Hearing Loss Help  

by Neil Bauman, Ph.D.

An 80-year-old man wrote:

During the night if I have to walk in semi-darkness or on badly lit pavement, and especially if I have to look up and down (to avoid potholes in the street pavement), I develop imbalance and a staggering gait, which embarrasses me a lot. My ENT consultant told me I had age-related Vertigo, and prescribed a short medicinal course which has not really helped.

I can understand your embarrassment. You appear drunk, but you’re not. What has happened is that the balance system in your inner ears is damaged–but people looking at you don’t know that.

Furthermore, I disagree with the diagnosis your ENT made because you are not experiencing vertigo from your description of your problem. Basically, you don’t have problems in good light–just when the light is poor. This is not the way vertigo works. Thus I am not surprised that the medications he prescribed didn’t work.

What has happened is that your vestibular system (balance system in your inner ears) has been damaged. When the light is good, your eyes compensate for your poor vestibular function. However, when there is no light, or poor light, then your eyes aren’t of much use, and you have the balance problems, staggering gait, and the lack of a steady horizon (indicated by your problems when looking up and down–technically known as oscillopsia).

Let me explain how this all works. Your body has three separate balance systems, your ears, your eyes and your proprioceptive system (basically pressure sensors in your legs and feet that tell you when you are upright). Your ears are the most sensitive of these three systems, your eyes are next and your proprioceptive system trails a distant third.

You can function reasonably well with any two of these three systems working. That is why under good light you have reasonable balance–your eyes and proprioceptive systems are doing their jobs. However, when you lose the light, your eyes no longer help you much. Thus only your proprioceptive system is working properly and consequently you have balance problems.

If this vestibular damage is permanent (and it may be), you have to learn how to live with it. As you can see, one of the secrets is to do your moving around during the day and limit where you go at night. Under poor light conditions, you would do well to have a companion to lean on and steady you. In the house, use night lights in the hallways so you can see well enough to go to the bathroom at night. Also, holding on to the walls helps.

Something obviously damaged your vestibular system. Perhaps it was from taking one or more of the many drugs that can damage your ears (ototoxic drugs). One strong indication of this would be any medication you started taking in the days or weeks before you bagan to notice your balance problems.

To learn more about this, read Part I of my article on Ototoxic Drugs at http://www.hearinglosshelp.com/ototoxicupheaval.htm. “Ototoxic Drugs Exposed” reveals most of the drugs that can damage your vestibular system. You can get a copy at http://www.hearinglosshelp.com/products/ototoxicdrugbook.htm.

by Neil Bauman, Ph.D.

Jeff wrote:

I have permanent, profound unilateral deafness, dizziness and tinnitus caused by an ENT doctor who had me use Tobradex drops in my ear, while assuring me they were safe, despite my questions, and kept me on them even after I developed severe vertigo, until I became deaf.
Most ENT doctors keep trying to sweep me under the rug, while denying there’s any risk to using Tobradex in the ear. I guess I’m the kind of data that doesn’t support their practices, so they’d rather deny my existence.

Do you know of any other people who have experienced deafness from topical aminoglycosides? The doctors keep telling me there’s no one else like me out there, but after studying the massive research on aminoglycosides I can’t believe I’m the only victim. My sense of total isolation is as profound as my ototoxic deafness.

I hear you Jeff. And in case it is any consolation, you are definitely not alone. Somewhere between 250,000 and 1,000,000 Americans suffer from damage to their ears from aminoglycoside antibiotics each year! Add to this number, the multitudes that receive damage to their ears from taking any of the hundreds of other ototoxic drugs that their doctors prescribe for them. This is why I wrote the book “Ototoxic Drugs Exposed” so people could be aware of what drugs can damage their ears and take steps to prevent a similar tragedy happening to them. This book is available at http://www.hearinglosshelp.com/products/ototoxicdrugbook.htm.

