Hearing Issues - Hearing Health Center

OR WHY YOU CANNOT UNDERSTAND WHEN YOUR HEARING IS NORMAL

by Dr. Ronna Fisher Au.D. FAAA

“How is your dad?” Jeremy asked his boss sitting across the table at a recent dinner party. “He died,” said his partner. “That’s great. Tell him I said hello.”

Jeremy knew something was wrong from the stricken look on everyone’s face. When his wife leaned over and whispered, “He said his father died.” Jeremy wanted to crawl under the table and disappear. He thought his boss said, “He’s fine.”

Jeremy called his doctor the next morning to get his hearing checked. He was only 42, but this was not the first time Jeremy had misunderstood. He was having more trouble hearing in court, making out what his wife said from another room and sometimes even when he was in the same room.

He was surprised when the doctor told him the tests were normal and his hearing was fine. “You just need to pay more attention,” his doctor said.

Jeremy’s struggle to understand in everyday listening situations is not uncommon. Studies over the last 10 years show that changes and deterioration of auditory processing in the brain begins at age 40. These changes are not detectable on a hearing test.

SO WHAT HAPPENS WHEN YOU TURN 40?

Hearing vs understanding. They are not the same.

Hearing is about loudness. If your hearing goes down, you just make the sound louder, right?

Wrong!

As any wearer of hearing aids knows, making them louder does not make them clearer. Turning up the volume does not mean you are going to understand any better.

Understanding is about processing. Your brain has to sort out, filter and make sense of all the sounds it receives. How does it do that? What does your brain need so you can understand clearly?

Temporal Processing – the rate at which we can process auditory information. The ability to follow rapid changes in speech, music and other sounds.
Have you ever thought that kids talk too fast? They are on their third sentence and you are still processing the first one. Kids do not talk any faster than they always did. Your temporal processing has slowed down.

The slower your temporal processing, the more time you will need to understand what someone is saying.

Working Memory – the mental sticky note we use to temporarily store and use information. Often used synonymously with short-term memory, working memory is critical for learning, reasoning and decision-making.
When you have difficulty understanding, your brain has to concentrate more and listen harder. You brain is so intensely focused on trying to understand, that it does not have the resources to transfer the information to your memory. Therefore, even if you “get it” your brain cannot store it.
Auditory Distraction – irrelevant sounds that break through your attention and focus and impairs your cognitive function.

In order to participate in a conversation, especially in a difficult listening environment, your brain has to separate all of the incoming sounds and focus on one of them.

Beginning at around age 40, the brain cannot filter out distracting information as well as it used to. The ability to encode and retrieve words severely erodes in “background babble.”

WHAT CAN YOU DO?

While you cannot change Mother Nature, there are a few things you can do to help you understand more clearly

If you can, turn off the TV, Radio, Music and any other distracting sounds
Eyes help make up for what the ears miss. Try to face and look at the person with whom you are speaking
In restaurants, try to sit in a booth or a table where you are facing the wall and the noise is behind you.
Hearing aids and PSAP’s (Personal Sound Amplifying Products). The solution for most people with a hearing problem, attention deficit disorder, or focus issues, is usually to make the signal (speech) louder than the noise or distraction. Amplifying the speech, even when hearing tests are normal, allows for easier listening and less distractions.

Increasingly, hearing aids and the lower cost counterparts, PSAP’s (which are not intended to correct hearing but make sound louder) are being fit and worn to use in those distracting and difficult situations or anytime when understanding clearly is a problem.

Dr. Ronna Fisher, Au.D., FAAA, Founder and President of Hearing Health Center

Dr. Fisher received her doctoral degree in Audiology from the Pennsylvania College of Optometry. She is a fellow of the American Academy of Audiology, has earned the Certificate of Clinical Competence from the American Speech-Language and Hearing Association, and is an active member of the Academy of Dispensing Audiologists, American Tinnitus Association, and the Illinois Academy of Audiology.

– Beck DL. (2015) Invisible Hearing Loss American Academy of Audiology Web site.
– Fullgrabe C, Moore BCJ, Stone MA. (2015) Age-group Differences in Speech Identification Despite Matched Audiometrically Normal Hearing: Contributions from Auditory Temporal Processing and Cognition. Frontiers.
– Grose GH, Mamo SK, Buss E, Hall JW. (2015) Temporal Processing Deficits in Middle Age. American Journal of Audiology 24:91.
– Helfer KS, Vargo M. (2009) Speech Recognition and Temporal Processing in Middle-Aged Women. Journal of the American Academy of Audiology20(4):264-271.
– Baycrest Centre for Geriatric Care.
– bit.ly/bg-babble

Balance disorders are very difficult to diagnose and treat because there is often more than one underlying cause. Knowledge of all the sensory systems that contribute to balance as well as how each system works together and interacts with the brain is essential.

How are balance disorders caused?

