Author Archives: Greg Lawrence

Hearing protection shields your ears from experiencing too much loud sound and is valuable in minimising your risk of noise-induced hearing loss. Although we often think of hearing protection as earmuffs worn around heavy machinery or on building sites – the truth is there are various types of hearing protection which can prevent accumulation of damage to our ears, caused by exposure to any type of loud sound.

Last week, HEARsmart released a independent review of filtered earplugs in a campaign called: What Plug? They worked on closely with Choice Magazine to review over 20 filtered earplugs, with a particular interest in those designed for listening to music. HEARsmart is our sister organisation that works to promote hearing health and prevent noise-induced tinnitus and hearing loss.

Filtered earplugs are a step up from foam earplugs and are much better for preserving the quality of the sound, while dropping the volume to a safer level. The HEARsmart team tested the earplugs across a range of different features both in the lab and the real world. During tests, it became very clear that earplug choice is personal – what suits one person won’t suit everyone, for example, ear canals come in different shapes and sizes, noise-reduction needs vary, some people want to stand out while others prefer to be discreet. What Plug? Is a searchable website that provides accurate, unbiased information about earplugs and their features from noise reduction and cost – through to appearance, sound quality, comfort and ease of conversation. Maybe it can help you choose your next pair of earplugs…

What Plug? Is a searchable website that provides accurate, unbiased information about earplugs and their features from noise reduction and cost – through to appearance, sound quality, comfort and ease of conversation. Maybe it can help you choose your next pair of earplugs…

To coincide with the launch of Hearing Awareness Week 2017, our public outreach arm, HEARsmart, has co-created a health promotion video about tinnitus with support from Australian Hearing, Uni Melb Audiology Clinic and Musicians 4 Hearing.

Typically, people with tinnitus report hearing buzzing or ringing sounds, even though the sound isn’t actually present in the world around them. This may not sound so severe, but over time can have a significant impact on the mental health and wellbeing of those who experience it. In addition, tinnitus can be an important early indicator of more serious hearing damage.

The video is targeted towards musicians (did you know musicians are 4x more likely to develop tinnitus?) and those in the music industry. So if you have a couple of minutes, skip over to HEARsmart and see what you think; and if it gets you  thinking about what sort of earplugs would be a good fit for you, keep in touch via HEARsmart socials Facebook, Twitter, and Instagram. We’ll keep you up to date with the launch of our independent review of filtered ‘plugs that is coming soon – it should help you work out which ones are right for you.

We often think of HEARsmart as a younger sibling to HEARnet Online. HEARsmart is the other public outreach arm of the HEARing Cooperative Research Centre (CRC), created to promote hearing health and prevent noise-induced tinnitus and hearing loss. HEARsmart is a little different however because its main focus is on young people, 18-35; but just like us it is independent and born from research.

You can watch the full video below.

Music has the power to motivate, move and inspire. From Mozart’s graceful melodies to Bob Marley’s breezy reggae beats, its emotive qualities enhance our health and wellbeing. But can music heal mental and physical suffering or help people with hearing loss listen better?

A growing body of research suggests it can. According to studies mentioned in an article on the Harvard Medical School website, music has been shown to:

• improve our experience of invasive medical procedures
• restore lost speech in people recovering from a stroke or traumatic brain injury
• reduce the unpleasant side-effects of cancer therapy
• aid pain relief – ranging from acute to chronic pain
• improve the quality of life for dementia patients.

This has led to an increased interest and participation in music therapy.

What is music therapy?

Music therapy uses music to trigger emotional responses to relax or stimulate people or to help them communicate or heal. It is usually facilitated by registered music therapists who are often accomplished musicians.

Research has shown it has positive effects on people with autism, stroke complications, dementia, depression and painful health problems. People involved in musical activities also appear to preserve speech listening skills better than others. Activities can involve singing, dancing, playing instruments, composing and creating.

