Top Ten Reasons Why I Need a Hearing Ear Dog


As many of you are aware, my sweet dear Hearing Ear Dog Amie passed away on June 13 of this year.  Initially, I did not even want to think about getting another dog.  As a family, we all needed time to grieve the loss of such a special friend.

Are we over the loss of Amie yet?  Absolutely not.  But I think I can now start to think about  getting another Hearing Ear Dog.  This is of course not about replacing Amie.  That is impossible.  But our hearts are certainly big enough to make room for a new dog to become part of our family.

One interesting thing that has happened to me over the few months is other people have also enquired as to whether I will get another hearing ear dog.  Interestingly, the question is not always posed the same.  In fact, they can be classified into three categories.

First, are the “Genuinely Curious”.  These people are truly just asking out of interest.  They do not hold any biases or preconceptions.  They are not fully aware of the impact of hearing loss in general, nor do they fully understand my particular details.  To these people, I do not mind explaining both my situation, the nature of deafness, and the role of hearing ear dogs.

The second group I call the  “Erroneously Positive”.  These people may make comments like “I really do not see you as deafened” or “You seem to be doing just fine”.  Generally, I do not sense any animosity or ill will.  Instead, I believe these people are actually complimenting me.  They judge my degree of disability (or rather lack of disability) on my functional abilities in a one on one conversation, rather than the results of my audiogram.  Interestingly, this flies in the face of the so-called ‘hearing aid effect” in which people with larger hearing aids are judged less positively than those with smaller devices.   These studies were done with photos.  I believe that showing static photos bears no relationship to the real world of communication.  Here I am with a cochlear implant, bigger than the biggest BTE hearing aid from 25 years ago, a hearing aid in the other ear and an FM system in my hand and yet folks don’t think I have that much of a hearing loss at all.  Its quite remarkable really.

The third and last group are what I call the “Ignorantly Hostile”.  Sadly there are quite a few of these people.  They make judgmental comments laced with suspicion and almost hostility.  They make comments like “Yeah, but you don’t really need a hearing ear dog…you just want a pet”.  Some comments are just ignorant, not so much hostile but annoying nonetheless.  Example “Now that you have your cochlear implant, you don’t need Amie anymore, right?”  I am not alone…I have read similar stories from other CI users.  For example, a CI user named Denise wrote “So? If you have a cochlear implant now, why do you need a dog? Didn’t that (as she gestured towards my CI and bling) fix you?”

One thing that many CI users would like others to know is that the cochlear implant is not a cure for deafness.  We have artificial battery operated ears that does not sound like normal hearing (See What Does a Cochlear Implant Sound Like).  It has an electronic microphone that does not have the same sensitivity as the normal ear.  Hearing aid and cochlear implant microphones work best in a 3-5 foot range.  Moreover, the CI or hearing aid does not have the same capacity to filter out noise like the normal cochlea.  Lastly, we cannot wear these devices 24-7.  When we sleep at night we are even more deaf than we were before we got our implants!

To illustrate the limitations of microphones, try this experiment.  Stand about 20 feet (6 meters) from another person.  Have a recording device in your hand.  Most mobile phones have a voice recorder.  Now have the other person speak to you and record their voice.  Did you hear and understand ok?  I am sure you did fine.  Now play it back the recorded version.  Listen to how thin it sounds and how much background noise there is.  Now do it again, but add some additional background noise from say a stereo or TV.  Listen again to how much harder it is to understand the recorded version.

Welcome to the world of people with hearing aids or CI’s.  This little experiment only shows the limitations of electronic microphones.  It does not even address the lack of noise filtering of our impaired auditory systems.

In short, here is tonight’s Top Ten List entitled “Reasons Why I Still Need a Hearing Ear Dog”

1. When I sleep at night, I take my CI off and I hear absolutely nothing.  I need to wake up to get to work in the morning and a regular alarm clock will not work.  Vibrating alarms are not bad…but read on.

2. Similarly, most fires occur at night when people are asleep.  Studies show that visual fire alarms do not work effectively in waking people up (see this article on Waking effectiveness of visual alerting systems ).  A hearing ear dog will physically wake me up.

3. I travel extensively for my work and I cannot take a suitcase full of technical devices with me everywhere I go.  I am not sure how I can hook up these devices to the main fire alarm of a hotel anyway.

