Considering a Cochlear Implant? You’re Never Too Old.

Is there  an age limit for cochlear implant recipients? I asked this question of several cochlear implant surgeons around the country. Their answer? Never.

All have implanted patients in their 90s and, as Anil Lalwani, of New York-Presbyterian/Columbia University Irving Medical Center said, he “routinely” operates on patients over 80. His oldest patient is 93.

Surgeon Jay Rubinstein, at the University of Washington Medical Center, has performed cochlear implant surgery on a 96-year-old. Like the others, he thinks chronological age is -not the issue, it’s a person’s overall health.

In other words, it’s not so much how many years you’ve lived as how well your body has held up. In April 2014, Mollie Smith, 99, became the oldest cochlear implant recipient in Europe.

Cochlear implant surgery takes about two to three hours and requires general anesthesia or heavy sedation, so the ability to tolerate anesthesia is essential. Even so, a 2009 study by Dr. Lalwani and others, found that cochlear implantation in the elderly carries minimal risk from anesthesia.

One of the important preexisting conditions that may preclude surgery is moderate or severe heart and/or lung disease, which could make anesthesia potentially dangerous, said Rick Hodgson, a surgeon with Head and Neck Surgical Associates in Portland, Ore. The oldest patient he has implanted was 92 and he’s doing well, Dr. Hodgson said, noting that as a surgeon he looks more at “biologic age than chronological age.”

Darius Kohan, an otologist-otolaryngologist in New York (who was my cochlear implant surgeon at New York Eye and Ear Infirmary), told me he implanted a patient who was 95 years 6 months old. The patient is still using the implant 21/2 years after surgery.

Even dementia may not be a disqualifier, the surgeons said, assuming that the patient is not violent or likely to destroy the external parts of the implant. A study published last summer on implantees with dementia found a significant cognitive improvement a year later. The patients also received regular auditory rehabilitation. It was not clear from the study whether it was the implant itself or the aural rehab that made the difference in improved cognitive abilities.

Jack Wazen, a surgeon and  partner at the Silverstein Institute and director of research at the Ear Research Foundation in Sarasota, Fla. (and a fellow board of trustees member with me for the Hearing Loss Association of America), was the most conservative of those interviewed on the question of dementia, saying he routinely implants those with mild to moderate cognitive decline, but not those with severe decline.

All agree on the importance of auditory rehab for older patients. As Dr. Hodgson put it, “Auditory rehab helps get the most out of the process. This is amazing and life-changing technology, so why wouldn’t we want to maximize the impact on someone’s life?” He added that younger implant recipients might still be in the workforce and get stimulation from their everyday environment. The older recipients are less likely to get that stimulation. Also important, as all the surgeons agreed, is a social support system. This doesn’t necessarily mean a companion in the home, but a regular conversation partner is essential. Social interaction is important in general for quality of life.

The one issue on which the surgeons differed was which ear to implant: the worse or the better one. With younger implantees, the decision is usually to implant the worse ear, to preserve the natural hearing in the good ear, often using a hearing aid in the good ear. But an elderly person may have been deaf for some time in the bad ear, and thus less likely to benefit from the implant.

Although most said that they would consider implanting the deaf ear, they might not if the ear had been deaf for a long period of time. Dr. Wazen specified five years or more. Dr. Hodgson pointed out that “the longer the duration of hearing loss, the higher the chance of diminished benefit due to deterioration of sensory elements in the inner ear.”

Both Dr. Lalwani and Dr.  Kohan said they would implant the worse ear. Dr. Kohan’s reasoning is that if the patient is still able to hear with the hearing aid ear, there may still be enough plasticity in the brain, with crossover from the nonhearing ear, to make an implant in the deaf ear function. Dr. Lalwani went further: “I would always implant the deaf ear. One does not lose anything from doing so. If the outcome is less than satisfactory, the other ear could always be implanted down the road.”

As for outcomes, all the physicians agreed that older recipients do well with cochlear implants. Dr. Kohan mentioned benefits like delayed mental deterioration, better quality of life and more independence.

Dr. Wazen is completing a study comparing the results among patients over 80 with those under 80. The study found no differences in healing or complication rates. All patients did better with the cochlear implant than they had with a hearing aid. The study did find that speech recognition scores with implants were better in the younger group. This may be due to a number of factors, Dr. Wazen said, “including length of deafness, poorer cognitive function [in the older group] and aging changes in the brain.”

So if your doctor recommends an implant, go for it, no matter what your age. “When elderly patients tell me they are too old for a CI,” Dr. Rubinstein said, “I tell them age is not important unless they are a cheese.”

This post first appeared on AARP Health on February 22, 2016.

