Seeing the Forest for the Trees…What’s Wrong with Audiology

I love my Audiology colleagues.  But I do not always love my Audiology profession.  For the most part, Audiologists are very skilled and knowledgable professionals.  We do an excellent job of assessing hearing levels, and identifying the site of lesion of the hearing loss.  We have incredible diagnostic tools at our disposal ranging from basic pure tone audiometry (we still mask better than anyone else), to ABR, to Otoacoustic emissions.  We understand how hearing aids work, how to fit them, and how to verify performance using real ear measurement techniques.  In short, we are very well trained at performing assessments.

So whats my beef?  Let me illustrate from a few examples.

1. When I started working as an educational audiologist in the 90’s, I was asked to report on the progress of child with hearing loss.  I did the usual…hearing assessment, hearing aid selection and verification.  I was an early adopter of the RECD, and I proudly showed how well the hearing aids were meeting DSL targets.  But the parents kept asking me why their kid couldn’t hear well, and I just kept thinking “Beats me, but I did a great job of hitting targets, so there”.  This started to make me realize I needed to look at things differently.
2. I have had numerous times where I have been asked to assist with an FM fitting on an adults who essentially who have no hearing left.  As recently as just a few months ago, an Audiologist, who was a recent graduate from a Doctor of Audiology (AuD) Program, asked me to help with a client who only have hearing at 250 Hz and 500 Hz.  In other words- deafened.  I thought, “Now you want to try an FM system on this client?  You should have introduced this 10 years ago when the client had a moderate-severe loss.”
3. The percentage of people with moderate severe losses or greater who use FM systems is disappointingly low.  Yes, I can hear my colleagues protesting saying “Adults won’t use FM”.  Well, if you polled the patients with hearing loss and asked them why they don’t use an FM, their likely answer will be “What’s an FM system?”, or “I was never told about these devices”.
4. People with hearing loss routinely complain of hearing in noise yet we rarely assess this.  We cannot just do a pure tone audiogram in quiet.  We need to assess the problem that is vexing our patients the most and then find equipment and strategies to deal with that.
5. How often are the limited number of rehabilitative lectures at Audiology conferences pushed back to Saturday morning.
6. How many patients know about other assistive devices such as vibrating alarm clocks and fire alarms that are also needed for daily living with a hearing loss?
7. I frequently am asked situational based rehabilitative questions.  For example, “Peter, how do you help a client hear in meetings” or “How can I help my client who works in a call centre?” etc.  Audiology seems poorly equipped at finding solutions to these situational problems.

What we need is to change Audiology practice from one that is almost exclusively diagnostically-driven to one that is also rehabilitative in nature. We have daily opportunities to do both in parallel:  to complete exemplary testing and then guide the rehabilitation of the patient based on test results.

Frankly the AuD has not helped expand the scope of our interventions, in fact, it has made us even more diagnostically focused.  This bias reduces our practice habits to those of technicians rather than professionals who practice to the full scope of our expertise.

In 2002, the World Health Organization introduced a classification of functioning, disability and health (ICF) to measure health and disability at both individual and population levels. The ICF “takes into account the social aspects of disability and does not see disability only as a medical or biological dysfunction. By including contextual factors, in which environmental factors are listed, ICF records the impact of the environment on the person’s functioning.” (www.who.com). The ICF can help identify: What is the patients level of functioning? What treatments or interventions can maximize functioning? What are the needs of persons with various levels of disability- impairments, activity limitations and participation restrictions?

How do we apply this framework to Audiology?  We view hearing loss as medical/biological dysfunction and our practice culture encourages us to focus on this.  We cannot stop at this – we must go further to examine patient’s functional capacities.

Without question, every patient should have their hearing levels fully and accurately assessed. In addition, we need to accurately determine, to the best of of ability with our non-invasive procedures, the site of lesion. The hearing loss is the genesis of the problem and we cannot proceed we fully understand what we are dealing with.  This is where Audiology shines.

Next we need to look at function.  At a minimum, we should perform a Hearing in Noise Test such as the LiSN-S PGA an all of our clients.  The world is a noisy place and we need to know in what situations our patients will have difficulty.

Functional capacities can also be assessed by asking our patients directly how they function in the context of their own daily lives using a tool such as the COSI.

Once we identify functional concerns, we need to then determne how to maximize function.  Here we need to consider all of the equipment needed.  For example, consider a client with a moderate severe hearing loss that performed poorly on the LiSN-S PGA and has identified several hearing in noise problems on the COSI.  Such a client will likely need a hearing aid with directional microphones, an FM system, and perhaps some alerting devices.  Then this client will need to be counselled how to use these devices properly.  This is a wholistic treatment plan.  But too often, a hearing aid is selected solely based on cosmetic concerns.  Nothing else is recommended, equipment such as FM systems are not discussed.  This is unacceptable.  We owe it to our clients to counsel them properly on the pros and cons of different equipment choices and on how to best navigate the world at-large with a hearing loss . In the absence of this collective practice change, our clients will succeed or fail only through trial and error. I believe that we are capable of delivering more.

