I worked with a patient a few years ago that asked me on her follow-up appointment if the Siemens Music hearing aid was named Music because it played music in her head. She told me that when the doors opened at her grocery store she heard loud, clear choir music. She would hear the same song for hours on end. She was not experiencing hallucinations related to a psychiatric illness. The ‘music’ she was hearing was an Auditory Hallucination related to her severe sensorineural hearing loss.
Auditory Hallucinations (AH) are defined as perceptions that lack an external stimulus. They are perceived as sound, and are not under any voluntary control. AH are typically associated with psychiatric illness; however, they are also reported in hearing impaired patients with no psychiatric symptoms. While some may consider AH to be a form of tinnitus, they are differentiated from tinnitus by the type of sound perceived and the source. Tinnitus is often reported as a humming, clicking, frying or tonal-type sound, while AH tend to be complex signals like music or speech. Tinnitus tends to result as damage to the inner ear, while AH are assumed to be generated in the central nervous system.
The sudden onset of music playing in one’s head is frightening, and leads to a heightened emotional state. Your patient may come to you upset and convinced that the hearing aid is playing the music they are hearing. The musical hallucinations are most common among elderly women with moderate to severe hearing loss. They are possibly related to auditory deprivation and have been observed following a stroke. Certain medications can also trigger AH. Tension, anxiety and stress seem to make AH more common and more intense.
Treatment for AH is typically focused on ameliorating the underlying cause. In many cases the cause can not be identified and behavioral, acoustic, pharmacological and Transcranial Magnetic Stimulation (TMS) therapies are utilized. Our role in helping patients with AH is to counsel them, assist with the diagnosis through audiological testing, and refer them for medical/neurological consultation.
For a thorough review of the nature and treatment of Auditory Hallucinations, see the Sept 2007 Hearing Journal article by Frank Musiek, et. al, “Auditory Hallucinations: An audiological perspective”.
Researchers report in a recent article in the American Journal of Medicine that analgesic use, which is the most commonly used drug in the United States, may be ototoxic and can substantially increase the risk of hearing loss, especially in men younger than 50.
Hearing loss is the most common sensory disorder in the United States, afflicting more than 36 million people. It is prevalent in the elderly, but about a third of those ages 40 to 49 already suffer some hearing loss. Common risk factors include loud noise, alcohol, hypertension, diabetes and the use of diuretic furosemide. Studies in animals and anecdotal reports in humans indicate high does of analgesics can interfere with hearing, but there have been few studies looking at regular use and none studying acetaminophen. This is according to the authors of the study.
The study looked at 51,529 men aged 40-74 who reported regular use of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Regular use for the purposed of this study was considered 2 + times a week. Detailed questionnaires were filled out by each participant at the time the study was launched in 1986 and re-administered every two years to the 20 year mark. The researchers controlled for a variety of other risk factors. At the 20 year mark they had 26,917 men who fit the study criteria. Of those 3,488 cases of new hearing loss were reported.
Controlling for other risk factors, the researchers found that among all men who used aspirin at least twice a week, there was a 12% increased risk of hearing loss. Among those who used ibuprofen and related analgesics, there was a 21%increase; for those who used acetaminophen, a 22% risk. But the risk was much higher when they considered only men younger than 50. In that group, there was a 33% increased risk for aspirin use, a 61% increase for ibuprofen and related NSAIDs and a 99% increase for acetaminophen.
In other words use of acetaminophen more than twice a week by men younger than 50 was found to double the risk of hearing loss, use of ibuprofen and related NSAIDs increased the risk by nearly two-thirds and regular use of aspirin increased it by about a third.
It was explained that the reason is pathophysiologic changes in the cochlea. Depending on the drug it can effect the outer hair cells motor proteins and/ or can reduce cochlear blood flow, increasing the effect of noise induced hearing loss.
The study did caution that the study group involved only men and that most of them were Caucasian. It is not clear how the results might extrapolate to women and other racial groups.
References:
The American Journal of Medicine, Vol 123, No3, March 2010
What if your patients knew that they could get a custom fit Bluetooth earset that would:
Offer greater security in cell phone transmissions
Better signal-to-noise ratio when listening in noisy environments
Improved safety while driving
Cost less than the deductible for a hypothetical car accident
Comfortably free up their hands for multi-tasking while talking at length.
Google records that the number of search hits for the word Bluetooth is a hot topic. Say “wireless earset” and no one will know what you are talking about. Say “your Bluetooth” and now you’re connected. According to Michael Foley, Ph.D., Executive Director, Bluetooth SIG, the installed base of Bluetooth products exceeded 1 billion in 2006. “To put this in perspective, 1 billion is greater than the number of PC users in the world and equal to the number of mobile phones shipped this year.” Market share anyone?
