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Over-The-Counter Hearing Aids; What Does This Mean for Audiology?

As technology and medical research continue to advance, more facets of your healthcare are becoming increasingly over the counter, whether that be medication, devices, or just medical advice. Treatment for hearing loss is no exception, with over the counter hearing aids becoming an imminent reality, invoking worry in many audiologists across the country. As hearing aids become more accessible over the counter, audiologists fear the impact on their profession and practice. This disruptive innovation is poised to achieve a new market foothold, becoming a more attractive option to new consumers who are looking for the most convenient and simple transition into hearing aids, taking business from traditional hearing aid manufacturers and audiologists who often bundle devices into their services. Though they seem convenient, the introduction of OTC hearing aids shows that despite intentions to increase accessibility and reduce costs, patients are not receiving the treatment they desperately need in exchange for ease.

Don’t Bypass Your Doctors Appointment Just Yet

According to the OTC Hearing Aid Act, the intention was to increase accessibility and affordability of devices, though OTC hearing aids have done little to achieve those goals. In fact, they hinder the ability of patients to get the information and proper assessments that they should have before finding the most effective hearing aid. OTC Hearing Aids utilize a business model designed to bypass diagnostic evaluations, hearing needs assessments, and audiologists all together in favor of self-identifying a device. Not only does this keep patients out of their doctor’s office, but also from receiving the medical advice they may need, ignoring the advocation by organizations such as the American Academy of Audiology for required medical evaluations for OTC hearing aids. Moreover, “receiving an OTC device is expected to be based on self-perceived mild to moderate hearing loss, not measured hearing capability that directly aligns with the definition provided by ASHA.”
 
As hearing loss can differ greatly from patient to patient, it’s critical that patients do not bypass professional medical advice. Herein lies the fear of audiologists, as numerous unofficial polls conducted via social media and trade publications have documented the anxiety had by medical professionals as OTC devices are positioned to impact not only their practice but their profession as a whole.

Changing Public Perception

To combat this imminent and disruptive technology, Audiologists must aim to change public perception about the importance of their profession and medical advice regarding hearing loss. ”The efforts of the profession should be focused not on a device, but rather on educating the public such that they recognize audiologists’ value and demand access to it.” says Dr. Sarah Sydlowski, Audiology Director of the Otolaryngology department at Cleveland Clinic, ”Take every opportunity to reinforce the value audiologists provide. Emphasize the importance of a hearing evaluation before deciding to use any hearing device. Help the public understand that an inappropriate hearing device can be as detrimental as no hearing device.” With proper advocation, audiologists can continue to give the critical information required for patients with hearing loss, ensuring that patients do not give up their doctors for convenience.

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New Guideline Updates On What You Need To Know About Sudden Hearing Loss

As we age, we often conclude that our hearing has gotten worse over time. Age-related hearing loss is an incredibly common result of the natural aging process, and most of us understand that our hearing will depreciate as we get older. But what happens when hearing loss comes on all of a sudden without years of build-up? Sudden Hearing Loss (SHL) can be a terrifying symptom for those suffering unexpectedly. Affecting up to 27 for every 100,000 people and over 66,000 new cases in the US annually, understanding what may cause SHL, what signs to look for, and when to seek treatment can help dramatically improve your quality of life and improve hearing recovery.
For these purposes, The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) have published new updates to their SHL guidelines, hoping new information will make a difference according to Seth R. Schwartz, MD, MPH, the methodologist for this update, “Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and quality of life. That is the overarching objective and purpose of this guideline update.”

What Is Sudden Hearing Loss?

Defined as a “rapid-onset subjective sensation of hearing impairment in one or both ears”, SHL can manifest in three ways: Conductive Hearing Loss (CHL), Sensorineural Hearing Loss (SNHL), or a mixture of both occurring in the same ear. CHL occurs when problems transferring sound waves through the outer ear arise, while SNHL is attributed to damaged cochlear sensory cells. Though Conductive Hearing Loss may be brought on by an abnormality in the ear canal, “eardrum”, or middle ear, both types of hearing loss can be brought on by many causes ranging from neurological disorders or infections, to head trauma or exposure to certain medications.
With many risk factors and variables involved, SHL can be a frightening condition to undertake for many patients with lifelong ramifications. If left untreated, an average of 25 to 30% of patients with SSNHL will achieve some level of spontaneous improvement, although not always back to their normal hearing level. If treatment is sought immediately, recovery rates improve to 50% or even more in some cases.

What Updates Have Been Made?

Knowing the importance of early detection and treatment, updates to the AAO-HNSF’s SHL guidelines were vital. Though the 2012 guidelines were crafted with the most current research at the time, medical science is constantly advancing, opening up room for improvement when it comes to treatment. Improvements such as addressing the need to distinguish SSNHL from CHL in patients who have shown initial signs of hearing loss, as well as clarify the need to identify “rare, nonidiopathic, sensorineural hearing loss” to help separate those patients from others who suffer from Idiopathic Sensorineural Hearing Loss (ISSNHL), a target population that this update addresses. Schwartz hopes that these updates will better suit the medical community when treating SHL, concluding “While the original guideline was a big step, this update provides an opportunity to improve diagnostic accuracy, facilitate prompt intervention, reduce unnecessary tests, and improve hearing and rehabilitative outcomes for patients.”