Cocktail Party Syndrome

In a previous post I wrote about a new study that shows that older brains have a harder time processing speech than do younger ones. In the study, even people with normal hearing had a hard time hearing in noise, what I call Cocktail Party Syndrome.

Several readers wrote to say that this same problem applies to lip reading and to ASL. I’m about to start taking ASL lessons (I’ll report on my progress) but I do worry that the old brain may just not be up to learning not only a new language but a language that is visual rather than aural.

Meanwhile, for those who may not have gotten to the end of my previous, rather lengthy post, here are some tips for keeping the hearing part of your brain agile. You might start with general brain-training exercises, which help in all sort of cognitive tasks. Physical exercise has been found help brain agility.

For exercises more specific to hearing comprehension you could use techniques like those used in auditory, or aural, rehab, where the brain is trained to recognize words more quickly and accurately. There are formal programs for this, like the online Listening and Communication Enhancement (LACE) programs, but you can also practice simply by listening to a recorded book and then checking the text to see whether you heard accurately.

Make sure you can see the speaker, and pay attention. Visual clues gleaned from facial expression, body language and the movement of the eyebrows and eyes assist speech comprehension. Formal speech-reading classes teach you to pay attention to these signals, but we all speech-read to some extent. It’s why even hearing people crane their necks to see a speaker, even if they can hear the speaker. This need to see as well as hear has an official name: the McGurk effect, named after one of the British scientists who discovered in the 1970s that we comprehend speech better if what we are hearing matches what we are seeing. The scientists called it “hearing lips and seeing voices.”

Make sure the speaker pays attention to you, too — starting with facing you. Ask companions to speak clearly and slowly but also naturally. For those with normal hearing, there’s no point in raising your voice because they can already hear — they just can’t understand. For those with hearing loss, shouting distorts the face and makes speech reading even more difficult. So ask them to speak slowly (but not too slowly) and clearly. And keep your eyes on their face.

Find a quiet corner and make it yours. Let people come to you, so that when they do you can hear them. If there’s someone you’d really like to speak to, ask them if they would sit with you. I find that involving others with my hearing loss, asking them to help, is often happily embraced. People like to be told how they can help. Most people, anyway — there are indeed very grouchy people out there who will be rude to you, but luckily they are not very often found at cocktail parties.

 

Trouble Hearing? It May Be Your Brain

Bouton: It’s All In Your Brain (Not Your Ears)
When it comes to hearing problems, the blame sometimes lies in the aging brain, not the ears. — Getty Images

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Older people may struggle to hear in a noisy environment, even with normal hearing, a recent study by University of Maryland researchers found.

Writing in the Journal of Neurophysiology, researchers Samira Anderson, Jonathan Z. Simon, and Alessandro Presacco, all associated with the UMD’s Brain and Behavior Initiative, found significant differences in the way older and younger people process speech in noise.

The study compared the brains of adults ages 61 to 73 with those ages 18 to 27. What they found was that our brains, as they age, get worse at processing the sound of talking when there are other sounds at the same time. In this case, the older adults scored measurably worse on speech understanding in noisy environments than the younger adults.

Both groups had normal hearing as measured by an audiogram. Importantly, they were also given speech in noise tests, and their hearing was still found to fall within the normal range. So what accounted for the disparity in speech understanding? The answer, alas, may lie in the aging brain.

Using two different kinds of brain scans — EEG (electroencephalogram) and MEG (magnetoencephalogram) — the researchers studied the midbrain area, which processes basic sound in most vertebrates, and the cortex, which has areas dedicated to speech processing in humans.

The cortical test involved listening to a male speaker reading from “The Legend of Sleepy Hollow,” by Washington Irving, while a secondary, female, speaker read from A Christmas Carol, by Charles Dickens. The midbrain test used just the female reading.

 

In the younger subjects, both areas of the brain responded normally to speech in quiet (one reader) and speech in noise (two readers), but in older adults, the cortex responded more slowly in processing speech whether or not there was secondary noise.

“For older listeners, even when there isn’t any noise, the brain is already having trouble processing the speech,” said coauthor Jonathan Simon in a press release.

“Older people need more time to figure out what a speaker is saying,” he added. “They are dedicating more of their resources and exerting more effort than younger adults when they are listening to speech.”

             What can we older adults do?

We could try brain-training exercises. This link is to an article about physical exercise that helps brain agility, but you could also use exercises like those used in auditory, or aural, rehab, where the brain is trained to recognize words more quickly and accurately. There are formal programs for this, like the online Listening and Communication Enhancement (LACE) programs, but you can also practice simply by listening to a recorded book and then checking the text to see whether you heard accurately.

Making sure you can see the speaker is also essential. Visual clues gleaned from facial expression, body language and the movement of the eyebrows and eyes assist speech comprehension. Formal speech-reading classes teach you to pay attention to these signals, but we all speech-read to some extent. It’s why even hearing people crane their necks to see a speaker, even if they can hear the speaker perfectly well.

