“Everyone mumbles.” or “if everyone spoke more clearly, I wouldn’t have a problem.” Have you thought or said either of those sentences before? If you have worked around industrial noise or find yourself over the age of 55, there is a good chance you have. But why? Surely it couldn’t be a reduction in hearing. Or could it? One of the most common misconceptions about hearing is that if it changes, you’ll know it. The truth is, in most cases, you probably won’t unless you get it checked. A reduction in hearing can be sneaky. It usually progresses slowly and usually involves higher pitches first. Both of these factors mean other people will probably notice you’re having difficulty before you do. Many people think that a reduction in hearing is like turning the volume down on the TV. It isn’t. When we lose our hearing from noise or age, for example, the part of our ear responsible for hearing higher pitches is what is damaged first. This leaves us with more of a problem related to clarity, than loudness. In other words, you may find yourself saying, “I heard you, I just didn’t understand you.” In speech, vowel sounds (oo, ee, ah) are low pitched and are what gives us the power or volume. Consonant sounds (p, t, k, s, sh) are high pitched. They are the ones affected first in most hearing losses. Unfortunately, they are also the sounds we need to understand one word from the next. That phenomenon is also why you may be able to hear the traffic on the highway outside, but yet can’t hear the TV or your spouse every time. So what are you supposed to do if you or someone in your life suspects you have a reduction in hearing? Well the good news is a hearing test is quick and painless. Depending who you see it may even be free of charge. What you will want to make sure of is that the test is comprehensive and thorough. There should be at least 5 or 6 procedures performed in that visit to even begin to come up with some answers. The “beep test” alone is not good enough. If the test results show some degree of hearing reduction, it is important to be educated completely about what your options are. If the results show that your hearing can be improved medically or surgically (about 15-20% of hearing losses), then you will be referred to your family doctor or an ENT (ear, nose, throat surgeon). If your hearing loss is permanent (age, noise, etc.) then you may be a candidate for hearing aids. A competent clinician should prescribe and dispense hearing aids with honesty and integrity. You should not feel as though you are being sold something, but rather that you are being cared for as you would be with your dentist, optometrist, etc. If you choose to adopt hearing aids into your life, you should know that you will undergo a trial period for the first 30-60 days. During that time, if you feel that your needs aren’t being met, you should have the option to return them, hopefully without charge. The hearing aid process should be a positive one in which you are able to work with your clinician to improve your conversations, relationships and overall quality of life.

I am occasionally asked by family who live in other provinces if I can “sell” them a hearing aid to save them money. I understand that hearing aids are an expensive proposition, but I have refused every time and referred them to excellent colleagues. My explanation is always the same. I tell them, “Who you see will make a bigger difference than what you get.” My family will need follow up and aftercare that I can’t deliver when they don’t live in Alberta. As a result, even though my own mother wears hearing aids, I am not her Audiologist.  We should never lose sight of the fact that hearing aids fall squarely under health care but it can be a confusing experience, with a lot to lose. It may be worthwhile to consider a few tips in finding the right professional.

“Biology is better than technology….” That’s a phrase I seem to repeat on a daily basis in my Audiology practice. In fact, I say it so much, I recently had a patient tell me I should trademark it! When it comes up in our clinical counselling, what I am usually stressing is that we need to protect our hearing, because once it’s gone, it’s gone. There is no medical or surgical method that can reverse the effects of noise damage. When that is the case, hearing aids are the only option for improved communication. But that is where my phrase comes from, because normal hearing is better than aided hearing, and aided hearing is not normal. My point is that we all need to learn how to preserve what hearing we have, so we don’t have to use hearing aids sooner than expected. Noise-induced hearing loss is really the only type of hearing loss that can reliably be prevented. In Central Alberta, it is a very real and widespread concern. With the number of blue collar jobs that sustain our local economy, it puts a large number of people at high risk for permanent hearing loss. Occupational health and safety only legislated protection from noise in the late 1980’s, but even now, there are workers that continue to be at risk for hearing loss, due to improper or inadequate protection from noise. I used to fly a lot for a previous job and I would always observe the ground crew faithfully wearing their hearing protection, but it seemed more often than not, that the earplugs were not inserted properly and therefore not offering any protection from the noise they were exposed to. Sometimes, improved counselling and instruction is all that is required to improve safety compliance and effectiveness. Other times though, a different strategy for hearing protection is needed and a basic foam earplug just isn’t the answer. To determine what the best solution is for you, we have to consider what it is that you do and what the requirements are. Is it industrial noise? Are you a musician? Are you a hunter or sport shooter? Each of these activities require very different solutions for noise protection. We also have to consider what we call “dose.” Noise is damaging from a combination of factors, including the loudness and time exposed. Industry calculates that we can safely withstand 85 dBA of noise for 8 hours unprotected. For every doubling of sound pressure (roughly 3 dB), we have to cut the time in half. So if the noise is 88 dBA, then 4 hours is safe, 91 dBA, 2 hours is safe, and so on. However, we also have to consider a unique form of noise induced hearing loss called acoustic trauma. These are sounds that are so loud, the effects are instantaneous. Firearm use would be a common example of this. For example, a shotgun blast can be 140 dB, which can do instant damage. In fact, that intensity of sound is above our pain threshold. The only reason we don’t necessarily perceive it as painful is because it is of short duration. But never the less, the damage is done.  Every problem has a solution and step one in solving the problem of hearing protection is consulting your Audiologist. If you are a musician, there are earplugs that can maintain the fidelity of your music without distortion. If you are a hunter/shooter, there are earplugs that allow you to hear properly and activate instantly at the moment you shoot. More commonly, if you work in noise, there are earplugs that can be custom fit to you, easy to wear and even filtered specifically to allow communication while still protecting from noise. Simply put, everyone’s situation is different and requires a solution specific to that person and that situation.

