not a problem as the earphones have individual volume settings. It took a few listening experiences to get the volume adjustment for each ear correctly balanced.

I noticed that the balance adjustment has to be changed depending on whether I am wearing hearing aids or not. When using the headphones without hearing aids, the weaker ear has to have the volume turned up higher than when I have my hearing aids in. Provided the volume is turned up a little to compensate for no hearing aids, my hearing is just as good as when I am wearing them. This is very useful because there are times when I am not wearing my hearing aids.

‘Overall, this product has great sound quality and once the settings are personalised, the volume of the television or other sound-producing equipment, even if mute, remains the same anywhere in the house. The batteries automatically recharge after each use with no input from the user and appear to have a long life. On the downside, while using the system, casual conversation with someone is difficult because of the earphones and they cannot be used with a telephone. Also, some people may find it tricky to find space for the transmitter.’

Suitability Henry Gardiner, Mild / Hearing HQ reader moderate loss Compatibility used with hearing aids and cochlear implants 14

Hearing HQ Aug - Nov 2015

way humans provide information to and from the ear and brain,” says Housley.

The issue of advancing years and deteriorating balance is also being addressed. American scientists estimate between 20 and 40 per cent of people over 65 who live at home fall each year.

Researchers at the US John Hopkins University found that people with a 25 dB hearing loss, classified as mild, were nearly three times more likely to have a history of falling.

Every additional 10 dBs of hearing loss increased the chances of falling by 1.4-fold. “Traditionally, loss of vestibular function is regarded from the perspective of specific diseases that only affect a small part of the population,” says Yuri Agrawal MD, assistant professor in the Department of Otolaryngology at John Hopkins University School of Medicine.

Such diseases include Meniere’s, vertigo and vestibular neuritis. “But there is increasing evidence that vestibular loss may affect a larger segment of this population, specifically the elderly, caused by a more general deterioration of the peripheral and central vestibular systems,” says Agrawal.

Ongoing research to preserve and grow auditory hair cells and nerve fibres can only assist in overcoming these, often debilitating, balance issues. It could also help manage some devastating neurological disorders.

KNOW YOUR TECHNOLOGY While world firsts are being accomplished in the lab and hopefully transferred to clinics and hospitals in the near future, technology is continuing to transform people’s lives.

While it has been discovered that hearing loss often leads to depression and cognitive decline, a recent study by researchers at the John Hopkins University has shown that wearing hearing aids may lessen forgetfulness and mental confusion linked to moderate to severe hearing loss.

In the past, hearing aids were often viewed as expensive, ugly, intrusive or bulky - but times have definitely changed. Australian Hearing’s 2008 hearing report showed that 57 per cent of Australians would wear a hearing aid if their hearing deteriorated.

Some people who use the latest hearing devices and accessories can

achieve normal, or close to normal sound perception – and in some noisy environments hear even more speech than those with excellent hearing. One of the biggest dilemmas now is not the look and quality of technology but the overwhelming choice and how to find the most suitable product for your needs.

These are all solvable problems that can be addressed with the help of a qualified audiologist.

Just dipping into the brave new world of hearing science reveals a wide range of auditory equipment that is lightweight, discreet, if not invisible, and packed with practical functions. These can help you listen to people in challenging situations – like in the car or at a lively social gathering, allow you to exercise in hot, dusty or windy conditions, play team sports or even swim in the sea and underwater. Other features include hearing instruments that can be adjusted via a smartphone or watch, intuitive technology that personalises hearing aids to your favourite settings and built-in tinnitus masking.

If discretion is your number one priority, hearing aids concealed within the ear canal like Unitron’s Quantum Micro and Siemens’ Insio (above) are some of the smallest examples on the market.

Another tiny, low maintenance, no-fuss option is Phonak’s Lyric (below). A mini

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www.hearforless.com.au Hearing HQ Aug - Nov 2015

Get Smart: ALD review What is it: Phonak’s Roger Pen is a wireless microphone that looks like a pen. It helps people to hear and understand more speech in loud noise and over distance.

‘I was recently advised to try the Roger pen by an occupational therapist as it was seen as the latest in adaptive technology for the deaf in a meeting situation.

The pen is an audio device that looks like a fancy silver pen, can be placed in the middle of a room and then relays information back through a lanyard into my hearing aid.

The first time I used the pen in a meeting I was stunned by how much I could hear. For the first time in a 15-person meeting situation, I could hear every participant. The volume of the whole room went up significantly. The sound seemed clear and not foggy.

Micro USB socket

Mic Mode

Connect

On/Off

Bluetooth smartphone connection

Recently, I attended a meeting with Senator Mitch Fifield and the State Disability Ministers including Martin Foley from my home state of Victoria. I just walked up and put the device on the table in front of them and could hear every word they all said. I have also shown other people who use hearing aids and implants the device, all of whom have been shocked at what a difference it makes.

The only areas for improvement are that it is a bit fiddly.

Turning it off took time to get used to. This meant that it was often not charged when I needed it. Also you have to ensure that the lanyard and pen are both charged. You can also connect it to the television and a mobile phone but I found it less helpful for these situations. It is great that it’s unobtrusive and looks like a pen. On the other hand, you feel a little nervous that someone will pick it up and walk off with it!

It’s a great device and is amazing in a group situation. You just need a routine to organise the equipment.’

Suitability Mild / moderate loss

Compatibility

works with most hearing aids and cochlear implants

16

Hearing HQ Aug - Nov 2015

Matthew Wright, CEO of the Australian Federation of Disability Organisations.

powerhouse that can be left for months at a time in the ear canal after being fitted by an audiologist, it is water resistant, so can be worn in the shower and has no fiddly batteries to change.

Meanwhile Siemens Binax, Pure and Carat aids and Phonak’s Naida Q (used with the assistive listening accessory, the Roger Pen – see review) promise to allow some users with hearing difficulties better understanding of speech in noisy places than people with average hearing.

And in bionic ear breakthroughs, Advanced Bionics, Cochlear Ltd and Med-El all have hybrid devices that offer the benefits of a cochlear implant’s electrical stimulation with the acoustic amplification of a hearing aid in one piece of equipment. Years ago, activities like swimming were thought to be too dangerous for people needing hearing aids or cochlear implants. But this has also changed with products like Advanced Bionics’ Neptune (right and above), a swimmable sound processor, Siemens’ Aquaris, a waterproof, shockproof hearing aid that has no seams, screws or pins and a silicone seal that protects the battery, microphone and receiver areas.

