I recently visited my audiologist here in San Francisco to meet with him and a representative audiologist from Widex to try out a brand new hearing aid- the Widex Passion. The representative was there to fit and adjust the new hearing aid and see how I responded to a unique concept called the audibility extender. The audibility extender brings the higher frequency sounds that are unavailable to me down to a lower octave that I can hear. It was amazing!

Its certainly a bewildering experience to have new sounds available that I’ve never heard before- and its not without a certain “unnaturalness” and strange sound artifacts. These are the inevitable consequence of tinkering with sound in this way. However, I found the new sounds to be something that I really want. For instance- I can barely differentiate between “sh”, “th”, “ch”, and “s” sounds. The audibility extender brought those particular sounds into a range that my hearing aid could amplify for me- at a lower octave. I could understand speech better as a result…truly amazing and I hope they keep this technology and continue to improve on it. It really clicks with me.

This concept won’t work for everyone. Some people find that the audibility extender makes speech harder to understand and find the strange sounds to be unacceptable. But I think if people stuck with this for a while and went through the training provided on a compact disc- they might find that these strange and foreign sounds become more useful over time. It really requires some work and flexibility. I told the Widex representative that it wasn’t unlike being on a hallucinogenic drug- where the brain has to grasp onto brand new sounds that it’s never dealt with before. I think the brain should be given some credit..built with a huge amount of flexibility it can deal with these new sounds over time and adapt to them. Im confident that the audibility extender will prove to be a more and more useful and positive experience for me over time. I’ll report back on this as I move along with it.

The audibility extender needs to be fined tuned and adjusted for each user. It helps to have someone tinker with the settings and get them right- otherwise the experience won’t live up to its full potential.

Some areas that I’m excited to use the audibility extender in: listening to bird songs, playing the higher notes on my guitar, the high pitched whirring noises that my transmission is apparently making, whispers, overhearing gossip.

This is a deal breaker for me- I might go with the Widex Passion hearing aids over all other hearing aids simply because of this feature. As a quick disclaimer: Please take my opinion with a grain of salt- what works for one person may not work for another. I’d like to hear from other people what they experienced when they tried this feature- both negative and positive!

As a quick sidenote: For my hearing loss, I felt that the Lyric hearing aid was even better than the Widex Passion in terms of sound quality and making high frequency sounds audible for me. Having said that- I find the Widex Passion to be a close second. I’m not going to wear the Lyric because it won’t work for my ear canal. I’ll write more on that later.

Heres an example of a negative reaction that I found at hohadvocates.org forum

Heres an article and a review of a clinical study of the audibility extender from The Hearing Journal

Another more technical article about frequency transpositioning in general

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.

Check out this New York Times article on the Lyric.

The author of that article asked her readers about their hearing aids on her blog. There are a lot of insightful comments from hearing impaired people and those involved with the hearing health industry.

I’ve been interested in a new hearing aid concept through Insound Medical, called the Lyric. [I've written about them already] The hearing aid fits all the way inside the ear, 1/16th of an inch from the ear drum. This means the device is invisible but it also means the sound doesn’t have to be amplified as much. Theoretically, the sound should be more natural and less distorted. Its supposed to be quite comfortable with its soft and spongy exterior. The spongy material helps dispel moisture that would otherwise be trapped. You can keep the hearing aid in your ear when your sleeping, showering, or doing just about anything but constant swimming. The device provides pure analog sound as supposed to the now ubiquitous digitally processed sound. Analog sound might prove to have its advantages over digital when it comes to hearing aids. The 500 people or so who currently wear the device swear by it.

Cost? You wear the hearing aid up until the battery runs out - which can end up going about 120 days but that varies based on environmental factors and your hearing loss. They charge an annual subscription fee of $2,900 to $3,600 (less if the hearing loss is in one ear). That would add up to a little more than the $6,000 or so I would pay for BTE hearing aids that last me 3 or 4 years. It would be worth it if they prove themselves to be better than my BTE options. Check out this New York Times article on the Lyric.

I’ll be trying the Lyric out myself in the next couple months and I’ll let you know what I think. It probably won’t be a good long term fit for me because I’m in the water almost every single day surfing (and I won’t stop doing so). But I’m very curious- I might as well try something on a 30 day trial or your money back that many State Laws provide.

