The Hearing Blog

April 25, 2012

FCC Updates Standards on Mobile Phones and Hearing Aid Compatibility

Filed under: Telephone Compatibility,Uncategorized — Tags: — Dan Schwartz @ 3:41 pm

There are many different wireless mobile phones available, and some of the wireless mobile phones work better with some hearing aids than others. The FCC has requirements for some, but not all, wireless phones to be hearing aid compatible.

On April 9, 2012, the FCC approved a new technical standard for testing phones for hearing aid compatibility (HAC). After this new standard is adopted and a 2-year transition period is completed, the Commission’s rules requiring phones to be hearing aid-compatible will apply to handset operations over additional air interfaces and frequency bands. Stated another way, the Commissions’ HAC rules will now apply to a range of new technologies and will allow for more accurate measurements of hearing aid interference, i.e, the new standard will improve the measurement criteria for determining if a mobile phone is hearing aid compatible or not.

You can download the MS Word .doc here, or you can download the Acrobat .pdf document here.

March 27, 2012

Setting Hearing Aid Maximum Power Output Using Stapedial (Acoustic) Reflex Thresholds

Filed under: Adjusting C/M levels,Adjusting SSPL-90/MPO,Auditory Neuropathy Spectrum Disorder,Central Auditory Processing Disorder (CAPD),Hearing instrument fitting,Madsen ZS76 Tympanometer,Stapedial (middle ear muscle) reflex,Tympanic membrane compliance,Tympanometry,Uncategorized — Tags: , , , , — Dan Schwartz @ 8:43 pm

Perhaps the handiest weapon in the Hearing Aid Professionals’ arsenal is the tympanometer, as if you draw a straight line between the audiologic information it can reveal and how that information will impact a hearing aid fitting, you’ll be rather surprised… And will have you running to your equipment dealer or eBay to buy one.

The tympanometer performs two separate functions, which each reveal significant data those of us “in the trenches” which we can use to nail down a good fit, by performing measurements in two disparate areas:

  • Tympanic membrane mobility via compliance measurement, which can yield all sorts of mechanical problems from the TM itself all the way through the Eustachian tube, & all stops in between;
  • Neural measurements, through stapedial reflex thresholds; also called “acoustic” or “middle ear muscle” reflexes.

The first item, relating to mechanical (conductive) problems, such as commonly found fluid in the middle ear cavity, is something that, when we detect a problem, we refer to a physician, as it is above our pay grade. Of course, busy doctors appreciate it when we give them good data in an easy-to-comprehend format, especially if there is a nice graph. For more on tympanometry, the reader is directed to this good article, which explains the various bugbears it uncovers.

However, the purpose of this article goes to the second function of the tympanometer, namely the detection and measurement of middle ear muscle reflexes to sound stimulus, as this can be highly revealing. In normal and some impaired ears, a reflex contraction of the middle-ear stapedius muscle will occur when sound is of sufficient energy, typically 90dB. The stapedius muscle is attached by a tendon from the rear wall of the middle ear to the head of the stapes; and when the stapedius contracts, the tendon produces tension on the stapes, causing the middle-ear ossicles to stiffen. This action reduces the transmission of sound energy through the middle ear, by acting as a dampener, to protect the delicate structures of the cochlea.

Stapedius and Tensor Tympani illustration

One way of visualizing the acoustic reflex function is to treat it as a negative feedback process with a unity gain amplifier, with the forward path signal (the so-called “afferent” signal) applied to a non-inverting Schmitt trigger and then fed back (the so-called “efferent” signal) into the negative input of the amplifier, acting as a control vector, hence reducing gain by 10dB. Note well that the stapedius muscles on both sides contract in response to sound delivered to either ear, as the signals are summed in the cochlear nuclei:

Acoustic (stapedial) reflex pathways using an equivalent negative feedback circuit model. Drawing ©Copyright Dan Schwart\z 2012

Acoustic (stapedial) reflex pathways using an equivalent negative feedback circuit model.

For more detailed drawings of the neural pathways, please see reference 3

First, acoustic reflex thresholds will give you an upper limit to the Maximum Power Output (MPO; previously SSPL-90) of the hearing aids, as the operating theory is that you do not want the instruments to constantly trigger the stapedial muscle reflex, as it is tiring to the patient.1 In fact, according to this paper by Ed Overstreet, this principal is extended to cochlear implants (CI’s) to determine M/C levels;2

Second, it can be used to screen for the dreaded Auditory Neuropathy Spectrum Disorder, which will tell you if a hearing aid will even work. This will be the subject for an upcoming article; but in the mean time, any stapedial reflex thresholds – Ipsilateral (“ipsi”) or contralateral (“contra”) greater than 90dB means ANSD can be in play, and must be followed up with more testing to confirm it or rule it out.

References:

  1. Using Acoustic Middle Ear Muscle Reflexes and Their Utility in Fitting Hearing Instruments by Jay B. McSpaden, PhD, BC-HIS, and Dana K. McSpaden, MSEd
  2. Relationship between Electrical Stapedial Reflex Thresholds and HiRes Program Settings: Potential Tool for Pediatric Cochlear-Implant Fitting by Ed Overstreet PhD, Lisa Buckler MA & Kristen Dawson MA
  3. Acoustic Reflex Threshold (ART) Patterns: An Interpretation Guide for Students and Supervisors Diana C Emanuel PhD

 

 

March 23, 2012

National Institute on Deafness and other Communications Disorders (NIDCD) 2012-2016 Strategic Plan

Filed under: 2012-2016 Roadmap,NIDCD,Uncategorized — Tags: — Dan Schwartz @ 9:18 pm

Established in 1988 by an Act signed into law by President Reagan, who himself was severely deaf, the National Institute on Deafness and other Communications Disorders (NIDCD) is one of the Institutes that comprise the National Institutes of Health (NIH). NIDCD is legislatively mandated to conduct and support biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; and supports efforts to create devices which substitute for lost and impaired sensory and communication function.

As part of their mission, the Institute periodically issues a roadmap, and we at The Hearing Blog are pleased to republish the Cochlear Implant and Hearing Aid Science Capsule excerpts from their 2012-2016 Strategic Plan,  along with an augmented Executive Summary.

Science Capsule: Cochlear Implants

The development of the multi-channel cochlear implant has made it possible to restore the perception of sound to people who are profoundly deaf or severely hard of hearing (HoH). In contrast to hearing aids, which amplify sound, cochlear implants directly stimulate the auditory nerve.

Over the past two decades, NIDCD-supported research led to major advances in multi-electrode signal processing, as well as in understanding the benefits of early implantation in children and the possible benefits of implantation in both ears. Because of this research, we now know that children with hearing loss who receive a cochlear implant within the first two years of life will typically experience a smaller gap in language skills and will be more likely to succeed in mainstream classrooms.

According to the U.S. Food and Drug Administration (FDA), in December 2010, approximately 219,000 people worldwide have received cochlear implants, including approximately 42,600 adults and 28,400 children in the United States. Roughly 40 percent of children who are born profoundly deaf now receive a cochlear implant, which is a 25 percent increase from five years ago. The rise in cochlear implant use among eligible people between 2000 and 2010 exceeded the target set in the U.S. Department of Health and Human Services’ (HHS) Healthy People 2010 (a set of science-based 10-year national health objectives), and a new target is being developed for Healthy People 2020.

NIDCD-supported scientists continue to improve cochlear implant technology through the development of noise-reduction signal processing and innovative electrode designs. For example, insertion of traditional cochlear implant electrodes can damage hair cells throughout the cochlea, so researchers are investigating methods to preserve residual hearing in eligible individuals by implanting a shorter electrode array. In addition, animal studies are underway to assess the risks and benefits of a new electrode design that is positioned inside the auditory nerve, with the hope this will provide an improved sense of hearing in crowds and other social situations in which more than one person is speaking. NIDCD researchers continue studies with children who received cochlear implants at a young age to determine what factors contribute to successful language learning and subsequent academic performance. Continued research to assess how current users benefit from a cochlear implant in one ear, along with a cochlear implant or a hearing aid in the other ear, will help inform the design of the next generation of implants.

Science Capsule: Hearing Aids and Hearing Health Care

NIH- and NIDCD-supported research has driven the development of hearing aids from the first electronic hearing devices invented in the 1950s to the sophisticated digital devices available today. Innovative collaborations between the NIH, the Department of Veterans Affairs (VA), and the National Aeronautics and Space Administration (NASA) have significantly improved hearing aid technology over the past 20 years. In addition to amplifying sound, today’s hearing aids are better designed to address the challenges of understanding speech, localizing sound, and hearing in noisy environments.

Despite these advances, NIDCD-supported scientists are continuing to seek ways to improve hearing aid technology, hearing aid fitting strategies, and auditory rehabilitation programs to enrich the communication experience and quality of life for millions of Americans who have hearing loss. NIDCD-supported scientists are developing more effective methods to reduce sound distortion, improve sound localization, and combine hearing aid and cochlear implant technologies. For example, NIDCD-supported research on the tiny fly named Ormia ochracea provided a model for the development of a miniature directional microphone for hearing aids to help users focus on a single speaker in a noisy room.

Improving hearing health is an ongoing priority for NIDCD. An estimated 17 percent of all American adults and nearly half of adults ages 75 years and older have some form of hearing loss, yet only about 20 percent of those who could benefit from hearing aids actually use them. For the past two decades, the NIH and the VA have cosponsored biannual national and international meetings to facilitate information sharing among hearing aid technology researchers. In 2009, NIDCD convened a workshop titled “Accessible and Affordable Hearing Health Care for Adults with Mild to Moderate Hearing Loss,” that resulted in research recommendations and a series of NIDCD research initiatives to explore new approaches, assessment methods, and small business technologies to improve access to hearing health care for underserved individuals. In addition, increasing the rate of hearing aid usage was a HHS Healthy People 2010 goal and continues as a Healthy People 2020 goal. NIDCD is committed to pursuing research to understand and improve hearing health for all Americans.

Executive Summary:

Approximately one in six Americans will experience a communication disorder in his or her lifetime. Communication disorders affect hearing, balance, taste, smell, voice, speech, and language. For hearing and balance: estimates indicate that 36 million American adults report some degree of hearing loss; two to three out of 1,000 babies born in the United States each year have a detectable hearing loss; and almost eight million adults report a chronic problem with balance. For taste and smell: more than 200,000 people visit a physician for taste and smell disorders annually, and many more of these disorders go unreported. For voice, speech, and language: approximately 7.5 million people in the United States have trouble using their voices; by the first grade, roughly five percent of children have noticeable speech disorders, the majority of which have no known cause; and between six and eight million people in the United States have some form of language impairment.

Modern society depends on our ability to communicate with one another. While science and technology have greatly improved this capacity, life can be profoundly difficult for those with communication disorders. Such disorders can affect the emotional, social, educational, and cognitive development of an individual, and the cost of these disorders in terms of human suffering, unfulfilled potential, quality of life, and economic factors is incalculable.

The National Deafness and Other Communication Disorders Act of 1988 became Public Law 100-553 on October 28, 1988, establishing the National Institute on Deafness and Other Communication Disorders (NIDCD) within the National Institutes of Health (NIH). The mission of the NIDCD is to conduct and support biomedical research, behavioral research, and research training in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. The Institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; supports research evaluating approaches to the identification and treatment of communication disorders and patient outcomes; and supports efforts to create devices that substitute for lost and impaired sensory and communication function. NIDCD’s focus within this broad mission is to bring national attention to the disorders and dysfunctions of human communication and to advance biomedical and behavioral research to improve the lives of the millions of people with a communication disorder.

To accomplish this mission, NIDCD manages a broad portfolio of both basic and clinical research. The portfolio is organized into three program areas: Hearing and Balance; Taste and Smell; and Voice, Speech, and Language. The three program areas seek to answer fundamental scientific questions about normal function and disorders and to identify patient-oriented scientific discoveries for preventing, screening, diagnosing, and treating disorders of human communication.

Public Law 100-553 also requires NIDCD to prepare a plan to initiate, expand, intensify, and coordinate Institute activities concerning the disorders of hearing, balance, taste, smell, voice, speech, and language. NIDCD met this requirement by convening a task force of scientific experts in 1989 to prepare the first strategic plan, which guided the Institute over its first few years. NIDCD has continued to update or rewrite its Plan on a regular basis.

The NIDCD Strategic Plan (Plan) serves four purposes:

    1. It helps the Institute to prioritize its research investment;
    2. It informs the nation’s scientists of emerging areas of opportunity for research and provides them with guidance as they formulate their own research plans;
    3. It informs persons with communication disorders and their support organizations of research accomplishments and potential future breakthroughs;
    4. Finally, the Plan shares research progress and areas of future research opportunity with the public.

The goals listed in the NIDCD Strategic Plan were selected by experts as research areas that present the greatest scientific opportunities and public health needs over the next five years. The Plan is not a comprehensive list of all research areas that NIDCD is currently supporting or plans to support in the future. Basic and clinical research being supported by NIDCD will continue to be given high priority. The NIDCD is committed to supporting new, innovative, hypothesis-driven, meritorious research, which can lead to improving the health of individuals with communication disorders.

To develop the 2012-2016 Plan, NIDCD convened a series of working groups and solicited input from scientific experts, the National Deafness and Other Communication Disorders Advisory Council, NIDCD staff, and the public. In consultation with communication research scientists and the public, NIDCD identified four Priority Areas that have the potential to increase our understanding of the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language and to further our knowledge in human communication sciences.

Within each Priority Area, the Plan lists emerging research opportunities identified as goals. A summary of the research goals for the Hearing & Balance portion of NIDCD’s three program areas is listed below [Editors' notes: Sections on Taste & Smell, and Voice, Speech & Language Research have been omitted; while each section of the Priority Areas has the full description from the Strategic Plan document added]:

Priority Area 1: Understanding Normal Function.  Deepen our understanding of the mechanisms underlying normal function of the systems of human communication. By defining what is normal in both animal models and humans, we can better understand mechanisms of disease.

  • Development of the Auditory and Vestibular System: Identify the molecules and genes involved in development of the peripheral and central auditory and vestibular pathways. Understand how auditory neurons recognize and establish tonotopic organization.
  • Homeostasis and Microenvironment: Increase understanding of homeostasis in the inner ear (e.g., ionic composition and maintenance, inflammatory response and toxin elimination, blood-labyrinth barrier, microcirculation, hormonal and other control systems) and in the middle ear (e.g., gas exchange, fluid regulation, innate immunity, and gene expression).
  • Mechanics: Expand knowledge of mechanics in the cochlea (e.g., interaction of hair cell membranes and sterocilia with supporting structures); in the middle ear (e.g., resolve important issues of middle ear mechanics, including tympanic membrane/ossicular coupling and the role of non-piston-like modes of stapes motion); and in the vestibular system (e.g., cupular and otolithic maintenance of posture and equilibrium).
  • Sensory Cell Transduction: Identify the molecular constituents of hair cell transduction: nanomechanical properties, molecular motors in hair cell membranes and stereocilia, ion channels and pumps; and their integration for hair cell tuning and maintenance.
  • Cochlear Amplification: Identify molecular determinants responsible for the biophysical traits that influence amplification, including the basis of its fast kinetics; delineate roles of stereociliar vs. somatic mechanisms in mammalian cochlear amplification; determine roles of amplification in low and high frequency regions of the cochlea; refine mathematical models of amplification and outer hair cell function.
  • Functional Connectivity: Clarify how afferent and efferent neural circuits process auditory and vestibular peripheral input. Understand how coding schemes influence plasticity and enable attention, cognition, and stress. Incorporate advanced techniques of functional and structural neural imaging and connectivity, ranging from molecular to systems scale.
  • Perception:
    • Auditory System: Determine how sound detection, discrimination, and recognition interact with learning, memory, and attention as well as with vision, tactile sensation, and balance to better understand auditory perception in real-world listening environments.
    • Vestibular System: Determine how vestibular, visual, and proprioceptive (the sensing of motion or position) systems interact to perceive space and motion and to maintain orientation.

Priority Area 2: Understanding Diseases and Disorders.  Increase our knowledge of the mechanisms of diseases, disorders, and dysfunctions that impair human communication and health. Understanding mechanisms that underlie diseases and disorders is an important step in developing better prevention and treatment strategies.

  • Epidemiology: Investigate natural history; genetic and environmental risk factors; racial, ethnic, and gender differences; and practical objective metrics for subpopulations to inform the development of evidence-based treatment strategies. Explore how complex comorbidities create differences in disease phenotypes and treatment outcomes.
  • Inherited Disorders: Identify gene mutations responsible for congenital and age-related deficits, understand structural consequences of such mutations, and develop high-throughput platforms for testing individuals. Understand how specific mutations relate to the severity and progression of disease. Investigate protein function to inform better prevention and treatment strategies.
  • Otitis Media: Improve understanding of susceptibility and pathogenesis related to genetics, prior upper respiratory infection, eustachian tube dysfunction and reflux, bacterial biofilms, polymicrobial infections, inflammatory dysregulation, and mucosal hyperplasia. Define immune pathways for effective middle ear protection by vaccines. Determine impact of vaccination on disease prevalence and infection by other microbes.
  • Inflammatory and Autoimmune Responses of the Inner Ear: Identify and characterize first responders to injury in the inner ear. Determine how molecules and cells cross the blood-labyrinth barriers to initiate immune response and autoimmune disease. Identify genetic and epigenetic risk factors. Investigate innate and cognate immunity in resolution of OM.
  • Tinnitus: Develop new animal models to understand the specific neural deficits responsible for tinnitus.
  • Other Acquired Disorders: Improve understanding of the pathogenesis of noise-induced, traumatic, idiopathic, ototoxic, neurotoxic, metabolic, and non-hereditary degenerative auditory and vestibular dysfunction. Improve delineation of the multiple processes resulting in presbycusis. Relate molecular, cellular, and structural (e.g., temporal bone research) otopathology to the clinical progress of disease.
  • Pathways and Damage: Determine how the peripheral and central auditory and vestibular pathways are reorganized following injury. Define the long-term changes resulting from early sensory loss. Identify molecular, genetic, and anatomical underpinnings of plasticity. Relate functional deficits to specific lesions in the pathways.
  • Changes in Perception with Disease:
    • Auditory System: Identify sources of variance contributing to large individual differences in response to similar intervention strategies among people with hearing loss. Improve understanding of the time course, sensitive periods, and complications of hearing loss
    • Vestibular System: Understand how disease affects perception of motion and spatial orientation, including connections with limbic and autonomic systems.