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Treating Hearing Loss With Inner Ear Drug Delivery

Hearing loss has a tremendous impact on our quality of life. The ability to hear is a vital part of our overall sensory experience and our connection to the world around us. The impact of hearing loss may be profound, with consequences for the social, functional, and psychological well-being of the person. A hearing impairment limits our engagement and affects our self-identity. Because many people with hearing loss neglect treatment due to the options available, a pharmaceutical approach to treatment may be the answer. New research is focusing on the inner ear for effective drug delivery.

Medications

Although there are 466 million people worldwide who have hearing loss, there are no FDA-approved drugs available for preventing and treating inner ear disorders. A lack of clinical experience involving the inner ear creates challenges for the pharmaceutical companies that are developing inner ear medications. With indications such as ototoxicity and Meniere’s disease, these companies are developing therapies such as otoprotection, hair cell regeneration, and gene therapy. Selecting the most appropriate delivery method that will transport the medication is of vital importance.

Delivery Method

Inner ear drug delivery involves three routes of administration: intratympanic, intracochlear, and systemic. Intratympanic uses a syringe injection to the tympanic membrane to deliver a drug across the middle ear and into the cochlea. This route is beneficial for administering drug solutions, drug suspensions, and injectable gels. Intracochlear is the transfer of the drug into the cochlea. Although this method is precise, it is also high-risk. An injection, a perfusion system, or a cochlear implant device are the delivery methods for this route. Systemic delivery is the favored route for future delivery as it poses a low risk for complications and is more comfortable for patients. Research is focusing on finding new systemic administration methods for ear therapy.

Advancements

There is progress in the improvement of inner ear drug delivery systems. Drug targeting, gene and stem cell therapy, and hair cell regeneration are making effective inner ear drug delivery a reality. Collaboration is vital for translating lab bench results into viable treatment options. Researchers feel confident that partnership will overcome the challenges of administering therapy directly to the inner ear.

Challenges

There are obstacles to be cleared in the development of efficient inner ear drug delivery systems. The main problem is not knowing the exact drug formulation for the intended drug delivery system. Another issue is the conversion of clinical findings that utilized animal models to applications for humans. What works in a rat may not be successful in a human. For systemic drug delivery, achieving a therapeutic dose in the inner ear after crossing the blood-labyrinth barrier without side-effects is the goal.

The Future

Inner ear therapies will encourage patients to seek care for their hearing loss. As an alternative to a hearing device, drugs provide a long-lasting, convenient, and efficient treatment option. The research team hopes that inner ear drug delivery systems will lay the groundwork for effective prevention and treatment with medications.

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Communicating Better With People Who Have Hearing Loss

You might believe that hearing aids are enough for communicating with people with hearing loss. Although hearing aids are beneficial in many circumstances, sometimes they are not enough. When talking, remember that a conversation involves two people: a speaker who sends the message, and a listener who receives the message. So, as a member of this communication pair, it is essential to communicate your message clearly to those with hearing loss. Here are a few approaches to help you do it better.

Get Their Attention

Try to gain a listener’s attention before you begin speaking. You might say the person’s name, or gently touch their arm or shoulder to gain their attention. These actions will allow the listener with hearing loss to prepare, so they do not miss the first part of your conversation.

Eye Contact

Please face the person with hearing loss and make eye contact. It is your facial expressions and body language that provide critical information to the message you are delivering. It is easy to see excitement, joy, confusion, and frustration on a person’s face.

Keep Hands Away From Face

When you are speaking, try to keep your hands away from your face. Doing this will allow you to deliver a more explicit speech while allowing your listener to pick up on visual clues by watching your mouth and face. Remember that speechreading depends on a listener being able to see your face, which improves their perception of the message.

Use Natural Speech

Try to keep your speech distinct, but do not exaggerate. There is no need for shouting, as it will only distort the message. Avoid mumbling and speak at a reasonable rate. Use pauses instead of slow speech, which will give the listener time to process your speech. Try to provide clues when you are changing subjects or state that you are changing topics.

Rephrase Instead Of Repeating

If your message is not clear, repeat it one time. If your listener is still having difficulty understanding what you are saying, try to rephrase your message differently. Make use of different words that have the same meaning. You may also ask your listener what part of the message they did not understand and repeat only that phrase or word.

Avoid Background Noise

Please try to reduce environmental noise as much as possible when communicating. Turn off the radio and television and move to a quiet place. When going out to a restaurant, request a table away from the kitchen, server station, or large groups of people.

Lighting

Good lighting on your face is essential for a person who is speechreading. When you are at a social gathering, sit where the light is good, and your face is visible. Poor lighting causes shadows on your face, and intense lighting from behind may cause difficulty from the bright light.

Consider An App For Translation

Several apps are now available that will allow you to speak into a smartphone and have your words appear on the screen for the person with hearing loss to read. Texting is another useful tool for communication.