KidsAudiologist

Archive for the ‘bone-anchored hearing aid’ Category

Updated 29th December 2018 to include additional references

A recent study looked at 20 years worth of data from emergency departments in the USA about children who had attended following a battery related incident. Whilst incidents were rare at 4.6 hospital visits per 100,000 children in the population that amounted to an average 3289 visits annually. The study looked at four scenarios – swallowing batteries (which accounted for 76.6% of visits), and putting them in the mouth (7.5%), the ear canal (5.7%) and the nose (10.2%). And it was most likely to happen in the under 5’s (mean age 3.9 years). More than 8 out of 10 visits were related to button batteries which are widely used in hearing aids, cochlear implants and other electronic devices. It’s also worth considering that the magnets used in some cochlear implant coils are a similar size and shape to button batteries and could also be a potential hazard. This means that audiologists and parents of young deaf children need to be aware of the risks and ensure children’s equipment is used safely:

  • Make sure young children have childproof battery locks fitted to their hearing aids so that they can’t remove the battery themselves.
  • Try not to let young children see batteries being changed. It is safer if they do not know that the battery compartment opens.
  • Ensure both the used and new batteries are stored safely and out of sight of young children.
  • Keep your used batteries in the original packaging so that you can be sure that no old batteries have gone missing and to keep the batteries safe.
  • Remember that even if you trust your own child not to fiddle with their batteries there may be other children in their school or nursery who don’t understand that they shouldn’t play with them.

Fortunately the majority of battery related injuries aren’t serious and can be easily treated. But occasionally injuries are serious so it is important to follow up any concerns you may have immediately. If you are concerned that your child may have swallowed a battery or put one somewhere they shouldn’t – take them to your nearest A&E department. Take a similar battery and the packaging with you so that the hospital staff can identify the type of battery and know what action they need to take.

References:

Button Batteries Pose Dangers to Children, Advance for Speech-Language Pathologists & Audiologists [Published online December 2011]

George, A.T., & Motiwale, S. Magnet ingestion in children – a potentially sticky issue? The Lancet, Volume 379, Issue 9834, Pages 2341 – 2342, June 2012

Hearing Aids; Information for families, NDCS, January 2012

Sharpe, S.J., Rochette, L.M., & Smith, G.A. Pediatric Battery-Related Emergency Department Visits in the United States, 1990–2009, Pediatrics [Published online May 2012]

UK’s top paediatric doctors warn of devastating impact of button batteries, GOSH Sept 2016

Hearing aid battery compartments need locks, CHI+MED Making medical devices safer, 2016

Keeping children safe from button batteries during the festive season and beyond! PHE Dec 2018

 

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Having recently joined the iPad revolution I’ve been thinking about apps which might be useful in our day-to-day work. Tina Childress is an Educational Audiologist and keeps a very comprehensive list of Apps for Kids (and Adults) with Hearing Loss. Also, the Apps in Education blog includes a good section on So what’s on the iPad for the kid in your class with a Hearing Impairment? and the Earmeter site includes How an iPad can be an incredibly useful tool for hearing aid practices. But here are a few that I’ve downloaded, had a play with and that I think have the potential to be useful tools in counselling children, young adults and families about the ears and hearing:

Auditory Verbal Price – £2.49
This little app uses sound, pictures and text of the 6 Ling sounds. The Ling sounds are a fantastic daily check for parents to do with their child to check their child’s hearing aids are working properly and that they are picking up the frequency range of speech sounds. You could download a free sheet of the Ling sounds with pictures from The Listening Room but some parents / teachers may like the convenience of having it on their iPad for daily checks.

Hearing Aid TicTacToe Price – £5.99
This is a game for 2-4 players aged 4+ years to help kids develop independence in using and understanding their hearing aids – first by matching pictures, then matching pictures with labels, and finally pictures with function. This app is one the the most expensive I’ve ever purchased but I can see that it could be a really useful tool for audiologists and Teachers of the Deaf that can be used over and over with different cohorts of children and at different times as they develop.