To hear conversations well in loud, busy places, it helps if you identify sound sources. Socially, it’s also important to understand the emotional state of the speaker, which is conveyed by pitch, tone and rhythm –also known as prosody. All these nuances contribute to hearing and understanding speech well in social spaces and gatherings. Combining auditory rehabilitation, cognitive training and music therapy can help a person with hearing loss achieve this goal.

Evidence music therapy boosts hearing 

The relationship between music therapy and hearing loss is less well known. But a study by HEARing CRC Member Chi Yhun Lo (pictured right) , at Macquarie University’s Department of Linguistics (Sydney), has made some fascinating findings.

“We wanted to see if music training benefits not just musical skills but also speech perception and social participation,” explains Chi, an audio engineer. His passion for music grew from working with the children’s band, the Hooley Dooleys.

Chi launched a free, 12-week music therapy program for children with hearing loss with Nordoff-Robbins Music Therapy Australia, a not-for-profit organisation based at Western Sydney University. Seventeen children wearing hearing aids or cochlear implants, aged between six and nine years old, attended the sessions at Macquarie University’s speech and hearing clinic.

Chi’s sessions involve weekly, face-to-face group music therapy sessions, homework with musical apps three times a week and test sessions tracking the children’s reactions to music and their speech perception abilities. “After 12 weeks of music training, the children’s speech-in-noise perception was improved by more than two decibels and their emotional prosody improved by more than 10 per cent,” explains Chi.

This resonates with a recent Canadian study of six to 15-year-olds that supports the relationship between instrumental music training and improved speech prosody perception. It recommends using music training to support auditory rehabilitation after receiving cochlear implants.

In earlier research, Chi discovered that adults with cochlear implants – who had once had normal hearing – were able to improve their ability to identify questions or statements after learning basic musical skills.

“I was looking at whether people could improve prosody, specifically being able to distinguish between questions and statements – where a question will have a rising intonation and a statement sounds flat or falls a bit,” explains Chi.

Parents involved in the children’s program are singing its praises for the way it builds confidence, creativity, identity and listening skills. And the children clearly light up in classes.

“I open the door to the clinic and the kids wave to me and run straight to the music room,” says Chi. “We try to leverage emotion and joy because when kids enjoy something they just learn it better,” he says.

Music as medicine

James with his beloved clarinet.

Music therapy struck a positive chord with deaf schoolboy James Barker whose hearing issues improved after taking part in weekly sessions at Macquarie University’s speech and hearing clinic.

James, eight, became profoundly deaf with sensorineural hearing loss after contracting pneumococcal meningitis at the age of eight months. He wears cochlear implants and attends a mainstream Catholic primary school where he is well supported. Using a microphone and sound technology he is able to boost his hearing skills in the classroom.

His mum heard about the music classes on the Aussie Deaf Kids Facebook page and applied after James and his twin brother Thomas recently took up learning instruments. “The twins had started in the school choir and were learning the clarinet (James) and the trumpet (Thomas) so the timing couldn’t have been better,” says his mum Grainne.

She adds the benefits of the program, a Macquarie University study, have been three-fold. They have boosted James’ confidence, his ability to identify certain tunes and hear what people are saying in noisy situations.

“He really enjoyed being in a music class with other hearing impaired children,” says Grainne. “I definitely think that James’ speech perception has improved. He’s saying, ‘Pardon?’ and, ‘Could you repeat that please?’ much less often.

“He is quicker to pick out tunes on the radio and has more melody to his voice. The progress that he has made in just three months is very impressive,” she says.

Dr Tomlin working with Eliza in the clinic.

Hearing well is not all about having healthy ears or wearing hearing aids. As the saying goes, “We hear with our ears but we listen with our brains.” When the connection between ears and brain is damaged, it becomes difficult to hear sounds and conversations. You might be unable to understand speech at a noisy gathering or struggle to multi-task such as preparing a meal while listening to a conversation. In these cases, our in-built auditory processing system can fail to work properly.

What is Central Auditory Processing Disorder and do you have it?

“Auditory processing is different to hearing,” explains Dr Dani Tomlin, researcher and clinical audiologist at the University of Melbourne. “It’s how we interpret sounds and translate them into something meaningful. It’s how we localise sounds and amplify one over another,” says Dr Tomlin.

