Hearing Informed

Thanks to Jeff Roth, the author of this story:

I have never been clear about the proper way to keep my ears clean.  I had grown up being told by my doctor that “the ears naturally clean themselves.”  The advice was to clean the outside of the ear canal, but do not go inside, as this disrupts the natural process of pushing ear wax out, possibly pushing wax so far into the ear canal that it gets stuck. Plus, it is good to have some ear wax.

At the same time, I independently learned the satisfaction cleaning out my ear canal with a bobby pin.  I figured, I could just go a little bit inside the canal instead of staying on the outside.  I got better at going deep inside my canal and periodically getting out big chunks of heavy, sometimes dark, wax.  For 15 years this method kept my ears happily fairly clean.  I was an avid swimmer and I never once had an ear infection, and I never fulfilled my doctor’s concern of puncturing my ear drum.

When I was in my mid-twenties I decided to follow my doctor’s advice, and see if my ears could take care of the cleaning themselves.  I stopped sticking bobby pins in my ear.  After maybe a year, my ears started to get clogged.  Determined to stay on my doctor’s advised course, I didn’t stick in any bobby pins but tried an over-the-counter ear wax softening agent.  I followed the full 3 day course, spending too much time lying on my side.  Afterward, I flushed out my ear, but didn’t get the wax build up I knew was in there.

In fact, my hearing started to get worse, and soon, my right ear was completely clogged.  I went to urgent care, and an incompetent nurse and doctor put stool softener in my ear (they said that would work the best), let it sit, and then spend 45 minutes shooting water into my ear with a syringe.  Did it work?  No, my ear just became painful, and nothing came out.  I got a bill of over $300, of which my copay was $90, and a referral to the ear nose and throat doctor.  I figured I would finally get some relief and some clear answers.

The ENT doc used 100% strength hydrogen peroxide in my ear, which he said works better than any of the softeners.  Then he successfully vacuumed out the wax.  I asked him why urgent care couldn’t have done that and he said it wasn’t the vacuum that is expensive, but the microscope that goes along with it.  I let him know the local Costco has one.  I didn’t bother telling him how I would have to pay for both the unsuccessful treatment and the successful treatment.

The doc confirmed my suspicion that my original doctor was wrong, people’s ear wax differs, and some have wax that will not come out on their own.  He said I could either come in once a year and get the same treatment (which would cost me $100 copay), or use hydrogen peroxide myself every once in a while and then flush out my ears with a mix of hydrogen peroxide and warm water.  I bought a syringe, but have actually found that the water pick on my shower works even better.  And I am confident the bobby pin helps as well.  Having finally gotten some good advice on how to clean my ear, I thought I’d share my story see what other people think.

Mind altering substances of many kinds may have something to teach us but they’ve been mostly dismissed, demonized, and cast into broad legal categories that aren’t meaningful.

I had a curious experience a number years ago with one of these schedule 1 substances that led to a bit of an epiphany. No, I didn’t discover the meaning of everything; nor did I experience some radical realization that I needed to join Scientology to save my thetan. My discovery was far more pragmatical and relevant.

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A typical earplug from Walgreen’s squelches so much sound that I don’t really enjoy concerts with them. Most earplugs are made of high density foam that muffle speech and music- they reduce sound more in the high frequencies (that I really need) than the mid and low frequencies, which makes the sound unnatural and unclear.

Hearing loss is a function of exposure time, average sound level, and the peak level of very loud sounds. To make things more complex- every person reacts a little differently to loud sounds and some people are more susceptible to hearing loss than others. However, most earplugs, when used for concerts, are overkill. They kill a lot more sound than necessary for hearing protection. The solution? I love my musicians earplugs from Etymotic Research. I can switch out little replacement buttons that change the amount of decibel protection to suit the situation. I find that the 25 decibel button works great for loud concerts and and I can hear a LOT more than I did with the typical store bought ones. The cost of $150 might be considered a bit steep- but its not all that much when you consider your protecting your hearing and having a great sound experience. Also- buying replaceable earplugs all the time will surely add up.

In the bay area I really appreciate the small concert halls that give a nice full sound without hurting my ears. My favorites: Yoshi’s in Oakland and San Francisco and The Kuumbwa in Santa Cruz.

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If you have a high frequency hearing loss (the most common kind) - then you aren’t likely to hear a thing coming out of the alarm clock of your digital watch. Alarm clocks beside the bed are a different matter- you can usually adjust the volume and have it set to a cacophonous radio station.

Before a trip that I made to Peru I did a search on the internet: “watches for the hearing impaired”. I came up with a couple places and I decided to try a watch called the VibraLight 3. This watch has a vibrating alarm clock that jolts your wrist and you awake. This seemed like just the right watch and it came in a number of nifty colors and styles reminiscent of my classic Casio.

The watch turned out to be an utter failure.

