The Latest In Medical Technology Advances For Hearing

When Myah Meredith was just a few weeks old, her parents received the distressing news that she was deaf. Today Myah, now 3 years old, hears even the softest sounds and speaks as well as any other child her age, say her parents, Kim and “Doc” Meredith, of Hodgenville.

A week after her first birthday, Myah had a cochlear implant, a surgical procedure that is “like a little miracle that enables a person to hear,” says Mary Beth Brinson, a pediatric audiologist with University Audiology Associates in Louisville.

“If you didn’t see the device she wears, you wouldn’t know,” her mother says. “You can’t tell at all by what she says, how she says it, or her accent. She can talk on the phone and hear from anywhere, even out in the yard with the weed-eater going.”

During the procedure, which generally takes two to three hours, surgeons implant a tiny device that bypasses damaged areas of the cochlea and creates electrical impulses that the brain interprets as sound, Brinson says. After a four- to six-week healing process, an external component that resembles a hearing aid is added. When the device is switched on, the patient hears, but “they typically don’t have meaning associated with that sound. It’s a very mechanized sound, but they can quickly attach meaning to it, especially the patients who are children,” Brinson says.

Audiologists try to keep the expectations of patients—and their parents—realistic to avoid disappointment. But for the Merediths, the decision to pursue an implant for their only child was an easy one and they consider the procedure a resounding success.

“I was thrilled one day when she turned around because she heard me stirring her cereal in a bowl,” Kim Meredith says. “Now she even hears the wind blowing. It’s beyond what I could have ever imagined.”
Cochlear implants are typically more successful for young children since “neural pathways, when not in use, deteriorate over time and also because young children don’t have a long auditory memory to overcome,” explains Brinson.

“We really want to get them implanted before they’re 4 years old,” she says. “If we implant a very young child and get good mapping of the implant, aggressive therapy, and a strong support system, they usually can hear well enough that they can develop some speech and language without lip reading.”

To receive a cochlear implant, patients must meet criteria outlined by the FDA; there are separate guidelines for both pediatric and adults.

Brinson, who previously worked with adult cochlear implant patients as well as children, says, “The criteria for adult implantation has changed quite a bit just in the last few years. It used to be that you (adults) had to be profoundly deaf to receive a cochlear implant.” Now the criteria is that “adults must have a severe to profound hearing loss in both ears,” says Brinson.

“Due to the change in the criteria, we are actually implanting people with some residual hearing, who have heard some speech, and that will actually help them learn the new sounds they are hearing. It is very promising.”

Brinson encourages anyone who thinks they may be a candidate, even if they were not in the past, to contact their audiologist and see if a re-evaluation is warranted since the criteria has changed; outcomes have also improved due to technology.

Relaying Messages
Cochlear implants are only one technological innovation now available to help those with hearing problems. Telecommunications relay service, or TRS, can enable people with hearing or speech impairments to communicate with those who use a standard telephone.

TRS incorporates a trained operator as a “middle man,” relaying information between two users. On one end, a hearing-impaired person uses a computer, other Web device, or text telephone device to type messages, which are received by the operator. The operator then voices those messages by telephone to the hearing recipient and types responses to the deaf person.

Calls can be initiated by either a hearing or non-hearing caller; services are available 24 hours a day, seven days a week, by calling an 800 number or logging on to a relay Web site.

Advances in Hearing Aids
Hearing aids also have improved significantly in recent years, says Peter Pearlman, branch manager and audiologist at the Louisville Hearing Aid Center, noting that they have become both smaller and more sophisticated.

Basic analog models in which only high and low frequencies could be controlled gave way to programmable analogs and finally to digital hearing aids, he says.

“The digital models have greatly improved sound quality, especially in noisier areas where analogs tend to distort sound,” he says. “They make it much easier for people to hear in restaurants, for example, especially with new multi-band hearing aids that reduce other noise.”

Some new hearing aids can actually separate voices from other sounds, amplifying the voices while reducing the background noise. But the best way for hearing aid users to improve their ability to hear conversation is with new directional microphones, Pearlman says. While some can be changed by pushing a button, some are automatic. With the manual ones, users push a small button to reduce noise from behind them, improving their ability to hear the voices of the people with whom they are speaking. Another button push returns the device to normal reception for situations like driving, when it is important to hear sounds from all directions.

There is a catch, though. Hearing aids with directional microphones come only in larger sizes, forcing some users to choose between two major advances—the ability to pick up speech more clearly and the dramatic reduction in the size of many hearing aids.

Many of today’s models hide far down the ear canal, making them virtually invisible to others. In addition to their aesthetic appeal, smaller hearing aids are more telephone friendly, Pearlman says.

“It’s easier to put your ear up to the phone and they work better with all different types of telephones,” he says. “For a lot of users, it’s just a lifestyle choice as to whether they prefer a smaller, less noticeable one or one that maybe offers the directional microphone but is a little larger.”