The primary goal for your first visit with an Audiologist should be to diagnose the hearing loss with an intent to consider the medical components of the loss. This will be accomplished through a series of tests designed to identify “site of lesion,” meaning where in the ear the loss is occurring, which in turn leads us to whether medical referral is necessary. A skilled audiologist can identify hearing losses that may be best treated medically or surgically and refer to ear, nose and throat (ENT) specialists (also called otolaryngologists). About 15-20% of hearing losses have the potential to be solved medically or surgically, without the use of hearing aids. Remember, in Alberta, an Audiologist carries the designation that allows direct referral to the ENT physician, whereas a Hearing Aid Practitioner cannot. You should know the difference. Hearing health care is a team effort between the Audiologist and Otolaryngologist much like vision/eye care is a team effort between Optometrists and Opthamologists, with similar roles and responsibilities. If diagnosis of a hearing loss suggests that the hearing loss is permanent (sensorineural) and medical treatment is not possible, the discussion will turn to whether or not hearing aids can be expected to be helpful. As I tell each of my patients, the need for hearing aids is not a black and white judgement call based on the data collected in the examination. As I tell the students I teach, we treat a person, not a file. The question we have to answer is how the reported hearing loss is affecting that particular patient’s life, relationships and the people around them. For example, we could generally expect that a retired person who lives alone and has minimal social interaction has a different set of needs than the person who is still in a career, volunteering or socializing in situations where the communication demand is high and frequent. The decision to pursue hearing aids should be based on a thorough needs assessment on top of the exam, so the Audiologist has an accurate picture of how the patient needs to communicate, with whom and in what environment. When the needs assessment is complete, the Audiologist should have a clearer picture as to whether hearing aids are needed and if so, which ones. At HearWell Audiology, the goal is to have a collaborative relationship between Dr. Towers and the patient to achieve the agreed upon goals. The goal of the process is to help that patient arrive at educated decisions. The decisions are ultimately up to you. Dr. Towers guides the process to ensure your decisions are based on best clinical practices, your personal experience, your expectations and your budget. It would be unfair for the Audiologist to control the patient’s wallet. Only you know the value of a dollar to you and your family. Dr. Towers aims to put your cost concerns or needs in perspective in a very concrete way so you can evaluate different levels of technology, different manufacturers or different styles. In the end, the Audiologist cannot ethically allow you to have something inappropriate for your hearing loss, but in most cases, there are dozens of options that can satisfy the needs assessment. Our process aims to help you arrive at the one that makes the most sense for you and your lifestyle. Most of this is accomplished through a lending/trial period that should be no less than one month but potentially even 2-3 months, where the intent is for you to learn and make decisions on how the technology functions for you in your life. This allows your decisions to be based on evidence, not someone else’s experience.

The first goal of the audiology exam is to determine if there is a problem requiring medical or surgical correction. As an audiologist, Dr. Towers, has the skillset and qualifications to first identify issues that require medical attention and refer directly to ENT (ear, nose and throat) specialists. If there is no need for medical referral, Dr. Towers relies on two specific criteria before prescribing hearing aids. First, is there a measurable and aidable hearing loss? This answer is arrived upon through the testing in the initial comprehensive audiology exam. Second, is the patient aware of the problem and seeking help? Sometimes patients are not aware of the hearing loss they have. Other times, they are aware, but not yet ready for help. Audiology is a rehabilitative profession and readiness is an important part of success with hearing aids. For that reason, Dr. Towers does not believe in undue pressure to pursue hearing aids. If you are ready for hearing aids, Dr. Towers will work with you in a collaborative way to reach a solution that is best for you. If you are not yet ready for hearing aids, he will arrange a plan with you to monitor changes in your hearing until you are ready.