Volume 44 Issue 9

HOH-LD-News
Vol. 44, Issue 9
August 28, 2010

Copyright (C) 2010 Hearing Loss Web, LLC. All rights reserved.

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Table of Contents
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- Article 1: HLAA Convention: Making Your Home Accessible and Safe

- Article 2: Couples dealing with Hearing Loss

- Article 3: Understanding and Managing a Severe Hearing Loss - Part Two

- Article 4: Short takes

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- Article 1: HLAA Convention: Making Your Home Accessible and Safe
By Bonnie O'Leary
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Editor: Here's Bonnie's coverage of Joe Duarte's presentation on how to install and use assistive and alerting devices in your home. My experience is that many folks with hearing loss don't take advantage of much of this wonderful technology, so hopefully Joe's workshop got people thinking about it.

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This workshop was presented by NVRC's dear friend and go-to expert, Joe Duarte, President/Co. Principal of Duartek, Inc., in Fairfax, VA. Joe shared with us some details about his life. He is a graduate of the University of Rhode Island with a degree in Biomedical Electronics Engineering. He was a systems engineer at IBM for 10 years.

Joe has a profound hearing loss, and received his first hearing aid at the age of four. In October, 2008, Joe's Med-El cochlear implant was activated, and it has made an enormous difference in his life. Born in Portugal, Joe moved to the states when he was 14. His wife Meg is also hard of hearing, and they have four hearing children. In fact, Joe met Meg when SHHH started a chapter in Northern Virginia, and they were among the first SHHH "couples" to get married!

Joe's workshop focused mainly on the needs of individuals who are late-deafened and hard of hearing. He started by asking if hearing aids are enough, but we all agreed that, for the most part, they are not. They don't fix the problem the way eyeglasses correct sight, they amplify background noise, and the more profound the hearing loss is, the harder it is to listen in noise. So what we need is more direct sound to our ears, a way to reduce background noise, and make speech sounds more clear.

To begin with, Joe stressed how important it is to get properly fitted hearing aids, and that they should have telecoils (t-coils, t-switches), and if possible, direct audio input (DAI). Bluetooth hearing aids are now on the market - Oticon has the Epoq Streamer, Phonak has the Smartlink, and Starkey has Eli. Benefits of having the DAI and telecoil include quiet listening in an airplane, use of FM "boots" with wireless microphones, their compatibility with Bluetooth devices, telephones and cell phones, iPods and other listening systems.

Once you have a good hearing aid that works well for your hearing loss, consider assistive devices to either eliminate or reduce communication barriers. Some possibilities are FM, infrared, and audio loop listening systems. Others are amplified phones and phone amplifiers, captioned telephone and two-line voice carryover, and sound amplification for notification systems. If it is not possible to have enhanced or accessible sound, then other options include use of visual alerting and vibratactile devices, and captioning.

Amplified phones with an audio jack can be used with neckloops, DAI, and various headsets. There are also phone amplifiers with volume and tone control. If amplification on the telephone is not enough, there is the captioned phone, or CapTel, as well as voice carry over (VCO), two line VCO, and video phones which enable one to listen and speech read at the same time because it's synchronized. Joe can use a video phone to talk to his family in Portugal. Skype, on the other hand, is not synchronized with the audio.

When we talk about a safe and accessible home, we want to be sure we have the right things in place. Options include smoke and fire detectors, carbon monoxide and gas detectors, burglary systems, NOAA weather emergency alerts, water leak detection, distress signaling, and medical alerts. One of the attendees mentioned that he has the ADT alarm system and they gave him all the accessibility options at no extra cost, but he assumes it was because he told them he would use a different security company if they did not.

Smoke detectors with built-in strobes are popular; some local fire departments sometimes provide free smoke detectors with strobe. You could also use a stand-alone strobe. The strobes can often be tied in to NOAA and community alerts. Security systems include those for burglary, weather emergency, water leak detection, panic button, door entry, and proximity sensors.

Specialized design for accessibility is critical. The carbon monoxide detector, gas detector and visual strobe are all important security components. And there are every day alerts to be considered too: the doorbell, telephone, video phone, baby crying, alarm clocks, apartment building intercom, and even timers.

The newest trend in what are called "Smart Homes" is home automation. The systems can be programmed to monitor and control just about anything in the home and can be programmed for accessibility purposes. They can be set so that all the lights in the house will blink to alert occupants to an emergency condition, and they can even shut down all audio and video (TV etc.) to alert the user to a possible fire or other warning. Leviton and Lutron wireless controls are two examples but they require some specialized planning. These can be integrated with security systems, too.

If you would like to chat with Joe about more details, you can email him at joe@duartek.com.

