Tinnitus or noise felt to come from the ears or head can be a debilitating condition affecting those without hearing loss but is more likely to occur in those with some form of hearing loss. It’s estimated that 70- 85% of the hearing impaired population experience some variety of tinnitus. The prevalence rates are higher with increased hearing loss because it is a deficit in properly functioning nerve fibres that enables other nearby nerve fibres to stimulate the brain even without a sound being present. It is normal for all of us to experience episodes of tinnitus and it’s often more pronounced after listening to loud noises / loud music. However, when the tinnitus is present constantly or affects sleep or an individual’s enjoyment of life, it is not considered normal. Often when people are stressed or tired, tinnitus perception can be heightened and can be more noticeable during quiet times or at night. Current research indicates that the use of amplification devices such as hearing aids can help diminish tinnitus disturbance in people with hearing loss. This is because hearing aids amplify external noise which can help “mask” the tinnitus. Hearing loss may change brain patterns which could be causing the tinnitus. Auditory stimulation through hearing aids could help re- establish proper functioning of the hearing nerve, pathways and brain. Also, because hearing aids help improve understanding of speech they decrease the “strain to hear” phenomenon and decrease the attention given to the hearing problems and tinnitus. Some studies report that in approximately 50% of new hearing aid users, tinnitus is reduced with hearing aid use. Many hearing aids now also have an in-built “tinnitus masking” feature that generates an external sound through the hearing aid which can be helpful.

The best people to talk to in regards to tinnitus and reducing it are Audiologists with a special interest / training in the area. Unfortunately, GPs are often not aware of treatment options or the cause of the tinnitus. Often people are told that “nothing can be done” to alleviate tinnitus but this is no longer the case. Tinnitus counselling, use of in-built tinnitus masking programs in hearing aids, medical treatments like the Neuromonics Tinnitus program (invented here in Australia) and Tinnitus Retraining therapy are all options in addition to hearing aids and some options are better than others depending on the nature of your tinnitus and your hearing levels. If your tinnitus is persistent and only in one ear, or is accompanied by dizziness and/or balance problems, consult your GP or audiologist to ensure there is no underlying medical condition causing the symptoms. 

The name of the test is the Listening in Spatialized Noise - Sentences test, or LiSN-S. It is available in English-speaking countries from Phonak. LiSN-S is used to diagnose a specific type of CAPD known as spatial processing disorder, or SPD. This is a reduced ability to selectively attend to sounds coming from one direction and suppress noise coming from other directions. You might expect a child to have SPD if they are having difficulty understanding speech in noisy situations, such as in the classroom. The cause of SPD is so far unknown, but it is more likely to be present in children who have had prolonged or repeated middle ear infections (otitis media) during early childhood, despite full recovery of their hearing thresholds. Research at NAL with the LiSN-S has also shown that all people with a sensorineural hearing loss experience some degree of SPD. As with any form of CAPD, children with SPD can have an FM system fitted to improve the signal-to-noise ratio. NAL has also developed the LiSN & Learn auditory training software to remediate this condition in children with normal hearing thresholds. Research and clinical trials have found, for all children who completed the training, no evidence of SPD remaining by the end of the training. The LiSN & Learn is available directly from the NAL website at http://shop.nal. gov.au/store/lisn-learn.html

