Being Well Program 410 - Hearing loss and prevention

>>Lori Casey: What did you say? Can you repeat that? If you found yourself asking those questions you might want to stick around for this episode of Being Well. Our guest is audiologist Dr. McNamara from speech communication disorders at Eastern Illinois University. We'll talk about all things related to hearing loss and prevention. Don't go away being well starts now. [music] >>Lori Casey: Well today on Being Well we're talking about hearing loss with audiologist Dr. McNamara. Thank you for coming by the show. >>Dr. McNamara: I�m happy to be here. >>Lori Casey: Tell us a little bit about where you work at Eastern and what you do? >>Dr. McNamara: We have a well I'm in the Communication disorders and sciences department and within that department we actually have a clinic where we provide services speech, language therapy but we also do testing for hearing. Our clinic does not dispense or disperse hearing aids, but we do the diagnostic part of it. >>Lori Casey: Tell us a little bit about what an audiologist does and what you're schooling is like? >>Dr. McNamara: It used to be that audiologist were pretty comparable to the schooling was pretty comparable to a speech language pathologist. You had to have a master�s degree about ten years ago they changed the requirements so the entry level degree to be an audiologist you have to have a doctorate now. There's two types of doctorates that they have they have a clinical doctorates and then the PhD doctorate which is more research clinical doctorate is geared more toward being able to provide comprehensive clinical services and so most of the audiologist now have clinical doctorates. >>Lori Casey: Thank you well let's talk today about what are the primary causes of hearing loss? >>Dr. McNamara: That's a very good question and it really depends a lot of age. For young children the primary cause of hearing loss that you'll see if often times ear infections. Some type of what they call otitis media and that's pretty relevant in smaller children. It is true you do tend to grow out of that but for adults it has a lot to do with noise exposure and age. >>Lori Casey: So I love when our guests bring models on the show. Tell us where when you have hearing loss where is it actually happening in your ear. >>Dr. McNamara: Okay and that's a very good question because once you kind of understand that then you can relate it to a little bit to what types of hearing loss they are and to the population. If I kind of explain to you how sound travels through the ear real quick then I'll be able to tell you where the break down is. As you can see here's our model of our ear here is your outside which is your pinna. When sound comes it travels through the ear cannel and it sets the ear drum or the tympanic membrane into vibration and what happens then is you have three small bones in what they call the middle ear cavity that actually do kind of a mechanical lactation they rotate back and forth. What they'll do then is there is this little I'm going to pull this out here it actually looks like a stirrup from what you would ride a horse but you would call it the stapes. It rocks back and forth and it sends some fluid in motion in here to what we call the cochlea which is your organ of hearing and then it excites some hair cells those hair cells send an electrical impulse to the brain and sounds heard. Now what's interesting is the tympanic membrane completely blocks off that middle ear space from the outside. That's what people don't understand sometimes. You also have a tube that runs down the back of your throat called your Eustachian tube and that's what allows some air into this middle ear space. So that Eustachian tube gets it doesn't function properly what it's supposed to do is supposed to open every once in while equalize the air pressure here to the air pressure on the outside. When it doesn't then you develop some fluid behind the ear drum and that fluid builds up and if it sits there for long enough it becomes infected and you have a full blown ear infection. That's where you hear about kids possibly having tube put in their ears. >>Lori Casey: I was going to ask where are the tube put when you have a child that has tubes in your ears where are they actually placed. >>Dr. McNamara: They insert the tube right through the tympanic membrane so the tube really has two main functions. To let air into the ear to kind of open up and keep that air flow in the middle ear and to drain out the fluid that's in there. Hopefully what will happen is eventually whatever caused that Eustachian tube to dysfunction you know it gets better a lot of times it can be you have a sore throat you have a cold. Eustachian tube opens up in the back on your throat well your sinuses drain down the back of your throat. You have sore throats your tonsils your adenoids so any number of those things can cause your Eustachian tube to dysfunction. >>Lori Casey: Okay so when you have hearing loss what part of the ear is being damaged or is damaged? >>Dr. McNamara: Well when you have problems in that middle ear space that can be called a conductive loss and that's usually in relation to maybe something�s wrong with these three small bones they don't move like they should anymore or you've built fluid up behind the ear drum that kind of thing. Then we move past that and to where I was talking about the cochlea. We have actual hair cells in there and once those hair cells are excited they send an electrical impulse to the brain. It's those hair cells that get damaged and that's when you have what we call more of permanent sensory neural type hearing loss. >>Lori Casey: So point that out on the model. >>Dr. McNamara: Right here is your cochlea. >>Lori Casey: That's when you hear of people having cochlear implants. >>Dr. McNamara: Exactly with cochlear implants what they