For many years, hearing aid manufacturers have focused on (and continue to invest in) improving hearing aid technology to help achieve better hearing in the presence of frustrating and distracting background noise. While hearing aids have certainly come a long way as far as the development of “hearing in noise” programs, many people with hearing loss continue to have significant difficulty hearing and understanding conversation in noise. Why is this so?

When an individual has a conversation with one other person in a quiet setting the most important factor in their ability to hear is audibility. In other words, can the listener hear the sounds of the other person’s voice in order to understand them? If you have a hearing loss, and are using hearing aids, then yes, in a quiet setting the hearing aids do provide audibility. However, when a conversation takes place in a crowded restaurant, audibility is only a part of being able to understand the conversation. When distracting background noise is present your brain has to perform a more complex processing task in order to understand what it hears. This portion of hearing is known as auditory processing.

It is known that an individual’s auditory processing ability changes throughout his or her life. At approximately 40 years of age, our auditory processing slowly begins to become less effective, but each person’s auditory processing changes differently. And of course, such changes are compounded when hearing loss is present. This is why it is so important for people with hearing loss to be aware of exactly what auditory processing is, and the approaches they can take to try to improve their own auditory processing skills.

Just as physical therapy can help muscles rebuild strength to regain or improve mobility, exercises in listening can improve auditory processing resulting in better understanding in difficult listening environments. Listening and Communication Enhancement or LACE, is a computer-based instructional tool designed to help individuals practice their auditory processing skills. The LACE program consists of a series of exercises developed by audiologists and engineers specifically to target those skills that can help adults improve their auditory processing.

LACE utilizes practice exercises in four specific categories: speech in noise, fast talkers, competing voices, and auditory memory. Within each of these categories the exercises become more difficult or easy depending on your performance and progress. So, as your improve your auditory processing skills, the tasks become more difficult. LACE also includes numerous pop-up “tips” designed to provide the user with helpful strategies and informational tidbits to improve your communication skills as well as provide additional information about hearing loss and hearing loss prevention.

The professional audiologists at Audiological Consultants of Atlanta encourage all of our patients to take an active role in their hearing rehabilitative process by visiting the LACE website at: http://www.neurotone.com/. When you visit this website you can learn about the LACE instructional program and download a free demonstration. The demonstration will allow you to sample some of the practice exercises in each of the four training categories noted above.

Research shows that auditory processing can significantly improve with the use of LACE. If you have hearing loss, LACE is most effective if used in conjunction with hearing aids. Don’t hesitate to ask our audiologists at Audiological Consultants of Atlanta about auditory processing and LACE.

Here are a few cold hard facts.
*Drumline rehearsals can reach peak levels of 115 dB. (The unprotected exposure limit at this level is less than 30 seconds.)
*Musicians experience significant sound exposure. (Many will develop some degree of hearing loss.)
* The human ear overloads at high sound levels making it difficult to distinguish the musical blend.
*Marching band sound levels peak as high as 120 dB. (The unprotected exposure limit is less than 7 seconds.)
*Ringing in the ears (tinnitus) and temporary hearing loss can occur from a single concert or high level sound insult.
We can do something about this problem and protect our musicians’ ears. Etymotic Research, has created a non custom high-fidelity hearing protection solution to preserving the hearing of band members across the United States by creating the Adopt a Band Program. The purpose of the program is to educate musicians about the importance of wearing hearing protection during practice and performance, advocating safe playing and practicing habits for today’s young musicians. Hearing loss is a function of exposure time, the average sound level, and the peak level of very loud sounds. Excessive noise exposure can cause permanent hearing loss depending on the intensity and duration of the sound source.

SUMMARY: 1- Noise induced hearing loss is preventable, 2-Protect your ears as you would your skin from sun OR your head from damage with the use of a helmet on the football field, 3-Realize that broken bones heal but your ears do not, 4-you can make a difference by becoming educated and spreading the word.
Utilizing ear plugs can help protect against this damage. Take this opportunity and “get on the safety bandwagon”!!

