Ask the Audiologist

Miscellaneous and Personal Stuff I Must Share
41

You’re quite welcome!

You are correct in thinking that it would be wise to wear hearing protection while performing (indeed, also while practicing!). You may already be aware of this, but just in case you are not, you can get ‘musicians’ ear plugs. The degree of attenuation will vary and the frequency response is flat, so you will not compromise the ability to discriminate the nuances of the music (regular foam ear plugs have a steep high frequency roll-off making it hard to discriminate some of the high frequencies). The musicians plugs can be custom-made for greater comfort. They can be obtained from any audiologist in your area.

I have worked with many musicians who wear hearing aids outside of a performance setting. It is not uncommon for musicians who need hearing aids to wear them when they’re not playing.

42

I can understand your frustration. The reason all hearing tests are completed in quiet is that there is an ANSI standard and a controlled environment is critical so that the test results can be compared from one test session to another so that any changes can be monitored.

Regarding testing a person’s ability to perform in noisy environments–this is starting to be tested under standard testing protocols. It involves mainly the person’s ability to understand ‘speech in noise’ and is a measure not of hearing, per se, but a measure of the person’s ability to understand speech against a given background of noise.

Many patients are frustrated to find their hearing is essentially normal, but they experience some of the same problems one with a hearing loss might (similar to yourself). Sometimes it is a function of poor acoustics, background noise, etc. but also there may be issues with auditory processing.

Auditory processing involves more challenging activities than just identifying whether or not there is a single tone present (which is what was done during the hearing test). These activities are higher level ‘listening’ tasks such as sorting out the signal from the background noise, interpreting a degraded signal, etc. There are tests to measure a person’s auditory processing ability that can be completed. They are not generally part of the normal test battery and may not be readily available as many audiologists do not offer these tests. It might be worthwhile to consult with your physician or audiologist to see if it would be helpful to undergo such tests.

43

There is such a thing as ‘hyper-sensitive ‘hearing, but it is not very common. In some extreme cases, the issue is so pronounced that the daily life of the individual is quite miserable.

There are really no special precautions that are necessary other than to use personal hearing protection when exposed to hazardous noise levels

44

Thanks for the info. I’ve got a part two if you don’t mind. I’ve noticed that my sensitivity is tuned to high frequencies in particular. I’ve no trouble “hearing a gnat fart” as my father puts it. On the other side, heavy bass or window wind type white noise will render me effectively deaf. When those type of noises are around everything becomes very, very muddy and I can’t hear anything but the low end as it shuts out everything else. As you noted above, both the low end effect and extremely high frequencies can drive me batty fairly quickly. Is there a name for this type of effect (other than a symtom of my hyper-sensitivity) and ought I be worried about it? FTR all my hearing tests have simply shown me to have superior hearing with no noticeable conditions.

45

We’re going through a situation with my 87 year old mother who lives with us. She has had tinnitus and hearing loss for many years and it is becoming more critical. She used to only have hearing loss on one side, but both sides now seem about equally shot. About six years ago, she was fitted for a hearing aid (a Siemens) to help her out at the bridge club, but she never liked it, the background noise cut through and she really couldn’t hear the voices better. Might have just been a wrong solution, but she hated it. She doesn’t go to the club anymore, her only hearing issues are with the TV and room conversation. She now thinks we’re whispering around her and says she feels like she’s in a tunnel - a very loud tunnel.

This is what we’ve done. She seems to be able to hear on the phone okay when my sister calls. We bought her an infared earphone set that goes through it’s own amplifier for the TV, and that seems to work, although sometimes she complains.

Her doctor fussed at her to get a hearing aid and gave her a referral, so we’re in the process. She has put this off because she doesn’t feel like spending $4,000.00 on a set of aids at this stage of her life. (She actually can afford it.) She had her audio test which confirmed that she can’t hear. :rolleyes: The MD examined her and said she probably just was losing her hearing to old age, OR, perhaps a little “inner-ear syndrome” for which he prescribed some vitamins and a little vial of histamine solution to put under her tongue which , he says, somtimes helps.

