NOISE-INDUCED HEARING LOSS

Noise-Induced Hearing Loss

Noise is one of the most common causes of hearing loss. According to the National Institute on Deafness and Other Communication Disorders (NIDOCD), 10 million Americans suffer from hearing damage from noise, and 30 to 50 million Americans are exposed to dangerous noise levels every day. One in four adults (aged 20 to 69) has noise-induced hearing loss (NIHL). The good news is: this type of hearing loss is preventable!

NOISE CAUTION:
Sounds can be harmful when they are too loud (even for a brief period of time), or when they are both lough and long-lasting. When we look at exposure to noise, we look at not only the intensity of the sound but also the duration one is exposed to that noise (ASHA, 2017).
0-70dBA: You can listen to sounds in this range as long as you want. This includes a typical conversation, dishwasher, sewing machine, and music set at low to moderate levels.
85-90dBA: Exposure for 8 hours or longer without protection can cause damage. This includes a lawnmower, city traffic, a motorcycle, a food processor, or a blow-dryer.
100dBA: Exposure for longer than 2 hours per day without protection can cause damage. This includes a hand-drill, snowmobile, pneumatic drill or a chainsaw.
115dBA: Exposure for longer than 15 minutes without protection can cause damage. This can include rock concerts and football games!
140dBA: Even a brief exposure to unprotected ears can cause hearing loss! This includes a firecracker near the ear, a gun blast and a jet engine. This is often termed “acoustic trauma” which denotes a one-time brief exposure followed by immediate permanent hearing loss, typically from a sound that exceeds 140dBA and sustained for less than .2 seconds (Mathur, 2016).

WARNING SIGNS OF NOISE-INDUCED HEARING LOSS:
NIDOCD (2017) reports these warning signs.
• Ears feel full after leaving noisy area.
• Sounds are muffled.
• Ringing or buzzing in the ear is noted after exposure.
• Difficulty understanding conversations.
• Difficulty hearing high pitched sounds (alarms, birds).
• Difficulty distinguishing some speech consonants (sat vs. fat).
• Hypersensitivity to certain sounds.

TEMPORARY THRESHOLD SHIFT:
Following a concert or exposure to noise, one may experience some of those warning signs. A temporary change in hearing ability may be present but hearing can recover over the next 16-72 hours. However, this may be a warning sign that sound was too loud, and you should take precaution so temporary changes do not become permanent changes. If after two weeks, normal hearing has not returned, it is likely some degree of permanent damage has occurred (NIDOCD, 2017).

PROTECTING YOUR HEARING FROM NOISE:
Remember, NIHL can be prevented. The Center for Disease Control and Prevention (2017) recommends the following.
• Wear earplugs or earmuffs when exposed to loud sounds.
• Wear earplugs or musician earplugs when at concerts or around live music.
• Move away from noise when possible.
• Always wear ear protection during shooting sports.
• For MP3 players and personal listening devices: decrease the amount of time you use headphones or earbuds. If you are wearing headphones and the person next to you can hear your music, it is too loud. If you cannot hear the person next to you speaking, the volume on your music device is too loud. An MP3 player at maximum volume can get up to 105dBA; basically, turn down the volume and protect your hearing.

If you are interested in custom noise protection, contact our office. We provide custom noise plugs as well as musician plugs which can reduce noise by 9dB to 27dB. We also provide “hunters’ ear protection.”

References
American Speech and Hearing Association. (2017). Noise. Retrieved from http://www.asha.org/public/hearing/Noise/
Centers for Disease Control and Prevention (2017). How Do I Know if I Have Hearing Loss Caused by Loud Noise? Retrieved from https://www.cdc.gov/nceh/hearing _loss/how_do_i_know_if_i_have_hearing_loss.html
Mathur, N. (2016). Noise-Induced Hearing Loss. Medscape. Retrieved from http://emedicine.medscape.com/article/857813-overview
National Institute on Deafness and Other Communication Disorders. (2017). Noise-Induced Hearing Loss. Retrieved from https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

Central Auditory Processing Disorder

CENTRAL AUDITORY PROCESSING DISORDER

Written by Allison Evans, 4th Year Audiology Fellow

Central Auditory Processing Disorder (CAPD) is a hearing disorder that impacts the brain’s ability to process sounds (Chermak, 2013). CAPD manifests itself in different ways that may be similar to other conditions such as language impairment, attention deficit disorders, or hearing loss. Therefore, comprehensive assessment for CAPD is most beneficial and accurate when analyzed in combination with patient and family report, observation, and diagnostic assessment (Bellis, 2004).