These fundamental changes need to occur at the University level.  Audiologists are intelligent and compassionate people; they are fully capable of practicing in this model.  They are simply not taught to think in this way.

Once we shift our focus to maximizing client function, we will be able to see not only the trees but the forest as well.

Hearing Not Required…

Shumka Dancers

I took my parents to see a Ukrainian Dance Troupe last night called “Shumka”.  This group based out of Edmonton Alberta (surprise, surprise) has been in existence for 50 years.  They put on an absolutely dazzling performance.  While my expertise on the art of dance is limited, I am certainly not ignorant to the elements of fine dance as I have been to about 10 ballets in my lifetime.  Last night’s performance, at least from my perspective, was every bit as technically sophisticated and beautiful as a ballet, but a heck of a lot more fun!

As I was watching and enjoying the performance, it dawned upon me that I was fully enjoying this event just like everyone else in the audience.  Sure, the dances were choreographed to music, but I heard that well enough. The music was not the focus of the performance, it was the dancers- their athleticism and ornate costumes.  I really did not need much hearing to enjoy this activity.  I just sat, clapped, and cheered like everyone else.

It seems that so many regularly occurring things in life are affected by hearing loss. Work, communication, enjoying television, theater, movies, music, going to a restaurant,  and going for drinks with friends, all require both technical assistive devices such as an FM system, and some accommodations from my family and friends in order for me to participate.  Not that I am complaining…I would not want to miss out on these important activities.  I am grateful that these devices grant me the necessary access and improve my ability to participate.

But its also nice to find exceptions to this through activities that are not taxing on the ears.  For me, these typically include hobbies such as fishing, archery, kayaking, hiking and photography.   And last night, it included dance!

Sometimes I wish I enjoyed more of the visual arts.  I have certainly tried…I have been to the Art Gallery of Ontario, the Musee du Louvre and Musee d’Orsay in Paris, the Met and MoMA in New York to name a few.  Sadly, visual art does not speak to me the same way that music does.  Perhaps I lack the training and education to fully appreciate the immensity of meaning these pieces of expression may hold.

In any event, there is much to enjoy in this world that does not require good hearing.  I find that it is quite beneficial to seek out these “hearing not required” activities to enrich our lives.  It also provides necessary relief from the challenges of hearing loss.  Its good for you!

For Family Day today, we are off to the Bell Lightbox (Home of the Toronto International Film Festival) to see a French film called Lancelot du Lac.  It will have English subtitles for all the viewers, not just me.  It should be fun!

What’s It Like To Have A Deafened Father.

This week’s entry was written by a person of whom I am immensely proud of and adore: my son Alexander.

Alex and Amie in Algonquin Park

Growing up with a father with a significant hearing loss is an experience that I have lived with for 17 years. As I write this, I am awaiting my father’s summation of morning routines, in which he will put his “ears” on, as I so boldly used to state when I was younger. This of course referring to the hearing aid and cochlear implant that he must put on each day before I can speak with him. Having a deafened father is not something that I see as common where we reside, so when I speak of this upbringing, it can only be based purely on my experiential knowledge and very little external influences.

There are many things that shape my father as the man that he is and the father that he is, and whilst his disability is undoubtedly a significant trait; with the power of today’s technology, it is not a difficult one to deal with. Certain aspects of my upbringing in this regard are difficult to recollect, as I have been accustomed to it being reality. And not reality in some form of bleak, cold, hard sense, but rather that I have never known any different. Growing up with a deafened father forces you to adapt to certain mannerisms that are prevalent in all people with this condition. Whether it means patiently waiting for my father to put on his hearing aid and cochlear implant before engaging in a conversation, or knowing to always get his attention by means of small hand signs or light physical contact, these things have become second nature. My father’s ability to engage in conversation and interact with me on a day to day basis is in no way diminished by his hearing loss, and if anything has increased the intimacy of our most heartfelt conversations. I say this because if his body language does not read as being fully immersed in the topic at hand, then I know from experience, and due to the fact that he would have difficulty expressing an opinion if he had not been fully listening and reading my lips that his response would seem distracted. This allows for a much more human feel to our household, as it removes a large majority of the potential for noisy dinner conversations, shouting across the house and scattered voicemail reminders of family plans.

As a young child, my father’s hearing loss did not provide any genuine troubles. The teasing on the matter from my cohorts would only exist as an extension of an insecurity, and a lack of terms to call me after the basics would be used up. However, as my mother and father instilled the values of confidence and compassion in me at a young age, I had the ability to recognize this as no substantial attack towards my father, but rather a last resort due to a lack of genuine teasing to conjure up. To draw upon a previous point, part of the reason it never bothered me is because I did not, and could not ever know any different. This was my father they were speaking about. Why should I care if they wish to tease, when my father had done so much for me? This was never became a prominent issue.