Their website for consumers has well made videos but they need to freaking add some captions to them if their consumers are hearing impaired.

I have a couple questions for my great readers:

Which hearing aids do you wear? Are you happy with them? - How do they help change your life for the better? What don’t you like about them?

Did you pay for them out of pocket? Were you able to get financial assistance from Insurance or other sources? Is the current recession affecting your choice to buy a hearing aid?

If you want to let me know anonymously, email me at davidsigismund@gmail.com. All information shared with me is confidential and private. Otherwise, just post here. Thank you for reading this blog. Your opinions matter to me.

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.

I was with several friends at the time (in Spain) and hanging out talking away about everything and anything. We had just ingested a small amount of Psilocybin because Nancy Reagan had told us not to. Several of the people I was with were Spanish speakers and were going in and out of English and Spanish. With my hearing aids and limited Spanish skills I was able to communicate with them in both languages (English being far easier of course).

As the “drug” kicked in I rapidly lost my ability to communicate in Spanish and eventually English too. I had the sense that my ears were taking in the sounds rather undistorted but all the abilities I had before ,to make up for my hearing loss and understand people, were gone..vanished. I couldn’t readily make sense of the syncopations and rhythms that make up everyday speech. I also couldn’t lip read nearly as well. So I was suddenly left with my ears, as they were, and no backup.

Before this experience I understood that I had a lot of unconscious habits that made up for a hearing loss but I didn’t really appreciate the extent to which they helped me talk with others. The way someone stood, the accents placed on words and sounds, the lips, and all the little expressions that a person gives were crucial to my understanding of language. Now that my mind was overwhelmed with unfiltered sensory experience- like the floodgates were simply opened- I lost most of these skills. It was rather disconcerting to experience the first time- confusion and panic were present. People were saying things to me and I really wasn’t “hearing” anything. At this point everybody was able to communicate with each other fairly well except for me. I was left with sound but no communication abilities. Its worth noting that everyone could reach this state eventually- I just reached it far sooner. It took me a good amount of time to accept the situation as it was and just give up communication for the while. As a side note: it would have been interesting to see if the same thing would have happened with sign language. Would I have kept communicating with my hands far longer than I could deal with speech? My guess is: yes.

The experience showed me that “hearing” is far more than just my ears with their eardrum and inner ear parts. Hearing and communicating are truly complex experiences that combine cognitive functioning, sound, and even sight. I think most hearing impaired people know that they have to use it all- one thing that isn’t there just leaves the brain with extra space to do something else

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Since 1989, Knowles Electronics has conducted seven Marke Trak surveys of the US hearing loss population. In one of the most recent surveys from 2007, some disturbing statistics were unearthed. It was determined that there were 1.2. million children ages 0 to 17 in the United States: 1) whose parents admitted that their children had “hearing difficulties” and that 2) that children did not use amplification. That leaves out the estimated 300,000 dependents aged 18 to 21 with unamplified hearing loss. In some of these cases a hearing aid wouldn’t be the answer. But a vast majority of these children are being left behind by going without hearing aids. It goes without saying that these children are denied a basic right to communication; its effects are like cascading dominoes that lead to mental health problems, social ineptness, lack of self confidence, poor academic performance, and overall broken dreams.

In Marke Trak VII, a targeted survey was sent to 3,000 parents of these dependents that have hearing loss but don’t wear any kind of hearing device. They were asked to discuss four major issues: 1) the nature of the dependents loss; 2)the treatment sought; 3)impact of hearing loss on dependents life, and 4)reasons why dependent does not use hearing aids. Almost 90% of the parents responded in some form to the survey.