do is they actually drill a hole through the bone in the back of your head and they have a wire they insert through the cochlea and because those hair cells can't send electrical impulses the wire now sends electrical impulses. Cochlear implants are really just for those people who have very significant hearing loss that hearing aids can't help those kinds of things. >>Lori Casey: So for someone that is born deaf what part of the ear doesn't work? Are the born with something that's deformed? What causes actually deafness? >>Dr. McNamara: It deafness there are several ways to define that are technically in audiology terms we talk about people that have very significant hearing losses where they can't hear speech at all. We're talking up in the 90 decibel range. When your 90 decibels that�s about not as loud as a jet airplane but it's pretty loud. I mean jet airplanes get up around 100 decibels to 110. But what happens is a lot of times they are born with damage to those hair cells or they can also have damage to this is the 8th nerve which sends those impulses to the brain, but a lot of times its damage and to the hair cell or the cochlea�s. What causes it can be hereditary or maybe there was some type of malformation of the cochlea you know during those gestation periods those kind of things. So it just really depends. >>Lori Casey: Okay when I was doing my research for this show I found out that they categorize hearing loss in different levels can you talk about what those are and kind of the symptoms of each level? >>Dr. McNamara: Exactly as audiologist what we like to do is when we do a hearing test we give individuals tones at different pitch levels and we see how soft the sound can get where they can still understand it. Then we break it up into mild, moderate, moderately severe, severe or profound hearing loss. So when someone has a mild hearing loss a lot of times people can still catch speech sounds especially when there is a quiet room on a one to one setting, but if they get a little distance from the speaker they'll notice they'll have some more problems. If they get in noisy rooms they notice they have a little more problems. Moderate hearing losses start to affect some of those speech sounds they can't pick all of those up like they should. When you get moderately severe usually you're below the level where a lot of speech sounds are formed so it's really you almost you definitely need some type of amplification in order to understand. When you get in that severe to profound hearing loss range it can even get to a point where hearing aids or something like that may not help you know because hearing aides are really limited to the amount of power they can proved and it may not be able to give you that extra boost that you need to pick up those speech sounds. >>Lori Casey: So I remember as a kid when the audiologist would come to school and you'd do the hearing test and you'd raise your hand. It seems like once that's done we don't have hearing tests. So how do you sort of if you're sitting there thinking well I don't know if I can hear very well what are some signs that you might self-diagnosis yourself with some hearing loss then move forward to getting a hearing test. >>Dr. McNamara: If you have trouble following conversations, if you have trouble hearing speech when there's noise now that one we talk about quite a bit. You may be able to understand people on an individual basis but when you get into some back ground noise you totally break down. If you notice a difference between your ears definitely come in and then there could be some more severe symptoms like that are associated with some specific medical problems that if you had constant ringing in your ear if you notice fullness in your ear if you notice dizziness those kinds of things. >>Lori Casey: So let me ask you a couple of questions if you were as a child if you had maybe tubes in your ears or suffered chronic ear infections are you more likely to have hearing loss as an adult. >>Dr. McNamara: Um that's a very good question cause I have get a kick out of my students that come in and say oh I had ear infections and I was deaf when I was little. I'm like well you really weren't deaf and you know your hearings probably back to normal now. It's very unlikely unless the ear infections go untreated ad then they can cause erosion of the ear canal the infection can get into what we call your mastoid bone. They can cause some erosion of the obstacles those three small bones and those are usually in cases when you haven't received the medical attention that you should. Scaring on the eardrum those kind of things so. >>Lori Casey: So is aging and hearing loss do they kind of go hand in hand? >>Dr. McNamara: Yes I always feel really of course I'm getting up there in age now to so not far from so I have my AARP card and all that. So I don't feel so guilty talking to people about that now. Just like all your other functions vision and things like that hearing will decrease with age. How much it decreases depends on the individual there's really no way to predict it but I try to when I talk to young individuals I really try to emphasis listen you know if you're 20 years old and you start out with hearing loss you know the prognosis isn't good. You know this maybe something that leads to where you have to wear hearing aids later and that kind of thing. So protect your hearing now. >>Lori Casey: So if you work in environmental an environmental area where you constantly have lots of noise that can lead to hearing loss or if you went lots of rock concerts as a teenager. >>Dr. McNamara: Absolutely there is definitely a rise in hearing loss of teens right now. They had a study that came out a couple years ago through the journal of the American Medical Association and they followed some teenagers about 15 years ago and then they retested new teens 15 years