Search for tag: "hearing loss"

Interviewer: So, today, we're here with Dr. John C. Carey. He's an MD and professor of pediatrics at the University of Utah Health and Primary Children's Hospital. So when we're talking about hearing loss in children, you know, when we're talking with newborns, you were telling me that there was a bit of this screening process that we do, what's it called?

Dr. Carey: So it's called universal newborn hearing screening. It was initiated in Utah in 1999, which was one of the first states to actually pass the legislation to screen all of our newborns. But by the mid part of the next decade, the mid-2000s, all 50 states had mandated that their health departments had to provide newborn screening so that we could detect early on, literally first few days of life, that that particular newborn had a hearing loss.

Interviewer: So, I guess, how frequently are we testing? Are we doing like, you know, the first week, the first month? I've heard 1-3-6.

Dr. Carey: In testing for all the babies that are born in the hospital, which in Utah is about 99%, the hearing screen is done before they're discharged. So it's done by one, two, three, four days of age. If they fail either ear, they get a second screen. That's usually done a week or so later. That's the one of the 1-3-6. We want to make sure that second screen is done before one month of age. And then from that, it turns out that the majority of those children who fail the first screen, don't have a hearing loss. There's something plugging their ear, like, you know, the ear wax of the newborn and so on.

So when they get their second screen, that really narrows things down to now we have a few percent of babies. And then when they're seen by three months by the audiology specialist, by the actual hearing specialist, we can determine whether or not they have what is called a permanent hearing loss or not. If there's fluid in the middle ear, it's not considered permanent because our ENT colleagues can drain that fluid with tubes. And eventually that, with time, can resolve itself. So that's not considered permanent. What's permanent is when it's not due to fluid and they still fail one or both ears, and then that's confirmed by the audiologist before three months.

Interviewer: And then you bring them in one more time at the six-month mark?

Dr. Carey: And then, well, by six months, we're hoping that all of those children who are determined to have permanent hearing loss of some degree could be mild, it could be more, but by six months all will have their hearing aids and also be, if they need them, and also be lined up for early education of children with hearing loss. So, by six months, we want that to be in motion.

Interviewer: And how many kids do you find are affected by these types of conditions?

Dr. Carey: After you go through the screening first time, second time, get the test by the audiologist, you're left at about 1 in 500 newborns. Now, there are a few weeks or months old. One in 500, which would be about 100 children a year in Utah, have a permanent hearing loss. After heart defects, hearing loss is the most common birth defect in human babies.

Interviewer: Wow.

Dr. Carey: So everything else you can think about from oral facial clefts or some of the orthopedic abnormalities or other syndromes, like Down syndrome, they all have a frequency of less than 1 in 500.

Interviewer: And what does the screening for a baby look like? Do you put little headphones on them? What does that look like?

Dr. Carey: You actually do put something in their ears. In the first screening, you put something in their ears, and this almost sounds magical, but what they're doing is they're putting a sound wave in through the ear canal. It goes through the eardrum and the three famous middle ear bones, the smallest bones in the body, through the oval window to the hearing structure called the cochlea. And so, when it gets to the cochlea, the hair cells inside, people are familiar with all that with maybe a hair cell problem, get to the hair cell, the hair cells bounce the sound wave back, and the computer detects that change.

So what you're doing, in Utah, what we're doing . . . other states do something different. Most states do what we do, which is to test cochlear, the inner hair cell function by bouncing these sound waves through, the hair cells react, bounce it back, and the computer at different frequencies, at different loudness records whether or not the cochlea is working properly.

Interviewer: Wow.

Dr. Carey: So if the hearing loss is due purely to the nerve and not necessarily the hearing nerve connected to the cochlea, but purely to the nerve, a child will pass the hearing screen much of the time. So the limitation of our hearing screening, which most states do, this is called an otoacoustic emission. You can see the words, oto, ear, acoustic, the sound. Emission is the hair cells bouncing it back, you know. Most states do otoacoustic emission.

Interviewer: So for one of these parents whose children are identified with one of these hearing issues, what kind of services can the Utah Hearing Center provide?

Dr. Carey: The beneficial aspect of early detection is that you actually get the kids in for treatment and proper education. And the majority of those children will go to a regular class in a regular school. Those that have the most profound degrees of hearing loss, that don't necessarily respond to hearing aids, can go to our outstanding special schools we have throughout the state. They're the schools for children with hearing loss and visual disabilities. They still do say deaf and blind. So those schools have their branches of them throughout the state. They provide for the children that have some of the more moderate to severe, but especially those that have the profound degree that if untreated with something like a cochlear implant, those children would go on to be called deaf.

So deafness is the degree of hearing loss preventing regular communication as you and I would have it in this type of setting so that one would have to learn sign language and then be a part of a very rich community of people with deafness. But on the other hand, would have more challenges with communicating with the rest of society. That particular place we're talking about, that particular situation, just, you know, in the last two decades, in half of my career here at Primary Children's can now be altered dramatically with a cochlear implant so that children with a cochlear implant will usually, with the right rehabilitation and such, will actually go to regular kindergarten.

