Nov 2017 The Gladstone Observer

INSPIRATIONAL. Definition: Making you feel full of hope or encouraged.

That's exactly what each and every nominee made you feel at the 2018 Queensland Australian of the Year ceremony held in Brisbane's grand Old Museum Building. In particular, Seniors News was there to report on the Senior of the Year category. The four nominees came from areas ranging from science to humanity, but they all shared an overwhelming desire to make people's everyday life better. These people did not need awards, notoriety or headlines, but gained satisfaction from bettering the lives of their fellow human beings.

Dr Dimity Dornan AO claimed the Queensland Australian Senior of the Year award for her work helping deaf children learn to listen and speak. She founded the Hear and Say Centres more than 25 years ago and has since championed the advancement of bionics, including extraordinary creations such as bionic eyes, limbs, nerves and more. Dr Dornan said the Hear and Say Centre for children who are deaf/hearing impaired and their families was born on July 6, 1992. She explained the impetus came after a private group of ear, nose and throat surgeons, and a group of audiologists wanted to start a cochlear implant program in Brisbane and she was asked to join with them to take care of pre-implant preparation and post-implant habilitation. In her own words, Dr Dornan wrote: "It was about this time, the point of no return, when I chanced upon my future motivating words, those of pioneer aviator Amelia Earhardt: 'Courage is the price that life extracts for granting peace’. "I took courage and set up a charity board consisting of about twenty representatives including hearing professionals, business, finance, education and medical personnel."

Dr Dornan has gone on to establish Hear and Say WorldWide, to expand the opportunities for deaf children in developing countries as well as several national and global research collaborations. As a past chair and co-founder of First Voice, she has played a significant role in raising the global profile of hearing health. Recognised internationally for her work, Dr Dornan is now building Human Bionics Interface, a global network of bionics thought leaders, researchers, clinicians, businesses, start-ups and investors to accelerate the delivery of bionic solutions that will address previously untreatable medical conditions.

 

Nov 2017 IEEE Spectrum

 lasersTwo of the vertical cavity surface-emitting lasers used in a new optical cochlear implant are shown here next to a matchstick. Each laser rests within a sapphire box.

Blinking lights could soon serve a whole new purpose. Recent findings have led German, Swiss, and Austrian researchers to develop a prototype hearing implant based on the concept that a series of laser pulses can trigger auditory signals from hair cells located within the inner ear.

An array of near-infrared lasers can produce a soundwave using what’s called the optoacoustic effect, the researchers believe. In their device, tiny vertical cavity surface-emitting lasers, which pulsate light at a spectrum of 1.4 to 1.9 microns, act upon the fluid within the nautilus-shaped cochlear canals in the inner ear. Basically, the infrared light is absorbed by the liquid inside the cochlea. A small fraction of the liquid will expand due to heat. If that happens rapidly enough, it generates a soundwave inside the duct of the cochlea. This stimulates or moves tiny hair cells located there, which in turn sends a signal along the auditory nerve which the brain understands as sound.

Over the last three years, the researchers have built tiny laser arrays and completed tests on guinea pigs, finding they could generate action potentials, the signals carried by auditory nerves, using vertical laser light and the optoacoustic effect. They compared stimuli in the guinea pigs from the laser array with an acoustic click. Both generated nerve signals matching in form and amplitude.

It is still early days but the hope is that this technology can be used to replace or improve hearing devices and cochlear implants, says Mark Fretz, a physicist and project manager at the Centre Suisse d’Electronique et Microtechnique (CSEM), an applied research and technology nonprofit based in Alpnach, Switzerland. The next steps would be to improve the energy efficiency of the device and make it smaller. Individual components developed for the prototype—including a tiny sapphire case for hermetically sealing implanted body sensors and an improved laser lens design—may also find other uses, such as allowing laser light to shine within the ear to improve balance.

Today’s cochlear implants rely upon sets of electrodes threaded through the skull to the inner ear. The electrodes create an electrical field which stimulates the cochlear nerve, converting ambient sound into electrical signals that the nerve carries to the brain. It’s difficult to focus an electrical field, however, so it tends to flow into other tissues, generating noise. There are still design challenges for the prototype, including how to solve issues with power consumption and how to shrink the components. A body implant cannot generate too much heat or it will damage cells and tissue around it. The researchers found that creating many, many pulses of 50 nanoseconds each essentially replicates a single burst of 50 microseconds and reduces the heat that would be generated by sustained shining. That burst is what’s needed to create an acoustic compound action potential—a signal that travels down an auditory nerve.