later and they found a rise in hearing loss by 31%. >>Lori Casey: We were walking around here on campus and well you see adults with a lot of colleges student ear buds in the ears constantly is that a common question will that lead to hearing loss? >>Dr. McNamara: Yes it will and the problem is that the students don't really realize how loud it is. Also I grew up in those teen years in the 70's where we had our big speakers in the back window and stuff, but it you know was dispersed a little bit. That is directly concentrated into their ears and that's what their seeing. What happens is when you have noise induced hearing loss you have this little notch that starts out it's called a (unclear dialog) where one of the higher frequencies start to drop and then the rest will and their seeing more prevalence of this high frequency notch in younger individuals. >>Lori Casey: How do you know what's to loud then? >>Dr. McNamara: You know it's really kind of a judgment call but I often tell my students and I've told my own children that if I'm walking beside you and I talk to you and you cannot hear me your ear plugs are too loud. >>Lori Casey: What about as we're talking about teenagers, teenage boys they like to do the same thing they like to have those really loud bass speakers in their car. Is that type of sound it's loud but it�s also very thunderous or whatever. Is that kind of frequency bad for your ears to or? >>Dr. McNamara: All loud frequencies are bad for your ears yes. So you know it really doesn't matter if it�s kind of that base or that high. This is why they have a lot of regulations in industries now the Occupational safety and administration have strict guideline that these individuals have to follow they can only be exposed to so much sound over a period of time and if they are they have to provide ear protection those kind of things. You know so when you're working in like an industry like that you have people watching over you but teenagers they walk out the door and you can tell em turn it down, turn it down but then you know they just might turn it back up. >>Lori Casey: Well I noticed in my neighborhood I noticed more and more people wearing hearing protection when their mowing their lawns. Probably not a bad idea. >>Dr. McNamara: It is a great idea and I will my husband will when he looks at this he will probably shake his head but he is a prime example. He is a superintendent of a school district never exposed to loud sounds but we have 3 acres and we have a riding lawn mower and being an audiologist we have followed his hearing and last time we tested him he started to show that noise exposure that drop in those highs. So brought the ear plugs home and it is time you know which he should have been wearing ear protection long before that. >>Lori Casey: For something like that as we're talking about that does it depend on say it takes you 45 minutes to it takes me 45 minutes to mow my lawn should I be wearing hearing protection? >>Dr. McNamara I say whenever sound you consider it loud you should wear ear protection it's really just a matter of taking you can get ear plugs at Wal-Mart, Walgreens, CVS it's a matter of taking some ear plugs sticking them in your ears pulling them out when you're done. Sticking them in your pocket but hearing conservation definitely something that isn't practiced as much as it should be. It's so simple so anytime you're exposed to a loud sound for an extended period of time pull out some ear plugs. >>Lori Casey: So say you go to your audiologist and yes you do have some hearing loss talk about hearing aids, cause they've made huge advances in hearing aids, it was always I don't want to wear one it's going to make me look old. Now they're so tiny you can't even see them. >>Dr. McNamara: They are and the trend for a while was the very very tiny ones that set in your ear, but now they have new style and they actually set up behind your ear and usually what they do is match them to the color of your hair and there almost invisible. They have a very small see through tube that routes the sound down what they called a dome that goes in your ear. The sound quality is extremely better almost all hearing aids now are digital so they have an ability to a big problem with older hearing aids was not only did they amplify the sound around you I mean not only were they amplifying the sound you wanted to listen to but they were also amplifying noise. Now with the digital they have some compression circuits to help ease that noise so you can concentrate on the speech a little more. Now they're not perfect and it's not like your hearing was originally but they are much better. >>Lori Casey: Can hearing loss ever be reversed? >>Dr. McNamara: Not at this point. I >>Lori Casey: mean there�s even in young children? >>Dr. McNamara: Not unless there's medical maybe more related to the middle ear. Then it can be treated there's some surgical things some medications those kind of things. But when you get into a permanent type sensorial neural hearing loss at this point there is nothing you can do except for consider maybe a hearing aid or some type of assistive device to hear better. >>Lori Casey: At what point I mean there are surgical options available for some types of hearing loss correct? >>Dr. McNamara: Yes there are some things like for example they have what they call bone anchored hearing aids now. People that have unilateral hearing losses are doing those and what happens is. Its a little bone vibrator that's implanted in the head and it takes sound into their deaf side and it helps to route it over so they hear it on their with their good ear. So they do have those they have cochlea implants but like I said cochlear implants really are for those individuals who have very significant loses that hearing aids don't help but as far as any types of okay like I have these hair cells in my