Cochlear Baha Support Price – £free
Love this and want to see many more of them for the various products around. It’s basically a manual for your Baha on your iPad, but because it’s on your iPad you have all the information to hand during the day if something goes wrong and you can troubleshoot it easily. There is also advice on travelling, using the telephone and MRI scans and includes helpful videos to follow on cleaning etc. Brilliant, really useful.

Blue Tree Publishing Price – £1.99 each
Have produced a range of iEducate apps which include animations and video which are really useful for demonstrating how the parts of the ears work. I think I would use this one quite a lot and it’s worth the £1.99. Bluetree have also produced a range of Drag & Drop Identification apps. These are basically jigsaws although I found them quite hard to do and think they might be good revision aids for students. There might also be the older child who is very interested in the ear or science more generally who would enjoy the challenge. I wasn’t sure if the content alone and the fact that you’re unlikely to use it very often was enough to justify the £1.99 each as it becomes quite expensive to get the full set. So try with one and see how you go first. Inner Ear, Middle Ear and Labyrinth all available.

Draw MD ENT Price – £free
At it’s most basic this is a lovely tool for showing an older child, teenager and family more about the workings of the ear. It gives some really nice detailed pictures of the ear that you can draw on with your finger to highlight parts as you discuss the anatomy and cause of hearing loss etc with them. At it’s most impressive, you can use your own photos which I’m sure ENT surgeons would find useful for showing patients photographs of their own ears. You can add labels and even email the finished picture to the patient if they want it!

Hearing Loss Simulator Price – £2.49
I think this app has the potential to be a great counselling tool for use with families. There are graphics to show where the common sounds, speech, and individual speech sounds are located for loudness and frequency, and there are lots of options in terms of audiogram configurations. All the recorded voices have an American accent but it is possible to record your own voice for use in simulations.

Play it down Price – £free
Pick a song from your library and crank up the age dial for a feel of what music may sound like in the future. It’s a bit gimmiky but it could be a useful tool in couselling teenagers about the potential effects of noise damage.

Relaxing Sounds of Nature Price £0.69 (lite version free)
Finally, there are masses of nature sound apps out there to choose from. I really like this one as it has a really large range of sounds to choose from, you can mix sounds to your taste, and there’s some beautiful pictures of scenary to accompany the sounds. It also includes a variety of white/pink noise to choose from. I wouldn’t hesitate to recommend this one to my tinnitus patients (and anyone else who wants to relax!)

Families who have a child with a mild, moderate or unilateral deafness frequently report that their child’s needs are poorly understood. This is often because the effect of their hearing loss may be more subtle than for those children with a more severe hearing loss. For example a mainstream teacher will find the child can hear them fine when working one-to-one with the child and not appreciate that the they can’t hear voices from further away and when there is background noise. This means that children have very reduced opportunities to benefit from hearing what is going on around them – incidental learning – and are therefore more likely to show delays in speech, language, educational, & social development than their normally hearing peers. Sadly, due to funding and capacity issues, local specialist support resources are often prioritised towards those children with more severe hearing losses so that training and awareness in schools may be low. Parents understanding and advocating for their child’s needs becomes even more important.
In 2010, NDCS was awarded a 2 year grant from the Department for Education under the SEN and Disability “Improving Outcomes” theme. We have been working with parents and professionals, providing specialist information and support on key barriers to achievement and to specific groups with a significant attainment gap. One strand of this work that I’ve been involved with has been to provide new information resources for parents that are available free to download – ‘Mild deafness’ and ‘Unilateral deafness’. This weekend I was involved in developing our first weekend for families of children who have a mild, moderate or unilateral deafness. All the deaf children were between 3 and 7 years old and they and their siblings appeared to have a great time occupied in the children’s activities sesssions. Parents attended sessions sharing their experiences, and heard from a young adult role model who grew up with moderate hearing loss in both ears. They also attended information sessions on audiology, technology, education, and NDCS events and services. 12 families attended and for 10 of them it was the first time they or their children had ever attended an NDCS event. Many had been told or held the perception that their child wasn’t ‘deaf enough’ to access specialist services, Disability Living Allowance, resources that help children develop listening skills, and even NDCS. A few families had shown an interest in learning sign language to help communication at times when their hearing aids couldn’t be used and to mix with other deaf children, but many had been poorly advised including that it would have a negative impact on their child’s spoken language development. This may have been one dimension of why families often hadn’t persued joining local groups and meeting other families with deaf children. Most of the children had never met another child that uses hearing aids and it was a real joy watching them playing together and making new friends ‘like them’ over the weekend. I believe the parents have all gone away feeling more confident that they understand their child’s needs and will be better able to make informed choices on behalf of and with their child.