One joy that I have had the pleasure of sharing with my father is that of music. As he has mentioned in previous entries, playing and listening to music is no easy task for anyone with any form of hearing loss. This has been a struggle for my father since day one, yet he never hesitated to give me his utmost support when I decided to pursue music as a passion. In fact, he joined me on this and our basement (or man’s den as my mother would say) has now been transformed into a small recording studio. The values that music has brought to my life are innumerable and without my father’s utmost support, I may not have gone nearly as far as I have. Music has allowed me to grow intellectually, emotionally and has given me confidence I needed after traveling to play shows to people across Ontario. None of this would have been possible without my father’s support, and the many long nights spent listening to me practice and helping me progress. Also, as mentioned in previous entries, a huge silver lining in the cloud, is our hearing ear dog Amie. Growing up with a dog has changed the very essence of who I am, and my love for animals and living beings has grown to be insatiable. My father and I have matching Amie tattoos, which is something I will carry proudly with me forever. When my father’s laser eye surgery took a turn for the worse, as a child I jokingly stated “This is a good thing Dad! We can get a seeing eye dog now too!”. These are two great things that have come out of my father’s hearing loss, that I feel a father without such a condition may not have been able to offer to the same extent.

All in all, growing up under this has had immense implications on me. It does go against many of the typical father son paradigms that exist in the all too unrelatable parenting advice columns, and it has most definitely been different. It goes without saying that there are ups and downs, as in any family relationship, but the majority of them have not been anything that any other family would not face. It has changed my outlook on people with disabilities, culture, society, technology and opened my eyes to many things that I would not have been aware of before. In many regards, it truly has shaped me into who I am today.

 

Thanks son!

10 Lessons My Hearing Ear Dog Taught Me.

As you may know, dear reader, my Hearing Ear Dog “Amie” has been living with cancer in her bladder (invasive transitional cell carcinoma) for some time now.  In fact, it has been almost 20 months ago that we were given the news that she may only have 2 months to live.  Somehow, she has beaten the odds and has survived much longer than expected.  All the vet can tell us is “Keep doing what you are doing.  I am not sure what it is is, but it seems to be working!”  To be honest, I am not sure either.

My wife and I were reflecting on the impact Amie has had on our lives.  In addition, how how Amie has changed my personality.

Here are some of the lessons Amie has taught me:

1. Praise is Better than Punishment for Changing Behavior.  Amie never responded well to being punished.  She hated it and would shut down even if I simply raised my voice a bit. But boy did she love praise.  Works much better for humans too.
2. Don’t Yell!  I was raised in an Eastern European household in which there was quite a bit of yelling.  We were all used to it and thought it was acceptable to fly off the handle once in a while.  Well, Amie never liked that, nor did my English wife.  However, whenever I had what our family referred to as a UTT (Ukrainian Temper Tantrum), Amie would hide in a corner and shake.  Within just a few short weeks of getting Amie, my UTT’s dropped off dramatically.  And they have stayed low for the 12+  years that Amie has been in our household.
3. Virtue of a Simple Life.  We can get all hung up on the latest toys and gadgets in life.  Oh look, the Joneses next door now have an Acura and a Beemer.  But Amie had no use for any of those things.  Her favorite toy is a squeaky hedgehog and a tennis ball.  Her favorite activity was a walk in the woods.  She kept us grounded and humbled.
4. Fortitude or Keep your Chin Up Despite Adversity.  Despite having herniated a disk in her spine, having cancer, and Idiopathic Vestibular Disease, Amie keeps wagging her tail, and loves our company. Similarly, being deafened may suck, but it clearly is not the end of the world.
5. Forgiveness.  If I forgot to feed Amie, or didn’t take her for much of a walk, she always forgave me unconditionally.  So if, for example, someone forgets to speak clearly for me, I try to forgive.
6. Identification of Good Character.  Amie is so sweet, she loves everybody.  There was no one that she hated, she saw good in everyone.  Some even overcame their life long fears of dogs after meeting Amie! But still, some folks did not like her.  And you know what, these people ended up not being nice people at all.  So having Amie saved me time but not wasting energy on these people.  On the other hand, there were folks I thought were unsavory characters, but because they took a positive interest in Amie, I also gave them a chance.  Turns out they were ok after all.
7. Naps are a Good Thing.  Amie was always ready to alert me at any time, 24 hours a day.  How did she do it?  By being well rested!  We should all take more naps or at least get a good night’s sleep.
8. Live Life to the Fullest.  A dog’s lifespan is much shorter than ours.  And there is nothing anyone can do about it.  Amie is 14.5 years old now, which is a pretty good life span for a dog.  But like all of our lives, it will end.  The Existentialists tell us that we could all use a healthy dose of Death Awareness to give us that kick in the butt we all need to get on with Living.  Nothing like seeing another creature’s life come to its end stages to reinforce that point.
9. Adapt.  After Amie’s back surgery for her herniated disk in her spine, one of her back legs did not have the same strength.  But she quickly learned to get up and down stairs by lifting up this weaker leg.  For larger flights of stairs, we carried her up, but she didn’t complain.  So if we need to communicate differently due to our deafness. so what?  Wear the damn hearing aid, use the FM system, stop complaining and get on with participating in life.
10. Be Sure to Say “I Love You”.  Ok, Amie can’t speak, but she can sure communicate her thoughts.  She always ran up to my wife, son, or myself with her tail wagging and gave us kisses.  Every single day!  You never get bored of being reminded that you are loved.