Bluetooth protocol offers a way to think forward with technology that is literally changing at the speed of light. The information is sent in profiles that is received by an electronic device with a matching PIN. That is why “the Bluetooth” has to be paired with the mobile phone. The devices are paired one time at start-up. Once in a great while, they may have to be paired again, should an error message consistently appear on the cell. When we fit ALDs and hearing aids, we want to offer options that will enable the consumer to be connected to whatever he/she desires. Bluetooth has the potential to link the ear with the TV, computer, video games, phone, entertainment system, ATM, car, or airline/hotel check-in. In addition, the list is growing because Bluetooth is low power, small size, low cost, and digital.
You already know how Bluetooth earsets are tearing down the stigma associated with wearing an electronic gadget on the head. With the Sound ID PSS, which is classified by the FDA as a hearing aid (HCPCS code V5298), the earset can be shaped to fit the hearing loss. The patient can listen monaurally to the environment, with direct connection to a favored sound source through a companion microphone, and switch over to a mobile phone call with the click of a finger. For example, a Realtor can place the companion mic in the back of the SUV and talk to clients – despite car noise – while driving and pointing out properties – and divert to a phone call – with both hands on the wheel.
Suggestions for making holiday meals and celebrations more comfortable and enjoyable for people with hearing loss and for those around them.
• Speak clearly, distinctly, and not too fast. Never shout.
• If you must repeat something, try not to appear frustrated or annoyed.
• If your comment or question is still not being understood, re-word it. Some words are easier to understand than others.
• In a group situation, try to include that person in the conversation.
• Look directly at the person when speaking and place yourself no more than five feet apart.
• Your facial expressions, gestures, and overall body language are important aids in communicating; make sure you have the listener’s attention and that the room is well lit.
• Conversation is greatly enhanced when there is no distracting background noise, for example, from a radio or TV.
• When dining out, choose a quiet restaurant. Noisy conversations or the clatter of dishes and tableware are barriers to effective understanding.
• Conversation is much easier in a room with carpeting and upholstered furniture than in a room with tiled floors, high ceilings or wooden furniture.
Did you get your hearing aid wet by forgetting to take it out when you shower or jump into the pool? In this week’s Ask the Audiologist, Alex explains the best way to dry out your hearing aid.
I’m a fairly new Hearing aid technician, so sitting with patients and discussing their recently acquired hearing aids is a rewarding, fun, and a challenging experience for me. I would like to think that the challenge is less for me than for most hearing professionals because I also wear the product; or at least a similar product to what each patient is wearing when they come into my office for instructions on how to use their new hearing aids.
I start the conversation by asking them if they are new wearers or experienced; this is important because I want to find out how much they know about hearing aids. I want to make sure that I can help them become satisfied hearing aid wearers. Typically the beginning point is to discuss and practice inserting and removing their hearing aids so they build a comfort level for taking them in and out.
Once we have accomplished this, we then move into how to use hearing aids; changing their programs and hearing aid settings. This is where the fun begins! I get to find out the different types of activities and events my patients partake in, and how much they feel they have been missing prior to their hearing aid purchase. Then I compare my experiences in similar situations and throw in a few antidotes to lighten up the tension in the room. I understand that someone wearing hearing aids for the first time may feel uncomfortable about not knowing what to expect or how to manipulate them in front of someone they don’t know.
I also understand that even an experienced wearer can be uncomfortable because they have been in their comfort zone with their existing hearing aids and now, with new technology, they are learning about a whole new product – in most cases, with many more features. So if I can tell some funny things that happened to me in the beginning and then give them some wonderful experiences with my newer hearing aid, it lightens the mood in the room and makes it much more comfortable for them to express their feelings to me.
By the way, if you’re wondering, I went from wearing Phonak hearing aids from 2006-2010, to now wearing the Siemens Pure 500 in the right ear. I am profoundly deaf in my left ear (no hearing aids would help me) and a slight hearing loss in my right ear. The Pure is a wonderful device and allows me to hear a lot more then I ever heard with my other product.
New hearing aid technology is amazing and being given the ability to share that with our patients is the most rewarding thing I’ve done in my career.
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I’m a fairly new Hearing aid technician, so sitting with patients and discussing their recently acquired hearing aids is a rewarding, fun, and a challenging experience for me. I would like to think that the challenge is less for me than for most hearing professionals because I also wear the product; or at least a similar product to what each patient is wearing when they come into my office for instructions on how to use their new hearing aids.