Cochlear, Advanced Bionics and Med-El have also developed waterproof cases for their Nucleus, Naida and Rondo devices respectively.

With so many options for an active and social life, there is no excuse not to make the most of Advanced time with family and friends.

Bionics Just take a note out of Stevie Nicks’ waterproof songbook and discover there are many case reasons to feel positive about the future, embrace technology and live life to the max well into your 60s and beyond.

HQ

Get Smart: ALD review What is it: The Apple Watch is a smartwatch that tells the time, makes calls, presents texts, Twitter and Facebook messages, holds apps, tracks fitness data and sends taps and vibrations to the wearer or other Apple Watch users to alert/notify them.

‘This is a sophisticated watch that is user-friendly. The set-up process is simple as it’s very similar to the iPhone.

When I first received a message notification, I felt two little pulses on my wrist and I had never felt anything like that. It lets me react instantly to notifications just like people who can hear. I like the way the haptic feedback (built-in tapping feature) feels. It’s very comfortable, it’s just like someone tapping me on the wrist – it’s almost like someone is with me to let me know about a notification.

The first thing I’m going to do is learn how to use maps properly. This will really help me when I am driving or walking around. I’m also going to personalise the vibration settings so I can fine-tune different notifications for different things that happen. If I am just getting a simple text message, I can answer it later, but, if there is something quite urgent or dangerous like a massive storm warning or an accident, I can be alerted straight away with a different vibration setting.

It’s also great for my work as an IT specialist. If someone has an urgent query I can be alerted straight away and I can respond to people more quickly if they have the watch as the taps are close to the skin, unlike the vibrations of a mobile phone which can be missed. People who do not speak English or sign well can also send information about how they feel quickly and easily. I am looking forward to using the heartbeat feature to do this. It’s good to be able to communicate feelings and tell my friends how I am feeling in a quick and simple way. The batteries could last longer and I’m hoping that, in the future, the vibrations can be used to assist in computer games or enjoying music. But, for me, this is much better than buying a regular watch.’

Alex Nyam, IT specialist for the Royal Institute for Deaf and Blind Children.

Suitability Mild / moderate / profound loss

Compatibility

works with iPhone 5 or newer & iPhone compatible hearing aids * * Visit https://support.apple.com/ en-au/HT202186 for a list of these aids

Enjoy more of the moments that matter most Roger is the new digital standard that bridges the understanding gap in noise and over distance, by wirelessly transmitting the speaker’s voice directly to the listener.

Highly discreet and hassle-free, Roger devices provide a solution to individuals who struggle to hear and understand speech in difficult listening situations such as noisy classrooms, bars and restaurants, outdoors, in public spaces, and even in the car.

Learn more at: www.phonakpro.com.au

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PART 1

Are you thinking about cochlear implant surgery?

Inspiring grandmother Liz Efinger relates her journey from ‘decision day’ to ‘switch on’ and life afterwards in an amazing three-part series.

My name is Liz and I am a lady of mature years. OK - I admit to being 81, but I am leading a very full and active life and hope to do so for many more years.

I live in North Sydney, NSW and my interests are friends, theatre, movies, travel and people. A very important part of my life revolves around music though so hearing is extremely important for me.

I retired from my professional life as a physiotherapist when I was about 50 and have been busy ever since. My hearing was very good when I was younger. I never had any problems until my early 60s. It was then that I realised, when lying in bed listening to the radio, that the hearing on my left side was diminished compared to that in my right ear.

I ignored this, thinking subconsciously (and rather stupidly) it would go away until I went on a group overseas trip on a music tour.

It became apparent that I was having trouble hearing what the tour leader was saying and that, in a crowd, it was hard for me to hear and distinguish conversation. Eventually, at the age of 63 I decided to have a hearing test. This resulted in me being prescribed a hearing aid on my left side.

I was told I had otosclerosis - a form

r a e l h c o C lant p im ry dia of bone overgrowth in the middle ear that causes progressive hearing loss. My audiogram was in a relatively straight line - my lower sounds were slightly worse than the high sounds at that stage.

I had trouble getting my hearing aid adjusted and my audiologist and I became good friends during frequent visits. It was at this time that I also became involved in choral singing joining - at one stage - three different choirs, and also attending singing lessons. I loved this but also found it extremely frustrating as I had trouble hearing myself properly in the choir, as well as hearing the surrounding voices.

Starting a new venture at the same time as battling an increasing hearing loss was not a happy combination but I am a fairly stubborn person. In spite of the problems I was experiencing, I was determined not to give up my new-found passion.

My hearing continued to deteriorate slowly and by the time I was 70, I needed a hearing aid in my right ear as well. Life continued with increasing frustrations. I had ongoing problems with hearing aid adjustments which were never ‘just right’.

This led me to seek further advice on improving my quality of life. In particular, background noise was becoming a nightmare, and conversation in public places was very difficult. Also, understanding movies and speaking on the telephone was a problem. I was referred to an ear, nose and throat surgeon at one of our leading hospitals and he was very positive that surgery for the otosclerosis would help.

The operation suggested was a stapedectomy. This is a micro-surgical procedure to relieve deafness by replacing the stapes of the ear with a prosthetic device.

I was advised that the operation was very successful and that the chance of it not working was only one per cent. I thought these were pretty good odds, so after doing my research and much thinking, I decided to go ahead with it.

‘Why not?’, I thought, if improvement was almost guaranteed?

In January 2005, I went ahead with this surgery. Post-operatively I had a bad time for weeks with my balance being badly affected. As time wore on, I was shattered to find that my hearing had not improved at all. In fact, I felt it was worse. My high tones had deteriorated Hearing HQ Aug - Nov 2015

19

Top: Liz with her nieces Kathryn, left, and Julie.

Left: Liz with her niece Kathryn at granddaughter Jackie's Holy Eucharist day.

Above: Birthday celebration with grandchildren (from left) Grace, 4, Jackie, 8, Yoobhin, 4, Liz, Isabel, 6, and Seong, 10.

Below: Liz and choir friends Barbara, left, and Pauline.