These responses shed light on haunting levels of ignorance and denial. Many the letters are downright flippant. There is usually a glaring discrpency between the subjective reporting of their child’s hearing loss level and the realities that are espoused in the letter. In fairness, some of these parents want the best for their children but can’t afford hearing aids or don’t get qualified advice. So many important questions are raised by these letters:

Minimization, Denial, or Neglect?…

“Kept saying ‘what’ at a young age of 4. Doctor said it may get worst or better not sure, but so far stayed the same. She was in special education so school was OK most of the time. At school she sits up close. Music, TV and games she turns up loud. Did not get hearing aids because doctor said it wasn’t bad enough.”—Parent of 20-year-old female described as having a moderate hearing loss in one ear

“The hearing loss was discovered from my daughter’s speech. She doesn’t talk as well as she should. The family doctor has her going to Easter Seals for speech. Hearing testing was mild but not real bad hearing loss.”—Parent of 4-year-old female with mild hearing loss

“When you talked to him, he wouldn’t answer you or he would say, huh? You have to repeat what you say to him. The teacher sets him closer up front of the class. He does not have hearing aids because his hearing isn’t that bad yet.”—Parent of 8-year-old child, with hearing loss described as moderate and inability to hear normal speech across a room

“She has requested seating at the front of the room in school in some classes. She will turn the TV up to a point where it is almost uncomfortable to others. Surgery repaired the rupture to her ear drum and she just lives with the mid to moderate hearing loss. Her hearing loss is not severe enough to warrant hearing aids.”—Parent of 14-year-old female with infection as a child, ruptured eardrum, and subsequent scarring from surgery, described as having a moderate hearing loss

“If she is in a room next to the room I am in, I have to shout or use the phone to call her. If she is in the same room, I have to speak loud and slow. I do not think her hearing is bad enough to warrant hearing aids.”—Parent of 15-year-old female with mild hearing loss and inability to hear normal speech across a room

Professional Recommendations…

Many of the parents in the survey make decisions not to to explore hearing aids for their children based on “professional recommendations” from pediatricians, audiologists, family physicians, or ENTs. Some of the parents received conflicting information from two or more professionals. Most of the information seems to either be egregious misinformation or a severe misunderstanding of competent information. Some of these “professional recommendations” that follow are completely perplexing…

“Both the audiologist and the ENT felt they were not necessary at this time even though she plays radio very loud and TV as well.”—Parent of 16-year-old female with otitis media up through age 11 years requiring PE tubes. Has hearing loss now in low tones and described as having moderate hearing loss

“When my son was about 7, I had him developmentally tested. This was just a precaution as a result of home schooling. He failed the hearing exam. We were referred to an audiologist who also failed him. So we went to his pediatrician. She tested him again in the office using her little machine, which she swears is very accurate. Her test came back with no problems whatsoever. My son is now 10 and he still complains of not being able to hearing some things. The only thing [the pediatrician] did, however, is to keep testing him with her machine and nothing ever comes back bad, and she has refused on two different occasions to give me a referral to go back to the audiologist. She also has stated that he’s just a boy, and he’s probably ignoring us, or even having selective hearing. The reason for not getting amplification is his doctor does not acknowledge he has a problem.”—Parent of 10-year-old boy with a reported mild hearing loss who cannot hear speech across a room; has had behavioral problems at school and difficulty with family relationships

“Couldn’t understand anything she said. Doctors said was nothing to worry about. When she still could not be understood at the age of 4, we knew she needed help. Her doctor still would not help us. She started Pre-K, and the teachers and counselors requested that she be tested. That’s when we were able to get her help. We have sought all methods of help with her hearing. All the doctor specialists, audiologists, and other experts, have told us hearing aids will not work for her. She has no damage to her eardrum. She has a blockage in her ear canal. They will not do surgery. She has been in speech and hearing classes from Pre-K to first grade. She is going into 2nd grade and her speech has improved but not her hearing”—Parent of 8-year-old female with moderate hearing loss who can not hear normal speech across a room “At approximately 18 months of age I noticed my daughter walked like a drunken sailor. She did not respond if I stood behind her and talked to her. I took her to our pediatrician’s office. At first he brushed me off. I persisted until he did a basic audio test. She was flat line—the test would have had a bell curve if she could hear. He referred me to an ENT doctor.”—Parent of 9-year-old female with mild hearing loss requiring speech therapy

“My son was having a speech problem at age 3 and the doctor wanted to check all aspects; he was found to have a high frequency loss in his left ear. The doctor said hearing aids would not help this type of hearing loss.”—Parent of 18-year-old male with high frequency moderate hearing loss requiring school adjustment and speech therapy most of his childhood