4. I have had hotel staff march into my room while I was in my birthday suit.  I did not hear them knock.

5. Hearing aid and CI microphones are not as sensitive as natural hearing.  So I am hit and miss with sounds.  The hearing ear dog will ensure consistency.

6. Many times the sounds I need to hear (doorbell, phone, microwave etc) are not at an adequate signal to noise ratio for a person with hearing loss.  It is buried under noise making it impossible for our damaged cochlea to detect.

7. If I know someone is coming to my house and I am alone, I must sit and wait on the main floor in order to hear them knock or ring the doorbell.  I can’t reliably hear these sounds from another floor of the house.

8. I sleep better at night knowing someone is there listening for me.

9. Traveling is actually easier with a working dog, at least to the countries I go to.  It reminds airline staff I cannot hear the announcements to board so they come get me ahead of time for pre-boarding.

10.  Hearing ear dogs help to filter out the assholes of the world.  If you don’t like dogs, I won’t like you.  So I get to find out a serious flaw in someone’s personality a lot faster.

For more information on Hearing Ear Dogs see the links below:

Lions Foundation of Canada

Pacific Assistance Dogs Society

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The Cochlear Implant Experience of Another Deafened Audiologist


I have a friend and colleague, Dr. Nashlea Brogan, with is also an audiologist with a profound hearing loss.  She received a Cochlear Implant on July 23rd of this year and was activated recently on August 23th.  We have been emailing back and forth a bit about how things were progressing for her.  I asked her if I could post these exchanges in my blog.  I think you will enjoy reading about her experience.  

A few background notes:

1. Nashlea received the Med-El Cochlear Implant. 

2. Nashlea was born with normal hearing.  She believes her hearing started to decrease in her teens.  She was tested at age 14 and by 18 years received her first set of hearing aids.  Since that time her hearing continued to progressively deteriorate such that she lost most of her hearing in her twenties and early thirties.  

2. Med-El, Cochlear, and Advanced Bionics all use different numbers of electrodes in their CI’s. So when Nashlea talks about the 13 electrodes, thats the number that Med-El uses.  My CI is from Cochlear Corporation and has 24 electrodes.  Note also that the length of the electrode arrays differ between the manufacturers.  There is on-going debate as to what the optimal length and optimal number of electrodes should be which I am not going to discuss here, but I just wanted you the reader to be aware of this.

June 17, 2012

Hello Peter,

Well, I have my big day for cochlear implant surgery on July 23 and activation on August 23rd in London. I was expecting the surgery to be in the 2013 winter but they called last week with an opening for this summer, eek!!!!

If you have any advice or recommendations I would truly appreciate it.  I have to continue managing my Hearing Centre’s during this time and do not know what to expect or how to even possibly plan. How long is recovery? Did you work between surgery and activation? After you were activated when did you return to work? Many people reported that they were exhausted in the first few months from sound? Did you travel during the initial months? What was work like when you returned? Sorry for all the questions, I am trying to leave the month after surgery and 2-3 months after activation as open as possible, but I am a planner. Is there anything you would have done differently?

Hi Nashlea.

I am very excited for you!

1. Recovery: varies greatly from person to person. I had my surgery on a Thursday. Went home next day Friday. Was back at work Monday. Others get really dizzy and need a week or two off.

2. Yes I worked between surgery and activation. I only took one day off.

3. I was not exhausted from sound. But I was impatient. You need to really chill out and wait. It takes months to get full benefit.

4. Read my blog!!!!

Aug. 10, 2012

Hello Peter,

Thanks for the reply and I really enjoyed your Blog both from the cochlear implant perspective and as an Audiologist.

I had my surgery and all went well, they made a full insertion through the entire cochlea with all 13 electrodes of the Med-El. I wasn’t really myself until 10 days after surgery, I had a lot of ear pain 5-6 days post surgery.   I am also living with my FM system, I never truly grasped how difficult having monaural hearing was.  My FM system, has made car trips, dining, work and any public situation manageable. I don’t know what I would have done without it. So, next the step is activation on August 23! Now I need to learn patience.

Thanks again

August 29, 2012

Hello Peter,

Activation a dream come true.

I had my cochlear implant activated last Thursday.  Now, I had prepared myself for a difficult time, I was scared from talking to other people and not being able to wear my hearing aid for three months in my other ear. I had advised my receptionist that I wouldn’t be able to see patients until I could understand some speech, I was terrified.

