San Francisco Audiophile Society Hearing Loss and Audibility

1. San Francisco Audiophile Society Hearing Loss and Audibility February 10, 2018 Peter J. Marincovich, Ph.D., CCC-A Joseph Hardeman, Au.D. Daniel S. Park, Au.D. Extern

2. FACTS SOUND & What does sound pressure sound like? HOW WE HEAR AND HEARING LOSS What does aging do to our ears? TINNITUS BALANCE COGNITION: Interventional Audiology HEARING LOSS PREVENTION: How we compromise our hearing? HEARING LOSS SOLUTIONS: Technology improvements in Hearing Aids ACTIVE LISTENING: Lip Reading and Listening Skills THE GOOD NEWS: Mobile Testing, Teleaudiology RECOMMENDED REFERRAL AND CONVERSATION TOPICS

3. FACTS • . 48 million Americans, about 20 %, • have some loss.s • >= age 65 1/3 has hearing loss • 1/3 hearing loss due to noise exposure • 6.2 million children have hearing loss • 50 million have tinnitus (ringing in the ears) • dizziness is the #1 complaint in Dr. office > age 70 • 1.6-3.8 sports/traumatic brain injuries annually • . Interventional Audiology • Audiologists, Cognitive Therapists, Nurse Practitioners • Internists, General Practitioners, Speech Therapy, • Physical Therapists, ENT, Neurologists, Gerontology. • Physiatrists, Cardiologists, Ophthalmologists, other …

4. SOUND sound • SOUND sound

5. Outer Middle Inner Central LoudnessClarity

6. Binaural Auditory Processing

7. BINAURAL (1+1=3) • Hearing in Noise • Localization • Quality, Naturalness • Depth Perception • Peripheral Vision • Visual Fatigue Hearing Vision

8. Common complaints . Hear ool, but not sure if it is “pool”, or “tool” or “fool” • Feel like the people around you are mumbling? • Struggle to hear clearly in background noise? • Find that soft sounds are too soft, but loud sounds are too loud, like TV commercials. • Find it challenging to explain your hearing situation to others.

9. NEEDS HELP R L

10. Tinnitus

11. Tinnitus, cont. • Prevalence: • 1 in 10 adults have tinnitus • #1 complaint among US Veterans Causes: Noise exposure Ear wax • Medications • Ear infections • Trauma/Concussions • Cardiovascular • Dental: TMJ • Hearing Loss

12. Tinnitus Management • In quiet, tinnitus is louder than everything • else. • A candle in a dark room is very bright. • A candle in a fully lit room is hardly noticeable.

13. Tinnitus Management, cont.?

14. Balance • Dizziness and balance

15. Balance Prevalence • The National Institute of Health statistics indicate • that balance-related falls account for over 300,000 • hip fractures in balance related falls every year, • which may lead to more serious health issues • 40-50% of patients 65 years old will fall, and half of • those individuals will fall more than once

16. What is Balance/Dizziness? • A feeling of motion • Difficulty walking • A sense of unsteadiness • A fear of falling • Trouble looking at moving objects

17. How do we keep our Balance? • The Vestibular System • Senses head motion • Proprioception/Spine • Keep us upright • Vision • Centers vision with movement

18. Outer Middle Inner Central

19. Benign Paroxysmal Positional Vertigo (BPPV)‏ • Most common cause of Vertigo • 50% of people ≥ 70 years will • experience an attack1 • Otoconia or Otolith ‘crystals’ dislodged 1 American Institute of Balance

20. 1st Step • Medical Evaluation • 2nd Step • Audiological Evaluation

21. 3rd Step • Vestibular Assessment • Audiology Evaluation: VNG Testing/Balance Testing • By recording and measuring eye movement

22. Treatment- Vestibular Rehabilitation and Balance Therapy • Physical Therapist specializing in balance will create a • treatment plan specific to patient difficulties • Habituation • Adaptation • Use of remaining vestibular system for recovery • Recalibrating the system • Increase Gaze Stabilization • Substitution • Use of other systems to compensate

23. Balance Treatment, cont. • Some disorders may • require a prescription to • manage symptoms, which • is why it’s important you • consult your physician • Dietary Adjustments • Sodium Restriction • Stimulant Restriction: Caffeine, Tobacco, Alcohol • If hearing loss, hearing aids can help with • localization/orientation, fatigue, safety

