May 2021

Many adults who would benefit from hearing aids don't use them, thanks in part to cost and stigma. But less-expensive, over-the-counter solutions, as well as the popularity wireless earbuds, are helping accelerate adoption.

tech solutionsElectronics manufacturers are increasingly producing software and products that address hearing loss. Smartphone apps, earbuds, and soundbars help people understand real-time, in-person conversations, phone calls, and streaming media.  "It's remarkable that so many more tech companies are even thinking about people with hearing loss," says Joe Montano, a New York City audiologist and professor at Cornell University's Weill Medical College. Montano was pleasantly surprised to learn that big box retailer BJ's is now selling a "dialogue clarifying" soundbar that makes it easier for people with hearing loss to understand movies and TV shows by reducing the prominence of music and sound effects in the soundtrack.

Zvox AV157 soundbarZvox AV157 soundbar

The Zvox AV157 sells for just under $200 and has a dozen settings that reduce sounds other than dialogue. Swampscott, MA-based Zvox, which also makes low-cost hearing aids and noise-cancelling Bluetooth headphones, has been in the soundbar business since 2004. The AV157 has been a godsend for Dick DeBartolo, the 75-year-old MAD Magazine writer and gadget reviewer who describes his hearing as "not tremendous.” "I just found the Zvox AV157 really amazing at clearing up the dialogue," said DeBartolo. He described watching a scene in a movie recently involving someone who was about to be hung in an old Western town. The crowd that had turned out to witness the hanging was screaming, at which point DeBartolo hit 12, the most extreme of the dozen dialogue clarifying settings. "The crowd basically vanishes," said DeBartolo. "You just hear the people who are going to do the hanging talking, which is more important to me than hearing the crowd yelling."

My wife, who has severe to profound hearing loss, has found Caption Calls, a recently enabled accessibility feature on Google's Pixel phone, to be a huge help in her struggle to understand people on the telephone. The one drawback is that the recipient of her calls hears a short pre-recorded advisory that the conversation will be captioned and some recipients promptly hang up, thinking it is a robocall. But Google's accessibility team has been advised of this shortcoming.

controlAmong adults 70 and older who would benefit from hearing aids, only 30% have ever used them according to the National Institutes of Health, and that number drops to 16% among people aged 20 to 69. Two factors figure into that phenomenon, advocates say: stigma and cost. But recent legislative and technological developments promise low-cost and stigma-free solutions.

This includes substantially cheaper over-the-counter hearing aids approved by the federal government (but still caught up in bureaucratic red tape), as well as the emergence of wireless earbuds as an affordable way to compensate for mild to moderate hearing loss. These earbuds are usually controlled by apps on smartphones.

Asked whether there was widespread awareness of the apps and earbuds in the hearing loss community, Lise Hamlin, director of public policy for the Hearing Loss Association of America (HLAA), said, "I've been hearing some good chatter about it… People like the idea of using something that looks like what everybody else is wearing."

airpods proAirPods Pro 

"Fifteen to 20 years ago, nobody would be caught dead with anything sticking out of their ears and now, of course, it's a fashion accessory," noted Richard Einhorn, the former chairman of HLAA's board. "AirPods were designed to not only be visible but really visible. You're really making a statement when you walk around with these sticks in your ears. From the standpoint of people with hearing loss, this is fantastic news because it means that people are no longer embarrassed putting things in their ears in order to hear. It's a small step now to put something in your ears to hear better."

Einhorn is a composer and record producer who suddenly lost much of his hearing in 2010. He is now a US consultant for Jacoti, a Belgian company whose key executives have spent 30-plus years working on hearing technology like cochlear implants. Jacoti's technology—and that of its competitors—will turn wireless earbuds into de facto hearing aids with a self-administered hearing test and the ability of consumers or a professional audiologist to tweak settings to compensate for hearing loss in individual patients.

"It's going to enable millions of people to hear better for the first time," said Einhorn, who notes that the frequency range for wireless earbuds is far greater than that of hearing aids. The result is that music will sound much better on the earbuds than on hearing aids, which are optimised for speech.

Jacoti signed a deal with Qualcomm in October to include its software on the chipmaker's QCC5100 Series Bluetooth Audio SoCs. Jacoti's software will be licensed by headphone and earbud manufacturers, who will load it onto the chip during the manufacturing process. Consumers will then be able to run a hearing test app on iPhones and Android phones, after which Jacoti creates a profile for each ear so the earbuds can adjust noise levels. "For example, in a busy restaurant or even in an open plan office their technology is designed to deliver assistive listening for live conversations so that those with mild to moderate hearing loss can more easily participate in conversations around them," according to Qualcomm.

Chris Havell, Qualcomm's senior director for voice and music product marketing, said the company wants to see Jacoti technology in as many earbuds as possible. "If you're going to focus on hearing enhancement and have hearing tests on the phone and make adjustments in the earbud, you want to make sure that that is done correctly," said Havell. "That's why we're engaging with Jacoti, because as a medical devices company, that's their strength.” Jacoti's hearing test apps, though they are software and not hardware, are certified as medical devices in the European Union, and are registered with the FDA in the US.

Which Apps and Devices Actually Work?

