revue canadienne d’audition vol. 6 no. 4 - ontario canada · vol. 6 no. 4 publications agreement...

Vol. 6 No. 4

Publications Agreement Number 40025049 | ISSN 1718 1860

Revue canadienne d’audition

www.canadianaudiology.ca

Peer Reviewed

OFFICIAL PUBLICATION OF THE CANADIAN ACADEMY OF AUDIOLOGYPUBLICATION OFFICIELLE DE L’ACADÉMIE CANADIENNE D’AUDIOLOGIE

Hyperacusis: An Introduction

Online Web Study on Hyperacusis

The Hearing Foundation of Canada's Youth Listening Summit

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Welcome back from one of the hottestsummers that I can remember. The

concept of “green grass” may be a thing of thepast. Good thing that I like beige/neutralcolours. Let’s hope that this is not the type of40+ degree weather we can expect in the future.I just returned from the Performing Arts MedicalAssociation (www.artsmed.org) conference inSnowmass, Colorado, and I was the onlyaudiologist there. Of the hundred or so people,there were physiotherapists, occupationaltherapists, orthopedic surgeons, rehab.medicine/physiatry specialists, family doctors, and quite a fewmusicians and musician educators. The conferenceunderscored our duty to educate our colleagues in differentfields about what we do, and what our training is. There was acase report about a drummer with strained wrists and elbows.

Occupational therapists, physiotherapists, physicians of everytype, and drumming instructors, were involved in trying to getto the “diagnosis.” I had actually seen many drummers in thissituation over the years and have published on this issue in thedistant past. The problem was that this drummer had read in (a magazine for drummers) that he should be wearing hearingprotection. After using his father’s industrial strength foamearplugs he started to notice wrist strain. It’s pretty obvious thatthe foam earplugs removed so much of his cymbal and rim shotsounds that he started hitting harder. This wrist issue wasactually a hearing/monitoring issue. And it’s something that Ihave written about in the distant past. (I believe that my articlewas entitled “The Wrist Sings the Blues”). When the drummeris fit with the proper form of hearing protection – not so muchas to lose the monitoring ability, but enough to still hear hismusic at a safe level (e.g., the ER-25) – the wrist and armproblems should cease. I am always amazed how our audiologytraining is half theory, half practical, and half common sense.The high point of the conference for me was the delightful taskof having to remind our colleagues in other, seeminglyunrelated fields, what an audiologist is. The beer at 10,000 feetwas also pretty good.

In this issue of the Canadian Hearing Report wecontinue with our columns. These are allwritten so that they can be read quickly andusually are of the calibre of writing style, thatthey can be shared with our clients. I amespecially impressed with Dr. Robert Harrison’s“For the Consumer” column. This question wasinitially posed to me by Gael Hannan (one ofour other columnists) and it was a question thatshe could not answer posed by a grade 6student, “How many hair cells can we losebefore we have a hearing loss.” I pulled out all

of my text books and more recent articles that I could find, andcouldn’t find anything that was clear. So, I asked Bob Harrison,PhD., of The Hospital for Sick Children. The result is a clearand concise overview of everything that we know, aimed at thelevel of a grade 6 student, which as far as I am concerned, isthe perfect level for me.

We also have regular columns from Gael Hannan titled “Fromthe Consumer”; Dr. Kim Tillery, “All Things Central”; andCalvin Staples with his selections from the blogs athearinghealthmatters.org.

And if you don’t like columns, we have a peer-reviewed articleby Dr. David Baguley from over the pond in England entitled,“Hyperacusis: An Introduction”, as well as the results of anonline study on hyperacusis by Dr. Rich Tyler and his colleaguesat the University of Iowa. We finish off with a most delightfulpaper by Kate Dekok on “The Rules of the Profession… AreThey Enough?” This was an expansion of a talk that Kate hadgiven for the last Seminars on Audition in Toronto in March,2011.

Let’s hope that climate change has not stolen my favouriteseason from us and we still have a beautiful fall.

Marshall Chasin, AuD, MSc, Reg. CASLPO, Aud(C),Doctor of AudiologyEditor-in-Chief

Canadian Hearing Report 2011;6(4):3.

Message froM the editor-in-Chief |

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L’été passera sans doute dans les annalescomme l’un des plus chauds à ce jour.

L’époque dus gazon vert est peut-être révolue.Je n’y perds pas grand-chose, moi qui préfère lestonalités de beige. Par ailleurs, espérons que cemercure à plus de 40 degrés ne soit pas ce quinous attend à l’avenir. Je reviens tout juste ducongrès de groupe Performing Arts MedicalAssociation (www.artsmed.org) qui s’est tenu àSnowmass au Colorado; j’étais le seulaudiologiste présent parmi les quelque centphysiothérapeutes, ergothérapeutes, chirurgiensorthopédistes, physiatres et autres spécialistes dela réadaptation, médecins de famille et musiciens etenseignants en musique rassemblés pour l’occasion. Unesituation qui fait ressortir la nécessité, et notre devoir,d’instruire nos collègues des diverses disciplines quant à lanature de notre champ de pratique et de notre formation.Nous avons assisté à la présentation d’un exposé sur unbatteur affligé d’élongation musculaire aux poignets et auxcoudes. Les ergothérapeutes, les physiothérapeutes, lesmédecins toutes spécialités confondues et les professeurs debatterie se sont employés à cerner le « diagnostic » de ce cas.Au fil des ans, j’ai rencontré nombre de batteurs aux prisesavec ce problème, j’ai même publié un article sur le sujet parle passé. Pour ce qui est de ce batteur, il a lu dans ModernDrummer (magazine de musique) qu’il était conseillé auxbatteurs de porter des protecteurs auriculaires. Après s’êtreexercé un temps muni des bouchons d’oreille en mousse decalibre industriel de son père, il a commencé à ressentir lescontrecoups d’une élongation musculaire au poignet. Il paraîtévident que, puisque ces bouchons d’oreille l’ont empêchéd’entendre les sons produits par ses instruments, il s’est misà frapper plus fort. La blessure au poignet est en fait unproblème d’audition et de surveillance (écoute). J’ai écrit à cesujet il y a longtemps (je crois me souvenir que l’articles’intitule « The Wrist Sings the Blues »). Le poignet et le brasreviendront à leur état habituel dès que le batteur choisira laprotection auriculaire appropriée, un dispositif lui permettantde conserver sa capacité d’écoute tout en entendant samusique à un niveau sécuritaire (p. ex., ER-25). Voilà quiillustre une fois de plus à quel point notre formation enaudiologie allie la théorie, la pratique et le simple bon sens.C’est ainsi que le point culminant du congrès a été pour moide décrire, avec beaucoup de plaisir et de fierté, ce qu’estl’audiologiste au bénéfice des collègues d’autres disciplines

éloignées de la nôtre en apparence. Sanscompter que la bière à plus de 3 000 mètresd’altitude était également délicieuse!

Vous trouverez dans le présent numéro dela Revue canadienne d’audition les chroniqueshabituelles. De lecture facile, elles sontrédigées de telle sorte qu’elles peuvent êtreutiles à nos clients. Je suis particulièrementimpressionné par la rubrique destinée auconsommateur du docteur Robert Harrison.Gael Hannan (une des rédactrices de laRevue) m’a posé cette question, qui

provient d’un élève de sixième année et à laquelle elle n’a purépondre, celle de savoir combien de cellules auditivesinternes nous pouvons perdre avant de subir une perteauditive. J’ai consulté tous mes manuels et des articlesrécents, mais je n’ai rien repéré de précis sur le sujet. Je mesuis donc adressé à Bob Harrison de l’Hospital for SickChildren. Il nous offre une vue d’ensemble claire et concisedes connaissances sur la question, compréhensible pour unélève de sixième année, ce qui me convient tout à fait.

Vous aurez donc le loisir de parcourir la chronique de GaelHannan sur le point de vue du consommateur, celle de KimTillery sur les questions centrales liées à l’audition, celle deCalvin Staples formée d’une sélection d’observations desblogueurs sur le site hearinghealthmatters.org.

Si vous en voulez plus, le numéro renferme également unarticle, révisé par des pairs, de David Baguley d’Angleterresur l’hyperacousie ainsi que les résultats d’une étude en lignesur l’hyperacousie de Roch Tyler et de ses collègues del’Université d’Iowa. Le numéro se conclut par un exposécaptivant de Kate Dekok qui se demande si les règles de laprofession sont suffisantes. Il s’agit de la version longue del’exposé que Kate a présenté au dernier séminaire surl’audition à Toronto en mars 2011.

Il ne me reste qu’à espérer que le changement climatique neme privera pas de ma saison préférée, que l’automne seramagnifique.

Marshall Chasin, docteur en audiologieRédacteur en chef

Message du L’editeur en Chef |


Moxi™

™

Moxi

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™ixMo

™

Official publication of the Canadian Academy of Audiology

Publication officielle de l’académie canadienne d’audiologie

www.canadianaudiology.com

EDITOR- IN-CHIEF / ÉDITEUR EN CHEF

Marshall Chasin, AuD., MSc, Reg. CASLPO, Director of Research, Musicians’ Clinics of Canada

ASSOCIATE EDITORS / ÉDITEURS ADJOINTS

Alberto Behar, PEng, University of Toronto

Leonard Cornelisse, MSc, Unitron Hearing

Joanne DeLuzio, PhD, Audiologist, Reg. CASLPO,University of Toronto

Lendra Friesen, PhD, Sunnybrook Health Sciences Centre

Bill Hodgetts, PhD, University of Alberta

Lorienne Jenstad, PhD, University of British Columbia

André Marcoux, PhD, University of Ottawa

Calvin Staples, MSc, Conestoga College

Rich Tyler, PhD, University of Iowa

Michael Valente, PhD, Washington University

MANAGING EDITOR / DIRECTEUR DE LA RÉDACTION

Scott Bryant, [email protected]

CONTRIBUTORS

ART DIRECTOR/DES IGN / DIRECTEUR ART IST IQUE/DES IGN

Andrea Brierley, [email protected]

SALES AND CIRCULATION COORDINATOR. /COORDONATRICE DES VENTES ET DE LA DIFFUSION

Brenda Robinson, [email protected]

ACCOUNTING / COMPTAB IL ITÉ

Susan McClungGROUP PUBL I SHER / CHEF DE LA DIRECT ION

John D. Birkby, [email protected]____________

Canadian Hearing Report is published six times annually by Andrew JohnPublishing Inc. with offices at 115 King Street West, Dundas, On, CanadaL9H 1V1.

We welcome editorial submissions but cannot assume responsibility orcommitment for unsolicited material.Any editorial material, including pho-tographs that are accepted from an unsolicited contributor, will becomethe property of Andrew John Publishing Inc.

FEEDBACKWe welcome your views and comments. Please send them to AndrewJohn Publishing Inc., 115 King Street West, Dundas, On, Canada L9H 1V1.Copyright 2011 by Andrew John Publishing Inc. All rights reserved.Reprinting in part or in whole is forbidden without express written con-sent from the publisher.

INDIVIDUAL COPIESIndividual copies may be purchased for a price of $19.95 Canadian. Bulkorders may be purchased at a discounted price with a minimum order of25 copies. Please contact Ms. Brenda Robinson at (905) 628-4309 orbrobinson@andrewjohn publishing.com for more information and specif-ic pricing.

Revue canadienne d’audition_______________________

Vol.6 No 4

contents3

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Vol. 6 No 4 |

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DEPARTMENTS

Message from the Editor-in-Chief Message du L’editeur en chef

Letter to the Editor

AUDIOLOGY NEWS

COLUMNS

FROM THE [email protected] CALVIN STAPLES, MSC

ALL THINGS CENTRALTypes of CAPDBY KIM L. TILLERY, PHD, CCC-A

FOR THE CONSUMERHow Many Haircells Need To Be Damaged Before We Experience Hearing Loss?BY ROBERT V. HARRISON, PHD, DSC

FROM THE CONSUMERAn Ounce of Prevention, Five Grams of Protection: A Collective “Shout Out” Against NIHLBY GAEL HANNAN

FROM THE LIBRARYHearing Loss in MusiciansBY MARSHALL CHASIN

REVIEWED BY MARIS. S. APPELBAUM

FEATURES

The “Rules” of the Profession … Are They Enough?BY KATE DEKOK, AUD

RESEARCH AND DEVELOPMENT FOCUSHyperacusis: an IntroductionBY DAVID BAGULEY, PHD

Online Web Study on Hyperacusis BY ANDREW J. KEINER, RICHARD TYLER,

AND SHELLEY A. WITT

The Value of Earplug Fit Testing BY RENEE S. BESSETTE, COHC

The Hearing Foundation of Canada's Youth Listening Summit

20

22

18

Kim Tillery, PhD, State University of New York, at Fredonia

Publications Agreement Number 40025049 • ISSN 1718 1860

Return undeliverable Canadian Addresses to:Andrew John Publishing Inc. 115 King Street West, Dundas, ON, Canada L9H 1V1

25

29

9

10

33

Maris S. Appelbaum, David Baguley, Renee Bessette,The Canadian Institutes of Health Research, Marshall Chasin, Kate DeKok, Gael Hannan, Robert Harrison, Andrew Keiner,

Calvin Staples, Kim Tillery, Richard Tyler, Shelley Witt

Indicates peer reviewed article.

35

39


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Ishared this with a patient today andthought I should share it witheveryone. One of my cochlear implantpatients uses an app called“ClearCaptions” to caption his phonecalls on his iPhone. The app is alsoavailable on Android Market so it’s notonly limited to iPhone users. Patients canjust search the iTunes Store or AndroidMarket for “Clear Captions” or go to theirwebsite: http://www.clearcaptions.com. ”

I think technology is just so awesome!I have some 90 year olds using all of the

Bluetooth connections and loving thefreedom it gives them. This week I hadthe opportunity to be interviewed by alocal TV station during their morningnews program. When I was chattingwith the producer she already had it inher mind that my target audience wasover 70. Well, yes, but I had a greatopportunity to educate her on why Iwant to reach 40 and 50 year olds aswell. This is the starting age group formost caretakers and so many in their50s already suffer from hearing loss.This group loves technology!