Symptoms of CAPD

Individuals with CAPD may experience on or more of the following symptoms:

• Problems discriminating words especially in a noisy environment
• Difficulties following directions
• Issues differentiating between speech and other sounds
• Problems spelling or reading
• Difficulty understanding information in the classroom

It is important to note that individuals who experience these symptoms do not always have CAPD, which is why diagnosing CAPD is most accurate with a multidisciplinary team approach (Bellis, 2004).

Diagnosing CAPD

The diagnostic multidisciplinary team for CAPD includes the following: Audiologist, speech-language pathologist, educator, psychologist, physician, and parents. An audiologist is responsible for performing a standard hearing test to rule out peripheral hearing loss and administering an evaluation that screens for CAPD. The speech language pathologist analyzes the child’s receptive and expressive language skills. The psychologist determines the individual’s cognitive skills. An educator provides information regarding the child’s academic abilities and ability to listen in the classroom. The physician is responsible for ruling out other pathologies that may impact the individual’s listening or learning abilities, and parents are able to provide information regarding the child’s ability to listen at home, additional concerns regarding the child’s ability to process sounds, and relevant medical history (Chermak, 2013).

Treatment/ Management

Currently, there is no cure for CAPD and more research is needed with regard to CAPD treatment efficacy. However, research has shown that auditory stimulation is beneficial to the brain’s ability to adapt and process sounds. Once CAPD has been diagnosed, it is important to take into consideration the reported difficulties of the individual so that treatment can be as deficit-specific as possible. Management of CAPD, much like assessment of CAPD, should involve a multidisciplinary team. Generally, management of CAPD includes the following (Chermak, 2013):

• Environmental modifications: There are various techniques that can be used to optimize the listening environment, particularly in the classroom. Signal to noise ratio (SNR) is a term used to describe the relationship between the speaker (i.e. the teacher) and unwanted background noise. In order to provide an optimal listening environment, it is critical to minimize the signal to noise ratio by increasing the level of the speaker while decreasing the level of competing noise. First and foremost, preferential seating in the classroom should be utilized to minimize SNR and provide visual cues for the listener. Assistive listening devices (ALDs) may also be used in the classroom. ALDs involve a microphone that is worn by the teacher and a receiver that is worn by the child to enhance the signal of the speaker. These devices are available at SENT Hearing Aid Center.

• Remediation Activities: Unlike environment modifications, remediation techniques for CAPD involve a challenging listening environment and focuses on specific deficit areas. Remediation activities are used to maximize the brain’s ability to process sounds through auditory training exercises. This is the most individualized management of the three treatment options because the direct therapy is specific to the listener.

• Compensatory strategies: Active listening techniques can be used to better enhance the listener’s ability to focus on the speaker. Problem solving techniques can also be used to better the child’s ability to listen when in a difficult listening or learning situation (i.e. advocating for oneself by asking for repetition).

Conclusion

Behaviors and symptoms of CAPD are similar to other disorders, which is why a multidisciplinary approach is critical to fully assess those who exhibit signs of CAPD. Effective treatment for CAPD does is not always clear and should be focused on the individual’s listening deficits. More research is needed regarding the assessment and treatment to better the outcomes for individuals diagnosed with CAPD.

If you think your child struggles with CAPD, contact our office to discuss the use of a device that consists of a teacher-worn microphone (transmitter) and child- worn, cosmetically appealing, open-fit hearing device (receiver).

References

Bellis, T. J. (2004). Understanding auditory processing disorders in children. ASHA-American Speech-Language-Hearing Association [artigo online]. Disponível em: http//www. asha. org/public/hearing/disorders/understand-apd-hild. htm (25 Abr 2006).[Links]

Chermak, G. D., & Musiek, F. E. (Eds.). (2013). Handbook of central auditory processing disorder. Retrieved from https://ebookcentral.proquest.com/lib/iub-ebooks/detail.action?docID=1887363

Hearing Loss, Cancer Treatments and Ototoxicity

Hearing Loss and Cancer Treatments and Ototoxicity

Certain medications can cause damage to the ear which could result in hearing loss, balance disorders or ringing in the ear. These medications are considered ototoxic (Cone, Dorn, Konrad-Martin, Lister, Ortiz and Schairer, 2016). There are now more than 200 known ototoxic drugs. These medicines are used to treat heart disease, serious infections and cancer. Ototoxic drugs can include NSAIDS, certain aminoglycoside antibiotics such as Gentamycin, Erythromycin, Tobramycin, Streptomycin, as well as diuretics such as furosemide, and cancer chemotherapy drugs including cisplatin and carboplatin (American Tinnitus Association, 2012).

