© 2007
The questions presented here were provided by SWC members.
For our December Newsletter, please feel free to send in your questions and/or comments for Michael concerning hearing aids, speech and audiology to newsletter@saywhatclub.com
Question: I’ve always wanted to ask audiologists if they ever inform their patients about CART. From all the people I have spoken to over the 18 years I’ve been providing CART, not one of them say they heard about it from their audiologist. Most of them who receive CART for the first time say they’ve never heard of it until their school got it for them. I’d be interested in hearing if the audiologists as a group have a position on the subject? Do they even know what CART is and how helpful it can be for people in school and even college?
Michael: Of course I cannot speak for all audiologists, but I’ve had conversations about CART (Communication Access Realtime Translation) with several of my audiologist colleagues in the past. I would like to think that any audiologist who works with patients who have severe-to-profound degrees of hearing loss would advise those people to seek CART services at conferences, lectures and other group educational settings. Some audiologists (and other professionals) may see a very small percentage of patients who may benefit from CART and, therefore, may be less familiar with it. In those cases, it would be most appropriate for the professional to refer to someone who works regularly with patients from this population and who would be, therefore, more familiar with all of the options available to people with these more significant degrees of hearing loss. I, too, am often surprised that people are unfamiliar with various services and products (not only CART) that they are eligible for. It’s important to help patients to advocate for themselves whenever possible. Obviously, it would be best if our patients could get all of the necessary information from every professional they see at all times, but we know that this cannot be counted on, for various reasons.
I do not know of any formal position of our professional associations specific to CART, but the scopes of practice of our professions encourage us to help our patients in ways consistent with the information that CART and other services provide. Indeed, a quick click around the AAA (
Question: I am hoping you can help me find some effective teaching tools. I worked for several years as an aide for a student with a cochlear implant. I learned to be very aware of acoustics and background noise pollution and how easily these could affect her.
Now I am pushing hard to lead positive changes in an old institution-style county nursing home. Staff members have many TVs as well as radios on, and consider it their right to do so. I have been unable to get across that fast, loud, and some other types of music are extremely detrimental in a large open room full of hard surfaces. This causes more confusion, anxiety, isolation, and "behaviors," especially among people who are hard of hearing and/or who have Alzheimer’s. I have also been unable to get across that someone’s medium-loud conversation in one corner of a big, angular, hard-surfaced room CAN make it harder for a resident to hear.
I wonder if you have any resources you could suggest for effectively communicating this information to staff. The child I worked with once had access to an audio tape of the ways various background noises challenged the hard-of-hearing. I would love to find something experiential like that. I’d like to get across that:
· Being in a noisy environment makes it very difficult -- if not impossible -- to hear.
· Sounds bounce off hard surfaces and create noise pollution.
· Soft surfaces absorb sound.
· Having two or more sources of sound such as a TV and radio going at the same time compounds the confusion, anxiety and behaviors.
· Too many elders are completely isolated in the dining room and other group settings because the noise.
· Pollution puts up a barrier wall to any possible communication.
Eventually I'd like to go for acoustic panels or ceilings. I can’t very well expect to have that OK’d by the budget department until staff begin to understand how poorly this building is designed and what to do that is beneficial rather than detrimental to hearing and communication. Any help you could give me would be very much appreciated!
Michael: Unfortunately, although acoustic standards exist for new construction in many states, older structures are often exempt from such features that would provide relief from reverberation and other competing noise that you describe. It sounds as if you have all of the correct information and some good ideas, but I am unsure how you may best convince the powers-that-be in this facility of the potential for benefit to many of their consumers. You might begin by emphasizing some of the lower- or no-cost modifications that might be made (i.e. room scheduling or staggering activities to minimize large groups). A somewhat more costly solution might be to have the facility purchase several personal amplifiers that individuals can use when engaged in small group or one-on-one conversations. The consumer will have a much better chance of following conversation in the presence of all of the ambient room noise. Such devices run between $100-150 apiece.
I am unsure whether you would be able to successfully create a situation that would best demonstrate the impact of competing noise to the administration. Perhaps a walk through some of the spaces during the busiest times might be a better way to demonstrate this. One can find sound files of various types of noise online, so this could be easy to reproduce if you felt it would have an impact. I’ve often found it helpful to demonstrate some of the effects of hearing loss to those without it by using filtered speech. In the past I’ve used a tape called the “Unfair Hearing Test” (Sight & Hearing Association), which produces speech as it might sound to someone with a certain degree of hearing loss.