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Hearing HQ Aug - Nov 2015

considerably and my low tones were slightly worse. So I was the ‘one per cent’ that did not have a good result and this was a big blow.

I eventually picked up the pieces, thinking there was nowhere else to go and I would just have to make the most of what I had and get on with my life.

I enquired about a cochlear implant but was told that, as my other ear was adequate, I would not qualify. I am so grateful and delighted that the situation has changed now and I am eligible.

At the time, it seemed I had no more options other than to struggle on with my inadequate hearing aids and get on with my life and this I have done for the past 10 years.

My life has continued along similar lines. I am travelling when I can. I still belong to a choir, which is a very important part of my life in spite of the frustrations I experience every day and every week. I attend concerts when possible.

Background noise is a complete nightmare. Conversation, apart from in a quiet place with only one exchange going at a time, has remained very problematic.

Of course, my social life is affected, but I have wonderful friends who are very understanding and put up with my problems and quirks. I found myself increasingly watching people’s mouths as I spoke to them and it seemed to help with comprehension although I can’t really lip-read.

In the meantime, I have, acquired four grandchildren, and there again, talking with them (and understanding them) has become an increasing frustration - for them and me.

I finally decided that there must be something else I could do and that is when the possibility of having a cochlear implant came into the equation.

I talked to a lot of people and went to a couple of audiologists who dealt with this procedure, and was told that I was definitely a candidate to have a cochlear implant now.

I thought very seriously about this.

However, there was a little hitch. At the same time I was diagnosed with hypertension (very high blood pressure) which I had never had before and it needed to be sorted out. I continued to investigate the cochlear option, and was fortunate in being able to contact

a handful of people who had had the procedure and everyone was very encouraging.

By then the hearing in my left ear was almost non-existent so I thought, ‘What have I got to lose?’ My better, right ear had gradually deteriorated also over the years, but with a hearing aid it was still giving me enough hearing to get by - so I had that in reserve.

My next step was to see the surgeon who explained the whole procedure to me. And so I decided to go ahead with it!

Having made the decision, I was very excited and a date was set for my surgery. My immediate reaction was, ‘How exciting was this?’ and I went into countdown mode. I was given the choice of three different cochlear implant brands - all similar but with some variations.

My task was to decide which one would be the best for me. This was not an easy decision to have to make. How does one decide such an important matter?

I read whatever I could and made my

decision subjectively.

The Advanced Bionics version (AB) gave me a good feeling and I was fortunate to be introduced to a young man who had had this type of implant last year.

He has been wonderfully helpful and supportive.

I have also spoken with recipients of the other two brands I looked at. I liked the fact that the AB device was connected with Phonak, a company which makes many hearing devices as well as hearing aids. Both my hearing aids were Phonak, and I had found they were as good as I could get. Also they had a microphone directed to the ear which seemed to be a good idea. Their associated appliances sounded wonderful to use with the cochlear implant for improved hearing in crowded situations, for use with the telephone, and any Wi-Fi appliances and carrying on conversations.

Most importantly for me, they seemed to have concentrated on the music aspect with the design of the electrode

combination. They appeared to be well up in technological developments.

Overall, it felt like the right choice for me so I notified the audiologist who ordered the device. I started to get quite excited that maybe there was light at the end my frustrations.

This all sounds very simple…but I must admit it was far from it!

This was only the beginning. It has taken months from deciding to undertake this journey to where I am now. I would go as far as saying this is probably the most important decision I have made in my life since choosing my life partner.

To have this cochlear implant is potentially a totally life-changing event.

For now, this is my ‘hearing story’ and I can’t wait for the next chapter!

* Tune into Liz’s journey next issue as she goes through implantation surgery and her much-awaited ‘switch on’ day.

Do you struggle to hear even with hearing aids?

A cochlear implant could help you restore your hearing.

Unlike hearing aids, cochlear implants don’t just make sounds louder. They are a complex device that can replicate the hearing function of the inner ear.

It is never too late to explore your options to improve the quality of your hearing – even if you are currently using hearing aids, you may experience a better result with a cochlear implant.

Contact SCIC Cochlear Implant Program on 1300 658 981 to find out more today.

Public and private clients Our cochlear implant ü ü services typically require Adults & children of all ages ü no out of pocket costs

1300 658 981 scicadmin@scic.org.au www.scic.org.au

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PORT MACQUARIE

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I

see how to hear

Life coach Deb Maes (Masters in Communication and Grad Dip in Applied Psychology) explains how we use our eyes to train the brain to hear.

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Hearing HQ Aug - Nov 2015

My fascination with Auslan (Australian Sign Language) and augmentative communication associated with hearing loss began when I was nine years old when a guest from the Deaf Society of New South Wales (NSW) visited my primary school. All I recall of the visit was learning finger-spelling.

I took to it like a duck to water. My new friend at school had a younger sister who was profoundly deaf and they used sign at home as their primary means of communicating. We found finger-spelling a fantastic tool to talk in class without getting into trouble with the teacher.

Once my friend left school, I didn't sign again until I met an adult deaf signer at the age of 23. I started our conversation with, “Can you lip-read?” When I got no reply, the cogs of my mind started ticking. “Wait!” I said to myself, “I know something about this” and started fingerspelling the words, “Hello. How are you?” After all those years I remembered what I had learned and used it as a tool to become proficient in signing.

Two years later I started interpreting.

But it took almost seven years to become a qualified interpreter, passing Australia’s National Accrediting Authority for Translators and Interpreters Professional Level III exam.

A subsequent Masters in Deafness and Communication at Sydney’s Macquarie University broadened my interest in the mechanics of hearing and thought and led me to studing more about cognitive psychology, biopsychology and neuroscience.

I never cease to be amazed at the ability of our brains to learn, especially as babies. Just imagine the world of sights and sounds we are born into. Of all the world’s incredible noises, how do we pinpoint the thing in our environment that is creating a particular sound we hear. It is miraculous how we can focus our attention on a certain sound while filtering out a range of other stimuli, like when we overhear our name, even when we are not listening. This ability was first named, ‘The cocktail party problem’ by Colin Cherry in 1953 when he researched how air traffic controllers hear their relevant information among many intermixed pilots voices coming through a loudspeaker.