Jacoti is not the only company whose mission involves using a smartphone app and wireless earbuds to help consumers with hearing loss. Search the iPhone and Android app stores and you'll find dozens of apps, including Ear Booster, Ear Scout, HearMax, Miracle-Ear, Hear Boost, Mobile Ears, Hearing Helper and Rogervoice. Some don't claim to be dedicated to ameliorating hearing loss but simply characterise their function as hearing personalisation or amplification. Many are free but Petralex, the product of a Moscow-based company, requires a $12-per-month subscription. A company spokesman says Petralex is installed on about 7,000 devices globally.

Mimi software, the product of Berlin-based Mimi Hearing Technologies, was used to test the hearing of more than 1.7 million people last year, according to CEO Philipp Skribanowitz. Like Jacoti's technology, Mimi can be used on Qualcomm's SOC and its hearing test apps are certified as medical devices in Europe. Mimi, which means ear in Japanese, licenses its hearing-assistance algorithms to smartphone and headphone manufacturers. The software is also available on a streaming app used by Rundfunk Berlin-Brandenburg, a German public broadcasting network.

Skribanowitz estimates that Mimi technology is currently on about a million devices and projects that in five years that number will grow to 100 million. 

The irony that earbuds, which are believed to be a significant cause of hearing loss in the young, are now being used to cope with hearing loss is not lost on Skribanowitz. "Twenty, 30 years ago, occupational [exposure] was a major cause of hearing loss but today consumer electronics is one of the biggest drivers of hearing loss," he noted. In the last several years, earbuds manufactured specifically for people with hearing loss have entered the market. This product line has been referred to as smart earbuds or hearables and, with the addition of sensors, can be used for medical monitoring and fitness tracking.

olive smart earOlive Smart Ear 

Tokyo-based Olive Union makes a $300 single earbud known as the Olive Smart Ear. It is classified as a personal sound amplifying product (PSAP), which exempts it from FDA regulation as a hearing aid.

Nuheara, an Australian company, makes the IQbuds2 MAX, a set of $319 "hearing buds" that have an algorithm used by audiologists to calibrate high-end hearing aids. The algorithm is licensed from the Australian government's National Acoustic Laboratories. But Nuheara is careful not to bill itself as a hearing-aid alternative. Perhaps that's a semantic splitting of hairs because the company does say it is focused on individuals with mild hearing loss.

IQbuds2 MAXiQBuds2 Max

"Our primary target customer is a 55-year-old person who recognises they have a little bit of hearing loss but aren't prepared to get a hearing aid," said David Cannington, Nuheara's chief marketing officer. "We're not trying to replace a hearing aid and we're not trying to replace the audiologist's role in helping people that have moderate to severe hearing loss. They have to go to see an audiologist. But we're using some of the technology that is typically found in a hearing aid in a consumer device."Cannington believes there will come a day when people wear a hearable for a good part of their day. "Whether it's to hear better or do biometric readings, that day will come," he said. "There's no doubt that there's going to be massive growth in this category."

iQstream TVIQstream TV

The company also makes IQstream TV, a Bluetooth box that allows wearers of Nuheara's hearing buds to independently control the volume of TV content. The device may appeal to couples in which one partner needs more volume due to hearing loss while the other partner does not.

As electronics manufacturers cater more to consumers looking to ameliorate their hearing loss or personalise their listening experience, we can expect all sorts of new products that will prove true that line in Paul Simon’s song "The Boy In The Bubble"—"These are the days of miracle and wonder." Expect this sort of innovation to move beyond personal devices to systems that deliver customised sound to people wherever they may be, from concert halls to sports stadiums. Miracle and wonder, indeed.

March 2021

Jaime  and Lexi VernonSongs for Sound is a nonprofit with a focus on providing hearing loss awareness and access to solutions and action through consultation.  It was founded by Jaime Vernon (R) after she received confirmation that her then13-month-old daughter, Lexi, (L) was deaf. After months of being misdiagnosed, months of lost opportunities, months of not knowing what was wrong, now there were solutions. Jaime Vernon decided to use lessons learned from those experiences to help others with hearing loss through information, assessment and resources. Missed hearing loss diagnoses are the most common story, she said.  “The real kicker for me was (that) I would rock her and sing to her during her whole first year,” Jaime said. “She would squirm and never put her head on my shoulder. I would cry. We didn’t connect.”

Lexi’s diagnosis was both a relief and a heartbreak, but hope arrived when the tot was deemed a candidate for a cochlear implant.  For 19 months, Lexi lived in a silent world, struggling to communicate. Then one day, while seated in a high chair in a strange room and distracted by the bits of snack Jaime was giving her, the audiologist turned up the sound and Lexi heard something.

“Lexi, Lexi,” her father said. “Lexi, it’s mommy and daddy,” Jaime said. 

The toddler paused, sat back as if to think and then searched for the sounds. Bubbles caught her attention while mom and dad continued speaking and pounding on the tray. Lexi flashed a broad smile that lit up her parents’ hearts and the entire room.  “Time stopped for a minute,” Jaime said.

Lexi showed no fear or consternation. Instead, her face glowed with confidence, curiosity and excitement. Two months later, while Jaime again rocked and sang a lullaby to her daughter, she felt a little head lean against her shoulder. 

With a thankful heart of a servant, that night Jaime founded Songs for Sound in memory of all the lullabies Lexi missed and so “no one will go without a lullaby.”  “I felt so much guilt (before the diagnosis) and the whole time she was carrying a burden I couldn’t do anything about,” Jaime said. “Her favourite sound is music. Now she can stream music into her implant.”