This need to see as well as hear has an official name: the McGurk effect, named after one of the British scientists who discovered in the 1970s that we comprehend speech better if what we are hearing matches what we are seeing. The scientists called it “hearing lips and seeing voices.”

To overcome that age-related decline in the ability to understand speech, then, make sure you pay close attention to the speaker. Make sure the speaker pays attention to you, too — meaning he or she should be facing you. Because your actual hearing is normal, there’s no need for a speaker to shout; in fact, shouting distorts the face and makes speech reading even more difficult. So ask them to speak slowly (but not too slowly) and clearly. And keep your eyes on their face.

Another simple solution: Hold conversations in a quiet environment.

 

This article first appeared on AARP Health on 2/05/17

Try this Trick to Hear People at Parties.

Reprinting this from the Journal of the Acoustical Society of America.

It seems worth a try.

 
Try this trick to hear people better at parties

People in noisy situations should face slightly away from the person they’re listening to and turn one ear towards the speech.

A new study concludes that this listening tactic is especially beneficial for cochlear implant users who typically struggle in noisy social settings such as restaurants.

The study also finds it compatible with lip-reading, which was unaffected by a modest, 30-degree head orientation.

“Noise can be a big issue for any listener and especially for someone with a cochlear implant,” says Jacques Grange of Cardiff University’s School of Psychology.

“Our study shows that by simply turning one ear towards the person they are listening to, cochlear implant users find it much easier to hear that person above background noise, enabling them to engage in conversations in noisy environments, and not become isolated.

“It’s better to have a clear signal in one ear than a mediocre signal in both.”

When tested in the laboratory, with the speech in front of the listener and interfering noise behind, the technique resulted in a 4-decibel improvement to intelligibility of speech in a noisy environment for both normal-hearing listeners and cochlear implant users.

A 4-decibel improvement can be the difference between understanding nothing and perfect understanding.

To simulate a realistic restaurant listening situation, acoustic measurements were also taken in the Mezza Luna restaurant in Cardiff and used to create a virtual acoustic simulation.

In the simulation normally hearing listeners were tested at each table with three different head orientations: facing the target talker, with a 30-degree head turn to the left, or with a 30-degree head turn to the right.

The UK charity Action on Hearing Loss funded the work, which appears in the Journal of the Acoustical Society of America.

Venus, Mars, and Hearing Loss

Hearing Loss and Gender Differences
Women acknowledge hearing loss differently than men. — Getty Images

We have long known that men and women talk differently. This includes the way they talk about hearing loss.

A 2015 study found considerable differences. Women were more than twice as likely as men to disclose the loss and offer helpful suggestions about how to talk to them. A woman might say, “I don’t hear well out of my right ear. Please walk on my left side.”

( For more suggestions on how to respond creatively and helpfully about your hearing loss see “How to Talk to Someone with a Hearing Loss.”)

Men tend to simply state that they are hard of hearing, and then offer an explanation about how they lost their hearing. One researcher commenting on the Harvard study suggested that men need to develop an “elevator pitch,” a strategy “that they can comfortably deploy when they need to disclose their hearing loss.”

The study, conducted by Jessica West and Konstantina Stankovic, colleagues at Harvard University and Massachusetts Eye and Ear in Boston, suggests that the women’s approach is far more helpful in successful communication.

The women’s strategy gives “a simple, straight-forward explanation of the hearing loss while highlighting ways in which communication partners can help the person with hearing loss to hear better in the situation,” they said. “It focuses on how to improve the communicative interaction rather than on the hearing loss itself.”

Men are almost twice as likely to have hearing loss as women, especially in the 20 to 69 age group, according to the the National Institute of Communication Disorders (NIDCD).

If men are twice as likely to have hearing loss as women, are they also twice as likely to use hearing aids? There is no really good study of this to date.  But how you respond to your hearing loss, with or without hearing aids, is crucial to successful communication.

There are other gender differences besides speech patterns that may influence communication. Men are less comfortable with sustained eye contact than women, and they are less comfortable showing emotion. These can affect the ability to speech-read, which is a substantial benefit to many with hearing loss.

The writer Gael Hannan has given several workshops on speech reading, including one called “Man-Lips: Men and Speechreading — Facing the Challenge.” She thinks there is a gender difference in speech reading success. Women do it better. Hannan has a hard time even getting men into her courses. She suggests that if you want to run a male-inclusive speech reading course, promote it as a “success strategy” and incorporate lots of gadgets.

What about those studies on hearing aid use? We see a lot of men with hearing aids, which might make you think men are more likely to wear hearing aids. But there are two reasons for that perception (or misperception). The first is that a hearing aid is more visible on a man with short hair or no hair at all. The second is that twice as many men as women have hearing loss.