If we incorporate what the Smartphones and tablets are capable of forthose with hearing loss, whether it ispurely for Bluetooth or the apps we canfind, we should promote this as well toour patients. I had loaded an app for apatient that had, white, pink, andbrown noise to help with his tinnitus.How cool is that?!

Judy L. Huch, AuDOro Valley, Arizona


Hi All,

CANADIAN ACADEMY OF AUDIOLOGY5160 Lampman Avenue, Burlington ON L7L 6K1 Tel.: 905.319.6191 / 800.264.5106, Fax: 905.319.8563

Web: www.canadianaudiology.ca, Email: [email protected]

BOARD OF DIRECTORS / CONSEIL DE DIRECTION

Rex BanksPresident / Presidente

Canadian Hearing SocietyToronto, ON

Victoria LeePresident-Elect / Présidente-Désignée

Provincial Auditory Outreach ProgramBurnaby, BC

Carri JohnsonPast President / Présidente Sortant

Near North Hearing CentreNorth Bay, ON

Petra SmithTreasurer / Trésorière

Hastings Hearing CentresLandmark, MB

Susan Nelson-OxfordSecretary / Secrétaire

Vancouver Island Health AuthorityVictoria, BC

Erica WongDirector / Directrice

Mount Sinai HospitalToronto, ON

Bill HodgettsDirector / Directeur

University of AlbertaEdmonton, AB

Steve AikenDirector / Directeur

Dalhousie UniversityHalifax, NS

Calvin StaplesDirector / Directeur

Conestoga CollegeKitchener, ON

Ronald ChoquetteDirector / Directeur

Régie de la Santé du RestigoucheCampbellton, NB

Susan English-ThompsonDirector / Directrice

Sackville Hearing CentreSackville, NS

Jim NellesDirector / Directeur

Connect HearingVancouver, BC

Glynnis TidballDirector / Directrice

St. Paul's HospitalVancouver, BC

Bill CampbellDirector / Directeur

Thunder Bay District Health UnitThunder Bay, ON

10 CANADIAN HEARING REPORT | REVUE CANADIENNE D’AUDITION

| audioLogy news

Please note that this is a free seminarbut that pre-registration is required.

Both Elliott Berger and Laurie Wells areworld class speakers.

Sponsored by 3M CanadaCourse Date and Location:September 20, 2011Hilton Garden Inn Toronto

In spite of decades of regulations,workers around the world continue toacquire hearing loss and tinnitus due to noise. Meanwhile, employers,employees, and professionals grapplewith the best approach to preventing thisdisabling condition. Often, goodintentions to protect hearing aren’tenough to stop the gradual changes inhearing thresholds. If noise is an issue inyour work life, you are invited to attendan all-day intensive seminar sponsoredby 3M Canada: Hearing Protection Devicesand Hearing Conservation Programs.Applying the content of this program canhelp you make a difference.

expert presentersTwo recognized experts, Elliott Berger,division scientist for 3M OccupationalHealth and Environmental SafetyDivision and Laurie Wells, AuD, doctorof audiology, of Associates In Acoustics,Inc., bring theory and practicalapplication together. An eloquent andengaging presenter, Elliott Berger hasbeen teaching about hearing protectiondevices for over 30 years. He shares hisunequaled command of technicalknowledge about hearing protectiondevices and his contagious enthusiasmfor helping others discover that all earscan be properly fit with hearingprotection! Laurie Wells has devoted her

audiology career to preventing hearingloss and has extensive experience as aconsultant and educator. With aninteractive presentation style, she elicitsparticipation no matter how large theaudience.

reLevant Content andCourse MateriaLsThe 3M Canada: Hearing ProtectionDevice and Hearing Conservation Programseminar is designed to help youunderstanding the science behindhearing protection devices and otherelements of hearing conservation withpractical tips that can be immediatelyimplemented into your hearingconservation program. The morningsession concentrates on hearing andhearing protection devices including thetopics:

• Hearing Mechanics• How Protectors Work• Laboratory Attenuation

Measurements• Considerations Regarding the NRR• Real-World Performance• Dual Protection• Selection, Use, and Care, and Fit

Testing• Communications• Specialized Hearing Protectors

The afternoon session addresses thebalance between compliance withregulations and applying a preventativeapproach to reducing the risk of hearingloss. Specific topics include:

• Best practices approach to hearing loss prevention programs

• Audiometric testing nuances• Significant threshold shifts

• Steps in determining if hearing shiftsare related to the workplace

• Essential records for hearing conservation programs

• Motivating employees to protect their hearing

Valuable time during the day can bespent with “ears-on” fitting of hearingprotection devices. Specialists will begiving live demonstrations of the EARfitValidation system. This innovativetechnology quickly and objectivelymeasures the attenuation a hearingprotector achieves in your ear.

Seminar materials are provided: aprofessional binder of the lecturehandouts, product information, andsupplemental resource information.Because of the educational focus, theseminar is approved for continuingeducation points for the professions ofnursing, audiology, industrial hygiene,and safety.

The 3M Canada Hearing Protection Deviceand Hearing Conservation Programseminar is a popular and uniqueeducational opportunity. Over 10,000people have attended since its inceptionand testimonials from attendees areconsistently over-whelmingly positive.

There is no fee to attend however pre-registration is required. For moreinformation and registration instructions,please visit:

eduCation Credits speCifiCto CanadaThis course is appproved for 0.5 CMP bythe Board of Canadian Registered SafetyProfessionals.

Coming to Canada: Intensive Seminar on Hearing

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audioLogy news |


This course has been awarded 1Registration Maintenance (RM) point bythe Canadian Registration Board ofOccupational Hygienists.

For more information please visit:http://www.e-a-r.com/hearingconservation/earseminars.cfmCourse Date and Location: September 20, 2011 | Hilton Garden Inn

Toronto | Vaughan & Homewood Suites byHilton Vaughan3201 Highway 7 West,Vaughan, ON L4K5Z7 | 866-539-0036Sponsored by 3M Canada

Unitron’s Favourite Sound Program and Impact Video Recognizes

Healthcare Professionals Around the Globe and Tells the World

that ‘Hearing Matters’

In recognition of the individuals whohave dedicated their lives to helpingpeople with hearing loss, Unitron hasunited hearing healthcare professionalsfrom around the globe to put thespotlight on the issue of hearing loss,staging a rolling global program that asksthe simple question, “what is yourfavourite sound?”

The first wave of the Unitron initiative,which reached out to US hearinghealthcare professionals, concluded atthe end of April, and has resulted in theproduction of an inspirational video thatshares a message that ‘Hearing matters.’The video, which will be made availableon Unitron’s website and YouTube andshowcases sound contributions from

hundreds of hearing healthcareprofessionals, including such favorites asbaby’s heartbeat, the roll of thunder, andmilk steaming for a latte. Along with thevideo, a full gallery of all soundsubmissions can be viewed atwww.unitron.com/mysound .

Favourite Sound campaigns are nowunderway or planned in other countrieswhere Unitron operates, includingCanada, France and Germany.

“We have been tremendously pleased bythe response to this program as it rollsout to hearing healthcare professionalsin the countries we serve. We believethis business is personal, and that beliefdefines everything we do as a company,”

says Unitron President and CEO,Michael Tease. “Clearly, our partnersand customers are equally moved by thepower of sound, and share in Unitron’spassionate belief that ‘hearing matters’.We look forward to seeing thecontributions coming in from othercountries around the globe.”

For every submission of sound received,Unitron US donated a financialcontribution to the NEADS, a nationallyrecognized non-profit organizationestablished to provide guide dogs fordeaf and disabled Americans. Similarphilanthropy programs were initiated forother countries.

Aging and Speech Communication: 4th International and

Interdisciplinary Research Conference Indiana University, Bloomington October 10-12, 2011

The goal of the fourth conference onAging and Speech Communication

is to integrate auditory and cognitiveapproaches to understanding age-relateddeclines in speech communication. Theconference will bring togetherresearchers working around the world inthe areas of cognitive processing and

sensory perceptual processing, especiallyhearing, to share their latest researchfindings with regard to aging and speechcommunication. Speech communicationis an ability that involves both sensoryencoding of acoustic information andthe processing of that information byhigher cognitive centers. Aging is known

to impact both the peripheral sense ofhearing and some cognitive functionsthat may be critical for processing theperipherally degraded auditory input. Bybringing together scholars activelyinvolved in research in these areas, it ishoped that further progress will be madein understanding and remedying the


| audioLogy news

speech-communication difficulties ofolder adults.

The conference program and info-rmation about registration, call for postersubmissions, student scholar-ships,travel, and local arrangements areavailable at the conference websitewww.indiana.edu/~ascpost/index.htm.

Some important dates follow: Registration and poster abstract sub-mission opens June 1, 2011. Poster abstract submission and student-scholarship application closes July 15,2011.

Registration closes September 10, 2011. For this conference, a new initiative hasbeen implemented and advertised inwhich stipends of up to $300 each willbe provided to those wishing to attendthe conference, but in need of familycare while in attendance. These stipendsmay be used to cover the travel expensesof the attendee's childcare provider sothat the childcare provider (baby sitter,spouse, grandparent, etc.) canaccompany the attendee and theattendee's child to the conference.Special conference registrations will alsobe made available on the conferenceregistration website to permit thechildcare provider and child theopportunity to have conference mealswith the attendee. Requests for suchstipends and registrations will be madeby the attendee during registration andwill be limited to the first ten suchrequests received for the 2011conference (on a first come-first servedbasis).

Conference Advisory Committee:Larry E. Humes, Indiana

University (Chair)Judy R. Dubno, Medical

University of South CarolinaSandra Gordon-Salant,

University of MarylandLouise Hickson,

University of Queensland, Australia

Kathleen Pichora-Fuller, University of Toronto-Mississauga, Canada

Jerker Ronnberg, University of Linkoping, Sweden

Mitchell Sommers, Washington University

ira hirsh 1922-2010Reprinted with permission from AcousticsToday

Ira Hirsh wasborn in NewYork City onFebruary 22,1922. He earnedBA degrees inEnglish and Mathin 1942 from theNew York StateCollege for

Teachers. A Year later he married fellowstudent Shirley Kyle, who became Ira’slife-long companion, colleague, andcollaborator. After earning an MA fromNorthwestern University’s School ofSpeech Ira served as a lieutenant in theArmy Air Force from 1944-46, first as aninstructor in communications and laterin aural rehabilitation. After the war, Irajoined the Psychoacoutic Lab at HarvardUniversity whose director was S.S.(Smitty) Stevens. Stevens assembled atruly remarkable group of scientists,during and just after World War II. Itincluded J.C.R. Licklider, HallowellDavis, James Egan, George Miller,George von Bekesy, and other well-

known members of the AcousticalSociety of America (ASA). The benefitsIra gained through those associationswere clear to all who knew him, as werethe influences of Ray Carhart andpioneers in audiology at Northwesternwhere Ira first became interested inhearing and deafness. Ira completed hisPhD in 1948, but stayed on at Harvardfor several years, where he developed afriendship with B.F. Skinner. He andSkinner shared a deep interest in music.Plus they both had interests in appliedpsychology (Skinner had just publishedWalden II in 1948). When Ira leftHarvard in 1951 Skinner gave him acopy of Helmholtz’s “The Sensations ofTone” saying that it was good science butuseless when the need was to tune apiano. “Take the damn thing with you”Skinner inscribed in the book. Ira did,and throughout his research career hedevoted a portion of his efforts to appliedquestions, including auditoryrehabilitation, noise abatement, and deafeducation.

In 1951 Ira moved west to St. Louis totake a research position at the CentralInstitute for the Deaf (CID), along withan assistant professorship in theDepartment of Psychology atWashington University. Ira quickly rosethrough the ranks becoming Director ofResearch at CID (1965-1983), Professorof Psychology in 1961, Dean of theFaculty of Arts and Science (1969-1973), and Chair of the PsychologyDepartment (1983-1987). Along theway Ira won numerous awards andhonors, including election to theNational Academy of Science, the GoldMedal of the ASA, and the WhetnallMedal from the Royal Society ofMedicine. At the time of his death onJanuary 12, 2010, Ira was the EdwardMallinckrodt Distinguished University

Professor Emeritus of Psychology andAudiology at Washington University.

A year after arriving at WashingtonUniversity Ira published TheMeasurement of Hearing which quicklybecame the standard textbook inpsychological acoustics courses as wellas a basic reference for audiologists. Inaddition to this book, Ira published over100 scholarly articles, many of whichlaid the groundwork for research thathas revolutionized such fields asaudiology, psychoacoustics, audiometry,and deaf education. For example, Irawas among the first scientists to pushauditory research beyond the study ofsingle tones, clicks, or noise bursts. Hisdissertation investigated the influence ofinter-aural phase on the detection oftones masked by noise, a phenomenonknown today as the masking-leveldifference, and around which a hugeliterature, both basic and applied, hasdeveloped. As another example, Ira andCarl Sherrick published a paper in 1959on the perception of temporal order andthe role this ability plays in recognizingsounds, both speech and nonspeech.His basic findings have been generalizedto other sense modalities and haveinfluenced such fields as soundlocalization and perceptual sequencingwithin a sensory stream. Ira’s strongestresearch connections were to the CentralInstitute for the Deaf in St. Louis, and itwas there that he enjoyed the excitementof his long research career.

Ira’s was a person who had highstandards for himself as well as others.As an academic leader and scientist hecould be forceful and demanding, buthis goal was always the betterment of thefield. He had an unflagging devotion topsychology as a hard science. Those whoshared his values and goals had a robust

ally and colleague.

Ira also had a life full of outside interests.He enjoyed his left-hander advantage intennis and in winters he could be foundfrequenting the ice-skating rinks aroundSt. Louis where he was an accomplishedfigure skater, and he and Shirleyperformed ice dancing. His interest inmusic was a life-long avocation, and heregularly was part of a barbershopquartet that performed at the meeting ofthe Acoustical Society. He directed andsang in the First Unitarian Church of St.

Louis choir as well as with the St. LouisChamber Choir and the Bach Society ofSt. Louis. He traveled extensively,including sabbaticals spent in China,Japan, and France. He became aconnoisseur of French wine and servedas a wine consultant to the WashingtonUniversity Faculty Club.

He was preceded in death by his wife of61 years, Shirley who passed away in2004.