Lexi’s parents used numerous resources to help their daughter make up the lost 19 months of verbal and auditory growth. She attended the Mama Lere Hearing School at Vanderbilt University, where she learned listening, speaking, singing and reading skills, and a regular preschool, where she was exposed to “real life” activities.

To provide professional and accurate services, Songs for Sounds enlists the expertise, support and aid of experts in otolaryngology and auditory programs. Hearing tests are free, as are resources to access tools for an improved quality of life. “We have a digital system that will send information to an audiologist and help people navigate with our care team,” Jaime said. “We take information, do a profile.”

A mobile outreach unit travels to cities, towns and villages all over the country to test the hearing of babies, children, teens, adults, veterans and senior citizens and a team makes regular trips to Jamaica, which has no auditory services.  The mobile unit has six stations with auditory software provide by Dr. Antonio Curci, co-founder of MelMedtronics Inc. To date, Songs for Sounds has held 850 events, provided 26,600 hearing tests and enlisted more than 650 community partners to be a part of the care team.  “The mobile experience is a glass showroom on wheels,” Jaime said. “It opens up and you walk in. What we do is out of a place of love based on what’s best for them.”

Playing off the success of the mobile unit, Songs for Sounds is dreaming big, with plans for a brick-and-mortar facility, a safe place for those live with hearing loss and need a getaway place and a support system of others with similar issues, concerns and fears.

Lexi is now a fearless, driven, disciplined, competitive 13-year-old seventh-grader at Brentwood Academy. She pitches for the Birmingham Thunderbolts and the Brentwood Academy Middle School softball teams and is a nationally ranked pitcher in the Premier Girls Fastpitch class of 2026. Lexi also plays volleyball on a travel team. She aspires to attend Ohio State University — her mother’s alma mater — Clemson, Florida or UCLA and become a neurological surgeon.

Feb 2021 The Hearing Journal

As 2021 begins in full force with optimism for a COVID-19 endgame, economic upturn, and global healing, emerging developments in hearing technology promise a significant impact, particularly on helping audiologists and patients cope with the new normal. From improved artificial intelligence to new mask mode features, to smart earbuds, these developments are transforming hearing care provision—as well as patient expectations—as additional factors, including over-the-counter (OTC) access and diverse device price points, are entered into a complex equation.

technologyTo shed light on this interesting convergence of hearing care provision, technology, and pending regulatory changes, The Hearing Journal (HJ) hosted an online roundtable discussion with leaders from the American Academy of Audiology (AAA), Academy of Doctors of Audiology (ADA), and American Speech-Language-Hearing Association (ASHA). In this month's cover story, we continue our discussion with ADA President Victor Bray, PhD, ASHA's Vice-President for Audiology Practice, Sharon A. Sandridge, PhD, and AAA President Angela Shoup, PhD, along with HJ’s Editorial Board Chair Fan-Gang Zeng, PhD, as the discussion moderator, on optimising advances in hearing technology, including OTCs and personal sound amplification products (PSAPs), to support hearing care professionals and audiology practices this new year.

Dr. Zeng: What recent advances in hearing technology are you most excited about, and how would you incorporate these—including OTCs, PSAPs, and hearables—into your practice? Do you think these advancements are threats or opportunities?

Dr. Bray: My first answer is about audiology in general and separate from consumer electronics. The single and most important update in audiology is the seating of the new congress and resubmission of the Medicare Audiology Access and Services Act, which is jointly supported by ADA, AAA, ASHA, and HLAA. Practitioner status, direct access, and recognition of both diagnostic and rehabilitative roles of audiology are critical to the maturing of the profession and logically necessary to the proper outcome of the AuD degree transition.

More specifically to the question of consumer electronics, there have always been efforts underway to alter or even disrupt the traditional provision of amplification to audiology patients. Personally, as a participant in three different start-ups working in that space, it has always been about disrupting the current models to see if we could bring something better to market—and at times we are able to do that. Certainly, many innovative products today and those on the horizon can potentially change the way patients and consumers access the tools to enable better hearing.

Here's what I am teaching our AuD students to prepare them for the world in which they will practice upon graduation in 2023. Dr. Dillon, a decade ago, described this as “connectivity and convergence.” For example, at present, a person with impaired hearing may be fit with RIC aids, a smartphone with Bluetooth, and a remote microphone. The technology already exists today to use a pair of earbuds as the ear-level device, a Bluetooth smartphone, and an app to reshape the sound for someone with mild to moderate hearing loss, with the smartphone utilised as the remote microphone. ADA has a long history of supporting entrepreneurial activities, and we do not necessarily view the new consumer electronic offerings as a threat. Any change is a potential opportunity to find and incorporate better solutions for hearing care, and we must keep an open mind. An important development is having major companies like Apple and Google contribute to the message that hearing loss is a major health concern. This can help raise awareness that hearing loss must be addressed and not ignored by individuals, families, and our health care system. Any time audiology prioritises the needs of our patients, audiology will win out.

Dr. Sandridge: We have this motto, “Challenges are opportunities to grow.” These challenges to our profession are incredible, great opportunities to embrace. I look forward to incorporating all kinds of OTCs. [At Cleveland Clinic], we are even talking about working with our innovations team in designing our own PSAP so we can have a Cleveland Clinic-branded, very inexpensive amplifier that we can market here at the clinic. There are tremendous opportunities to get on board with all of these developments. As Victor said, anytime you can raise awareness about hearing loss and its impact on health-related quality of life—it's a win-win situation.