Today, I feel like I won the lottery of life!!!!! The audiologist first tested all 13 electrodes from 250Hz to 6000Hz and I could hear all of them. Once I was activated both the Audiologist and my husband sounded like daffy duck or mermaids!!! That sound lasted only a few hours, we went to a restaurant after my appointment and I could hear the waitress, the music, the other people talking. It has since gotten better hour by hour.

My biggest and most rewarding moment of all this was my children. For the first time, I heard all my 3 year old girls little words!!! She hasn’t stopped talking to me since. I can hear my nieces and friends children talking. When they say mommy to me from behind or another room I hear them. Not hearing children was the hardest part of having a hearing loss for me. I was happy going to work, I did public talks all over Sarnia, I travelled, went out, the hearing loss was more of an inconvenience for these things. But with children I felt isolated and dependent on other people to help me understand what my 3 year old niece was asking me, even my own daughter! I was nervous going to my sons mothers day’s tea in SK because of me not hearing him singing, or if his friend might ask me something with the other mothers looking on.

No sounds have been too loud, all the environmental sounds are exactly as a I remember them. A little history on me, I was born with normal hearing, they think it started to decrease in my teens, at age 14 I was tested but not enough loss for amplification and by 18 years I received my first hearing aids (I had normal hearing to 1500Hz at that time), I have lost most of my hearing in my twenties and early thirties.

I just never imagined this…..its so wonderful and to think its getting better!!! The one thing that i have never heard or read about CI’s is how separate every sound is. I always felt with hearing aids that all the sounds were meshed together, for example I could hear lots of noises in a car, it was loud and made speech hard to understand but the sounds were all blended in one big ball of background noise. Now, I can hear all the indicators, the sounds the buttons make when you press them, the tires hitting the road or cracks, and the acceleration of the motor every time the gas is pressed, and speech is separate not competing with the car sounds.

I haven’t felt any background noise since the moment of activation, in restaurants, cars, and the mall. I hear all the sounds of people walking, talking, machines, music but I wouldn’t describe them as background noise like a hearing aid!

I could type forever. I feel so happy, so full of energy, I don’t even want to take the implant off at night. What an amazing and incredible device!!! What sounds should I go listen to today, ha ha!!

Well Nashlea, thanks so much for allowing me to share your experiences.  I want the readers to know that everyone’s CI experience is unique.  I had no post-surgical ear pain or dizziness, yet Nashlea did.  On the other hand, I needed months to achieve the benefits from my CI that Nashlea received in only a few hours.  Patience is the key.

Details about Nashlea’s Audiology practice:

Bluewater Hearing Centre
316 George St.
Sarnia, ON
N7T 4P4 Canada
Phone: 519.344.8887
Fax: 519.344.4873email:info@bluewaterhearing.ca

Where NOT to Leave Your Hearing Devices


I blew a gasket yesterday.  Not proud of it, but it served to reinforce some points about how much I love hearing.

It was a hot a sticky day…about 34C with the humidity (thats about 94 degrees F, my dear American readers).  I was assembling my new tree stand in the garage but I was sweating like polar bear in Florida.  First I took off my shirt.  I can do that now and not have people scream in horror.  Got a chance to show off my new tat in the process.  But I was still too hot and sweaty.  Even though both my hearing aid and cochlear implant are water resistant, I still don’t feel comfortable getting these expensive devices drenched in sweat.  So I took them off and put them both on the hood of the car.  I turned around and went back to my project.

Here’s my new back piece Tattoo. It doesn’t have too much to do with the story, but I needed a picture.

Meanwhile, my son is having a real hankering for some Indian food.  He earlier asked me for a couple of shekels for this..I gave him enough for himself plus extra for some butter chicken and naan bread for me.  Point is, I knew he was going to drive off at some point, so this is not his fault.

So I am working away in the garage with my back turned to the car.  After about 15 minutes I turn around to get a glass of water in the house and see that my wife has returned from her errands. I start to talk to her but say “Hang on,let me get my hearing aid and CI which is on the hood of the car….Holy S#@*!”.  I now realize the car is gone along with my hearing aid and cochlear implant.  I am cursing like a trucker…screaming like a banshee…swearing like a sailor…angry like a, well you get the picture now.

Half a block away we find the hearing aid.  But so what.  I barely hear with that thing, its the CI I really need.  We continue to search the road while at the same time we are calling and texting my son to stop driving and pull over.  I am still panicking.  I have mental images of my cochlear implant becoming road kill.  Finally, he gets the message. Turns out the magnet on the CI kept it stuck to the hood, even though he had been driving for 20-30 minutes.  He pulled it off the hood and brought it home.  The CI still worked despite bouncing around on the hood of a moving vehicle.