“Loss of high pitch in left ear and was told only old farmers have had this hearing loss. Nurse in school informed me. Was told that hearing aids would not help. He adjusts himself if unable to hear.”—Parent of 14-year-old boy with high frequency hearing loss

In pre-kindergarten she was tested and failed the school hearing test. We immediately sought the advice of her pediatrician, who retested her. She failed the second test and we were asked to go to a specialist. The specialist did a series of tests and determined that her hearing loss was minor and that a hearing aid would be too costly for us when she really didn’t need one yet. The specialist suggested yearly reviews to track the problem. If the day comes when she will benefit due to more loss of hearing or new technology, then we will fully investigate our new options and make an informed decision.”—Parent of 10-year-old female with bilateral hearing loss described as mild

“Discovered hearing loss in 4th grade by teacher who suggested a hearing test. The audiologist diagnosed that there is some loss in both ears, more in the right. “Th” and “ch” sounds are not heard. Asked for an annual check-up. Aids would not make a significant difference at present times.”—Parent of 15-year-old female with moderate high frequency hearing loss

Stigma…

About a third of these parents mentioned that the stigma associated with wearing hearing aids impacted their decision not to wear hearing aids. “Stigma” means issues like: (20%); peers make fun of the dependent with hearing aids (19%); people will treat the dependent differently (19%); they are too noticeable (18%), and/or make the dependent look disabled (17%) or mentally slow (14%).

“The stigma attached to wearing a hearing aid has been negative for C___. She does not like to admit there is anything wrong. It’s not cool to wear a hearing aid in her opinion. Hearing aids are really only for old people.”—Parent of 21-year-old female who had childhood ear infections

“His hearing loss is not too severe. He has special seating in school which helps him pay attention more. It’s difficult with new relationships. We must tell people to speak to him face-to-face or on left side. Family was saddened by many surgeries but we speak slow and clear, and louder than normal. He gets very frustrated often. He doesn’t want hassle at this time with hearing aids. Maybe when young adult he may change mind.”—Parent of 8 year old described as having moderate hearing loss in one ear

“Teacher and audiologist didn’t want to make him uncomfortable with learning and made suggestion that, as long as the special seating in classroom was helping, then a hearing aid would not be needed.”—Parent of 18-year-old male with mild hearing loss in one ear and moderate in the other

“The doctor indicated that hearing aids were not an option since her hearing loss wasn’t serious enough to put him through self-esteem problems at this time. He speaks very loudly and can tend to get in trouble at school because of it.”—Parent of 9-year-old male with a 10% loss in his right ear due to damage from prolonged high fever

Financial Considerations…

Nearly 3 in 10 respondents indicated that financial or value considerations impacted their decision not to get hearing aids for their dependent; 22% indicated they could not specifically afford hearing aids.

“We have not gotten hearing aids. I did look into them. The cost was none that I could afford. But he has done very well without them.”—Parent of 14-year-old dependent with otitis media at age 4 and 8 years, and previous surgeries for PE tubes

“Insurance does not cover cost and doctor has not recommended.”—Parent of 14-year-old boy with moderate hearing loss and inability to hear normal conversation across a room

“We stopped at a hearing store one day when she was about 7 or 8 years old. They were offering free testing. Laura threw a big fuss at first but finally agreed. We were told her loss was about 20% in her right ear and 35% in her left ear, but our insurance didn’t cover the devices then, and she hated the idea so much we decided not to buy them.”—Parent of 16-year-old female with otitis media as a child believed by parent to result in eardrum scarring and hearing loss

“When we moved to El Paso, the doctors have told us that the problem was a minor one and did not require any medical treatment or hearing aids. It is my opinion that the military did not want to pay to look at her and this is why were told it was a minor problem. We will be transferring to Hawaii and were told that they have a better track record and will actually try to help our dependent to hear.”—Parent of 7-year-old female with bilateral mild hearing loss requiring front-row seating with attempts to get her FM at school. The school audiologist told the mother it was a genetic defect and her hearing was comparable to that of a 70-year-old “I do not like the way they look in people’s ears and some are so expensive too. It affected my child’s performance at school because she would have to lipread to understand what the person is saying to her.”—Parent of 6-year-old female with moderate hearing loss unable to hear speech across a room

What do my readers feel and think when they read these letters? There is obviously a maelstrom of questions and issues that these letters raise..