The other day, I had a patient come in who had two sets of PSAPs that she bought from Amazon for $37 and $70. And she got what she paid for—they were crap. We ended up getting her into very low-end hearing aids. But why not offer these as an early solution?

Years ago, we put together a questionnaire, which we recently redesigned with questions for patients, including, “Do you want to be a part-time user?” and “Do you want to just use this occasionally?” With this questionnaire, you can create a perfect avenue to offer patients with inexpensive units that they can use occasionally to just get them started [with amplification]. And when they want to use amplification full-time, you can offer them other routes. If we don't embrace them, then we are not going to be providing our patients with the whole continuum of care.

It is also an exciting time because there are so many options. The biggest challenge I see is trying to find which device to embrace and bring in. There is no reason why we can't bring in Apple AirPods and Bose products, for example, and sell them to make it convenient for the person to purchase it right there and then from us. The options are limitless, and the opportunities are there. We just have to put it in our business plan and go for it.

Dr. Shoup: Advances in technology that can offer additional benefits to patients are always an opportunity to positively impact their quality of life. However, I do think these do not replace the critical role of the audiologist. In many cases, there is an increased need for the person to have access to knowledgeable skilled providers who can review the many options and identify those best suited to meet the individuals’ hearing care needs.

It is one thing to take AirPods, for example, and put them on somebody who has perfectly normal hearing or even somebody who has a mild pure-tone hearing loss. But when we start looking at people with more complex hearing needs, they just become frustrated. Fitting the right solution into the complex communication and lifestyle needs of individuals with unique auditory systems and brain experiences really requires knowledge and experience—and that is what we bring. Furthermore, we have to ensure that multiple technologies can be appropriately integrated and that the end-user is capable of implementing the recommended strategy to effectively utilise the recommended system. These often require both provider expertise and individualised training and counselling, which could take a bit of time depending on the digital literacy gap that we may be encountering.

Regarding the type of technology I'm most excited about right now, I tend to stay very focused on patients who have significant hearing difficulties and significantly impacted auditory systems. I am most excited about the potential of new connectivity options using Bluetooth that will allow similar ease of access as we have with telecoils and loop systems. For example, having open-source options, such as the low-energy audio being developed by the European Hearing Industry Manufacturing Associations in collaboration with the Bluetooth Special Interest Group, will allow hearing aid and cochlear implant users to access sound in large venues without requiring complicated pairings or additional technology. It will be very freeing to patients! It will enhance their access to information and entertainment and their enjoyment of media. They can become more engaged with their communities. The concept of finding something that is freely accessible in entertainment venues and large group opportunities is something that I'd be most excited about.

Dr. Zeng: Based on what Angela, Sharon, and Victor just said, we are entering a very exciting time. This naturally leads to the next question: What is your personal and organisational position on the regulatory side? And perhaps, more importantly, as audiologists and as a profession, where and how can you make money as a business?

Dr. Bray: Times of change are times of opportunity. But for some people, these can be times of threat. It is an opportunity for audiology to embrace the challenge even though our initial response might be fear and threat, e.g., “This can't be good for me because it is going to change what I have been doing.” But if we look at the positive side, change can be good. It takes the right mindset to take advantage of an opportunity. Regarding OTC, ADA continues to support the bipartisan and bicameral Over-the-Counter Hearing Aid Act of 2017. We also continue to support the recommendations from the consensus report that came from ADA, AAA, ASHA, and IHS. These are established product requirements: define concise out-of-the-box labeling, define comprehensive inside-the-box labelling, define the new OTC category that is easily comprehensible by consumers, and provide adequate provisions for consumer protection. We continue to support all of those things. Many ADA members may choose to incorporate OTC devices into their practices just as many of them now incorporate PSAP amplifier options. We can also expect to see a continuation of many business practices that incorporate variations of bundling and unbundling of services from the product as determined to be the best for that audiology practice. Decisions about bundling and unbundling are not necessarily dependent upon whether we are talking about hearing devices, hearing accessories, PSAPs, or OTCs because OTCs can be successfully incorporated into a practice with either model.

Dr. Sandridge: Challenges are opportunities. OTCs were initially seen as a huge threat and a huge challenge, but we can take it as an opportunity to incorporate them. As Angela said, it is our responsibility to make sure that we educate the consumers. Noting the findings of the MarkeTrak 10 survey, the people who had gone to health care providers were very determined to go back to and get devices from health care providers because they had the knowledge and expertise. There are many opportunities for us to promote our expertise, knowledge, and abilities as professionals to consumers such that when they have a hearing problem, they may easily want to go get an inexpensive OTC or PSAP, but they know that they can come to us to help them set up their device. We'll be the professionals to help them along the way. For those who will experience distortions, and won't do well with OTCs, for example, we'll be there to help them when they realise these are not their best option.

Dr. Shoup: We at AAA are still in support of the consensus recommendations for the new OTC hearing aid classification. We very much support the idea that the individual member will have to make choices for their unique practices. The Academy does provide multiple resources to assist with planning for the unbundling of services from products.