The platinum based compounds cisplatin and carboplatin have been known to cause hearing loss, especially in high doses. Chemotherapy from the platinum group is used to treat head and neck cancers, brain cancer and lung, bladder and ovarian cancers. They are also used to treat brain, bone and liver cancers in children (Cone et al., 2016). Hearing loss from the platinum group is typically bilateral, symmetrical and sensory neural in nature (Bass, White and Jones, 2013). Hearing loss usually occurs shortly following treatment; however, a late onset hearing loss has also been documented in patients treated with cisplatin. Bass et al. report the number of cancer-surviving children with hearing loss as the result of ototoxicity is significant. While carboplatin is far less ototoxic than cisplatin, the risk for developing hearing loss should not be discounted.

It is still important to remember that treatment with a particular medication, even an ototoxic one, may actually be the best hope for curing a life-threatening disease or infection. Therefore, anyone who has undergone cancer treatment with cisplatin or high doses of carboplatin or radiation to the head or neck, or treatment for serious infections with certain aminoglycoside antibiotics, should have their hearing tested at least once following completion of the treatment (Vanderbilt Cancer Center, 2016).

References
American Tinnitus Association. (2012). Ototoxic brochure by League for Hard of Hearing.
Bass, J., White, S., Jones, S. (2013). Monitoring ototoxicity in the pediatric oncology population. American Speech-Language-Hearing Association. http://www.asha.org/Articles/ Monitoring-Ototoxicity-in-the-Pediatric-Oncology-Population/
Cone, B., Dorn, P., Konrad-Martin, D., Lister, J., Ortiz, C., & Schairer, K. (2016). Ototoxic medications (medication effects). American Speech-Language-Hearing Association. http://www.asha.org/public/hearing/Ototoxic-Medications/
Vanderbilt Cancer Center. (2016). Hearing loss. http://www.mc.vanderbilt. edu/documents/cancersurvivor/files/Hearing.pdf

Bone-Anchored Devices for Conductive and Mixed Losses

Bone-Anchored Devices for Conductive and Mixed Losses

A bone anchored implant combines the concepts of osseointegration and bone conduction hearing. Osseointegration is a structural and functional connection between living bone and the surface of an implant. This involves the anchoring of a surgical implant (as in a bone-anchored implant) by the growth of bone around it. A bone-anchored device is a surgically implantable system for the treatment of hearing loss through direct bone conduction (Cass and Tringali, 2016).

Bone-anchored devices have been used since 1977 and were FDA approved for treatment of conductive and mixed hearing loss in the U.S. in 1996. In 2002, the FDA approved its use for single-sided deafness as well (Cass and Tringali, 2016)(this was discussed in the SSD blog on our website).

The bone-anchored system consists of three parts:
• A small titanium implant that sits in the bone behind the implanted ear
• An abutment or magnet
• A sound processor that sits behind the ear

How does it work?
The sound processor either clicks on the abutment or a magnet is implanted under the skin and the processor is attached to a second external magnet which attracts to the internal magnet. Once the processor is attached, the processor picks up sound waves and transforms them into sound vibrations through the skull.

Who is a candidate?
Those with conductive or mixed hearing loss could be considered a candidate. Ear problems which could cause conductive or mixed losses include recurrent ear infections, congenital aural atresia or ear malformation or stenosis of the ear canal.

At SENT Hearing Aid Center, we program two transcutaneous devices: one by Oticon Medical and another by Cochlear Corporation. We also program the two magnet-based systems: one made by Cochlear Corporation and the other by Sophono.

For more information, contact our office.

References
Cass, S., & Tringali, S. (2016). Surgical placement of bone-anchored hearing systems. Medscape, http://emedicine.medscape.com/article/1604065-overview

Hearing Loss and Diabetes

Hearing Loss and Diabetes
The global prevalence of diabetes in the U.S. is estimated to be 9% among adults, and according to the Center for Disease Control (CDC), diabetes will affect nearly one third of the world’s population by the year 2050 (CDC, 2014). It is reported the prevalence is rising and predictions also suggest that by the year 2025, there will be a 57% increase in the prevalence of diabetes in North America. Nearly 30 million people in the U.S. currently have diabetes and 86 million adults have prediabetes (CDC).