Jeff continues:

I have heard there may be other people out there like me, who suffer from the long term symptoms of ototoxic poisoning, but have no one to talk to who really understands. I want to form a support group for people like me, where we can go on-line and talk to each other, listen to each other, give each other support, plus share information specific to ototoxic drugs and their side effects. It’s so incredibly lonely suffering from the effects of ototoxic deafness. I think having a place where we could communicate with each other would help us all.

I wholeheartedly agree with you Jeff. You will be pleased to know that there is indeed just such an on-line support group that was set up for this very purpose. You, and anyone else that is interested, can join this group by sending a blank email to mailto:Ototoxic-Drugs-subscribe@yahoogroups.com?subject=Subscribe. (If this doesn’t work because you have AOL for example, send a blank email to Ototoxic-Drugs-subscribe@yahoogroups.com, and put “Subscribe” in the subject line.)

by Neil Bauman, Ph.D.

A mother wrote:

My daughter is seven years old, and has a sloping loss from moderate to profound in both ears. Her worse ear has a 70 dB loss, dropping to profound in the 2000 Hz range. I don’t think her current hearing aids give her the range of sound that she needs, especially in the high frequencies. I’m looking for a digital aid that gives her greater range. Any suggestions would be great.

There are three solutions as I see it.

1. Use standard digital hearing aids that are set to have more high-frequency emphasis.

This is only going to be of limited help because she can’t hear much or anything in the high frequencies now. Therefore, even if the new hearing aids had greater range and amplify all the high-frequency sounds, she still wouldn’t hear them!

2. Get a special hearing aid that transposes high-frequency sounds into lower-frequency sounds.

Sonovation (http://www.avrsono.com) makes a special line of ImpaCt digital frequency-compression hearing aids. These hearing aids transpose the high-frequency sounds down to the lower-frequency sounds your daughter still hears. Once her brain adapts to the new strange-sounding speech, these hearing aids can be an excellent choice. Many people with her kind of hearing loss love their ImpaCts.

3. Once her hearing deteriorates such that hearing aids no longer give her significant help, she may be eligible for a cochlear implant. Then she will have an excellent chance of having reasonably-good high-frequency hearing once more.

At this point in her life, I’d suggest investigating option 2. ImpaCt hearing aids could be an excellent choice for your daughter.

by Neil Bauman, Ph.D.

I have just set up a new on-line discussion list on Yahoo called “Ototoxic-Drugs.”

The purpose of this list is to bring to light and discuss the ototoxic (ear-damaging) side effects various drugs have on our ears and what you can do to prevent this from occurring in the future.

If your ears have been damaged from taking any ototoxic drug, or you want to learn about drugs that can damage your ears, this is the list for you.

Ototoxic drugs can cause such ear damage as hearing loss, tinnitus (ringing in the ears), hyperacusis (where sounds are now too loud), auditory hallucinations (hearing music and other phantom sounds), dizziness, vertigo (spinning sensation), ataxia (staggering gait), nystagmus (eyes jerk horizontally), all sorts of balance problems, some vision problems and some physical problems such as fatigue, poor memory, etc.

If you would like to learn more about the ototoxic side effects of drugs, would like to share your experiences, or want to find other people who have suffered the same side effects as you have, we’d be glad to have you join us. To subscribe to this list, simply send a blank email to Ototoxic-Drugs List.

You can also learn more about ototoxic drugs by pointing your browser to the article at http://www.hearinglosshelp.com/articles/ototoxicupheaval.htm.

by Neil Bauman, Ph.D.

Here’s an interesting question I recently received. “I am hearing impaired and need a VCO cell phone. Can you help me?”

For anyone who doesn’t know about Voice Carry Over, VCO is a technology that allows people who cannot hear on the phone, but have good speech to use a phone. Here’s how it works. You dial the relay operator (711), and she connects you to the person you want to talk to. Then, when your party speaks, the relay operator types out what he says. You read this on the two-line display on your special VCO phone. To reply, you just speak in your normal voice. With VCO, you can use a phone, even if you can’t hear a sound!

Landline VCO phones are readily available, but, as far as I know at this time, there are no cell phones made specifically for VCO operation. However, all is not lost. You can still have cell phone VCO if you do the following two things.