 

Lessons learned:

1. Don’t put expensive hearing devices on the hood of a car.  Duh!

2. Try not to curse too much when you can’t hear.  You can’t monitor your loudness.  Turns out the whole neighborhood heard me.  (Sorry folks.  But maybe you learned a few new fascinating words? They may come in handy later.)

3. Boy do I I love to hear.  So much so, that the thought of having to wait a few days to get a replacement CI freaked me out.  I can go an hour or 2 without hearing, but not more than that.

4. I still wish I never needed these things.  Normal hearing people can sweat, swim, get dirty and still hear just fine.  But there is no point wishing for something thats never going to happen.

5. I was very lucky yesterday…maybe I should go out and buy some lottery tickets.

My fellow people with hearing loss or parents of kids with hearing loss…do you have any stories like this to share?

Bear Encounter with a Deafened Dad


An Ontario Black Bear

I have had several opportunities this summer to camp in one of the most beautiful places on earth: Algonquin Provincial Park.  It is located about 3 hours north of Toronto and is pretty big.  It is 7,725 square kms which, for my American friends, is about the same size as the states of Delaware and Rhode Island combined.   For my European friends, that is about one quarter the size of the country of Belgium.

Algonquin Park has over 1,500 lakes and 1,200 kms of streams and rivers.  It is also the home of lots of wildlife.  I personally have seen many species of wild animals in Algonquin Park including beaver, huge moose, deer, wolves, and finally black bears.  It is an encounter with the latter animal, Ursus Americanus, which serves as the inspiration for this story.

For years I have camped in Algonquin and never once saw a bear.  But in 1999, the spring bear hunt was cancelled in Ontario.  Some say that this caused the population of black bears in Ontario to rise from 100,000 to over 250,000.  Others argue the increase is smaller than that.  I am not going to go into the reasons why they cancelled it or whether I agree with it.  But needless to say, when the bear population grows over 150%, the chances of encountering a bear increase.

So, a few years ago, my son (who was about 12 at the time) and I decided to do some backcountry country camping in Algonquin.  We packed up our gear, loaded the canoe on the car and off we went.  We selected a lovely site on a lake so we could swim and fish.  We had just finished an afternoon swim and I was starting to make dinner while my son went to gather firewood for a campfire.

Of course, I did not have my cochlear implant on because I was still drying off from the swim.  I was barefoot and just in my bathing trunks.  Delicious meat with no wrapping on it.  I turned to go to the tent, which was about 4 meters or 12 feet behind me, to get a t-shirt.  And there he was..Big George the Bear as I later called him.  George was just sitting there beside the tent and staring at me, probably wondering why I was so calmly ignoring him up until that point.  Well George, you snuck up on a deaf guy that’s why.

This is not George, but looks almost exactly like him. George has a green ear tag.

He was a beautiful bear with a gorgeous coat…but I would have preferred to see him on a high definition television or in a zoo like 99% of the rest of the sheltered world.  I was close enough to see that he had a green tag in his ear.  This indicates that he had already been tranquilized, tagged and relocated for bugging people.  Well, I guess George wanted some more Doritos from the car campers which were only about a one hour paddle away.

Note that George was not interested in anything I had in the tent.   I am a very careful camper.  All food and toiletries are safely suspended high up in a tree and not in the tent.  You would be surprised what bears consider to be food (which is almost anything).   I have heard of people leaving Preparation H hemorrhoid cream in their tents only to come back later and find a bear happily munching away on the tube.  Yuck.

After my initial surprise to see a wild bear right behind me, my thoughts turned to my son.  Where was he?  Should I call out to him? But I did not have my CI on so I would not hear a thing if he responded.  I stupidly forgot to bring bear spray or bear bangers with me.  For those unfamiliar with these protective devices, bear spray is a large can of  pepper spray under high pressure.  If needed, you can squirt it into a bears face and it will take off but in intense pain.  I had the unfortunate experience of spraying a tiny amount into the wind and having it come back at me.  It was extremely painful even though the amount was only miniscule.  Pepper sprays such as bear spray is actually illegal in many parts of Europe, but that makes sense.  Why would a European ever need it? There are no dangerous animals there.