- Charles S. Watson.

audioLogy news |


joins GENIE AUDIO as Sales Director

Genie Audio Inc., leader in audiology equipment distribution and manu-facturing, is proud to announce that Ed Quidayan has recently joined its Toronto branch.

Genie Audio’s President Yvan Croteau stated, “Ed knows the ins and outs of this industry and is eager to help health professionals tailor their instrumentation needs. We are extremely pleased to welcome him to our growing team.”

Ed Quidayan can be reached at (647) 624-6178; [email protected]

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CAA WelcomesDr. Gordon Hempton

as the Keynote Speaker of the2011 Conference and Exhibition

What is an acoustic ecologist?

Acoustic ecology is the study of sound in living communities—how sound is produced, the obstacles of intelligible message sending, the synchronicity of species in wild environments, human noise impacts, and more. In short an acoustic ecologist listens to places and strives to understand how each place is as unique as a thumbprint.

How did you become interested in acoustic ecology?Purely by accident. I discovered that despite my academic success I was a terrible listener. Whimsically I bought a microphone to hear what I could hear and in one instant a whole new world opened up to me. I’ve been hooked on listening to the world ever since—it has now been 30 years.

Can you give an example of one of your recent projects and its potential impact?

My latest project is for Parks Canada in collaboration with Canadian Geographic at Grasslands National Park in Saskatchewan. I am conducting a sound survey of Grasslands NP to determine species diversity, sonic value, and most importantly to determine if it is one of the last great quiet places in the world—meaning that human caused noise pollution is largely absent. I will include my fi ndings as part of my keynote address.

What is your favourite destination in the world for listening, and why?

To date the Sinharaja forest of Sri Lanka (UNESCO World Heritage Site), is the place that I have most enjoyed because the rhythms of its music created by insects, frogs and birds are so complex, yet, linked. You must listen to the evening ambience for more than fi fteen minutes before most of the patterns are recognized, and when the brain fi nishes its work, you listen clearly to one of nature’s greatest symphonies.

Dr. Gordon Hempton is an internationally renowned acoustic ecologist who travels the globe in pursuit of Earth’s rarest natural sounds. His many accolades include an Emmy for the PBS television documentary Vanishing Dawn Chorus and awards from The National Endowment for the Arts and the Rolex Awards for Enterprise. Here, Dr. Hempton gives us a quick glimpse into his world.

Q&A

14th Annual CAA Conference and ExhibitionOctober 19-22, 2011

Victoria Conference Centre, Victoria BC

For registration, speaker list, and travel & hotel information go to:www.canadianaudiology.ca


| froM the

[email protected]

calendar of

events

Ihope everyone is checking outhearinghealthmatters.org on aregular basis. The website is prettyhandy as a starting point for manytopics you might want to explore ingreater detail. This month I thought Iwould explore a variety of differentblogs to submit to CHR. I rarelychomp on the topic of ethics as for themost part I think it is pretty simple; bea good person. However, I wasreviewing Ray Katz’s blog on ethicsand I thought maybe we'll all have alittle man in mirror session. Iimagined with the changes in ourindustry many of us are presentedwith the issues Ray blogged about ona regular basis. It also appears Raymight be doing a bit of an informalsurvey so you can send your answerson to him via the website.Additionally, I included MarshallChasin’s Weber’s Law awaking! It isquite interesting how we all continueto learn. Finally, I included two blogson new technology. Thetechnologically driven world we livein changes rapidly and without muchnotice. I am uncertain as to whetheror not either of the tech blogs belowwill readily and successfully be part ofour practices, but I thought we bestcheck it out. Happy Reading!

ethiCs -bLaCk, white, orgray

By K. Ray Katz

Every once in awhile my mindstumbles and an old subject rises tothe top. Ethics can be a subject withmore than a few grey areas, althoughthere are some people who have a veryblack and white view of it. I believethat I always ran an ethical business(practice) but even so, I can’t say thateveryone would agree. Most of usbelieve we are ethical people, but weeach were raised in a differentenvironment and our experiencestend to provide us with slightlydifferent interpretations of ourprofessional rules of conduct. Peoplewho have never worked in acommercial business may have adifferent view of what is “proper” fromthose who have.

Do you remember when it wasunethical to sell hearing instrumentsfor a profit. People were kicked out oforganizations for such conduct.Things have changed and willcontinue to just as we change. Ourlaws, rules, and professional standardsall try to strip away our different waysof thinking regarding ethical conductand have us think and act in a waythat is clear, open, honest, andbeneficial to our clients. I have noquarrel with this and have even donemy small bit to help promote ethicalconduct within our professions.

With this said, I have constructed afew scenarios, and would like you torank them as:

By Calvin Staples, MScsepteMber 8–10, 2011

19th Annual Conference on theManagement of the Tinnitus PatientThe University of IowaRegistration Website:

http://www.continuetolearn.uiowa.edu/conferences/c

onferences.htm

septeMber 20, 2011

E•A•R Hearing Conservation SeminarHilton Garden Inn Toronto | Vaughan & Homewood

Suites by Hilton Vaughan | http://www.e-a-r.com/

hearingconservation/toronto.cfm

oCtober 10–12, 2011

Aging and Speech Communication: 4thInternational and InterdisciplinaryResearch Conference Indiana University, Bloomington

www.indiana.edu/~ascpost/index.htm.

oCtober 19–22, 2011

Building Bridges ConferenceCanadian Academy of Audiology 2011Conference and ExhibitionVictoria, BC | http://www.canadianaudiology.ca/

oCtober 20–21, 2011

Services that Promote EarlyDevelopment for Deaf and Hard ofHearing Children 0–6 and theirFamiliesMississauga, ON | Info: 905: 803-6735

noveMber 3–5, 2011

Academy of Doctors of AudiologyAnnual Convention (ADA 2011)“Rock the Boat: How to Practice, Manage and Lead

in Rough Waters” | Bonita Springs, FL

http://www.audiologist.org/events.html

noveMber 17–19, 2011

2011 ASHA ConventionSan Diego, CA

http://www.asha.org/events/convention/l


|

Ethical = 1 Questionable = 2Really questionable =3Unethical = 4 I punt = 5

I would really like you to send me yourresults and you may rest assured thatno one’s name will be made public. Youcan even send them anonymously ifyou prefer. Your additional commentsshould you choose to undertake thisassignment, will be greatly appreciated.The results will be tabulated andprinted in next week’s blog.

A. ____ An office purchases all of itsinstruments at the wholesale, singleunit list price and sells them at anamount deemed to be competitive with

its competition.B. ____ An office owner and itsemployees want to attend a seminarthat involves registration and travelexpenses and accepts a manufacturer’soffer to pay for the trip.C. ____ A manufacturer provides traveland attendance at one of its seminars tooffices who purchase a set number ofunits.D. ____ An office accepts a prepaid tripof their choosing from a manufacturerafter purchasing a set number of units.E. ____ An office uses pointsaccumulated on its credit card forbuying units at full wholesale, and usesthe points to go to a professionalseminar and gets a quantity discount

rebate check from its supplier.F. ____ An office gets a quantitydiscount from its supplier but does notreflect that discount in the price itcharges its clients.G. ____ An office sends each new clienta check for their share of the office’squantity discount for that month.H. ____ An office sells all of its units atits cost and charges a separateprofessional services fee.

Good luck to everyone and PLEASEsend me your answers.http://hearinghealthmatters.org/haveyouheard/

weber’s Law ... weLL aLMost,weLL ... Maybe not...

By Marshall Chasin

I received this comment to an earlierblog on Weber’s Law from Dr. BrianMoore in the UK…. “Reducing the stereovolume from 60 dB to 55 dB may be quitenoticeable, but barely noticeable if onewere to reduce the stereo volume from 90dB to 85 dB.” … This is a mis-interpretation of Weber’s law. A reductionin level of 5 dB corresponds to a fixed ratioof intensities. So, according to Weber’s law,the change from 60–55 dB is equallydetectable to the change from 90 to 85 dB.In fact, owing to the ‘near-miss’ to Weber’slaw, the change from 60 to 55 dB would beLESS noticeable than the change from 90to 85 dB.”

Thanks for the clarification. I have beenstating Weber’s Law that way for over30 years, but you’re never too old tolearn something new. I actuallyconsulted with 10 of my friends (yes, Ihave 10 friends … I pay them verywell) who are audiologists and they allalso had the same misinterpretation!

The bottom line is not so muchwhether a just noticeable difference isgreater or less at lower sound levels, butthat the just noticeable difference israther large at all levels in a loud bandor orchestra. This is clearly not aWeber’s Law issue as I had initiallythought, but the result is similar- onecan reduce the stage level by 5 dB andit is not really noticeable by, or evenobjectionable to, the performers.This past week was spent with over 100of the most talented up and comingclassical musicians at the NationalYouth Orchestra of Canada. These areamazing musicians and some were asyoung as 15. Typically the string playersare the younger ones because they startat age 3 and the brass and woodwindsare older. It takes longer to hit yourstride for brass instruments. Among themany “experiments” I did with themusicians was to have them listen to arecording of a very intense piece byShostakovich – Josef Stalin’s favoritecomposer – that they had justperformed. When asked to listen forany “changes” I was able to reduce thevolume by about 6 dB before anyonenoticed a change. Most, if not all,

would happily play at a level thatwould result in only 1/4 of theirdamage (a 6 dB reduction) withoutmuch urging.

This was one of the results of theexcellent study by Jeremy Federmanand Todd Ricketts (Federman, J., andRicketts, T. 2008. Preferred andminimum acceptable listening levels formusicians while using floor and in-earmonitors. Journal of Speech LanguageHearing Research, 51(1), 147–160.).Namely that musicians, under certaincircumstances, are willing to accept alower listening level. In the Federmanand Ricketts study, the musiciansaccepted this lower level (called theminimal acceptable listening level)when in ear monitors were used, ratherthan the stage “wedge” floor monitors.So, … my apologies for attributing thisto the Weber Law where it probablybelongs under the more generalheading of masking, and I am positivethere are other headings but am toogun shy to travel much further.

http://hearinghealthmatters.org/hearthemusic/

in-the-Mouth hearingdeviCe approved forConduCtive Loss

By David Kirkwood

SAN MATEO, CA – The U.S. Food andDrug Administration (FDA) has clearedthe SoundBite Hearing System for usein treating patients with conductivehearing loss. SoundBite, which ismanufactured by Sonitus Medical, Inc.,a San Mateo medical device company,is the first non-surgical and removablehearing system to transmit sound viathe teeth.

Earlier this year, the FDA had clearedSoundBite for treatment of patientswith single-sided deafness. Approvalfor use with conductive hearing lossfurther establishes SoundBite as a non-

surgical and less expensive alternativeto bone-anchored implants SoundBiteimperceptibly transmits sound via theteeth to help people with single-sideddeafness or conductive hearing losswho are not candidates forconventional air-conduction hearingaids. It uses bone conduction to deliversound to the inner ear.

The system consists of an easilyinserted in-the-mouth hearing device –custom made to fit around either theupper left or right back teeth – and asmall microphone unit worn behindthe ear. No modifications to the teethare required.

The SoundBite hearing system will beavailable starting early this fall throughphysicians and audiologists in selected

markets in the U.S. It will then beintroduced to additional marketsnationwide over the following severalmonths. For information on availability,go to www.soundbitehearing.com/find/.Commenting on the FDA’s action, AmirAbolfathi, CEO of Sonitus Medical,said, “We are pleased that the uses ofthe SoundBite system continue toexpand. As we begin the roll out of ourproduct in partnership with otologists,ENTs, and audiologists, we remaincommitted to increasing the number ofpatients who may benefit from ournon-surgical treatment option.”

http://hearinghealthmatters.org/hearingnewswatch/2011/in-the-mouth-hearing-device-approved-for-conductive-loss/

|


survey finds ConsuMerdeMand for water, dustproof hearing aids

By David Kirkwood

PISCATAWAY, NJ – A survey of 500hearing aid wearers, conducted bySiemens Hearing Instruments, Inc.,showed that many of them want morerobust products that can better hold upduring swimming and other activitiesthat they want to enjoy without givingup their ability to communicate.

According to the study, hearing-impaired Americans want to lead amore vibrant daily life, but feelrestricted by their hearing devices.The Siemens survey, which wasreleased last week, found that for fearof water damage to their hearing aids,wearers refrain from activities theywould otherwise enjoy, such as

swimming, lounging in the pool, orsoaking in a hot tub. A third ofrespondents state that wearing theirhearing device on a day with adverseweather conditions directly affects theirroutine.

Many hearing aid wearers avoidwearing hearing aids when doingactivities, such as like woodworking,farming, and construction, that mightexpose them to dust or dirt.

About 53% of respondents expressedinterest in sturdier hearing aids, bettercapable of handling a broader range ofenvironmental situations. When askedabout specific hearing aid attributes,more than 70% of respondentsexpressed interest in a waterproofdevice, with 63% and 60%,respectively, interested in shock-resistant and dustproof qualities.

Siemens released the survey results inconjunction with the introduction of Aquaris (www.usa.siemens.com/aquaris), which it describes as “the firsttruly waterproof, dustproof, and shock-resistant hearing aid.”

According to the company, the newhearing aid’s housing is constructedfrom a single piece and featureswatertight seals and membranes. As aresult, Siemens says, Aquaris can besubmerged in water up to 3 feet for 30minutes without damage to theinstrument.

http://hearinghealthmatters.org/hearingnewswatch/2011/survey-finds-consumer-demand-for-water-dust-proof-hearing-aids/

Canadian Hearing Report 2011;6(4):15-17.


We have come a long way fromwriting a (C)APD evaluation

report with general statements about thediagnosed auditory processing disorder.Audiologists today can define the type(s)of (C)APD a client exhibits based onthree models that have more similaritiesthan differences. In the 1980s Jack Katzand colleagues at SUNY at Buffalodeveloped the Buffalo Model andreported their findings in the early1990s.1,2 The Bellis / Ferre Model wasfirst reported by Jeanne Ferre3 known asthe CAT files (indicating differentCATegories of (C)APDs) that was latermade into broader areas of (C)APD.4 Athird model, the Spoken-LanguageProcessing (S-LP) Model, described in2002, was provided by Larry Medwetskyand colleagues5 at the Rochester Speechand Hearing Clinic in New York. Someaudiologists use one model while othersincorporate different aspects from morethan one model to diagnose (C)APD.