Most important is to recognise that audiologists are integral to the accurate identification and appropriate management of hearing loss. With their knowledge base, audiologists work to develop a comprehensive treatment recommendation, which may include device selection and optimisation, as well as supportive counselling, training, and guidance through a customised hearing rehabilitation plan on what to expect and how to be successful. OTCs can be part of this process. Some patients may have already accessed OTCs before they see an audiologist. The audiologist can then work with the patient to verify whether the device meets the individual's needs. If it does not, is it possible to optimise that specific device to meet the needs as best as possible? Audiologists must also educate the patient on the appropriate use and care of the device and how to integrate the device functionality into the overall hearing rehabilitation plan.

Also in the discussion of OTC devices, we need to recognise the importance of informed choice. If patients come in with an OTC device that we think may not be best for them, we have the ability to assess it—and I've seen this work beautifully. We need to educate patients about speech sounds—which speech sounds they are getting, which ones they are not, and where the device is falling short in giving them access to those speech sounds. They can make the decision then while also considering other options and price points. We must not push these people away and keep them from getting the appropriate education so that they will address their communication needs more effectively.

Dr. Zeng: I enjoyed listening to your insightful comments. It is indeed an exciting time. Thank you for sharing your time and expertise with us in this virtual roundtabl

Feb 2021 RACGP GPNews

But it’s not all bad news. Study co-author Professor Henry Brodaty speaks to newsGP about how GPs can help patients be proactive.

In Australia, hearing loss affects 74% of people aged over 70, and has been identified as one of 12 lifestyle risk factors that account for 40% of dementia cases. But now researchers have confirmed, for the first time among Australian cohorts, just how significant the association is between self-reported hearing loss and mild cognitive impairment, a precursor to dementia. The research draws on the first six years of data from the Centre for Healthy Brain Ageing’s (CHeBA) Sydney Memory and Ageing Study from 2005–2017, involving 1037 Australian men and women aged 70–90.

 Participants underwent detailed neuropsychological and clinical assessments every two years and were categorised into one of four groups: no problems, mild problems, or moderate to severe.

 Individuals who reported moderate to severe hearing difficulties had poorer cognitive performances overall, particularly in the domains of attention/processing speed and visuospatial ability.

 They also had a 1.5 times greater risk for mild cognitive impairment or dementia at their six year follow-up.

 Scientia Professor Henry Brodaty, co-director of the CHeBA at the University of New South Wales, was a co-author on the study.  ‘We found that at baseline, people with moderate to severe hearing performed worse than the people who had no or mild hearing problems,’ he told newsGP.  ‘Over six years, there was a 60% greater risk of developing mild cognitive impairment or dementia, and looking at continuous data at the neurocognitive performance on testing, there was substantially greater deterioration in the moderate to severe group than in the other two groups.  ‘So everyone declined a little bit, even the people with no hear loss, but the people who had moderate to severe declined significantly more.’

 But it’s not all bad news. According to a 2017 report published in The Lancet, addressing midlife hearing loss may prevent up to 9% of new dementia cases.  ‘There have been studies since that review … looking at the effects of hearing aids, and findings that that risk is ameliorated,’ Professor Brodaty said.  ‘One of the potential mechanisms that this may play a part in is that people with hearing loss tend to withdraw socially, as it can be difficult in a group to hear things. But we know that people who are more socially engaged … have a lower risk of dementia than people who are socially isolated.

 ‘So we’d encourage people to get hearing aids. ‘However, those of us who work clinically – and most GPs will know this – find that if you get people who are over 80 needing hearing aids, it doesn’t work too well, because they don’t like using them. [For instance] my mother. We spent several thousand dollars on her hearing aid, and it lived very comfortably in a drawer by her bed.

 ‘But the earlier people start using the hearing aid, the more likely they are to continue using it and to get the benefits from it.’

Henry BrodatyScientia Professor Henry Brodaty, study co-author and co-director of the CHeBA, says when it comes to dementia risk factors, being proactive can go a long way

One identified weakness of the study is that it is based on self-reported hearing loss. As the study has progressed however, researchers have started to measure participants’ hearing using audiometers, which they plan to analyse in future.  What Professor Brodaty is keen to make clear is that hearing loss is only an ‘associated’ dementia risk. ‘We know that for older people in the community, their greatest fear used to be cancer – not the economy, not the pollution, not global warming – but now, it’s dementia. People are terrified,’ he said. ‘But we’re not saying people with hearing loss are going to get dementia. That’s a really important message to get across because the majority of people over a certain age will have some hearing problems. ‘We’re saying that there’s an increased risk. For example, if the risk of having dementia in your 70s is 10%, and you have a 60% increased risk [due to hearing loss], you risk is still 16%. So the absolute increase is small.’

 Aside from encouraging the use of hearing aids, where appropriate, Professor Brodaty says there are a number of things GPs can do to help their patients be proactive against cognitive decline.

 ‘If there are any symptoms of memory loss, GPs should be testing for cognition,’ he said.  ‘Mini-mental is the one that’s most commonly used, but it’s a bit weak, particularly in frontal executive function. So the MoCA may be a better example, or the one we developed, the GPCOG, is quicker than the Mini-mental and performs slightly better.  ‘They should also look at all the modifiable risk factors – is a person physically active? Are they obese? Do they have type 2 diabetes? If they have high blood pressure in midlife, should that be treated? Are they a smoker? Any heavy alcohol use?

 ‘And GPs should be thinking about doing this for themselves, it’s not just for the patients.’