So if you have a child with a mild, moderate or unilateral deafness remember that “NDCS uses the word ‘deaf’ to refer to all levels of hearing loss” and that all of our current services and events are open to you.

They’re popping up everywhere and are chosen for their status providing renewable and clean energy – wind farms. Earlier this month I was asked if I could answer a couple of questions about how wind turbines may impact on the hearing, and hearing aid / cochlear implants, of local residents. I have to admit to not really knowing anything about them so I put the question out on Twitter too…

… and although I didn’t get any responses that answered the question I did get some from other users who said they’d be interested in what I found out. So here’s a summary of what I learnt after some research, but I’m still learning so do add any comments with further evidence if you have it.

Q 1. Is there is any research on the implications for deaf people with hearing aids of living near to turbines?

A. No. There is no research, literature or other evidence (that I can find) of any positive or negative impact on hearing aids, cochlear implants or their wearers living near wind turbines. I can find two statements written by members of the public saying that turbines cause problems for hearing aid / cochlear implant users but cannot find any fuller description, case study, or evidence as to why this should be.

and

Q 2. Can you offer a professional opinion about the impact on of the turbine on a young person’s hearing and possible damage?

A. What I have established in relation to wind turbines and the ear/hearing:

  • There is no evidence that the noise generated by wind turbines causes hearing loss, and wind turbines are not loud enough to cause hearing loss.
  • It is known and widely acknowledged that wind turbines generate significant levels of infrasonic acoustic energy (noise that is below the frequency range that the human ear detects as sound).
  • There is some limited lab-based research evidence  (such as this) that suggests infrasonic sound (vibration) may cause some disruption or abnormal stimulation of the inner ear (cochlea and vestibular system) that may form the basis of the symptoms of ‘wind turbine syndrome’. These symptoms include tinnitus, vertigo, disturbed sleep, headaches, memory and concentration deficits, irritability and anger, fatigue and loss of motivation.
  • Wind turbine syndrome is not experienced by the majority of people living near turbines. The data may be difficult to establish as those closest to the turbines (ie those who rent land to the energy companies) are often motivated to be positive about turbines due to financial incentives, and/or gagging clauses in contracts that prevent them saying anything negative about them. But many of the symptoms can also be explained by other factors such as stress and annoyance etc.
  • Planning guidelines in the UK says that turbine noise should not exceed 5 decibels above background, ambient noise. A wind farm produces a noise of about 35-45 decibels at a distance of 350m. Rural night-time background noise typically ranges from 20 to 40 decibels. No indoor levels are specified.
  • Most hearing aid wearers would be able to follow a close one-to-one conversation easily in this level of background noise.
  • In terms of background noise levels and the effect on hearing aid wearers it would be my opinion that if these levels were accurate and maintained, that outdoors the natural noise of the wind would be likely to be more of a hindrance than the turbine noise to the hearing aid or cochlear implant wearer (wind blows over the microphone and is amplified, wind also carries voices away from the listener etc). Indoors it is unlikely that these levels of background noise from outside would be significant or even heard. These background noise levels are certainly a lot lower than the average town or city dweller experiences most of the time.

I have located just one document for audiologists “Wind-Turbine Noise; What Audiologists Should Know” (Audiology Today, Jul/Aug 2010). It includes lots of information on the acoustics, infrasonic vibration levels, and the potential health problems that could be associated with wind turbines (such as tinnitus and vestibular disturbance) but is clear that the levels generated aren’t loud enough to cause noise damage and makes absolutely no mention of problems associated with hearing aids or cochlear implants.