All the models above recognizeDecoding as a type of (C)APD when aclient struggles in identifying, mani-pulating and remembering phonemes.In fact, Bellis6 states that decoding maybe the only true form of an auditory

processing disorder. Decoding isdiagnosed by obtaining (1) weaker rightear competing performance verses leftear competing performance on theStaggered Spondaic Word (SSW) test,1,5

(2) weak right ear performance on thespeech in noise tests,7 or (3) weak rightear / both ears on the Dichotic Digit test.8

Site of lesion studies suggest theprobable dysfunction site is the primaryauditory cortex of the left hemisphere7

and the phonemic zone of the lefttemporal lobe9 causing weak readingand spelling skills related to weakphonemic skills.2 The inability to processwords quickly and accurately is anotherclassic sign.5 Children and adults arereferred usually due to consistentlymishearing the auditory message evenwhen they have normal peripheralhearing. Other noted problems areomissions of grammatical morphemes,difficulty in differentiating vowel sounds,inaccurately processing the messageeven when given extra time to processthe message, and exhibiting a word-finding problem or a receptive languagedisorder.10

Integration is another generallyaccepted type of (C)APD. This type is

the most severe due to an immaturecorpus callosum or other neural areasinvolved in transferring informationacross the hemispheres.2,8 Difficultiesseen in this (C)APD type are in drawing,dancing, receiving dictation, andperforming multimodal tasks.8 Somemay display significant readingproblems, respond to tonal tests as amalingerer does, and show difficulty inintegrating auditory and visualinformation,2 including suprasegmentalprocessing difficulties.5,11 Significant leftear dichotic test errors places the clientin this category. Children are referredbecause of academic or behaviouralproblems related to sensory integrationand language issues, severe readingproblems, or they are receivingoccupational therapy.

The Organization type of (C)APD isseen differently in all three models. Thistype is diagnosed when stimuli arerepeated out of sequence (known asreversals) on the SSW or PhonemicSynthesis tests. (These are the only teststhat have norms for reversals.)Originally, the Bellis/Ferre model hadthis category, but in time removed it tobe a secondary profile, naming it the

By Kim L. Tillery, PhD, CCC-A

About the Author

Dr. Kim L.Tillery, professor and chairperson of the Department of Communication Disorders andSciences at the State University of New York at Fredonia, also has a private practice in diagnosingand treating individuals with (C)APD. She has been honoured to present 90 workshops or presentationsat national, international, and regional conferences, and authored and co-authored several chaptersand journal articles on (C)APD.

| aLL things CentraL

Types of CAPD

Output-Organization deficit.7 The othermodels include Organization as a type ofprocessing disorder. The S-LPcharacterizes this type when onestruggles in keeping speech sounds,words and directions in order. It shouldbe noted that weak organization,planning and sequencing are associatedwith prefrontal dysfunction12 commonamong individ-uals with attentiondisorders. When reversals are foundduring the (C)APD testing it may berelated to attention or learning disordersrather than C(C)APD.13,14

Two other types of (C)APD are not seenin all the models: Tolerance FadingMemory (TFM)) and Prosodic. TFMor working memory (how informationis maintained in the conscious memory)may give limitations in expressivelanguage, motor programming and theability to inhibit impulsivity.2,5 Adultsand children with attention deficits areat risk for this type of (C)APD possiblydue to the close proximity of the frontaland anterior temporal lobes.13,15 AProsodic type of (C)APD is characteristicof difficulty perceiving tonal info-rmation, mathematics, poor socialcommunication, and weak visualperception problems.8 These areproblems also seen in individuals with aNonverbal Learning Disorder (NVLD),so differential diagnosis is warranted.

Understanding the models and types of(C)APD allow audiologists to provide amore defined diagnosis and specifictherapeutic measures to assist with thebehaviours and difficulties seen in theseclients. The models also givecharacteristics related to processing areasthat overlap with other disorders. Achild with a Decoding type of (C)APD isat risk for receptive language disorderswhile an Integration type places one atrisk for receptive and expressive

language disorders. The TFM andOrganization types are seen in childrenand adults with attention or learningdisorders. While the field of audiologyhas advanced in diagnosing the type(s)of (C)APD, there is more work ahead inimproving reliable differentialdiagnosing.

referenCes1. Katz J, Smith P. The Staggered

Spondaic Word Test: A Ten-MinuteLook at the Central Nervous Systemthrough the Ears. Ann NY Acad Sci1991;620:233–51.

2. Katz J Classification of Auditory Processing Disorders. In Katz J, Stecker N, and Henderson D, Eds. Central Auditory Processing: A Transdisciplinary View. Chicago: Mosby Yearbook; 1992.

3. Ferre JM CATfiles: Improving the Clinical Utility of Central Auditory Function Tests. Paper presented at the American Speech-Language Hearing Association Annual Convention. San Antonio, TX; 1992.

4. Bellis TJ, Ferre JM. Multidimensional approach to the differential Diagnosis of Central Auditory Processing Disorders in Children. J Am Acad Audiol 1999;10(6):319–28.

5. Medwetsky L. Central Auditory Processing Testing: A Battery Approach. In Katz J, Ed. Handbookof Clinical Audiology, 5th Edition. Baltimore: Williams and Wilkins; 2002.

6. Bellis TJ. Assessment and Management of Central Auditory Processing Disorders in the Educational Setting: from Science toPractice (2nd Edition). Clifton Park,NY: Thompson Learning; 2003.

7. Bellis TJ. Assessment and Management of Central Auditory

Processing Disorders in the Educational Setting: From Science to Practice. San Diego: Singular Publishing; 1996.

8. Bellis TJ. Developing Deficit-SpecificIntervention Plans for Individuals with Auditory Processing Disorders.Semin Hear 2002; 23(4):287–95.

9. Luria AR. Higher cortical functionsin man. New York: Basic Books; 1996.

10. Tillery KL. Central Auditory Processing Evaluation: A Test Battery Approach. In: Katz J, Ed. Handbook of Clinical Audiology, 6th Edition. Baltimore: Williams and Wilkins; 2009.

11. Medwetsky L. Mechanisms Underlying Central Auditory Processing. In: Katz J, Ed. Handbook of Clinical Audiology, 6th Edition. Baltimore: Williams and Wilkins; 2009.

12. Barkley RA. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment: 2nd Edition. New York:Guilford and Press; 1998.

13. Keller W, Tillery KL. Reliable Differential Diagnosis and Effective Management for Auditory Processing and Attention Deficit Hyperactivity Disorders. Semin Hear 2002;23:337–47.

14. Tillery KL. Reversals, Reversals, Reversals: Differentiating Information for CAPD, LD and ADHD. SSW Rep 1999;21:1–6.

15. Keller W, Tillery KL. Intervention forIndividuals with (C)APD and ADHD: A Psychological Perspective.In: Chermak G, Musiek F, eds. Handbook of Central Auditory Processing Disorders, Volume II: Comprehensive Intervention. San Diego: Plural Publishing; 2006.


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| for the ConsuMer

More than you would probablythink is my first response. A

young person with “normal” hearingwill have many more haircells than areactually needed. This redundancy mayexist because it provides a buffer suchthat we can have some cell loss but withlittle functional consequence.

Remember that the haircells (in themammalian cochlea) do not regenerate;we are born with about 20,000 of themand they have to last a lifetime. We canactually loose lots and lots of cells andstill have relatively normal hearing. Aswe get older, we tend to loose haircellsfor our very high frequency hearing,but because we do not use thesefrequencies for speech understanding,we can often not notice the loss. Thisprogressive high frequency loss withage probable starts very early on. As arule of thumb, imagine we start withhearing up to 20,000 Hz. For each dayof our life, starting at puberty, we loseabout one Hertz per day from this top

By Robert V. Harrison, PhD, DSc

How Many Haircells Need To Be Damaged

Before We Experience Hearing Loss?

About the Author

Bob Harrison is professor and director of research in the Department of Otolaryngology – Head andNeck Surgery at the University of Toronto. He is also a senior scientist in neuroscience and mentalhealth at The Hospital for Sick Children. Bob has basic training in biological sciences, with doctoraldegrees in auditory neuroscience from universities in the U.K. He worked with scientists in England,France, and the Netherlands before moving to Canada. His research ranges from basic laboratoryscience to clinically applied projects in the area of hearing loss and communication disorders. Hisresearch philosophy is to take new basic science findings and apply them to promote wellness andimproved health care.

range. That means about 1000 Hzevery three years. Nobody really noticesthis gradual high frequency loss, untilafter many years we start to lose hearingin the range that we use for speechcommunication. This gradual hearingloss with age involves haircell loss thatwe are not even aware of at all.

Let’s now consider haircell loss in thelower frequency regions that we reallyneed for communication. Well, even atlow frequencies we can lose more than50% of haircells and still not see a

difference in threshold sensitivity. Wecan lose many outer haircells and stillhave enough to perform the cochlearamplification role. Again there is builtin redundancy. I would estimate thatfor outer haircells, when we get downto last 30–40% of our total, then wewill notice a problem. At this point thehearing deterioration may be clinicallymeasurable and show as a mildaudiometric loss.

For the inner haircells, we can probablylose even more cells before there is

noticeable threshold deterioration. Iwould estimate (based on some of myown experimental work, that we canhave just 10–20% of inner haircells, butstill not measure, clinically, anaudiometric loss. There may be someother problems with hearing, such asdifficulty in speech understanding, butnot threshold sensitivity. This conditionexists in many types of auditoryneuropathy spectrum disorder.

So overall, here is the simple answer tothe initial question. If we have 20,000haircells to start with, we can lose all ofthe haircells in frequency regions fromabout 4,000 Hz to 20,000 Hz and notnotice much. That’s about 2.5 octavesworth of cells so we are down to about12,000. Of these, let’s say there are3,000 inner and 9,000 outer hair cells.We can lose half of the outer haircells(4,500 left) and need only 20% of innerhaircells (600 remaining). So overallwe can lose 75% of our haircells, andjust get by. The real problem comes, ofcourse, when our stock is expended,and there is no more redundancy in thesystem. That point can come early on ifwe have been abusive to our earsthrough noise exposure, and thesituation will come naturally to us aswe age.


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| froM the ConsuMer

You’re standing in aTim Horton’s line-

up, irked by themusic leaking fromthe earbuds of theteenager behind you.It’s not just the noise;you are exasperated atthe universal poorlistening behaviour

that, according to the 2005-06NHANES survey, has contributed to a30% increase in teen hearing loss overthe previous decade.

Should you say something to help him?As an audiologist, your professionalscope of practice includes theprevention of hearing loss. Butrespectful of the right to personalchoice, you probably just shake yourhead and wait for your coffee.

But, just this once, wouldn’t you love tosay, “Excuse me, could you turn it downa bit? But if you insist on giving us anear concert, could you play somethingwe all like?”

(You take the plunge.) By the way, areyou trying to destroy your hearing?Keep it up, young man, and you’ll beswapping those earbuds for hearingaids by the time you hit the big 3-0! (And finally, the professional push.)“And, don’t give me that look because Iam an audiologist – an AWDEE-OLLA-GIST – so I know what I’m talking

about! Here’s my card, share it withyour friends, you’ll need it. Thanks forlistening!” Wouldn’t that feelwonderful?If I’m in the line-up, the hard of hearingperson, I don’t hear the music but I seethe earbuds, the slightly bobbing head– and I’m really ticked off. I did nothingto cause my hearing loss, and I’ve hadto work long and hard to get past the“why me?” whinge, to accept my realityand to move on. But I live with itschallenges every day, and here’s a kidwilling to throw away his good hearingfor cheap volume thrills!

To be fair, he may not realize thedamage he’s incurring – has anyoneexplained the consequences to him, inhis language? And can we blame himfor using technology that is available,affordable, and sexy, and which comeswith no visible “user beware”?

Noise-Induced Hearing Loss (NIHL)prevention is not taught in schools, ordiscussed by the average family doctor.In survey after survey of teen listeninghabits, youth say that they have neverreceived the prevention message butwould wear earplugs if they wereadvised to.

Let’s shout out about NIHL! Mosthearing-related organizations –consumer groups, manufacturers,service providers, hearing healthprofessionals – include some info-

rmation about noise and prevention ontheir websites. But unless a person ismotivated to click on these sites, ourmessages will go unread, a spit in thewind.

It’s time for Canadian consumers andprofessional hearing-related organ-izations to brainstorm a comprehensiveNIHL-prevention strategy, to developthe partnerships and resources to makeit a reality. School-based programs arecrucial, such as The HearingFoundation of Canada’s Sound Senseelementary program. But, for realimpact and long-term behaviouralshifts, effective health promotions needmany message iterations that resonatewith the intended audience. Youngpeople learning about NIHL for the firsttime at a Youth Listening Summit heldby the Hearing Foundation said,“OMG, what we’re doing is self-mutilation! In order to get through tous, you need to scare us, freak us out!”Let’s discuss how we, as individuals andas members of hearing healthorganizations, can help stem the tide ofNIHL and keep our hearing healthy foras long as we can.

I do not want my 16-year old son andhis friends to live, unnecessarily, withthe hearing challenges that are my dailyreality. And, if they are armed with anounce of knowledge and five grams ofearplugs, they won’t have to.


By Gael Hannan

An Ounce of Prevention, Five Grams

of Protection: A Collective “Shout Out”

Against NIHL

froM the Library |

Hearing Loss in MusiciansBy Marshall Chasin (Ed). San Diego: Plural Publishing (2009). 186 pp., $65.00.

Orders: www.pluralpublishing.com. ISBN13: 978-1-59756-181-5, ISBN10: 1-59756-191-9.


Hearing loss in Musicians by Chasin is a practical guide book foraudiologists working with professionals in the music industry,

as well as for patients who suffer from hearing loss but enjoy listeningto music. According to the editor, the main focus of the book is thatmusic may be considered as a form of occupational noise exposurefor musicians, The book is divided into three sections. The firstsection (chapters 1 to 5) addresses the problem of music-inducedhearing loss, the second section (chapters 6 to 11) suggests somesolutions to the problem, and the third section (chapters 12 to 14) isabout future forms of assessment.