 While there is no magic bullet to prevent the onset of dementia entirely, Professor Brodaty says being proactive may prove to be just as effective as if there were one.  ‘What we’re trying to do is at least delay the onset of it, because it’s mainly a disease of late life,’ he said.  ‘The risk doubles every five years. So if you can delay it for five or 10 years, for many people, that’s going to be delaying it until after they die.’

Jan 2021 Canada Newswire

Covid-19 symptoms range from respiratory distress and fever to completely asymptomatic cases. Several viral infections are known to affect the auditory system and recent case studies propose that SARS-CoV-2 is no exception. Emerging reports indicate the manifestation of both sudden sensorineural hearing loss as well as milder levels of damage during a SARS-CoV-2 infection. Inflammation, ischemia, and thrombosis have, amongst others, been identified as possible causes. Despite the current directives for home isolation and closure of certain services, accessibility to early audiological evaluation and monitoring upon suspicion or detection of sensorineural hearing loss remain essential.

Canada newswireA review of emerging case reports and studies suggests that injuries to structures in and around the peripheral and central auditory systems may occur following the infection of SARS-CoV-2; the virus which causes the response more commonly known as COVID-19. Of interest, is the occurrence of hearing loss and other related deficits in both asymptomatic patients and those exhibiting symptoms related to COVID-19. While these reports and studies do not establish causality, various attributions of cause have been proposed and will be highlighted in this article.

The most apparent observations of hearing loss are from confirmed cases of infection of SARS-CoV-2 along with the timely onset of sudden sensorineural hearing loss (SSHL). In March 2020, Sriwijitalai and Wiwanitkit were early in reporting the occurrent of unresolved SSHL in a patient with COVID-19 related respiratory care and recovery. Similarly, Degen, Lenarz and Willenborg (2020) reported the case of a 60-year old man with reported deafness and loud white noise tinnitus bilaterally.

Audiologic testing confirmed anacusis on right side and profound sensorineural loss on left side. MRI results for this patient were indicative of an inflammatory process in the right cochlea and meningeal contrast enhancement was detected at the base of the right temporal bone. Cochlear implantation was conducted preventatively on the right side in anticipation of ossification. The left ear was treated with intratympanic injections of triamcinolone without any noted results. This patient also received azithromycin and furosemide during hospitalisation, both of which have documented ototoxic effects, but could not have caused the pathological results observed with MRI, or the asymmetrical audiologic findings. The authors highlight the association between Covid-19 acute respiratory distress syndrome and encephalopathy, with more than half of all cases showing meningeal contrast enhancement which subsequently can cause sensorineural hearing loss. Koumpa, Forde and Manjaly (2020), also reported a case of SSHL with accompanying tinnitus without abnormal MRI findings. The 45-year old COVID-19 patient was intubated for 30 days to treat bilateral pulmonary emboli and no ototoxic medications were administered. Bedside testing suggested 65-85 dB descending hearing loss with thresholds at 2, 3, 4, and 6kHz being most affected.

A 7-day course of oral prednisone followed by intratympanic steroid injection were administered. Partial improvements of thresholds were subsequently observed. Similarly, Lamounier et al. (2020) reported on a case of predominantly unilateral loss with accompanying disabling tinnitus showing some partial low-frequency improvement following the administration of combined oral and intratympanic corticosteroid therapy. As contemplated, delayed therapy has a limited potential of hearing threshold recovery, such as was observed in an unresolved case of unilateral profound high-frequency SSHL with accompanying tinnitus (Lang, Hintze & Conlon, 2020). Their 30-year old patient did not show any improvement following a course of oral prednisone which was commenced seven weeks after the positive result of SARS-CoV-2 infection and three weeks post onset of hearing loss. The authors highlight the importance of a low index of suspicion of SSHL in hopes of providing a time-sensitive recovery with use of corticosteroid therapy.

Interestingly, cases where SSHL is the only condition related to infection of SARS-CoV-2 have also been noted. Rhman and Wahid (2020) reported a 52-year old male patient with a positive SARS-CoV-2 swab who was otherwise asymptomatic but was subsequently referred for sudden sensorineural hearing loss on the left side preceded by a gradually increasing tinnitus. Hearing thresholds revealed a severe sensorineural hearing loss for the left ear. No intracranial abnormalities could be detected with MRI and no other attributable causes for the sudden hearing loss could be identified. Intratympanic injection of methylprednisolone provided a partial recovery of hearing. Suspecting an emergence of SSHL following the SARS-Cov-2 outbreak, and the known viral etiology of SSHL, Kilic et al (2020) performed a polymerase chain reaction (PCR) test on adults who presented to an ENT clinic with the sole complaint of SSHL. One of the five patients was found to be positive for SARS-CoV-2, and otherwise did not exhibit any symptoms of Covid-19.

A widely cited mechanism to explain the manifestation of SSHL revolves around the same receptor to which SARS-CoV-2 binds to enter the body; the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 is known to enter the body by binding to ACE2 receptors of the alveolar epithelial cells and endothelial cells of the lungs and from there bind to other areas of the body where ACE2 receptors are found. (Cure & Cumhur Cure, 2020). While it is not known if these receptors are expressed in the human cochlea and whether or not they would permit a direct entry of SARS-CoV-2, they have been found in the mucosal epithelium of the Eustachian Tube and middle ear spaces as well as the cochlea of mice (Uranaka et al., 2020). An ensuing release of inflammatory cytokines would then likely result in oxidative damage of hearing structures. Other possible hypotheses to explain the pathophysiology of SSHL have been proposed, namely, but not limited to, a SARS-CoV-2-induced deoxygenation of erythrocytes leading to the hypoxia of hearing structures, or conversely a thrombosis caused by a change in vascular microstructure leading to ischemic lesions (Cure & Cumhur Cure, 2020).

