Auris Repletus by Dr. Tom Goyne

Sudden Hearing Loss a Sign of Things to Come?

A study was recently published in the journal Stroke that lends some evidence, with caveats, to something I have always suspected [link: Sudden Hearing Loss May Portend Stroke - washingtonpost.com]:

Sudden hearing loss may foreshadow a stroke by as much as two years,say Taiwanese researchers.

The researchers analyzed five years of follow-up data on 1,423 patients hospitalized for an acute episode of sudden hearing loss and found they were more than 1.5 times more likely to suffer a stroke than a control group of 5,692 patients hospitalized for an appendectomy.

It seems logical.  Often, cases of sudden hearing loss are related to interruptions to the  inner ear's blood supply, similar to the way strokes occur in the brain, also known as ischemic attacks, and if it can happen in one part of the head, isn't it likely it can occur in another part as well?

To date, no other replicating study has been done, and this one had several variables left uncontrolled, but it certainly looks like something worth investigating further.

Better Hearing Institute's Effort to Lower Taxes

Link: Better Hearing Institute: Hearing Aid Tax Credit Website - Welcome!.

Several factors deter the patients I encounter everyday from obtaining proper amplification.  The largest, of course, is denial that their hearing loss is affecting their life.  But a close second is the cost of hearing aids.

As I've mentioned before, there is a bill before both houses of Congress that would award families a $1,000 tax credit every five years for purchasing two hearing aids.  And now, the Better Hearing Institute has made it very easy for you to contact your elected representatives in Washington and tell them you want them to support the bill.  Just visit their website hearingaidtaxcredit.org and click on "write congress".  The form takes less than one minute to complete.

Recommended Viewing

On Sunday, April 20th, CBS in conjunction with Hallmark will broadcast a movie entitled Sweet Nothing in My Ear, which stars Jeff Daniels and Marlee Matlin.  A brief synopsis:

Suppose your deaf child could have an operation (not without risk) that might allow him or her to hear again.

Dan Miller (Daniels) and his wife Laura (Matlin) only want what's best for their happy and healthy eight-year-old son Adam (Noah Valencia) who's been deaf since age four.  Laura opposes the surgery -- an implant.  Being deaf, she doesn't consider it a disability and believes an operation, regardless of the outcome, would make Adam feel that something was wrong with him.  However, Dan, who can hear, misses talking and listening to his son.  For him, an operation is worth the risk, believing Adam's life would be easier and more complete if he could hear.

This is a devoted family facing a moment of truth. Together or apart, Dan and Laura must make a life-altering decision on behalf of their son...

Ever since cochlear implant surgery became prevalent, this very issue of whether or not to implant children has been a source of contention.  Though the movie is a fictional story, thousands of families have had to grapple with this very decision.  It should be an interesting movie and looks to be well-made.

My DVR is set, how about yours?

Ask Congress to Listen Up

Thirty-two million Americans suffer from some degree of hearing loss, roughly one out of every ten.  But few obtain the amplification they need to help their condition.

A large reason for this is the stigma that has been attached to hearing aids, the outdated concept that only the old and the infirm would ever consider using them.  For instance, in countries where hearing aids are routinely covered by insurance, the percentage of hearing impaired individuals using amplification is not that much different than in America.

As hearing aids continue to make great strides in both appearance and effectiveness, this stigma will most likely fade away.  But one issue that will remain will be the cost of hearing aids.  As of 2004, the average cost of a device was over $1,700.

But, help could be on the way.  The U.S. Senate's Finance Committee and the House of Representatives' Ways and Means Committee are considering a set of bills called the Hearing Aid Assistance Tax Credit.  If enacted, the tax code would allow tax credits for individuals or families $500 every five years to purchase hearing aids.

Unfortunately, similar versions of these bills have expired in Congress in the past with little or no attention given to them.  Unless more attention is paid to the current versions, they will likely experience the same fate.

I would encourage you to make your voice heard on this important issue and contact your senators and representatives.  If you're not sure how to do so, visit Congress.org and use the search box on the top left sidebar to get the contact information for your elected officials.  Send them a message and encourage them to consider this important legislation.