In the first section, the topic is introduced and music-induced hearingloss is differentiated from classic noise-induced hearing loss. Adetailed review of the anatomy and physiology of the peripheralauditory system is found in chapter 2. The biomechanics andbiochemistry of noise-induced hearing loss are covered detail. Thenext chapter examines the medical disorders associated with noise-induced hearing loss and specifically how they relate to musicians.These two chapters are excellent reviews for those who have alreadystudied these topics. The discussion of tinnitus, including its causesand prevention, is covered in more depth in the next chapter. Thefinal chapter of the first section is about the risk of hearing loss thatfaces the music consumer. This is a useful resource for counselingpatients who are concerned about safe listening levels for portablemusic players.

Section 2 covers various solutions to the problems associated withexposure to damaging levels of music and chapter 6, in particular, isa discussion of hearing protection specifically for musicians. The textoffers a quick review of the current methods of establishing damagerisk criteria, which are based on industrial noise. Music represents adifferent sound spectrum, but these criteria are the best guidelineswe have at this point in time. The author covers the limits ofconventional earplugs and suggests strategies for choosingappropriate custom and noncustom versions of earplugs formusicians. The next chapter is an overview of the problem musiciansface in trying to monitor their music and the music of otherperformers with whom they are playing, while at the same time not

Reviewed by Maris S. Appelbaum, Department of

Communication Sciences and Disorders, Montclair State

University, Montclair NJ

Reprinted with permission from Ear & Hearing 2010;

31(1):152. Copyright 2010 Lippincott Williams and Wilkins.


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damaging their hearing. This providesthe introduction for personal monitorearphones. This section has specificinformation regarding in-the-earmonitors. This information isinvaluable to audiologists working withmusicians and counseling them aboutpreserving their hearing. Chapter 8provides an interesting look at theacoustics, such as reverberation andbackground noise, of performance andteaching halls. These are performancespaces that can be designed withconsideration of the hearing health andsafety of the music professional while atthe same time enhancing theperformance. This chapter is also anexcellent resource and review foreducational audiologists who areconcerned about classroom acoustics.The next chapter is a brief look atinexpensive environmental modificationsto reduce exposure to damaging levelsof music. This chapter is, once again, awonderful counseling tool. Chapters 10and 11 cover the topics of hearing aidsand cochlear implants and the

processing of music. These chapters areinformative in counseling patientsregarding realistic expectations and inparticular in the suggestions made foraudiologists to program hearing aids formaximum listening pleasure.

The final section of the book is anaudiologically friendly introduction tomusic and the similarities between thetwo professions. As an example of this,the author makes comparisons betweenmusicians’ loudness judgments and theequivalent decibel level. This is awonderful introduction for nonmusicalaudiologists! Chapter 13 is a gentlereminder that the musician depends onhis hearing for his livelihood and thatdamage may have occurred sincechildhood. This chapter suggests amultidisciplinary model in which wewould counsel the musician to “choosea comprehensive health evaluation formusculoskeletal problems, perform-ance anxiety, and hearing assessment”(p. 139). The need to develop newaudiological tests to assess the

functional hearing in musicians isdiscussed in chapter 14, with anexample of one such tool.

Finally, the appendices are extremelyhelpful handouts for patients. Inparticular, Appendix B contains factsheets with information on how to playand listen to music safely for manytypes of musicians. These should beavailable in every audiology office.

This is an excellent source ofinformation covering a wide range oftopics from prevention throughmanagement of music-induced hearingloss and its symptoms. There are manypages of practical advice that can easilybe incorporated into any audiologypractice. The text is a welcome additionto any medical audiology coursecurriculum or to a practicingaudiologist’s library. Chasin’s manyyears of working with musicians giveshim special insight into their specificneeds.


Iam a hockey mom. I can tell you allthe rules of the game, where the

players should be on the ice and I candress a child with all the equipment inrecord time. I have laced up countlessskates, carried hockey bags bigger thanme, and have spent countless hourswatching the game. I should make agreat hockey player then, right? Well,not so much – I can’t skate. Just becauseI know all the rules of the game, doesnot make me a great hockey player. Iknow all the rules but I do not have theskill to apply those rules to the game.While I have no intention of taking uphockey any time soon, I have spentconsiderable time over the past 6 yearstrying to improve my “skills” as anaudiologist. I learned all the “rules” atschool and through CEUs in the yearsfollowing. I always knew intuitively thatI needed more than those rules todeliver the level of care and service tomy clients that they deserved.

As an industry, we spend time learningthe rules of our profession. How many

manufacturer seminars do you attendeach year? Five, six, or more? We do agood job at keeping up with the latesttechnology and amplification optionsfor our clients. Many of us can recite thelatest names that manufacturers give tothe latest hearing aid available andperhaps the names that they give theirnoise reduction system. We know therules. We know that verification is thecornerstone to a hearing aid fitting. Weknow that we have options forprescriptive targets: DSL? NAL?Proprietary? We know how to connectthe hearing aid to the Noak link. I liketo think that for the most part, this issolid information in our consciousnessand that we have a working knowledgeof these rules to maximize the potentialsuccess of our hearing aid selectionsand fittings. Are these “rules”important? Of course and we cannot doour job without them, but the selectionand fitting of hearing aids goes wellabove and beyond the “rules” of ourprofession. If we were to fit hearing aidson Kemar (the mannequin used in

acoustic research), we would not needskill in what we do. We would applythe rules we know and we would have100% success 100% of the time. Thereality is we fit aids on ears that areattached to people – people who cometo us with different life experiences,expectations on what hearing aids canand cannot do, socioeconomic statusand cultural backgrounds. We spendconsiderable time on the “rules” of ourprofession, yet we often leave thedevelopment of our “skills” toexperience, rather than taking an activerole in it’s development. The questionsthen become, what are the necessaryskills needed to apply these rules to ourclient experience with us in the office,and what exactly does that look like?

Clients come to us for a variety ofreasons and as a clinician, you mayhave a solution or recommendation forthe very reason the client came to seeyou. We need to remember that simplybecause a client comes to your office fora hearing test, does not mean they will

feature |

The “Rules” of the Profession …

Are They Enough?By Kate DeKok, AuD

About the Author

Kate DeKok is Chief Audiologist with ListenUP! Canada



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follow and comply with yourrecommendations. For the purpose ofthis article, we will look at therecommendation of a hearing aid. Fora client whose hearing is at a levelwhere they can benefit from hearingaids, it takes more than giving them anaccurate test for them to decide to goahead not only with yourrecommendation to get a hearing aid,but also future recommendationsduring the fitting process of settings,programs, size of aid, etc. We need togain client compliance and this takes askill set that involves a number ofthings:

1. Meet our client where they are in their journey with hearing loss.

2. Ask good questions and listen to the answers.

3. Relay clinical knowledge in a meaningful way to client.

4. Enter into the client’s world by understanding what the client is experiencing.

5. Walk with the client through the appointment.

6. If the client needs aids, give the client the info and guide them through the decision-making process.

Let’s take a quick glance at what eachof these “look like” in clinic:

Meet your CLient wherethey are in their Journeywith hearing LossWe all know that there is a span ofapproximately seven years betweenwhen a client first has a sense they mayhave a hearing loss to when they decideto accept treatment of amplification.Each client comes into your office atdifferent points in this process. Somemay not even realize there is a problemyet. It is our job, as hearing health careprofessionals, to figure out where each

client is in this process. We also need totruly understanding why the clientcame for a hearing test, what broughtthem in and how hearing loss affectstheir life and the lives of their lovedones.

The biggest argument I hear for notgetting this information is that there is“no time” in the appointment. Myresponse to that is “How can youpossibly provide treatment for hearingloss, if you do not know whatinformation you need to give to yourclient or understand their perceptionsabout hearing loss and hearing aids?”

Clients will rarely offer up all of thisinformation so it is our responsibility toask the right questions:

• How are you finding your ability to hear?

• How do your spouse/children/friends find your ability to hear?

• What has prompted you to come in for a hearing test today?

• Tell me about a time when you didnot hear as well as you would like.

• Tell me about a situation(s) whereyou would like to hear better.

• Tell me what you know about hearing aids.

• Do you know anyone who wears hearing aids? If so, how do they find them?

These questions give you a sense of whatcould be asked and I am certain that youmay have your own questions as wellthat guide your discussion with yourclient in a way where you can gainimportant information that digs a littledeeper than our standard case historyquestions. Clients often come to us withlittle knowledge about the hearing healthcare field, so by spending a few momentsasking some probing questions it willhelp you, as a professional, to gain a

better under-standing of where yourclient is at in their hearing loss journey.

ask good Questions andListen to the answersI think we can all agree that this isparamount in what we do, yet I thinkthis is one of the most underdevelopedskills in our profession. I am not talkingabout asking the case history questions– your receptionist could ask those! I amtalking about the questions that are“customized” for each person that walksthrough your door. I am talking aboutthe questions that are directed at yourclient for you to gain insight into theirpersonal journey with hearing loss. I amtalking about intuitive and thoughtfulquestions which arise based on yourclient’s answers and those which willleave your client feeling like they havebeen heard and they have beenunderstood. Restating back to the clientwhat they have just shared with you willprovide assurance and comfort to theclient as well. This will solidify in theclient’s mind that you have both heardand understood what they have said.

reLay CLiniCaL knowLedgein a MeaningfuL way to theCLientIt is not what you say, but how you sayit.

We require skill in applying our clinicalknowledge to the client in a way thatthe client will not only understand, butwill also be able to apply to their ownlife in a meaningful way. For example,when we tell a client he has a moderatesensorineural hearing loss, what doesthat mean to the client? It means theyhave some hearing loss and it soundsperhaps not too bad … after all, it isonly “moderate.” This is importantinformation to give a client, but weshould not stop there. Let’s make thatstatement of a moderate sensorineural,

meaningful to the client by saying “Youhave a moderate hearing loss and thistells me that in quiet if someone islooking at you, you may be able tofollow most of the conversation. If thereis background noise, you will know theperson is talking but you may not beable to make out all the words. Doesthat sound familiar?” By adding howthe moderate loss may present itself ina client’s life, the information movesfrom a statement with little meaning tothe client, to a statement that puts intowords what the client is experiencing.

If the client needs hearing aids, youcould say “Your hearing is at a levelwhere you could benefit from hearingaids.” But, don’t stop there! Continueon with pertinent examples showinghow a hearing aid can impact yourclient’s life. By now in the appointmentyou should know some personaldetails, so bring the conversation fullcircle by adding: “Your hearing is at alevel where you could benefit fromhearing aids. If you decided to tryhearing aids Mrs. Jones, I would expectthat you will be able to hear the bidsmore clearly when you play bridge onWednesdays and I would also expectthat you will be able to hear yourgrandchildren more clearly when youbabysit them on Mondays.” Bring the“concept” of a hearing aid into the“reality” of your client’s life.

enter into the CLient’sworLd by understandingwhat the CLient isexperienCingA client asked me once, “Kate, do Ihave a hearing loss?” I was taken by thequestion and responded, “No, I don’t.May I ask you why you asked?” and theresponse was “You just put into wordswhat I have been experiencing and youseem to really understand what I amgoing through.” I consider that to be

the best compliment I have receivedfrom a client and reinforced for me theimportance of spending a few extraminutes with clients to “enter into theirworld.”

This is also a great way to build trustwith a client. Enter into their world byasking questions, listen to the answers,and make sure you don’t do all thetalking – listen up! This is not easy. It iseasier often to set a hearing aid toapproximate target, than to sit for a fewminutes with a client listening to whatthey are telling us and asking goodquestions based on that conversation. Iget that the days are busy. Betweenclients you are getting your chartingdone, talking with clients on the phone,responding to e-mails, not to mentionany personal issues weighing on yourshoulders. You have done thousands ofhearing tests in your career and this isjust one more. By developing this skill,you will find your relationships will bemore meaningful with your clients andin turn your client may be more willingto comply with and accept yourrecommendations.

Your client should come to you with avariety of questions. Some you mayanswer several times per day. Regardlessof the question, every single one of theclients concerns, apprehension, andquestions must be addressed thought-fully and answered fully. It takes askilled clinician to do this as the clientmay not come right out and askdirectly, rather it may be more subtle.For example, you may recommendhearing aids for your client. They tellyou that their neighbor got hearingaids, they whistle all of the time and shenever wears them. A skilled clinicianwill pick up on this and address it byexplaining that different people havedifferent experiences with hearing aidsand that constant feedback is not

normal and should that happen withthe client’s hearing aids, it would befixed.

What happens if you don’t address theclient comment? After all, they didn’task a question, they were simplymaking a comment. Remember that thecomment is very likely the client’sperception and we know that a client’sperception is their reality, even if theinformation is not correct. In this casethe information was correct (theirfriend had a hearing aid that whistled)but her perception is likely that allhearing aids whistle and are in thedrawer (not correct!). It is our job togive clients valid and relevantinformation on which to base theirdecisions. Addressing all a client’sconcerns will go a long way to puttingtheir “mind at ease” about this newjourney with a hearing aid.

waLk with theCLient throughtheappointMentRemember the firsthearing test you didwith a real client(not one of yourclassmates!)? Iwill bet youwere nervousand slightlyunsure ofyourself.

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Your mind may have been racing withall the “What ifs.” What if I put theinserts in the wrong ear? What if I haveto mask something? What if I forget toadjust the VU meter? What if they tryto fake a hearing loss? For many of yourclients, this is their first hearing test andthey may be experiencing some of thesame concerns you had during yourfirst hearing test.

First time clients are often nervous.They may not know what to expect.They have never met you before andyou are leading them into a small roomwith a big door and a small window.You are putting foam in their ears andthey are hooked up with wires. You areasking them to respond to beeps thatthey can barely hear, and they mayworry about whether they are doing agood job or not. They will wonder howlong they will be locked in the soundbooth and have no idea how long thetest takes. And who knows, maybetheir neighbour was just in to see youand she left with a $3,000 pair ofhearing aids. After all, they don’t reallywant to spend $3,000, they just camein for a hearing test.