First, you need a cell phone that is TTY compatible. (You may already have a TTY-compatible cell phone. If you don’t know whether it is TTY-compatible or not, ask your cell phone provider.) If you don’t already have a TTY-compatible cell phone, ask your cell phone provider which of their phones are TTY-compatible. For example, as of today, most, if not all, of Verizon’s new phones are TTY-compatible.

Incidentally, I suggest you stay away from Nokia cell phones as long as they require a special adaptor that the other phones don’t require. This is one extra part that can break down or get lost. As a result, you can make life simpler if you avoid Nokia cell phones at this time.

Second, you need a Krown VCO device. Krown has three devices that will work to convert a TTY-compatible cell phone into a VCO cell phone:

1. the PVCO
2. the PVCO-C
3. the PocketComm

I suggest getting either the PVCO-C or the PocketComm as the PVCO can’t plug directly into your cell phone. Instead, it has to be acoustically coupled. As a result, extraneous noise can get into the phone and mess up the signal.

The PVCO-C and the PocketComm both can be plugged directly into your cell phone’s headset jack (assuming that your cell phone has the standard 2.5 mm headset jack).

The difference between the PVCO-C and the PocketComm is that the PocketComm is also a full-blown TTY (teletype) as well as a VCO adaptor.

Since they both cost exactly the same ($189.00 plus $12.00 shipping from Krown), I’d suggest the PocketComm as you get more “goodies” for the same price. You never know when you might want full TTY capability in the future.

You can view (and purchase) the PCVO-C from Krown’s website at http://www.krowntty.com/html/products/pvco2.html. Likewise, you can view (and purchase) the PocketComm at http://www.krowntty.com/html/products/pocketcomm.html.

by Neil Bauman, Ph.D.

A lot of people say they hear “noise” in their ears, or that their ears are “ringing.” One lady wrote, “I’ve not seen much on how to deal with the constant noise in my ears. It has gone way beyond the ringing I so often see mentioned.”

That ringing sound, called tinnitus, is more of a stereotypical sound than a reality. I say my ears are “ringing,” but what I really hear is a high-pitched whine, or a low-pitched rumbling sound. Some people hear “crickets.” One person described hers as sounding like someone pounding on a piece of sheet metal.

The truth is, tinnitus has many different sounds. Tinnitus may be a ringing, roaring, rushing, beating, clicking, banging, buzzing, hissing, humming, chirping, clanging, sizzling, whooshing, rumbling, whistling or dreadful shrieking noise in our ears. To some people, tinnitus sounds like rushing water, breaking glass or chain saws running. All these numerous sounds come under the generalized heading of “ringing” or tinnitus.

To learn more about tinnitus and its many causes, point your browser to http://www.hearinglosshelp.com/articles/tinnitus.htm. However, if you are really serious about alleviating or eliminating your tinnitus, you need the specialized information contained in the book, “When Your Ears Ring–Cope with Your Tinnitus–Here’s How.” You can get a copy at http://www.hearinglosshelp.com/products/books.htm#tinnitus.

by Neil Bauman, Ph.D.

“Sally” wrote:

I am considering buying new hearing aids as mine are about 10 years old and are not digital. Are the digital ones really that much better? Also, what features would you suggest I look for? I’d appreciate your thoughts on all this.

Here are my views on this issue. As far as the quality of sound goes, digital hearing aids do not produce better sound than analog hearing aids. This was proved by one audiologist. He recorded speech through a digital aid and an analog aid. He then played these two examples to a group of fellow audiologists and asked them to vote. Surprisingly, they voted for the analog aid as producing the better sound. So don’t listen to all the hype that says that digitals produce so much better sound.

However, digital aids do have some nice features that analog ones don’t have. Besides it is getting harder and harder to find someone selling analog aids now.

Here is the list of features you should look for in your new aid–depending on your hearing loss and your typical listening environment.

First, you want hearing aids with telecoils (t-coils). If they don’t have t-coils, don’t get them. That’s how important they are–even if you don’t know what a t-coil is or how to use it at this point. Just make sure you have them. Telecoils allow you to couple your hearing aid with a great variety of assistive listening devices to give you unbelievably clear sound.