You often hear the little ones on flights crying, especially on descent because of ear pain associated with an inability to equalise air pressure. Problems with regulating ear pressure is common and can be as high as 25% in children and 5% in adults. People with upper respiratory infection, allergies causing congestion or middle ear problems are more likely to have trouble equalising their ears when flying because their pressure equalisation tubes (Eustachian tubes) are typically not functioning at their optimum. Every few minutes when we swallow, talk, chew or yawn, this closed tube opens and allows air in and out of the middle ear space. In a normal functioning ear, the pressure of the air behind the ear drum is equal to atmospheric pressure. For most people these tubes do a good job of keeping the pressure in the middle ear spaces equal to the atmospheric pressure inside the plane and they have little if any discomfort or prolonged hearing issues.Chewing, yawning or performing the Valsalva manoeuvre (blocking the nose and blowing into a closed mouth) can help to equalise the pressure and often a “popping” sensation is described when the Eustachian tube opens and the pressure is equalised. For others flying can be a painful experience. Their Eustachian tubes can be blocked and when the plane takes off the atmospheric pressure becomes lower than the pressure of the air behind the eardrum causing the eardrum to bulge outwards. On landing, the eardrum bulges inwards and often the Eustachian tube is “locked” up to the extent that even the Valsalva manoeuvre is ineffective. In extreme cases this pressure build up can result in a burst eardrum. In children, the Eustachian tubes often cannot regulate themselves as well as adults resulting in ear pain.Here are some suggestions that may assist in providing ear relief for travellers:1. Where possible never fly with an upper respiratory infection.2. Perform the Valsalva manoeuvre at ground level before take-off to check if your ears “pop”.3. If you consistently have ear issues when flying, consult your GP or audiologist to check if your eardrum appears normal and that your canals are clear of wax and debris. A tympanometer is used to assess the functioning of the middle ear system including the Eustachian tube.4. Your GP may recommend or prescribe nasal sprays for use prior, during or after a flight.5. During descent when the pressure change is greatest the Modern Medicine of Australia Journal recommends:- staying awake (Eustachian tubes do not open well during sleep)- yawn or make chewing movements (with or without food)- swallow fluids or suck a lolly (menthol or eucalyptus) and allow babies to suck on a breast/bottle- do the Valsalva manoeuvre6. Use special EarPlanes* earplugs during flight.7. In severe cases of middle ear problems or pain, grommets (tympanostomy tubes inserted in the ear drum) may be required.* EarPlanes are a type of earplug developed specifically for flying by the prestigious research centre the House Ear Institute. They are available for adults and children to help slow down the rate of pressure change. 

I was pleasantly surprised how effective they are when I used them recently. Typically I need to constantly chew, swallow and perform the Valsalva manoeuvre to reduce my ear discomfort and blocked hearing on flights but with the EarPlanes I experienced little pressure change. They are inserted into the ear canals when the seat belt sign goes on at take-off and removed at maximum altitude. The Ear Planes manufacturer recommends re-inserting their plugs an hour before landing rather than waiting for the seat belt sign to turn on and they can be removed again when the seat belt sign goes off.

Assistive listening devices are a useful supplement to many wearing hearing aids and / or cochlear implants. The most well known “wireless” assistive listening device is the FM (frequency Modulated) system. An FM system consists of a microphone, a receiver and a transmitter. The microphone is used by a speaker or teacher (when an FM system is used in the classroom) and is positioned very close to the speaker’s mouth.This signal is then transmitted to the hearing impaired person via radio waves to a receiver either worn on the body or connected directly to the hearing aid/cochlear implant. This analogue wireless transmission of a signal is fairly robust and the Australian Government has put aside an FM frequency for low power assistive listening systems to minimise interference from other radio users. FM systems help a hearing impaired person overcome:1. Distance effects2. Listening to speech in the presence of background noise, and3. Listening challenges in reverberant (echoey) listening environments. Most hearing impaired people would benefit from an FM system in some specific listening situations. FM systems are used for nearly all hearing impaired children here in Australia and Australian Hearing funds these devices. FM systems are compatible with nearly all hearing aid systems and all cochlear implant systems.Blue-tooth is a digital wireless solution which allows for direct communication between hearing aids and external devices that are blue-tooth compatible ie. Phones, TV’s, MP3 players and also from one hearing aid to another. Blue-tooth allows communication between different devices without the need for cords and wires through the use of short wavelength radio signals. This communication between aids could potentially result in better hearing outcomes and allows users to change volume and programme settings simultaneously in both right and left worn hearing aids. While many hearing aid systems can give users connectivity to bluetooth enabled devices, no cochlear implant or middle ear implant system has blue-tooth compatibility.

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