And now for the questions:

What is the deal with the histamine and the inner-ear syndrome?

When she goes back to the hearing aid test/sales person, what can she actually expect to be helpful to her. Would her old Siemens be an option? Might it still work?

And the money question: Doc sent her for an MRI. I’ve had MRIs for my back. When she got in the machine, they gave her this silly putty goop to plug her ears. She said it was the noisiest experience of her life, like a building collapsing around her, and she’s still bitching, quite loudly, that she should have been warned how horrible it was going to be and how many people die of heart attacks in there, anyway. I remember soft machine noises, but not what she is describing. What was going on? We’re they bombarding her ears to see what was happening, or just a weirdness because of her earplugs and hearing loss?

She’ll be back there Wednesday so it would be cool if I could clue her in before she shows up and gives everyone in the office hell.

Thanks a million if you can help.

46

I had an MRI on my knee a few weeks ago. My head was not inside the machine, but they gave me earplugs anyway. Sucker was LOUD, even with the earplugs. I jumped several times from being startled - an especially loud noise would come up out of the general din. The technician told me later that the older machine that they used to have was quieter, but took twice as long to get readings. Maybe your grandma was in a newer, louder machine. I can imagine that if her head was actually inside the thing, it might sound like a building collapsing.

47

You’re welcome!

As for “where the sound is coming from” … Sometimes the sound is being generated at the level of the inner hair cells themselves and this is audible to the person. Other times it is being generated higher up the neural pathways. Sometimes our bodies behave in strange ways.

Regarding the phase cancellation, I had one lady who had tinnitus that I could hear! It was what is known as ‘objective tinnitus’. Most of the time the tinnitus is ‘subjective’ and can only be heard by its owner. In this lady’s case, however, I could hear it quite loudly when she would put her head in a particular position. Most likely cause in her case was some sort of vascular issue.

48

The condition, generally, is known as hyperacusis. I am not sure if there are further breakdowns in classifications or categories to address situations such as yours. At present, it is not likely anything that you need to worry about; it is more a matter of being able to cope with it in such a way that it has minimal impact on your daily life. This may be a matter of trial and error and I am not sure what I would recommend other than if you find something that works, continue to use it!

49

Regarding your Mother:

Issue of the histamines and the ‘inner ear problem”: I am not sure about this, so I really can’t comment. It may be useful for you or another family member to accompany her to doctor visits to offer support and to be sure that the various topics and recommendations discussed are understood and can help you help your Mother. I am not saying she is confused, but perhaps the doctor is treating a couple of different issues, but in her mind, it may all be related to her ears. Often, what a doctor tells the patient is not the same thing that the patient tells the family. Perhaps some of the Physician Dopers can answer this question.

Issue of the loud MRI: Some MRIs are very loud. I think that when she was given the ear plugs the technicians could have made sure she was aware of what to expect. Maybe they did and she did not hear them. When a person has a sensory impairment (in her case a hearing loss), it can be frightening to suddenly hear a very loud noise, especially if she was not prepared for it.

Additionally, sometimes a person with a hearing loss cannot tolerate loud sounds. A phenomenon known as ‘recruitment’ can occur which results in the inner ear reacting to loud sounds in an abnormal way, due to the damage to the sense organ of hearing. It is something that will vary among individuals, and must be taken into account, especially when setting up a hearing aid.

Issue of the six-year-old hearing aid: Adjusting to life with a hearing aid is a process that can take months. Some people are willing to adapt and accept certain limitations. Other people are not willing to work with the process and demand perfection immediately. In fact, emerging studies are looking at the effect a person’s general outlook on life (optimistic or pessimistic) and the anticipated success of hearing aid use.

