KidsAudiologist

Archive for the ‘noise’ Category

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!)

Advertisements
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

Last updated 24th November 2016

Useful resources for families on the ear, hearing and hearing loss in languages other than written English. If you know of others that are publically available to share please comment below.

Cochlear implants

Communicating with deaf children

Ear infection & glue ear

Hearing aids

Hearing tests

Helping your deaf child to learn

Newborn hearing screening

Parenting & families

  • Positive Parenting DVD with options for spoken English, Polish, Urdu, Sylheti, Punjabi and Somali with English subtitles and British Sign Language
  • Parenting a deaf child parenting tips available in Welsh
  • Who am I? DVD with options for spoken English, Polish, Punjabi and Urdu, with English subtitles and British Sign Language
  • All Together DVD with options for spoken English, Urdu, Sylheti and Punjabi, with English subtitles and British Sign Language
Speech and language development

Vision care

In addition to above the New South Wales Multicultural Health Communication Service in Australia hosts a selection of leaflets in other languages, and the National Institute on Deafness and other Communication Disorders has a large selection of leaflets on hearing, deafness, tinnitus, speech & language development etc in Spanish.

What is Hyperacusis?

Hyperacusis is a term used to describe a general oversensitivity of the hearing so that everyday environmental sounds appear loud, intrusive and sometimes painful to the person affected. Often, children with hyperacusis have normal levels of hearing. A Deafness Research UK study suggests that 6% of children may suffer with oversensitivity to noise although certain groups of children seem to be particularly affected by hyperacusis, for example those with Autism Spectrum Disorder, Williams’ syndrome and Down’s syndrome. Many children with hyperacusis also have tinnitus.

Are there other types of sound intolerance?

Yes. Hyperacusis is used to describe a general oversensitivity of the hearing to all everyday sounds. If dislike or fear is specific to a particular sound, then the term phonophobia is used. Recruitment is used to describe a specific form of reduced sound tolerance in people who have a hearing loss.

What should I do if my child suffers from over-sensitivity to sound?

If your child wears hearing aids then they should be programmed taking into account any recruitment so that sounds are not amplified above the level comfortable for the child. If a baby or young child appears to startle or be upset by loud noises with their hearing aids in the audiologist should adjust the hearing aids to ensure that sound levels are comfortable to wear.

If your child doesn’t wear hearing aids and/or appears to have normal hearing levels then the first thing to do is ask your GP for a referral to an audiologist for a full assessment of their hearing. If the hearing tests are normal then your audiologist or GP can arrange for you to see a paediatrician who specialises in audiology or an audiovestibular physician (doctor who specialises in hearing and balance problems). The best course of action for each child depends exactly on their circumstances and needs. For some children a simple explanation of hyperacusis and knowing that they aren’t alone and lots of people experience it is enough to reassure them. For those childen who are very affected by their hyperacusis (and tinnitus if they have both) then they will be helped by specialist help from a paediatric audiology team with experience of childhood hyperacusis and tinnitus. Following assessment they will use a combination of techniques including an auditory desensitisation programmeTinnitus Retraining Therapy (TRT) and cognitive behavioural therapy.Combined with providing tools to help children self-manage these will give children back some control and reduce the impact of the hyperacusis on their day-to-day life.

Where can I get further information and support?

The British Tinnitus Association (BTA) has some great information on-line and available to download.  There is also a case study ‘When the world is too loud: understanding hyperacusis’ about techniques to help people manage their hyperacusis, and a book review of  Hyperacusis: Mechanisms, Diagnosis and Therapies by David M Baguley and Gerhard Anderson (published by Plural Publishing).

Information on auditory desensitisation and managing hyperacusis in children is available from Deafness Research UK.

The Tinnitus and Hyperacusis Centre (London) provides in-depth information about the biological and auditory processes of hyperacusis.

The Hyperacusis Network is a support network for sufferers of hyperacusis.

UCL run an annual Advanced Audiology Masterclass in Tinnitus and Hyperacusis. The 3 day Masterclass starts with a research update on the current understanding of the mechanisms of tinnitus and hyperacusis. It then addresses the different approaches for the assessment and management of these symptoms in adults, before focusing on paediatric patient management. In 2010 the lectures were recorded and can be watched free here including a presentation of a case study ‘Managing anxiety in a child with hyperacusis’.

This week is Road Safety Week in the UK and so today’s post is inspired by our Benefits Appeals Advisers who support families with Disability Living Allowance tribunals and who are frequently challenged on what difficulties deaf children have and why they require additional supervision near traffic, especially as the majority are using hearing aids or cochlear implants and therefore have ‘corrected’ deafness.

Clearly, deaf teenagers and adults don’t remain a hazard in traffic and develop terrific coping mechanisms such as taking extra care to visually check for vehicles before crossing roads, and perhaps utilising their peripheral vision more effectively than hearing people. But these skills take time to develop so what do families need to know when their children are young?

