Hearswell Blog

On Migration

I am going to talk about migration, but not the kind you’re thinking. This is an article about epithelial migration. Particularly epithelial migration in the ear canal. 

An ear canal, averages one inch long and one-third inch in diameter. It flows up and back in a gentle ’S’ curve. The skin on the outer half is pretty much like the rest of the skin on your body. If damaged, it will heal in the usual manner .  Normal skin cells develop in deep tissue and migrate upward,  until they reach the surface, die, and fall off. The term for shedding dead skin cells is desquamation. 

The skin of the inner ear canal is different.  It is more keratin based, similar to your hair and finger nails. This inner half is often referred to as the bony portion of you ear canal because it is surrounded by bone, while the outer half is surrounded by cartilage.   

When this keratin grows, it starts at a basal location and migrates laterally, this is called epithelial migration. The epithelial migration of your inner ear starts at your ear drum. Your ear drum is composed of three layers, and the top layer grows outward radially along your ear canal. This layer is extremely thin like a dragonfly wing and very easily damaged. This is one of the main reasons you should not insert any objects into you ear canal, even Q-tips.

Hair, and fingernails will keep growing until you cut them, the skin of your inner ear canal goes through a desquamation process. The point where the inner bony portion meets the cartilaginous outer section is called the isthmus because your ear canal narrows there. Epithelial migration continues to occur up to the isthmus where it meets the “normal” skin. It then curls inward, and unsupported by the underlying bone, it crumbles away.

Occasionally this process of epithelial migration and desquamation does not function properly, and problems can develop. 

“As it is with all health issues, early detection is the key to better outcomes,” says Dan Rochel of Hearswell in Isanti. The method of viewing into an ear canal for inspection is called otoscopy. “We visually inspect the ear canal at every appointment using a video-otoscope, so our patients can see what we see” says Rochel.

The most benign of these issues is a false eardrum. This occurs when, instead of crumbling away the thin layer of keratin curls to block the ear canal. Oftentimes earwax will build up on this thin layer of skin. This can cause very mild hearing loss, and is easily remedied by the removal of the dead skin layer. 

Keratosis obturans is similar to this condition, but instead of the thin layer curling up, it piles up into a much thicker plug. In addition to hearing loss, this can cause tissue damage and scarring. The remedy can be as simple as removing the plug. If left too long the plug needs to be excised surgically. 

Cholesteatoma is another issue that  occurs deeper in the ear canal. This happens when the desquamation process forms a pocket between the skin and bone. These are dangerous and complications include bone and nerve damage. Cholesteatomas need to be surgically removed and often causes permanent damage to hearing and anatomical structure. 

At Hearswell, ear canal inspections  are part of the standard clinical practice. If you have questions about ear anatomy, or other hearing related issues, Give them a call. 


Wax In … Wax Out

Wax In - The most common subject that any hearing health care worker gets asked about is ear wax.  Usually with a negative connotation. Something along the lines of “yuck…ear wax”.  

First and foremost what we need to realize is; Earwax is good!  Normal amounts of ear wax produce  numerous benefits. There is the obvious one of trapping and preventing small particles from reaching the eardrum. The substance also serves to moisturize and lubricate the sensitive skin of the ear canal. An invisible, yet very important function of ear wax is infection protection. The antimicrobial functions of ear wax are due primarily to the Ph balance, the lipid content and the enzyme lysozyme.

The proper name for ear wax is cerumen (Sir-oo-men). Cerumen is a naturally-produced secretion.  It is made up of a mixture of water-soluble viscous secretions, sebum from sebaceous glands and less viscous secretions from modified apocrine sweat glands. The consistency  varies from light and oily, to thick and sticky, The bulk of it is environmental detritus and shed skin. There is no wax. 

The removal of cerumen should be left to natural processes. The technical name for these mechanics are desquamation, and epithelial migration, which conveniently will also be the subject of a future article. For now, we’ll just say it migrates laterally, dries up, and falls out. Simple.