Nov 2017 Huffington Post

Tracy MurphyTracy Murphy, Au.D., a member of the American Academy of Audiology Board of Directors

In September, I was contacted by a representative of the American Academy of Audiology, who wrote that the AAA “is working on educating the public of the many factors that can contribute to hearing loss and the seriousness of that loss.” The message recounted the story of Teresa Jennings, who was diagnosed with Lyme disease in 2011. “As if chronic fatigue and other Lyme symptoms were not enough, within a year and a half after her diagnosis, her hearing in both ears began to severely decline.” Her story continues:

“Jennings started treatment at a clinic in Washington, D.C. where she traveled from Illinois every three months for medical care. When her hearing first began to decline, she saw several audiologists for hearing aids but the cost was not affordable so she went to a large, national big-box discount store and purchased hearing aids.

“After wearing the hearing aids but struggling to hear sufficiently, Jennings finally decided to again see an audiologist in 2015 and she found one in Highland Park, Ill. She is the executive director of the Barrington Park District in Barrington, Ill., where she has been since 1992. Her hearing loss was having a serious impact on her work and her confidence. She was also starting to experience depression. The Highland Park audiologist was willing to work with Jennings on a payment plan. Because her Lyme medical expenses were so high and she’d met her deductible, her insurance covered some of the cost. With this financial assistance and flexibility, Jennings purchased hearing aids and suddenly realised the tremendous difference—she could actually hear! She took out a loan to pay off the balance.”

Tracy Murphy, AuD, is an Illinois-based clinical audiologist who works with North Shore Audio-Vestibular Lab and a member of the American Academy of Audiology Board of Directors. Murphy is the audiologist who treated Jennings.

Murphy referred Jennings to an ear, nose and throat (ENT) specialist, who ordered an MRI to rule out a brain tumour or other brain-based cause of hearing loss. “Since the hearing loss was so rapid, which is unusual, we just wanted to rule out other causes,” Murphy explained in an email. “The MRI was negative and it was determined that Jennings had neurological Lyme. Many Lyme patients lose their hearing from the disease,” Murphy said. “Teresa’s hearing loss was severe to profound.”

I spoke with Murphy by phone in September to discuss her knowledge of Lyme-related hearing loss. “There’s a huge connection,” Murphy said. “And one thing we say in our practice is, ‘if we’ve seen one patient with Lyme disease, then we’ve seen one patient with Lyme disease.’ There is no template to the disease. Especially if it goes untreated for a long period of time, there’s no way to know how it’s going to affect somebody,” Murphy said.

I explained my personal experience, beginning with moderate fluctuating hearing loss in my left ear shortly after I was treated for Lyme disease at age 19, and its progression to profound, total loss of hearing, often accompanied by loud tinnitus and ultimately by vertigo attacks and a diagnosis of Meniere’s disease.

“Some research shows or suggests an association between susceptibility for autoimmune issues in reaction to Lyme disease. I don’t know how hard and fast that stands, but it is something that’s talked about. So there’s that question. As far as hearing loss, it could be anything. It could be asymmetric—in your case, it was on one ear, it was unilateral. It can fluctuate. Vertigo can certainly be a symptom. It can affect every system in your body, not just hearing loss. It’s really a frightening disease from a global standpoint in terms of what it can do to your body. And the deer population growing, I think it’s becoming much more prevalent. Did you have that bull’s eye target, that red rash, when you were diagnosed with Lyme disease?”

“I did,” I told her. “I’m 39 years old now. When I was first diagnosed, I was 19. I don’t actually have much of a memory about it, but my mother tells me that I had ‘a really bad flu.’ She took me to the doctor, and the doctor called her into the exam room and said, ‘I want you to look at this rash on his back. That’s Lyme disease.’ So that stuck out in her mind because she thought it sounded so exotic. So I was kind of quote-unquote fortunate in that I did have a rash and so the first diagnosis was easy and definite.”

Since I was diagnosed with Meniere’s disease—a progressive, irreversible hearing disorder—and then recovered my hearing and experienced no further vertigo episodes following antibiotic treatment for Lyme disease, I wondered whether audiologist pay attention to non-hearing-related symptoms that co-occur among their patients.