Bear Spray

I recall reading about what to do if you encounter a bear.  Note that your strategies for black bears will be different than brown or Grizzly bears.  Black bears are excellent tree climbers so don’t bother trying that.   With Grizzlies, you more or less play dead and pray to what ever Deity you worship.  With black bears, I have read, you actually try to make your self appear big and scare it away.

Black Bears are excellent climbers…so don’t climb a tree!

So I made my decision.  I was going to scare the bear.  If he ran, great.  If not, at least my son would be protected, he could have me.  Believe me, there is plenty of meat on me, particularly back then when I was a chubby deaf guy.  So I grabbed the pot I was boiling water, dumped out the water, got a spoon and started banging it while at the same time roaring at the bear.  I must have been quite a sight.  Shirtless, shoeless, chubby white deaf guy chasing a bear with a pot and a spoon whilst dropping F bombs.

The thing ran so fast.  I heard bears are fast runners, but to see it live with my own eyes was something else.  But most importantly, my son was safe.  He returned out of the woods with a look on his face that said “That’s it, my old man is now crazy”.  He never did see the bear himself.

So what did I learn from this experience?

1. I am very proud that my first instinct was to protect my child.  We all hope that we will do so, but it is nice to have been tested and passed.

2. I never go into the backcountry without bear spray and bear bangers now.  This is of particular importance to a person with hearing loss.  In humans, hearing is the best sense we have for detecting danger.  It works 360 degrees, 24 hours a day, 7 days a week.  Our other senses can’t match hearing for danger detection.  So, all the more reason for a person with hearing loss to protect oneself whilst in bear country.

3. It is true what the experts say about what to do if you encounter a wild bear.  I would suggest reading up on that if planning a trip to the back country.

4. But I am not afraid of bear encounters, just respectful of the animal.  Statistically speaking, I have a greater chance of being killed on the highway while driving up to the park.  Just keep the campsite clean, store food and toiletries up in a tree, and bring bear spray for protection.

Here are some pictures of a recent trip my son and I did on Algonquin.  Enjoy!

Sunset in Algonquin from our campsite

My son Alex filling his head with knowledge.

That’s me in my kayak.

Amie, Bass Guitars, and Good Health.


I have not posted in a while.  I needed some time off.  Amie, my sweet friend and hearing ear dog passed away on June 13.  She was such a big part of our family; her passing hit us all pretty hard.  I wrote many tributes to her already in my blog, you can read them here and here.  Amie, we miss you terribly.

Two happier items to talk about.  My band played another event on Saturday July 21st.  We raised over $800 for the Multiple Sclerosis Society of Canada.  This time I really got the sound right.  I had all the settings tweaked really well so I could hear exactly what I needed.  Moreover, what pleased me most was my ability to keep playing the correct parts when our singer deviated from the song.  I was able to hear that we were not at the part of the song I expected and still played correctly.  In addition, my guitarist was able to glance over at me and mouth instructions.  It was such a massive confidence booster to know that we can screw up but still recover without anyone in the audience even knowing it.  For more information on how I play live music with my hearing loss click here.  Also, this link here talks about how I keep the beat.

Also, I continue to improve my health.  I started in March at about 260 lbs and I am now 221 lbs.  I continue to run, work out, and avoid eating most things that are white (Salt, sugar, starch-filled things, white bread, white pastas, creamy things etc).  I blogged about the weight loss here.

I will be back to regular blogging again soon.  Meanwhile, here is a picture of me on the far left in the black t-shirt with some friends at my Saturday event.  Next picture is with my wife enjoying the vineyards of Niagara region.

Cheers!

Hanging out with friends at the MS Fundraiser I did with my band Below the Belt. Thats me on the left in the black v-neck.

Enjoying time at a vineyard in Niagara Region with my lovely wife.

Working Out Deaf


I won the contest at work.  We had a bet who could lose the most percentage weight.  Yippee for me!  I lost 29 lbs in 9 weeks.  Just over 11% body weight reduction.  I still need to lose about 25 more to finally put an end to the “chubby deaf guy.”

Working out Deaf…do you wear your hearing instruments or not?  Yes, I have a water resistant hearing aid and cochlear implant.  But years of being taught  to fear moisture on my expensive hearing devices still is in me and I can’t seem to get over that.  Thus I always remove my CI and hearing aid when I work out.  This has pros and cons.