Wax out - Occasionally though, there is occasion to manually remove the cerumen from your ear canal(s). Some legitimate reasons are for procedures, or observation of the ear canal or ear drum.  The most common though is from a benign condition called cerumen impaction. Simply put, a plugged ear canal. Usually, a person cannot tell that they have cerumen impaction. But there are some physical signs, such as popping or crackling sounds with jaw movement. Infrequently the impaction can cause pain or discomfort.  Cerumen impaction can cause episodic hearing loss.  This can range from barely perceptible to moderate in severity, and is easily remedied by removal of the offending mass.

There are three procedures for removing cerumen. 

1] Curette: which is a small loop or scoop. 

2] Lavage: which simply means rinse out 

3] Otoendoscopy: A tiny vacuum system. 

 Of these three systems, notably absent is the cotton swab, commonly know as the Q-tip. “A cotton swab can be carefully used to about the depth of the cotton on the swab.” says Dan Rochel of Hearswell in Isanti “It cannot remedy impaction, it can only plug your ear up by stuffing wax down further.”

 The only method that should be used on a home remedy basis is the lavage method, often sold in pharmacies.  They consist of a solution that you put into your ear; and a bulb syringe to rinse it out. The most common brand name is Debrox. These should be used only with recommendation of a hearing health care professional, and should never be used if there is a damaged ear drum. The method of viewing into an ear canal for inspection is called otoscopy. “We use a video-otoscope, so our patients can see what we see” says Rochel. At Hearswell, video otoscopy, and cerumen management are part of the standard clinical practice. If you have questions about ear wax, or other hearing related issues, Give them a call.

Protect Your Hearing

In 1981, OSHA implemented new requirements to protect all workers in general industry (e.g. the manufacturing and the service sectors) for employers to implement a Hearing Conservation Program where workers are exposed to a time weighted average noise level of 85 dBA or higher over an 8 hour work shift.

In 1986 RONALD REAGAN, proclaimed the month of May as Better Hearing and Speech Month, and and called upon the people of the United States “to observe this month with appropriate ceremonies and activities.”

With these two actions, the US emphasized the importance of our sense of hearing as a contribution to our quality of life. The public’s awareness of the importance of protecting hearing is working to reduce hearing loss. According to The National Institutes of Health, Among adults aged 20-69, the overall annual prevalence of hearing loss dropped slightly from 16 percent (28.0 million) in the 1999-2004 period to 14 percent (27.7 million) in the 2011–2012 period.4

However, in recent years there has been increasing concern with the popularity of the ubiquitous ear buds. Ear phones themselves will not cause damage, but the ability to isolate sound to ones self tend to lead to an increase in volume.

One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Age-related hearing loss is the most common, but  hearing loss caused by excessive noise exposure is the next most common factor. It is important to understand the effects of noise exposure, particularly because such exposure is avoidable.

Wearing hearing protection is the best way to avoid damage, especially if you must work in an excessively noisy environment. You should also wear them when using power tools, noisy yard equipment, or firearms, or riding a motorcycle or snowmobile. 

People are often concerned about their ability to hear speech, or faulty machinery with hearing protection. However, just as sunglasses help vision in very bright light, so hearing protectors can enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. However, it is essential that persons with impaired hearing wear protectors to prevent further damage to their hearing.

Hearing protection is easy to find and varies in expense from mere pennies for the foam inserts, to $10- $30 for over the ear headsets.  For people who are regularly in noise environments, we recommend custom made ear plugs. These are comfortable than foam inserts, and less cumbersome than muffs.

We at Hearswell care about your hearing, and offer a full line of custom earplugs. Please take care to protect yourself from excessive sound.

Loss Strategies

Hearing Aids don't always work.

While hearing aids are still the front line treatment for hearing loss, there are limitations to their effectiveness. Background noise, listening to people at a distance, telephone, television — these situations present special challenges to nearly all people, but, especially the hearing impaired.

Fortunately, there are many solutions that can help people with diminished hearing that can be used both with and without hearing aids.  

“The very first, and most important thing to do is to get a hearing evaluation. Hearing loss usually varies in the way it presents. In order to help your hearing, you must first know where your hearing needs help.” says Dan Rochel, owner of Hearswell in Isanti.