“Yeah,” she said emphatically. “An audiologist has a huge responsibility to draw that information out. Part of how we approach hearing loss is as a symptom of something else going on. My personal opinion is that people are too often diagnosed with something like Meniere’s disease or Meniere’s syndrome when that really probably isn’t the case, but I think it’s easy for physicians to want to find an answer and lump patients into a category so they can treat them. There’s a responsibility on the patient no matter what specialist they’re seeing to be an advocate for themselves and report the symptoms they’re having, but every healthcare professional including an audiologist has a huge responsibility to take a very thorough case history and put those pieces together. Because when you’ve got flu, malaise, headache, fever—you may not have the rash—audiologists are aware of Lyme disease and have a responsibility to refer elsewhere, especially with the hearing loss. And not just with Lyme disease. With any pathology that is found.”

What about, I asked her, a patient like me who had a wide array of other health problems? I have always been anxious filling out medical intake forms because I know through experience that many doctors react to seeing so many unrelated boxes checked—neurological problems, anxiety and depression, rashes, allergies, etc.—by assuming that their patient is a hypochondriac. I’ve been asked by more than one doctor, for example, why I wrote down neurological symptoms on my intake form when I was not at a neurologist’s office. “Because,” I told these doctors, “your forms specifically ask for this information and I don’t like to lie.” I’ve also been asked by a neurologist why I mentioned joint pain and rashes, when that’s not his specialty. Same answer. “Because you told me to tell you all of the life-affecting symptoms I have had in the past few years, and those have affected my life. If you only want the neurological ones, that’s fine, but you didn’t specify that and I thought the others might be relevant.”

So I asked Murphy: When you see tons of boxes checked on an intake form, do you sometimes see this as a “trouble” patient or a potential hypochondriac? “Hmm,” she said. “That’s a really good question.” I was a little afraid of what might follow, but it sounded like it was going to be forthright. “I guess,” she said, in 24 years of practice, I’ve never witnessed a patient that I believed was a hypochondriac. Your symptoms are your reality, and part of my job as an audiologist when you come to me and you have this list of symptoms is to figure out why you’re feeling the way you are and to get you to the people who can help figure it out. In the case of Lyme disease, what I find unfortunate is that there’s a blood test that can help diagnose it. And I’m not a treating physician, I’m not an MD, but I would think that for a physician lab work would be the first thing to do.* I think Lyme is often overlooked or easily dismissed. And your story is a perfect example. You need to be your own advocate. I’m sure you have your medical history documented pretty thoroughly in terms of when symptoms started and all of that. Nobody can argue with the fluctuating hearing loss. Nobody can argue with all of these neurologic symptoms, and these are the patients I love to work with because I want to help find an answer to what’s going on. So you can be persistent, and if any provider doesn’t seem to be hearing what you’re saying, then you need to see a different provider. Since Murphy mentioned blood tests, I asked whether she was aware of the two-tiered Lyme disease blood tests’ notorious shortcomings. Varying studies have shown the sensitivity of the two-tiered testing process recommended by the CDC to be between 18% and 67% sensitive—meaning that many patients who live with Lyme disease will receive false negative test results. Virginia and Maryland, states profoundly affected by Lyme disease, have passed laws requiring physicians to inform patients about the insensitivity of the blood tests as a result of advocacy by the National Capital Area Lyme Disease Association, or NatCapLyme.

“That I did not know,” Murphy said. “In my job, I would refer you to have a physician order it.”

I asked Murphy how commonly she sees Lyme disease patients in Illinois. “I don’t see it that often in practice,” she said. “We don’t see it as extensively as in some other parts of the U.S. But we have a handful of patients that we’ve treated.” I had recently met someone who lives in a part of the country where Lyme disease is not thought to be common, and she was told by multiple doctors that she can’t have Lyme disease because, the doctors said, “we don’t have it here.” She thought she may have acquired it during travel. “Oh,” Murphy said. “It’s everywhere.”

Just a few days ago, on November 19, the CDC issued a report cautioning healthcare professionals and the public that despite CDC surveillance maps that suggest Lyme disease primarily affects the United States east coast and Great Lakes region, “clinical suspicion of Lyme disease in a patient should be based on local experience rather than incidence cutoffs used for surveillance purposes,” because Lyme disease has begun to “emerge in neighbouring states.” In other worse, Lyme disease may be contracted even in areas where it is thought to be uncommon. The Bay Area Lyme Foundation has discussed how the CDC’s problematic geography-dependent case definition makes life difficult for Lyme disease patients and the doctors who treat them in states such as California. Author Amy Tan (The Joy Luck Club) has been outspoken about her experiences with Lyme disease, including that “the doctor said it was impossible for me to get Lyme in California.”