Priority Area 3: Improving Diagnosis, Treatment, and Prevention.  Develop, test, and improve diagnosis, treatment, and prevention of diseases, disorders, and dysfunctions of human communication and health. Diagnosis considers normal function and provides targets for prevention and treatment. Improvements in prevention and treatment lead to better outcomes with fewer side effects.

  • Regeneration: Develop in vitro systems to identify genes and factors that promote regeneration of specific cellular phenotypes (e.g., hair cells, supporting cells, spiral ganglion neurons, cells of the stria vascularis); understand factors that regulate hair cell regeneration; and determine which genes and extracellular factors control cell-specific differentiation.
  • Pharmacotherapeutics: Develop targeted delivery of viral vectors for gene therapy and site-specific, controlled, sustained molecular therapy for both developing and dysfunctional pathways. Develop therapies to improve neuronal stimulation, resist cell damage, and enhance cell repair.
  • Tinnitus: Apply advanced imaging techniques to provide measures of changed neural activity in people with tinnitus. Identify pharmacologic agents to prevent tinnitus resulting from traumatic, ototoxic, degenerative, and other acquired disorders. Identify behavioral, pharmacological, surgical, and device-based treatments for improving tinnitus.
  • Otitis Media: Develop polyvalent vaccines for polymicrobial middle ear infection. Develop new drug delivery systems to the middle ear to prevent development of, enhance innate immunity to, and speed recovery from inflammation. Develop therapies to prevent and treat biofilms.
  • Interventions for Hearing Loss:
    • Examine existing and develop better aural rehabilitation strategies. Investigate how aural rehabilitation strategies are affected by treating comorbid conditions that influence success, such as dementia, diabetes, osteogenesis imperfecta, and stress.
    • Traditional (external) Hearing Aids: Improve device performance in background noise and other real-world settings.
    • Cochlear Implants: Improve efficacy of bilateral implants, short electrode implants, and hybrid cochlear implant/hearing aids in the same or opposite ear in conjunction with auditory/aural rehabilitation, assistive electronic devices, sign language, in home and educational environments. Improve prediction of outcome and maintenance of outcome over time.
    • Other Implants: Improve efficacy of partially and fully implantable middle ear devices, round window transducers, bone-anchored devices, ABI, and other brain implants.
  • Interventions for Dizziness and Balance Disorders:
    • Develop safer, better tolerated, and more effective pharmacological treatments for vertigo.
    • Develop vestibular prosthetic devices and minimally invasive surgery for better control of imbalance and vertigo while preserving hearing and other functions.
    • Develop improved behavioral approaches for the rehabilitation of chronic vestibulopathies.
    • Develop improved methods of systematic diagnosis and delineation of subtypes of dizziness/vertigo in order to identify subpopulations that might respond best to targeted therapies.
    • Understand post cochlear implantation dizziness and the connection with vestibular migraines.
  • Metrics:
    • Hearing Disorders: Develop metrics that better define functional hearing and communication abilities under real-world listening conditions; differentiate clinical subtypes of hearing disorders; identify early pathology in its preclinical stage; provide better measures of performance, communication skills, and disease-specific quality of life instruments for cochlear implant users; and improve assessment of the perception of, and reaction to, tinnitus.
    • Balance Disorders: Develop metrics for the perception of equilibrium, dizziness, vertigo, and spatial disorientation with emphasis on relationships among disequilibrium, emotional disabilities, and cognitive disabilities.
    • Identify common data elements to improve communication among scientists and clinicians across different specialties.
  • Management of Older Adults: Improve hearing loss management, including screening, treatment, and rehabilitation. Define the underserved population of older adults for hearing health care. Determine if early access to hearing health care changes health outcomes later in life. Develop and evaluate the effectiveness of screening methods. Reduce risk of falls in older adults due to imbalance. Develop assistive balance aids and training programs to augment stability and posture in the elderly.
  • Clinical Trials and Other Clinical Research Studies: Develop and implement infrastructure to identify 1) investigators with expertise in epidemiology, clinical trials, data registry, and other clinical research and 2) academic- and community-based clinical practice settings with geographic, racial, and ethnic diversity in order to facilitate rigorous, cost-effective clinical research and maximize human subjects protections.
  • Emerging Technologies (including Bioengineering, Nanotechnology, and Neural Prostheses): Capitalize on emerging scientific advances and technologies from nanoscience, biomedical engineering, and other areas to improve treatments and develop novel devices that support impaired function.
  • Training: Promote the cross training of basic scientists, clinician scientists, and physician scientists to facilitate the development of interdisciplinary research teams and to stimulate translational research.

 

  • Priority Area 4: Improving Outcomes for Human Communication.  Accelerate the translation of research discoveries into practice; increase access to health care; and enhance the delivery, quality, and effectiveness of care to improve personal and public health. Scientifically validated prevention and treatment models will lead to better personal and public health only if they are translated effectively into routine practice.
    • Hearing Health Care: Identify factors that influence a person’s motivation and perceived need for hearing health care. Examine the impact of organization, financing, and management of health care services on the delivery, cost, access to, and outcomes of services. Develop innovative delivery systems, including telehealth and the Internet, to increase awareness, access, and affordability. Identify cost-effective approaches for diagnosis and treatment.
    • Comparative Effectiveness Research and Evidence-Based Medicine: Through clinical trials and epidemiological comparative effectiveness research, identify best treatments for a given medical condition for a defined set of individuals. Develop and use clinical registries, clinical data networks, and other forms of electronic health data to inform the conscientious, explicit, and judicious use of current best evidence in making decisions about hearing health care options.
    • Implementation and Dissemination Research: Investigate effective implementation of “best practices” among health care providers to translate advances into routine community practice. Increase the effective dissemination of health information to the public to promote healthy behaviors.
    • Community-Based Participation in Research: Promote community-based research to identify factors that influence outcomes for people with hearing and balance disorders in diverse real-world settings. Engage deaf and HoH individuals in community-based research to aid in developing behavioral interventions to improve their quality of life. Develop methods to address communication disorders in diverse populations, considering variations in care and practice settings.

We at The Hearing Blog are happy to mirror at these links the PDF files for both the Strategic Plan and the Executive Summary~

March 22, 2012

My new $25 Auditory Neuropathy/Dys-synchrony Sniffer (Madsen ZS76 Tympanometer)

Filed under: Audiologic Test Gear,Auditory Neuropathy Spectrum Disorder,Madsen ZS76 Tympanometer,Stapedial (middle ear muscle) reflex,Tympanic membrane compliance,Tympanometry,Uncategorized — Tags: , , , , — Dan Schwartz @ 6:16 pm

This is a two-part story on me scoring a working clinical tympanometer for $25… And why it’s such a valuable tool for both detecting  Auditory Neuropathy Spectrum Disorder, and also for adjusting & troubleshooting hearing aids.¹

One of the big mistakes I made when I closed my hearing aid dispensing lab in 1995 was letting go of my Rexton I-28 tympanometer (impedance bridge), as it was providing valuable auditory neuropathy/dys-synchrony diagnostic information — But I didn’t recognize it at the time… Nor in fact, did almost anyone else in the hearing care profession.  More on this in an upcoming article on auditory neuropathy spectrum disorder.

So, recognizing the need to add a clinical tympanometer back into my arsenal against hearing loss, I had been combing the pages of eBay for another I-28, or maybe something a bit newer (and nicer), to find something that I could properly test stapedial reflex thresholds again. (These are also called middle ear muscle reflexes or acoustic reflexes.) Besides searching for tympanometer  I was also combing through impedance  looking for a mis-labeled bargain, when this gem popped up:

Madsen Impedance Audiometer ZS 76 1B

Madsen Impedance Audiometer ZS 76 1B (click to enlarge in a new window)

Headset from Madsen Impedance Audiometer ZS 76 1B

Headset from Madsen Impedance Audiometer ZS 76 1B (click to enlarge in a new window)

Up for your bid is a Madsen Impedance Audiometer ZS 76 1B. It is in overall good shape as shown in the pictures. There is some wear here and there as expected. The case has some writing on it and the top looks like something dribbled down it leaving a light stain. The unit and case will need a light cleaning by the new owner. When the unit is plugged in the light came on as shown. The knobs seemed to turn easily. The one red light to the left of the db meter did not come on but it might be because of the settings of the unit at the time. When I put the headphone on my ear I did hear some noise coming out of it but not alot. There again it may be the settings of the unit. Please note: I know nothing about these so you are buying it “as is”. This is why I listed it as for parts and repair. It may work fine but I don’t know. My loss is your gain. Please feel free to ask any questions you have before bidding and I will try to answer them. Thank you for looking and your bid.

Well, I’m an Electrical Engineer, and I figured that if the seller couldn’t figure out how to use it (there was no manual), there was a either a chance that it indeed worked, or that if it wasn’t working, at least I could use my voltmeter & ‘scope to take a shot at fixing it. Well, guess what folks? It works! So, all that is left to do is get a 1.0 cm³ calibrator cavity (or have my machine shop make one), get some eartips, and I’m off to the races. There is one modification I’ll most likely add: Although I don’t test infants, the 226 Hz probe tone has too long a wavelength to use for tiny ears, so I’ll splice in a 1000 Hz oscillator, to give me that capacity.

Not too shabby for a total of $39.52, including shipping to my door.

Footnote:
1) Now, about my statement on  using a tympanometer for adjusting & troubleshooting hearing aids: As it turns out, one trick taught to me many years ago (I think it was by the late Sam Lybarger) is to measure the acoustic reflex thresholds, and use those figures to set the instruments’ SSPL-90 (now called MPO), on the theory that you don’t want to have the hearing aid output constantly triggering the stapedial reflex, as it is tiring to the patient. The fact that this is now being done to set C/M levels on CI’s for infants & others who can’t report back, as described here by my friend Ed Overstreet PhD, appears to validate this tried-and-true concept~

March 18, 2012

ANSD 2012 Conference: Variation in Detection and Discrimination Abilities in AN/AD: Implications for Management

Filed under: Auditory Neuropathy Spectrum Disorder,Uncategorized,Variation in Detection and Discrimination Abilities: Implications for Management — Tags: , — Dan Schwartz @ 2:47 pm
Linda Hood PhD (right)

Linda Hood PhD (right)

At the ANSD 2012 Conference in St Pete on Friday, March 16th, Professor Linda Hood PhD presented on the Variation in Detection and Discrimination Abilities in AN/AD, and the Implications for Management. You can download her presentation here.

ANSD 2012 Conference: Hyperbilirubinemia and Bilirubin Induced Neorological Disease (BIND)

Filed under: Auditory Neuropathy Spectrum Disorder,Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND),Uncategorized — Tags: , , — Dan Schwartz @ 1:57 pm

Steven Shapiro MDAt the Auditory Neuropathy Conference 2012 in St Pete on Thursday morning, we had a very interesting presentation by Steven Shapiro, MD on Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND). Dr Shapiro is with the Division of Neurology in the Department of Pediatrics, at Children’s [sic] Mercy Hospital, which is part of the University of Missouri-Kansas City. You can download the handout here (5MB PDF file)

March 13, 2012

Auditory Neuropathy Spectrum Disorder Conference 2012

Filed under: Auditory Neuropathy Spectrum Disorder,Auditory Therapy,Cochlear Implant,Education,FM Assistive Devices,Uncategorized — Tags: , , , , , — Dan Schwartz @ 11:56 am

Diagnosis and Management of Auditory Neuropathy Spectrum Disorders Conference, All Children's Hospital, St Pete, Florida

We’ll be live blogging from the upcoming Conference on the Diagnosis and Management of Auditory Neuropathy Spectrum Disorders (ANSD), hosted by USF Professor Charles Berlin and Vanderbilt Professor Linda Hood, this Thursday through Saturday March 15th through 17th at All Children’s [sic] Hospital in St Petersburg, Florida.

Topics covered include:
• Results and Outcomes from more than 500 ANSD Patients
• Hearing Aids vs. Cochlear Implants
• Cortical Evoked Potentials
• Newest Developments in Trans-Tympanic ECochG
• Speech Language Management

You can follow developments on Twitter by using the #ANSD hashtag & by following @ANSD2012

On the docket are the following sessions: Just click the links below for the separate blog entries, as they become available…
Thursday:
• The Pathophysiology and Clinical Presentation of Auditory Neuropathy/Dys-Synchrony, by Charles Berlin PhD
• Hyperbilirubinemia and Bilirubin Induced Neurological Disease (BIND), by Steven Shapiro MD
• Sample Case Presentations and Discussions, by Courtney Oliszewski AuD, Sybil Faylo AuD & Bridget Rickman AuD
• Differentiating ANSD from Central Auditory Processing Disorders and the Use of Cortical Evoked Potentials in ANSD, by Thierry Morlet PhD
    For more on cortical potentials as discussed, please see Cortical Reorganization and Cross-Modal Plasticity in Children with Cochlear Implants: Clinical Implications by Dr Anu Sharma
• Cochlear Implants in Infants & Children with ANSD, by Kirsty Gardner-Berry PhD
    [Kirsty is coming all the way from Sydney Cochlear Implant Center, and we are looking forward to hearing her views on the Nucleus vs HiRes 90k vs i100 implant circuits.]

Friday:
• Genetics of Hearing Loss in General and auditory neuropathy/auditory dyssynchrony (AN/AD) in Particular, by Melissa Crenshaw MD
• Hands-on Practice Session in Otoacoustic Emissions (OAE) and Auditory Brainstem Response (ABR) Testing, by Kathy Slifer AuD
    [We're looking forward to this one, and will have pictures.]
• Pediatric Grand Rounds: Hyperbilirubinemia, by Steven Shapiro MD
• Variation in Detection and Discrimination Abilities in AN/AD: Implications for Management; by Linda Hood PhD
• Managing Infants with ANSD During the First 12 Months of Life – Let’s Not Just “Wait & See,” by Kirsty Gardner-Berry PhD

Saturday:
• The All Children’s Hospital Cochlear Implantation Process, Selection and Management, by Peter Orobello MD, Kathleen Wasylik MD, Anne Oliver MA, & Shelly Ash MS
• Hearing Aids, vs. Monaural vs. Binaural Cochlear Implantation Results in Speech and Language Acquisition, by Susan Spirakis AuD
    [We're looking forward to this one too, and will have questions regarding differing findings from Mike Dorman & his bimodal studies.]
• Little Patient, Big Doctor: My Journey and Experiences with Big Doctors vs Children as Patients, by Haleh Rabizadeh-Resnick JD
    [Haleh was the subject of the controversial report   Don't let a doctor destroy your baby's hearing on CNN]

   

March 10, 2012

Dangerous new teen trend on hearing loss vs technology

Filed under: Education,Teenage hearing loss,Uncategorized — Tags: — Dan Schwartz @ 9:39 am

We’ve known for decades that loud music causes permanent, irreversible sensorineural hearing loss, and since time immemorial teens have always had a sense of invincibility.

However, there’s a very important — And dangerous — new trend we’re seeing with today’s youth: Watch this video produced by high schoolers, paying close  attention to the boy at 0:58 & girl at 1:18. You’ll see that these two teens have the attitude that “technology will fix the problem” …And that they are somewhat correct.

 

When you look at what these kids see in their daily lives, with the sophisticated technology in their latest iPhones, cars, and medical devices, their optimism of technology addressing noise-induced hearing loss is not irrational — And that perception is causing teen deafness at an alarming rate, with the latest studies showing an increase from 14.9% in 1994 to 19.5% — That’s one in five – by 2006, according to this robust study in JAMA.

Hat tip to Mimosa Acoustics for pointing out this surprisingly insightful video, originally published here.

February 28, 2012

Uni study in DFW of CROS & BiCROS hearing aids for single-sided deafness

Filed under: Single-Sided Deafness,Uncategorized,University clinical studies — Tags: , , , , , — Dan Schwartz @ 12:35 pm

 

To all of our readers in the Metroplex who either have, or know someone in the area with limited or no hearing in one ear BUT have normal or some hearing in the other, Prof. Erin Schafer (e-mail) in the Audiology school of University of North Texas in Denton is  is recruiting (paid) volunteers  for clinical trials on a new CROS & BiCROS¹ hearing aid system.

As she told me on the phone, as part of the test you’ll get a  complete audiological exam compliments of the study, worth many hundreds of dollars in and by itself.

The best part? Dr Schafer is also really  nice!