Pros:  I like being in my own little world sometimes.  I enjoy the peacefulness, and I seem to focus better on exercising.  I can work out as intensely as I wish with no concern about damaging my hearing instruments.  Lastly, at the gym, there can be some arrogant jocks spewing off stupidity.  My son tells me some of the conversations he has heard.  A real classic was some meathead dude looking forward to visiting LA because  “Almost all the women in LA have done porn.  Its true dude!”  These are the times I consider myself blessed to be deafened.

But there are some cons and some safety points to consider.

First, I think I need a t-shirt that says “I am not a douche-bag…I am deaf”.  Although I try really hard to not block anybody and be aware of my surroundings, sometimes people ask me questions like “are you done with that machine”.  I look like I am ignoring them, which gets erroneously interpreted as arrogance.  I mean, thats what guys do in the gym, right?  It is almost a dick slapping contest.  Well, no, not for me…I am not a jerk like some of the other guys in the gym, I am just deaf.

Then there are the safety issues.  I also run outside with no hearing aid or CI.  Let me officially state that I am not advocating this for anyone because you may not hear a car and get run over.  The safest thing would be to run on a treadmill if you insist on doing it “deaf”. Or use your hearing instruments whilst running outside.  Try protecting them with products like the Hearing Aid Sweat Band or Ear Gear.  I have not personally used these products, so don’t interpret this as an endorsement…but check it out.  Lastly, you when you are done with your exercising, put the hearing instruments in a Dr-Aid kit of some type.

There are now hearing aids that are water resistant.  Phonak has the new H2O line of hearing aids as does Siemens with the Aquaris product.  In addition, the Cochlear Nucleus N5 is water resistant, while the Advanced Bionics Neptune is actually waterproof.

But I have taken some steps to increase my safety, namely by enhancing my visibility.  First, I wear a reflective safety vest.  This makes me pretty much glow when headlights shine on me.

This vest makes me more visible.

But I didn’t stop there.  I also added some flashing lights to the vest.  I have a white at the front and a red one on my back.  If you can’t see me now, should you legally be driving?

These lights make me look flashier than Elton John.

The decision to exercising “deaf” is entirely personal.  I prefer it for myself, and I accept the related risks (not hearing traffic, and not hearing jocks).

What Do You Do When You Can’t Hear Anymore?


Here’s a simple question that seems to confound many hearing health care professionals.  What do you do with a patient who can’t hear anymore?

I guess we should back up a bit a define what we mean by “can’t hear anymore”.  What I am referring to is patients with hearing losses typically in the profound hearing loss range with auditory-only monosyllabic word identification scores typically around 25% or less.  Note that we need to look at both the hearing loss and the word identification score as the variability of communication performance in this hearing loss range is massive.  Additional, we should look at auditory-visual word identification to see how well the patient can utilize the addition of lip-reading information.

Lets look at a case that I recently encountered.  The woman had a left corner audiogram.  Word identification score was 0%.  Auditory visual speech perception was not much better, but was not assessed by the clinical audiologist with an AuD so we don’t really know.

I was contacted and asked if I could help with the FM fitting at this office.  I agreed, but as is always the case, I was not given all the details.  I got there, asked to see the file and my jaw dropped.  The conversation with hearing health care professional (HHCP) went something like this:

Me: So what are we doing with this patient?

HHCP: We are fitting an FM system?

Me: Why?

HHCP: What do you mean why?

Me:  I mean “why?”, thats what I mean.  What will the FM system do?

HHCP: It will help the client hear better.  She and the family are pretty frustrated.

Me:  Well of course they are.  But how will the FM help the client hear better?  Will it improve her word identification score?

HHCP: Sure.

Me:  How?

HHCP:  By improving the signal-to-noise ratio.

Me:  When you did the word identification test, did you do it in background noise, or in quiet?

HHCP:  In quiet.

Me:  So we are already looking at the best possible score and thats 0%.

HHCP:  I guess…

Note that this is not the first time I have had a conversation like this with an audiologist or a hearing instrument practitioner.  It seems to me that most clinicians have no clue what to do with patients who have little or no hearing.  I am not 100% sure of the reason for this, but I suspect that it goes back to our problems with our training. And that is as follows:  We are only trained on how to assess hearing and how to fit a hearing aid.

The audiologist in this example is, like most of my colleagues, a good and decent human being who truly wants to help the patient, but doesn’t know how.  He is simply the end product of his training.

As an audiologist who also had 0% word identification and little hearing, I would like to offer my hearing health care professional colleagues a few suggestions on what to do with these kinds of patients.  This is just a starter list…books could probably be written on this topic.