Yet we do not remember the excitement and joy of many hearing discoveries because our brains delete information around the age of five, a process known as ‘synaptic pruning’. Consequently, we lose our memory of these special moments, but retain the abilities we gained (Craik & Bialystok, 2006). How amazing it would be if adults could access how the brain starts to make sense of auditory stimuli as it did when it heard sounds for the first time.

A few years ago, I was able to get close to this experience as I shared such a moment with several adult deaf sign language users who received a cochlear implant. At the time, I was enrolled in a Graduate Diploma in Psychology at the University of New England (UNE, NSW) and had to conduct a research project. Being proficient in Auslan, I was able to talk to some implant recipients about their experiences, as they were hearing and making sense of sounds for the first time. What we discovered is helpful, fascinating and illustrates some things neuroscience reveals about brain plasticity.

It might sound like we have plastic brains, but the term ‘neuroplasticity’ refers to changes in neural pathways and synapses due to changes in behaviour, thinking, and emotions - as well as

Mark Williams explaining how his brain honed in on the auditory stimuli to make the association between eyes and ears.

changes from injury.

Prior to this discovery, it was commonly believed that the brain was a static organ and could not repair, adapt or change. The brain’s ability to find new and innovative ways to adapt can also apply to the loss of a sense, using one sense to teach another sense.

Norman Doidge (2007), author of the best-selling book, ‘The Brain that Changes Itself’ relates an example of a woman, Cheryl, who lost her balance due to severe damage to her vestibular system. This balance system in the ear is responsible for our orientation in space.

Cheryl had the sensation of perpetually falling. People with this condition are referred to as ‘wobblers’.

Cheryl worked with American neuroscientist Dr Paul Bach-y-Rita, one of the pioneers in brain plasticity. He developed a sensor device that sat on her tongue and sent signals to the brain when she moved. When she leaned forward, she recalled, “Electric shocks that feel like champagne bubbles go off on the front of my tongue, telling me that I am bending forward.” From this very first time, the sensation of falling forwards left her. But even more exciting is that residual effect.

As she continued to wear the device the residual effect built up to hours, days and months until she no longer needed to use it.

This ability of the brain to reroute - using alternate pathways when the usual neural pathway is blocked, was illustrated by the cochlear implant recipients I worked with on my research at UNE. One of them, Mark Williams, described the experience of driving down a freeway for the first time just days after the implant switched on. As he drove along with the window down, he felt something like a brushing or slapping sensation on his cheek. He found this curious because he couldn’t see anything that had done this - nothing seemed to have touched him. However, he soon realised that he had this sensation every time a car passed. As he watched the cars pass by and his eyes registered each moving vehicle, the feeling resolved into the ‘whoosh’ sound we know as a passing car. What his eyes saw became sound.

Another example was the report of his first visit to a Chinese restaurant after

being implanted. When he looked down at his food, he heard a cacophony of sound. But when he used his eyes to look at the sound, the incomprehensible noise immediately resolved into a cup being placed on a saucer, a person speaking in a foreign language, or a person laughing.

Learning from this, he decided to use this strategy of letting his eyes inform his hearing on a day out at Sydney’s busy Paddy’s Markets. He began looking to identify the sound. He noticed two people talking. As soon as his eyes found them, it was like his brain ‘zoomed in’ on them and this particular sound became amplified - all the other noises dissipated - and the sound resolved into two people talking and he recognised it as voices.

This is not surprising, as the brain learns by association. When things are going on at the same time, the brain creates an association to learn that something is causing the other. This is called a ‘pairing’. For example, I put my hand on the stove and at the same time I got pain in my hand. I have learnt that the stove is hot and can burn me, and the association is created at the apparent speed of light.

Using previous experiences, we automatically respond to a new stimulus. This results from repeated pairings of the neutral stimulus and the environmental stimulus and is called ‘classical conditioning’ (also known as Pavlovian or respondent conditioning).

It was made famous by Ivan Pavlov and his experiments with dogs when they salivated at the ringing of a bell at feeding time. Classical conditioning has become the basis for a theory of how we learn and had great influence in the mid20th century.

What this man chose to do was very clever. He created the opportunity for his brain to make repeated pairings, using a sense that he was very capable with, his eyes, and let that support his brain in mapping across to make sense of sounds.

Just as Bach-y-Rita’s work showed that, “We see with our brains, not our eyes” (Doidge, 2007), he let his brain hear using his eyes. “The discovery that the visual, auditory and sensory cortices all have a similar six-layer processing structure… means that any part of the cortex should be able to process whatever electrical signals were sent to it,” explains Doidge.

It seems this is what is going on for the man who took part in my research.

Just as was the case with Cheryl, who no longer needed to use her tongue to inform her ears, it did not take this man long before he could recognise specific sounds without looking. His brain had made associations. Not all recipients in the research project achieved the same results as this man, but the ones that did all used this strategy - utilising their eyes to learn to hear.

Watch the video of Mark Williams at www.hearinghq.com.au.

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all about. all about...

Meniere's Disease More than 150 years after it was first recognised as an inner ear problem, Meniere’s Disease is still misdiagnosed and misunderstood, writes David Becconsall, B.App. Sc. Physiotherapy, vertigo specialist physiotherapist.

What is Meniere's Disease?

French physician Prosper Meniere was the first to theorize that attacks of vertigo, ringing in the ear (tinnitus) and hearing loss, came from the inner ear rather than from the brain.

This idea, formed in the 1860s, was finally accepted and Dr Meniere’s name has been synonymous with the condition ever since.

Meniere’s disease is a chronic, incurable vestibular (inner ear) disorder which causes repeated attacks of dizziness due to increased pressure caused by excess fluid build-up in the inner ear. Fluids in the inner ear chambers are constantly being produced and absorbed by the circulatory system.

Any disturbance in this delicate relationship resulting in over-production or under-absorption of these fluids can lead to increased pressure producing dizziness, hearing loss and tinnitus (ringing or buzzing in the ears).

Who gets it and why?

Meniere’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The exact number of people with Meniere’s is difficult to measure because no official reporting system exists. Numbers used by researchers differ from one report to the next and from one country to the next. Support group Meniere’s Australia reports that around one in every 600

people have the condition.

Around 90 per cent have it in one ear while 50 per cent can expect to develop it in both. The National Institutes of Health estimates around 615,000 people in the US have it and 45,500 new cases are diagnosed there each year.