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(c)2010 by Northern Virginia Resource Center for Deaf and Hard of Hearing Persons (NVRC), 3951 Pender Drive, Suite 130, Fairfax, VA 22030; www.nvrc.org; 703-352-9055 V, 703-352-9056 TTY, 703-352-9058 Fax. You do not need permission to share this information, but please be sure to credit NVRC.

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- Article 2: Couples dealing with Hearing Loss
By Tami Klink
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Editor: It's great to have family members who are supportive as a person's hearing becomes progressively worse, and we all know folks who do a great job of this. With hearing aids improving and cochlear implants becoming increasingly common, we have lots of situations in which family members have to deal with a person's hearing getting BETTER! How hard an adjustment is that?

Here with one family's experience is Tami Klink, who writes an amazing blog with hundreds of interesting posts. Read more of her work at http://www.livinglakecountry.com/blogs/communityblogs/100616414.html

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I've been getting a recurring question lately from quite a few people. How is a relationship impacted when a person who has a hearing loss gets a hearing aid or cochlear implant? It's a good question from the perspective of those that live with someone that has hearing loss.

In trying to find some numbers on this, there is not much information or data on the number of couples that this affects or the outcomes of the relationship once the person with hearing loss suddenly becomes part of the hearing world.

There are many couples that deal with hearing loss as they age. There are also many couples that (like in my case) have hearing loss all of their life and marry a normal hearing person. In my case, my husband has known me since High School and realized early on that there would be challenges and frustrations living with someone that can't hear unless my hearing aid is in and on. Even with the HA's, I still miss things. So, he becomes my ears when I am in situations where the acoustics in a room are not good. He took on the role of being my ears and keeping watch on how conversations were going in case I started answering things wrong or in some cases, not even being on the topic that was being discussed.

He backs me up and I had to learn to be positive about any comments coming from him when I was putting myself in a situation where I looked just plain silly. My 4 kids grew up with a Mom that didn't always hear what they were saying and adjusted to having to repeat themselves or even get me back on track days later when I thought I had heard something that hadn't been said the way that I thought.

It causes conflict and in some cases (when I was still in denial) interesting scenarios. I used to stubbornly refuse to admit that I had heard something wrong. In the last few years, I've come to realize that it's better for me to admit I had no clue in some conversations so that all of them could get me straightened out. Nothing like showing up early for something only to find out that you heard the date wrong.

You need to take responsibility for your errors and admit that you goofed up. Otherwise, the situation continues to escalate and it gets to the point where you are starting to find Post It notes everywhere reminding you of where something is and who needs to be picked up at what time. The Post It company loves us.

Once technology caught up with my loss, I was able to become much more independent and handle most social interactions quite well. This led to another problem for the 5 people in my family suddenly not having to be my ears. This can lead to some feeling that they are no longer needed. While the person with hearing loss is having a great time hearing things on their own, the people that spent all that time watching out for you are suddenly wondering what their new role is.

With the advent of Cochlear Implants, there are now a lot of people doing what I am now doing. But, their spouses and families are in bewilderment as to what their job now is. This can lead to a lot of problems in relationships. The hearing spouse feels left out. They no longer feel as important in your life and see that they are not needed as much. Talk about a confusing situation!

Just when the spouse got used to their role in your life, you turned the tables on them. While they are happy that you can now hear much better, they feel like a used doormat when it comes to being able to participate in your life. All of a sudden you are doing things that they used to have to help you with. They are confused and you are having the time of your life.

There are 2 ways that this can go. Some go down the road of anger. This is the big one to watch out for. You, as the one with hearing loss need to be aware of how you are treating them and the emotions that they are now feeling. If this is not done, the resentment and anger will build to the point where all of a sudden the relationship could be in trouble. Unfortunately, there is not a support system in place for those that join the hearing world. You are given your HA's or Cochlear Implant and pretty much sent on your way. I have yet to learn of a support group or program for couples as well as their children to participate in that will help everyone adjust to this new hearing person. With insurance not paying for hearing aids and limited numbers of people being eligible for medicare to pay for the CI's, those without a cadillac insurance plan or the funds to expend have a hard time affording the technology that will improve their hearing. So, if you have friends with hearing loss and no resources to get it improved, you will also be dealing with these relationships taking on a different flavor. Some will see their friendships wane, while others will try and assume their previous role of not being able to hear well with those around them in order to alleviate any feelings of resentment from the friends with hearing loss. It's a complex situation.

The other way I've seen this go is for all involved to be open and communicate their feelings or perceived sense of not being needed in your life. This takes a lot of work, thought and effort on everyone's part. You almost need to be thinking about all of this before you get your HA or CI. You need to have a plan that involves everyone so that you can avoid the pitfalls of high emotions and wrecked relationships.