Here are the most common behavioural characteristics of CAPD.

Difficulty understanding speech:

• when lots of people are talking
• in busy, distracting and noisy places
• in reverberant environments (eg. cafes with hard surfaces)
• when rapidly presented
• when sentences contain words with similar sounds
• if you are multi-tasking while trying to listen

Auditory processing issues can happen with or without hearing loss but they often occur together, particularly in older adults. Researchers, including those at the HEARing CRC and The University of Melbourne, have identified practical ways to help people with CAPD improve listening capabilities. However, there are many things we still do not understand about this complex disorder.

What we do know is up to one in 10 Australian children are believed to be affected by Central Auditory Processing Disorder (CAPD). Many ageing adults acquire it as their auditory and central nervous system connections lose function and efficiency. Research also shows declines in working memory and attention as we age making it harder to hear and understand speech.

Children with recurrent ear infections or those exposed to nicotine (cigarettes) are also more likely to have auditory processing problems. But interestingly, both children and adults involved in musical activities appear to preserve speech listening skills better than others.

Dr Tomlin explains babies are usually born with the ability to hear but their auditory processing skills continue to develop into teenage years. So if ear infections block sound in childhood, the part of the brain involved in auditory processing seems to remain dormant or underdeveloped. “Children develop listening skills up until adolescence,” says Dr Tomlin. “Just as these skills develop in the early years, they are also declining as we get older. What’s not well understood is why, as we age, people find it harder to listen in noise. In particular, people with dementia do very poorly at listening in noise,” she says.

It is difficult to estimate how many older people are affected by CAPD because it can be hard to recognise. For example, its symptoms mimic other health issues such as hearing loss, attention deficit hyperactivity disorder (ADHD), autism, dementia, multiple sclerosis and brain injury. However, there are a range of tests (including auditory and cognitive tests) that can be done to identify it.

Increasing numbers of people seem to be affected by CAPD due to changes in our listening environment. “We have a harder world to listen in now. There are noisy classrooms and more adults are working in open plan offices and struggling to hear,” says Dr Tomlin. It means people have to make more effort to listen during conversation.

Unfortunately, increased listening effort leads to fatigue, meaning many people with CAPD can end up avoiding social interaction and become isolated and lonely. Research has shown that the less we use auditory pathways, the more we lose the ability to hear well. There may also be a link with this social isolation and higher chances of developing dementia. So how can this be prevented?

What can make you hear better? Other than hearing aids…

Technology has come a long way in providing hearing aids that assist people with CAPD. Many have in-built functionality to help the wearer understand what direction sound or speech is coming from and tune out distracting background noise. But there are many practical, simple things people can do to improve listening skills.

HEARing CRC PhD student Julie Beadle (pictured right), of the MARCS Institute, Western Sydney University, is hoping to develop a new listening test. It aims to improve current test methods by including visual and aural noise distractions to emulate real life conversations.

Her award-winning research reveals older adults find it harder than youngsters to understand speech in noisy situations but both groups are able to hear better if they see the speaker’s face. By removing visual distractions, such as people talking in the background and clearly presenting the speaker’s face, older people understand up to 50 per cent more than with visual and auditory noise.

“This is called the visual speech advantage,” explains Beadle. “Older adults can get just as much of a  visual speech advantage as younger adults. So it’s really important to look at a person’s face when they are talking. It’s where you get the extra information you need to process speech,” she says.

People with untreated severe hearing loss are five times more likely to develop a form of dementia.

Hearing Loss and Alzheimer type Dementia

Research has shown a strong link between hearing loss and Alzheimer type dementia and other dementias. People with severe hearing loss are five times more likely to develop a form of dementia. Even those with mild hearing loss have double the chance of acquiring the condition than people with normal hearing.

One study led by Dr Frank Lin, Professor of Geriatric Medicine at Johns Hopkins University in the US, shows auditory impairment is associated with a 30-40 per cent rate of accelerated cognitive decline. His team is now trying to identify if better treatment of hearing loss could reduce dementia rates.