I have calculated that, during my yearsas an audiologist, I have completed21,000 hearing tests. I can recite theword lists in my sleep and complete ahearing test with my eyes closed (well,not quite!). I can look at an audio andwithin seconds get a picture of what isgoing on or any additional tests thatneed to be done. Just because we arenow comfortable and familiar with theprocess of hearing testing, does notmean your client is comfortable withthe process. Consider individuallycustomizing the appointment, results,recommendations and follow up for the

client and not simply following theroutines we become accustomed to.Remembering that what your clientmay be thinking/feeling puts a newperspective on how we interact withthem throughout the process of thehearing assessments and counseling.

if the CLient needs aids, givetheM the inforMation andguide theM through thedeCisionAt the end of the day, the decision topurchase a set of hearing aids alongwith the style and price of the aids isnot ours to make, it is the client’s. It isour job as clinicians to give our clientsthe information they need to make aninformed decision. Sure, we may havespecific ideas on what the client needsbased on the audiogram and ourassessment of their lifestyle, dexterity,and preferences, but it really is theclient’s decision.

where do we go froM here?Just as we should ask our clients “good”questions, we too must ask ourselvessome hard questions in our quest todevelop our skill in relating to clientsin a more meaningful way.

1. Do I treat each of my clients as individuals – each being equally deserving of my full time and attention during their appointmenttime?

2. What new or different questions can I ask clients to determine whythey have come for an assessment?For example: what are the implications of potential hearing loss on their life and on the lives oftheir loved ones; what are their views and knowledge about hearing aids and amplification?

3. How can I relay my clinical findings to a client in a non-technical and relevant way that both makes sense to the client andtranslates effectively into what theclient is experiencing?

4. Am I giving my client all the appropriate and relevant information they need to make aninformed decision on amplification? Am I showing themall the pertinent styles and price points of the solutions available?

5. What can I do to ensure that the entire client experience in the office, from the moment they call the office, is a comfortable and easy process that anticipates whatthey truly need and is customizedfor that client?

The skill set required to effectivelyapply the rules to our client’s time withus in the office is not one that is learnedinstantly or in a classroom. It is not onethat is graded by a professor or clinicalsupervisor or boss. It is a skill set thatmust be continually evaluated,monitored and fine tuned by eachhearing health care professional forthemselves. It is a skill set that is trulynever mastered – sure, some cliniciansexhibit exceptional skill in this area, butit is never mastered. It is a skill thatdeserves as much time developing asour knowledge of the rules does. Tobecome an exceptional hearing healthcare professional requires anunderstanding of the rules andcontinual development of the skillsrequired to apply those rules to yourclient care and experience, as you walkalongside your client in their journeywith hearing loss.


researCh and deveLopMent foCus |

Hyperacusis: An Introduction

By David Baguley PhD


About the Author

David Baguley is a consultant clinical scientist (Audiology) at Addenbrooke's Hospital,Cambridge, UK., a fellow of Wolfson College, Cambridge University, and holds an honorarychair at Anglia Ruskin University.

The experience of becoming troubledby decreased sound tolerance can be

catastrophic for a patient and theirfamily, and represents a real challenge forthe audiologist. Whilst the symptom hasbeen described for many years, it is onlyin the past decade that protocols fordiagnosis and treatment have beenformulated, and that an evidence basefor treatment efficacy has begun to build.

In this piece I seek to introduce thereader to modern understandings ofhyperacusis, and present treatmentstrategies. Whilst I acknowledge thatthere are major shortcomings in boththese areas, I will indicate that it ispossible to diagnose and treathyperacusis in a clinical audiologysetting in a way that can set the patient(and their family) on the road torecovery.

definitionsThere are many words in current use toindicate a decrease in the ability totolerate sound.1 The word hyperacusis

seems first to have been used byPerlman,2 and a suggested latermodification to hyperacusis dolorosa3

was not widely adopted. A definition ofhyperacusis is “an abnormal, loweredtolerance to sound.”4,5 In practice thisrefers to individuals who havedeveloped a sense of discomfort whenexposed to external sound of anintensity that would not trouble mostothers. For some the discomfortdepends on whether they make thesound, or some external source – in suchcircumstances it is usually the case thatself made sound is tolerated better. Forothers, however, the source may beirrelevant. Similarly, for some it isspecific sound that is bothersome, suchas that of an unruly child, whereas forothers it is all sound that evokesdiscomfort.

The term phonophobia has been appliedto these situations, especially when it isa specific sound that is bothersome, butthere are two issues with that. The firstis the implication that as a “phobia” this

is essentially a psychologicalphenomenon, and optimally treatable bypsychological therapy – but whilst theremay be psychological features to a case,this may not be true. Second,phonophobia is used very specifically byneurologists to describe the soundintolerance symptoms experienced bysome migraine sufferers, and it is farfrom clear that hyperacusis in general issimilar to that.

Proponents of tinnitus retraining therapy(TRT) have introduced a new word todescribe hyperacusis: misophonia6 Thisderives from the Greek for “dislike ofsound,” and so resonates with theaversion experienced by patients. It isyet to be seen whether this term isadopted outside the TRT community.

It is interesting to note that patientsdevelop their own terms to describetheir situation. The HyperacusisNetwork (www.hyperacusis.net) patientcommunity uses the phrases reduced orcollapsed sound tolerance to describe


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their experiences and these words arevery meaningful for patients inindicating that the clinician understandstheir problem.

prevaLenCeAt the present time firm evidence aboutthe prevalence of hyperacusis is sparse.A study in Sweden7 combined internetand postal survey techniques andidentified a figure of 8% of the adultpopulation who reported loudnesstolerance issues, but this probably doesnot represent the number of people forwhom that is clinically significant. Amore realistic estimate is of 2% of theadult population.1

Even less is known about the prevalenceof hyperacusis in childhood. There issome evidence regarding an associationbetween sound tolerance issues andchildren identified with autismspectrum disorders (ASD), but there ismuch work to be done in this area.There are indications that hyperacusis inASD may be a form of auditory hyper-vigilance, and as suchphenomenologically different fromgeneral adult hyperacusis experiences.8

pathophysioLogyWhilst hyperacusis may be idiopathic,in some individuals there are indicationsthat it is associated with other symptomsor conditions. The link with migrainewas mentioned above, and bothdepression and post-traumatic stressdisorder have been linked withhyperacusis. Interestingly these threeconditions may share a serotonergicbasis, and this has been proposed as amechanism underlying hyperacusis.9

A number of specific medical conditionscan also give rise to sound tolerancesymptoms.10 An absent stapedial reflex,such as seen in some patients with facialpalsy, may result in an apparent increase

in the perceived intensity of sound.Some patients report hyperacusis posthead injury. Reduced tolerance to soundis a recognised feature of lyme disease,and has also been reported in Addison’sdisease, multiple sclerosis, andfibromyalgia. As such, the clinician whoassesses a patient with hyperacusis needsto be mindful of these (and other)differential diagnoses.

The relationship between hyperacusisand tinnitus is complex. Many personswith troublesome tinnitus reporthyperacusis (perhaps as many as 40%),and it does seem that the overwhelmingmajority of hyperacusis patients reporttinnitus. For some people soundtolerance was reduced first, and thentinnitus developed: for others this wasthe other way around. This is an areawhere more research is needed.

What then is the mechanism(s) ofidiopathic hyperacusis? There are severaltheories, and whilst none of them isentirely satisfactory, they all propose thathyperacusis is a manifestation ofincreased central auditory gain. Somehave proposed medial auditory efferentsystem dysfunction as underlying this,but evidence regarding the lack ofimpact upon loudness tolerance whenefferent modulation of hearing is ablated(in surgical vestibular nerve section forexample4) argues against this. Thepossibility of disturbance of serotoninfunction has been mentioned above, butthis is a very broad proposal, not linkinghyperacusis with the disruption of aparticular form of serotonin orconcentration thereof. Sahley andcolleagues considered that glutamatefunction in the primary auditorysynapses may be potentiated by opiodpeptides released during stress, leadingto the over-representation of theintensity of sound. It is difficult to seehow this proposal might be empirically

tested, and in any case the relationshipbetween hyperacusis and stress is morecomplex than this implies. In a sense weare starting from the wrong place inmaking these and other suggestions: thefact is that how loudness is encoded andperceived in the human auditory brainis as yet poorly understood and so itshould not be a surprise that themechanisms of loudness perceptiondisorders remain obscure.

Work by Craig Formby and colleagues11

provides emergent evidence thatloudness perception can change, andthat it is influenced by thepresence/absence of sound stimulation.Experiments where volunteersconsistently wore earplugs, or widebandsound generators (at a stable intensity)have respectively demonstratedreduction or increase in the ability totolerate intense sound. Work by Munroand Blount12 corroborates these findingsby indicating that stapedial reflexthresholds can reduce when earplugs areconsistently worn. The idea that thehuman auditory brain is plastic, and canadapt on the basis of learning, injury andsound stimulation is now widespread.Hyperacusis may well be a consequenceof a set of circumstances that influenceloudness perception.

audioLogiCaL assessMentSome aspects of the audiologicalassessment of a patient with hyperacusisare straightforward, but others requiresome careful thought. Pure toneaudiometry is essential, though amodified technique where initialpresentation is at a lower intensity thanusual protocols dictate is preferable. Thestimulus intensity required for stapedialreflex testing, and a neurologicalauditory brainstem response assessment,may be problematic, and these testsshould be withheld unless there is aspecific value.

The issue of whether or not to useloudness discomfort testing is morecontentious. In support of the use ofsuch a procedure is the need to quantifythe extent of the patient’s difficulties,and the possible utility of results pre andpost treatment as an outcome measure.Against is the distress this may cause apatient, possibly corroding trust in theclinician. Further, there are indicationsthat the data elicited from such tests ismarked by large test-retest variability,and influenced significantly by theinstructions given to the patient. Thereare differing opinions about theseprocedures in specialist centres: it is theauthor’s current practice not to useloudness discomfort tests routinely, butonly when specific circumstancesindicate – this might be a patient requestor medico-legal aspects.

A number of validated self reportinstruments now exist for the assessmentof hyperacusis (Table 1). Unlikeloudness discomfort testing these are notstressful for the patient, and do allowstaging and outcome assessment.

A additional tool of potential value is theHospital Anxiety and Depression Scale17

which enables low impact screening forthese symptoms with a well validatedinstrument.

treatMentsSelf-help has great potential value forpeople with hyperacusis. The recently

published book “Living with tinnitusand hyperacusis” (available onwww.amazon.ca).18 contains practicalmaterial for patients and their partnersto work through, and is based upon acognitive behaviour therapy program,though advice on sound therapy is alsoprovided. Another useful self helpresource is the Hyperacusis Networkcommunity based at www.hyperacusis.net.The information provided is clear andpositive, and the message boardscharacterised by sharing of practical andpositive information.

Regarding therapy delivered by anaudiologist, evidence is sparse aboutwhat is optimally effective. There arethree elements which have beensuggested: (1) counselling; (2) soundtherapy; (3) relaxation therapy.

The first two elements are broughttogether when a tinnitus retrainingtherapy approach is utilized. In thatprotocol some directive counselling isused to help the patient understand theirhearing system, and how a dysfunctionalcentral gain system may be involved intheir symptoms. The distinction is madebetween decreased sound tolerance, andmisophonia (aversion to sound). Inhyperacusis, a desensitisation soundtherapy strategy is used, starting withvery low intensity wide band sound,which over time is increased in intensityas the patient’s tolerance increases. Inmisophonia, a strategy of presenting

pleasant sound to the listener isdescribed. For details the interestedreader is directed to Jastreboff andHazell6 and Jastreboff.19

An alternative sound therapy approachis to use wide band sound stimulation,but at a comfortable and consistentintensity. The underpinning argument isthat this may allow the dysfunctionalcentral auditory gain to be recalibrated,and hence the hyperacusis may beameliorated.1

Patients with hyperacusis are oftenstressed and anxious, and for some,relaxation therapy may be of substantialbenefit. There are many forms ofrelaxation therapy, but as progressivemuscle relaxation therapy has a provenrole in tinnitus management, porting thetechnique across to hyperacusis seemssensible. Andersson and Kaldo20 give ascript for relaxation that can be usedwith hyperacusis patients.

It has been mentioned above thatMcKenna et al.18 have provided acognitive behaviour therapy (CBT)approach for patients to use in a self helpcontext. Baguley and Andersson21

proposed that CBT techniques have arole in treating hyperacusis in the clinic,and that this approach may beparticularly effective in treating the fearand anxiety components that may bedebilitating for some patients. Thechronic shortage of psychotherapists

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Table 1. Self report instruments for hyperacusis

authors (date) type items validation set Comments

Khalfa et al. (2002)13 Questionnaire 14 201 individuals from

general population

Nelting et al. (2002)14 Questionnaire 27 226 hyperacusis patients Validated by Blasing

et al. (2010)16

Dauman and Rating scale for 249 tinnitus patients

Bousau-Faure (2005)15 difficulty of activities


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with a working understanding ofhyperacusis may be a barrier to patientsreceiving such treatment.

The evidence base regarding the efficacyof these various components ofhyperacusis therapy is vanishingly small,and this is an area where well designedclinical outcome studies are keenlyawaited. The heterogeneity andcomplexity of hyperacusis experiencesare a challenge to getting such datahowever. Such data that does exist islargely in the form of conferencereports,1 and positive about theprospects of success in treatinghyperacusis, but not of a standard thatmeets the needs of evidence-basedpractice.

refLeCtionsIn this piece I hope to have whetted thereader’s curiosity about hyperacusis, andencouraged those with an emergentinterest to seek out more information,and clinical experience. The experiencesof people with hyperacusis are a richfield for research, and the multitude ofquestions yet to be answered will occupyaudiology clinicians and researchers fordecades to come.

ConfLiCtsNone declared.

referenCes1. Baguley DM, McFerran DJ.

Hyperacusis and Disorders of Loudness Perception. In: Moller A,Langguth B, Deridder D, KlienjungT (Eds) Textbook of Tinnitus. NewYork; Springer;13–24, 2011.

2. Perlman HB. Hyperacusis. Ann Otol Rhinol Laryngol 1938;47:947–53

3. Mathisen H. Phonophobia After Stapedectomy. Acta Otolaryngol

1969;68:73–7 4. Baguley DM, Axon P, Winter IM,

Moffat DA. The Effect of VestibularNerve Section Upon Tinnitus. ClinOtolaryngol Allied Sci 2002;7(4):219–26.