Interviewer: The Science of Speaking Clearly up next on The Scope.

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Interviewer: I'm talking with Dr. Sarah Hargus Ferguson, associate professor of communication sciences and disorders at the University of Utah. I have a scenario for you to ponder. I have a grandfather-in-law who is getting older and he's definitely having a hard time hearing other people speak. What are your basic suggestions for how we can help people like that understand what we say?

Dr. Ferguson: Audiologists have a number of strategies we offer to family members if they are having trouble communicating with someone who is hard of hearing. We'll have things like make sure they can see your face, make sure you're reducing any noise that is in the background, and another thing that we almost always say is speak slowly and clearly.

Interviewer: What does that mean, slowly and clearly?

Dr. Ferguson: Its sort of one of these things that we sort of assume that talkers know what to do. We say speak slowly and clearly and maybe they'll do something like this, which is just slower. Maybe they'll do something like this. There is a lot of variability in what people do. The earliest research in this, in the mid '80s at MIT, looked at whether or not this clear speech is actually is easier to understand. This clear speech being the speech that people get when you tell them to speak clearly. It showed that yes, it is easier to understand. That's a good thing.

They did some acoustic analysis at that time trying to get at the question of "What makes clear speech clear?" There are lots of things that are different about clear speech acoustically versus conversational speech. We know that it's slower, we know that it's louder, we know that talkers do things like release the final consonants on words. But we don't know actually matters from an understanding standpoint. We don't know which things actually help.

Interviewer: Let's take one part of this like talking about the vowels. What is it that you think is the hard to hear listener can't hear?

Dr. Ferguson: You can think of vowels partly like playing notes together on a piano. There's usually energy. There are two target frequencies for each vowel. These frequencies are called formant frequencies and they have to do with the position of your tongue. When you move your tongue from "e" to "ah" to "ou" you're changing the resident characteristics of your mouth and that moves those formants or these notes around.

So "e" and "ou" the lower of the two notes, the F1, the first formant is the same. The second note of two is quite different. So around 2000 hertz is a very important frequency. And that's about where that second note or formant of these vowels falls. If you can't hear F2 "e" and "u" are going to sound the same.

Interviewer: How would you fix something like that in a speaker?

Dr. Ferguson: We know that if they move their vowels just generally further apart from each other. "E" and "a" are pretty far apart acoustically, "ah" and "ou" are pretty far apart acoustically and there are other vowels in-between that spread out that. We call it a vowel space. If we spread out that vowel space, that tends to make them easier to understand. Telling a talker how to do that is a little challenging.

Interviewer: What about constants? What are some of the tricky ones there?

Dr. Ferguson: For people who have . . . they typical hearing loss we have for people who get older affects the high frequencies. What you're missing mostly there are constants that we call "stops." "Puh", "tuh", "kah", "buh", "duh", "guh" those have high frequency.

Interviewer: There are a lot of them.

Dr. Ferguson: Which is a lot of them and they've got high frequency energy. Then our fricative sounds, "ss", "sh", "ph," those sounds. The complaint that we often hear is the speech is loud enough because if you've got good hearing in the low frequencies, you're hearing vowels, you're hearing people's voices just fine. The loudness of it is just fine. But without your stop and fricative consonants, everything sounds muffled. The Charlie Brown teacher voice, where you're missing that high frequency stuff.

As far as what happens to consonants in clear speech, we know that people put more energy. I mentioned about how they release their final consonants. Instead of saying "bit" they say "bit." They've got this nice "t," that part is called "the burst." First of all, its there, so its not unreleased. But also they tend to put more energy, so the "ss" and "sh" sounds, tend to be higher in intensity and also more distinct from each other acoustically. "Ss" gets a little more higher in pitch and "sh" gets a little more lower in pitch to move them a part from each other.

Interviewer: You've identified some of these vowels and you also know of some of these constants that give people trouble. How do you take it to the next step to figure out how to make those clear to the listener?

Dr. Ferguson: The approach that I have chiefly taken, I refer to as a "talker differences" approach. My dissertation involved recording 41 talkers producing conversational speech and clear speech. There is a huge variability among those 41 talkers in terms of what they do acoustically and in terms of how much clearer their speech sounds, whether its easier to understand. I used statistical techniques to out, okay, I've got this change in how understandable speech is and I've got these acoustic changes. Which of these acoustic changes are actually correlated with the improvements in speech understanding?

Interviewer: So you're taking real people's speech and figuring out, okay, here are my clear talkers. What is it that they're doing to make them understandable. What do you hope to do with this information?

Dr. Ferguson: What I really hope to do is have an intervention that I can apply to the frequent communication partners of people with hearing loss, or patients with hearing loss. It could be their spouse, children, anybody that they talk to a lot and have a quick and dirty test that we can do on that communication partner. Figure out, tell them to speak conversationally, tell them to speak clearly and see are they effective? If I made clear speech clear, I could do an acoustic analysis right on the spot and know if they're an effective clear speaker.