Second, if you get automatic anything, such as automatic t-coils, automatic volume control, automatic adaptive programs, etc., make sure you can manually over-ride each automatic feature. If you don’t, you could be very sorry. If you find you don’t often need to manually over-ride your new hearing aid’s computer, great, but you will be able to do so when you need to.

Third, you should get either directional microphones and/or noise-canceling microphones on your hearing aids. This can really help you in noisy situations. Some hearing aids are much better in this regard that others, so you have to try them out to see which works the best in your situation.

Fourth, you want excellent wide band dynamic compression or the equivalent. This feature amplifies softer sounds yet, at the same time, doesn’t allow louder sounds to become so loud they hurt. This is very important if you have severe recruitment like I have. However, watch out, some hearing aids are set so that they cut the sound out at times, which is very disconcerting and totally unnecessary in my opinion. Others distort compressed sounds quite a bit. Again, try your aids out under different conditions and have them adjusted as many times as needed to get the compression set to work properly for your ears. If your audiologist can’t do this, dump those hearing aids and try someone else.

Fifth, get hearing aids with feedback suppression, especially if your present hearing aids squeal a lot. This is cool feature, but be careful, there are different types of feedback suppression. Some just reduce the amplification at that frequency. You don’t want this, or else you’ll not be able to hear any sounds at that frequency. Good feedback suppression circuitry senses the feedback condition, and suppresses it without affecting the sound quality.

Sixth, make sure your new hearing aids have plenty of reserve power so if your hearing deteriorates further, you don’t have to buy new aids in a year or two. For example, my hearing aids are now 9 years old, yet I still have plenty of reserve power, even though my hearing has been dropped quite a bit in the last two years.

There are a number of other features you should consider, such as the number of programs the hearing aids have–typically 3 or 4; the number of channels they can be adjusted by–typically somewhere between 7 and 16; whether they have direct audio input (DAI) connections; whether they have integrated FM receivers, and the list goes on.

However, the first six things are those features I’d particularly want.

In addition, you want to get your hearing aids from a reputable company, and you want a good audiologist that is willing to work with you to program them to work the best they can for you.

by Neil Bauman, Ph.D.

A lady wrote:

I’ve been reading your books with interest and read that eventually the balance system is irreversibly damaged in most people with Meniere’s disease. I was wondering how people cope with mobility at this point. Is a cane or walker still helpful or does it mean a wheelchair? What do most people do?

Meniere’s disease can indeed damage the balance system in your ears. However, even totally destroying this balance system (called the vestibular system) doesn’t leave you flopping around on the floor like a jellyfish. This is because we have, not one, but three separate balance systems. Thus when one quits working properly, our brains rely more on the other two to help keep us balanced.

You can read about our three balance systems (vestibular system, visual system and proprioceptive system) and how they all work together to keep us upright in my article at http://www.hearinglosshelp.com/articles/balancesystem.htm.

Furthermore, each of these balance systems consist of two (redundant) subsystems. For example, there is a separate vestibular (balance) system in each of our inner ears. Thus, if one side is damaged or destroyed, the other side takes over and allows us to keep our balance.

In fact, this is exactly what happens in the vast majority of people with Meniere’s disease. Meniere’s disease typically only attacks one ear. Thus, most people with Meniere’s, unless they are having a severe vertigo attack where they can’t even sit up, use whatever balance systems are still working and manage to get around reasonably well. Their brains learn to adapt and pay more attention to any balance system information that is still reliable.

However, people with damaged vestibular systems are not as steady on their feet as they once were. In fact, if the damage is severe in both ears, they may lurch and stagger–much like the proverbial “drunken sailor.” Such people often use canes or walking sticks to help steady themselves. Even so, I don’t know of any that are confined to wheelchairs solely because of their Meniere’s.

If you have damaged both vestibular systems, you will have a much more difficult time when it is dark (when you can’t use your eyes effectively) or when walking on uneven or soft ground (which messes up your proprioceptive system). Under such conditions you may have to “hang on” to a wall or another person.