From the flyer:
“We are studying the potential benefit of a specialized hearing device for people with limited/no hearing in one ear and normal/some hearing in the opposite ear. Do you all have patients, friends, or family members who might be candidates for the study? We are paying $20 an hour and offering a trial with this new device. Please see attached for more info.”

University of North Texas study of CROS and BiCROS hearing aids by Professor Erin Schafer

Click to enlarge and open in a new window

 

If you are interested in participating in this study, please e-mail Dr Schafer at Erin.Schafer@unt.edu or call her at 940-369-7433.

Editors’ comment: CROS and BiCROS hearing aids have traditionally had low user satisfaction, with a “love it” or “shove it”  response (and with more of the latter when they get into noise): This explains the popularity of the “BAHA” bone anchored hearing aid for SSD, as despite the nuisance of the post protruding through the skin, satisfaction with that device is very high. However, in my conversation with Dr Schafer, I think she may be on to something with her project, so if you qualify and are in the Metroplex, I encourage you to sign up and give her solution a try. DLS

1: CROS = Contralateral Routing of Offside Signals, where sound from the dead ear is transmitted to the good ear to eliminate the head shadow effect.
BiCROS is where the better ear also has some hearing loss, and would have a hearing aid on it as well.

February 27, 2012

Is your infant, child or adolescent hearing impaired? Take the quiz!

Filed under: Pediatric hearing loss,Uncategorized — Tags: , , — Dan Schwartz @ 5:27 pm

For those of you who suspect a child from age 4 months to 12 years has a hearing or listening difficulty,  the free Early Listening Function (ELF;  4 months to 3 years), and the Childrens’ Home Inventory for Listening Difficulties (CHILD; 3-12 years) Discovery Tools  for parents and caregivers are short questionnaires to fill out that can provide answers, and guidance on how to ask for help.

You can download ELF (4-36 months) here, and download CHILD (3-12 years) here, both as PDF files.

• The CHILD questionnaire focuses on the parents’ role in the observation and monitoring of their childs’ listening behavior. The 15 items in this questionnaire represent typical family communication situations at different distances and in background noise. The CHILD tasks relate to dynamic communication situations and is appropriate for use with children aged from 3 – 12 years. The parent uses an eight-point scale to estimate the childs’ listening ability. Adults carrying out the tests check the childs’ response to both speech in different environments and to other important sounds such as an alarm clock. Apart from providing the hearing care professional with vital information regarding the effectiveness of hearing aids, the CHILD also represents a reality check regarding the communication challenges the child is facing in daily life. If a child is having difficulty communicating in background noise or when speech is at a distance at home, this could underscore the need for an FM assistive system included in the IEP or 504 to improve the “listening ease,” especially when the child enters school. The CHILD questionnaire can also be used to compare different hearing instruments and settings for effectiveness.

• The second questionnaire, the ELF, defines 12 contrived listening activities that parents and caregivers present in the home environment and then observe the responses of their children aged from 0 – 3 years. The object of these activities is to elicit child responses to quiet, typical and loud sounds in order to discover the individual child’s hearing range or “listening bubble:”

The 'Listening Bubble' as described in the Early Listening Function (ELF) test

An example of a quiet activity is rubbing together the palms of the hands or saying ‘sh, sh, sh’ out of the childs’ view, while noisy activities include knocking loudly on a door and speaking in a loud voice. The user-friendly questionnaire allows the parent or caregiver presenting the activities to monitor the child’s response at various distances from the sound’s source and to rate this on a simple, three-tier scale. As the adults observing the responses gain experience and confidence, they are able to better understand the effects of hearing loss on their child’s access to communication in the home. When the ELF results are shared with the audiologist the information will be invaluable to ongoing effective audiological management and validation of the hearing aid fitting

ELF was developed by Karen Anderson PhD and CHILD was developed by Anderson and Joseph Smaldino PhD stimulate the secret ingredient of successful pediatric intervention: Parental involvement

The questionnaires are also mirrored  on The Hearing Blog here for ELF and for CHILD.

We thank Oticon USA for sponsoring the publication of ELF and CHILD, and we thank AudiologyOnline.com news for some of the material used in this article~

February 17, 2012

Advanced Bionics website hacked for over 24 hours

Filed under: Advanced Bionics corporate security,Uncategorized — Tags: — Dan Schwartz @ 10:34 am

Go to the Advanced Bionics main website (http://www.AdvancedBionics.com) and then in the lower right corner, click on the Country selector, and choose Singapore. (or, click this link to go directly to the  http://www.AdvancedBionics.com.sg page). Pretty ugly, ehhh? What’s worse, this has been going on now for at least 24 hours.

The Hearing Blog takes this very seriously, as does the United States Food & Drug Administration (as well they should): This is a corporate website for an implanted medical device manufacturer; and if it has been breached, this is a Very Serious Matter, as once breached, what documents have been viewed, destroyed, or altered by malware planted inside the firewall rings of protection. We are calling on the FDA to order that a complete audit of the Advanced Bionics corporate IT system be conducted, as besides the defacement we do not know what other damage has been done.

We originally saw this yesterday morning, and got a chuckle out of it, as did others who saw my post on Facebook pointing it out… In fact, we wrote a friend joking that if we did this, it would be the booking photo of Sonova CEO Andy Rihs when he was arrested last year by Swiss authorities for insider trading. CI advocate Rachel Chaikoff said she sent a few e-mails to AB; and we figured that the Sonova  corporate IT security department would have jumped on this, and patched their server & firewall holes… especially since they are part of a $6 billion Swiss conglomerate; and this was on a weekday. However, “on further review” when we saw this security breach continuing for over 24 hours showing poor IT security, we here at The Hearing Blog are now calling on the FDA to take action, as among other things, HIPAA patient privacy laws may have been broken.

This is a screen capture of the Advanced Bionics Singapore home page, as of about 9:30am EST on Friday, February 17, 2012 (click to enlarge):

Screen capture of the Advanced Bionics website hack, 9:30am EST 2/17/2012

Screen capture of the Advanced Bionics website hack, 9:30am EST 2/17/2012

Short link for this post: http://TinyURL.com/AB-webhack

February 10, 2012

Rarefaction and condensation… or should it be compression?

Filed under: Acoustical wave propagation,Acoustics,Audio Engineering,Physics,Thermodynamics,Transmission Line Loudspeakers,Uncategorized — Tags: , , , , , , , — Dan Schwartz @ 1:44 pm

One annoyance I’ve had for over three decades is the use of the term “condensation” (the opposite of rarefaction) when describing acoustic wave propagation in gaseous fluids. Instead, I’ve always preferred the term “compression” instead of “condensation,” as it more accurately describes the thermal process taking place, whether the propagation is taking place in an isothermal (P*V)=constant or more commonly adiabatic (P*V)γ=constant thermodynamic process; where γ = 1.4 for an adiabatic process, and unity for an isothermal (such as an ideal gas law) process, with the exponential notation typically omitted.

My reason for this change is that the term “condensation” implies a phase change from gas to liquid, such as occurs  in a condenser in a refrigeration circuit or boiler steam circuit. Since (in most cases) we are dealing with adiabatic propagation, the temperature actually increases when gases are compressed, moving away from the phase change curve.

For the less common case of isothermal propagation, such as through fiberglass insulation, then condensation could (theoretically) occur; however, I would still prefer to call it “compression” as even at the linearity limit of an acoustic wave of 194 dB intensity (which is 14.7 psia or 1000 millibars), gas → liquid phase change will not occur… But it will be guaranteed to rupture your eardrums. [Hat tip to Wayne Staab PhD for pointing this out.]

Update: It turns out I’m not the only one using this terminology: While looking through the Audio Related Things page of the late Georgia Tech Electrical Engineering Professor W Marshall Leach, I ran across  An Electroacoustic Analysis Of Transmission Line Loudspeakers, the 2007 Georgia Tech PhD thesis by Robert Allen Robinson Jr of which Dr Leach was one of the advisors. Dr Robinson too uses the “rarefaction and compression” nomenclature throughout, including on page 100 (PDF page 117). Here’s an animation of the process:

compression-rarefaction animation

Compression -- Rarefaction Animation

 

Adiabatic and Isothermal descriptions

 

As a side note, loudspeaker engineers trained by Georgia Tech professors Eugene Patronis &/or W Marshall Leach (both Fellows of the Audio Engineering Society) will quickly recognize that the way to increase the box volume of a loudspeaker is to pack it with fiberglass for a volume increase of about 1.2x (using a  γ ≈ 1.2), as the acoustic waves will propagate in a manner in between adiabatic and isothermal… At the expense of lowering box Q, which is Not Good for the unassisted 4th order vented response. Of course, you can pack your cabinet with steel wool for a  γ approaching 1.4, but then it gets messy with the driver magnet. For a more thorough discussion on this, including frequency dependence and derivation, please see pages 100-101 (PDF pages 117-118) in  An Electroacoustic Analysis Of Transmission Line Loudspeakers, the 2007 Georgia Tech PhD thesis by Robert Allen Robinson Jr~

February 7, 2012

Frustration with so-called “minimal” hearing loss (updated)

Filed under: Central Auditory Processing Disorder (CAPD),HLAA Convention,Minimal hearing loss,Single-Sided Deafness,Songbird FlexFit,Starkey AMP,Tinnitus,Uncategorized — Tags: , , , , , , , — Dan Schwartz @ 3:47 pm

UPDATE: Please see the new item below about an audiologist for a hearing aid manufacturer in footnote 4

Better Hearing Institute  director Dr Sergei Kochkin had an interesting reply to Jason Galsters’ What motivates hearing aid use:

“So many of the people with hearing loss have mild hearing loss and are simply not candidates for amplification.“

We don’t buy that statement, for two reasons:

(1) When a person walks through the Hearing Aid Professionals’ doorway, this individual realizes they have an issue with understanding spoken communications. We give them a free, quick hearing threshold test & speech test in quiet, discover they have 10-15dB average thresholds, and then send them on their way with a pat on the head, telling them “too bad, your hearing loss isn’t bad enough to qualify for hearing aids” …And who can blame them, as there’s a fear of a reprimand from a licensing board for selling hearing aids when there’s no benefit? (But, more on this in a few moments).

But wait a minute! The person has a problem communicating, and the salient question should be, does the minimal peripheral screening test detect the cause of the difficulty? And the answer is a resounding NO: Do we screen for auditory neuropathy (ANSD) by running a stapedial reflex threshold (SRT) test, or at least a speech-in-noise (QuickSIN or HINT) test? Do we screen for auditory processing disorders (CAPD)?  Do we screen for outer hair cell integrity using otoacoustic emissions (OAE)?

Bueller? …Bueller? …Bueller?…

(2) Led by the surprisingly good Songbird FlexFit hearing instrument and followed up by the Beltone First Step  program  and Starkey with the AMP micro canal hearing aid (nice work, Jason!), these people are bypassing the barrier thrown up by the dispenser or audiologist and getting the help they need.

Sergei, here is my question for you, as the “Keeper of the MarkeTrak industry statistics:” Of the many thousands of Songbird instruments sold every month, I wonder what percentage of people are motivated to buy who have already had “free” screenings & have been told “Sorry, your hearing loss isn’t bad enough for hearing aids?” I have actually seen people with a PTA of almost 20dB with thresholds @3-4k of 30dB being told those dreaded words. [And parenthetically to our severely deaf readers, how many have you been told that you aren't "deaf enough" to qualify for cochlear implants, and left to struggle with the help you need but is just out of reach?]

Many years ago at the NJHAA convention  (during my first stint as a Hearing Care Professional 1985-95), Dr Bob Martin alerted me to these issues, and he raised the points above. In addition, he pointed out that some of the problem goes back to the the whole concept of “Audiometric Zero,” which is no more than a statistical average of what “normal” hearing is, based on the landmark work by Bell Labs of Fletcher & Munson at the 1939 Chicago World’s Fair. But, as any of us who has tested kids & teens knows, we often see -5 & -10dB thresholds, and as “Dr Bob” pointed out, if a person had a -10dB threshold at, say, 1kHz & it’s now +15dB, that’s a 25dB drop that the brain has to deal with.

BENEFIT:

Now, let’s circle back around to the issue of benefit I raised early on in section (1): What do we do with this population with a communication handicap more severe than the screening audiogram indicates, like with my colleague, speech pathologist Martha, who was having all sorts of problems in restaurants & meetings? (Some of you may have met Martha at the Hearing Loss Ass’n of America 2010 Convention in Milwaukee, as she was my co-presenter on (class)room acoustics). Her thresholds are in the 10-15dB range, not “deaf enough” for hearing aids. She knew, however, from her audiology training she has a problem, and that it needed addressing. Same for my friend Jenifer, whom I counseled to go to the nearest Miracle-Ear: The audiologist told her the same thing: “She doesn’t qualify.” But for both ladies, it left their communication problems unaddressed.

Noted longtime audiologist and textbook author  Wayne Staab PhD weighs in with this quote in Hearing aids: Who needs ‘em?  in Hearing Health Matters:

Dr. Staab, who’s been practicing audiology since the 1960s, points out that a person’s decision to get hearing aids is “never based on the degree of hearing loss, but only on the degree of ‘hurt. If the hurt is not great enough psychologically, emotionally, economically, or socially, there is no justification for hearing aid use.”

Elaborating, Wayne says that in the farming and ranching country where he comes from, older people often have treatable hearing losses as defined by their audiometric thresholds. However, they but don’t hurt enough to feel the need for hearing help. Why is that? It’s often a matter of lifestyle, he explains. For example, he says, “Many farmers live with their spouses, they speak with them from fairly close distances, and they use their television volume controls as their hearing aids.” In other words, they hear well enough for the way they live.

Sometimes, it works the other way, Wayne adds. He has fitted people with “normal” hearing thresholds because they weren�t satisfied with their unaided hearing. [Emphasis added: DLS]

What I counseled both ladies to do was order a Songbird (1 for Martha, 2 for Jen), as they have a 45 day free trial, take it out for a spin in meetings, restaurants and  the cafeterias, and see if it actually helps clear up their communications problems. [I believe this is ethical, because both ladies had been screened for diseases by the school district audiologist & Miracle-Ear audiologist, respectively. Also, I felt comfortable because I had no financial interest in the initial Songbird trials to determine if there's indeed benefit.]

What happened with these two ladies?

Martha, who had audiology schooling, was so pleased, she went to a local audiologist & bought an Oticon Vigo, complete with the Streamer, which you saw her strutting around the Milwaukee HLAA convention, purchased even before the battery on her disposable Songbird died;

Jen was having an issue with fitting¹ but she was so surprised at what she was missing, she returned them in the 45 day free trial period, instead purchasing a pair of Starkey AMP micro canal hearing instruments to try, programmed at gain family 2, -4db in lows & +6dB in highs� And she immediately liked it right at the default volume of 3, of 5 volume steps. What’s more, I love the ability to remotely tweak her programs over the phone, which is a Really Nice Feature.

THE SALIENT QUESTIONS:

A) How many more people like Martha & Jen are there out there, who have a communications handicap that is missed by what the hearing aid professional checks for in the screening audiogram & speech-in-quiet tests?

B) How many of these people have purchased Songbird hearing aids²  or personal sound amplifier products  (PSAPs) to address their handicap after “passing” the dealer screening?

C) How many of these people are, in fact, part of the statistic of 33 million Americans with hearing problems? This has Major Implications for Market Trak, as if these people are in the universe of 33 million, the HA dispensing profession may indeed be *reducing* the universe of (33-8.4 = 24.6 million) candidates;

D) On a related note, this affects children as well as adults, as how many schoolchildren fall into this crack, and would benefit from FM or low gain HA’s in school, even if the classroom meets ANSI/ASA S12.60-2009 acoustical standards for reverberation time & background noise? For more on this, please see my comment about the twin problems of tinnitus  & “I can’t hear what the teacher is saying” that the supposedly “normal” hearing six year old daughter of my author friend Shanna Bartlett Groves‘  faces every day in Test The Ears You Love  on her Lip Reading Mom  blog.

CONCLUSIONS:

Many Americans with auditory communication challenges are taking the steps necessary to overcome them, but are being met by hearing aid professionals who rely solely on the screening audiogram and basic speech audiometry, which do not fully address the challenges the patients face, especially with respect to listening ease, and are turned away as not being “deaf enough.” Some of these people are resorting to over-the-counter hearing aids and other PSAPs with mixed results, while a few hearing aid professionals will go ahead & fit hearing aids; but as we’ve documented above, even when the audiogram says the patient won’t benefit from amplification, the patient deigns to disagree.

UPDATE:

After this article was published, we had the following e-mail conversation with a support audiologist for a hearing aid manufacturer after she read this article. Here is the exchange:

Audiologist: On a side note, I read your blog and couldn’t agree with you more.  In fact, I am one of those people whose perceived handicap does not match my “normal” hearing thresholds.

DLS: Incidentally, since you are “one of those people whose perceived handicap does not match my ‘normal’ hearing thresholds,”  do you (proverbally) “eat your own dog food?” Hitch up your NOAHlink, slip on a pair of [redacted] instruments, and play around some on yourself, especially with your streamer!

Audiologist: I have had the same thought, but have never actually used hearing aids.  Text messaging and closed captioning are my friend.  Your suggestion is a good one.  I just might try it.