There is probably still much we don’t know about the turbine technology, as well as the potential impact on the technologies on the human body. At the moment audiologists serving populations in areas where there are wind farms should be aware of potential health problems that patients may complain of. But I can find no evidence of any significant negative impact on existing hearing loss or on any hearing aids or cochlear implants that are worn.

Further reading

Wind turbine sound and health NHS Choices, January 2010

Scientist Challenges the Conventional Wisdom That What You Can’t Hear Won’t Hurt You June 2010

Analysis of How Noise Impacts are Considered in the Determination of Wind Farm Planning Applications Hayes McKenzie Partnership, June 2011

Wind myths: Turbines can damage your health February 2012

Hansard – Written Answers (Wind Power), 27th March 2012

Three babies are born every day with a cleft lip and/or palate, and Cleft Lip and Palate Awareness Week is a chance to spread the word and educate about this condition and the great work that the Cleft Lip and Palate Association (CLAPA) do.

Did you know that children born with a cleft palate are very likely to have difficulties with their hearing?

The most common type of hearing loss in children with cleft palate or cleft lip and palate is caused by otitis media with effusion (OME), commonly known as ‘glue ear’. Glue ear is a buildup of sticky fluid in the middle ear. For the ears to work properly the middle ear needs to be kept full of air. The Eustachian tube runs between the middle ear and the back of the nose and throat area and shares many of the muscles of the palate. The Eustachian tube opens regularly during swallowing, yawning and speaking, allowing air to be exchanged. Generally in children this tube is not as vertical and wide as it is in an adult and as a result doesn’t work as well. In children with a cleft palate there are likely to be additional structural abnormalities of the Eustachian tube and the muscles may not work as well. If the Eustachian tube doesn’t open efficiently or becomes blocked, air cannot enter the middle ear. When this happens, the cells lining the middle ear produce fluid. With fluid filling the middle ear, it becomes harder for sound to pass through to the inner ear and these sounds become more muffled.

Glue ear may not cause any problems in hearing or it may cause a mild to moderate deafness (20-60 dB) in the affected ear. For most children without a cleft palate, glue ear is a temporary condition that they grow out of by around 8 years old as their Eustachian tube and other cavities grow larger. However, almost all children with a cleft palate will get glue ear before the age of one and it may persist much longer than for other children. For this reason children should be monitored closely. Depending on the child and degree of deafness caused by the glue ear several options are available.

For further information on the types and causes of hearing loss, and managing any hearing difficulties download the NDCS booklet Cleft palate and deafness; Information for families. (Log in is required but membership is free and takes just a few minutes on-line.)

During the last year the NDCS Youth Advisory Board decided that the most important thing they wanted to improve was Deaf Awareness in schools. To read about the why’s and how’s have a look at one YAB member’s blog, but put simply “who better to tell other young people about the issues facing deaf young people than deaf young people themselves?!”

So for next weeks Deaf Awareness Week (7-13 May 2012) NDCS have launched a new campaign – Look, Smile, Chat to improve understanding of deafness among teenagers and help deaf and hearing teenagers to communicate with each other.

Look, Smile, Chat

Most deaf teenagers go to mainstream school and some of their classmates don’t know how to chat to them. Simple steps can make a big difference – click on the logo above for more information, where you’ll find free lesson plans, posters and films to support the campaign.

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Updated Nov 2018 with further links 

In this blog post Meriah Nicols describes What it’s like to wear waterproof hearing aids!

Analogue hearing aids

There have been a couple of different models of water resistant / waterproof hearing aids available on the market for many years that are suitable for a range of hearing losses. Most children now use digital hearing aids so these wouldn’t be recommended for everyday use but some parents may choose to purchase one for holidays or swimming classes etc. The two manufacturers I am aware of are Starkey who supply the Rion range of hearing aids (tel: 0500 262131 or email sales@starkey.co.uk) and Puretone who supply the Lotos range of hearing aids (tel: 01634 719427 or email webmail@puretone.net).

Digital hearing aids

Water resistant and waterproof digital hearing aids are now also available in the UK.