Talk about how things may change. Do trial runs with your HA or CI (once you have gotten comfortable with the new hearing abilities) and see how things are now different. Let your spouse or family member know of the new things that you are now able to hear and how your social interactions are changing. Continue to let them know how much you appreciate their patience and more importantly, how much they mean to you in your new hearing life. Take the time to try and explain the difference you are now seeing vs. when you needed to have them by your side all of the time. Encourage them to cut the cord in a way that keeps them just as involved in your world as they were before you got the HA or CI.

And, most importantly, don't forget to laugh. We all know of the many humorous situations we get ourselves into when it comes to hearing. Remind them of all of the times that they saved you from an embarrassing situation. After all, if they had not taken the time to watch out for you, you probably never would have gotten the confidence to take the steps to better hearing.

Have a great week!

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- Article 3: Understanding and Managing a Severe Hearing Loss - Part Two
By Mark Ross, Ph.D.
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Editor: Here's Mark Ross with a provocative article on managing a severe hearing loss. This article originally appeared in "Hearing Loss" magazine and is reprinted with the author's kind permission.

This is part two of two parts.

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Professionals hold different views regarding the feasibility of using this feature for people with severe hearing losses. Decisions that have to be made concern the degree of compression to utilize, at what intensity level it should begin, and how quickly or slowly it should be activated to incoming speech signals (the time constants). These are not yet settled issues as far as I can see. When one "compresses" a relatively large range of speech inputs into a small area, the signal will consequently be distorted (albeit intentionally) to a certain extent. Often this is a desirable outcome; some people with severe hearing loss can utilize the acoustic information provided in this narrow range to increase their speech perception capabilities. Other people with severe hearing loss will not be able to benefit from highly compressed speech, possibly because in addition to the elevated hearing thresholds, the damage to their hair cells also produces various kinds of psychoacoustic distortions.

This latter group of people apparently prefer a linear setting, where a similar amount of gain is provided for all input levels until the output limits of the hearing aid is reached, It is only at this point that the hearing aid's gain is reduced. While softer sounds may not be audible in this approach, that portion of the input sounds that can be perceived is relatively undistorted. There are studies that support both approaches, as we would expect because of the usual range of individual differences. The solution to this dilemma, similar to the one made above in regards to frequency range, is to devote one hearing aid program to wide dynamic range compression (WDRC) and the other to a linear mode of amplification (called compression limiting). That way a person can compare both approaches and use the one he or she prefers.

There are several other potentially helpful features that can be included in a hearing aid intended for a person with a severe hearing loss. A few years ago, it was thought that directional microphones would not be helpful to such people. Some recent research, however, suggests that those with a severe hearing loss can derive benefit from directional microphones, perhaps not as much as someone with less of a hearing loss, but significant nonetheless. A necessary feature to include in any hearing aid meant to be worn by people with a severe hearing loss is a feedback management program. For many years, such people have disturbed themselves and those around them with the constant presence of acoustic squeals emanating from their hearing aids. An effective feedback management circuit, while perhaps not completely eliminating feedback, will permit the user to realize at least 15 dB or so of increased amplification before the feedback occurs. Finally, and this hasn't changed from the early days of personal hearing aids, is the need to have a well-fitting earmold that completely occludes the ear. Not for them, unfortunately, are vented earmolds (except perhaps for a tiny pressure vent) or any sort of non-occluding tube or earmold.

In the severe hearing loss category, the most difficult hearing aid candidates are those with sharply sloping audiograms, where thresholds at 500 or 1000 Hz are relatively good (perhaps about 20 to 30 dB) while those at higher frequencies fall into the severe and profound categories. The fitting challenge is not over-amplifying the low frequencies while at the same time delivering some perceptually useful sounds to the higher frequencies. Much depends upon the steepness of hearing slope, the frequency point where the thresholds begin to drop off, and the extent of the hearing loss at the higher frequencies. In these instances, it is useful to measure the hearing thresholds at the inter-octave points. In the usual audiogram, the hearing thresholds are measured at 250, 500, 1000, 2000, and 4000 and 8000 Hz. Depending upon the frequency where the thresholds appear to drop off, the Audiologist should also measure the inter-octave frequency, as at 750 Hz if the drop off occurs at 500 Hz. This detailed information may be very useful when fitting a hearing aid. Generally, people with a severe high frequency hearing loss are often discouraged from trying a hearing aid. Still, for a motivated person, it is often worth a try. Sometimes even a little hearing aid benefit can make a big real-life difference.

Unfortunately, a possible solution to the audiological dilemma these people present is not yet available as a routine clinical procedure. This is the hybrid cochlear implant, one that uses a short (6 to 10 mm electrode) in order to foster the preservation of acoustic hearing in the low frequencies. The goal with this arrangement to is provide the person with acoustic low frequency sounds (either directly or with a hearing aid) and high frequency auditory information via the cochlear implant. This combination of acoustic and electric hearing has been found to result in higher speech recognition scores than with either mode alone (acoustic or implant). Although research on hybrid implants has been going on for about ten years, FDA approval has not yet been obtained. So, for the present, this management alternative for people with severe hearing frequency loss is not available.