5. Moller AR. Tinnitus: Presence and Future. In: Langguth B, Hajak G, Kleinjung T, Cacae At, Moller Ar (eds) Tinnitus :Pathophysiology and Treatment. Progress in Brain Research 166:3–18, 2007.

6. Jastreboff P, Hazell JWP. Tinnitus Retraining Therapy. London: Cambridge University Press, 2004.

7. Andersson G, Lindvall N, Hursti T,and Carlbring P. Hypersensitivity toSound (Hyperacusis): A PrevalenceStudy Conducted Via the Internet And Post. Int J Audiol 2002;41:545–54.

8. Gomot M, Belmonte MK, BullmoreET, Bernard FA, and Baron-Cohen S. Brain Hyper-Reactivity to Auditory Novel Targets in Childrenwith High-Functioning Autism. Brain 2008;131: 2479–88.

9. Marriage, J, Barnes, NM. Is CentralHyperacusis A Symptom of 5 Hydroxytryptamine (5-HT) Dysfunction? J Laryngol Otol 1995;109:915–21.

10. Andersson G, Baguley DM, McKenna L, and McFerran DJ. (2005)Tinnitus: A MultidisciplinaryApproach. London: Whurr; 2005.

11. Formby C, Sherlock LP, and Gold SL. Adaptive Plasticity of LoudnessInduced By Chronic Attenuation and Enhancement of the Acoustic Background. J Acoust Soc Am 2003;114: 55–58.

12. Munro KJ, Blount J. (2009) Adaptive plasticity in Brainstem of Adult Listeners Following Earplug-Induced Deprivation. J Acoust SocAm 2009;126(2):568–71.

13. Khalfa S, Dubal S, Veuillet E, Perez-Seliaz F, Jouvent R, Collet L. Psychometric normalisation of a hyperacusis questionnaire ORL J Otorhinolaryngol Relat Spec 2002;64:436–42.

14. Nelting M, Rienhoff NK, Hesse G, Lamparter U. The Assessment of Subjective Distress Related to Hyperacusis with a Self-Rating Questionnaire on Hypersensitivity to Sound. Laryngorhinootologie 2002;81:32–34

15. Dauman R, Bouscau-Faure F. Assessment and Amelioration of Hyperacusis in Tinnitus Patients. Acta Otolaryngol 2005;125:503–9.

16. Bläsing L, Goebel G, Flötzinger U, Berthold A, Kröner-Herwig B. Hypersensitivity to Sound in Tinnitus Patients: An Analysis of a Construct Based on Questionnaireand Audiological Data. Int J Audiol2010;49(7):518–26.

17. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Sandinavia1983;67:361–70.

18. McKenna L, Baguley D, McFerran D. Living with Tinnitus and Hyperacusis. London: Sheldon Press; 2010.

19. Jastreboff P. Tinnitus Retraining Therapy. In: Moller A, Languguth B,DeRidder D, Kleinjung T (eds). Textbook of Tinnitus. New York: Springer; 575–96, 2011.

20. Andersson G, Kaldo V Cognitive Behavioral Therapy with Applied Relaxation. In: Tyler RS (ed) Tinnitus Treatments. New York; Thieme; 96–115, 2006.

21. Baguley DM, Andersson GA (2007)Hyperacusis: Mechanisms, Diagnosis and Therapies. San Diego: Plural; 2007.



Online Web Study on Hyperacusis

By Andrew J. Keiner, Richard Tyler, and Shelley A. Witt


About the Authors

Andrew J. Keiner, Richard Tyler, (left) and Shelley A. Witt are with the Department of Otolaryngology– Head and Neck Surgery, University of Iowa Hospital and ClinicsIowa City, IA. Correspondence can be directed to: [email protected].

Hyperacusis can be devastating formany of our patients. We know

so little about its mechanisms but oftensee the negative impact on our client’slives. There are many unansweredquestions about hyperacusis. Whatcauses hyperacusis to develop? Is therea link between hyperacusis andmigraine headaches? Can risk factors,such as hearing loss, predispose anindividual to hyperacusis? Our earlywork uncovered an association betweenhyperacusis and tinnitus.2 Furtherwork is necessary to understand whythese associations exist.

We define hyperacusis in three ways 3

• loudness-hyperacusis, • annoyance-hyperacusis• fear-hyperacusis.

Patients experience loudness-hyperacusis when moderate sounds areperceived as very loud. Individualswith annoyance-hyperacusis

experience varying levels of annoyanceby sounds, often independent ofloudness. Some individuals develop afear of being in places where they areconcerned about certain sounds; this isknown as fear-hyperacusis orphonophobia. Patients can experiencethese symptoms independently or in

combinations.

At our website, patients can take asurvey which asks questions about theirperceptions and experiences ofhyperacusis. Preliminary results aredisplayed in Figures 1 and 2.

Figure 1


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All subjects were given a list of noisysituations and asked which of themwere feared most based on theirreaction to those sounds. Figure 1shows the 10 most-feared situationsbased on participant responses.

In Figure 2, subjects were asked to ratethe severity of sounds on a scale of 0(least) to 100 (worst) for the threesubgroups of hyperacusis. The graphshows the averaged responses of allsubjects for hearing music in a car.

There is no established cure forhyperacusis, yet; Formby2 shows greatpromise at least for some. Manypatients with hyperacusis choose towear earplugs to make everyday noisesmanageable. People should use hearingprotection whenever they are exposedto potentially damaging noise.However, for less intense noise thistechnique is not recommended as the

reduction of sound level for longdurations could change the way thebrain reacts to sound, particularly whenthe earplugs are removed.2 Patientswho decrease the level of ambientsound may actually increase theirloudness hyperacusis. Instead, werecommend using sound therapy todesensitize and treat the hyperacusis.

One form of sound therapy involvesplaying continuous low-levelbackground noise throughout the day.In another technique, sound is initiallypresented at comfortable levels and isgradually increased over time untilmoderately-loud sound is tolerable forthe patient. This technique is calledsuccessive approximation of sounds. Athird approach is to record difficultsounds and listen to them at lowerlevels, gradually increasing the levelsover time.3 Counseling can be helpfulfor many patients. The extent of

counseling necessary varies by patientand is determined by the patient’s levelof distress.

Although there are effective treatmentmethods, much remains to be studiedabout hyperacusis and its mechanisms.It is our hope that through continuedresearch and greater understanding,more effective diagnosis andmanagement methods will becomeavailable for patients. Please help ourresearch efforts by directing yourpatients to our online web study onhyperacusis at the following link.

http://survey.uiowa.edu/wsb.dll/127/iowahyperacusis.htm

referenCes1. Formby C, Sherlock LP, Gold SL,

and Hawley ML. Adaptive Recalibration of Chronic AuditoryGain. Seminars in Hearing 2007;28(4):295–302.

2. Tyler RS and Conrad-Armes D. Thedetermination of tinnitus loudnessconsidering the effects of recruitment. Journal of Speech andHearing Research 1983;26(1):59�72.

3. Tyler RS, Noble W, Coelho C, Haskell G, Bardia A. Tinnitus and Hyperacusis. In: Katz J, Burkard R,Medwetsky L, Hood L (Eds.). Handbook of Clinical Audiology Sixth Edition. Baltimore: Lippincott Williams & Wilkins; 2009.


Figure 2



The Value of Earplug Fit Testing

By Renee S. Bessette, COHC

About the Author

Renee S. Bessette, COHC, is the Global Brand Manager, Howard Leight / Honeywell Safety Products

Although prevention has been themantra in occupational hearing

conservation programs over the years,the hoped-for results have not beenrealized. Despite years of regulation,hours of training, and billions ofdispensed earplugs, the incidence ofnoise-induced hearing loss (NIHL) inthe workplace continues to riseworldwide. In the United States, over22 million workers are exposed tohazardous noise on a daily basis, and 8million suffer from NIHL.1 In somenoise-intense industries, the rates ofhearing loss are tremendous. Forexample, 50% of carpenters andplumbers, and 90% of retiring coalmine industry workers have NIHL.1

Safety professionals have a universalchallenge in protecting the hearing oftheir noise-exposed employees: howmuch protection do their employeesactually achieve with their earplugs?

As rating methods are based uponidealized laboratory conditions,designed to test the capability of thehearing protector, publishedattenuation ratings like the NoiseReduction Rating (NRR) have been

criticized for being too generous intheir estimation of noise blocking(attenuation). Studies indicate thatwhile some workers in real-worldworksites achieve the publishedattenuation on the package, manyworkers do not. This has led to a varietyof inappropriate de-rating methodsapplied to hearing protection aroundthe world, and has contributed to muchconfusion in knowing how toaccurately estimate a hearing protector’sattenuation in real-world use. Thus,

determining if workers have optimalreal-world attenuation for their noiseenvironment is critical to the success ofan occupational hearing conservationprogram.

ear pLug fit testingteChnoLogyThrough new earplug fit testingtechnologies, safety managers andworkers now have an accurate, real-world picture of hearing protectoreffectiveness, providing a starting


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benchmark on which to build theirHearing Conservation practices. Firstand perhaps foremost, fit testingprovides a formal metric from whichone can determine whether employeesare receiving optimal protection fortheir noise environment, requireadditional training on how to fit theirearplugs, or need to try a differentmodel.

Earplug fit testing benefits both safety

managers and employees alike. For thesafety manager, it fulfills regulatoryrequirements for training withdocumented results. For employees, itdemonstrates the importance of properprotection in the workplace, and helpsthem select and compare protectors tofind the best choice for their ears andspecific applications.

In a recent evaluation, a UK laboratorythat performs technical studies and

certifications on personal protectiveequipment for the EuropeanCommunity identified that an earplugfit testing system “appeared to have thepotential to aid correct fitting andselection of earplugs.” Further, itvalidated that earplug fit testing “datademonstrated that it would be a usefultool for ensuring Hearing Conservationwithin the workplace.”2

fieLd attenuation studyThe value of fit testing was evident in afield attenuation study conducted bythe Howard Leight AcousticalLaboratory on the performance ofhearing protection devices. Conductedon over 100 workers at eight differentfacilities, the study showed that one-third of workers achieved attenuationhigher than the published attenuationfor their earplugs, and that anotherthird achieved attenuation within 5 dBof the published rating. But the lowestone-third of workers had attenuationthat was more than 5 dB belowpublished attenuation.3

The study then interviewed the workerswho obtained high attenuation valuesto determine the common factors thatcontribute to good earplug fit, andhence, good attenuation in use. Onlyone factor was found to be a consistentpredictor of good fit: one-on-onetraining. That is, the more often aworker had received individual trainingin the proper use of hearing protectors,the higher the probability of a good fit.The same was not true for grouptraining, such as watching annualtraining videos or passing outbrochures.

The importance of fit testing as a criticalelement of one-on-one employeetraining cannot be overstated. Nogeneralized rating scheme for hearingprotectors can be effective without

knowing how much attenuationindividual workers actually attain. If asafety manager were to supply earplugsbased on the assumption that allearplugs only achieve half of theirpublished attenuation in the field, thenclearly two-thirds of the 100 workers inthe study would be seriouslyoverprotected, since they are achievingmuch higher protection than 50%. Fittesting of hearing protectors bridges thegap between the laboratory estimates ofattenuation and the real-worldattenuation achieved by workers asthey normally wear their protectors.

Additionally, fit testing can be aninvaluable tool in reducingcompensation claims for noise-inducedhearing loss at the workplace. Fittesting records can help document thateffective steps were taken to selectappropriate hearing protectors, trainworkers in their proper use, and todocument a proper fit with a particularprotector. This level of powerfuldocumentation has been unavailable tohearing conservation programs in thepast.

the future of hearing LosspreventionEarplug fit testing is gaining greateradoption by hearing conservationexperts and by industry as a key tool inhearing loss prevention.

In a Best Practice Bulletin issued by analliance between the National HearingConservation Association (NHCA) andOccupational Safety and HealthAdministration (OSHA), earplug fittesting was endorsed as a

recommended best practice in reducingoccupational hearing loss as well as ametric to assess a hearing conservationprogram’s overall effectiveness.4 Thebulletin also cited fit testing as a way to“match the employee’s hearingprotector attenuation to his/her noiseexposure level. This may be particularlyuseful in hearing critical jobs or forthose with hearing impairment.”

At the 2011 NHCA conference, a full-day workshop spotlighted the availableearplug fit testing technologies, andallowed attendees to try each system.Several platform presentationsthroughout the conference alsoidentified the benefits of earplug fittesting, emphasizing the benefits ofselection of an appropriate hearingprotector and one-on-one training forworkers. Plus, the Safe-In-SoundAward, presented by NIOSH / NHCAfor excellence in hearing lossprevention, was presented to ShawIndustries. In presenting the award, theaward recognized Shaw’simplementation of earplug fit testing asa critical success factor in its hearingconservation program.5

In addition, an ANSI working grouphas been assembled to evaluate andcreate a new standard for theperformance criteria of hearingprotector fit testing systems.6

ConCLusionWhile many occupational hearingconservation programs have the bestintentions to ensure that workers areusing hearing protectors, the ultimategoal is to ensure that workers wear

them properly 100% of the time whenexposed to hazardous noise. Earplug fittesting technology better enables andempowers workers to achieve this goal– and facilitate a life of healthy hearing.

referenCes1. Centers for Disease Control and

Prevention. Work Related HearingLoss. NIOSH Pub. No. 2001-103. Atlanta: Author.

2. Hear Forever. INSPECInternational Limited Report on theHoward Leight VeriPRO Ear Plug Fit Testing System. Available at: www.hearforever.org/veriproinspecreport.

3. Witt B. Fit Testing of Hearing Protectors. Occupational Health &Safety. Available at: http://ohsonline.com/articles/2007/10/fit-testing-of-hearing-protectors.aspx.

4. OSHA/NHCA Alliance. Best Practices Bulletin: Hearing Protection — Emerging Trends: IndividualFit Testing. Available at: http://nhca.affiniscape.com/associations/10915/files/AllianceRecommendationForFitTesting_Final.pdf.

5. NIOSH. 2011 Safe-in-Sound Excellence in Hearing Loss Prevention Awards. Available at: http://www.cdc.gov/niosh/updates/upd-02-24-11.html.

6. ANSI S12.71-200X standard, Performance Criteria and Uncertainty Determination for Individual Hearing Protector Fit Testing Systems.