cochlea�s that have been ruined by sound exposure by age and they don't function right anymore there's really nothing they can do to go in and repair those actual hair cells. Now in the future possible and I mean they are looking at things like implanting other peoples cochlea�s I mean you know there's all types of research they're doing in that area but as of right now if you have a sensorial neural hearing loss your options are you either live with it or you maybe consider amplification. >>Lori Casey: So what's the stage I know you talked earlier in the program about the stages of hearing loss mild, moderate, severe at what stage do you recommend a hearing aide? >>Dr. McNamara: You know it really depends on the individual and we talk a lot about this you might have a lady that and elderly lady that's at home doesn't go out much and she might have a mild hearing loss so it would be just maybe figuring out some ways for her to compensate for that in her environment, but then you have another individual who she's real active, plays in the card club, and golfs with a group of ladies and you know it's really important for her to be out and catch those conversations and she may be more of a candidate for hearing aids. >>Lori Casey: So it's more on lifestyle >>Dr. McNamara: It is definitely lifestyle based it does become a safety issue when the hearing loss becomes significant enough that they don't hear people speak or they don't hear their doorbell ring you know in those instances those kind of people would definitely be candidates, but it has a lot to do with lifestyle and need. >>Lori Casey: So how often should we have our hearing tested? If you go to the doctor once a year you get your cholesterol all that sort of stuff the hearing just goes on the weigh side unless you have a problem. >>Dr. McNamara: Yeah you know we recommend annually. I do have some individuals that come into our clinic every year on the dot to get their hearing tested and that tends to be some of my older patients you know because they want to monitor their hearing those kind of things, but I always encourage a lot of my students now to get their hearing tested because this is a gold piece of paper you know forty years from now if you have a problem that arise you actually have some evidence of where you hearing was at once. A lot of times when we see people we don't see them till after they already had the problem started so we really don't have anything to compare it to. So you know I encourage anybody get your hearing tested. If you don't have any problems its okay to wait two or three years to have it done again come in immediately though if you notice a change. If you have a problem in your hearing get it checked annually. >>Lori Casey: Okay let's talk in these last minutes or so about some preventative measures we should be taking before it becomes a big problem. >>Dr. McNamara: My the thing that I advocate the most for is hearing conversation you know if you are going to be exposed to loud sounds for an extended period of time pull out the earplugs. Just try to be real conscious about that that is the best thing you can do for yourself at this time. >>Lori Casey: Okay well Dr. McNamara thank you so much you're our first audiologist on Being Well. This has been very informative and I hope our listeners/viewers learned something new. >>Dr. McNamara: Thank you very much >>Lori Casey: Thanks for coming back. >> Monica Becker: Imagine what life would be like if you lost your hearing. No music, no sounds of nature, no listening to the voices of your loved ones. But some people with profound hearing loss do have options. Cochlear implants, in the right patients, offer the chance to hear again. >> Barbara: I�m an old time radio fan. This is what I�m listening to right now, it�s called America at War. >>Vivian: That may seem like an unusual hobby For a woman who can�t hear. I�m deaf now. Barbara Daly�s hearing started to fade when she was in her 20�s. Over the years it got worse. >>Barbara: I could be sitting right here and there�s a fire alarm right above me and I would never know it was going off. >>Sarah: But because of the type of hearing loss Barbara suffered, she was a candidate for cochlear implants. A cochlear implant is a technology for people who have severe, profound hearing loss. It can bypass the damage in the inner ear and allow those folks to hear well. Sarah Oakley is a clinical audiologist at Mayo Clinic. She says normal hearing works in this way: your outer ear collects sound waves which vibrate the ear drum and middle ear bones called ossicles. The vibrations continue into the inner ear where they stimulate fluid and tiny hairs which send electrical signals to the brain. After age 40 our hearing can start to fade. Hearing aids can help, but after a certain point they don�t help because they can�t overcome the damage. In that situation, a cochlear implant is a good solution because it can bypass the damage. There are two parts of a cochlear implant. The outside part is a little computer that picks up sound and processes it. The inside part, which is implanted by a surgeon, receives the processed sound and converts it to an electrical signal that stimulates the hearing nerve. There�s always the anxiety that it�s not going to work. When the first of two implants was turned on, Barbara heard nothing. Then a crackling noise like radio static. All of a sudden it started happening. I was actually hearing. If Barbara takes off her processor. It�s just like a hearing aid over my ear. She can�t hear. So Lexi the hearing dog helps her around the house to let Barbara know if, say, the oven timer�s going off. (beep, beep) What is it? Good girl! >>Vivian: Cochlear implants are not perfect. But with implants, Barbara says her world has come alive. And she can once again listen to old time radio. For Medical Edge I�m Vivien Williams. [music]