The direct verification of these proposed etiologies, or others to follow, may shed light on the possible prevalence of SARS-CoV-2-related hearing loss. However, a broader hearing assessment strategy of both symptomatic and asymptomatic cases may also have significant merit. As support of this argument, using transient evoked otoacoustic emissions (TEOAE) which are sensitive to changes of cochlear function, Mustafa (2020), was able to observe differences in cochlear function between asymptomatic individuals, aged 20-50 years, with confirmed infection from SARS-CoV-2 and a control group with normal hearing.

Significantly lower TEOAE amplitudes were also accompanied by significantly poorer hearing thresholds at 4, 6, and 8kHz despite no hearing impairment being noted during case history. These results are indicative that SARS-CoV-2 may also cause milder forms of hearing loss than the more apparent cases of SSHL noted above. While the study makes no mention of severity of loss or whether or not there was an asymmetric nature to their results, there is nevertheless indication that milder forms of hearing dysfunction may be measured in individuals infected with SARS-CoV-2. It may also be inferred from these results that hearing dysfunction may be a specific indicator (symptom) of infection for individuals who are otherwise asymptomatic for COVID-19.

As we commence to obtain reports which indicate the potential effects of SARS-CoV-2 on the auditory system, we acknowledge the need for systematic studies on the matter to help establish prevalence as well as other epidemiological data. Also, as part of a broader remedial scope, future studies should also evaluate if milder occurrences of hearing or auditory processing deficits are also prevalent for both symptomatic and asymptomatic cases. In this context, access to audiology services is of substantial value to allow for the adequate surveillance of hearing loss, most notably in cases of suspected SSHL where timely assessments and treatment are often of utmost importance to allow for any recovery of hearing function.

Jan 2021 WDIV ClickOnDetroit

metro womanHenry Ford Hospital in Detroit has been at the forefront of a lot of different kinds of surgery and medical treatment. One in particular is called piezoelectric sound conduction, which is a new electronic way to help those with hearing loss and restore full hearing. For Roseville nurse Angela Holland, she said it made a difference in her life.

Holland grew up in Roseville, and at age 12, she needed a growth inside her ear surgically removed. That meant the loss of the hearing structures inside her left ear. “I had to make sure sitting or standing to the left of people, turned my head a lot in crowded spaces. It was difficult if someone was behind me and I didn’t see them,” she said.

The coronavirus pandemic didn’t help as people with masks have muffled voice and lip reading is impossible. But a regular check up came with an unexpected surprise. “She (the doctor) asked if I ever considered having hearing correction. I hadn’t known that was possible,” Holland said.

In September, she had the surgery to attach a unit to her skull. The device also connects to Bluetooth, which Holland can answer the phone and no one else can hear. “Piezoelectric layers of the internal device expand and contract to send sound vibrations through the bones of the skull to the inner ear, to the cochlea,” said Dr. Kristen Angster.

With her hearing restored, Holland got married two days later. “I made sure my husband stood on my left because I spent all my life making people stand on my right and so I could hear him through my left ear say his vows,” she said. “I’m trying to listen to different types of music to kind of train the inner ear on the processor to listen.”

Jan 2021 Geauga Maple Leaf


Roz KvetRosalind “Roz” Kvet was not surprised when she started losing her hearing in her mid-40s

Many of her relatives have the same condition where the hair cells in the inner ear degrade, gradually causing deafness, she said. Hearing aids allowed Kvet, 79, of Chardon, to continue to teach elementary school students in Kirtland until her retirement, but the children’s’ high-pitched voices were a challenge, even with a microphone system the school district installed for her.

When Kvet learned Cochlear had developed a highly successful cochlear implant that bypasses the damaged cells and sends electric signals to the brain which interprets them as sound, she thought the program was only for people who had been born deaf. “I never, ever dreamed I would get an implant,” she said.

So, she continued using hearing aids as her hearing continued to deteriorate. Then, during a visit to her audiologist, the subject of an alternative came up. “She surprised me by saying, ‘I think you’d qualify for a cochlear implant,” recalled Kvet. So she went for the test – and failed. The process tests how much hearing a person has in his or her “good” ear and she still had a high enough percentage that she didn’t qualify for an implant, Kvet explained. Not to be deterred, she returned a year later and she had lost enough of her hearing to qualify for a cochlear implant.

In 2012, Kvet met with Dr. Cliff Megarian, otolaryngology surgeon with University Hospitals, and her operation was arranged.

The process took about 90 minutes.

“I came out looking like a Civil War soldier,” she said, adding her head all bandaged up. The surgeon had drilled a hole in her skull for the internal implant just under the skin behind her ear. The second part of the system is an audio processor, worn externally, that detects sounds and sends them to the implant. After a while, the bandages were removed, but Kvet knew the equipment wouldn’t be turned on remotely for a month, so she waited to fully heal and went on with her life.

When the miracle occurred, she remembers she was washing something in the bathroom sink. Kvet thought she heard popcorn cooking until she realised it was the soap bubbles popping in the sink. The excitement she felt is reflected in part in her poem “Bubbles, Birdies, My Buddy —and Popcorn,” which reads: “Amazing!!!  Awesome!!!  Adoring!!! “I hear forgotten sounds — be still my heart! “NO! Sing with joy!”