Also, not only is the degree of hearing loss important when it comes to hearing aids, but equally important is the person’s ability to recognize words once they are made loud enough to compensate for the degree of hearing loss. Simply making it louder will not make it better. Sometimes, if the loss is so extensive that the ear can only recognize 34% of the words in a quiet setting when tested, then using a hearing aid in a busy seniors complex (or bridge hall) will be challenging. A huge part of fitting hearing aids is counseling and helping the family to understand and set realistic expectations and to learn new behaviors when trying to cope in a variety of challenging listening environments. An audiologist should be able to explain to you and you mother what is possible and what is not possible.

It may be that two hearing aids would be better than one. In most instances, this is the case. Our ears are designed to work as a set. When wearing two aids, each can be set lower individually so there is less noise coming in; with one aid, the settings must be higher as it is only one ear doing the work of two. When both ears are aided, the brain can work more efficiently and there is a ‘summation of loudness’ that occurs. Also, with all of the options with directional microphones, she may find some satisfaction with this sort of microphone technology. She must also learn where to sit in the bridge hall to maximize the use of these microphones. Also, understanding about background noise and competing speech noise is something the audiologist may be able to go over. This is hugely important for her to understand.

Lastly, and this is about the most difficult of all: As we age, our ability to process information begins to diminish. We take a tiny bit longer to process large amounts of information. If you talk with her, just … slow … your … rate … down. Just a bit. Give information in smaller chunks. The impaired ear will also take more time to process information as, remember, it is working with less information, even when a hearing aid is used. When a parent has given up her home and is living with family, there can be a feeling of powerlessness. Psychologically, it can be overwhelming and sometimes the parent will get stubborn or cantankerous and just plain hard to deal with; it is perhaps a way of maintaining ‘control’ or dignity. A loss of vision, or hearing, or smell, or touch can leave a person feeling very vulnerable and sometimes a bit paranoid (like thinking you are all whispering about her).

Perhaps you can go with her to the audiologist and be part of the decision making and rehabilitative process so that you can remind your mother what has been said, and you can support what the audiologist is trying to achieve with the fitting goals of the hearing aid. It is part of a process and at least there is a required trial period and if at the end she is not happy and decides to not wear the hearing aid, she can return them and receive nearly all of her money back.

Good luck!

50

I have a question. Barring any specific complaints, is it a good idea for people to regularly go to have their ears checked or cleaned of earwax? I don’t fool around with Q-tips too much, though I stick my pinky in my ear if it itches. I’ve read discussions in audiophile groups about people going in for a physical or something, and having a bunch of wax discovered and removed, and regaining hearing they didn’t realize they were missing.

51

Thank you for the reply. I was watching for it.
I was at the doctor with her during this last appointment, which was a good idea. He pretty much ignored her to talk to me since it is easier for him. It ticks Ma off no end to be talked around, but what can he do? I get the feeling the he’s using a let’s try everything we can approach with the histamines and the MRI, but these guys are notorius about not giving out too much information, so you wonder what they are really up to.

I realize that it’s a tough situation, and no solution is going to be perfect. From what I read, the biggest problem is one of expectations. And right now, she has very low expectations because of her previous experience. That’s probably bad since the more they offer her, the less she will be satisfied. She doesn’t go to the bridge club anymore. The only place she does go anymore is to the library, a very small amount of shopping and rarely to dinner.

That’s as right on as it gets and truly compounds the issue. We have a pretty good home life, but a lot of our effort goes to keeping her from giving up, and being able to hear us better would help a lot. I’ll see what the hearing aid maven says tomorrow.
Thanks for the encouragement.

52

What a good thread!

My husband has hearing loss. Even as a kid, he had trouble distinguishing voices from crowd noise, and the loss has progressed to the point where he has trouble hearing me even if I stand quite close if he’s not looking at my face.

He’s had tests done and they confirm that he has hearing loss, but they always say that because he has lost hearing only in the high frequencies, a hearing aid would be useless.

Is this really the case?