Diabetes mellitus is a group of diseases which includes altercation in glucose metabolism which ultimately results in elevated blood glucose levels. Diabetes can be classified as Type 1 or Type 2. When beta cells of the pancreas no longer make insulin, Type 1 diabetes is evident. When the pancreas continues to make insulin but a cellular impairment in sensitivity to insulin causes raised blood glucose levels, Type 2 diabetes is apparent (Bainbridge, 2010). Bainbridge reports that adults with diabetes can experience cardiovascular disease risk factors such as hypertension and high cholesterol, and diabetic retinopathy, which is the leading cause of blindness in the U.S. Diabetes is the leading cause of kidney failure among Americans. Severe diabetic nerve disease is a major cause of lower extremity amputations. Since diabetes is a systemic disease that affects multiple sense organ systems, it is reasonable to question whether the auditory system or hearing is affected.

The National Institutes of Health (2008) found that hearing loss is twice as common in adults with Type 2 diabetes as with those who do not have the disease. The link between hearing loss and diabetes was found at all frequencies, but a somewhat stronger association was found in the high-frequency range. The study found 54% of those with diabetes reported hearing loss for high frequency sounds as compared with 32% of those without diabetes. Bainbridge also found a stronger link between diagnosed diabetes and hearing loss in younger people than older people. U.S. data suggests that in those 50-69 years old with diabetes, 70% have high-frequency hearing loss and one-third have low or mid-frequency hearing impairment.
Why is hearing loss twice as common in adults with Type 2 diabetes?

Although the reason is speculative, some researchers suggest it may be due to poor circulation. The elevated blood sugar levels associated with Type 2 diabetes can damage to blood vessels and reduce blood flow which could damage the structure of the inner ear. Since the inner ear does not have a back-up supply of blood flow, in cases with diabetes, permanent damage to the blood vessels in the inner ear could occur. The American Diabetes Association suggests the higher percentage of glycated hemoglobin can increase the risk for hearing loss because high blood sugar damages blood vessels throughout the body, including the ears. Post-mortem studies of diabetic patients have shown damage to nerves and blood vessels of the inner ear.

Studies have found:
• Sclerosis of the internal auditory artery
• Thickened capillaries of the stria vascularis
• Atrophy of the spiral ganglion
• Demyelination of the eighth cranial nerve
• Loss of outer hair cells (Bainbridge, 2010)

Recommendations:
• Patients with diabetes should maintain good blood glucose control in accordance with the guidelines from the American Diabetes Association.
• Diabetic individuals should avoid tobacco use as smoking increases the risk of cardiovascular disease which could further compound the risk of hearing damage (Bainbridge).
• All patients with diabetes should have their hearing tested annually. The earlier hearing loss is detected, the more effective hearing aids are likely to be.

References
American Diabetes Association. (2010). Standards of medical care in diabetes. Diabetes Care, 3. S11-S61
Bainbridge, K. (2008). Diabetes and hearing impairment: An epidemiological perspective. American Speech-Language-Hearing Association.
Center for Disease Control. (2014). Diabetes prevalence. https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
National Institutes of Health News (2008). Hearing loss in common in people with diabetes. https://www.nih.gov/news-events/news-releases/hearing-loss-common-people-diabetes

Hearing Loss Triples Risk of Falling

Hearing Loss Triples Risk of Falling

Researchers report, those with mild hearing loss (25 decibels) are three times more likely to have a history of falling as compared with those with normal hearing, and for every additional 10 decibels of hearing loss, the likelihood of falling increases by 1.4 (Lin and Ferrucci, 2012). The study was completed at the John Hopkins School of Medicine and the National Institute of Aging on over 2000 adults between the ages of 40 and 69.
Falls are responsible for numerous injuries and deaths among Americans 65 and older. The issue of falls is a health concern, generating billions of dollars in healthcare expenses due to extended hospital stays, surgical interventions and related treatments. The Center for Disease Control and Prevention (2013) sates one out of three adults age 65 and older fall each year, and falls continue to be the leading cause of fatal and nonfatal injuries.