1. Counsel the patient.  Specifically, let them know that they cannot hear anymore and we need to change tactics.  In the case example above, and with the managing audiologist’s permission, I sat down the patient and her family and told them just that.  The woman’s son practically had tears in his eyes…tears of frustration.  He said “You are finally the first person to finally tell us what we have been saying for years, “my mother can’t hear”.

2. Let them know what a hearing aid can realistically do.  In this woman’s case, it might provide a few basic awareness cues of loud sounds in the environment.  Thats it.  It will do little for speech perception.

3. The patient has two basic choices now.  1. Cochlear Implants or 2. Switch entirely to a visual approach.

4. Cochlear Implants:  Make the referral to the closest implant program.  Give a basic description of what it does, but stress that you are NOT a cochlear implant audiologist and they should get the correct information from the proper professional.  Resist the temptation to give too much information here, unless you are very informed about CI’s.  And don’t worry about candidacy.  Let the CI centre work that one out.  Most audiologists wait way too long to refer to an implant centre. When in doubt, refer to the CI centre.

5. The second option is to switch to visual approach.  This can include learning sign language, using written notes, using text messaging via a mobile phone, things of that nature.

6. Lip-reading as an exclusive method if communication is not an option in my opinion.  An explanation why is another entire blog posting, but basically far too many words look the same on the lips and it is extremely exhausting to lip-read all day long.  It is best used as a supplement to hearing.  Works great for folks who still have some usable hearing.  See a fellow blogger’s posting on this topic.

7. Discuss alerting devices that use visual or tactile stimulation.  This folks need to know when there is someone at the door, if the phone rings, if there is a fire etc.  Hearing Ear Dogs could be discussed here as well.

8. Give options for phone communication.  In the past that would have meant getting a TTY (sometimes called TDD’s).  Nowadays, we have even more options including text messaging, instant messaging, email via computers, email via smart-phones etc.

9. Make sure the patient knows about captioning.  This includes TV, but also real-time captioning (CART).

I provided all this information to this lady and her family.  I also took back the FM and told them that it would be a waste of money at this time, but if they got a cochlear implant, an FM system can be added then.

This woman, who’s hearing loss was progressive over the years, should have started using an FM system when her hearing loss was moderate-severe.  Her time for the FM came and went.  FM systems need to be added much earlier, not when the client is a CI candidate.  That’s too late.

What Does a Person with Hearing Loss Know About Hearing Loss?


Recently I was sent an email from an audiologist (really nice recent grad) asking how to help a patient with hearing loss hear better in the noisy workplace.

When the issue of using an FM system came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”.  So I was asked to come up with some other suggestions.

Ummm, ok,  I have a whole bunch of problems with this.

First, I think we need to clarify when we need to listen to our patients and follow the patients lead.  At other times we, as audiologists, SLP’s, hearing instrument practitioners or hearing resource teachers need to provide leadership and guidance to our clients with hearing loss. As an Audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.

First, here is a list of things where the person with hearing loss knows best:

  1. Ask and find our all the different situations in which the person with hearing loss is having difficulty.  List them all and seriously look at how we are going to help overcome those challenges.
  2. The patient knows and can tell you how it feels to be in a given situation.  Don’t be afraid to ask about this.  When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that.  It is good to just let the patient explore their feelings and frustrations.
  3. Discuss past experiences both good and bad to see what you are up against.  For example, find out if the client ever tried an FM system or ever used directional microphones in the past.  Likely if something was a failure in the past, find out how much coaching the patient had in how to use the equipment.

In short the patient knows, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss.  But here is what the patient does not necessarily know and where the expertise of the professional is required.

List of Things a Patient with Hearing Loss Does NOT Know;

  1. Whether or not a hearing aid is even needed.
  2. What electroacoustic characteristics are needed in the hearing instrument
  3. What style of hearing instrument is most appropriate.  A patient can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done.  Period.  Yes, many patients have lots of choices of the form factor, but some do not.  We need to lead here, not follow.
  4. What technology for managing noise is needed?  For example, if a client has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that an FM system is needed, the hearing health professional NEEDS to communicate this to the client.  The client does not know what technology is required.  They just know the situations they find challenging.
  5. How to effectively use the equipment.  You cannot simply toss the equipment at the client and hope they figure out how to use it in the difficult listening situations that were identified.  Patients need our counseling and coaching here.