Since my hearing loss came and went for years before becoming generally poor with fluctuating-volume tinnitus, I wondered whether hearing loss can be related to seasonal allergies in any way, or whether it might come and go with seasons for any other reason. “That’s a hard question to answer,” Murphy said. “I’ll answer it the best I can. There are people who have hearing loss that fluctuates, but they don’t have their hearing tested seasonally to see if it fluctuates seasonally or not. So if someone says that they have fluctuating hearing loss, I want to see it documented that it’s fluctuating. So that’s a tough one. There are things seasonally that can affect one’s perception of one’s hearing, such as allergies that causes a clogged sense of hearing. That’s usually a qualitative change in hearing and not necessarily a quantitative change in hearing, which is again why I want to see the test results.”

“But,” Murphy said, “there’s a large group of people who can have fluctuating hearing loss. And whether it fluctuates on a seasonal basis or a monthly basis, my suspicion when I hear that—and you might find this interesting—is that it typically comes from some sort of an autoimmune process. And I find that link between autoimmune susceptibility and hearing loss interesting as well. And the link between autoimmune and Lyme disease, hearing loss associated with Lyme disease can fluctuate. It can also fluctuate with Meniere’s disease, and so I can see why they wanted to put you into that category. But that’s why that thorough history going back as far as you can can be critical. I don’t often see hearing loss where it’s a sensory neuro-hearing loss seasonally with someone unless it’s someone who has documented fluctuating hearing loss that changes with barometric pressure. But that would fluctuate anytime there was a change in barometric pressure and not just spring.”

I told Murphy that her suggestion of an autoimmune connection was particularly interesting. I was diagnosed with mast cell activation syndrome/disorder (MCAS/MCAD), which can be associated with Lyme disease. Treatment with a combination of H1 and H2 antihistamines has had a profound positive net effect on many of my symptoms. Doctors such as Elena Frid, a neurologist and neurophysiologist who treats Lyme patients, believe that autoimmune illness often is a major component of Lyme disease. Autoimmune disease as a component of hearing loss “is being introduced” to the audiology field “in terms of what research is being done,” Murphy said. “Audiologists are diagnosticians for the most part, and we work on the rehabilitation of patients. But in terms of medical treatments and studies involved in what can help or hinder improvement—we might be involved in the testing to see if it’s improved. I can’t answer how much is going on in terms of Lyme disease specifically. We were just at a regional conference in Chicago and one of the ENTs that I work with presented some case studies and specifically highlighted Lyme disease and its effects on hearing. And we are making audiologists aware of that as an issue, and it does have to be ongoing and pervasive.”

Murphy wasn’t aware of much of the controversy surrounding Lyme disease, which in many cases lead doctors to dismiss patients who have been treated for Lyme disease and then never recover. These patients are determined to have “post-treatment Lyme disease syndrome,” which according to the CDC occurs after the infection has been eradicated for unknown reasons. Among recommendations for patients, the CDC recommends that patients “talk with a counsellor who can help you find ways of managing your life during this difficult time.” As a result of this sort of language, many healthcare providers infer that these patients may be hypochondriacs, may be attention seeking, or may be mentally ill and in need of psychiatric interventions. Lyme disease specialists, on the other hand, cite hundreds of studies documenting Lyme disease-causing bacteria that persist in laboratory settings following antibiotic treatment, and believe that many patients require longer-term and different antibiotics to fully cure their infections, and call for increased federal research into the nature of Lyme disease and how to treat it.

Murphy said that Lyme patients who are not physically ill “hasn’t been my experience…but that underscores my comments at the beginning of this conversation. If you’ve treated one patient with Lyme, you’ve treated one patient with Lyme. It is not a cookie-cutter disease in terms of symptoms, in terms of how it affects one’s life, in terms of how pervasive the sequalae of that disease will be for an individual. Ideally, you’re going to take your antibiotics and it’s going to go away before that later-stage diagnosis when it’s going to have those neurologic symptoms, cardiac symptoms, pain and all of that. But you can’t cookie-cut any diagnosis because one thing I’ve learned is no two patients are the same, including how they respond to treatment. I can take that down to a hearing loss level. Someone who has age-related hearing loss is going to respond very differently.”