Firstly are limitations of the hearing technology and what even the best hearing aids or cochlear implants can’t do. Parents often report that their child appears to be startled as if they didn’t notice a lorry or train approaching and this is probably an effect of the limitations of the microphone pick-up range, coupled with a reduced dynamic range. Microphones pick up sound at an optimal distance of just a few feet. This means that any sounds that have come from further away may have ‘bounced’ off other objects on the way (reverberation). This means that sounds can get distorted and makes it very difficult to judge distance or direction the sound is coming from. Hearing aids are programmed so that they amplify sounds within the wearers ‘dynamic range’ (the quietest sound a person can hear and the loudest sound they are comfortable with). However, because the dynamic range for most deaf people is reduced, the speed at which sounds grow from quiet to loud is quicker. Additionally, microphones are often affected by wind noise outside too obscuring what the wearer needs to listen to, but the programming of the hearing aids should prevent uncomfortably loud sounds getting through to the listener (eg lorries passing). Additionally, hearing aids are limited to the frequency ranges of speech and therefore sounds outside those ranges and heard by hearing people aren’t available (think for example about the restrictions on hearing music which has a much wider frequency range than speech). So what hearing and deaf people are hearing are quite different because of the features of the hearing loss and properties of the hearing aid.

Secondly is the limitations of the hearing nerve pathways – after all hearing isn’t all about the ears. It’s also very much about the brain and the clever things it does with the sound it receives and a hearing aid has almost no effect on this aspect. The brain can focus on what we want to hear and filter out alot of unwanted background noise but has a much harder time doing this when the sound input is not as good as normal. This means that the brain is going to have a harder time when sound has come via a hearing aid, the aid has amplified background noise, and the auditory pathways between the ear and brain are not be as developed as they should be due to the hearing loss and poorer input. The brain is also responsible for ‘localisation’ or working out which direction a sound comes from and this is important in judging speed and direction of traffic. To do this well the brain needs to have consistent and equal sound input from both ears and this would be the goal of programming and persuading deaf children to wear their hearing aids all the time. Filtering and localisation are skills which develop as we get older (young children are very bad at it and it normally naturally develops with age, deaf children may never fully develop them). More important reasons why early identification, good quality hearing aid fitting, and consistent hearing aid use are vital to enable deaf children to develop these skills well.

Last time I wrote about protecting young ears from noise. Today I’m going to look at older children and teenagers.

If anyone regularly takes part in noisy leisure activities I would recommended that they use hearing protection. Excessive exposure to loud noise can cause permanent hearing loss. Teenagers won’t fully appreciate the effects of noise on the ears as permanent damage takes time to show up and often not until well into adulthood. However, one of the early signs of possible damage to the ears from noise is tinnitus – or a ringing in the ears. Most teenagers will have experienced this following a gig or night out at a club for example. Excessive noise exposure is based both on the level of sound (in decibels) as well as the length of time you are exposed to it. So it is possible that longer, lower exposure can do as much damage as shorter, high level exposure. Noise does not have to be uncomfortably loud or painful in order to damage the ears. As a very general and crude rule of thumb, if you need to raise your voice over the noise to have a normal conversation then the noise level could potentially harm the hearing and participants should consider using ear protection for that activity.

Common leisure activites that can result in excessive noise exposure include:

  • headphone/earphone use with MP3 players, iPods, computers, games consoles
  • in-car stereo systems
  • night-clubs
  • gigs
  • go-karting and motorsport
  • motorcycles
  • shooting
  • playing musical instruments/bands

Some MP3 players and iPods come with noise-limiting software that prevents the volume being increased above safe levels. If the player doesn’t come with this software it can sometimes be downloaded after purchase. Try to ensure teenagers take regular breaks from using headphones and encourage them to set the volume of the player in quiet surroundings and avoid turning it up in background noise which can increase the total noise level above safe levels. Good quality noise cancelling headphones are available on the market that help to reduce the effects of background noise and therefore enable the volume to be kept lower. If teenagers are hearing aid wearers it is possible to use special adapters that link the player to the hearing aids directly so that they benefit from the personal amplification programming of the hearing aids. For further information about how this is done contact the NDCS Technology Team for further advice.

Advice to teenagers and adults who regularly attend night-clubs is to avoid dancing directly in front of a speaker and to take regular breaks from the dance floor to a quiet area (perhaps 15-20 minutes every hour). Foam ear plugs, available from most high street chemists are also available. Further information written for teenagers about protection form club noise is available from the ‘don’t lose the music’ campaign or follow @safedecks on Twitter.

For teenagers who are starting to play in bands it’s worth knowing that more and more professional musicians are now using specialist hearing protection. Basic earplugs (such as the yellow foam ones from chemists) do reduce the overall volume of noise but tend to be very poor for listening to music since they reduce different frequencies (pitch) by different amounts and therefore distort it. Several manufacturers now make specialist earplugs for musicians. There is a range of earplugs in different styles and attenuation (degree of noise reduction). The cheaper versions are ‘one size fits all’ and usually have less attenuation. Alternatively you could pay more for ‘custom fit’ which are made to fit each person individually and are a popular choice with people who would wear them for longer periods of time such as professional musicians. Custom fit ear plugs are made from an impression taken of the ear. Your local NHS audiology department may be able to do this for you. Alternatively, you could ask a high street hearing aid audiologist for an appointment. (See your local phone book under ‘hearing aid dispenser’ or ‘hearing aid audiologist’). For examples and further information try hearingprotection.co.uk or Puretonemusic.net

Some useful websites and articles:

House Research Institute’s Earbud for teenagers and teachers

Techlicious.com Blog Save your kid’s hearing with these headphones

The ASHA Leader Youth Hearing at Risk Tools for Fun and Learning

The ASHA Leader  Teens at Risk: Audiologists Respond

Hearing Loss Web Music and Hearing Loss

British Tinnitus Association Information for musicians

Control of noise in the context of teachers of music – practical advice and guidance for schools


Twitter Updates

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 42 other followers

Blog Stats

  • 69,537 hits