Best and Worst Musical Instruments for People with Hearing Loss

As a hearing impaired audiologist, and amateur musician, I often get asked by parents to help select a musical instrument for their child with hearing loss.  Although I have not seen a specific research study analyzing this exact question, we can, based on what we know about hearing loss, make an educated recommendation.

Lets first take a look at some fundamental components of music.  These include Pitch, Timbre, Harmonics, Loudness, and Rhythm.

Pitch is the frequency of the sound, measured in Hz.  For example, middle C is 256 Hz.  When we hear a melody we hear changes in pitch. In Western music, the smallest unit of pitch change is the semi-tone and there are 12 semitones in one Western octave.

Unfortunately, people with hearing loss have reduced ability to recognize pitch due to the damage in the hair cells of the cochlea.  In other words, some people with hearing loss cannot tell the difference between two pitches that are close together.  They need larger and larger differences between two pitches before they can tell that they are different.

Harmonics are a series of tones that are multiples of the fundamental frequency.  So if I pluck a middle C on a guitar or a piano, you will not only hear the fundamental frequency of 256 Hz, but also mathematical multiples of the middle C such as 512 Hz.  Again, this is a pitch based perception task and is hard for people with hearing loss.

Timbre is the unique combination the pitch, harmonics, the attack and release times of the note, that gives each musical instrument its unique colour and character.  Timbre is what tells us a guitar is a guitar or a violin is a violin.  This can also be hard for people with hearing loss.

Intensity of sound is measured in decibels.  We perceive intensity as “loudness”.  Of course when we have a hearing loss, soft sounds are inaudible, but hearing aids and cochlear implants do a pretty good job of allowing us to hear the soft sounds again.

Finally rhythm is the arrangement of sounds in time.  It is the beat or pulse of the music, and fortunately, people with hearing loss can still perceive rhythm quite well.

So based on what we know about hearing loss and about the components of music, it is clear that we will have greater difficulty with instruments that require good pitch perception abilities.  Below are two suggested list of instruments.  The first is a list of good instruments to select for people with hearing loss.  The second is a list of instruments that may be too challenging for the hearing impaired ear.  These lists are based on theory and some practical personal experiences, but are only recommendations.  If you, or your hearing impaired child, have your heart set on playing a particular instrument, by all means give it a try.

1. Piano.  Piano is a good instrument for people with hearing loss for many reasons.  First, it is professionally tuned, so you do not need to tune it up every time you play.  If it is out of tune, then then the other instruments playing with the piano, must be tuned to the piano, and not the other way around.  Moreover, it is kind of like typing.  You see a symbol on the music staff, and you have to hit the corresponding key of the keyboard.  The hard part about piano is the same for all people, whether they have a hearing loss to not, which is learning to read multiple note music.
2. Acoustic or Classical Guitar.  Guitar has frets on it, which precisely cuts the string at the correct point to give the correct note.  Daily tuning is required, but the easy solution here is to buy an electronic tuner.  I also think acoustic guitar is easier on the impaired ear than electric guitar.
3. Fretted Electric Bass Guitar.  The fretted electric bass also has frets that precisely cut the string at the correct point.  Interestedly, this is why Leo Fender, the inventor of  the first electric bass, called it the  “Precision” or “P-Bass”.  It was the first bass with frets.  With bass, one only plays one note at a time, making this easier on the ears to perceive.  Also, it is also a rhythm based instrument which should be easier for people with hearing loss.  (Although some people just have no rhythm period).
4. Electric Guitar.  I ranked electric guitar lower than acoustic guitar because when used with a lot of distortion, it is hard to hear the notes through all those harmonics.  If you plan to play electric guitar, stick with genres like indy or popular music, and stay away from heavy metal, or hard-core.  However, a plus of electric guitar is that you can get an amp with a headphone jack and plug your FM system into that for practicing.
5. Digital Drums.  One of the problems with drums is that they can get really loud and overload the microphones of the hearing aids and cochlear implants.  So this is what is nice about a digital drum kit.  You get a volume control that allows you to set the volume at a perfect level, not too loud or too soft.  Moreover, all the digital drum kits I have seen have headphone jacks to plug your FM system in.
6. Flute.  General the woodwind instruments can be good choices because there are lots of keys that allow you to make the correct note more precisely.
7. Clarinet. Same as flute
8. Saxophone.  Same

Challenging Instruments to Play with Hearing Loss.