 DLS: Ummm, if you’re using text messaging, that’s one thing; but if you’re using closed captioning, that’s a whole new ballgame. I’ll bet if you used Bob Sweetows’ LACE you’ll find yourself already a good speechreader.
What are your ipsi & contra reflex thresholds? Your QuickSIN (or HINT) scores? Have you ever been evaluated for ANSD? For CAPD?!
Hmmm, this could get interesting, especially if you plug in hearing aids & things do NOT improve.

See, this can happen to even a hearing care professional…

FOOTNOTES:

(1) Jen also had a minor issue related to eartip size vs need for venting, and needing more gain, which caused feedback. If she were local, I would have made a custom earmold with proper venting and use it instead.

(2) If it seems like I’m a fan of the Songbird FlexFit  hearing aids built right here in New Jersey, you’re right: Unlike the other over-the-counter “listening devices” from China you see on eBay & at WalMart with poor high frequency response, the FlexFit is unique in that when you look at the specifications  it is a real digital hearing aid with an ANSI S3.22-2003 response to 8kHz and an AGCi kneepoint of 67dB (click to enlarge):

Songbird FlexFit acoustical performance, with annotated graphs

Songbird FlexFit hearing aid acoustical performance. Please note my annotations on the graphs

 

(3) Here’s why I’m a Big Fan of the Songbird family… And it’s due to their RCA Sarnoff Labs connection.  As many of you who know, I was a Georgia Tech co-op Electrical Engineer at RCA-Camden in 1979 & 80; and while I was in the IRR project I had the privilege of spending time at the RCA David Sarnoff Research Center in Princeton, opened in 1942. Some of you who are older may have learned acoustics from the Labs’ Harry Olson, whom along with Leo Beranek wrote the textbook you used. The first time I walked into the lobby, I saw in a glass case the 1955 Emmy® trophy awarded to the labs for Color TV — One of twelve Emmy® Awards the Lab have received for everything from stereo TV audio to H.264 Digital TV. [If you're a technology buff, watch this amazing December1953 YouTube clip].  So, the next time you see a Songbird commercial, know that you can draw a straight line between the technology in that hearing aid and the TV you’re watching it on.~

 

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September 28, 2011

FM: A Success Story In The Library

Filed under: FM Assistive Devices,HLAA Convention,Oticon Focus on People Awards — Tags: , , , , — Dan Schwartz @ 9:02 pm

FM: A Success Story In The Library
By Sarah “Speak Up Librarian” Wegley.
Edited with an introduction by Dan Schwartz

On occasion, when someone has real success we’ll post it on The Hearing Blog under their byline, so other people can learn from it. When my friend Sarah was having trouble understanding speech with her workplace, she first tried a hand-held “Pocket Talker” style assistive device coupled to her hearing aids via an inductive neckloop. But, this didn’t work very well, suffering from interference in certain places and just overall poor performance. However, at the Hearing Loss Association of America convention, Sarah saw — And heard — the benefits of using an FM transmitter & receiver to bring sound from the speaker’s lips straight to her ears, regardless of the amount of background  noise in the library where she works. Although originally looking at the pricey Oticon system, I suggested instead the Bellman Audio Domino, which costs less, works better, and in fact the Classic version is what we use. Fortunately for Sarah, her university library employer agreed to buy an FM system for her, and they purchased the premium Pro version, which has the unique ability for the wearer to remotely switch the transmitter microphone from omnidirectional to zoom with just a touch of the button on the receiver.

Sarah was so excited at the performance, she wrote not one, but two blog articles on it, here and two days later here. Following are excerpts from her articles:

I am very excited to share with all of you that I have found a solution to my hearing difficulties at the reference desk. The answer for me is the Bellman Audio Domino Pro FM system. I have one that comes with a neckloop so the beautiful, clear sound goes directly into my hearing aids’ telecoils. Here’s a summary of the advantages I’ve experienced while wearing the FM system at the reference desk:

  • No lipreading required! I can hear even the whisperers;
  • I can now hear patrons behind me who are trying to get my attention;
  • I can hear the phone clearly when I am away from the desk helping a patron at a computer. Before I relied on keeping an eye out for the red flashing light which signals an incoming call;
  • The HVAC [heating, ventilating, and air conditioning] noises that bothered me before have faded away to being unnoticeable;
  • I can easily hear my coworkers at the desk.
  • No more tension from straining to hear.

Best of all, my employer purchased the system for me to use at work so there was no cost to me. So, how does the system work you may be wondering. There are two main parts – a receiver and a transmitter. The transmitter is about the size of a cell phone. I place it on the reference desk and am wirelessly connected to it so I can walk away from it at any time which is particularly useful in my situation. The receiver I wear clipped onto my pants pocket. The neckloop mentioned before plugs into the receiver. I’ve worn the neckloop under my clothes and I think it’s rather unobtrusive. The same size as the transmitter, the receiver is noticeable since it hangs outside my clothing. But that’s important so I can access the volume and function controls.

When I walk away from the desk to assist a patron one-on-one at a computer, I switch a button on the receiver so sound is no longer coming from the transmitter but coming instead from the internal microphone on the receiver. I have learned to put the receiver in the pants pocket closest to the patron for best results.

If I forget to switch the function from transmitter to receiver and a conversation occurs at the desk while I’m away, I can hear every word clearly. It’s incredible but a bit distracting from my focus on the patron beside me.

Another funny thing for me is the realization that patrons have conversations with each other while they’re working at the computers. Now that I’m wearing the FM, I can hear people chatting. My coworkers just shook their heads when I reported in wide eyed amazement that “the students talk to each other!” Heh.

For me wearing the FM system makes me feel like this might be what normal hearing is like. I don’t give my hearing a thought. It just happens. It’s actually easy. I can’t believe how much I was missing even with hearing aids.

A coworker asked me why I didn’t wear the FM system all the time then. At first I was horrified at the thought of hearing ALL the time at work. I like my quiet. It helps me concentrate on my work. Later, I realized a better response would have been to explain that the FM system helps in difficult listening situations. Such as I was experiencing at the public reference desk with the people who whisper and the HVAC noise. Back at my cubicle, my coworkers know to get my attention and come talk to me directly rather than call out from across the room. For me, it’s better that way.

I recommend the Bellman Audio Domino Pro FM system with two thumbs up. I’d like to thank my friend Dan Schwartzwho suggested this system and provided lots of helpful assistance before and after I got it.

Bellman Audio Domino Pro

Here's a photo of my FM System in its travel case. At the top is the neckloop, on the left is the charging device with plug. In the center is a clip-on microphone I can give a speaker to wear if I have to attend a meeting. Next over is the transmitter. At far right is the receiver.

  Here is a video from Bellman describing the Audio Domino Pro Sarah uses daily. There is a similar video for the Audio Domino Classic here.

 

Short link to this story: http://wp.me/p1mNFo-P

Coming soon: The next article in our series on FM titled: FM: The Unfair Classroom Advantage

September 26, 2011

New Research Shows Listening And Hearing Is Different For Children With Cochlear Implants

Filed under: Cochlear Implant,Education,Impact on Education,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 12:14 pm

Cochlear implants allow profoundly deaf infants to hear speech, which, with proper auditory therapy, allows them to learn spoken language. However, this new study from cognitive psychologist Derek M Houston, PhD, associate professor of otolaryngology at Indiana University School of Medicine shows that the children receiving the implants don’t automatically know how to listen when people speak to them.

Research presented at the recent Acoustical Society of America research meeting showed that deaf babies with cochlear implants spent the same amount of time “listening” as normal-hearing infants of the same age. However, these children with implants spent less time listening than younger normal-hearing infants who had the same amount of hearing experience. Dr Houston said,

When infants are born deaf, their development is shaped by a silent world.  They learn to tune into the sights, smells, and touches that are relevant to them in their environment – but not the sounds. When they receive a cochlear implant, their world changes and is filled with sounds.  But for these infants who have already begun to adapt to their silent environment, sounds may not – at least at first – be perceived as relevant to them.

It has been well-established that infants will look longer at a simple display – the checkerboard pattern – when hearing something they are interested in.   I measured their ‘looking time’ at the pattern when it was paired with a repeating speech sound, and compared that to the looking time at the same pattern with no sound.

Houstons’ research revealed children with cochlear implants spent less time looking at the checkerboard pattern than children who could hear from birth. In addition, two years after implantation, children who were less attentive to speech early-on performed more poorly on a word recognition task. In other words, these infants and toddlers may hear the sounds around them, but not have any motivation to focus on them, which slows their ability to learn speech… And this can be traced for years through word recognition testing.

Furthermore, this research goes towards explaining why prelingually deafened children and adults have not developed a sense of danger to environmental warning signals: For example, they may hear a car horn while crossing a street, but it does not register in their brain properly, i.e. it does not trigger the instinctive danger reflex.

An abstract of Dr Houstons’ research is available at http://asa.aip.org/web2/asa/abstracts/search.may11/asa220.html

Short Link to this story: http://wp.me/p1mNFo-7c

Original source: Listening and Hearing, Not the Same for Children with Cochlear Implants







August 14, 2011

Dying to Hear Again… And She (Almost) Did [Reposted from The Telegraph (UK) Hearing Blog]

Filed under: Cochlear Implant,Kristin Fleig,Profiles,Re-posts from The Telegraph (UK) Hearing Blog,Uncategorized — Tags: , , — Dan Schwartz @ 6:54 am

Originally posted in The Telegraph (London) Hearing Blog on October 15th, 2009 17:14 BST

Dying to Hear Again… And She (Almost) Did

Kristin Fleig is one gutsy Kentucky girl. She gambled her life to break her curse of deafness once and for all, almost dying from other causes in the process.

The girl from Bardstown lost her hearing to meningitis as a baby in her left ear, while her right ear deafness is due to MYH9 Chromosome Mutation. This mutation affects the hearing, vision, and kidneys of the person who suffers from it. Kristin, unluckily, has problems with all three. Six years ago at age 13, she had a lifesaving kidney transplant; but by late last year [2008] it too had failed; and was then placed on the transplant list while undergoing dialysis three times per week.

Also, Kristin lost her hearing completely last year; and most cruelly, it happened the week of Christmas. Having worn a hearing aid in her right ear, she stopped, because she had no benefit from it; and then passed the tests to qualify for a cochlear implant on March 19th [2009], starting the ball rolling for her to hear again, including financing by Medicaid of Kentucky.

All was going reasonably well when I first met her in April of this year. In May, when an infection from dental work temporarily took her off the transplant list, Kristin made a gutsy call: She was going to stay off the transplant list until she could get her cochlear implant. That’s right: She chose continued dialysis, with all of the risks and many hours per week in a chair at a clinic. She essentially was betting her own life, to hear again. She did this because, of specific immune conditions, once she had the transplant, it would be at least three years before she could have the implant surgery, leaving her in total silence.

In early July, she was finally approved for the surgery; and was waiting for Dr. Gorden McMurry at Jewish Hospital in Louisville to schedule her for time in the surgical suite.

Disaster struck on the afternoon of Friday, July 16th,  when, during her dialysis, she threw a massive blood clot in her brain the size of the palm of a hand. Her condition was so tenuous, she had to be taken by medevac helicopter to the head trauma ICU in Louisville, where she stayed in hospital for 11 days in great pain, receiving well wishes from all across America, and from friends and strangers from as far away as Australia and the United Kingdom.

But, on August 18th, her dream finally came true: She got her shiny new Advanced Bionics CI surgically implanted into her skull & electrode array threaded into her cochlea; and was now on the path to hearing. As soon as she healed, she also put herself back on the transplant lists, and is waiting for that phone call telling her she has two hours to get to the transplant hospital for her new kidney.

Today on October 15th at 8:00AM EDT (1:00PM in London), Kristin goes to her CI audiologist Barbara Eisenmenger AuD to have the implant activated, during the “first stimulation” process. Finally, after months of silence, gambling (and almost losing) her life, she finally will taste success.

We at The Telegraph Hearing Blog have been watching this dramatic story unfold since April when we first met her; and in just an hour those first sounds will begin magically appearing in her head. We would like to welcome her back to the hearing world. It was one gutsy call by the kid from Kentucky, betting her life she can hear again. So, the next time you believe hearing isn’t that important, remember Kristin’s life-or-death gamble.~

Short URL to this entry: http://tinyurl.com/CI4Kris

UPDATE: Kristen posted this note on her Facebook page

I was activated today. I am “hot” as my friend calls it. It was a wonderful day despite the cold air and rain. I could hear some today, but it is mostly a “whistling” sound. I have heard some interesting things in the short time I have been turned on. First, I will tell you about the process then I will tell you what I have heard.

I arrived at the audiologist office this morning. I was taken back right away to the room. She put my CI on and did all her “fancy schmancy” work as I call it. BTW, she calls it the most boring of all the mappings. She fiddled around to set it up. She kept asking me to tell her where her voice was on the chart. The chart was numbered 1-10. Depending on the setting and her voice, that is what number it was. She said I was so low on the chart starting out, that it would be the reason for some of my “whistling”. She then turned it up and it was a little clearer. I could actually make out some words when she talked. It was interesting. After we practiced a little, she made me some programs. I have three programs that I am to work with for the next 10 days. I am to change programs when the one I am set on is not working (i.e. no sound or not hearing clearly). When I go back on the 26 she will see where I am at. After she made me some programs, she ask me to repeat 3 words. I did have some trouble repeating the words, but got 2 out of the 3. After that, she told me about my “box of goodies”. May I add that box has a lot of stuff and more for me to find room for. LOL! My Dri-Aid case is included. She told me to use it every other day or as needed. I will start using it tomorrow. Last step of the day was the sound booth. I got my first hearing test with my CI. The lowest I heard was 30 DB. She said it would get lower as we moved on. Over all it was a good day.

Now as to what I was hearing so far today. I have heard some interesting noises, condsidering that everything is constantly noisy for me at the moment. I have heard the dogs running, dogs scratching carpet, microwave beeping, mom’s voice, sister trying to get my attention, clicking of keys on keyboard, paper rustling, turning signal in car, car beeping when doors open, and my favorite thing of all water running. The audiologist office has a fountain outside, I heard it. I was so amazed. This is just the beginning soon it will get better.

That was my day today. I will be sharing more as I move on in my journey.

Kris

Kristin Fleig at 1st stim

Kristin Fleig

August 10, 2011

Less-than-honest NBC Today segment on hearing loss

Filed under: Education,NBC Today,Shelley Borgia AuD,Uncategorized — Dan Schwartz @ 2:00 pm

As an RCA Engineering alumnus, I’ve always had a soft spot for their NBC Division; and this sentimentality still exists to this day, even though Comcast now is the owner. Imagine my delight when my friend & crack Audiologist Dr A U Bankaitis posted this clip of a seven-plus minute segment on this mornings’ NBC Today show featureing an interview by Matt Lauer of hearing loss sufferer Jim McDade & his Audiologist Dr Shelley Borgia (e-mail) of Park Avenue Acoustics; and also of Lauer getting his hearing tested by her; and finally a “dog and pony” show of the various hearing instruments on the market:

 

…And much to NBC’s credit, the video is fully captioned: Thank you.

But, as I listened to it, something struck me a bit odd: Listen carefully to McDade speak in this clip:

 

 

Does something sound a little out-of-whack to you, too? Here is what was said:

Matt Lauer: 39-year-old Jim McDade is a true child of the 80′s growing up with headphones.

Jim McDade: I would wake up in the morning and my ears would be throbbing.

but compare it to his speech formation. Something smells a bit ripe to you too now, doesn’t it?

Perhaps the answer is in this next clip, starting at 6:20. Turn on the captions so you can follow the exact dialog:

From the transcript:

Matt Lauer: These are a little larger over here?

Shelley Borgia: These are the older traditional hearing devices.

ML: That made him cringe.

SB: Yes.

ML: Those are the ones that worried you?

Jim McDade: I had to grow up in grade school with something like that [Emphasis added].

Whoa! Looks like we caught Jim McDade and Dr Shelley Borgia being a bit less-than-truthful about the cause of his (McDades’) deafness: Although the “Advocacy Journalism” message of the NBC Today segment is that loud headphone usage can lead to hearing loss — And it certainly can; and may in fact have exacerbated his deafness – there is more to the story, with his childhood hearing loss significant enough to both require his need for hearing aids .AND. affect his speech production.

What makes this segment less-than honest is that, except for the slight speech impediment and McDades’ offhand admission of wearing hearing aids in grade school, we would have never known the cause of his problems is not as advertised. I’ll give Matt Lauer a pass on this, as he is neither an expert; and also maybe his “crap detector” had been been turned down a bit because he’s dealing with the identification of his own mild hearing loss.

On the other hand, I fault both Borgia and McDade for their less-than fully truthful, agenda-driven statements, as when pertinent facts to a story are withheld, the issue of iPod-induced hearing damage loses credibility; and for this they should both be reprimanded.

Shelley Borgia, AuD, of Park Avenue Acoustics in NYC
Audiologist Shelley Borgia, AuD, of Park Avenue Acoustics in NYC, who was less-than 100% truthful in her appearance on NBC Today

 

 

As a side note, there may indeed be a real issue of McDade not wanting to show he wears hearing aids: Perhaps he was teased & bullied when he wore them in grade school, as kids can be merciless, especially on the playground. Fortunately, in the last several years, I’ve been receiving anecdotal reports that this has subsided; and in fact we are seeing more and more kids strutting their ear hardware, as you can see from this photo gallery I’ve assembled.

 

July 5, 2011

Please Don’t Use Sarcasm With My Students: Guest article by (e

Filed under: Education,Relationships,Uncategorized — Dan Schwartz @ 2:26 pm

July 5th Update: Footnote added on the interrelated subjects of bluffing, “tuning out” and late afternoon exhaustion.