To learn more about Meniere’s disease and what you can do about it, point your browser to http://www.hearinglosshelp.com/products/books.htm#menieres_disease.

by Neil Bauman, Ph.D.

Did you know that people born with extreme reverse-slope hearing losses, such as I have, generally have perfect speech? In contrast, people born with severe ski-slope hearing losses often struggle to produce acceptable speech, even after years of extensive speech therapy.

One lady told me: “My son has a hearing loss pattern similar to yours, and likewise has similarly-good speech.” Then she asked: “Could you explain how this works?”

Be glad to. Here is the secret why some people with severe hearing losses have perfect speech, while others with similarly-severe losses have “deaf” speech. Before I begin, let me explain the difference between a ski-slope loss and a reverse-slope loss. Both of these losses get their names from the shape of their curve on an audiogram.

The ski-slope loss is the common type of hearing loss most hard of hearing people have. A person with a ski-slope loss has an audiogram that looks like a ski hill–with the top of the hill on the left and sloping steeply down to the right. This means the person typically hears low-frequency sounds reasonably well, but cannot hear high-frequency sounds much if at all.

In contrast, a reverse-slope loss has the ski hill on the right and slopes steeply down to the left. Thus, this person doesn’t hear low-frequency sounds well, but has close to normal (or even abnormal) high-frequency hearing.

Now let’s link these differences to speech. I’m going to oversimplify things a bit so you can see how this works. Lower-frequency sounds (such as the vowels) give speech its volume. When you think about it, you’ll realize that the vowel sound is the loudest part of each syllable in English words.

High-frequency sounds (such as many of the consonants–but not all) give speech most of its intelligence. By this I mean that if you only hear the vowels, you hear a person talking, but it sounds like so much gibberish. However, by adding the high-frequency sounds, you make speech understandable or intelligible.

Lets take as our example the word “stop.” Stop is composed of 3 voiceless consonants–actually just air coming out of the mouth without any sound produced by the vocal cords–and one vowel that actually produces vocal sound. Thus:

S – air hissing between the teeth–a very high-frequency sound.

T – a burst of air released from behind the teeth–another high-frequency sound

O – a loud vowel sound produced by the vocal cords–lower-frequency sound.

P – a puff of air from the cheeks forced between the lips–another higher-frequency sound.

Now, if you have the typical ski-slope loss, where you hear low-frequency sounds quite well, and do not hear high-frequency sounds, when someone says the word “stop” all you hear is the short “o” sound, which sounds like “awe,” not “stop.”

However, if you have the extreme reverse-slope loss, where you don’t hear the low-frequencies well, but have excellent high-frequency hearing, you would hear the voiceless sounds of the “s,” “t” and “p” and, because the “o” is a loud sound, you would likely hear a bit of it too. Thus, you would hear the whole word correctly–assuming it was loud enough for you to hear it in the first place.

Now, since you hear all the individual sounds in this word, you also naturally produce them correctly when you speak. Thus, people with extreme reverse-slope losses typically have perfect speech without taking any special speech training, even though they actually don’t hear much speech unless it is amplified.

In contrast, the person with the typical ski-slope loss hears just the short “o” sound, so that is what they repeat. Consequently, their speech is “flat”–what I call “deaf” speech.

People with ski-slope losses typically need extensive speech therapy in order to learn how to make “voiceless” sounds such as the “s,” “sh,” “ch,” “t,” “th” and “f” sounds that give so much of English its intelligence. Such sounds are not easy to produce correctly if you can’t hear them. (Think how difficult or impossible it would be to learn to whistle a tune, or even whistle at all, if you couldn’t hear any of the sounds you were trying to produce.)

These voiceless sounds depend so much on aural feedback–meaning you listen to the sound you make, and if it isn’t “right on,” you immediately correct it. If you cannot hear these sounds, you don’t get this feedback. Consequently, you don’t correct these sounds. The result is poor speech.

Incidentally, if you have a reverse-slope hearing loss, many people will refuse to believe you can’t hear them because of your perfectly normal speech. It happens to me all the time.