Siemens were the first to launch a waterproof model known as Aquaris in 2011. The Aquaris is suitable for moderate hearing losses. Unfortunately Siemens (now Sivantos) recently announced that they would be discontinuing the Aquaris range although they would be supporting the current ones for the next 5 years. At the moment NHS audiology services can buy hearing aids outside of the contract if there is a more suitable model available so if parents are interested in this model ask your audiologist for advice on the options locally. They may feel that your child’s current hearing aids are more appropriate for a number of reasons, including if for example they use direct audio input with a radio aid at school (which isn’t available on the Aquaris).

Phonak and Oticon also market a range of hearing aids that they describe as water resistant and suitable for protection from rain, splashes and sweat, but not suitable for immersion – and both manufacturers hearing aids are widely available from the NHS. They meet similar water protection ratings as the Siemens Aquaris above and both Phonak and Oticon say they are suitable for temporary immersion in water but do not go as far as saying they are waterproof. Wearers should follow normal care procedures should their instruments get excessively wet and temporarily stop working.

Are my child’s hearing aids waterproof? (HearingLikeMe.com, May 2018)

Kids can be kids when life gets a little wet! Giving parents confidence when it comes to kids enjoying water activities and keeping their hearing aids on (Phonak Audiology Blog, August 2018)

Buying hearing aids privately

If you’re interested in buying waterproof hearing aids privately in addition to your NHS hearing aids then I would advise speaking to an independent registered hearing aid dispenser rather than a chain who tend to be tied to one particular manufacturer.  Your local audiology department may be able to advise on a local trusted dispenser, download the NDCS publication Hearing Aids; Information for families which includes a section on purchasing hearing aids privately, or contact the NDCS Freephone Helpline who would be happy to provide you with further guidance.

Cochlear Implants

The first cochlear implant that was suitable for submerging in water was the Neptune by Advanced Bionics. Children will need to have  compatible internal parts to be able to use this speech processor so if your child was implanted some time ago ask your audiologist when the Neptune speech processor will be compatible for them.

Cochlear’s FreedomNucleus 5, Nucleus 6, and Advanced Bionic’s Harmony speech processors are all described as water resistant but are not suitable for swimming or bathing in. However the Nucleus 6 can also be used with the Aqua+ accessory making it waterproof.

Cochlearimplantonline.com has a useful brand comparison chart showing lots of details for the Cochlear, Advanced and Med-El devices including water resistance ratings.

This YouTube clip gives advice from other cochlear implant users on ‘waterproofing’ other models of cochlear implant processor and the experiences of a couple of families who have tried this method are blogged about here and here. But word of warning – do take care and consider the risks of being charged to repair/replace your cochlear implant if the NHS believes your negligence caused the damage.

Bone anchored and bone-conduction hearing aids

I am not aware at the time of writing of any water resistant or waterproof options for these types of hearing aid.

Acoustics & swimming pools

Finally, there are lots of situations when waterproof (and therefore sandproof, dustproof and mudproof!) hearing aids and cochlear implants could be really useful for deaf children. However, if one of your concerns are swimming classes then it is worth bearing in mind that the acoustics in swimming pools are often so bad that even with hearing aids or cochlear implants it is impossible to hear a swimming coach or someone on the side calling to you. So additionally, it is worth contacting NDCS who run a project called Me2 aiming to make mainstream leisure activities and sports deaf-friendly. Contact the Me2 team for tips and guidance for swimming coaches to help make life easier for your child during lessons.

Water protection ratings

Oticon Safari (rated IP57) and Phonak Sky Q (IP67) making them waterproof up to 3 feet (1m) for 30 minutes. Oticon Sensei (IP58), and Siemens Aquaris, Phonak Sky V, and Advanced Bionics Neptune and Cochlear Nucleus (when using the Aqua+ accessory) are rated IP68 meaning they can be continuously immersed in water greater than one meter.

If you want more technical detail on how the hearing aids are tested and the standards they are tested to see this Wikipedia entry on IP Codes and watch how the Siemens Aquaris hearing aid was tested on YouTube.

 

 


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