The two of us had just been seated at our reserved table when the waiter began telling us about the chef’s daily specials. As the waiter proceeded through the offerings, both my husband and I leaned over toward him in a vain attempt to take in even part of what he was saying. Then the waiter finished and said that he would be back shortly with water for both of us. My husband immediately leaned toward me and raised his voice to ask if I had heard what the specials were. I vigorously shook my head “No” and replied to him that I had only been able to approximate every third word that the waiter had said. Each of us had frowns on our faces as we realized that our “dining experience” was doomed to be a very noisy one, one where normal conversation would not be possible.
Unfortunately, this type of dining experience has become all too common in Atlanta as well as in other cities. As an audiologist with normal hearing, I was greatly frustrated trying to communicate in such an environment; I can only imagine the difficulties experienced by many of our patients with less than optimal hearing. The words that first come to my mind are “impossible to communicate.” Others find some environments so distressing that they describe them as “unbearable and unnecessary” or “annoying and stressful” or even “physically painful and subsequently choose “to give it up”.
What Is Going On Here?
Many new restaurants seem to be designing their spaces with what they think is a more contemporary look with the high ceilings, wood floors, and a great number of glass windows. Recently, many restaurants have also done away with carpeting, heavy curtains, table linens and plush banquettes. The result? Fewer soft, sound-absorbing materials which pushes many patrons’ priority of enjoyment and pleasant conversation to the back seat. As we have discovered, many restaurant customers rate their overall dining experience based on a variety of factors, which include not only the quality of the food enjoyed but the company and the total experience.
Customers Can Vote With their Dining Dollars
Many potential customers have decided to respond to the noisy environments which exist in restaurants by refusing to patronize them. Such actions may take time to have an impact, but should eventually pose a problem for restaurants that fail to take corrective action.

A recent online Omnivore article in Atlanta’s Creative Loafing magazine (August 2011 – posted by Cliff Bostock) addressed the problem of excessively noisy restaurant spaces when it published an email from a Decatur resident regarding a local restaurant. The article also included a number of additional reader comments that expressed dismay with loud restaurants and promised to “vote with their checkbooks.”

In addition, the well-known Zagat Survey, which publishes restaurant guides, is currently considering expanding their rating system to include noise level. Its current restaurant rating categories include: food, décor, service, and cost.

An Audiologist’s Thoughts
During daily conversations with all our patients of all ages, I have heard the following statement more times than I can count: “When I go to certain restaurants I cannot converse with my dinner guest! It is stressful and frustrating.”

Having a hearing impairment certainly makes it difficult to hear in certain listening situations but these challenging environments are difficult for normal hearing people as well. The improvement in hearing aid technology has made a positive difference but even the best of technology has its limits. We must be realistic in what we expect from the technology AND be our own advocate in the “restaurant scene”.

An Audiologist’s advice for a quieter, more peaceful dining experience:

• If possible, sit in tables in alcoves, which provide a barricade against sound waves
• Avoid sitting in locations near the bar or kitchen
• Avoid sitting near large parties
• Ask for additional light, and look at your dining companion when he or she speaks. Without realizing it we do read lips.
• Request that management turn the music down, even if you get dirty looks. Not only does this reduce noise, but it will result in people talking more softly.
• If possible (most likely online) look at photographs of the restaurant ahead of time. No carpet or table cloths and boxy dimensions should raise “noisy” red flags.

In closing … Bon Appetit

References:
Better Hearing Institute: Aural Education and Counseling
Audiologic Rehabilitation with Adults & Significant Others: Is it really worth it? 2009, Jill E. Preminger

What do we mean when we say “Cognitive Hearing?” This term refers to the complex set of brain processes that occur between the initial point when a sound is heard and the point where one is able to grasp the meaning or significance of that sound. This takes place in a very short period of time, and requires some very complex brain activity.

There are many factors involved in hearing and understanding what you hear. The sense of hearing is actually a very complex process. We hear sounds through a series of vibrations and signals sent from the nerve of the inner ear to the brain. This is where incoming speech is processed, and at this point it relates to the understanding rather than the hearing.

Below is a list of processes involved in hearing and understanding what you hear:

• Auditory Periphery – converts incoming acoustic signals into physiological information.
• Listening – selects information with the attention and effort of the hearer.
• Comprehending – interprets all contextual, linguistic and grammatical information.
• Reacting – storing in memory, reasoning and responding.

Each of these processes becomes somewhat less effective as we age. Research has indicated that when tests are performed to compare a group of adults with hearing loss to another group of adults that did not have hearing loss, both performed similarly? This result was seen both when study participants were faced with tests designed to examine their understanding of fast speech, and when examining their understanding of speech in background noise (reference: Pichora-Fuller et al., 1995). The aging brain slows down, just like the rest of our body!

The hearing impaired person has to work much harder through all phases of the hearing process. At the start there is more effort required to “listen” to and “hear” the incoming speech. Very often when more effort is applied to one task, less effort is available for everything else. This “division of labor” may lead to what is often referred to as “selective hearing.” The automatic reallocations of energy and resources likely tend to slow and reduce a person’s ability to process incoming sounds. Persons with hearing loss must dig more deeply into their cognitive abilities in order to attempt to make sense of a compromised auditory input. And, naturally, when someone is required to process multiple incoming sounds at the same time, their understanding of these various inputs will suffer. Individuals with hearing loss are often observed to appear to have problems with recall, comprehending language, or other cognitive deficits due to the compromised sound input. These difficulties are seen as secondary to the actual loss of hearing experienced by the individual (Beck and Clark, 2009).