Despite extensive research, the exact cause and reason why Meniere’s starts is unknown.

Factors thought to increase its likelihood include genetics, circulatory and metabolic functions, viral infection, allergies, an autoimmune reaction, migraine, toxic or emotional unbalance.

The leading theory is that attacks result from increased pressure from excessive fluid in the inner ear and/or from the presence of potassium in this area where it doesn’t belong. Some people with Meniere’s find that certain triggers set off attacks. These include stress, overwork, fatigue, emotional distress, illnesses, pressure changes, certain foods and too much salt in the diet.

Symptoms Meniere’s disease may start with fluctuating hearing loss and is often characterized by attacks of dizziness that vary in frequency and duration from once or more a day to once a year, lasting a few hours to 24 hours.

It is this unpredictability that makes it challenging to manage.

Hearing loss and head noise usually Hearing HQ Aug - Nov 2015

25

accompany attacks, which can occur without warning. Violent spinning, whirling and falling, associated with nausea, vomiting and a sensation of ear pressure or fullness are also common.

If attacks do recur, they are usually less severe and shorter than the first. In between episodes, sufferers tend to be asymptomatic making diagnosis difficult as Meniere’s markers are only present at the time of symptoms.

Occasionally hearing impairment, head noise and ear pressure occur without dizziness. This type of Meniere’s disease is called Cochlear Hydrops.

Similarly, episodic dizziness and ear pressure may occur without hearing loss and tinnitus; this is called Vestibular Hydrops.

During an attack of early-stage Meniere’s disease, symptoms can include any of the following symptoms: • • • • • • • •

spontaneous, severe vertigo fluctuating hearing loss aural fullness and/or tinnitus anxiety blurry vision nausea and vomiting cold sweat palpitations or rapid pulse

Warning signs Oncoming attacks are often preceded by an “aura,” or the specific set of warning symptoms including balance issues, dizziness, light-headedness, headache, hearing loss or increased tinnitus and sound sensitivity. Paying attention to these can allow a person to move to a safe or more comfortable situation before an attack.

After the attack, a period of extreme fatigue or exhaustion often occurs, prompting the need for hours of sleep. The periods between attacks are symptom free for some people and symptomatic for others.

Many symptoms have been reported after and between attacks including concentration difficulty, fatigue, palpitations, cold sweat, lightheadedness, nausea, neck ache or stiffness, unsteadiness particularly in dim light and vision problems.

Late-stage Meniere’s disease refers to a set of symptoms rather than a point in time. Hearing loss is more significant and 26

Hearing HQ Aug - Nov 2015

is less likely to fluctuate. Tinnitus and/ or aural fullness may be stronger and more constant. Attacks of vertigo may be replaced by more constant struggles with vision and balance, including difficulty walking in the dark or in visually stimulating surroundings and occasional sudden loss of balance. Sometimes, drop attacks (Tumarkin’s otolithic crisis) occur characterized by sudden brief loss of posture without losing consciousness.

Treatment Unfortunatley no treatment currently exists to cure Meniere’s. However, it can be eased by medication or surgery as well as diet modification, stress reduction, exercise and natural therapies.

Medical options are aimed at improving the inner ear circulation and controlling fluid pressure changes in this area. Some medical treatments aim to reduce the severity of an attack while it is occurring while others attempt to reduce their severity and frequency in the long term.

Surgical options block the movement of information from the affected ear to the brain. In the most severe cases, destroying the inner ear so that it does not generate balance information to send to the brain or destroying the vestibular nerve so this information is not transmitted to the brain, can relieve the patient of disabling symptoms.

Medical and dietary management Medical treatment is effective in decreasing the frequency and severity of attacks in 80% of patients. Treatment may consist of medication to stimulate inner ear circulation, decrease inner ear fluid pressure or prevent inner ear allergic reactions. Vasodilating drugs are used to stimulate inner ear circulation and are prescribed together with anti-dizziness medication such as Serc (betahistine HCl) as a vestibular suppressant for Meniere’s disease. Vasoconstricting substances have an opposite effect and should be avoided.

These include caffeine (coffee) and nicotine (cigarettes).

Some medications are prescribed for attacks to reduce the vertigo, nausea/ vomiting or both. These include diazepam (Valium), lorazepam (Ativan), promethazine (Phenergan), dimenhydrinate (Dramamine Original

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AVOID ALLERGENS TRY TO REDUCE STRESS

CUT OUT

COFFEE DON'T SMOKE

GO WITHOUT

SALT BOYCOTT

MSG

Formula), and meclizine hydrochloride (Antivert, Dramamine Less Drowsy Formula).

Meniere’s may also be caused or aggravated by metabolic or allergic disorders. Special diets (reduced sodium) or drug therapy (diuretics to control water retention) are good for conservative, long-term treatment.

Vestibular physiotherapy Vestibular rehabilitation therapy (VRT) is widely used to help imbalance that can plague people between attacks. Its goal is to help retrain the body and brain to process balance information.

The success of such programs is dependent on the patient's compliance and practitioner’s experience to monitor and moderate a tailored exercise program. This needs to take account of the patient’s tolerances and limitations with movement, head motion, imbalance, visual dependency and postural intolerances.

Other non-surgical options Around 20% of people do not respond to medication or diet modification. In these cases, a physician may recommend a treatment that involves more physical risk such as intratympanic injections. The amino glycoside antibiotic (Gentamicin) is injected into the ear which selectively destroys vestibular tissue.

This procedure is usually reserved for patients with Meniere’s in their only hearing ear, or in both ears and when other medical options have not been successful. Recently, intratympanic steroid injections have been used which have lead to less risk of hearing loss and persistent imbalance.

Surgical management Surgery is successful in relieving acute attacks of dizziness in the majority of patients. Residual hearing and tinnitus may improve, stay the same or worsen.

Two categories of surgery are available. The goal of the first type is to relieve the pressure on the inner ear such as ‘endolymphatic shunt’ and ‘cochleosacculotomy surgery’. However, these are not as widely used now due to unfavourable statistics on long-term effectiveness. The goal of the second type of surgery is to block the movement

of information from the affected ear to the brain. The process involves either destroying the inner ear so that the ear does not generate balance information to send to the brain, or destroying the vestibular nerve so that balance information is not transmitted to the brain.