We at The Hearing Blog do not pretend to have a corner on the market when it comes to Hearing & Deafness issues; so when a particularly good article comes along, we request of the author permission to reprint it in its’ entirety, as we did with Lost in Music Trivia.

Today, it is our pleasure to present Please Don’t Use Sarcasm With My Students, written by my friend (e

Please Don’t Use Sarcasm With My Students

I wish some teachers and school staff members would stop using negative sarcasm with some of my deaf and hard of hearing students. Sarcasm can sometimes be confusing. Some of my students are not sure how to respond because they may not know if the person is being serious or not. It can be hard for deaf and hard of hearing people to hear the slight difference between a sarcastic tone and a serious one. Many rely on facial expression and if the person says something harsh but is smiling, we may assume that he or she is being sarcastic. But, not everyone express sarcasm or seriousness in the same ways. It can be hard to tell if the person is being sarcastic especially if you are unable to hear the tone of their voice.

I think that when sarcasm is being used with some students, it would be helpful for the person to explain to the students that they are being sarcastic. People should be careful with how they use sarcasm with students. Lighthearted sarcasm is fine, if used in moderation, but negative sarcasm or sarcasm used to put down the student is not all right, in my opinion.

Negative sarcasm can be hurtful and embarrassing. For example, if I were to state the obvious, I think it would be rude if someone I work with were to sarcastically tell me, “Really, Einstein?”

I remember as a child I thought one of my teachers was being sarcastic and I laughed thinking she was only joking. She got angry and acted as if I insulted her, because it turned out she was not being sarcastic. That was a very uncomfortable situation.

e)

Footnote: While we’re on the subject of trying to help our normally-hearing friends understand what it’s like to be hearing impaired, our friend e) has written another superb article titled Eh? What? Huh? What’s That? Come Again? Wait–What? that also merits reading, along with this authors’ comment and e)s’ reply.

June 25, 2011

Smashing Success: HLAA Convention 2011

Filed under: Education,HLAA Convention,Katie-louise Bailey,Telephone Compatibility,Tinnitus,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 11:51 pm

This past Thursday afternoon to Sunday morning the annual Hearing Loss Association of America Convention was at the Hyatt Regency in the Crystal City section of Arlington, just outside of DC… And it was a smashing success, with over 1200 people preregistered, and hundreds more walk-up for free Expo Hall passes and on-site registration, making it the largest HLAA Convention in history.

All of the HLAA workshop classes provide ASHA & AAA CEU’s; and the two I attended on Saturday were chock full of information needed by hearing healthcare providers of all stripes:

Hearing Aid Compatibility in the 21st Century was led by Senior Group Manager for Accessibility Tony Jasionowski of Panasonic and Senior Engineer Al Baum from Uniden. Al, who is active both in IEEE¹ and TIA², spared no engineering detail explaining TIA-1083 — Telephone Terminal Equipment Handset Magnetic Measurement Procedures and Performance Requirements. Yes, it’s a mouthful; but for us Engineers (and for hearing aid dispensers & audiologists) it’s a G-dsend, as it lays out on which two orthogonal axes as well as the magnetic field strength scalar quantities new phones must supply to hearing aid telecoils.

What makes TIA-1083 so nice is that it addressed the problem we Hearing Aid dispensers & users had with 1A2 POTS compatibility with  the vertical T-coils found in BTE instruments, as well as the vertical T-coils glued to the faceplate of ITE’s by some manufacturers. As someone who has worked in the trenches as a retail hearing aid dispenser, nothing was more frustrating than taking the calls from irate patients (legitimately) complaining that they couldn’t hear on the phone, especially with BTE’s. HLAA’s Lise Hamlin & others cooperated with TIA to make this specification work… And it’s a signature achievement for all parties involved.

 

Tinnitus: Current Neuroscience Research and Theories was conducted by Amber Leaver PhD, who is a post-doctoral research fellow at Georgetown; and she taught us a lot, treating us as she would a class of grad students, and not dumbing it down. The only downside is that neither of the two recent treatments — Neuromonics or Widex Zen.

Our friend Bonnie O’Leary at Northern Virginia Resource Center (NVRC) took copious notes and emailed her Seminar report to Members; however, since the link has not yet been posted to their HLAA Convention Reports page, I am pasting Mrs O’Learys’ report below:

NVRC News – June 22, 2011

Tinnitus:  Current Neuroscience Research and Theories

By: Bonnie O’Leary, 6/22/11

If you struggle with tinnitus, you are not alone.  There are over 46 million people in this country who have some form of this often debilitating condition.  This tinnitus workshop was presented by Amber M. Leaver, PhD, who got involved with tinnitus research at Georgetown University’s [sic] Medical Center two years ago.  I thank her for providing notes from her power point to assist us in our report.

Dr. Leaver began the workshop with some background on tinnitus.  It is a common hearing disorder in which a person hears a “phantom sensation” of sounds in the ear – buzzing or ringing are the most common – even though no external sound is present.  Tinnitus can come and go, it can bother us
for long periods of time, or it can be present constantly.  Groups at high risk for developing tinnitus include those who are exposed to loud noise: construction workers, musicians, and military personnel.  More military veterans receive  compensation for tinnitus and hearing loss than for any other medical issue.

Tinnitus can be associated with difficulty sleeping and fatigue, stress, anxiety, depression, and other factors.

Causes of tinnitus

The exact cause of tinnitus is unknown, but there are triggers to watch out for.  The  most common is exposure to loud noise and resulting hearing loss.  Head or neck injury, temporomandibular joint/jaw dysfunction (TMJ), and certain drugs are other triggers.  However, not everyone with hearing loss or head injury develops chronic tinnitus, and this is a phenomenon that neuroscience research is attempting to understand.  To understand tinnitus, we need to understand how the brains of people with tinnitus are different from those without tinnitus.

Neuroscience research

How does tinnitus affect the brain?  Currently, research identifies changes in two parts of tinnitus patients’ brains: the auditory system and the limbic system.

The auditory system begins in the ear, where sound is converted to neural impulses which travel to the auditory sensory processing center, or the auditory cortex.  People with tinnitus have hyper-responsiveness to sound in their auditory cortex, especially sounds like their tinnitus sensation.  In all people, the auditory cortex contains tissue that’s organized by what pitch it responds to best, like a keyboard on the brain. This is called tonotopy.

When we lose our hearing, these “brain keyboards” are missing “keys” corresponding to the hearing loss, and they also have extra “keys” corresponding to pitches close to their hearing loss.  In tinnitus sufferers, these extra keys often match the tinnitus sensation, and it is thought that the imbalances in hyperactivity and tonotopy produce the tinnitus sensation.  What is unclear is whether these changes are due to hearing damage or to tinnitus itself, making it hard to prove that changes to the auditory system alone cause tinnitus.

The limbic system is considered the emotional part of the brain, but it has also shown to be involved in deciding the value of our thoughts and behaviors.  The limbic system seems to be different in people with tinnitus due to a section of the brain being structured differently than in people without tinnitus.

Similar differences in this part of the brain are found in people with depression and chronic pain.  Dr. Leaver and her colleagues propose that this part of the limbic system works like a noise-cancellation system. When this system doesn’t work well, people are not able to suppress unimportant thoughts and perceptions – including phantom perceptions like tinnitus.

The impact of research on the development of treatments for tinnitus

As many of us know, there is currently no cure for tinnitus, and there is no treatment that works for everyone.  It will be crucial to identify the brain basis of tinnitus to develop effective treatments.  If the brain basis is mostly auditory, then treatments should target the auditory system.  If, on the other hand, the brain basis is limbic, then treatments will have to target the limbic system.

To learn more, Dr. Leaver directed us to the website for the American Tinnitus Association.

However, the highlight for me was meeting Miss Katie-louise Bailey, who came all the way from Derby, England for an action-packed week here in America with her friend Anna Herriman. For those who don’t (yet) know her, Katie-louise is a star soccer player who played for the England Deaf Ladies football team in international tournaments as well as University of Derby; and she is also one of UK’s top 250cc motocross racers, riding  for the Kawasaki factory team. Besides being a well-known athlete who just happens to be hearing impaired, she is also quite a role model for deaf & HOH young adults in the Derby & Nottingham region, across England, and around the globe, with her leading by example… And I’m proud to call her my friend.

Given the size of the crowd, all went surprisingly well, with the only real glitch Sunday at the Awards Breakfast when the adjacent session of the (Wired To Fail) Loop Conference bled into the banquet room, raining on Joe Gordons’ parade as he received a Lifetime Advocacy Achievement Award for his captioning advocacy. Other than that hiccup (which was Ampetronics’ fault), Convention Director Nancy Macklin indeed did a very good job with the largest HLAA convention in history.

Footnotes:

1: IEEE = Institute of Electrical & Electronics Engineers, of which yours truly is also a Member.

2: TIA = Telecommunications Industry Association

June 19, 2011

Wired to Fail: The Second International Loop Conference

Filed under: HLAA Convention,Induction Hearing Loops,Uncategorized — Tags: , , , , , — Dan Schwartz @ 12:58 pm

The Second International Hearing Loop Conference started out as a troubled convention as far back as last June, culminating when the HLAA convention planning staff the conference site booking by not anticipating demand (after HLAA vigorously marketed the conference for six months), with many people being turned away; and many more not even coming, because it was “sold out” two weeks beforehand — This is the first time in history a convention has actually sold out! I spoke to AAA President Pat Kricos — Whom I actually felt sorry for — on Saturday about the sellout, as, having entrusted the booking to HLAA, AAA Members who depend on these classes for CEU’s were also left out in the cold.

 

Then, having strongly cautioned HLAAs’ senior staff last year in Milwaukee to perform a site survey for electromagnetic interference (EMI, noise) at the venue, and to make sure every room that had loops was working properly, we walk into the HLAA Awards breakfast, switch on our T-coil receivers… Only to clearly hear the of the loop conference next door. As it turns out, loop equipment vendor Ampetronic installed the loops but didn’t bother to check it for spillover into the main ballroom (and vice versa). Worse, this rained on the Hall of Fame Award being given to my friend Joseph Gordon, for his many decades of his effective advocacy.

 

Now, as an Electrical Engineer and long time hearing aid dispensing engineer, I have written extensively about my opposition to baseband induction “hearing” loop use on purely technical grounds, as it is a very troublesome “hack” that should have never been, especially for large rooms: And what happened this morning only proves the point: Even loop provider Ampetronic botched the job. Worse however, someone in authority ordered that the wonderful infra-red system donated by Williams Sound be shut down, because this “is now a Loop Conference” — Nice going.

 

Next, the workshop on “Understanding and Addressing Causes of Environmental Interference with Telecoils” was misleading at best, because presenter Richard McKinley of Contacta — who himself is (fortunately) not hearing impaired — played down, and even skipped over the very real causes of EMI in the United States; and why there is less EMI in the UK & Europe than in the US. Please see section 2 of Poynting the Wrong Way: Why “hearing loops” are almost useless for the reasons why, including that electric utilities run their  distribution transformers at 110% of Φ(sat), which causes harmonics to be generated from  the 60 Hz sinusoid being convolved with the B-H hysterisis curve (transfer function).,

 

However, McKinley made a significant error on his analysis of high voltage (115kV & up) power distribution & transmission line interference, when he stated that it is only a problem within 3-5 times the phase conductor spacing: This is demonstrably false, both from my own experiences, and also that he failed to take into account that in fact when there is negative sequence current from a phase current unbalance on a wye power system, zero sequence currents will flow through the ground conduction path. For the tower system used for 115kV & up, the ground wires you see above the phase conductors are much thinner than the phase conductor bundles themselves, as they are there only for voltage balance and shielding against lightning: 90% of the zero sequence current is actually carried through the earth, through a buried conductor, and through the shielding of the buried relay wiring.
More later…

 

June 1, 2011

Cochlear Implant Channel Crossover: First Person Report

Filed under: Charge distribution,Cochlear Implant,Music,Uncategorized — Dan Schwartz @ 10:23 pm

Melbourne piano teacher Daniela Andrews (Blog | Facebook)  accidentally leveled a Very Damning Indictment of her simultaneously implanted Nucleus 5 CI’s, where she points out a major flaw in Cochlears’ design, with its’ 24 electrodes spaced too close together for its’ 22 hardware channels: This causes Channel Crossover, which Daniela unintentionally — Yet so eloquently — described. If you remember back in February, there was the special Interior Design Concert by the Bionic Ear Institute for people with CI’s. Daniela, as a music professional, was one person involved with it; so you know she has the “street creds.”

At some point after she was implanted, she wrote the following that was picked up in the Australia Hears blog under Listening to music with a hearing loss. I copied & pasted it below; with my notes [blue, in brackets]:

3. Playing music

There is not a large amount of research investigating whether playing music can help with re-training the brain after a hearing loss. However there are some personal stories we can share. Daniela Andrews lost her hearing around 4 years ago, and for the last 10 months [implanted April 2010] has bilateral cochlear implants:

“At first, the piano sounded terrible. Like somebody had broken into it while I was in surgery and mixed up all the notes for fun. Playing scales barely resembled an up and down pattern at all. [This is channel crossover, caused by the electrodes being spaced too close together, stimulating the wrong nerve endings in the spiral ganglion] There were random low tones in between higher ones, and vice versa. Being simultaneously implanted brought another challenge – each processor rendered two different tones for the same note. [This is diplacusis -- the same tone sounding different in each ear -- which is exacerbated by the randomness caused by the channel crossover.] Familiar songs sounded alien-like with all these extra wrong notes thrown in. How was my brain ever going to make sense of that mess?”

Technically, each channel could have been remapped to produce a chromatic scale; but that would be painstaking and time consuming… And according to feedback from several CI manufacturer insiders, is above the skill level of many CI audies.

There are two parts to the solution for better music enjoyment:

  • Wider electrode spacing, to stop the crossover;
  • Current steering (think of a spotlight, instead of a floodlight), to shape the charge distribution, which will fill in the gaps between the electrodes.

    • Of the four CI manufacturers, Advanced Bionics uses 16 electrode contacts spaced out over 21mm; Neurelec (not available in the USA) uses 12 electrodes spaced out over 23mm; while MedEl uses 12 electrodes spaced over 31.6mm. In addition, both AB (Fidelity 120) and MedEl (FineHearing) have current steering, for much better music performance (though AB has severe implant reliability problems, with five recalls in the last decade).

    There are many factors that go into choosing a CI, as indeed there are differences in performance, as well as ergonomics and reliability. We recommend treating the issue of channel crossover as one data point in your decision matrix.

    April 21, 2011

    Advanced Bionics: Fingers tapping…

    Filed under: AB 2010 Recall,Cochlear Implant,Uncategorized — Dan Schwartz @ 3:13 pm


    As many  readers are aware, last week Advanced Bionics has received TÜV approval to ship newly modified HiRes 90K implants with the CE marque, with submission to the US FDA pending. Over the last four days, we have repeatedly reached out to AB media relations, corporate, and other individuals with requests for more information contained in their TÜV and FDA applications, specifically as to the steps they have taken in Engineering, QA/QC, and Reliability, to assure audiologists, surgeons, and most importantly patients that the failures that occurred leading up to the November 23rd “voluntary” recall will not happen in the future.

    We are interested in presenting facts surrounding the steps Advanced Bionics has taken to improve the reliability of the HiRes 90K; and we await their reply.  If AB so chooses,  a reply may be posted in the comment section of this article; and we will publish it unaltered.

    If anyone from Advanced Bionics wishes to contact us, we can be reached anytime at 609-417-1348 or at Dan@Snip.Net ~

    3 June 2011 Administrative Update: When I removed the Disqus comment plug-in, the comment nesting was lost, so all comments are now listed flat

    12 April 2012 Update: Removed the recall ticker~ 

    February 19, 2011

    TIA Urges FCC to Retain Existing Hearing Aid Compatibility Requirements

    Filed under: FM Assistive Devices,Telephone Compatibility,Uncategorized — Tags: , , , — Dan Schwartz @ 11:38 am

    Washington, D.C.  The Telecommunications Industry Association (TIA)  filed comments with the FCC on Monday, 14 February in response to its request for comments on existing Hearing Aid Compatibility (HAC) requirements. TIA urged the Commission to retain existing HAC regulations, which have been enormously successfully in promoting innovation and accessibility in the wireless market place.

    HAC regulations require mobile service providers and device manufacturers to offer a certain amount of hearing aid compatible devices to ensure accessibility by consumers with hearing aids. Per the Better Hearing Institutes‘ MarkeTrak VII industry survey there are approximately 8.4 million people wearing hearing aids, of which a subset of 5.1 million people have T-coils of unknown orientation (polarization). The percentage benchmarks are a result of a consensus plan developed by consumers, industry, and standards organizations in 2008, with an agreement to review in 2010. TIA comments are part of this review.

    TIA, which represents companies that manufacture and supply the products and services used in global communications across all technology platforms, urged the FCC to delay revising HAC percentages or revising technical requirements tied to the standard by stating in its filing that: “Issues concerning the ANSI C63.19-2007 standard should be revised after the 2010 standard is adopted and manufacturers have had the opportunity to test and obtain HAC certification.”