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The Hearing Foundation of Canada's Youth

Listening Summit

In November 2010, the Canadian Institutes of Health Research brought together participants in the Hearing Foundationof Canada's Youth Listening Summit to talk about the state of research on noise-induced hearing loss and the developmentof a program to address it among adolescents. (Transcript reprinted with kind permission from the Canadian Institutes ofHealth Research.)

now Listen up!Researchers and health advocates areexpressing increasing concern aboutthe link between overexposure to noise– largely from listening to music atunsafe levels – and the development ofearly hearing loss in youth.

The Hearing Foundation of Canada has developed an award-winningelementary hearing-health program,Sound Sense/Oui à l’ouie. It wanted todevelop a program to reach teenagers.In 2008, the Foundation held theCIHR-funded Youth Listening Summit,with the goal of developing a programto reach this important age group. Thesummit brought together 30 youthparticipants, 10 of whom had hearingloss, and 30 professionals from a varietyof relevant fields. Prior to the summit,the youth participants tested the MP3listening levels of 150 of their peers; theresults showed that 30% of teenagerswere listening at decibel levelsconsidered dangerous.

The summit led to the development ofiHearYa!, a program featuring a liveassembly, interactive website and socialmedia site. “The power of iHearYa!,”says Gael Hannan of The HearingFoundation, “lies with the fact that

young people are delivering themessage in the way that they knowtheir peers will listen.” The programwas delivered with positive feedback inthree pilot project presentations and theHearing Foundation is now seekingfunding to extend the program’s reach.

Three participants in the YouthListening Summit came togetherrecently to discuss the problem ofnoise-induced hearing loss and thisinnovative approach to addressing it.

partiCipantsMarshall Chasin is an audiologist andthe director of auditory research at theMusicians' Clinics of Canada inToronto, the coordinator of research atthe Canadian Hearing Society, and thedirector of research at ListenUpCanada. Dr. Chasin presented aworkshop at the Youth ListeningSummit about the impact of noise-induced hearing loss on musicians andother people.

Robert Harrison is a senior scientist atThe Hospital for Sick Children inToronto, in the Neuroscience andMental Health Program and a professorin the Department of Otolaryngology –Head and Neck Surgery, and

Department of Physiology at theUniversity of Toronto. Dr. Harrison wasan advisor on the development of thesummit, gave a lecture on biologicaland clinical aspects of noise-inducedhearing loss, and participated in allgroup discussions.

Marwa Nather was a youth participantin the Youth Listening Summit. Herselfhearing impaired, she followed up herparticipation in the summit by helpingto deliver one of the pilot presentationsof I Hear Ya! to students at her highschool, Dante Alighieri AcademyCatholic Secondary School. Ms. Natheris now studying psychology at TrentUniversity.

Moderator: Thank you all for beinghere today. I’d like to start by asking,what is the research telling us aboutnoise-induced hearing loss amongyouth?

Bob Harrison (BH): There is nowplenty of research going on whichrelates to the basic mechanisms whichcause hearing impairments as a resultof noise exposure. So in relation toyouth and the use of MP3 players, weknow a lot about what happens whenthe ear is stimulated with very high


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levels of sounds. I could talk for hourson this subject but just to say that weknow what sound levels can causedamage to hearing and we know whatsort of hearing deficits result from thisdamage. From this experimental data,we can extrapolate and confidentlysuppose that the levels (and duration)of sound exposures from misused MP3players CAN cause damage to thecochlea. We know from much moreapplied or clinical research that youngchildren and adolescents and adults areat risk for hearing loss because weknow that the levels of sound that theyare listening to on MP3 players is highenough to cause damage to the hearing.

So we have a wealth of basic andclinical research which tells us there isa potential for hearing loss in youth.More directly, there are a large numberof case studies and epidemiologicalsurveys which show that young peoplewho have a history of using MP3players unwisely are at risk fordeveloping a significant hearing loss.

Marshall Chasin (MC): I do someresearch but I’m primarily a clinician.It’s the expected norm for a 19-year-oldperson to have measurable hearing lossalready. We know from largeepidemiological studies that music doescause hearing loss. In other words,music is at the same level that you’dexpect noise to be from a factory. If wesubject someone to prolonged exposureto 85 dB, which can cause permanenthearing loss, people would say: That’snot loud. It’s astounding how quiet 85dB is. It’s maybe a dial tone on atelephone. It may be people clappingloud in an audience. It’s the sound ofthe toilet flushing when you’re veryclose to it. These are all 85 dB. It’s yourMP3 player on half volume, dependingon the earphone. And humans, as arule, are not very good creatures at

discerning differences of loudness. Andso people will say: “Well, that doesn’tsound that loud.” And they’reabsolutely right, it doesn’t sound allthat loud but it is damaging, it isintense. We don’t really see music inthe same way that we see noise. Wedon’t have a good gut feeling of therelationship between intensity that iscausing damage, and the loudnesswhich is where we set the volumecontrol. Also we don’t have goodmeasuring tools that can give us goodsensitive information about theproblems of the inner ear.

Moderator: So we have the knowledge,we have the research – how do we getthe message out?

BH: There is a need for publicawareness, for educational programs toinform at-risk individuals. MarshallChasin does it for musicians, forexample, and we want to do it foryoung people who are, if you like,ignorant of what they’re doing to theirhearing. We want to take what weknow and we want to prevent thehearing loss. So the HearingFoundation of Canada organized this “IHear Ya” Youth Summit. One of themain reasons for it was to try and workout what would be the best way ofgetting the message across toadolescents.

Moderator: So Marwa, this is whereyou came in. How did you get involvedin the summit?

Marwa Nather (MN):When I took thedevice that is used to measure thesound of MP3s to my school, to findthe loudness that people were hearing.I found that most were using soundsover 85 dB. And I remember I had asheet saying the normal decibelshearing and the loudness that would

cause hearing loss and when I showedit to the students, they were actuallyvery shocked. I didn’t see that theywould change the loudness that theyare listening at, but after thepresentation that I did at my schoolafter the Hearing Summit, I noticedmany people who were actually tryingto lower the volumes.

Moderator: So why do you think theywere ready to change just then but notbefore when you first did thisexperiment with the measuring device?What made the difference?

MN: I believe that it was because Ispoke of a personal experience andmaybe they’re afraid that it wouldhappen to them too.

Moderator: Tell me more about yourparticipation in this summit. What wasit like?

MN:Well, it was my first time meetingother people with hearing loss and itmade me realize that it wasn’t an easything and that other people really doneed to be aware of the loudness thatthey’re hearing in order to preventhearing loss.

Moderator: Part of the summit wastrying to figure out how this programfor teenagers should look. So whatthings did the youth think would beimportant for the “I Hear Ya” programfor it to work?

MN: Some of the things were to put aban on high-powered MP3 player orsaying the maximum loudness that itshould be. And maybe that could givepeople a warning. And another thingwas educational programs at school.Make special classes or, for example, insciences, maybe provide a unit abouthearing loss and about the ear.

Moderator: Bob, what do you think?This is a bit of a different approach toknowledge translation, I think,involving the youth so strongly. Do youthink it makes a difference?

BH: Well, I think Marwa was animportant participant; as shementioned, she represented one whohas a hearing loss. And a lot of youngpeople don’t have that contact or, evenif they do, they don’t actuallyunderstand what it can mean to have ahearing loss. So there was that shockand awe factor. We thought that gettingyouth involved in the development of“I Hear Ya” would actually tell us – andit actually did tell us – more about theway young people communicate andinfluence each other. For example, thisnotion that they’re using social mediato send messages, we felt that this wasimportant to understand and howbetter to do this than by involving theyoung people themselves?

Moderator: What do you thinkchanged as a result of theirinvolvement?

BH:Well, I think there are a few thingsthat I got from this. First of all was thatyouth are going to be more influencedby their own peer group perhaps thanby some old professor like MarshallChasin coming in and giving them alecture. And so, getting the messagespread among themselves is likely moreinfluential. The other thing I found wasthat you need – and I use the words“shock and awe” – you need to sort ofexaggerate things a bit and make it avery strong message, as opposed to,“You might get a hearing loss if you dothis.” You’ve really got to hit theseyoung people with a very strongmessage. Subtlety is out of the window,I think, when you’re trying to influencekids.

MC: I agree totally with Bob. Eventhough I’m a really dynamic speaker,nobody is going to listen to a mid-50sguy who represents their dad or momor whatever; they’re going to listen toMarwa, people her age, peers. We’veseen this in the musical field for years.In 1990, less than a third of those thatI tried to bully into getting earplugsactually got them. By 1999, however,the last time we did the review, about96% of those same people did get themand it wasn’t that the old fogies werebecoming better salespeople but otherpeople have stepped up to the plate,such as Pete Townsend of the Who,other rock-and-rollers, the TragicallyHip, who are really cool and groovy –and it’s these people who have turnedsomething around from being not socool to, now it’s cool to protect yourhearing.

MN: People are very ignorant ofhearing loss, of the idea of gettinghearing loss. I remember when I wasback in high school, every time I’dmention to someone: “Your music’s soloud and you might get a hearing loss,”the response was usually: “Oh, I’m soyoung, I’m not going to get a hearingloss.”

Moderator: So how do you tell themthat, no, it’s what they’re doing nowthat will harm their hearing?

MN: Honestly, the only way that I canget to them is by showing them whatI’m going through, especially if I’m atclass and have to use an FM system orI have to raise my hand a couple oftimes to ask for the teacher to repeatsomething, then they actually get it andsay: Okay, well, we don’t really want togo through that.

BH: Young people feel immortal, so theidea of hearing loss, as Marwa has said,

is something that they associate witholder people. But it’s not somethingthat’s in their experience, which is whyMarwa and others like her are veryimportant: to show people that you canhave a hearing loss as a young person.

MC: There’s no way that we’re going tochange the view of a teenager, as Boband Marwa pointed out. I think amulti-factorial approach may be able towork. Getting someone who’s cool andgroovy out there, Justin Bieber, orsomeone like him, would do infinitelymore than anyone else but even withhim, there’s only so much that JustinBieber can do. You’d have to have amulti-factorial approach, statistics withexamples and signs of hearing loss,coupled maybe with somemanufacturers designing MP3 playerswith lights going off or a vibrationgoing on if a level exceeded a certainpreset level.

BH: One of the things that I have oftenadvised clinicians or parents to do,which is a little bit along the lines of“direct advice from adults isn’t going towork,” is go to the fancy package yournew MP3 player came in and you willfind in the box a warning from themanufacturers and, in many cases, theyare very extensive and well-writtenwarnings. That sort of directinformation from manufacturers in thedevices probably does influence to acertain extent young kids.

Moderator: Bob, you’ve mentionedthat you wanted to do some research tothe effect of “I Hear Ya” and see howeffective it is. So have you been able todo that?

BH:We actually haven’t got the “I HearYa” programs really up and running yet.You know, we’re still at that pilot stage.And once we do have things moving

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ahead then, certainly, we will want togain evidence that it’s working, bywhich I mean that the importantmessages about the risks of hearing lossare effective.

Moderator: Marwa, you made one ofthe program’s pilot presentations atyour school. So what do you think?Raising awareness is one thing, gettingpeople to actually change something, awhole other thing. What’s the necessarystep to get to that changing behaviour?

MN: Students, you have to scare them,show them that this is going to happen.They still won’t really understand it.They have this idea that it’s not goingto happen to them. Or they also say“We’re going to enjoy our youth nowand then we’re going to worry aboutthe future later.” But they don’t knowthat the present, actually what happensnow, is going to affect their future.

MC: Another approach one could takeis that there’s nothing inherently wrongwith MP3 players or portable music aslong as it’s done correctly. There’snothing inherently wrong with listeningthrough earphones as long as it’s donein moderation. The one thing that Ifound has been very useful is to say tothem: “There’s nothing wrong withlistening to music. Enjoy it thoroughly.Your favourite song comes on, turn upthe volume and enjoy it – just turn itback down to a more reasonable level

afterwards.” I talk about the 80/90 rule– 80% volume for 90 minutes a daywill give you one half of your daily doseof music exposure.

BH: One of the things that Marwamentioned was that there may not bean immediate perceived hearing loss inyouth that are using MP3 playersdangerously. And this is one problembecause, in many cases, the hearing lossdon’t become evident to an individualuntil much later on in their life. So youcan have damage to the inner ear thatis not revealed by a clinical test or is notevident to the individuals themselves.However, the damage is occurring andit will become evident to them muchlater on in life. Many studies are nowindicating that people in their 30s arenow having hearing loss that is not age-related. They have a hearing loss thatyou would normally expect to get at age60 or 70. It is a premature type of age-related hearing loss that is almostcertainly due to noise exposure. Butthis is one of the problems: theimmediate effects of noise-inducedhearing loss are very often notimmediately apparent in young people.

Moderator: Before we go, I’d just liketo ask each of you for a statementwrapping up the value of things like thesummit when you’re targeting youth.

MN: I would say that it’s better to paynow than wait until later to see the

results because, later, it’s going to be toolate and you don’t want to have theexperience in hearing loss for the restof your life, especially at a young age.

MC: Prevention is the cornerstone,coupled with early intervention, goodeducation, a multi-factorial approach,and more family physicians involvedand aware of the problems when theysee the kids.

BH: As Marshall mentioned, a multi-pronged approach to this issue isrequired. We need to have education ofhealth care professionals, parents,courses in schools. The peer-to-peerinfluence is what we were probing atthe Youth Listening Summit and it toldus that kids talk to each other in veryinfluential ways. They have socialmedia, you know, Twitter, Facebook, allthese ways of communicating and, inorder to get a message out to youth ingeneral, we wanted to capitalize on thisinformation transmission mode. That,for me, was quite a very importantaspect of the Youth Listening Summit.It told us more about how youth mightinfluence each other in sending thisimportant message about being carefulabout noise exposure levels.


Scan the image at left with your smartphone or iPod for more information.

*Sarampalis, A., Kalluri, S., Edwards, B., Hafter, E. (2009, October). Objective measures of listening effort: Effects of background noise and noise reduction. Journal of Speech, Language, and Hearing Research, 52, 1230-1240.

Individual results may vary.

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© 2011 Starkey Laboratories, Inc. All Rights Reserved. 8/11

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