24. An Ounce of Prevention Hearing Protection

25. How loud sounds effect hearing 3000 Hz 20% 4000 Hz 60% 6000 Hz 20% R L

26. How do I know if sound is too loud? • If you have to raise your voice when you are within 3 feet.

27. How do I know if sound was too loud? • 1. Ears ring • 2. Sounds are somewhat Muffled • 3. Ears feel full or plugged

28. What can we do? • Measure sound and exposure • Apps for smart phones: 80 dB/8 hours • Education • Hearing monitoring • Counseling • Custom Hearing Protection

29. Hearing is our most important: Social Sense

30. Correlations with Hearing Loss • Memory • Cognition • Loneliness • Isolation • Tinnitus • Balance and Gait • Cardiac • Others…

31. A note about a : Correlation • What a correlation is: • 2 or more things happen at the same time • What a correlation isn’t: • cause and effect

32. Memory: The Bottom Line • In summary, the same brain functions that affect hearing also may cause problems with memory and other cognitive function, according to this study. • “The researchers aren't sure yet why brain function is inhibited with hearing loss but are looking at several theories.Social isolation could play a role”. People who can't hear may not be as engaged in conversations because it takes too much effort and they don't want to embarrass themselves. • Hearing loss and cognitive decline in older adults.JAMA Internal Medicine, Lin, F. R., Yaffe, K., Xia, J., Xue, Q-L., Harris, T. B., Purchase-Helzner, E., Simonsick, E.L., 2013. • .

33. Hearing Loss Solutions THE MA5P METHODtm Assessment: Soft/Comfortable/Loud Adaptation: Individual/Prescriptive: THE BEST HEARING AID IS NOT A HEARING AID Active Listening Coaching Assistive Solutions AfterCare

34. Equalization

35. Hearing Improvement

36. ACTIVE LISTENING: LIP READING • FRONT CONSONANTS, formed by the lips • P, B, M LIPS SHUT • F, V LIPS TO TEETH • WH, W LIPS PUCKERED

37. Active Listening: Listening Skills you can begin using today • 3 KEYS to better communication • Prepare • Attention and Speak Slower • Maintain • Let’s Face it • Repair • Ask Good Questions • Next Lip Reading/Listening Skills CLASS: SRJC Springtime

38. The Good News: • Improved Hearing benefit in Patients with Mild Hearing Loss, Carole Johnson, et al., Journal of Academy of Audiology, 2016. • “Evidence exists that supports the notion that individuals with even mild hearing loss benefit from improved hearing”

39. Audiology Associates recommends: • 1. Get baseline hearing test at 60 years of age • 2. Then every 2-3 years. • 3. If complaints of: Ringing, Pressure or Fullness, Dizzy/Unsteady, Muffled, Hx of noise exposure, Pain, Tuning Fork Asymmetry, difficulty obtaining history (soft speech), MIGRAINES, …

40. Patient Referral Conversation • Patients don’t know what they don’t know. Hearing loss is very gradual. When vision changes you can’t see, but when hearing changes you can still hear. Because we tend to lose high pitch hearing initially, and we continue to hear low pitches well, (design of the ear), patients will say, “I hear ok, but sometimes I miss words”. • When REFERRING: Not for a hearing Test • Refer for an: EAR FUNCTION EVALUATION

41. At Audiology Associates our focus is simple, we restore people’s lives through better hearing, keeping them more active, healthier and feeling younger. The Journey is just as important as the Destination! Thank You! www.audiologyassociates-sr.com 1-866-520-HEAR (4327) Find us on Facebook www.facebook.com/AudiologyAssociates

43. Tuning Fork Tests • Rhine's Tuning Fork • 512 or 256 Hz • Soft tap • Which is Louder: • A: Bone conduction, • base around ear • B: Air conduction, fork • perpendicular, 1 cm • C: Bone: base forehead • Weber Tuning Fork • Which is Louder • A: Bone conduction, • base on midline • Sound appears quieter in ear with sensorineural deafness Conductive loss: Left Sensorineural loss: Right