Possible reasons for the relationship between falling and hearing loss:
• Hearing loss decreases one’s awareness of the surrounding environment.
• Those with hearing loss may not hear pets or people around them, increasing the potential to trip and fall (Lin and Ferrucci, 2012).
• Cognitive issues increase in those with hearing loss, and cognitive overload can be a hindrance to balance (USNews, 2012).
• There is a relationship between hearing and balance function. The vestibular function of the inner ear provides sensory information about spatial orientation, motion and equilibrium (Lin and Ferrucci, 2012).

• Those with hearing loss are using more of their mental resources to hear and interpret speech and may have fewer resources left over to dedicate to maintaining balance (USNews, 2012).
• Cochlear disorders which include vestibular dysfunction could lead to poor balance (Lin and Ferrucci, 2012).
It is well-documented that untreated hearing loss can lead to a myriad of health and safety issues. Research is on-going, but it is reasonable to be aware of the link between hearing loss and falls. We recommend having your hearing tested annually and encourage people with hearing loss to wear their hearing aids.

References
The Center for Disease Control & Prevention. (2013). Home and recreational safety fall: Falls among older adults, an overview.
Lin, F. & Ferrucci, L. (2012). Hearing loss and falls amoung older adults in the United States. JAMA Internal Medicine.
USNews. (2012). Hearing loss triples risk of falling: Study. Retrieved from http://health.usnews.com/health-news/news/articles/2012/02/27/hearing-loss-triples-ridk-of-falling-study

MEDIA RELEASE: SENT Hearing Aid Center Donates Hearing Aids and Services to Long-Time Patient

LOCAL AUDIOLOGY PRACTICE DONATES HEARING AIDS TO LONG-TIME PATIENT

Sacramento, Calif. (August 23, 2016)—S.E.N.T. Hearing Aid Center, a division of Sacramento Ear, Nose & Throat Surgical and Medical Group (SacENT), is fitting Gabby Eyman, a 24-year-old Sacramento native, with a pair of hearing aids as a part of their community giving program on August 31.

Eyman, a long-time patient of SacENT and S.E.N.T. Hearing Aid Center, was born with Turner Syndrome, a chromosomal disorder. Signs of Turner Syndrome include hearing problems, as well as short stature, delayed puberty, infertility, heart defects and learning disabilities. Eyman has worn hearing aids her entire life; her current pair of hearing aids are outdated and do not fit well.

The hearing aids, donated by Siemens/Signia, will make Eyman’s job as a full-time nanny much easier. S.E.N.T. Hearing Aid Center is donating all hearing aid services regarding fitting this instrument, and follow-up thereafter to this patient. “I’m super excited to get these new aids,” said Eyman. “It is very hard to understand what I hear sometimes and these aids will help me so much.”

Hearing aids bring sound into the ear and amplify it to a level that compensates for the level of hearing loss. If not covered by any insurance, hearing aids can cost up to $5,000 for a pair. People with hearing loss typically benefit most from hearing aids that have been individually fitted and programed for their specific hearing needs by an audiologist.

Single-Sided Deafness

Single-sided deafness (SSD) is defined as a condition when one has non-functional hearing in one ear that does not receive benefit from traditional amplification and normal or near normal hearing in the other ear. While the precise incidence of SSD is unknown, the prevalence is estimated at 3-6% of the population (Baguley et al., 2006). Those with SSD experience problems hearing in background noise, difficulties with localization and spatial hearing and difficulties hearing those who are near their non-functional side (Cire, 2012).

Causes of SSD
• Presence or removal of an acoustic neuroma (a benign, slow-growing tumor in the cerebellopontine angle).
• Sudden idiopathic loss due to an unexplained viral infection often causing permanent damage to the hair cells and fine structures of the cochlea.
• Vascular issues that damage the auditory pathway.
• Blunt trauma to the head which results in a transverse fracture of the temporal bone.
• Meniere’s disease whereupon excess fluid pressure in the inner ear causes long-term damage to the cochlea.
• Congenital or genetic issues.
• Autoimmune ear disease.
(Cire, 2012)