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Traveling with hearing aids can be a taxing business. It’s easier to deal with breakdowns at repairs at home within a familiar infrastructure. A potential onslaught of moisture, theft, and unexpected breakdowns await. Instead I just try to prevent and avoid disaster. I depend on my hearing aids while traveling even more than I do at home- unfamiliar accents and languages drain all the listening power I have. Here are my tricks that i discovered over time:

1. I learn how to say “I didn’t hear you, could you repeat that” in the foreign language of the country I am visiting. It won’t serve you well to just learn “what?” - this often leads to more confusion- the other person will think that you don’t understand what they are saying (cognitively), not that you just didn’t hear them. They could also think you are saying “what?!” as in a slangy “you don’t say?!”, and you’ll get no response. This is an important distinction.

2. Bring an extra mold (I just bring an old one) and new tubes to attach the hearing aid to the mold. Molds can break or crack – especially when the temperature or pressure is changing rapidly. I also bring a small plug that attaches to the mold and transforms the mold into an earplug for sleeping in noisy conditions or, in my case, dancing on very loud club floor.

3. A min-dri aid which extracts the moisture out my aids at the end of the night. I find my hearing aids will temporarily quit on me at times while moving through humid climates. If this happens I pray and then put them in the dri-aid box and they usually work fine the next morning. A major theme: avoid moisture.

4. Extra batteries: lots of them. I prefer the best ones: Rayovac Proline. Keep in a relatively air tight pouch. See below.

5. Waterproof pouch for keeping my hearing aids dry and protected when Im not wearing them. I like the pelican cases. Also to hold batteries, and extra tubes, brush and tools for cleaning the aids.

5. A lock so that I can keep the thieves away at times when I need to leave my hearing aids and go to a place I can’t wear them- like the ocean.

6. If possible, I bring one of my old hearing aids as a backup, fully repaired and brought up to date at a place like Hearing Haven. Hearing Haven can bring an older hearing aid up to date for a solid price.

7. Pay a few hundred dollars to have my hearing aids insured for loss or damage from Esco. I would rather pay a few hundred than three thousand dollars to replace a broken, lost or stolen hearing aid.

8. On a long trip? I contact my audiologist and let them know I will send them a package with my hearing aid if it needs repair. Ask them what they will need besides the hearing aids. I come prepared with an envelope, esco insurance info, bubble wrap for protection, addresses, and stamp.

9. A cleaning brush and wax remover. You shouldn’t have to pay for these.

10. Communication is nearly impossible? Which it certainly can be sometimes for anybody on a trip- Take along this helpful picture book and point to what you want.

I’ve always found it fairly ineffective to evaluate how well my hearing aids are working in the sterilized, rectilinear office of my audiologist. The fitting needs to begin with the audiologist- an important step for me in figuring out exactly what which aid and what amplification works best for me. However- the office hardly mimics the everyday conditions that my hearing aids need to work in. Here are some specific examples:

1) Driving in my car with both the drivers side and passenger side windows down while talking to my friend in the passenger seat. I usually have to shout to hear myself and lean to my right to catch everything she is saying. Or I can use it to mask the fact that I am not really listening. Its often nearly impossible for me to hear what people are saying in the backseat at a normal volume. I need them to lean close.

2) Sitting across my friend at dinner while talking in a crowded restaurant and later sitting side by side at a bar and talking. At the same time, attemping to overhear the akward, tense coverstation between a duo on a first date.

3) Listening to a mentally anguished person in a square in Peru is shouting in Spanish about his takes on the bible and coming apocalypse. There is the added difficulty of the open air and a foreign language. Foreign languages are always a good deal more difficult. I found it quite enjoyable to actually hear a person a like this with my Resound hearing aids.

4) Listening to all the instruments in a small jazz hall with excellent acoustics, a sound that isn’t too loud for amplification. Making out different parts of the drum kit. I also like to try play guitar and test how that sounds compared to the sound of a person playing in front of me.

5) A phone message that comes through on my cell phone with a lot of interference. The call is giving me an address for 201 Chardhill St. , or 301 Gardhill St, or is that 201, Gargfill St. The high frequencies that I need most suffer on a cell phone- and put my hearing aids to work.

6) A customs officer that has a heavy accent , instructing me to open specific items when I can barely hear what hes asking me to do- making me feel and look nervous at a time when its not advantageous.

7) Making out with my girlfriend and trying to make out what she’s whispering into my ear.

8) Waking up in the middle of the night while sleeping, deep in the mountains on a backpacking trip, and overhearing a bear trying to move his way around some food that I have strung up. The chattering of birds warning of the bears presence.

As we can see- none of these conditions seem to closely resemble an audiologist office. So I recommend that people get out and wear their hearing aids, under the required trial period, and see how their aids really work. I temper my expectations and look for the tangible differences that I notice. I go back to the audiologist and and them adjust the decibels for different frequencies. Figuring out what works right seems to take a lot of patience and practice.

I wish there were more studies from the hearing science journals and manufacturers that were going after these real world conditions. I understand that its extremely difficult to do objective, statistically rigorous, empirical studies under these conditions I have described. It doesn’t help that each individual is going to react differently- although I believe there will be more of a continuity than we would think. However, my subjective interpretation as to how the hearing aid is really working, at the end of the day, is everything.