    On behalf of its members TIA submitted the following comments regarding the Wireless Telecommunications Bureau’s Public Notice:

  • TIA should retain the existing benchmarks adopted in 2008 and provide time for manufacturers and service providers to test and deploy new models and services under the current standard.
  • Consistent with Section 710 of the Communications Act, FCC concerns related to HAC requirements would be more effectively addressed through the standards development process. TIA recommended that all relevant industry stakeholders should be presented with the opportunity to engage the HAC industry in that process.
  • The FCC should continue to ensure that information collected under the Accessibility Act not impose an undue burden on manufacturers and service providers. The current reporting requirements, which TIA argued could be streamlined, have proven effective in responding to consumer input.
  • The FCC should not dictate technical standards for handset manufacturers. To do so would jeopardize industry innovation in improving such features as volume control, display screens and backlights.
  • TIA urged the FCC to facilitate collaboration among all stakeholders including the Food and Drug Administration (FDA), in order to facilitate a dialogue among hearing aid manufacturers and hearing aid users.

    • “TIA members have been integral to the successful implementation of the Commission’s hearing aid compatibility policies,” TIA stated in its filing. “Consistent with its recently-announced Innovation Package of policy recommendations, TIA submits that by encouraging collaboration among stakeholders and the utilization of voluntary consensus-based standards, the Commission can continue to improve accessibility and encourage innovation, thereby meeting its statutory obligations under Section 710 of the Communications Act and maintaining the enormous success of the Commission’s HAC regime.”

    In its filing, TIA also pointed out FCC Chairman Julius Genachowski’s “decision to follow the recent Presidential memorandum to Federal agencies targeting burdensome regulations.”

    “TIA’s members – companies in the information and communications technology industry – are among the most innovative in the world,” said Vice President for Government Affairs Danielle Coffey. “President Obama recognizes that, while sometimes regulation is necessary, it is imperative that we carefully consider the impact regulations will have on bringing new and improved products and services to the marketplace.”

    TIA’s full comments on Hearing Aid Compatibility (PDF opens in a new window) are available on its FCC filings page at tiaonline.org.

    February 1, 2011

    Guest column: Lost in Music Trivia

    Filed under: Relationships,Restaurants & bars,Uncategorized — Tags: , , , — Dan Schwartz @ 9:28 pm

    By guest author Sarah Mosher of the Kansas City chapter of the Hearing Loss Ass’n of America

    Foreword: From time to time The Hearing Blog will publish articles by guest authors who have a unique perspective. This article struck the editor, because it shows what can go wrong when a normal hearing person dates a hearing impaired person without knowing all of the ramifications. Here is the story of Sarah Mosher at a noisy bar on Sunday night…

    Have you ever played music trivia games? You know, where you go to some bar that’s hosting a music trivia night, and they have a really loud announcer there barking out orders, and people sit around and listen to the song that’s being played and try to guess who sings it? Yeah,  me neither…

    Well,  last night, a friend of ours wanted to go play music trivia with his girlfriend. So my boyfriend and I decided to go with him. We figured we’d eat dinner with them and chat for a bit and then leave when they started to get into the game. I knew this, and I thought I was mentally prepared for the evening. I was thinking, “Loud, noisy bar. Check. Lots of screaming people. Check. Music in the background I may or may not be able to hear over all the other ruckus. Check.” I was ready for it.

    Apparently I wasn’t ready enough. We had a horrible waitress and by the time we got to order drinks we were already irritated with her. I asked if they could make a mojito, to which she replied, “Sure! But not frozen. On the rocks ok? With salt?” Out of the corner of my eye I saw the other people at the table react to her statement. So I repeated what I said: “mojito” not “margarita.” She goes “OHHH… Got it.” When we ordered food, I ordered a cheeseburger, with cheddar cheese, and fries. She responds, “you want fries AND cottage cheese??” Everyone else at the table said they understood me perfectly, so they didn’t know what her problem was. [Editor's note: Even a mild hearing loss can cause speech to be misunderstood -- This waitress needs a hearing test, and probably hearing aids.] But I felt…  a whole mixture of emotions, I guess. Thoughts like this were running through my mind: What was wrong with me? Was I not speaking clearly enough? Can people not understand me like I thought they could? It was not a good start to the evening.

    So, the bar becomes increasingly louder as we eat. I’m attempting to lipread around mouths full of food, glassware, and napkins. I catch less than one percent of what people say. I start watching the televisions. They’re showing the Pro Bowl game and the Winter X Games. None of the televisions have captioning on them. My boyfriend is nicely trying to draw me into the conversation and keep me in the loop. I appreciate his efforts, but last night it just wasn’t enough. It wasn’t him, by any means, but I just wanted, for once, to just understand.

    Finally, the music trivia game starts. ALL the televisions are still going, ALL the conversation is still going, AND the guy gets on a microphone and starts yelling through it. It was the most ridiculous thing ever and my hearing aid absolutely rejected it all. It was one loud mass of noise. Pure static. No comprehension anywhere. The guy on the mic stops speaking and every single head at my table cocks an ear upwards and gets that faraway look on their faces as they listen to the song being played. I cannot hear the song over everything else that is going on. So we sit there, locked in place as the seconds drag by until one of them bugs their eyes out and shouts “{unintelligible name of band}!”

    Oh. I hadn’t thought of that part… they are all shouting out the name of the band they think is playing the song. Yeah, that’s real easy. Lipread the crazy made-up name of some band you’ve never heard of. I can do that in my sleep. (Yes, that whole line is dripping with sarcasm there…)

    At that point, I just had it. I couldn’t take it anymore. I looked at my boyfriend and basically demanded we leave. It wasn’t a very nice exit, but I had to get out of there. I was just drowning in static and lost in noise. My brain was being suffused with noncomprehension. I had to leave.

    Walking out of that bar into the cold silence of the winter night was the highlight of my entire weekend. I could breathe again. I could hear the wind whipping around my head. I wasn’t lost. I knew exactly what was going on around me. I could feel the ground under my feet again. I knew who I was.

    *whew*

    Despite preparing myself mentally for that night of music trivia, it’s really hard to prepare yourself for the unexpected things that can break you down. It’s hard to know what to do in a situation like that. It’s not like people could interpret music. And if they don’t know what the song is, because that’s the point of the game, how are they going to inform you of it? I thought about it afterward, as my boyfriend asked what he could have done to make it better for me, and I really had no answer to give him. I couldn’t think of anything that would have improved the situation. Sure, there could have been captioning on the televisions. We could have had a nicer waitress. But when it comes to playing music trivia, there really isn’t anything that could be done.

    Have you ever been in a situation like that, where you just couldn’t handle the “being hard of hearing” aspect of yourself? Where the situation was harder than anything you’ve been in before and you just didn’t know what to do? Please share!

    January 27, 2011

    Auditory Therapy: The Missing Ingredient

    Filed under: Auditory Therapy,Cochlear Implant,Uncategorized — Dan Schwartz @ 6:44 pm


    By Dan Schwartz and Anne S, with an extensive comment by Jane R Madell, PhD

    February 24, 2012 Update: Added free pediatric resources from John Tracy Clinic, with corrected links~

    Often, the missing ingredient for many hearing impaired people is auditory therapy, or (re)habilitation (AR), especially for those who are sold hearing aids for mild to moderately severe hearing loss. AR is typically given along with speech therapy for hearing impaired children, and is especially important in the first three years as the regions of the brain that process auditory and visual information overlap: With a hearing impaired child, the natural tendency is for them to use the “easier” means of visual and manual communication — sign language — which will “crowd out” auditory development.

    For teens & adults, AR is also sometimes included at some of the 250 CI centers in the US (you pay your dues and you take your chances); and at all 21 CI centres in the UK.

    • The John Tracy Clinic, one of the finest pediatric audiology centers in the world, now has three free Distance Learning for Parents Courses, which can be taken  mail or now turbocharged by the Internet, online anywhere in the world.

    • Mini Course: Designed for use by families in the first few years after identification of their child’s hearing loss, this course summarizes initial information, provides considerations for decision making and gives suggestions on support. It has separate sections about hearing loss, communication and parent roles. Extended learning ideas help parents recognize what they know, consider how they feel and identify steps they wish to take.
    • Baby Course: Geared toward infants and toddlers (i.e., birth to two), this course discusses early hearing loss, infant-toddler development, parent-child communication and learning through play. Suggestions are given for emphasizing communication through natural routines. Parents can choose specific ideas to encourage beginning language and auditory learning.
    • Preschool Course: Developed with preschoolers in mind (i.e., ages two to five), this course provides parents with tools to foster language growth and facilitate family interactions. Modules discuss communication, thinking and social development. Suggestions are given for activities to encourage language, listening and speech. Parents choose ideas that fit their child’s developmental level and their family’s current concerns.

    These self-paced lessons are available at no cost to parents; and are available online or through the mail. Parents receive family friendly information with fun activities; and then submit report forms with their comments. Also, individualized encouragement and personalized correspondence from experienced parent educators is sent by the Clinic via web or mail. We at The Hearing Blog  recommend these courses for grandparents & caregivers; and strongly recommend them for both parents of hearing impaired infants and children: Click this link right now to register. Now, not tomorrow or later today: It’s that important.

    •  Well-respected University of California-San Francisco (UCSF) audiology professor Robert Sweetow has the very good Neurotone LACE Listening Program AR (auditory therapy) DVD and Web based program with many dozens of exercises. I have received good reports on LACE from audiologists, including one who dispenses hearing aids and includes it in her package. There are samples of each of the exercises you can download on the Neurotone website;

    •  There are additional resources from the cochlear implant (CI) community available for auditory therapy available for free from Advanced Bionics and for a fee from Cochlear:

    • Advanced Bionics has The Listening Room as part of their “Hearing Journey” website, with a number of environmental sound, speech, and music exercises. Although they may seem simple for people with mild to moderately severe hearing loss, they still nonetheless can be quite helpful as a “reality check;”
    • MedEl has a number of AR packages available for both purchase, and also complimentary web-based and downloadable SoundScape exercises. Download the Bridge PDF catalog for an entire listing of their AR pacages & materials for all ages;
    • Cochlear Americas has their extensive HOPE program which consists of their Sound and WAY Beyond and HOPE Notes software. To see how HOPE Notes was created by Providence RI musician Richard Reed, click here to read an interview of him by AudiologyOnline Editor Carolyn Smaka. If you are .NOT. in the Americas, i.e. in the EuroZone, Australia, or elsewhere, please click here and select your region and country from the map. Also, your CI centre may supply you the Sound and WAY Beyond &∓/or HOPE Notes software to supplement your auditory (re)habilitation program, as this will vary by country — Some — Like UK — provide much better post-implant rehab services than we receive here in America.

    If you don’t believe me that it can really suck here in the US, see the next item…

    •  Underscoring the importance of what happens when AR is not done, one need only watch the superb and touching HBO documentary Hear and Now, as filmmaker Irene Taylor Brodsky accidentally documents what happened when her parents did .NOT. get the AR they needed. From my detailed Movie Review on the Amazon.com Hear and Now page:

    I strongly recommend this movie for anyone who already has a cochlear implants, prospective CI candidates or parents of kids with CI’s; and also all Audiologists, whether practicing or are studying to become one, as filmmaker Irene Taylor Brodsky accidentally documented two avoidable CI failures, with Sally’s worse than Paul’s.

    Watch the movie twice: The first time, just sit back and enjoy the story with your entire family, as any member of the viewing public would do so, as that alone rates a good Four Stars. But then, watch the second half again, from the implant surgery forward through 1st stim and subsequent MAP’s to the end.

    Notice something missing?! HINT: Sally Taylor has personally told me this is the most common question asked at film screenings.

    —> WHERE IS THE FOLLOWUP AUDITORY THERAPY? <—

    That’s right, Paul and (especially) Sally were victimized by their CI center, with poor quality 1st stim, followup MAPs, and the total *lack* of auditory (re)habilitation. This is a superb documentary of an absolute, miserable #FAIL by the Audiology profession, *especially* in Rochester, NY, which has 90,000 deaf residents — The highest concentration in the world. In fact, both Sally and Paul are retirees from NTID (National Technical Institute for the Deaf; one of eight Colleges at RIT), so it’s not like deafness is an unknown quantity among the healthcare profession in the area.

    If you already watched the edited version on HBO, buy the DVD anyway as it has an additional 20 minutes that didn’t make the cut, mostly of booth testing… But it’s worth it to those to both groups — Hearing healthcare professionals and hearing impaired patients & their families.

    I very strongly recommend this film for any and all in the hearing healthcare industry, as it clearly demonstrates how auditory rehab is critical to patient success; and what happens when professionals #FAIL to provide adequate followup care.

    I also strongly recommend this film to any and all members of the hearing impaired (hard-of-hearing, deaf and Deaf) community, as well as to their families.

    Please see my detailed review on the Amazon.com Hear and Now page for a more extensive discussion of the importance of Auditory Therapy

    •  The John Tracy Clinic also offers intensive three-week On Site Family Summer Sessions for children with hearing loss 2 through 5 years old and their families worldwide are offered at the John Tracy Clinic (JTC) campus in Los Angeles. Children attend a spoken language preschool designed to identify their strengths and needs. Parents participate in an education program to learn about hearing loss, auditory-verbal techniques, emotional support for families and educational services for their children.Specialists provide audiology, counseling and consultation services to children and families. Summer sessions include a(n):

    • Auditory-oral preschool program
    • Comprehensive audiological services
    • Daily intensive parent education classes
    • In-depth speech-language assessments
    • Parent support groups led by trained counselors
    • Recreation programs for brothers and sisters, grades 1st through 6th

    Summer services are offered free of charge as are all other family services at John Tracy Clinic. To learn more, read the Overview page, read a first-hand account written by a parent, or download a one-page informational PDF. Enrollment applications and answers to general inquiries can be obtained by calling 1-800-522-4582 or emailing pals@jtc.org. ~Dan Schwartz, Editor

    Some of the listening practice stuff that I do… I have worked 1-on-1 with the CI program audiologist for an hour every week for most of the past 3 years; but many of what I’ve done are exercises you can do on websites like some of the ones that I have listed below, and some things with a friend or family member… And you don’t need a special sound-proof booth to do these. People often ask how I have improved so much with my level of comprehension of speech with my ABI, and I usually say that I’ve practiced a lot; but people say, “what do you mean by that?” How do you practice listening?” With the ABI [Ed.: Auditory Brainstem Implant], it’s kind of like you have to learn how to hear again, because as a baby you learned how to hear naturally, but now I needed to learn those sounds are not the same as they were before, and fit things together like its a big puzzle. I don’t understand everything with the ABI, but I do understand a lot. [The other day, I talked to my mom on my cell phone for 15 minutes and understood mostly everything she said!]

    Here are some of the things I use for listening practice, for my fellow ABI user friends…. (I tried to only tag people who’ve gotten ABI or CI in the past few years, or might be getting one soon… And people who just think that robot ears are awesome!)

    SUGGESTION: Keep a record of scores on the online listening quizzes and games, then do the same one in a few months or next week and see if you can improve your scores;

    LISTENING STORY/CONVERSATION ACTIVITY: Get a family or friend to try to talk with you while holding a piece of paper (or thin fabric, which works better) in front of their face. It can be challenging but when I started doing that, it was just sounds really. I’ve progressed to being able to have pretty clear conversation, or repeat back person reading a story — Read a sentence, pause, listener repeats… etc.)

    PHONE ACTIVITY WITH SOMEONE: Practice talking on the phone by calling a friend or family member (whom you know the voice of well) while they are in another room of the same house/apt/building. Try planning the call by making a list of what you will talk about. Example: You ask them a question about what they did this weekend, and they answer, then you confirm if that was what they said. Strategies include: Ask for spelling of words that you get stuck on (and I found it helpful to sometimes try using the military code alphabet letter list which you can switch some around on or make your own but you need 2 copies of same thing. A = Alpha, B = Bravo, C = Charlie… so if the word you didn’t understand was, for example dog, they can say “D – Delta, O- oscar, G-golf”), ask for something that is unclear to be rephrased, or repeated (but if 3 repeats don’t work, try spelling or rephrasing).

    PHONE ACTIVITY ALONE: And try listening to the words and stories on here: 1-800-458-4999 – Cochlear Practice telephone recordings, which can be viewed here. There are new recordings every day. If you get bored of the fairy-tales, there is some pretty interesting different ones, usually on the weekends, like such as the time line of Abe Lincoln, Dr Martin Luther King Jr’s “I have a dream” speech, Robert Frost poems, Cochlear Implantee success stories, and more.)

    OTHER ACTIVITIES: Lots of great stuff from the home page of the ManyThings.org links here and here. Play around and find what you like. The “minimal pairs” sound comparisons are great; or go to the home page of this site and try the “easy activities/games for beginners.”

    • www.elllo.org has a lot of listening activities at various levels here, here, here, and here. Most of them are geared at foreign students learning English, but its a great site.
    • There are also a large number of listening practice selections available through the TalkEnglish.com website
    • Free music online at www.GrooveShark.com , LOL. [Editor's note: This website uses the very latest browser plug-ins, which can at times cause computer lockups and crashes.]
    • The Grammar Girl: Listen, and you can read it too, but this one is really boring, I thought. My audiologist said she thinks this changes each week, but this particular link is new to me, so I’m not sure yet.

    ~Anne S., Auditory Brainstem Implant user

     

    January 14, 2011

    BREAKING: Advanced Bionics Layoffs

    Filed under: AB 2010 Recall,AB Layoffs,Cochlear Implant,Uncategorized — Tags: , , , , , — Dan Schwartz @ 11:22 pm


    BREAKING NEWS: Advanced Bionics lays off 150 100+ employees in the wake of the FDA-ordered Recall Production Halt, including longtime field support staff.  Details to be posted as they become available.