Solutions
• Do nothing.
• CROS/BICROS hearing aid: CROS is an acronym for contralateral routing of signals. It consists of two parts, a microphone (transmitter) worn at the bad ear and a hearing aid (receiver) worn at the good or better ear. The microphone at the dead ear picks up sounds and routes the sound from the dead ear to the better ear. While previous wireless devices had issues with excessive battery drain, the new Siemens/Signia CROS device provides clear transmission of sound without excessive battery drain. We have had great success with this instrument. For more information on Signia and Siemens hearing instruments visit: https://www.signiausa.com/
• Bone conduction solutions: Originally referred to as BAHA (bone anchored hearing aid), this solution consists of osseointegrated devices which include an implant, an external abutment or a magnet and a sound processor. The sound processor sends vibrations via the abutment or magnet to the implant through the skull through bone conduction to the better hearing ear. Surgical implantation is required and can be completed through Sacramento ENT: www.sacent.com
Following a specified healing period, the sound processor is fit to the patient. At SENT Hearing Aid Center, we offer bone-conduction devices from these manufacturers:
 Oticon Medical: http://www.oticonmedical.com/
 Cochlear Corporation: http://www.cochlear.com/
 Sophono: http://sophono.com/

What a CROS Aid or Bone Conduction Device Does:
• Helps you hear when someone is speaking at the “bad ear” by sending the sound to the “good ear.”
What a CROS Aid or Bone Conduction Device Does Not Do:
• It does not improve sound localization. Two ears provide cues that allow us to localize sounds. When one ear is taken out of the equation, confusion occurs, and we have difficulty identifying near and distant sounds. Since all the sounds are going to one ear, localization may still be difficult.
• This device may not help with understanding speech in noise.
Which Device is Right for You?
I have found that those who have lived with congenital, unilateral hearing loss may be better off doing nothing. They have learned how to live with the issue. If the loss was recently acquired, the CROS or BAHA may be a good option. It is always easier to start with the “non-surgical” CROS option, and at SENT Hearing Aid Center, we offer a 60 day trial on hearing aids, including the CROS.

References
Baguley, D., Bird, J., Humphriss, R. & Prevost, A. (2006). The evidence base for the application of contralateral bone anchored hearing aids in acquired unilateral sensorineural hearing loss in adults. Clinical Otolaryngology, 31, 6-14
Cire, G. (2012). Understanding single sided deafness: Evaluation and treatment for professionals. Audiology Online

COCHLEAR IMPLANTS

This next blog was written by our Cochlear Implant audiologist, James Griffitts, Au.D. and 4th Year Doctoral student, Meghan Williams.

COCHLEAR IMPLANTS

Have you ever been in a situation where it is quiet, you are wearing your hearing aids, and you just cannot understand what your wife, child, or significant other is saying? Has your audiologist told you that your hearing aids are turned up all the way, and just cannot be turned up anymore? Do you find yourself withdrawing from social situations because even with hearing aids you might not understand someone, and don’t want to embarrass yourself? While these situations can be frustrating for individuals with hearing loss, they may be a sign you are a cochlear (koe-klee-er) implant candidate.

What is a cochlear implant?
A cochlear implant, a small electronic device, is the alternative that can be used when one no longer receives benefit from hearing aids. There are two parts to a cochlear implant: the external component that sits behind the ear, like a hearing aid, and the internal component that is surgically implanted. (National Institute on Deafness and Other Communication Disorders, 2014)

Step-by-step how the cochlear implant works:
In order for an individual with a cochlear implant to “hear,” sound must travel from the external component to the internal component of the device. The external component includes the microphone, speech processor, and transmitter. The microphone gathers sound from the environment and sends it to the speech processor. The information received by the speech processor is then changed into a digital signal and sent to the transmitter and to the internal components of the device. The internal component includes the receiver/stimulator and the electrode array. The receiver/stimulator receives the signal from the transmitter and changes it into electrical impulses that travel along the electrode array. The electrode array activates the auditory nerve and sends the signal to the brain, where it is interpreted as sound. (U.S. Food and Drug Administration, 2014)

Who is a candidate?
Not everyone with hearing loss is a candidate for a cochlear implant. The hearing loss must be due to damage to the hearing nerve, also known as sensorineural hearing loss. For individuals who are 18 years or older, the hearing loss must be in both ears, moderate to profound in severity, and the individual must have limited or no benefit from hearing aids. For children 2-17 years of age, they must have severe to profound sensorineural hearing loss in both ears and receive little or no benefit from hearing aids. Children 12-24 months must have profound hearing loss in both ears and receive little or no benefit from hearing aids. The benefit from hearing aids is evaluated by an audiologist when determining candidacy. (Cochlear Ltd., 2016)

Manufacturers:
There are currently three cochlear implant manufacturers that are FDA approved in the United States, and several other smaller manufactures throughout the world (U.S Food and Drug Administration, 2015). The companies approved in the U.S. are Cochlear Corporation, Advanced Bionics and Med-El. At Sacramento ENT, we currently offer cochlear implants from Cochlear Corporation and Advanced Bionics.