As audiologists, we understand that each person is a unique individual, and each person’s ability to hear and understand can vary greatly. We also understand how the various factors of cognition, attention, memory, and hearing can each play a critical role in hearing and understanding. While it is true that little can be done to restore cognitive function, there are strategies that can help persons with hearing difficulties. These strategies include the use of advanced hearing aid technology designed to reduce the effort required to understand speech, and help individuals to thrive.

Processing complex speech sounds requires a physically intact listening system and a well- managed listening strategy. Human brains are highly amenable to training, habilitation, and rehabilitation due to neuroplasticity (the ability of the brain and nervous system to change structurally and functionally as a result of input from the environment). However, the longer a person with hearing loss goes without proper stimulation of their auditory system, the longer it will take for them to adjust to better hearing. We’ve all heard the saying “use it or lose it.”  It definitely applies to hearing. Don’t put off better hearing…your brain will thank you!

http://www.youtube.com/watch?v=IGQmdoK_ZfY

View the YouTube video featuring Chuck Leavell at: YouTube Etyhead.

Help is on the way! After much discussion and deliberation, the Federal Communications Commission (FCC) finally responded to these requests and has adopted regulations that require both cell phone manufacturers and cell phone providers to provide phones that sound clearer to the hearing aid wearer.  (See the link for the FCC below.) Now, all cell phones are required to have both a T-rating and an M-rating that will indicate how well they will work with hearing aids. Improvements include less static and interference, and on some phones, better communication with the telecoil (T-coil) program that is included on the hearing aids. 

Your first step should be to consult with your audiologist and obtain the “T-rating” of your telecoil-equipped hearing aid. Armed with this information you will be ready to go shopping for a new cell phone. When you get to the cell phone store, the cell phones (or their boxes) will be marked with either an “M” rating or a “T” rating.   The higher the “M” or “T” number (up to 4), the more likely it will be capable of providing you with improved sound clarity.  The T rating means the cell phone will connect with a telecoil-equipped hearing aid; if your hearing aid does NOT have a telecoil, the T rating will have no effect on the clarity.  The M rating refers to a reduction in interference when the phone is held up to a hearing aid.  Note that your hearing aid will also have an M rating, up to 4.   The overall clarity of the phone when coupled with your hearing aid will depend on the total of both numbers when added together. (The number of the rating from the cell phone PLUS the number of the rating from your hearing aid is the overall total number.)  Ideally, you will want a total of six (3 + 3) or greater for optimal clarity.

If you are interested in hands-free options for use with your hearing aids, there are a number of excellent products available on the market. Some of the latest and most technologically advanced hearing aids, such as the Clear products from Widex, and the new line of hearing aids from Phonak, are able to directly couple to cell phones via a “streaming” type of device that the user either wears around his or her neck, or carries in their pocket.  This allows the sound to go directly from the cell phone into the hearing aids, thus providing optimal clarity with reduced outside noise interference. 

If you would like to adapt your current hearing aid for use with your cell phone (and you have a telecoil-equipped hearing aid) there is a device that makes this possible.  The CLA7 Amplified Power Neck Loop manufactured by ClearSounds is capable of connecting directly to a cell phone (or to an iPod) for hands-free use (it utilizes your hearing aid’s telecoil program).

Provided below are the internet web addresses for two handy neck loop comparison guides; one for non-Bluetooth-enabled devices and one for Bluetooth-enabled devices (see end of article).

The takeaway advice here is this:  You CAN successfully use cell phones with hearing aids;  just be sure to “try before you buy” when it comes to selecting your new cell phone.  Look for the highest T and M ratings and try it out in the store with your hearing aids and a familiar voice. Any one of ACA’s audiologists will be happy to work with you to determine which set-up is best for your needs.  It is clearly no longer necessary to avoid cell phone use just because you wear hearing aids.

FCC Consumer Facts on Cell Phone/Hearing Aid Compatibility:

http://www.fcc.gov/cgb/consumerfacts/hac_wireless.html

Neck Loop and Ear Hook Comparison Guide (from TecEar):

http://www.tecear.com/Neck_loop_ear_hook_guide.htm

Bluetooth T-coil Headset Comparison Guide (from TecEar):

http://www.tecear.com/Bluetooth_Comparison_Guide.htm