The volume control is not your only option on television.  Tuning your TV and stereo frequency response can produce more clarity. Most people have hearing loss that is more severe in the higher pitched sounds than in the lower pitches. If this is the case, turn up the treble and turn down the bass.  If you have a TV larger than 13”, made after 1993, you also have text captioning abilities. As of 2014, your remote  will have a special button to turn this ability on and off easily.

Some phones also allow you to adjust the frequency response to match your hearing deficit, which can be very helpful. If not, there are many solutions for telephones available. All phone lines have a surcharge on them called Telecommunications Relay Service or TRS. These dollars go towards different types of phone systems for the hearing impaired and other disabilities. These can range from the from extra loud to text captioning. There is even  a three digit code to connect users up to some of these services: 711. There is no charge to the user. Of course with the increased use of cell phones, 'texting' has become ubiquitous, and has been a fantastic help to people with severe hearing loss. 

In situations where there is background noise, or reverberation, there are also helpful strategies.  In most of these areas, avoid the middle of the room.  This is where reverberation, or echo, is most pronounced, and is usually where there will be the most background noise. Particular room acoustics, and amplifier placement can change this rule of thumb dramatically, so sometimes you have to experiment to find the best location for better hearing. 

“The above tactics can be helpful to anyone who's having trouble hearing in a given situation.” says Rochel, “and with the exception of some forms of TRS service, they do not require special instruments.”

Of course these strategies are also available to people who are lucky enough to have hearing aids. However, the addition of hearing aids into the mix dramatically increases the resources available to the hearing impaired.  For instance, many hearing aids have a mechanism called a tele-coil built into them.  A tele-coil, or t-coil, is a small copper coil used to boost the magnetic signals from the telephone handset. 

Over the last few years, many hearing aids have been designed to connect directly to devices such as TV’s, computers, tablets, and cell phones. Since the sound a hearing aid wearer receives is tuned for their particular hearing loss, this greatly improves the clarity and reduces the background interference for the listener.  Remote microphones are another popular hearing aid. These are used in any instance where a listener is trying to zero in on a particular sound source, such as a spouse in a crowded restaurant, or a teacher in a classroom. These are simply a microphone that can broadcast to a hearing aid for up to 100 feet. The mic can be a small lapel pin, or the listeners own cell phone.

Tele-coils have been available in hearing aids for decades. In many parts of the world, public spaces are “looped”.   This means that the building’s PA system is hooked up to a transmitter that emits a magnetic signal that can be picked up by a hearing aid with a t-coil.  Technically these are called ‘audio induction loops’. Over the last decade or so, these have started to become the international standard.  Here in the USA, they have not caught on as rapidly, mainly because of higher initial cost.  While we Minnesotans are a little behind our neighbors in Wisconsin and Michigan, soon we should be catching up. By statute, new construction of public buildings in MN will include these ‘loops’. Right now, there are many churches and public built-ins that have loops. 

At Hearswell in Isanti, they don’t just sell hearing aids. “We are in the business of helping people hear better, utilizing whatever tactics or technologies we can” said Dan Rochel of Hearswell.  The Minnesota Department of Human Services estimates that up to 14% of the population, or 750,000 people have hearing loss.  If you have questions about what you can do to help yourself or a loved one hear better, call Hearswell.

Selective Hearing

We’ve all heard the old adage, “They only hear what they want to hear.” We make jokes about our friends and family having “selective hearing,” when they aren’t listening or we can’t get their attention, but is selective hearing a real thing? As it turns out, it is. However, it’s not a conscious choice but rather a high level cognitive function called Selective Auditory Attention. 