If they're not, there would be an intervention where we could say "Here is how you need to speak for your partner to be able to understand you better." They could practice this, record how it went and this would be part of an overall oral rehabilitation program we would have with a patient with hearing loss. It could involve hearing aids if they were motivated to get them, and clear speech would be just one of the many communication strategies that we would work on.

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Interviewer: Do your kids really have a hearing problem, or is it just kind of selective hearing? How loud is too loud? These and other hearing questions, let's answer them right now. We're with Dr. Jeremy Meier. He's an ENT specialist with the University of Utah Healthcare. Hearing loss. First of all, symptoms. From what I understand, they can be subtle and mistaken for other conditions.

Dr. Jeremy Meier: Right. If a child is not paying attention to you or they're sitting down and you have to call them several times, the big question always is, "Is that selective hearing, or is that true hearing loss?" So, other things to watch for would be if a child seems to be asking you, "What?" a lot or if they're asking for you to repeat yourself quite a bit, if they're turning the TV up loud or if they're moving closer to the TV, if their teachers is noticing that they're not paying as much in school, that might be ADHD. It might be concentration issues, but it also might be that they're not hearing or understanding the teacher as well.

Interviewer: Kind of like how back in the day if you didn't have good vision, you might lose interest because you couldn't see?

Dr. Jeremy Meier: Exactly.

Interviewer: Same sort of thing? That's interesting.

Dr. Jeremy Meier: Exactly.

Interviewer: All right. So those are some of the symptoms you can look for. Let's talk about things to watch out for to keep your kids safe from losing their hearing. How loud is too loud?

Dr. Jeremy Meier: Yeah. So, nowadays with the earbuds and the headphones, if you can hear those when the child has them on their ear, then that's definitely too loud.

Interviewer: Okay.

Dr. Jeremy Meier: It's important to realize that not only is it the intensity of the sound and how loud it is, but also the length of time that they're listening to that music. Both of those can play a role.

Interviewer: Are there things other than listening to music through earbuds that can cause hearing loss?

Dr. Jeremy Meier: Well, any type of loud noises. So whether it's gunshot or firearms.

Interviewer: Hunters.

Dr. Jeremy Meier: Right. Hunters. If they're at a loud concert, and we've all had that time where we've been to a concert and came home with ringing in our ears.

Interviewer: Is one concert going to hurt you?

Dr. Jeremy Meier: Temporarily. Typically not in the long-term.

Interviewer: Okay. But a lot of loud concerts.

Dr. Jeremy Meier: Right. Over time, that can definitely play a role.

Interviewer: Would you recommend wearing ear plugs?

Dr. Jeremy Meier: Yes, actually, yes, if you're going to go to a lot of concerts.

Interviewer: It might be a little nerdy, but at least you can hear people say that you're a nerd.

Dr. Jeremy Meier: That's right. And down the road, your ears will thank you.

Interviewer: All right. What else could cause some hearing loss that you would want to keep the kids away from?

Dr. Jeremy Meier: Well, a lot of times, kids will have ear infections. They had a history of ear infections or if they had fluid built up in their ears and no one notices that. Then the child goes to elementary school and has a hearing test at school and all of a sudden they fail it, then everything starts to make sense. Mom starts to realize that, "Maybe they weren't ignoring me as much as I thought, and they truly had some hearing loss all along."

Interviewer: Are kids more susceptible to hearing loss than adults?

Dr. Jeremy Meier: More hearing loss occurs as we get older. With everything, as we start to lose our senses, we start to lose our hearing. However, younger kids will often have fluid in their ears, and they have what's called a conductive hearing loss. So that's more common in kids than adults.

Interviewer: If a child experiences hearing loss, is there anything that can be done?

Dr. Jeremy Meier: Fortunately, in most kids, there can be. It depends on what kind of hearing loss it is. If they have fluid in their ears, we can place tympanostomy tubes and remove that fluid. And that's the cure for a majority of children. If it's a sensorineural type of hearing loss or if there's been nerve damage, whether they were born with that or it came on from an unknown cause, then we can typically place hearing aids.

Interviewer: Okay.

Dr. Jeremy Meier: But in those cases, there's nothing that we can do surgically to restore the hearing.

Interviewer: All right. What about earbud damage because I listen to my music too loud?

Dr. Jeremy Meier: That's going to develop over time, and unfortunately there's nothing we can do to repair that.

Interviewer: Do hearing aids help?

Dr. Jeremy Meier: Hearing aids can help that, but they only help to a certain extent.

Interviewer: Yeah, sure. And who wants to wear hearing aids when you don't have to?

Dr. Jeremy Meier: Exactly.

Interviewer: What's the most important thing when it comes to kids and their hearing?

Dr. Jeremy Meier: I would just remind them that the loud music that they're listening to now may not be affecting their hearing at this age, but down the road it can have consequences.

Interviewer: Really, they might not notice symptoms from really loud music and think they're immune, but 10 or 20 years later that music could've affect it.

Dr. Jeremy Meier: Exactly. It's just the same thing with whether it's sun exposure or our diet, we don't realize it until we're 40 or 50 and regret the things we did when we were younger.

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