In either instance, vestibular physiotherapy is useful to help the brain compensate from the loss of inner ear function due to surgery. Examples of this type of surgery include transcanal (oval window) labyrinthectomy, translabyrinthine labyrinthectomy and section of the vestibular nerve, retrolabyrinthine section of the vestibular nerve, and middle fossa section of the vestibular nerve.

Coping strategies Dealing with Meniere’s on a day-to-day basis is challenging because attacks are unpredictable, prognosis is difficult due to its erratic nature - symptoms can remain the same, disappear one day and never return or become more severe and disabling - and the fact that it is incurable. However, there are many things sufferers can do to alleviate symptoms and live life to the full.

Firstly, ensure you inform all your friends and colleagues that you have the condition and how it affects you. Because the symptoms of Meniere’s are invisible to others, it is important to make people aware of it. Explain what might happen before and during an attack and how they can help. Also, relate the importance of a low sodium diet.

As well as educating them about the effectiveness of this dietary regimen, it helps to have the support of others to stick to it. Ensure that you have appropriate medication and know what to do before, during and after an attack. Experts suggest lying down on a safe, firm surface and avoiding head movement. Focusing on a stationary object about 50cm away can help. Rest in bed or sleep afterwards for a short period but getting up and walking around as soon as possible is said to help the brain readjust quicker.

Most importantly, visit your doctor or a vestibular physiotherapist to learn about ‘reset’ exercise programs to regain your best equilibrium.

HQ

Hearing HQ Aug - Nov 2015

27

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Q A

How often do I need to replace my hearing aids with a new pair?

Jawan Sayed: The answer to this question will depend on a number of variables. Hearing aids should function well for at least four to five years. Although they may still work after this period, technological advancements as well as a change of hearing may mean that once this timeframe approaches you may benefit from new hearing aids to improve listening ability. In addition, you need to consider what type of hearing aids are being used. Factors such as illness, general health, an alteration in hearing ability or a change in lifestyle may result in needing to change your hearing aids. For example arthritis may result in deteriorating dexterity and you may no longer be able to manage controls

or smaller batteries. In this situation, the option of hearing aids that have a remote control with large buttons and devices with larger hearing aid batteries may be the solution. Taking up a new sport, starting a fitness regime or changing jobs to a more dusty or humid environment may also mean you require more robust aids that tolerate moisture and dirty air.

Hearing aids like many other electronic devices are exposed to the wear and tear of daily use including humidity and perspiration. These factors may require the devices to be sent away for repair or service. The service and repair fees may differ from one hearing aid manufacturer to another however a minor check of hearing aid function and cleaning the aid can cost approximately $70 and a major repair may exceed $300. Sometimes repairing old hearing aids out of warranty may be less cost effective in the long term for the user than purchasing a new set of hearing aids. Cleaning your hearing aids often and scheduling routine appointments with your audiologist will help ensure optimal performance over the lifespan of your audiological equipment.

Q

I have otosclerosis and I am considering stapedectomy surgery to improve my hearing. My surgeon has recommended stapedectomy surgery, but in my research I have read about stapedotomy surgery being better.

What is the difference between the two operations?

Melville da Cruz: Otosclerosis is a hereditary disease which results in progressive stiffness of the stapes bone, the third of the three middle ear bones. As the stapes bone becomes progressively stiff it transmits sound energy less efficiently through the middle ear resulting in conductive hearing loss.

What is so exciting about otosclerosis is that the middle ear component of the hearing loss is treatable by surgery,

A

ts

generally called stapedectomy. The principle of this operation is to restore sound transmission to the inner ear bypassing the fixed stapes bone. This can be achieved either by removing the entire stapes bone (stapedectomy) or drilling a very fine hole through it (stapedotomy) and replacing it with an artificial stapes bone. When stapes operations were first developed in the 1950s, it was necessary to remove the whole stapes bone before introducing an artificial stapes replacement (generally made of fine stainless steel wire and fat taken from the ear lobe). As the micro drills, and more recently lasers, were developed it became possible to drill a fine hole (less than 1 mm in diameter) through the stapes footplate and introduce a replacement stapes bone (made of titanium/platinum and Teflon) to effectively bypass the fixed bone, leaving the remaining footplate largely intact. Both operations in skilled hands produced wonderful hearing results, and both operations still carry similar risks of permanent and severe hearing loss (dead ear, less than 0.5%).

However, the stapedotomy operation produces less trauma to the inner ear, preserving the higher hearing frequencies. The modern stapedotomy

replacement bones are also safer to revise if necessary and the replacement prosthesis is compatible with MRI (magnetic resonance imaging) scanners if imaging of the region is required later on.

Because of these advantages, all modern stapes surgery for otosclerotic hearing loss is in the form of stapedotomy.

Q

Can you please give some advice about earplugs? I have tried a few different ones for when I mow the lawn and use power tools and for my hobby which is model train construction. The ones I have tried are either uncomfortable or really stand out of the ears. I would like to be able to wear something that isn’t so obvious. Can you help?

Emma Scanlan: There are a range of options available depending on your budget and needs. Custom-made earplugs can be produced in a flesh colour (you would need to go to your local hearing clinic for these). These fit well in the ears because they are made to match the exact shape of your own anatomy and are usually more comfortable and seal better than generic plugs. They also tend to last longer.

Alternatively and more cheaply, you could purchase some off-the-shelf plugs in flesh colour or clear colour from many chemists or hearing clinics and the cost will vary from around $5- $30 depending on the make and model.

The shop-bought items should have some information on the packaging regarding the level of attenuation (dampening) that you will receive from the plugs. Some are disposable after one usage and other silicon-based plugs will last much longer. The important thing for the power tools and mowing is to reduce the sound pressure to a level that is not dangerous to your hearing and the fit of the earplugs really matters for this. If air is escaping around the earplug, then sound will also be leaking in around the plugs to the eardrum. Some people prefer to use earmuffs for noisy situations as it is easier to make sure they are really covering the ears, but they are, of course, more obvious when you are wearing them. Earmuffs can be purchased at hardware and specialty shops.

A

Q A

What should I do with my used hearing aid batteries?