53

I was wondering when an earwax question would come up. I’m going to speak in general terms, since earwax circumstances and conditions vary among individuals: Some folks are real wax factories and others produce essentially no earwax at all.

Cerumen (the fancy term for earwax) has a special function: to keep the ear from drying out, and due to its stickiness, to keep foreign objects from falling in. The cerumen is produced by specialized glands, sort of like oil glands. The rate of production varies among individuals, as does the texture and consistency fo the cerumen. Often, as we get older, the rate of production increases.

The ears are also self-cleaning. The cerumen is produced and gradually migrates to the outer area of the canal, and finally may fall out of the ear. In some instances, due to the shape and size of the canal, the wax can’t make its way to the outside. If the rate of production outpaces the rate of migration, there can develop an excess, which sticks onto itself. Before long, the cerumen has become a ball or a plug.

Generally when a physician or audiologist looks into the ear, the fact that he or she can see wax is a good thing. But it is important that the eardrum can be seen and that it is healthy. If the cerumen begins to obsure the eardrum and seems to be closing off the canal, it will likely need to be removed.

Ideally, use of a soft cloth (say, a damp wash cloth) to swash out the very opening of the canal does the trick. Sometimes, it is a matter of simple over-the-counter solutions designed to break up the cerumen so it can migrate out of the ear. Always use these as directed, by the way—the use of drops, oils, or prepared solutions should be used very sparingly as the ear canal has a certain pH factor. These various remedies can change the pH balance and lead to other problems.

Note that more aggressive “at-home efforts” may cause problems, and I always advise against Q-tips, ballpoint pens, and other pointy objects. There are better alternatives available from your doctor.

For example, in more problematic situations, the physician can irrigate the ears, or use a suction machine to “vacuum” out the ears. After such a treatment, the patient may well feel his or her hearing has improved—my husband had a serious enough problem in the past that required suctioning, and he reported that he could hear better afterwards.

The best course of action to deal with earwax—and the heart of the answer to your question—is to consult with your doctor to see what applies in your particular situation. Like I said, circumstances and conditions vary among individuals.

54

Thanks for the compliment–I’m glad you’re finding the thread useful!

Years ago, a loss only in the high frequencies was very difficult to fit with a hearing aid due to the fact that the low and mid frequencies were normal, so no amplification was needed. With a circuit that only amplifies the high frequency, most patients reported that the aids made everything sound “tinny” and that the presence of the hearing aid in the ear made the ear feel plugged up.

Today, the trend has been to go with what is called an “open fitting”. Essentialy, a tiny hearing aid sits on top of the ear. The aid includes a circuit that is more sophisticated and precise for fine-tuning in the high frequencies, which will help with clarity of sound. To get the hearing aid to stay in place and to deliver the amplified sound to the ear, a very slim tube travels into the ear canal, but instead of occupying the entire ear canal space, only a small tip is situated at the end of the tube. This helps avoid the sensation of the ear feeling plugged up.

Many patients like these hearing aids: small, discreet, great sound quality, and no plugged up feeling. The fitting goal is to bring in only the frequencies that are missing due to the hearing loss, so the aid often helps the person hear a bit more sharply with increased clarity overall.

As always, a big determining factor in the success of a given hearing aid fitting is the motivation and dedication for the patient to use the aid regularly, everyday, so that the ear learns to use the amplified sound.

In sum, then, with the changes in technology, it is entirely possible to succcessfully fit a high frequency hearing loss.

Hope this helps!

55

It does. I’m going to show him the thread.

I think he’d be a model patient. He tends to do really well following instructions when it’s for something like his hearing. He hates his hearing loss.

Thank you.

56

No shit, I just came in here to find out how many posts it would take to get to what I would have posted…
9. Freakin’ nine. I love this place! :smiley:

57

Deborah, you forgot one important fact about earwax - how much cats love it! :smiley: <— also slightly green with nausea smiley