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As you may have noticed, in the top of the right-hand sidebar on this site now features a tracking widget for this legislation.  Check back to watch the the bills' progress.

Great Advice

Bill Bass, a writer for Men's Journal, interviewed Dr. Craig Kasper, an audiologist with the New York Otolaryngology Group and co-director of the New York Tinnitus Center. about hearing loss and tinnitus -- something Bass himself suffers from.

Kasper is quite knowledgeable, and I like this quote best regarding tinnitus treatment:

"There are always options available.  If someone tells you there is nothing that can be done, you have to walk out the door."

Relation Found Between SIDS and Hearing Acuity

It is estimated that for every 1,000 infants in the world, one dies as a result of Sudden Infant Death Syndrome (SIDS), making it is the leading cause of death among infants.

Up until now, warning signs as to which children are at greater risk for SIDS have been few and far between.  But researchers at Seattle's Children's Hospital may have discovered a screening for SIDS, and best of all, it is a test that is already in place in most of the fifty United States -- newborn hearing screenings.

From the press release:

One of the greatest medical mysteries of our time has taken a leap forward in medical understanding with new study results announced by Dr. Daniel D. Rubens of Children’s Hospital and Regional Medical Center in Seattle. Rubens’ study published in July, 2007 in Early Human Development found all babies in a Rhode Island study group who died of Sudden Infant Death Syndrome (SIDS) universally shared the same distinctive difference in their newborn hearing test results for the right inner ear, when compared to infants who did not have SIDS. This is the first time doctors might be able to identify newborns at risk for SIDS by a simple, affordable and routine hearing test administered shortly after birth. In the study, medical records and hearing tests of 31 babies who died from SIDS in Rhode Island were examined and compared to healthy babies. Rhode Island has a particularly robust database of newborn hearing test data.

The next step in research is to find out exactly why there is a link (the study's authors suggest that sensory cells in the inner ear also serve to measure carbon dioxide levels in the body, besides their role in hearing), which will hopefully lead to even better understanding and greater prevention of SIDS.

Improved Performance Leads to Increased Acceptance of Amplification

In recent weeks, the advertising campaigns of a leading hearing aid manufacturer have received a significant amount of attention, both positive and negative (examples: 1, 2, 3).

While discussing the merits of the campaigns -- you can decide for yourself if they will be effective or not -- Phonak CEO Valentin Chapero tells Business Week, "It's very difficult when you are making a product that actually nobody wants."

It's true, there is very little demand for hearing aids, despite the fact that over 30 million Americans have some form of hearing loss.  But, there is reason to think that is going to change, and it has nothing whatsoever to do with a schnazzy ad campaign or catchy slogan.  It has everything to do with improved performance.  Several times a day, patients tell me that they are pleasantly surprised to find they have none of the complaints about hearing aids that their parents, aunts and uncles had about amplification.

The fact of the matter is, for decades hearing aids were incapable of processing sound in the manner that most patients with hearing loss need it to be processed.  They did not treat loudness growth differently across pitch ranges, something that is absolutely necessary for improved clarity along with loudness comfort.  It wasn't until the arrival of multi-channel devices in the early 1990's that this was possible, and it is only in the last five to seven years that the industry has gotten pretty good at designing devices that do it quite well (for more, read here).  It wasn't for lack of trying however, for many years we did not fully understand the nature of the ear and cochlear hearing loss and even if we did, the technology did not exist to engineer the devices anyway.

As time goes by and the success stories with hearing aids that people tell over a card game begin to finally outnumber the negative experiences recounted over the years at those same card games and family gatherings, gradually, people will become much more accepting of amplification.

Think about it this way.  If the automobile industry had failed, despite their best efforts, to improve upon the first "horseless carriages" and they remained unreliable and uncomfortable, would there be more cars in Los Angeles today than people (there really are, look it up)?  No.  Cars would have remained a product with a small niche until significant and worthwhile developments actually came about.  History tells us that when technology actually catches up with the needs of consumers, it is almost always a success.