Roberta Marino: There are no laws in Australia regarding hearing aid disposal. Up to 97% of hearing aid button cell batteries end up in household waste potentially causing damage to our health and the environement. Adding to this, the processes used to create and distribute batteries are not eco-friendly. Hearing aid batteries are typically made of zinc, mercury and steel and are called zinc air batteries. A typical hearing aid battery lasts a week. So if you are wearing two hearing aids, you will be using around 104 disposable hearing aid batteries a year. If you are using disposable batteries with your cochlear implant processor, which has greater power requirements, you would be using around 312 batteries for each processor. Many audiology clinics collect used batteries and forward them to the council for recycling.

Unfortunately, Australia can only recycle car (lead-acid) batteries and all other types including hearing aid batteries are sent overseas for recycling. Some battery companies such as Hearing Aid Batteries Express (www.habex.com) have invested in a recycling bin from French utility company Suez Environnement. Used batteries can be forwarded to Habex (preferably by road mail) and they fund shipping to Suez Environnement for recycling. Adding to these sustainable projects, a European Union ban on mercury as a stabilizer in button cell batteries is due to become effective from October 2, 2015. Following the same ban in many US states, the EU ruling sends out a clear international message that mercury-containing batteries should not be manufactured or offered for sale. To find out how you can safely dispose of your hearing aid batteries and prevent further contamination, you can contact one of the following companies: Suez Environnement www.suez-env.com.au; Battery World www.batteryworld.com. au; Cleanaway www.cleanaway.com. au/batteries or your local council. Where possible, look at rechargeable battery options. Not only are they cheaper for you, they are substantially less harmful for the environment.

Hearing HQ Aug - Nov 2015

29

REAL PEOPLE

As an audiologist working with cochlear implant recipients, Helen Court now understands how her clients feel

30

Hearing HQ Aug - Nov 2015

In my 20s, I was diagnosed with Meniere’s disease after noticing a severe decrease in my left hearing levels while completing my Masters degree in Audiology. Ironically, I would spend my entire career looking after others and restoring many peoples’ hearing, all the while brushing off the impact my own hearing loss was having on me. After the initial deterioration of my hearing in my twenties, throughout my thirties and into my early forties, it worsened leaving me with Single-Sided Deafness (SSD) and tinnitus. After seeing the amazing impact cochlear implants have on my patients’ quality of life, I was delighted when these devices were approved for use with SSD. Over the years, having a lot of access meant I had tried almost every hearing aid available on the market thanks to my resources at the clinic. However I found that none of these were very effective.

Five days after Ear Nose and Throat surgeon Dr Chris Que Hee implanted a cochlear implant into my left ear, I not only switched on hearing in my left ear, but switched myself on to the world around me.

It’s the little day-to-day improvements that are making the most difference – I can now talk to my two children, aged eight

Main picture: Photo Warren Lynam / APN

''

I have worked as an audiologist for almost 20 years. In that time I have helped many clients find solutions to their hearing problems, whether it be through a hearing aid, cochlear implant or other implantable device.

One of the most rewarding aspects of my job is switching on a client’s new cochlear implant, which allows them to experience the world of sound. Some of these people are hearing sounds for the very first time. From young children, teenagers and adults, to the elderly, the look of surprise and pure joy on their face can be the same and fills me with happiness every time. After treating thousands of clients for hearing loss, I am now finally able to completely understand the emotions that come with receiving a life-changing device.

On the October 27 2014, I switched on my own cochlear implant on a typically busy day between appointments with clients. I could suddenly hear the scratching of my pen against paper as I wrote.

The clicks of the equipment in my office seemed very loud during the next few appointments. These little sounds may not seem like much, but they represent a whole host of sounds that I had been missing out on for almost 20 years.

''

real stories and 10, while they are sitting in the back seat of the car. Such a basic example, but the implant really does make parenting a lot easier when I can hear my children and communicate with them in all situations, especially environments that are a bit noisy. It also makes a huge difference in social situations and at my workplace.

Before, it was obviously very difficult to hear sounds coming from my left side. People would walk up and talk to me and think I was ignoring them, when really I just couldn’t hear them. Another challenge was trying to figure out what direction sounds were coming from. SSD makes it very hard to localise noise. It was a huge struggle to understand speech in noisy situations, and I had to resort to lip-reading to remain in the loop at dinner parties and other social gatherings. As soon as the cochlear implant became available for SSD, I signed myself up to start the process.

The whole process was quite easy because I have guided many patients through it before, so I knew what to expect from the operation, the recovery and the ‘switch on’.

I believe receiving this implant has made me a better audiologist because I can now put to rest any concerns my patients have about cochlear implants as I have gone through the process myself and can confirm how effective they are.

{

When I switched on my implant, I actually heard silence for the first time

About 3000 Australians suffer from SSD, a condition that is often overlooked and frequently misunderstood. Besides helping to restore hearing in my left ear, the most amazing gift the cochlear implant has given me is the ability to hear silence. Now that may sound very strange coming from someone who has been deaf on one side for 20 years. During this time, my tinnitus got worse and worse to the point where I would constantly hear a loud ringing in my left ear. When I switched on my implant, I actually heard silence for the first time. I am always so busy taking care of other people’s hearing that I didn’t notice how bad my Helen with husband Michael and (l-r) children Abigail, 8, and James, 10

own hearing had become, especially my tinnitus.

I love having a sensation of sound in my left ear. It somehow makes me feel more balanced and without it everything sounds dull and empty. I hate taking my cochlear implant off, and I don’t have to – there are some very helpful accessories available that allow you to wear your processors while participating in watersports. I have been enjoying more freedom while out sailing on weekends. Getting my cochlear implant really was one of the best decisions I have ever made.

HQ

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here to help Many not-for-profit organisations around Australia and government agencies provide valuable support, advice and information on hearing issues. Please visit www.hearingHQ.com.au to find out more about any of these organisations and to link directly to their websites. For an organisation to be considered for listing they must be a not-for-profit, charity or completely free service.