The relationship between hearing loss and dementia is shrouded in complexity. For example, dementia is not a disease but a presentation of symptoms that occur when the brain stops working properly. Also, many people wrongly view ‘dementia’ as ‘Alzheimer’s disease’. In reality, there are more than 100 diseases that are linked to dementia.

Alzheimer’s disease is the most common cause accounting for up to 70 per cent of people with dementia. Some forms of Alzheimer’s and frontotemporal dementia (which usually affects behaviour before memory) can be genetic. But most dementias are not inherited.

It is important to note that typical hearing loss does not cause Alzheimer’s disease and not everyone with hearing loss will develop a dementia. Also, people can show Alzheimer symptoms but have dietary, hormone deficiencies, cognitive difficulties or depression. In these cases, the symptoms may be reversible.

The most common dementias – Alzheimer’s and cerebrovascular disease (damage to the brain’s blood supply) – have no cure. The disease progression varies but people usually live four to eight years after an Alzheimer diagnosis but can survive 20 more years. So improving communication between doctors and audiologists and finding better ways to support and test people for hearing loss and dementia is becoming increasingly urgent.

Can hearing aids help prevent the onset of Alzheimer type dementia?

Part of the problem is that hearing loss and dementia have many similar symptoms. But Emma Scanlan, Principal Audiologist at Australian Hearing, explains patients can do a lot to improve quality of life – starting with early diagnosis, a good support network and the use of hearing aids.

“Dementia can be overestimated or misdiagnosed due to hearing loss,” says Scanlan. “I was seeing a lady in a closed dementia unit in an aged care facility who was considered to have a very significant level of dementia – but actually she had a severe hearing loss which had never been diagnosed or treated,” says Scanlan. “Once she had a hearing aid, she was able to move out of the unit,” she explains.

So what can be done to identify and assist those at risk? Consulting a doctor and an audiologist is the obvious first move. But more research is needed to analyse the overlap between the two conditions. Wearing hearing aids – earlier rather than later – can help.

Dr Anil Lalwani and his team, at Columbia University Medical Center in the US, published a study in the American Journal of Geriatric Psychiatry last year. “Our study suggests that using hearing aids may offer a simple, yet important way to prevent or slow the development of dementia by keeping adults with hearing loss engaged in conversation and communication,” explains Dr Lalwani.

This is supported by a study on cochlear implantees with cognitive decline who were found to have improved mental ability a year after surgery (although they also received auditory rehabilitation which may have influenced this result).

Here, we look at the many positive actions that can be taken to stave off cognitive decline and the research that is paving the way to the better diagnosis of both conditions.

How to help loved ones with hearing loss and dementia

Having a supportive family is critical in improving communication and wellbeing for people with hearing loss and dementia.

Maintaining empathy and composure, ensuring you are facing the person when talking to them in a well-lit area and speaking up can make a big difference, says Scanlan. Greg Savage, Professor of Clinical Neuropsychology at Macquarie University, says research backs up the importance of familial support. “We have found that when a family member is helping in cuing, the overall performance is much better than when a partner is not helping in that way,” explains Professor Savage.

If a relative suspects hearing loss or the early signs of dementia, suggesting a hearing test is a sensitive way of addressing the topic. “Sometimes a hearing test can be a good first step to make, rather than admitting you think someone is developing dementia because they are becoming forgetful,” says Scanlan. She adds that feeling cross or frustrated with the person will only increase their fear of social interaction.

Encouraging a healthy, low fat, low sugar diet is also sensible as diabetes has been linked to hearing loss and Alzheimer’s disease, and high blood pressure and raised cholesterol increase the risks of vascular dementia. But having ways that allow for early diagnosis and intervention are key to improving outcomes.

“Most people wait seven to 10 years before they do anything about it. During that time psychological and social impacts of hearing loss can be far-reaching,” says Scanlan. “One thing we do know is that it’s not so much the hearing loss itself but hearing loss that hasn’t had any intervention that seems to cause the most impact on the affected individuals, their partners and families,” she says.