Services provided by Sacramento ENT:
Receiving a cochlear implant begins with a thorough evaluative process. One must undergo a number of tests in order to establish candidacy. These tests include hearing tests, imaging studies including a CT scan and/or MRI scan, and a test of inner ear balance function called a VNG. Other medical tests may be necessary depending on age or health. Once the decision has been met to proceed with the cochlear implant, one of our audiologists will sit down and help reach decisions regarding the colors, sizes, and accessory devices that are included with the implant. Four to six weeks after the device is surgically implanted by our otologist, the patient will be seen by one of our audiologists to provide the external processor and “turn on” the device; this is also known as the initial activation. This appointment is primarily used to begin to re-introduce sound to the patient as well as provide enough knowledge to be able to manage batteries, remote controls and other accessories. It is important to remember that this is the first of multiple appointments with the audiologist. Several follow up appointments will take place within the first few months, at which times the processor settings will be adjusted and fine-tuned. Reaching maximum performance with the cochlear implant can take up to a year or more. These appointments are also used to review and demonstrate accessories such as wireless devices to be used with the phone or television. The audiologist will also monitor your progress with additional auditory tests as well as ensure the device is being used as much as possible as this facilitates faster progress.

Our audiologists are always happy to answer any questions and help with any concerns throughout this process. If you would like more information on candidacy, please contact one of our Cochlear Implant audiologists through the website: www.sacent.com.

References
Cochlear Ltd. (2016). Candidacy. Retrieved from http://www.cochlear. com/wps/wcm/connect/us/for-professionals/products/cochlear-implants /candidacy
National Institute on Deafness and Other Communication Disorders (NIDCD). (2014). Cochlear Implants. Retrieved from https://www.nidcd.nih.gov/health/cochlear-implants#c
U.S. Food and Drug Administration. (2014, June 6). What is a Cochlear Implant? Retrieved from http://www.fda.gov/MedicalDevices/ ProductsandMedicalProcedures/ImplantsandProsthetics/CochlearImplants/ucm062823.htm
U.S. Food and Drug Administration. (2015, October 28). Cochlear Implants. Retrieved from http://www.fda.gov/MedicalDevices/Productsand MedicalProcedures/ImplantsandProsthetics/CochlearImplants/

HEARING LOSS AND CARDIOVASCULAR DISEASES

Research shows a person’s hearing health and cardiovascular health frequently correspond.

Cardiovascular disease includes coronary artery disease issues which can be caused by a number of factors including high blood pressure, elevated blood sugar, high cholesterol and atherosclerosis. Researchers have found that narrow, clogged blood vessels which become unable to provide enough red blood cells to deliver oxygen and glucose can lead to cellular starvation (Friedland, Cederberg & Tarima, 2009).

The Better Hearing Institute (2013) reports a significant relationship between cardiovascular status and audiometric pattern. Inadequate blood flow can lead to blood vessel trauma of the inner ear which can contribute to a low frequency hearing loss, which is now thought of as a marker that may predict the potential development of cardiovascular disease. Audiogram pattern correlates strongly with cerebrovascular and peripheral arterial disease, and Friedland and his cohorts believe a hearing test may be a screening test for those at risk.
The American Journal of Audiology reports there is significant evidence that impaired cardiovascular health can negatively impact hearing and improved cardiovascular health may contribute to healthier adult ears. Therefore, it is recommended that adults:

• Have hearing tested: Those with low frequency hearing loss should be regarded “at risk” for cardio or cerebrovascular events and appropriate referrals should be considered.
• Those with known cardio or cerebrovascular disorders should have their hearing tested regularly and consider hearing aids early in order to improve quality of life.

References
Better Hearing Institute. (2013). Heart disease and hearing loss linked press release. Retrieved from http://www.betterhearing.org/news/heart-disease-and-hearing-loss-linked-so-get-your-hearing-checked-world-heart-day-bhi-advises
Friedland, D., Cederberg, C., & Tarima, S. (2009). Audiometric pattern as predictor of cardiovascular status: Development of a model for assessment of risk. Laryngoscope 119, 473-486
Hall, R. & Kerchen, S. (2010). The influence of cardiovascular health on peripheral and central auditory function in adults: A research review. American Academy of Audiology