INFORMATION & SERVICES ACT Deafness Resource Centre - Canberra Information, referral and advocacy services T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395 Audiological Society of Australia Inc Information on national audiological services T 03 9416 4606 F 03 9416 4607 Australian Government Hearing Services Program Government assistance eligibility information T 1800 500 726 TTY 1800 500 496 Australian Hearing Australian Government audiology clinics T 131 797 TTY 02 9412 6802 F 02 9413 3362 Better Health Channel VIC Govt funded health & medical information www.betterhealth.vic.gov.au Deaf Can:Do (formerly Royal SA Deaf Society) Services to SA deaf and hearing impaired T 08 8100 8200 TTY 08 8340 1654 F 08 8346 9625 Deafness Foundation Research, education & technology support T & TTY 03 9738 2909 F 03 9729 6583 Ear Science Institute Australia Implant Centre Help with ear, balance & associated disorders T 08 6380 4944 F 08 6380 4950 Guide Dogs SA.NT Adelaide based aural rehabilitation service T 1800 484 333 TTY 08 8203 8391 F 08 8203 8332

Tinnitus SA Impartial tinnitus information and options T 1300 789 988

Catherine Sullivan Centre - Sydney Early intervention for hearing impaired children T 02 9746 6942 F 02 9764 4170

Vicdeaf Advice and support for hard of hearing T 03 9473 1111 TTY 03 9473 1199 F 03 9473 1122

Cora Barclay Centre - Adelaide Auditory-Verbal Therapy for 0-19 year olds T 08 8267 9200 F 08 8267 9222

ADVICE & SUPPORT

Hear and Say Centres - QLD Early intervention and cochlear implants T 07 3870 2221 F 07 3870 3998

Acoustic Neuroma Association of Australia Support and information on treatment E info@anaa.org.au T 03 9718 1131/02 4421 6963 Aussie Deaf Kids Online parent support and forum www.aussiedeafkids.org.au Australian Tinnitus Association (NSW) - Sydney Support, information & counselling services T 02 8382 3331 F 02 8382 3333 Better Hearing Australia (BHA) Hearing advice by letter, email or in person T 1300 242 842 TTY 03 9510 3499 F 03 9510 6076 Better Hearing Australia Canberra Hearing Loss Management & Hospital Kit T 02 6251 4713 BHA Tinnitus Self Help/Support Group - TAS Support group for those with tinnitus T 03 6244 5570 BHA Tinnitus Management Services T 1300 242 842

HEARnet - a better understanding of hearing loss & interactive ear diagram. www.hearnet.org.au T 03 9035 5347

Broken Hill & District Hearing Resource Centre Inc T 08 8088 2228 F 08 8087 9388 www. bhhearingresourcecentre.com.au

Lions Hearing Clinic Free or low cost services in Perth T 08 6380 4900 F 08 6380 4901

CICADA Australia Inc For people with or considering cochlear implants www.cicada.org.au

Lions Hearing Dogs Australia Provide hearing dogs and training to recipients T 08 8388 7836 TTY 08 8388 1297

CICADA Queensland For people with or considering cochlear implants E cicadaqld@tpg.com.au

National Relay Service Helpdesk Telephone access service for hearing impaired M-F 9am-5pm, Sydney time SMS 0416 001 350 T 1800 555 660 TTY 1800 555 630 F 1800 555 690

CICADA WA For people with or considering cochlear implants Coordinator: Lynette 08 9349 7712

Parents of Deaf Children - NSW Unbiased information, support and advocacy T 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193

Deaf Children Australia Services for hearing impaired children T 1800 645 916 TTY 03 9510 7143 F 03 9525 2595

SCIC - Sydney Cochlear Implant Centre Gladesville, Newcastle, Canberra, Gosford, Port Macquarie, Lismore, Penrith T 1300 658 981

Hear For You Mentoring hearing impaired teens T 02 8937 4150 E info@hearforyou.com.au

Telecommunications Disability Equipment Contact information for special phones: Telstra 1800 068 424 TTY 1800 808 981 F 1800 814 777 Optus 133 301 937 TTY 1800 500 002

Meniere’s Australia Dizziness & balance disorders support T 1300 368 818 F 03 9783 9208

The Deaf Society of NSW Information & services to NSW Deaf people T 1800 893 855 TTY 1800 893 885 F 1800 898 333 SMS 0427 741 420 The Royal Victorian Eye & Ear Hospital Cochlear Implant Clinic T 03 9929 8624 F 03 9929 8625 E cic@eyeandear.org.au

34

Hearing HQ Aug - Nov 2015

Self Help for Hard of Hearing People (Aus) Inc Educational association T 02 9144 7586 F 02 9144 3936

EDUCATION Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kids T 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933

RIDBC (Royal Institute for Deaf and Blind Children) Hearing and vision impaired education & services T & TTY 1300 581 391 F 02 9871 2196 RIDBC Hear The Children Centre - Sydney Early childhood intervention for hearing impaired T 1300 581 391 F 02 9871 2196 RIDBC Matilda Rose Centre - Sydney Early childhood intervention for hearing impaired T 02 9369 1423 F 02 9386 5935 Taralye Oral Language Centre - Melbourne Early childhood intervention & advocacy T 03 9877 1300 F 03 9877 1922 Telethon Speech & Hearing - Perth Early intervention program and specialist paediatric audiology services T 08 9387 9888 F 08 9387 9889 The Shepherd Centre - NSW & ACT Early intervention and cochlear implants T 1800 020 030 F 02 9351 7880

ADVOCACY & ACCESS SERVICES ACT Deafness Resource Centre T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395 Arts Access Victoria/Deaf Arts Network T 03 9699 8299 TTY 03 9699 7636 F 03 9699 8868 Australian Communication Exchange (ACE) T 07 3815 7600 TTY 07 3815 7602 F 07 3815 7601 Cap that! Captioned for Learning www.capthat.com.au Deafness Council Western Australia Inc T & SMS 0488 588 863 Deafness Forum of Australia T 02 6262 7808 TTY 02 6262 7809 Deaf Sports Australia T 03 9473 1191 TTY 03 9473 1154 F 03 9473 1122 Media Access Australia T 02 9212 6242 F 02 9212 6289 NMIT Centre of Excellence Vocational Education T 03 9269 1200 F 03 9269 1484

OTHER BHA Hearing Aid Bank - donate old hearing aids T 1300 242 842 T 03 9510 1577 Planet Ark - Find a battery recycler near you www.recyclingnearyou.com.au/batteries JobAccess Disabilities workplace solutions T 1800 464 800 TTY 1800 464 800 F 08 9388 7799

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