In my case, I was diagnosed with Meniere’s disease and told by an ear, nose and throat specialist that my hearing loss was progressive, potentially to the point of total deafness, and likely irreversible. The hearing in my left ear has been almost totally restored following antibiotic treatment for Lyme, and I haven’t had a single vertigo attack since then. Hearing loss was among the least severe and therefore among the least of my health-related concerns when I was being ravaged by Lyme disease symptoms.

Murphy underscored the importance of not neglecting auditory health, however. “There are correlations,” she said,” between hearing loss and early onset dementia.”

Whether or not you have any tickborne illness, if you have significant hearing loss or balance control problems, visit the American Academy of Audiology website at audiology.org and click “find an audiologist.”

Nov 2017 Fredricksburg Today

Rebekah Funkhouser has plenty to say about UMW. The Washington Guide tells prospective students about scholarships, financial aid … and the time she saw a live camel crossing Ball Circle. But it’s the first thing she shares with the groups that gather for tours across campus that makes her own journey through college so personal. “I have a cochlear implant,” she says. “If I don’t answer your question, ask me again.” The device restored the hearing she lost as an infant, but it took years to polish her speech. Now, with an internship at one of the country’s top hearing research centres under her belt and help from UMW’s Office of Disability Resources, she’s found a new voice. And in the career she plans to pursue in audiology, she’ll help others find their voices, too. “I just want to be an advocate for spoken language,” said Funkhouser, a junior psychology major with a linguistics minor. “I think it’s completely possible for hearing-impaired people to learn how to talk and talk well.”

She was just 9 months old when bacterial meningitis – the country’s second most common cause of auditory loss – took her hearing, forcing her parents to fit her with not one but two hearing aids. When they failed to work, doctors placed a cochlear implant inside her head behind her right ear, to stimulate the auditory nerve. After the hours-long surgery was over, Funkhouser’s battle was just beginning. For years, she would climb in the car with her mother on Saturdays for the two-hour trek from their home in Mount Jackson, Virginia, to an auditory specialist in Richmond. Little by little, through techniques like imaginary dialogue with dolls and stuffed animals, she perfected her speech. “My therapists always wanted me to be more and more specific,” said Funkhouser, who owned a town full of conversation-inducing Barbie gear – dream house, hotel, airplane, you name it. “Speech therapy pushed me to become an extreme storyteller.”

From kindergarten through high school, she blossomed in her small tight-knit community, but the cafeteria and other loud places posed problems. Music class was “a nightmare,” she said. Restaurants and concerts – think Justin Bieber, Darius Rucker and Miley Cyrus – take the frustration up one more notch. So when Funkhouser headed to college, she made it a point to learn what tools each school could offer. Mary Washington – with multiple resources, including the TypeWell system, where professors wear microphones that send lectures to off-site transcribers – rose to the top. Funkhouser was a sophomore when she landed her first internship, a stint with her childhood auditory therapist, where “it was really cool to be on the other side of things,” she said.

A second internship this past summer – this one at the Oregon Hearing Research Centre in Portland – took her over the top. Of the hundreds who applied, only two dozen were chosen by the facility, where many researchers, including Funkhouser’s mentor, Dr. Lina Reiss, have hearing loss themselves. “It was a really unique experience,” Funkhouser said. “I got to learn alongside someone who’s had the same hardships as me.”

As she conducted her own study, examining the perceptions of people with both cochlear implants and hearing aids, she referred to the notes she’d hauled across the country. Thick with information about data collection, ethics, presentation and more, the lessons she’d learned in UMW Associate Professor of Psychology Hilary Stebbins’ research methods class “came up over and over again.”
“She’s an extraordinarily driven student,” Stebbins said of Funkhouser. “She doesn’t just take every opportunity, she goes out and finds opportunities to do really impressive things.”

Like joining a faculty-led program to Venice and Croatia, traveling to Central America with Students Helping Honduras, joining next semester’s Three-Cities study abroad program in Italy, and prepping for grad school. “Dr. Becky” has a nice ring to it, said Funkhouser, who plans to pursue a degree in in speech therapy or audiology. For now, she’s pouring her energy into enjoying her time as an undergrad. “I love bragging about how awesome Mary Washington is,” she said. “It’s really fun to take people on tours and tell them about the school and all we have to offer.”