    Posted 11:15 PM January 14, 2011

    UPDATE 1A: We have received additional reports after the first one received Friday 11:00PM  that the number of layoffs is “slightly over 100.” We can confirm that there was one unnamed layoff at Rixheim; Linda Luallen being laid off from Valencia; Phil Ives, Ph.D being laid off in Denver; and we are still awaiting reports from Hannover and AB-UK

    CLARIFICATION: We received an email from a very upset friend, Terri Ives, Ph.D, about us naming her husband Phil as one of the 100+ that was laid off in Update 1 published on Monday; with the implication that he was the source of the leak on Friday night when we broke the story to the world — He was .NOT. our source. Instead, we happened to see a post on his wife’s Facebook page on Sunday that Phil was laid off. Phil and Terri are both honorable and trustworthy professionals; and anyone implying anything to the contrary will be met with the Full Force of this publication~

    Update 1A posted 3:00 AM January 19, 2011

    Clarification posted 8:00 PM January 20, 2011

    UPDATE 2: We are in receipt of an unusual email from Jennifer Raulie, an Audiologist at Advanced Bionics whom we know, sent Monday afternoon to a reader of this publication. Here is an excerpt:

    My name is Jennifer and I am one of the audiologists on staff at Advanced Bionics. I was reviewing the Hearing Journey [URL added: Ed.] today and came across several of your posts. Welcome to the online community! It is nice you see you there! I just wanted to reach out to you to let you know that the information in the links to The Hearing Blog you posted is absolutely false and not based on any factual information. The person that runs this blog has no connection to Advanced Bionics or Sonova and in fact is not even a CI recipient of any brand. It was clear to me, from reading your posts you figured this out on your own, but I just wanted to reassure you that what you read was in fact garbage.

    We would like to remind Ms Raulie that Sonova Holding AG (SOON.VX) is listed on the Zurich Exchange; and her denial — “what you read was in fact garbage” — of their  Advanced Bionics subsidiary’s  layoffs could be construed by Swiss and EU regulators as making  materially false statements about the financial condition of a publicly traded corporation.

    As we have previously stated, we are in no way affiliated with any corporation or other entity; and we accept no advertising; and for that, we thank Ms Raulie for emphasizing that point.  However, the Editor, Dan Schwartz, must take exception to a cheap shot by Ms Raulie when she wrote “in fact is not even a CI recipient of any brand.” That is indeed true, as although Mr Schwartz is a candidate for cochlear implants, he is not a user yet due to insurance issues. Why Ms Raulie chose to raise this extraneous issue cuts to the very core of her letter: Instead of explicitly addressing the issues she, as a spokeswoman for her employers, factually disputes, all she can do is resort to name-calling.

    Our answer to Ms Raulie, Sonova, and Advanced Bionics is this: Tell us explicitly where we are wrong, supply us with documentation so we can verify your claim; and we will promptly correct the record. Please address your correspondence to Dan@Snip.Net: We are awaiting your reply.

    Update posted 3:00 AM January 19, 2011

    December 10, 2010

    Failing Ugly II: More on the Advanced Bionics Recall

    Filed under: Cochlear Implant,Uncategorized — Tags: , , , — Dan Schwartz @ 12:10 am


    UPDATE #3 (1 August 2011): Vindicated! Our friend Tina in London has just published Why 2 Advanced Bionics HiRes 90K cochlear implants failed, including the source document (PDF) sent to the Malaysian Ministry of Health, Medical Device Control Division, confirming the failure resulted in a dangerous DC bias condition. The fact that Advanced Bionics significantly misrepresented to the Malaysian Health Ministry the damage occurring from the electroplating effect caused by DC bias conditions — Which involves the “ripping off of the metallic crystals from the electrode contacts, destroying it (them) over time… And leading to consequent damage in the tight spaces of the cochlea, as such electro-chemical reactions can produce bio-toxic byproducts, as well as introducing potentially damaging changes in the local pH,” and which is independent of any painful overstimulation and can occur silently — is in and by itself a matter for further investigation by the FDA and other regulatory authorities for the misleading statement to the Malaysian government.

    Original document: Advanced Bionics report to the Malaysian Ministry of Health, Medical Device Control Division (click to open PDF in a new window).

     

    UPDATE #2 (19  Feb. 2011): Please see the comment by “Mary” about the working conditions at AB.

    UPDATE #1 (7 Jan. 2011): Please see the update on the lack of implant burn-in in the first article in this series Failing Ugly: Advanced Bionics cochlear implant circuit goes haywire

    We at The Hearing Blog have received more information on the so-called “voluntary” recall of the Advanced Bionics HiRes 90k cochlear implant, making us stand up and take notice. If you haven’t read the first article in this series, please click on Failing Ugly: Advanced Bionics cochlear implant circuit goes haywire.

    The first item is pretty mundane, and confirms what we published previously: A scan of the patient recall letter, signed by Gerhard Roehrlein, PhD, CTO & Interim CTO (click to enlarge):

    Advanced Bionics US Recall Letter sent 11-29-2010

    Advanced Bionics US Recall Letter sent 11-29-2010

    The second item gives us pause: The five page PDF (click here for entire PDF file) sent to European and UK CI centres from their Rixheim office, signed by Michael E. Sundler, Senior Vice President. Several things in this communications jumped out at us. First was this paragraph at the bottom of the first page, which shows this recall was anything but “voluntary:”

    If our records showed that you have any unregistered implants in your possession, a list of serial numbers was provided for devices that must [emphasis added] be returned to Advanced Bionics.

    Second, the troubleshooting advice is unsettling, for reasons to be discussed:

    1. Identified recipient is reporting/showing signs of extreme pain with their typical program:

    a. Exchange all external equipment.

    b. Create a program with all M’s set to 0.

    c. Try the ‘zero’ M program.

    d. If the recipient hears nothing/does not demonstrate an adverse reaction, they do not have the issue. Discontinue use of the ‘zero’ M program.

    e. If they experience extreme pain or demonstrate an extreme adverse reaction with this program, discontinue use of the sound processor. It is likely that they have an implant with this issue.

    f. Contact your AB Clinical Specialist or Technical Service Europe.

    The rest of the letter just outlines scenarios where the user currently didn’t have symptoms, and also if implanted within the last two years; and then an acknowledgement letter to be signed & returned.

    What jumped off the page at us was that, in combination with the posting below for the young child, the M levels (upper levels of stimulation) can be set all the way to zero and the problem(s) still manifests itself.

    Put another way, if the M levels were set to an arbitrary level far below the T levels (threshold limits), i.e. the upper limit M levels were set to 5% of the threshold and overstimulation occured, that would point the finger at a failed voltage regulator module (VRM) on the implant circuit, as this would imply AC signals crossing the output capacitors. However, with no input (as stated with the M levels set to zero) we still have an overstimulation condition, this would imply a failed short output capacitor, leading to the electroplating effect: This involves the ripping off of the metallic crystals from the electrode contacts, destroying it (them) over time… And leading to consequent damage in the tight spaces of the cochlea, as such electro-chemical reactions can produce bio-toxic byproducts, as well as introducing potentially damaging changes in the local pH.

    The the third and most distressing is this post on Tina Lannin’s influential CI Blog about the recall:

    Firstly i have never posted on this site before and have only just found it after trying to find more information on recent events.

    I do know however some of the information on one of the confirmed cases relating to the recent recall and although i do not know or understand any of the technical details i do know of some of the time frame leading up to this.

    Bilateral implant surgery on the case that i know of was in April 09. Problems occured shortly after activation on one side. Company and audiologists tried various ways to fix problem but recipient was unable to wear device for integrity testing. Eventually integrity test was carried out under general anaesthetic in Nov 09 and device was explanted in Jan10. So AB have had faulty device since then to investigate. Confirmation of device fault came 2 weeks before AB made their recall press release.

    Like i said this is only one of the confirmed cases. The company where not very forthcoming in admiting this case was related to press release but after reading the description of problems recipient experienced and the timing of device fault notification they eventually confirmed this.

    Original implant that was not removed and showed no fault is working well as is the second implant recieved in Jan 10 but not at the same level.

    This is troubling on several levels:

    • First off, although very few adults get simultaneous implants, it is common among infants and young children;
    • Second, it shows how yong children cannot report back if they have a problem;
    • Third, something is pretty far amiss with the CI audiologist when s/he has to perform a sedated integrity check under general anesthetic. We can accept that if this was the only CI; but obviously the child is successfully using the other implant… In other words, the implant so badly Failed Ugly, the child could not even stand to have it turned on;;
    • Fourth, the bad implant was built prior to April 2009, which sets in motion a whole new set of questions consisting of what did they (Advanced Bionics & Sonova) know, and when did they know it?

    The first three questions not only go back to the competency of the AB technician, but also to the CI audiologist at that particular center; and also to the surgeon, who is “captain of his ship.”

    The fourth question goes back to how much Advanced Bionics disclosed to Sonova’s auditors when they were at their HQ in the second week of June 2009 when they were performing their Due Diligence. Given that Sonova Holding (SOON.VX) is a publicly traded company, and given how their shares have tumbled since the recall was announced two weeks ago, one has to be suspicious.

    Along these same lines, how much did the Advanced Bionics division of Sonova Holdings AG disclose to FDA regulators? To the UK and EU regulators (for their CE marque)? To the Zurich stock exchange to meet their disclosure rules?

    We here at The Hearing Blog have not received any return contact from Advanced Bionics. There are many thousands of people out there that have AB HiRes 90k implants in their head, in their young children’s head, have surgery dates, or are in a holding pattern, waiting for answers~

    Short URL for this article: http://tinyurl.com/FailUgly2

    November 27, 2010

    Failing Ugly: Advanced Bionics cochlear implant circuit goes haywire

    Filed under: Cochlear Implant — Tags: , , , , — Dan Schwartz @ 2:09 pm


    Workhorse HiRes 90K implant circuit recalled as it can “Fail Ugly”

    –>Did the surprising lack of burn-in cause this recall?

    January 7, 2011; Version 1.2

    Please be sure to read the follow-up article Failing Ugly II: More on the Advanced Bionics Recall Although we’re not investigating earlier failures per se, we are interested in how AB handled them.

    The Hearing Blog is opening an investigation into the two confirmed, and nine (or more) possible catastrophic failures of the Advanced Bionics HiRes 90K cochlear implant (CI) electronics module in the last several weeks, resulting in extreme overstimulation, causing extreme discomfort to the point of pain and headaches, with the possibility of permanent damage to the cochlea and auditory nerve. In general, when there is a problem with a CI, it will “fail gracefully” by shutting down. However, this particular recall involves the implant “failing hot,” which we call Failing Ugly.

    We chose Failing Ugly on purpose: When a CI fails, it should fail gracefully, quietly shutting down until restarted or serviced as needed. Think of driving down the highway and getting a flat tire, where you let off the gas, steer to the shoulder, and coast to a stop: No Big Deal, as Stuff Happens. Now picture this same car with a throttle stuck wide open: This is Failing Ugly, and the end result can be messy, sometimes ending in a wreck. The same is what usually happens when a CI processor or implant fails: It is supposed to fail gracefully, but as we will show in this article this is .NOT. what is happening.

    There have been two separate documents circulating about the Advanced Bionics HiRes 90k implant circuit failures: The first was the announcement Tuesday morning (11/23/2010) from Sonova’s Invester Relations department, which was picked up by the Wall Street Journal later that morning in an article titled Sonova Shares Tumble on Hearing Implant Recall. Late Tuesday evening, the Sonova announcement was placed on the Advanced Bionics website. There is now an abridged recall notice here on the FDA website. We also note here that any and all announcements issued by AB over this recall must be approved in advance by the US Food & Drug Administration (FDA).

    Beyond that, there was a second document: The official letter sent to AB CI recipients who have devices from the affected batche(s)/lot(s).

    UPDATE: The  5 page third PDF document, sent to UK and EU CI centers is in the second article in this series on the AB recall. 

    The Hearing Blog received the following copy of the Recall letter at 9:30PM EST on Tuesday night:

    This is the email sent out by Advanced Bionics on Tuesday 11/23/2010 at 9:30PM EST (Wednesday 2:30AM UK). This is more serious than in the press release from Sonova’s investor relations department from earlier in the day.

    —————**** Recall Notification****—————

    Advanced Bionics HiRes 90K Cochlear Implant

    Dear Cochlear Implant Recipient or Parent,

    Our mission at Advanced Bionics is to improve the lives of the hearing impaired, and the safety and well-being of our recipients is our first priority. Because we are committed to ensuring that our products are as safe as possible, we are voluntarily informing you that we have become aware of an issue with the HiRes 90K cochlear implant. The issue can result in pain, overly loud sounds, and/or sudden shock sensation in the implanted ear while the implant is receiving power.

    Thus far, our investigation shows that of the more than 28,000 implanted HiRes 90K devices, only two explanted devices have been confirmed to have this issue. There are 9 other patients with similar symptoms which our investigations have not yet ruled out as related to this issue. For the two confirmed cases, there were no symptoms upon initial activation of device. However, the patients experienced symptoms after 8-10 days of use. Both recipients were re-implanted with HiRes 90K devices and their clinicians report that they are progressing well.

    We are conducting an extensive investigation of this issue using an independent scientific research organization. Their current analysis suggests that, if present, the issue will first occur within 90 days of device use. However, the onset of symptoms may be delayed after initial activation, and they may continue to occur intermittently. In the unlikely event that this symptom occurs, continued device use may lead to damage to the inner ear and/or the auditory nerve. If you or your child experience pain related to implant use, remove the external equipment immediately and contact your cochlear implant clinician to schedule an appointment. If the evaluation of your device identifies this problem, device replacement is advised.

    It is important to note that it is not unusual for cochlear implant recipients to experience overly loud sounds. Most of these cases can be resolved with standard troubleshooting, such as the replacement of external equipment. The vast majority of these cases are not signs of the issue described above and do not require explant of the device. We will notify you again as more information from our investigation becomes available.

    We sincerely regret any concern this notification may cause. Advanced Bionics assures you that we will correct this issue and continue to improve our product reliability. If you have any questions regarding this letter, please contact an Advanced Bionics representative at 877-577-4628 (telephone) Monday – Friday 5:00 a.m. – 7:00 p.m. PST or http://www.advancedbionics.com (live chat) Monday – Friday 5:00 a.m. – 7:00 p.m. PST.

    In order to assure the effectiveness of this communication, please complete the enclosed acknowledgment form and return it to us at your earliest convenience by using one of the following options:

    E-mail: confirm@advancedbionics.com
    Fax: 661-362-7621
    Mail: Self-Addressed stamped envelope

    Unfortunately, there is a 30 day grace period for the FDA’s MAUDE Adverse Event Report database. Speculation on the Internet is rampant, with this 30 day delay until submissions are made public only stoking fears, of which we will not participate. To date, over 200,000 hearing impaired people have received cochlear implants, from as young as 5 months all the way into their 90′s. Cochlear implant technology is safe and effective for all ages with very few exceptions: This underscores why our independent investigation is important, to ensure the excellent reputation CI’s have achieved over the last two decades is maintained. It is our belief that sunshine is the best disinfectant, so once the cause of these failures is pinpointed and rectified, the Fear, Uncertainty and Doubt (FUD) can be refuted, putting both affected recipients and candidates’ minds at ease.

    We need to remind our readers that The Hearing Blog is a privately hosted, independent publication that accepts no advertising, no samples, and no manfacturer or distributor funding. We are modeled on the same decades-long policy Consumer Reports‘ uses, to assure readers the content is unbiased.

    We also need to remind our readers that hearing is important: Just look at the 200 thousand people who have undergone general surgery to get it restored, including many of my friends like Kristin Fleig, who was dying to hear again… And (almost) did.

    This article is tentatively divided into three subsequent sections:

    Engineering Analysis: The “who, when, where, why and how.”

    First, what is happening is that there appears to be a component-level failure in the implant circuit, one which overrides the many fail-safe mechanisms built in since this circuit was introduced in 2003. This failure causes an overvoltage — an overcurrent — to be applied to one or more electrode contacts, powerful enough to cause a loud, painful jolt. In addition, there is the distinct possibility this would induce current biasing if (and we stress the word IF) the failure includes a shorted output tantalum electrolytic capacitor, which would cause a(n electro)plating effect, ripping metallic crystals off of the electrode button contacts, destroying it (them) over time… And causing consequent damage in the tight spaces of the cochlea, as such electro-chemical reactions can produce bio-toxic byproducts as well as introduce potentially damaging changes in the local pH. Is this a possibility? Let’s look at the carefully worded recall notice, which was approved by the FDA:

    In the unlikely event that this symptom occurs, continued device use may lead to damage to the inner ear and/or the auditory nerve.

    This statement would not be present in the recall notice if the failure would not cause damage from bio-toxic byproducts &/or local pH changes. This “failing hot” is also why we use the term “Failing Ugly.”
    Let’s use an easy-to-understand analogy of one possible failure mode: Picture a Class B (push-pull) audio amplifier with +/- X volt power supply rails coupled to a loudspeaker voice coil through a tantalum electrolytic capacitor. Now, short out one of the two transistors, connecting that supply bus directly to the capacitor: The voice coil is still protected, because the capacitor blocks the DC bias — It acts as a fail-safe, limiting damage. This is also why we qualified the failure above with the word IF. Now, IF we have a second failure where the capacitor shorts out — which is the failure mode of tantalum electrolytic capacitors — now the power supply bus is directly coupled to the loudspeaker voice coil, which will cause the speaker driver to travel to one or the other limit, caused by the DC bias across the terminals. In the case of the implant (which uses lower voltages than an audio amplifier), this will cause the electroplating effect, and the consequent electro-chemical reactions described above. So important is the prevention of plating, the FDA requires all CI stimulations to pass a rigid mathmatical and electrical test where the integral (summation) of the total charge over any 10 minute span must be zero.