But the fact is that we simply don’t know the ratio of hearing aid use in men and women. Two reputable studies in the past five years have found two different results.

A large 2011 Swiss study of 4979 adult male and 3410 adult female hearing aid users found that women were more likely to use their hearing aids regularly, and for longer periods during the day than men. The men were more likely to blame their non-use on the limited benefits they got from the hearing aid.

A more recent study of hearing aid use in the United States among older adults found that men said they used their hearing aids at about the same rate that women said they did. But it’s important to remember that this is self-report. We all know the temptation to answer the way you think you should answer. Only about one third of the respondents who could benefit from hearing aids had them.  The Swiss study also relied on self-report but added hearing loss data and hearing aid technical information, which may have affected the results.

The bottom line for understanding speech better: talk more like a woman, behave more like a woman and wear your hearing aids.

 

This article first appeared in a slightly different form on AARP Hearing Health on January 24, 2017

Two New Smart Hearing Aids Win Awards

Bouton: New Hearing Tech for 2017
The ReSound Enzo. Photo: ReSound

The annual Consumer Electronics Show in Las Vegas January 5-8 honored two new hearing aids with awards for innovation.

Both communicate with other smart devices, a technology that already exists in other hearing aids.

But, unusually, these are for those with severe to profound hearing loss, a niche market not often addressed.

Both of these hearing aids, the ReSound Enzo pictured above and the Oticon Opn, won CES innovation awards for their ability to connect to a user’s other smart devices, including phones, tablets and even household devices such as smoke alarms. The Oticon Opn, according to the manufacturer, “can be programmed to talk directly with doorbells, smoke detectors and other smart devices.”

Actually, it’s the other way around: These devices talk to the hearing aid. Your smart doorbell, smoke alarm, lighting, safety equipment and appliances can be programmed to send a signal through your hearing aid to let you know, for example, that someone’s at the door or that the smoke detector has gone off. As Victoria Woollaston wrote in Wired , “Missing vital sounds like smoke alarms can be a matter of life and death.”

Opn also features technology that the manufacturer says can make it easier for wearers to hear in noisy environments. Its proprietary BrainHearing technology boosts the parts of the signal the individual doesn’t hear well, such as soft speech, and reduces other sounds.

The ReSound ENZO, a hearing aid specially designed for people with severe to profound hearing loss, can link with the iPhone to directly stream phone calls, music and navigation into the hearing aid. ReSound has another made-for-iPhone model (the LiNX), as does Starkey (the Halo), but what makes this one special is that it is for those hearing aid wearers with the most severe hearing loss — a traditionally small, overlooked portion of the market.

“Paradoxically, the severely hard-of-hearing consumers who need the latest and greatest sound processing innovations are often the last to get them,” wrote David Copithorne on Hearing Mojo. “It’s frustrating for the customers with severe hearing loss who are among the most passionately engaged and brand-loyal consumers in the hearing aid market.”

 Like the LiNX, the Enzo allows you to preset audio levels for specific environments like restaurants or your office. The hearing aids don’t come cheap, however. Right now the suggested manufacturer’s retail price ranges from about $2,500 for “entry-level” aids to $6,700 for the top-level aids.

Other innovations at CES that could help those who are hard of hearing include wireless noise-canceling earbuds that enhance sound quality better than other existing earbuds. Apple introduced its AirPod ($160) in September along with the iPhone 7. They joined previously released wireless earphone products, including the Bragi Dash, Samsung IconX and Jabra’s Elite Sport.

Airpods are not hearing aids, but they do allow someone with a mild to moderate hearing loss to hear streaming sound more clearly. These “hearables,” which were also a feature at CES 2016, can act as fitness trackers, health monitors and so on. The hope is that they will eventually serve as hearing aid–like devices. As Consumer Reports noted, “We expect to not only see more cord-free earbuds at CES, but models that actually go beyond noise-canceling technology: The next generation of wireless earbuds will actually filter out ambient noise, and function a bit like a hearing aid to help you hear better in noisy environments.”

CES offers a huge collection of some of the most groundbreaking, innovative devices around. Let’s hope more of them can be applied to the needs of the hard of hearing.

 

This column first appeared on AARP Health on January 12, 2017 

Did You Grow Up with Hearing Loss? Lipreading Mom Needs Your Help with “Project Language & Literacy”

This is from Shanna Groves, Lip-Reading Mom.

My first experience with hearing loss occurred in kindergarten. When the teacher asked the class to listen to and respond to questions through headphones, all I heard through them was garbled spe…

Source: Did You Grow Up with Hearing Loss? Lipreading Mom Needs Your Help with “Project Language & Literacy”