Selective Auditory Attention is the modern term for a theory first developed by a British cognitive science researcher named Edward Cherry in 1953. He termed it ‘The Cocktail Party Problem’.  It has to do with our ability to lock in on a particular voice amidst many. We all use this ability in varying degrees every day. All sounds consist of a combination of frequency (pitch) and amplitude (loudness). As sound travels from our ears to our brain it goes through an extensive filtering process, mainly in the auditory cortex. Currently it is thought that this filtering process has three main characteristics: segmentation, integration, and segregation. Segmentation sorts sound into priority, integration puts sound ‘in order’, and segregation sorts out the important information from the unimportant, or the signal from the noise as researchers state it.  It’s what allows us to understand our partner in a noisy restaurant. While our skill at doing this filtering varies from person to person, hearing loss, even mild hearing loss, decreases our ability to focus on a particular sound.  We all develop some hearing loss as we age.  As we lose our hearing, the clarity, or resolution of sounds in our environment decrease. Just as a loss in our vision makes sharp detail degrade into vague shapes, even a slight decrease in our hearing affects our ability to parse out sounds. As we lose our hearing, sound becomes ‘blurry’, and our skill at Selective Auditory Attention declines.

Hearing aids can help restore a persons ability to hear in background noise.  First, by reducing the ‘blurriness’ of sound and restoring some of the clarity back into your life. Secondly, modern hearing aids have varying levels of sophisticated background noise processing ability.  These technologies try to mimic the Selective Auditory Attention processes. “In my opinion speech in noise testing should be performed in all hearing evaluations” said Dan Rochel of Hearswell in Isanti.  “In the past decade, most of the R&D in the industry has been aimed at solving background noise issues, and the research has had tremendous impact in this area,” Rochel continued.  At Hearswell,  all hearing evaluations, and hearing instrument assessments are done using industry ‘best practices’. This includes the  speech in noise testing. 

If you’ve found that your hearing is losing it’s edge, or your current hearing specialist does not do Signal in Noise testing, give Hearswell a call to be sure you are getting the most up to date hearing health care.

Real Ear Measurement

How would you feel if you were on a commercial airline flight, wheels up, seatbelt sign off, and the intercom came on: “Good Morning Ladies and Gentleman, this is your captain speaking. Thank you for flying KindaSorta Airlines flight #007 to Pennsylvania.  We are ascending to an altitude of … Oh, I don’t know… really high. At cruising altitude we will be going really, really fast. We are scheduled to arrive in Pennsylvania early this afternoon. Arrival time depends on whether we have a headwind or a tailwind. Relax, and thanks for flying KindaSorta Airlines.” 

If you are like me, you would probably finally give the ‘Flight Safety Procedures’ card a thorough read. 

Sometimes you can get this kind of lackadaisical approach to fitting hearing instruments. According to all the major hearing instrument manufacturers, and all the industry’s professional organizations, hearing aid fittings should be validated using a technique broadly defined as Real Ear Measurement(REM). Sadly, it is estimated that only about 35% of clinicians use REM on a regular basis. 

“Too many hearing aids are fitted to patients using the  manufacturer’s ‘first fit’ algorithm.” said Dan Rochel, owner of Hearswell in Isanti.  These programs use the acoustic properties of a standard measuring tool, called a 2cc coupler. That would be fine if all ears resonated sound just like a 2 cc coupler. But they do not. Studies show that human ear canals very greatly in the way they resonate sound. 

So, the best way to make sure that hearing instruments are performing to their ‘prescription’ is to measure what is actually going on in the patient’s ear.  This is what REM does.  A very sensitive, and finely tuned microphone is attached to a silicone tube about 1mm in diameter (probe tube), and then the tube is placed in the ear canal very close to the eardrum. The patient’s hearing aid is then placed in the ear. A calibrated sound is played.  The probe tube picks up the sound at the eardrum and relays that information to a computer. In this way a practitioner can see exactly what the  patient is receiving from the hearing aid.  “there is no more accurate way to perform, or validate a hearing aid fitting” says Rochel

The equipment used for this procedure can be used on any type of hearing instrument, old or new.  At Hearswell,  all hearing evaluations, and hearing instrument assessments are done using industry ‘best practices’. This includes the latest in REM techniques. Give them a call to be sure you are getting the most up to date hearing health care.