1. Violin.  Violin does not have any frets on it.  It requires one to listen carefully to make sure you are pressing on the correct part of the fingerboard.   However, I have heard of people with hearing loss still successfully playing this instrument.  It all depends on your hearing capabilities.
2. Viola.  Again, same as a violin
3. Cello.  Same issue as violin.
4. Upright or Fretless Bass.  Same as violin
5. Trombone.  Trombone shares some of the same characteristics of a fretless string instrument.  One must move the slide to the correct point to produce the proper pitch and therefore requires good pitch perception.  Not easy on the ears.
6. Acoustic Drums.  The reason I put acoustic drums on the “Challenging” list is that this is a very loud instrument.  Very loud sounds can over-saturate the microphone or the analog/digital converter in a hearing aid or cochlear implant.  This will make things sound really distorted.  Interestingly, when I play in my band, I actually try to move as far away from the drums as possible.  I still keep the beat using the device I made.  See this previous posting.
7. Trumpet. Trumpet uses a combination of three buttons or valves to partially produce its pitch.  The other influence is the shape of the lips.  Therefore, it does require a bit of hearing pitch perception to make the correct note.  I successfully played trumpet when I was in high school, but I only had a moderate loss of hearing at that time.
8. French Horn.  Similar issues to a trumpet.  However, I found that the shape of the lips affected the pitch more in a French Horn than trumpet.  Not sure why, but the French Horn players in our high school band had a harder time keeping pitch than the trumpet section.

So there you have it.  If you are currently playing an instrument and you have a hearing loss, please share your experiences!

10 New Years Resolutions for People with Hearing Loss

Here we go again…its that time of year where we make all sorts of cliche New Years resolutions.  We all make the typical “lose weight” “exercise more” types.  Those are permanently affixed to every year’s list of resolutions for me.

As a person with significant hearing loss, there are some things which we can do that will make our lives more enjoyable.  So here are some suggestions for New Years Resolutions.

1. Develop and Enjoy a Hobby.  As people with hearing loss, our communication challenges affect us in so many ways.  Its easy to let this dominate our lives.  So this is why I put this one at the top of the list of resolutions, because I feel it critical to develop and nurture our entire person.  For me, I have taken up Archery.  I love how archery calms me.  In addition, It requires much practice and skill, so it challenges me.  And it completely takes my mind off my hearing loss.
2. Learn to use a new Communication Device.  Have you tried captioning on your TV?  Have you tried an FM system?  Do you use your different programs on your hearing aid?  This year, make it a goal to pick a device and learn to use it well.
3. Learn a New Communication Technique.  There are all sorts of behavioral ways we can learn to communicate better.  Technology is only part of the story.  Ask yourself questions such as “Do I always make sure I sit with the light behind me so I can see other people’s faces better for lip-reading?”, or “Do I use a specific clarification rather than just saying what or pardon me?”.  Pick just one technique and try to apply this as much as you can.
4. Take Action. This involves learning to be assertive, but not aggressive.  I need to work on being a bit more assertive.  For example, when I sit in a restaurant, sometimes I do not pick the best seat.  The best seat would be one in which I can see as many faces as possible and where the background noise is behind me.  All I need to do is just say to my dinner party “Do you mind if I sit there?  It would help me communicate better.”
5. Learn to Accept Things.  Even with all the best technology and communication techniques, there are certain situations that may still be too challenging.  For example, even though I may go out to a bar with friends, I cannot hear all the communication from all the people in my group.  With the use of my FM system, I can, however, have conversations with one person at a time.  Therefore I have learned to accept this limitation.  I wish I could hear all the jokes zipping around me, but I can’t.
6. Develop Calmness.  Again, another one I need to work on.  I am getting better, but sometimes I do get frustrated by my limitations.  Normally, this drive I have to not let this hearing loss limit me is a good thing.  It has driven me to become an audiologist, and learn to use all sorts of technologies and strategies to communicate better.  But sometimes, we might hit a brick wall.  I can get worked up by this and boil inside and its not healthy.  This year, when I get that feeling, I will try to draw upon the calmness I am learning from Archery. (See how this all ties in together?)
7. Teach a Loved One Communication Strategies.  Communication is a two way street.  I would say that perhaps unlike other disabilities, hearing loss always affects your love ones.  Talking always involves at least one other person and as such, requires changes from communication partners.  So take some time to teach one “significant other” some techniques.  For example, my niece is likely the fastest talking teenager on planet earth.  It is incredible how many words per minute she can say.  I have worked on getting her to slow down when talking with me. Interestingly, she is now working as a waitress saving money for University next year and she has found that she does her job better when she slows down her speech for her customers.  Win win!!
8. Plan a Dinner with Good Communication Techniques.  This one is a fun project.  Scout out a restaurant that is low noise and has good lighting.  Pick out a table that also fits these two criteria.  Pick out a seat that allows you to see everyone and where your back is towards the background noise.  Decide the number of people in the dinner party that you comfortably can communicate with.  Think about the communication devices you will be using, such as an FM system.  Think about the request for clarification techniques you will employ. And then make a reservation and enjoy!
9. Read.  For the majority of us, our sense of vision is just fine.  Our eyes are an unimpaired portal to information.  The more we read, the more we keep in touch with the world around us.  Topics become more familiar, which assists greatly in lip-reading and hearing.
10. Take Time for Family.  Here’s another one for me.  I get so wrapped up in dealing with my own hearing loss issues, that I sometimes do not see how things are with my family.  Be sensitive to how your hearing loss affects your other family members.  Be thankful for the things they are already doing to help you.  Also, your family members have things happening to them, both good and bad.  Make sure we take time to listen to them, rejoice in their successes, and help them with their challenges.  Its not always just about us.