Now back to the patient who can’t hear at work.  The specific situations at work need to be fully explored.  Ideally, you can do this formally with the COSI.  Again, the patient understands this so much better and he needs to tell us as much as he can about his challenges if we are going to have any chance of finding solutions.  Next we need to explore why he feels that an FM system would not work.  He likely does not know how the technology works or how to use it effectively.  There are excellent FM counseling tools available for this purpose.

But we have to stop letting patients dictate the wrong things.  I have seen in my 20+ years of professional experience numerous patients who are wearing “dirty little secret” tiny aids and are not getting the correct amplification.  We need to provide leadership here and work the client towards more appropriate amplification.

Similarly, we must always consider not just the amplification needs but also the hearing in noise needs as they relate to the client’s own personal situation.  Will the client need directional microphone technology?  Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will FM technology be needed?  Most patients with moderate severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.

I agree that we cannot force anyone to take our professional advice.  But patients do have a right to make an informed decision.  In my opinion, we are obligated as Hearing Health Care Professionals to give the patient all the facts.  Too often, when I give talks about directional microphones, FM systems, and other assistive devices,  a patient will ask me “How come this is the first time I am hearing about this stuff?”

World’s Best Travelled Hearing Ear Dog


Amie loved her long walks.

 

Last weeks blog posting was a bit heavy. Its time for a lighter blog post…and a fan favorite in the blogosphere.  Amie the Hearing Ear Wunderdog.

I guess I am getting sentimental again because Amie is having a tough time these days.    Due to the Transitional Cell Carcinoma in her bladder, she is having suffering from urinary incontinence.  We need to keep her diapered at all times or in the crate with an incontinence liner.  Its stressful for all of us…

Hence the need to reflect upon better days when Amie and I travelled the world together.  We came up with a list of all the places Amie and I have been together.  I must say, it’s pretty impressive for a dog.  Here’s what we came up with:

  • San Diego, California
  • Salt Lake City Utah
  • Chicago, Illinois
  • Atlanta, Georgia
  • Vancouver, Victoria, Whistler, and Kelowna in BC
  • Calgary and Edmonton in Alberta.
  • Hiking in the Alberta Rockies
  • Saskatoon and Regina Saskatchewan
  • Winnipeg and other parts of Manitoba
  • Pretty much every city in Ontario
  • Quebec City and Montreal, Quebec
  • Halifax, NS
  • Charlottetown, PEI
  • Moncton, NB
  • Whitehorse, Yukon
  • Zurich, Stafa, Bern, Kandersteg, Murton, and other places in Switzerland.
  • Plus more, but cannot recall

It is during these trips that I have had some of my funniest stories with Amie.  One time we were doing a training session at the Westin in Ottawa.  Normally Amie just sits in the room while I present, or maybe greets some guests.  But this time she we suddenly realized she was gone.  Turns out she sniffed out that some bankers in the next seminar room had a way better buffet of cheeses and meats (we had veggies and dip…boring!).  Little monkey.

Amie sitting nicely, hoping for treats.

Another time I was in a Montana’s Steak House.  We were seated in a booth and I took Amie’s leash off while she sat beneath the table.  She couldn’t go anywhere…we were in a booth.  Right?  Wrong!  Turns out the walls to the booth did not extend all the way to the floor.  She snuck out and was seated in front on a table of a nice old couple who were sharing their Prime Rib with her.

Another favorite is during a trip to Kandersteg, a village high up in the Swiss Alps.  The Inn owner was terrified of dogs her entire life…until she met Amie.  Amie’s sweet and kind disposition essentially cured this woman’s lifelong fear of dogs.  By the end of our trip, the Inn owner was taking Amie by the leash and introducing her to all the other guests in the Pub.

For years I have done what I like to call “Kids Days” at Phonak. Here we bring kids to the Phonak office and give them a factory tour, followed by a pizza lunch and an Amie Hearing Ear Dog Demonstration.  But for the longest time, I kept getting the same kids returning year after year.  The teacher’s explained that the kids could go wherever they wanted for their trip, but they all wanted to come to Phonak.  Well, it really turns out that they all wanted to come see Amie again. “Forget the Zoo, forget Rock Climbing, we want Amie”.  And here I thought they wanted to come see me.  Nope.

Going to Bass Pro Shops looking for matching outfits.

As we get closer to the difficult day, I want to make sure we always remember Amie in her glory years…as one of the most well travelled and loved Hearing Ear Dogs in the whole world.

Everybody loves Amie, especially her mom.

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.