As a matter of fact, the quality of today's hearing aids has audiologists and researchers thinking less about audibility at the ear-level and more about processing in the brain.

Gadgets Inspired by the Inner Ear

One of the reasons audiology is an interesting profession is, well, frankly, we get to play with gadgets.  Be it a digital hearing aid, sound-level meters, or a piece of diagnostic equipment, audiologists have their fair share of toys.

If you find medical gadgets and technological advancements interesting, then a website I would highly recommend is Medgadget.  Hearing science is often featured on the site -- in recent weeks there have been entries on a "do-it-yourself" video-otoscope, an at-home kit to screen your child for an ear infection, a vibratory fire-alarm clock for the hearing-impaired, and a hypothesis by scientists that nerves do not actually use electrical charges to transmit signals, but actually use sound to transmit signals.

An entry on Medgadget about two weeks ago featured a device for alerting drowsy drivers to wake up.  What's interesting about the device is how it illustrates how engineers often are inspired by the inner workings of the human body.  In this case, the user wears a device on his/her ear that makes a loud beeping sound if the user's head tilts forward just ten degrees.

Clearly, this device was inspired by the inner ear and the vestibular system.  The inner ear is filled with fluid and when the head is tilted, the fluid in the inner ear moves in response to gravity, which in turn stimulates sensory cells in the vestibular portion of the inner ear.  These cells in turn send signals to the brainstem and brain that the head is moving in space.

What will they think of next...

Promising News in the Prevention of Noise-Induced Hearing Loss

The best way to prevent noise-induced hearing loss is simple: avoid excessive noise [I'm looking at you, iPod User].

Unfortunately for some, that isn't possible.  Certain occupations require people to be in noise to do their jobs -- soldiers, construction workers, pilots, etc. -- and while the use of hearing protection does a good job, it isn't perfect, nor is it always possible to use it 100% of the time.

In a press release, researchers at the Washington University in St. Louis announced they may have found a pharmacological form of protection:

Research at Washington University School of Medicine in St. Louis suggests a medicinal form of hearing protection may someday be a possibility. A group headed by Jianxin Bao, Ph.D., research associate professor of otolaryngology and head of the Central Institute for the Deaf's Presbycusis and Aging Laboratory, has found that two anti-epileptic drugs can prevent permanent hearing loss to a significant degree in mice exposed to loud noises.

As with any study, there are details to be considered.  Firstly, the medication reduced the hearing loss by 5 decibels, however, the mice still exhibited hearing loss.  Make no mistake, 5 dB is significant, but it's not as if the drugs will give you ears of steel.  Secondly, the proper dosages and side effects must be determined for humans.

Very promising for sure, but still several years away from being available for the general public.

The methodolgy and results of the study will be published in Hearing Research.

An Example of the "Half Empty" Scenario

Patients will often bemoan the insurance coverage for hearing-related healthcare.  Typically, I agree with them, but it is certainly a glass half full/half empty type of scenario.  I remind them (and I) that it could be worse, if insurance companies had more of a say in what was best for a patient's care, few would get the best care.

Interestingly, this story in the Guardian, a British newspaper, where healthcare is nationalized, drives that point home quite well:

The maximum wait for NHS hearing tests is to be slashed from more than two years to less than two months, as new technology is introduced to accelerate fitting of digital aids for hundreds of thousands of older people, the government said yesterday.

Ivan Lewis, the health minister, said the average wait for a hearing assessment in south-east England was 45 weeks. It could then take years for patients to be fitted with a digital hearing aid.

He pledged that the maximum wait for an audiology assessment would be cut to six weeks by April next year. Most patients should be fitted with a digital hearing aid within days of a test showing they needed one.

Lewis cites new open-ear technology as one of the reasons for the decreased wait-time and while I applaud their efforts to expedite matters, the fact is that in America, patients typically have to wait just a week or so for an appointment to be tested.  And if an open-ear device is appropriate, they can obtain it at that time.