Hearing aid prices vary widely. A basic, non-programmable amplifier starts at around $500, while a programmable model costs $900 to $1,200, Pearlman says. Digital hearing aids range from $1,100 to more than $3,000 for very small, high-end models.

It isn’t necessary to get the most expensive model, but Pearlman strongly recommends that users get a hearing aid for each ear.

“We were designed with two ears,” he says. “Speech discrimination and directional hearing are better with two ears and it’s much easier to hear in groups. It’s really better to get two moderately priced hearing aids than one very expensive one.”

Ringing Ears
While some people experience hearing loss, many suffer from hearing too much. Tinnitus, a constant noise often described as “ringing” in the ear, “can be very emotionally destructive and is difficult to treat,” says Burton J. Cohen, M.D., a senior partner in Kentuckiana Ear, Nose and Throat and a clinical professor at the Department of Surgery, Ear, Nose and Throat Division at the University of Louisville School of Medicine. According to the American Tinnitus Association, as many as 50 million Americans suffer from the problem.

Cohen, who often sees on average about six patients a day complaining of tinnitus, says the first step is discovering the cause, which can range from a simple buildup of wax to more serious and less treatable problems. Often the only remedy is to block the noise with other sounds, he says.

“Most people with noise in their ears aren’t bothered too much during the day because it’s masked by other noise, but about 5-10 percent have trouble sleeping at night due to tinnitus,” Cohen says. “We tell them to turn on the radio or a tape recording of music or other sounds like waves to mask the noise.”

People who attend lots of loud rock concerts in their youth may not realize they’ve done permanent damage to their hearing for many years, Cohen says. “They may experience a temporary hearing loss after a concert, but it comes back in a day or two. They don’t notice a permanent hearing loss until they’re in their 40s and they don’t realize it’s been there 30 years.”

For more information on hearing loss, prevention and hearing aids, see this month’s Health column. Stress management, biofeedback, psychotherapy, tranquilizers, and sleeping pills can also help patients learn to deal with tinnitus, Cohen says.

Most recently Cohen and his colleagues are also trying out a new ultrasonic tinnitus masker that is worn like a hearing aid. The device “puts out a tone in the ear that you can’t hear, but it is supposed to mask tinnitus for anywhere from two to 10 hours after it has been turned off. The masker can be customized to the range of an individual’s tinnitus so that it masks the frequency range they are hearing,” explains Cohen.

PREVENTING HEARING LOSS
Many kinds of hearing loss are preventable simply by turning down the volume of our lives. Cohen advises staying away from loud noise, particularly anything that stays above 85 decibels for a long period. Keep headphones and car radios at a low level, don’t sit near the speakers at concerts, and if you can’t avoid exposure to loud noise, wear earplugs.

HOW LOUD IS A DECIBEL?
A whisper: 15 to 25 decibels
Background noise in the home
or office: 40 to 60
Loud Music: 100 to 120
Jet airplane: 140 to 180
Source: www.WebMD.com

HEARING RESOURCES
Resources for learning more about hearing loss, hearing tests, choosing a hearing aid, cochlear implants, and protecting your hearing:

American Tinnitus Association
Dedicated to awareness, treatment, and prevention of tinnitus.
www.ata.org

Hamilton Relay Service
Provider of telecommunications relay services for the hearing impaired.
(800) 618-4781 (voice or TTY)
www.hamilton.net/relay (telephone relay service)
www.hiprelay.com (Internet relay service)

Heuser Hearing Institute
Offers comprehensive not-for-profit hearing services for children and adults, and home of the Louisville Deaf Oral School.
(502) 515-3320 (voice)
(502) 515-3323 (TDD)
www.thehearinginstitute.org

Kentuckiana Ear, Nose and Throat
3 locations in Louisville
(502) 583-9425
www.yourentmd.com

Louisville Hearing Aid Center
Suite G-9, Medical Arts Building
1169 Eastern Parkway
Louisville, KY 40217

University of Kentucky
Department of Otolaryngology
740 South Limestone, Suite B317
Lexington, KY 40536
(859) 257-5405

National Association on Deafness and Other Communication Disorders
www.nidcd.nih.gov

University Audiology Associates
601 South Floyd Street
Louisville, KY 40202

Web MD
Internet site offering information about many medical conditions including hearing issues.
www.webmd.com

TIPS FOR BUYING A HEARING AID
• Be certain an adequate trial period is offered. State law mandates a 30-day trial, but longer is better.

• Be sure the hearing aid comes with a warranty and a good service program.

• Choose the device that best suits your lifestyle and budget.

• Consider whether you prefer a smaller hearing aid that others can’t see or a somewhat larger model that offers options like a directional microphone.

• If at all possible, get a hearing aid for each ear, to help balance the directional hearing.

• Don’t be swayed by manufacturer names or advertising. Choose the model that meets your needs.

• Make sure you are comfortable with the vendor you are dealing with. If you are being pressured to make a quick decision or buy the most expensive model, go elsewhere.