Stigma and Hearing Loss.

Over the past year, I have been growing my hair.  I have done this for a couple for reasons.  First, I am still in the midst of a mid-life crises, but in a good way.  I am celebrating the fact that I still have a full head of hair at 47, and I am showing if off it a silly display of vanity.  Second, it looks good when I am playing in my band (its great for head banging).  But thirdly, I must confess, is that it is helping to conceal my hearing devices.  The latter was not one of the initial motivating reasons to grow my mop, but I have noticed a change in the way people look at me now that the devices are less visible.

People tell me I look like Matthew McConaughey's chubby, but sexy, deaf brother.

So what is the issue here?  Obviously there is still a stigma associated with hearing loss.  Lets look at the definitions of this word “stigma”.  The Merriam Webster on-line dictionary defines stigma as “a mark of shame or discredit” and “an identifying mark or characteristic; specifically : a specific diagnostic sign of a disease”.

So do I see using a hearing aid, a cochlear implant or an FM system as a sign of shame or discredit?  Of course not.  In fact Canadians, Americans, Europeans, Australians, and others who live in the developed world should realize how fortunate we are to be living in a society in which our either our incomes or social programs can afford to provide us with devices that can help us hear again.  World wide, there are likely millions of individuals with hearing loss who cannot afford the luxury of better hearing.

Are using hearing devices a specific diagnostic sign of a disease?  Well, maybe.  It certainly does give away the fact that I do have a hearing loss.  But as I will point out later, there are other signs that indicate the presence of a hearing loss, namely, one’s communication abilities.

I think that for many years, hearing aid companies did not help to diminish the perceived  stigma associated with hearing devices.  They constantly tried to advertise “invisible” hearing aids.  One could even order hearing aids that were delivered to your home in a “plain brown envelop”.  What’s up with that?  Are we ordering porn here? These kinds of marketing practices only served to reinforce the notion that hearing loss is shameful.

Frankly, I think most of the notion of hearing aids being stigmatizing on an individual is bullshit.  The ultimate proof of that comes to me every year around Christmas time in which I go to lots of Holiday parties.  What I am about to describe to you has happened to me so many times, I wish had a nickel for every time it occurred.

The scene is set as follows.  I have my refreshing beverage in my right hand.  In my left hand is my Phonak SmartLink+ FM transmitter.  I am happily conversing away with lots of folks, and inevitably, someone will ask about it.  The conversation goes something like this:

Other Person: “Hey, what’s that thing you got there?”

Me: “Well, that’s my FM transmitter”

Other Person: “Oh yeah, so what does it do?

Me: “”It picks up your voice and helps block out the background noise.  so I can hear you a lot better in this noisy party”

Other Person: ‘Wow, cool.  so how do you hear with it?”

Me: “Well, it transmits via FM radio waves to little receivers attached to my cochlear implant and my hearing aid”

Other Person: “Wow, thats so cool.  You know my Dad should get one of those.  His hearing is way worse that yours”

Me:  “Really?  Wow. His hearing is worse than mine?  Is he deaf?”

Other Person: “No, no , no.  He’s not deaf.  Probably just hearing loss due to age.  But he just completely falls apart in social gatherings.  He totally avoids them.  Constantly saying “what?” all the time.  Drives us all crazy, especially my Mom.  He won’t even go to things like this anymore.”

Me:  “Does he wear a hearing aid.”

Other Person:  “No, he doesn’t want anyone to know he has a hearing loss.”

So what do I conclude from this exchange?

1. People judge the amount of “disability” you on the basis of your behavior and your ability to function, not just on the presence of hearing devices.
2. Because I seem to function better in a noisy environment with my FM system, hearing aid, and cochlear implant, I am perceived as having LESS of a hearing loss than a silly old coot with presbycusis (hearing loss due to age) who won’t even wear a hearing aid.
3. Often the biggest barrier to better communication is the person with hearing loss themselves.  They erroneously think others won’t notice their hearing loss if they do not wear a hearing aid or use an FM system.  The fact is that they are constantly having communication breakdowns and this is extremely obvious to everyone.