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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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Call me a little sick, but I enjoy listening to (and reading!) the oral arguments given in Supreme Court cases. We can thank Jerry Goldman, who created Oyez in 1994 in an effort to share details about the Justices and their cases. He’s taken thousands of reel-to-reel tapes of the Supreme Court proceedings stored in the National Archives and converted them to streaming audio (with captions) and MP3’s on his website. This is an unprecedented look inside a notoriously mysterious institution. Justice David Souter once said, in regards to allowing cameras to broadcast it’s proceedings,”the day you see a camera come into our courtroom, it’s going to roll over my dead body.” That didn’t stop Jerry Goldman from providing an excellent website with audio and transcripts of the court’s oral arguments.

Oyez is extremely accessible for the hearing impaired: the transcripts are excellent and intuitive. Unlike a lot of captioned television out there, these transcripts follow along with the speech with precise timing- beginning a line just as the speaker starts. Not only do we get the text- but the speaker is identified with a name and picture. Also, I like that they underline the text that is being spoken. The transcript is especially pertinent here because the audio quality is poor- high quality digital recordings are not a priority for the Supreme Court. They use reel to reel. Jerry Goldman is pushing for high quality digital recordings.

What I really love: I can listen to the personalities of the Judges- the anger, irony, humor, and utter frustration that comes forth. The tension between the judges is quite apparent at times, even though they go to great lengths to hide it. All these things I could sense before (I’ve got that skill down)- but now I can also follow exactly what they are saying. That is very valuable. I hope that more websites follow this transcript model and dare to improve on it.

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From the point of view of a hearing impaired person, the iPhone sucks. The features that would make the phone more accessible to the hearing impaired are within the internal chip’s capabilities but they have been purposely crippled by the software that runs the phone.

Paula Rosenthal at Hearing Exchange has this to say,

Apple’s new iPhone is not hearing aid compatible on microphone or telecoil settings. Complaints have been filed with the FCC because HLAA believes that Apple, when designing the phone, could have tested it for hearing aid compatibility implemented standards to make it accessible to hearing aid and cochlear implant users.

A hearing aid like Oticon’s Epoq is Bluetooth enabled: it’ll take sound from an MP3 player or phone (or both) and route the sound wirelessly right into the ears. No headphones, no interference, and because they are tailored to fit, they sound great too. However, Steve Jobs has decided to cripple the iphones nascent features so that the iPhone supports mono, call only Bluetooth. i am not part of the “i” in iPhone.

Thanks to David at Hearing Mojo for bringing this to my attention. Check out this forum discussion at MacRumors and go to the iPhone discussion area and tell them what you think. Also see this locked up thread at Apple’s iPhone discussion area.You can also call Apple’s PR Department at (408) 974-2042 or write Steve Jobs.

For the more technically inclined check out Live Journals “Hearing Aid Hacking”.

A new privately held, venture backed company named Insound Medical has developed a very interesting new “hearing solution” called the Lyric (its funny that they avoid “hearing aid” at all costs- most companies are doing this in one way or another). Developed by ENT physicians and audiologists, this new hearing aid rests very close to the tympanic membrane. No surgery is required for this invisible hearing aid. It’s placement minimizes occlusion (like talking inside of a barrel) and feedback. When the battery dies the device dies- usually about 120 days. The user can control the volume or turn it on and off via a magnetic adjustment tool. The Lyric can fit the ear canals of about 75% of the people out there.

Downsides to this hearing aid: these aids aren’t waterproof, limited frequency range and power, and the pricing information, which is really a subscription based fee, is opaque.

Things I like:

1) invisible hearing device

2)minimizes the effect of sounding like I’m “talking inside of a barrel”

3)new, creative idea from a small company when consolidation seems to be the trend.

4)built with lots of input from hearing impaired users. The device uses analog sound which might prove itself over digital.

5)uses your own ear to naturally draw the sound toward the hearing aid

Who can Wear Lyric?