In brief, hearing assistance is available for the person with a severe hearing loss, either through well-fit hearing aids or a cochlear implant. In order to realize the most assistance, it is necessary to ensure particularly careful preliminary testing and, usually, more attention to various amplification possibilities than is usually the case. While such a fitting may take more time, the results are worth it.

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- Article 4: Short Takes
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Editor: Here are our picks of some additional stories that you may find interesting. For more, please point your browser to: http://www.hearinglossweb.com/news/curr.htm

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Interview with Developer of Cochlear Implant Music Appreciation Program

SMAKA: This is Carolyn Smaka from AudiologyOnline and today I'm speaking with Richard Reed who has developed a software program to help cochlear implant (CI) recipients enjoy music. Richard, how did the idea to develop this program come about?
REED: I should begin by mentioning that I'm a cochlear implant recipient. At conferences and online, other CI users always ask about music. My project began as a way to address some of those questions. For a lot of CI users, once they do relatively well with speech comprehension, improved music is next on their wish list. At its most basic, my CI music project pulls together some of the kinds of practice materials I wish I'd had early on in my own CI process.

http://tinyurl.com/2a9cfv3

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Designing hearing aid signal processing to reduce demand on working memory

Imagine two scenarios. In the first, you're a little late driving in an unfamiliar city (without satellite navigation), and you're on your way to an important meeting. In addition to looking for street signs, you are struggling to read a map to help you find your way. The heavy traffic is disturbing you. You accidentally miss your exit and must determine a new route to your destination. You are frustrated, and it takes a lot of mental effort to complete the task. By the time you arrive, you're exhausted. Now, imagine a second scenario. You're driving to work along the same familiar route you take daily. Traffic is flowing smoothly, and the trip is routine. While driving, you think about your weekend plans. Suddenly, you realize you've arrived at work. You've driven through the whole town without actually noticing how you were driving, and you arrive precisely on time while expending little mental effort. [snip] The above examples are analogous to different listening situations. Some listening situations appear effortless, while others demand much greater effort to understand what is being said. We know hearing-impaired people expend more listening effort in demanding listening situations.

http://tinyurl.com/2cop8n

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Information on the new no-mercury-added batteries

In late 2009, I learned that I belonged to a group of hearing healthcare professionals who had absolutely no idea that zinc-air batteries had approximately 10% mercury in them. I have been working in our industry since 1980, when battery packages read "mercury batteries." When zinc-air batteries became available, I mistakenly assumed they contained no mercury. But, since discovering my ignorance in this matter, I have begun to see advertisements in our professional journals for "mercury-free batteries." That inspired me to take an online continuing education course from one of the battery manufacturers. I also made phone calls to hearing aid companies and battery manufacturers. Now, with the goal of sharing some of my experiences with my colleagues so as to assist them in the transition to these batteries, I have prepared the following summary of what I've been doing with my patients in terms of battery education.

http://tinyurl.com/24k29kp

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One Online Store and two Employment Opportunities appear in this issue. (Ads appear after this brief table of contents.)

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Employment Opportunity 1
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Exciting Career Opportunities at GLAD

GLAD is an Affirmative Action Employer with equal opportunity for men, women and people with disabilities. For more information on the following positions, please go to: www.gladinc.org. The status of all positions is: Regular, Full-time, Non-Exempt, Full Fringe Benefits unless otherwise noted. All positions are open until filled.

* Outreach Coordinator -- Bakersfield, CA (on hold)
* Placement Coordinator - Santa Ana, CA (on hold)
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Currently accepting applications for the following positions:
Assistant Director for Instruction
Graduation Coach *10 Month Position
Teacher-High School Math *10 Month Position
Teacher-High School Language Arts *10 Month Position
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Substitute Teachers (hourly paid, based on credentials)
Support Services Worker-Library Aide (hourly paid)

* 10 month employees work 200 days (10 months) but receive payroll checks during each of the 12 months of the year.

For more information about these positions, visit the Georgia Department of Education web site at http://www.doe.k12.ga.us/pea_hr_jobsearch.aspx
Download Job Applications at:
http://www.spa.ga.gov/word/jobinfo/stateapp-emp.doc

Completed applications may be mailed, e-mailed, or faxed to:
Denise Clark, Personnel Office
Georgia School for the Deaf
232 Perry Farm Rd. SW
Cave Spring, Georgia 30124
denise.clark@doe.k12.ga.us
Fax: (706) 777-2240

For more information about these positions, contact Denise Clark, Personnel Office, denise.clark@doe.k12.ga.us or visit the Department of Education web site at www.doe.k12.ga.us

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