But this brings me back to the hair thing.  The cochlear implant is bigger than a hearing aid, so folks do stare a bit.  It can get annoying.  So, I grew my hair a bit and it covers it up more.  So shoot me for wanting to look a bit cooler.  But I can assure you, I would never trade my ability to function for the sake of cosmetics.  I know that I would be perceived far worse if I kept saying “what, huh, pardon me”.  The hearing devices and FM system help me function and decrease negative perceptions.

Hearing during the Holidays.

The Holiday Season is now upon us.  There are work Holiday parties, Christmas parties in the neighborhood, Christmas or Hanukkah family dinners, you name it.  And they all have a couple of things in common:

• It is noisy
• Alcohol is usually served
• The main activity is talking and listening.

These functions are not easy for people with hearing loss.  We function best in quiet settings and smaller groups where there is no competing noise.  Moreover we need to concentrate harder to communicate, so remaining sober and unintoxicated is a must.

You don't want to be like this guy.

Given that you will be going to places in which there is a high noise level, you need equipment and strategies on how to communicate in this environment.

So here is the Stelma Survival Christmas Guide for People with Hearing Loss.

1. If you have a mild loss of hearing, you must use a hearing aid with a good Directional Microphone.  As I discussed in a previous blog entry, these microphones will pick up the person talking in front of you and reduce the noise behind you.
2. Due to the high noise level of these functions, people with moderate, moderate-severe, severe, or profound  losses of hearing will definitely require an FM system attached to the hearing device (hearing aid or cochlear implant).
3. You need to set your FM system microphone to the SuperZoom position for maximum noise reduction.
4. If it is a cocktail party type of event, you will be standing and talking.  So you will place the FM transmitter in your left hand and your refreshing beverage in your right hand.
5. When conversing, you will point the transmitter at the person you wish to communicate with.  We call this the Reporter Style of using an FM system.  Also make sure you hold the transmitter correctly.  See this video clip for more details.
6. Remember to use Specific Requests for Clarification if you misunderstand.  For example instead of “what?”, say “Can you repeat the last part you said?”.  See my earlier blog entry on “What’s Wrong with Saying What”
7. Try to position yourself in areas with lower noise.  So if the music is blasting in the living room, move to the kitchen or dining room where these is less noise.
8. Try to position yourself in areas with better lighting.  Again, if the living room is dark, stay in the kitchen where there is better lighting.
9. Keep your alcohol consumption to a minimum.  It takes a lot of concentration for us people with hearing loss to communicate and alcohol gets in the way.  Not to mention drinking and driving is illegal.  I typically drink Gin and Tonics, but I alternate with mineral water and lime.  That way nobody bugs me about not having a drink in my hand.

If anyone else has some strategies that they use for coping with Holiday Parties, I would love to hear from you.

Happy Holidays everyone!

Strategies for Communicating in Restaurants

Dining plays in an important role in many cultures.  I think we can all agree that we do not eat simply to nourish our bodies.  It is the human connection that seems to be the most important part of dining.  We propose marriage, celebrate birthdays and anniversaries, close business deals, and simply connect with friends and family while dining.

Unfortunately, many people with hearing loss cannot enjoy the social benefits of dining due to their reduced ability to communicate in this noisy environment.  Indeed, many simply accept that they will only be there to consume the food and not much else.  Others simply choose to eliminate this social activity from their lives altogether.  This is very sad.

There are solutions, however.  These will depend partly on your degree of hearing loss, and partly on how noisy the restaurant is.  In the chart below I list the possible solutions for the various environments for different hearing loss levels.  Note that I am assuming that you have a hearing aid.  The last line is suggestions for CI users.

Degree of Hearing Loss	Cafe(SNR @ 5 – 0)	Restaurant (SNR @ 0 to -5)	Bar (SNR @-10)
Mild	Hearing Aid with Directional Microphones	Hearing Aid with Directional Microphones	FM system in Zoom
Moderate	Hearing Aid with Directional Microphones	Either FM system in Zoom or hearing aid directional mic	FM system in Zoom.
Moderate-Severe	Either FM system in Zoom or hearing aid directional mic	FM System in Zoom	FM system in SuperZoom
Severe	FM system in Zoom	FM system in Zoom or SuperZoom	FM system in SuperZoom
Profound	FM system in Zoom	FM System in SuperZoom	FM system in SuperZoom
Cochlear Implant	Directional mic on CI or FM system in Zoom	Directional mic on CI or FM system in Zoom	FM system in SuperZoom

So what are these microphone positions I am referring to?  Well, on the SmartLink and ZoomLink there are three different microphones.  The Omni mic is at the bottom and it picks up sound in all directions.  I never use this position in a noisy restaurant.  The middle microphone is called the Zoom position.  This picks up sound from the front, but not from behind.  The top microphone is referred to as the SuperZoom position.  This is a beam forming microphone that only picks up sound directly in front, but not from the sides or behind.