Although you might not want to do anything to jeopardize your status in this facility, if there are others (family members, other professionals, etc.) at this residence who also share in your concern about the impact of noise on the residents, it might be helpful to have them approach the administration as a group. If the facility perceives that it is not of great concern, they are less prone to do anything about it. It is possible that family members who have come for visits have found loud music to be distracting to their conversations with their loved ones; it is also possible that other professionals such as social workers, nurses, psychologists or doctors have found the same problems you note. There can be power in numbers. I wish you well in your efforts to help those who are having difficulty in these adverse noise conditions.
Question: I lost the hearing in my right ear thirty years ago, due to Meniere’s Disease; and my left ear, in which I wear a hearing aid, is getting progressively worse. I have always loved classical music and have played the piano since I was a child. After we downsized into a condo two years ago, I exchanged our old Steinway piano, which needed a lot of work, for a smaller Korean piano and started playing again. I also attended classical music concerts regularly. Last winter my piano started to sound dreadfully out of tune. I knew what the notes should have sounded like, but many of them were terribly discordant. Recorded music on a CD was no better. This situation didn’t improve, after the tuner worked on the piano; so I realized that the problem was my hearing loss. Perhaps you can give me some strategies, so that I can enjoy listening to music again. Sometimes, if I concentrate on hearing the note in my head before striking it on the piano, I hear the note in tune. But I can only successfully listen to simple one-line melodies, instead of the complex musical works that I used to enjoy.
Michael: This is a great question, and I wish I had a good answer to it. The first thing I would advise is to be sure that your hearing test results are current, and that the hearing aid has been set for those most-recent results. If hearing has changed and you are using a device with older settings, then it can make things sound “out-of-tune.” If, in fact, you are fit appropriately, it is possible that hearing has changed so much that certain frequencies are simply not being perceived …and obtaining information from only one ear is limiting in itself. You may not be playing piano “loud enough” to trigger that part of the auditory system (note that I am not suggesting that you play louder, which may result in some not-so-happy neighbors in your new condo). You mention that recorded music appears to be out-of-tune as well. You may want to try to listen to recorded music under earphones, and at a somewhat higher intensity (although not for long as we would not want to further damage your hearing), to see if you are then able to perceive it in tune. If so, it is possible that you are in need of an adjustment to your hearing aid (i.e., you would then be CAPABLE of hearing those sounds, but are simply missing them in daily activities). I will say, though, that we are learning an increasing amount of information about the brain, about the way it perceives sound, and about its “plasticity.” What we see leads us to believe that the brain can often acclimate to sound, and that it, in some cases, may “re-wire” itself (within limitations) in response to injury and other losses, such that the more you listen to these sounds, the more “natural” it may again be perceived, albeit with limitations. That’s not to say that your hearing sensitivity will suddenly “improve” with continued auditory stimulation, but your perception of the quality of sound may. I still advise you to ensure, first, that your hearing aid is fit in a way appropriate to your current hearing level.
Question: There are so many hearing aids on the market that it all becomes very confusing. What is the difference between programmable aids and digital aids? My audiologist says that in-the-ear canal hearing aids are the newest and best there is. I’m confused! I don’t want the newest and best, I just want one that’s right for my hearing loss. Are hearing aids focused on different hearing losses? Or is that where the digital and programmable come in? I’ve been to two audiologists and they are both trying to get me to buy in-the-ear aids which, as you know, are very expensive. Thank you for any help you can give me.
Michael: I can certainly appreciate that it can be confusing to try to keep up with all of the different types of technology, sizes and styles that exist in today’s hearing aids. Believe it or not, it is frustrating to some audiologists (including me) at times, too! But, it is exciting to see some of the changes that have come along in recent years.
Programmable devices are hearing aids that can be programmed by the dispensing audiologist (typically using a computer). That’s all it means. Digital hearing aids make use of a computer chip which stores information about how to process sound, and helps to convert the sound to usable information. Programmable devices came on to the market in the early 1990s, and digital devices became commercially available in 1996. It is important to note that these two features do not significantly alter the look of devices. Programmable and digital devices come in all shapes and sizes, as do their technological precursors. Today, most hearing aids are both digital and programmable, but this does not mean that either of those features makes the hearing aid necessarily better. The “best” hearing aid for someone is based upon a whole host of patient characteristics, including hearing loss, lifestyle, vision, manual dexterity, etc. I advise all patients to bring questions to their audiologist about why s/he feels certain features may or may not be better for someone. There are some good, informative, unbiased consumer brochures on the market regarding various hearing aid options, such as one provided by AARP, and there is a wealth of information that can be found by linking through both the ASHA (American Speech Language Hearing Association) and AAA (American Academy of Audiology) websites, and navigating to the consumer areas.