But “hearing” the more complicated sounds, like someone talking, took a little more time.

“For three days, it felt like Donald Duck talking — an acoustic guitar in one ear and an electric guitar in the other,” Kvet said, adding her brain started to sort it out after a while. Being able to carry on a conversation with friends and relatives made a big difference. Better still, she was able to hear sounds made by her infant grandson for the first time.

Kvet has a deep appreciation for everyday noises most take for granted. When a wren outside her window serenades her or her only grandchild, Quinn Krapf, 8, sings to her, joy is the best word to describe her emotion. It is a main component of the freeform poem she wrote and the quilted collage she created recently, both of which she submitted to the Inspire Us contest held by Cochlear. Kvet’s poem and the collage, featuring pictures of Quinn, were selected to decorate the Cochlear Americas headquarters southeast of Denver, Co.

There are interesting details of her experience with the cochlear implant Kvet is happy to discuss.

Every six months, she visits with a cochlear implant audiologist and is hooked up to a computer to check the device’s operation and make some minute alterations to volume and other aspects of the connection. “They have to make changes. Otherwise, your brain goes to sleep,” Kvet said. “She can see how many hours you use your implant.”

Technology has advanced incredibly and Kvet has learned to use a “clicker” or remote control to adjust for speaking on the phone, listening to music or even to others when there is a lot of background noise. “Usually, I can hear better in a restaurant than other people,” Kvet said. “My hearing is like 96%.” She is also an A-plus student in her speech and hearing therapy. Her homework consists of listening to various programs to keep her hearing sharp.

A little icing on the cake: Medicare paid for the cochlear implants, Kvet said. Because of her family history, she is also active in encouraging people with hearing loss to be aware the progression eventually could affect their minds. “My mother was stone deaf. I couldn’t have conversations with her,” Kvet recalls, adding if a person loses the ability to hear, he or she may also forget the meaning of words. “It may have caused Mom’s dementia,” she said.

Her daughter and Quinn’s mother, Stacy Kvet, is a psychologist at DePaul University in Chicago and Kvet insisted she visit an audiologist to determine a hearing baseline. The testing showed Stacy, 50, has started to lose her hearing. “Make sure you get hearing aids. If you wait too long, it could be too late,” Kvet said.

Dec 2020 The Hearing Journal

The original goal of telemedicine was to enable those who live in remote or underserved areas to access adequate medical care and service. The COVID-19 pandemic has greatly expanded the targeted audience of telemedicine. For example, many elderly individuals who need hearing care the most during this pandemic are not willing or able to go to traditional clinics out of fear of infection or hiatus of non-essential care. The movement toward telemedicine has also been accelerated due to its heightened attention, acceptance by the health care providers, expanded reimbursement by insurance companies, and relaxed policies on wearable and over-the-counter medical devices by regulatory agencies.

Now, the key question is: Are technologies good enough to support safe, effective, and satisfactory telemedicine in hearing health care? Here, I argue that the answer is yes for most essential hearing care and service. Let us first examine the audiogram, which measures hearing thresholds as a function of sound frequency from 120 to 8,000 Hz. A good audiogram requires a calibrated audiometer, a quiet test environment such as a sound-treated booth, and an audiologist who knows how to operate the audiometer. Out of nearly 100 online hearing tests or apps, at least three use high-quality and relatively cheap consumer electronics such as iPad and Sennheiser headphones to achieve sufficiently accurate audiograms without any professional intervention at home (e.g., HearX, P.A.R.T., and SHOEBOX). As audiological evaluation moves away from the audiogram to functional speech in noise recognition tests, the need is further diminished for calibrated equipment, a quiet environment, and trained professionals.

Otoscopy and tympanometry are critical to diagnosing a middle ear infection, the most common cause for children to visit hospitals. A smartphone-based test system has produced comparable and slightly better performance in diagnosing middle ear infection than the traditional in-office professional care model. Note that this level of performance was achieved by parents at home with video instructions and machine learning algorithms. Other objective measures such as evoked auditory potentials can likely be reliably obtained using easy-to-use dry electrodes and apps in a home environment soon.

Remote-fitting hearing aids or cochlear implants (CIs) have been researched in the last twenty years but did not gain much traction until COVID-19. A low-hanging fruit is for patients to get their devices initially fitted by a professional in the clinic and then receive subsequent care remotely using wired or wireless connection to the devices with teleconferencing consultation from the professional. Most hearing aid and CI manufacturers have built sophisticated in-situ microphones, telemetry circuits, and data-logging capabilities to allow remote device monitoring and adjustment, if necessary, for optimal performance.

In the near future, artificial intelligence will automatically fit the hearing aids and CIs for most patients, potentially eliminating even the need for a first-time face-to-face appointment. In fact, auto-fitting a CI may have results similar to that obtained by an average clinician. Successful, widespread application of auto-fitting will liberate clinicians and allow them to focus on complicated and difficult cases while broadening the scope of the traditional hearing care to include patients with autism and dementia.

If there is a silver lining from COVID-19, then it is telemedicine. I believe that telemedicine for hearing loss is not only here to stay, but also its advanced version, or automated care, is coming to provide safe, effective, and satisfactory performance and services for many people with hearing loss across the globe

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