Benign Positional Vertigo (BPPV) – BPPV is the number one cause of all dizziness. It involves intense, brief episodes of vertigo associated with a change in the position of your head, often when you turn over in bed or sit up in the morning.
Vestibular Neuronitis – inflammation of the inner ear
Ménière’s Disease – a buildup of fluid in the inner ear
Vestibular Migraine – dizziness and vertigo that may or may not be accompanied by headaches
Head Trauma
Multiple Sclerosis
Stroke and heart attack
Slow-growing tumors
Joint and muscle weakness
High or low blood pressure
Viral infections

How are balance disorders diagnosed?

Case History: one of the most important components in diagnosing balance disorders. Details about the imbalance can often determine which part of the inner ear or brain is involved.
Diagnostic Hearing Evaluation: the hearing system and the vestibular system are very close in physical proximity. They function together. Any part of the ear can cause and/or contribute to a loss of balance.
Auditory Brainstem Response: tests both the ear and the brain by measuring the timing of electrical waves from the brainstem.
Voluntary Eye Movement Testing: measures the ability to coordinate eye movements with head movements crucial for walking, driving, etc.
Videonystagmography (VNG): computerized testing that measures, records and analyzes eye movements under various conditions.
Computerized Dynamic Posturography (CDP): measures and tracks all of the components (eyes, inner ear, muscles and joints) involved in maintaining balance.

How are balance disorders treated?

Treatment of balance disorders consists of Vestibular Rehabilitation and Balance Retraining. An individual treatment plan is designed for each patient based upon the patient’s history, the findings from the diagnostic testing performed and the functional limitations caused by the imbalance.

The goals of all treatment plans are:

Decreasing or eliminating dizziness/vertigo
Improving balance function and safety
Improving visual motor control and tolerance of motion
Increasing activity levels
Reducing falls or risks of falls

Everyone (well, everyone over 50) worries about losing their memory and fears the “A” word…Alzheimer’s. We all know someone who has it; and we all panic at the thought of, “that could be me.” So we take care of ourselves. We try to eat better, exercise some, check our blood pressure and cholesterol levels regularly, and suffer through periodic prostate, mammogram, and colonoscopy exams.

BUT THERE IS SOMETHING YOU NEED TO KNOW. YOU ARE PROBABLY MISSING A SIMPLE BUT CRITICAL CHECKUP.

WHEN IS THE LAST TIME YOU HAD A HEARING TEST? GRADE SCHOOL?

No one wants to admit or deal with difficulty hearing and understanding. The majority of people assume that frequently misunderstanding conversations and saying, “What,” “huh,” “pardon me,” all the time is just another unwanted consequence of getting older. Difficulty hearing is usually dismissed and ignored: even by your doctors. Most doctors don’t even ask about your hearing let alone include a hearing check as part of your routine physical.

A multitude of studies at John Hopkins¹, CUNY Graduate Center², and elsewhere³ have confirmed definitive links between untreated hearing loss and brain function.

CONSIDER THE FACTS:

You don’t hear with your ears. Your ears are just an appendage to catch the sound signals and send it to your brain to process.
There is a specific area of the brain (Wernicke’s area) whose sole purpose is to decipher and make sense of the sound it receives from your ears.
Your ability to hear, process and understand is directly related to your cognitive functioning.
When your hearing diminishes, your brain stops getting the stimulation it needs to process information.
Lack of adequate stimulation causes deterioration. It’s a classic case of “use it or lose it.”
Your brain’s ability to hear, understand and process sound information is directly related to your memory. You can’t remember what you didn’t hear!

CLINICAL STUDY RESULTS:

83% of patients diagnosed with Alzheimer’s have untreated hearing loss
Even a minimal decrease in hearing doubles the risk of dementia. A moderate loss (the majority of people seeking treatment) raises the likelihood of developing Alzheimer’s 500%.
Every test of cognitive function was significantly worse in scores for mental status, memory and executive functions in those with untreated hearing problems.⁴
When your hearing diminishes, your brain stops getting the stimulation it needs to process information.
Hearing loss actually shrinks the brain one cubic centimeter every year due to the loss of grey matter and brain tissue.⁵
Diminished hearing ability significantly affects your kinesthetic sense of your environment. You are 300% more likely to lose your balance and fall when your hearing decreases.⁶
Early detection and treatment increases cognition, improves memory, preservers speech processing ability and enriches personal relationships
When treated with hearing aids, 33% of Alzheimer’s patients were reclassified to a less severe category
Appropriate hearing treatment increases cognitive function, enhances memory, improves balance and decreases depression.⁷
In every case, caregivers reported that hearing treatment improved their relationship.

Why do we frequently check our blood pressure, heart, cholesterol levels, moles , eyes and teeth? Why do we have regular checkups and examinations?
Because early detection and treatment is critical!

Difficulty hearing is not just an inconvenience and getting your hearing checked is no longer optional. Yearly hearing checkups are vital to your overall health can well being.
And it could save your brain!