The SuperZoom and the Zoom microphones are the most effective in noisy environments like a restaurant

The trick to getting the most out of your directional microphone or FM system is getting the correct seat. You want to have the noise that you don’t want to hear BEHIND you.  A lot of people make the mistake of getting a table in the corner and having the person with hearing loss sit in the corner facing the entire restaurant.  This is the WRONG seat.  You want the background noise in your back.  This way your directional microphones, either on the hearing aid or the FM system, cancel out this noise and only pick up the person in front.

So here are the steps I take when going our for dinner.

1. Try to find restaurants that are already quieter.  Choose restaurants that don’t blast music during dinner.
2. Ask for a table in a quiet section of the restaurant if possible.
3. Seat yourself with your back towards the background noise.  The waiter will try to seat you in the corner with your back to the wall.  He means well, but ignore him and seat yourself correctly.
4. If you are a small group, seat the other people in front of you.  Ideally you should see the people you wish to hear in front of you and that’s it.  This way your microphones are only picking up those you wish to hear.  I then place my FM system on the table about half a meter away from the people I want to hear.
5. If you are a larger dinner party, this presents a challenge.  You will still seat yourself as I described.  But your microphones will not always be pointing at the person who is talking.  You need to move your microphone towards the person you wish to converse with.

A couple more points to consider.

1. If I am having dinner with just one other person, I may get his person to wear the transmitter.  But I do so after the waiter finishes blabbing about all the specials and takes my order.  (Some of these waiters seem to love the sound of their own voice because they talk way too much.  Hint to waiters: Less talk and better service = bigger tip from me).
2. The FM microphones work best when they are as close to the talker as possible.  So place the transmitter on the table no more than half a meter away.
3. When the waiter brings the food, grab your microphone off the table, then reposition it.
4. When having Sushi, keep the microphone away from your Soya Sauce.  I have killed a few transmitters from spills.
5. In large dinner parties, you will still miss out on some conversation because the microphone is only pointing at one or two people at a time.  Yes, this is still a limitation.  But you can either sit at home and sulk, or you can still be partially engaged.

What’s Wrong With Saying “What?”

This post was inspired by a fellow blogger (http://chroniclebionicwoman.wordpress.com/2011/10/25/bionic-woman-on…faking-it/) who wrote about the perils of “faking it”.  It got me thinking of what we folks with hearing loss do when we don’t understand or hear.

Our initial inclination is the say “what?”, “huh?”, or “pardon me?”.  However, many moons ago, when I was in grad school for Audiology, I began to wonder if this was a good strategy to employ.  Or maybe we should try a more effective strategy.

When we fail to understand what has been said, we need to employ a request for clarification (RQCL).  RQCL can be classified into 2 categories; Specific RQCL and Nonspecific RQCL.  The chart below shows examples of the two different types.

Nonspecific RQCL	Specific RQCL
What?	What was that last part you said?
Huh?	Can you please say that again more slowly?
Pardon me?	Did you say you were going shopping?
Can you please repeat that?	Can you please move your hand away from you mouth and repeat again?
I didn’t hear you, come again?	Are you talking about baseball?

As you can see the Specific RQCL either asks the communication partner to repeat or rephrase only a portion of what was said.  Or it requests a change in the manner in which the utterance was spoken.  In either event, we are guiding the communication partner to a successful repair of the communication breakdown.

I had a theory that our communication partners would respond more favorably to Specific RQCL.  So I designed a series of experiments in which people had to rate how they felt about a person with hearing loss after watching a videotape of a conversation between a person with hearing loss and a normal hearing individual.  The conversations were scripted ahead of time to control for the number of communication breakdowns that occurred (Low, Medium, and High) as well as the type of repair strategy used (Nonspecific and Specific).  Subjects then used a semantic differential scale to make the ratings.  Below are just a few of the items from the scale I devised:

Talking to this person would make me feel…

Composed       1      2      3      4      5       6     Irritated

Energetic         1      2      3      4      5       6      Tired

Pleased            1      2      3      4      5       6      Annoyed

Comfortable    1      2      3      4      5       6      Uneasy

Here are the results from the study.  Note that a higher number indicates a more emotionally negative rating while a lower number indicates a more emotionally positive rating.  In other words, we want a lower number.

These results show a couple of things:

1. When we have a low number of communication breakdowns (less than 25% of the exchanges), people have a more positive reaction to us.  It didn’t seem to matter if we only said “what”.  As long as we don’t do this too often, reactions will still be positive.
2. When we have a medium or high level of communication breakdowns (greater than 50% of the exchanges), people start to get pissed off.
3. If we use Specific RQCL, people react more favorably, especially as the number of breakdowns increased.

So what does this mean for us folks with hearing loss?

1. It is crucial we get the best possible technology to help us hear and understand better so that we can reduce the number of communication breakdowns that occur.  That means having good working hearing aids or cochlear implants with directional microphones and, if needed, an FM system.
2. Try to use Specific RQCL such as “Can you please repeat the last part”, “can you please slow down” etc.