    One failure mode theory can be pretty much set aside: Dendritic crystalline growth on the circuit chip, which could indeed happen in a matter of days. For this to occur, it would require moisture to be present, which is due to a failure of the hermetic seals in the implant case. One longtime implant engineer told me that dendrites will grow with just a few monolayers of water present and a small dc voltage. The reason we are setting this aside is that if indeed it were true, there would have been dozens, probably hundreds of similar overstimulation failures in the last 6-7 years from the infamous Astro-Seal (“Vendor B”) episode.

    Another tantalising possibility is a software glitch in the new SoundWave 2.0 software. The stim software that is downloaded from SoundWave to the processor is supposed to be identical between SW V1.6x and V2.0; but this is one area where bit-for-bit comparisons can be easily verified and ruled out.

    [This is not to be confused with the boot-up of the implant electronics package itself: What sets Advanced Bionics' method apart from the others is that when the implant circuit powers up, large data tables are downloaded from the processor into the implant memory itself as a BIN file, taking 1.5 to 2 seconds before stimulation starts. These data tables contain various combinations of complex electrode firing patterns, which allows for the 88,000 forward data updates per second to take place. There are many software fail-safes built in that cause a graceful shutdown, so this too can be quickly ruled out.]

    So, we are back to a component-level failure that causes the output to Fail Ugly. If the design engineers did their job properly, there will only be a minimum of any singular component failure that will cause this nasty overall failure; and more importantly from a reliability standpoint, adding the complexity of additional monitoring circuitry will greatly decrease the overall MTBF (mean time between failures, the reciprocal of the failure rate per million hours).

    The open questions Advanced Bionics needs to answer are:

    • Which component failed — Semiconductor, or tantalum capacitor?
    • Was it an open or short failure?
    • Have these failed circuits been attached to 1j or Helix electrode arrays, or to both?
    • Where in the circuit is this failed component located?
    • What is the proximate cause of the component failure?
    • What are the destructive and non-destructive test results from this batch of components?
    • What have been any recent component changes?
    • Have any components been purchased from a new or different vendor?
    • What have been any recent QA/QC changes?
    • Since these are “infant mortality” failures occurring at 8 & 10 days (and perhaps the one at 11 days along with 8 others), why weren’t these detected during incoming inspection or during burn-in?
    • What is/are the manufacturing date(s) &/or serial numbers of the implant batch(es) containing the offending component batch?
    • Is the batch of bad components confined to one manufacturing batch? To one reel?
    • Can this failure be detected with the SoundWave 1.6x or 2.0 tools as released to the CI centers? To the tools issued to the clinicians?
    • Can Neural Response Imaging (NRI) be used as issued to detect and/or confirm this failure? If not, is there a software update to NRI in development?

    I just received my AB implant within the last year: Don’t panic, as your implant is probably .NOT. in the batch subject to this particular Ugly Failure. Unless you show symptoms of the painfully loud overstimulation, you’re OK for the moment.

    Just to clarify, the implant electronics from the three manufacturers licensed in the United States — AB, MedEl, and Cochlear — all have similar failure rates where they fail gracefully. This recall is totally different, as it involves Failing Ugly.

    I’m considering an AB implant: Do I fish, or cut bait?

    Once you decide to get a cochlear implant, there are many factors that will go into your choice, as well as the influence (both good and bad) of your CI audiologist and surgeon. If you have not yet read Tina Lannin’s excellent blog articles on CI’s in general, and more specifically on choosing a CI brand, please do so, as it contains very good information.

    Our recommendations:

    1. Ask your surgeon if s/he implants AB’s 1j semi-curved (lateral) or Helix (perimodional) electrode [But note this one surgeon's response when he was asked]:

    • If he implants the 1j electrode, then a very good substitute is the MedEl Sonata Ti100 implant with the 31.6mm FlexSoft electrode and the Opus 2 speech processor (either with or without the optional remote — makes no difference). It is our belief that the speed and current steering of the MedEl implant when combined with their FineHearing stimulation software is more than adequate to the task; and since you would be getting a lateral placement with either the 1j or FlexSoft, the longer MedEl electrode combined with the tonotopic matching provided in Maestro 3.x MAP (programming) software (which is .NOT. in AB’s SoundWave 2.0) will provide a better overall experience, especially if a hearing aid is used in the other ear;
    • If he implants the Helix electrode, it’s a tougher call: Even though Soundwave 2.0 does not provide for tonotopic matching (which we consider a major limitation of the AB system), the perimodional (tight spiral) placement does indeed provide a cleaner (purer) stimulation. Unlike brokerage Helvea analyst Daniel Jelovcan’s prediction of the AB implant being off the market for six months, we here at the Hearing Blog believe it will be closer to six weeks .IF. — And only If — the failed component has been identified and has been scrubbed from the implant production stream;

    2. If you are the parents of a pre-lingually deafened infant scheduled to be implanted before the age of 18 months, we recommend .NOT. delaying the scheduled implant surgery date, as every day that goes by is that much less auditory and speech development will occur in your child’s brain as it is developing. For this group, The Hearing Blog recommends either MedEl’s Maestro system with the Sonata Ti100 implant connected to the 31.6mm FlexSoft electrode using the Opus 2 speech processor and the FineHearing stimulation software; or Cochlear’s Nucleus 5 system with the 25.4mm Contour (perimodiolar) array and the two-way Remote Assistant for its diagnostics.

    We here at The Hearing Blog take no comfort in publishing this article, because cochlear implants are safe, effect… And life-changing to over 200,000 people so far.~

     



    July 13, 2010

    Series on FM: Soliciting User Experiences&c.

    Filed under: FM Assistive Devices,Uncategorized — Tags: , , , , , , , , — Dan Schwartz @ 4:58 pm

    Update #1 January 27, 2011: Please scroll halfway down to red portion of the text

    The project of rating two new digital FM systems, the Bellman & Symfon Audio Domino (PDF w/specs) ($495 street)  and the Etymotic Research Companion (specs;  how it works) system ($699 street w/three transmitters and ER-6i isolator earphones) is turning out to be a three-part series of articles, taking much more time than I expected… And I am soliciting comments on any FM system about your user, parent, teacher or hearing healthcare professional experiences — Good .AND. Bad. Please post your experiences in either the Comment section below, or email them to me at Dan@Snip.Net

    The first of the three will be how and why FM — When it’s done properly — is a tremendous help to the hearing impaired and others, from infants & toddlers receiving auditory therapy, to children (including those with cognitive impairments), to high school & college students in large classrooms & lectures, to adults on the job, and in noisy social situations, to the elderly watching TV.

    Most of the first article in this series will center upon the discussion on these 4 pages in Jamie Berke’s About.Com Deafness Forum.  [And Yes, the story about the beer is true!]

    The second article in the series will deal with the situation when FM is .NOT. done properly, and interference or other issues result. Phonak’s FM system appears to be a serial offender, but there are other culprits. This article will go into the techno-details on things like multipath distortion vs dropouts, transmitter power, and other things a computer geek or Ham Radio operator would understand… So the challenge is to make it readable for the average parent.

    The third article in the series will be test results from these three systems:

    § The Bellman & Symfon Audio Domino (PDF w/specs) ($495 as tested with earphones) is a flexible single transmitter system, with excellent audio quality, decent range, and highly directional microphones on both the transmitter & receiver;

    § The Etymotic Research Companion (specs;  how it works) system ($699 as tested with three transmitters and ER-6i isolator earphones) ships with either one or three transmitters, and is the only system (besides the Phonak DynaMic extension to the troublesome Inspiro) that provides many-to-one capability;

    § The Comfort Audio Contego ($795 as tested w/neckloop) is a single encrypted transmitter system; and was screened by the author at the HLAA Convention in Milwaukee.

    Update #1: Due to time constraints I have not been able to fully update this blog entry; however I posted this reply on Dr. A.U. Bankaitis’ blog:

    Although they have differences, the Bellman Audio Domino Classic costs $200 less, and performs as well as the Comfort Contego. While the Contego has a zoom mic, the Audio Domino Classic has a tone control on the receiver, and also when stereo is input into the transmitter jack, the system switches to digital stereo (more on this in a moment).

    Previously, A.U. raised a point about the 40ms latency of the Audio Domino vs 10ms delay in the Contego (vs. no latency with analog!) and how it can interfere with lipreading cues. [Note:In googling Comfort Contego specifications there is no mention of latency.] From personal experience, I haven’t noticed any latency issues; but more importantly, if either system is used with a TV, it is important to note that with the shift from NTSC to HDTV the lead/lag for the separate AC3 and MPEG audio streams can be up to 150mSec (and in practice is often much higher), so the (supposed) 30ms delta between the two doesn’t seem to be a factor.

    Now, let’s say your patient wants a zoom mic on the transmitter & receiver: With the Contego, the user has to walk over and manually switch the transmitter. But, remember when I said above that the Bellman Audio Domino Classic transmits in digital stereo? Well, so does the Audio Domino Pro… But also, the Pro version does something Really Clever: The audio from the omni mic rides on the left channel simultaneously with the audio from the zoom mic! This way, the user need only push the button on the receiver to “zoom” the transmitter, saving endless user fiddling.

    My friend Sarah, who blogs on her Speak Up Librarian website received upon my recommendation the Audio Domino Pro from her employer to use at work. She wrote two extensive first-person reviews here and here that are worth reading.

    Finally, I welcome everyone’s own observations of FM ALD’s, whether good or bad; clinician or user, on The Hearing Blog’s article covering all things FM.

    Update #1: January 27, 2011 @3:45PM EST

    June 25, 2010

    Hearing Loss Ass’n of America Convention 2010 summary (updated)

    Filed under: HLAA Convention — Tags: , , , , , , , , , , , — Dan Schwartz @ 10:21 pm

    The annual convention for the Hearing Loss Association of America wrapped up Sunday morning, following a busy three days of meetings, workshops, speeches, receptions, and a symposium.

    Shortly, I’ll be posting the revised and extended notes from the workshop Martha Jones CCC-SLP and I presented on (class)room acoustcs.

    There were a few Cheers and Jeers at the Convention worth mentioning:

    Cheers to audiologist Tina Childress: She saw the CI processor blinking light on a little old lady sitting next to me, came over, and troubleshooted it, including swapping out coils with her own.

    Jeers to HLAA executive director Brenda Battat, who preaches installing loop induction systems (which do .NOT. work well)… But only two of the meeting rooms had loops! The convention center ballroom, where the keynote and hearing aid technology symposiums were held, and the banquet hall in the hotel did .NOT. have loops installed, instead relying on wide area infrared ALD’s (assistive listening devices).

    Cheers to Williams Sound for donating the wide area infrared ALD systems actually used. Gee, I wonder why it worked so well?!

    Jeers to the unidentified vendor supplying the induction loop ALD system for the reception in the Harley-Davidson Museum: It was not set up properly, since it was too weak; and also there was no high frequency boost to compensate for the steel decking below the concrete floor, the roof decking, and the perforated sheet metal walls.

    Cheers to Patricia Trautwein of Advanced Bionics, who booked a much quieter venue  for their reception this year. Sound meter readings were in the 70-75 dBa range, which makes it easier for the hearing impaired.

    Jeers to exhibitor Phonak for not having their new Dynamic Soundfield system in their exhibit booth, even though their US headquarters is only 90 minutes away near Chicago.

    Cheers to my co-presenter Martha Jones, CCC-SLP for putting on a superb first half of the From Mouth to Ear: Acoustic Architecture, Assistive Listening Devices and New Room Acoustical Standards Workshop.

    Jeers to Hearing Aid Research & Development Symposium moderator Dr. Catherine Palmer of Univ. of Pittsburgh: When a fellow Member complained about how her audiologist was not competent in helping her set up ALD’s, she (Palmer) made excuses for the professional incompetence, rather than offering to investigate. In fact, it is incumbent on professors just like her to assure that their audiology schools graduate professionals who are competent in dispensing hearing aids & ALD’s. If these “professionals” can’t — or don’t want to — do the job properly, then they should get out of the business. And if these Ivory Tower professors and schools can’t — or won’t — weed out these inept students, then they should lose their accreditation.
    Update (12/30/2010): Here is the 42 page PDF CART transcript of the symposium: Note the (deservedly) openly hostile questions from the audience about their experiences with their audiologists.

    Cheers to HLAA’s Nancy Macklin, flying solo for the first time, for putting on a successful convention, and working to contain costs for the Members.

    Jeers (again) to Hearing Aid Research & Development Symposium moderator Dr. Catherine Palmer of Univ. of Pittsburgh: The top hearing aid engineer in the world was only 90 minutes away, yet the Big Bald Guy wasn’t even invited. Besides the late Sam Lybarger, Mead Killion has probably helped more people hear better than anyone else in the industry.

    Cheers to the management at the Midwest Airlines Center in Milwaukee for keeping the temperature at a comfortable 72 degrees (I measured): This was much more pleasant than the noisy, hot & humid Opryland venue last year.

    Jeers (yet again!) to  symposium moderator Dr. Catherine Palmer of Univ. of Pittsburgh and Laurel Christensen of GN ReSound: This time for Palmer’s poor quality control in allowing Christensen to show a five minute movie to the Members without captions! This is the Cardinal Sin, coming in front of an audience of over 500 hearing impaired users, yet not captioning their video. #FAIL! [Thank you to Larry Stiverson at HearingLossWeb.com for his more detailed report on the Symposium.]

    Cheers to AOS President and crack cochlear implant surgeon John Niparko, MD, incoming AAA President Patricia Kricos, PhD, VA Chief Audiologist Lucille Beck, PhD and IEC Chair Conny Andersson for taking time out of their busy schedules to fly to Milwaukee to address our Convention. Second cheer to Pat Kricos for spending parts of three days and conducting a workshop: She “gets it” with her excellent attitude towards us in the hearing impaired community.

    ~edited 3:30PM 9/24/2010

    June 13, 2010

    Hearing Loss Association of America Convention

    Filed under: HLAA Convention — Tags: , , , , , , , , , , , , , , — Dan Schwartz @ 7:56 pm

    There are many reasons to attend this year’s annual Hearing Loss Association of America Convention in Milwaukee, June 17-20. Yes, there are 19 hours of workshops that offer 1.9 CEU’s for ASHA & AAA (and by extension, IHS for hearing aid dispenser licensure) — And some of these workshops are hosted by the likes of Pat Kricos, PhD, Sam Trychin, PhD, and even crack CI surgeon John Niparko, MD, from Johns Hopkins.

    All that being said, Christie Nudelman wrote a brilliant blog entry on her experience at her first HLAA Convention, last June at Opryland. Rather than opine, I’ll let Christie say it in her own words:

    My First Time at an HLAA Convention

    By Christie Nudelman

    Last year I attended the HLAA convention in Nashville for the first time. I was the proud recipient of a grant from the Rocky Stone Scholarship program. This was a GREAT to help me offset the cost to get my feet wet with HLAA.

    You see, I joined HLAA, Boulder chapter, in March 2009 for my first meeting ever! I got information about the conference and I wanted to connect with others LIKE MYSELF. I heard there was an effort to get younger people to attend, in addition to workshops and fun activities; so I said why not? The conference venue was amazing in itself. It was HUGE, too!

    The schedule of events allowed you freedom to attend what you wanted, when you wanted and then some (i.e. after hours get-togethers). The keynote speakers were great, the workshops were well thought out and the parties were always fun! In addition, the people were all so amazing and accepting. At the conference, you are amongst a “like kind” – they don’t ask you about “your accent”, or look strangely at you when you ask them to repeat 3 times! I was amazed to be around so many people who “got me” – they understood me and I could just be myself! I remember one profound moment when I was in the exhibit hall trying out the CapTel phone and I called my mom. I told her, “I feel like I found a home here at this conference!”

    Key takeaways I got:

    You have to go to her blog entry to see what she took home!

    Now, back to those workshops. As it turns out, Martha Jones, MS, CCC-SLP and I are hosting the workshop on (class)room acoustics this Thursday at 1PM, titled From Mouth to Ear: Acoustic Architecture, Assistive Listening Devices and New Room Acoustical Standards (click link for syllabus). What works out well is that Donna Sorkin, PhD is teaching What Children with Cochlear Implants Need at School (Part 1 Part 2 Part 3 Part 4 Part 5); which is a nice primer to what Martha & I will be teaching.

    Hope to see everyone in Milwaukee in just a few days!

    Welcome to The Hearing Blog!

    Filed under: Uncategorized — Dan Schwartz @ 2:02 pm

    Welcome to The Hearing Blog! I’m Dan Schwartz, your host; and we will be discussing issues related to Hearing and Deafness, with the occasional detour into related topics such as acoustics, noise control, and high fidelity audio. In short, if it deals with sound, then it’s fair game!

    While you’re at it, take a look at the various links to the right, as there is some very interesting content from other people around the world worth mentioning. While you’re at it, click the button below to follow this blog:

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