Saved By Bell

100 years ago, Alexander Graham Bell made the first transcontinental phone call.  Though Mr. Bell is famous for the instrument we call the telephone, few people realize that Alexanders primary focus was on amplifying sound to help the hearing impaired. His father, uncle, and brother taught elocution (public speaking) at universities in Europe. As Alexander Graham Bell was growing up, his mother gradually became deaf. These fateful facts had a profound impact on the young genius. One of his first jobs was teaching deaf students visible speech, an amazing system of translating speech into images, which was invented by his father. In his 20's he founded a school teaching deaf people to speak, one of his students was young Helen Keller.  He even fell in love with and married one of his pupils, Mabel Hubbard. She insisted he go by the less formal name Alec, and Alec it was. He even changed his signature.  She was profoundly hearing impaired. He delivered his dying words to her in sign language.

It was Alexander Graham Bell's passion for helping the hearing impaired that led to the invention of the electronic hearing aid. Oh, and also the telephone.

For the next 50 years, hearing aids progressed using Alexander Graham Bell 's patents. They were not very portable, unless you count strapping or hanging a box to oneself. These clumsy units had vacuum tubes, and were fragile and hot. Still, these machines were a miracle for thousands of people who lived in an otherwise quiet world.

Then about 50 years ago the invention of the transistor changed all that. Now hearing aids could be made small enough to be worn at ear level, and had enough fidelity to lend viable aid to even moderate hearing losses.  These instruments could be worn in or on the ear, and had rudimentary adjustments for frequency response.  Along with the advances in electronic sound processing, government level programs were established to research effective amplification prescriptive measures, most notably, Australia's National Acoustic Laboratory and the United States Veterans Administration.  Finally, Hundreds of  thousands of people who would have otherwise  been isolated in social situations could now do well in simple sound environments. Unfortunately, the technology could do little to help people with mild losses, or mild to moderate losses in modestly complex acoustic environments .

About 25 years ago, several important advances followed the invention of the integrated circuit, or microchip.

Hearing aids size and power consumption shrunk, and the instruments went from wearable to nearly comfortable. Sound processing technology allowed sophisticated  frequency response such as multiple channels or tracks for automatic volume control, sound compression, and feedback suppression. But just as importantly, researchers were developing equipment and techniques to better understand how brains process language and sound.  Digital sound processing came into regular use in hearing aids. Further miniaturization of the circuitry now started to produce instruments that could help nearly anyone struggling with hearing loss, from mild frequency specific losses, to the profoundly impaired. 

Expanded research into fitting prescriptions continue to optimize hearing aid fittings for diverse populations. Australia's NAL-2 and Western Ontario University's DSL.v5 are the result of thousands of hours of research into hearing aid 'prescriptions'.  In 1997 the US Department of Veteran Affairs established The National Center for Rehabilitative Auditory Research(NCRAR) which is unique among auditory research facilities because of its focus on the rehabilitation of auditory dysfunction and translation of research findings into practice.

Today, neurologists are beginning to demonstrate how important hearing is to over-all well being. Research continues to show real measurable benefit from hearing aid use. More importantly, our understanding of how our brains process speech and sound is gaining by leaps and bounds. Chips in hearing aids are fast enough to analyze 1200 million operations per second! This is fast enough to enable modern instruments to manipulate sound bilaterally, simultaneously, in closer approximation to how our brains utilize acoustic information. In addition the little machines can automatically recognize speech in noise, and filter out noise BETWEEN syllables. They can connect to phones, TVs and public address systems, some even connect to the internet.

Yet despite the fact that todays hearing aids function at the cutting edge of neurology and technology, and in lieu of the fact that every authoritative body that has studied them, recommends them, hearing aid adaptation rates remain at around 35% of people who could benefit from them.  Alec Bell would be disappointed that the inventions he made to help people hear are going so underutilized. 

Like Alexander Graham Bell, HearSwell is passionate about helping people hear better. They know that folks with hearing loss can lead happier, healthier lives through the use of these little miracle machines. HearSwell wants to help more people learn and experience what modern hearing aids can do. To that end, they put on regular informational seminars. They have also set up no risk, no money down trial periods. If you or a loved one suspect hearing loss, give them a call at 763-444-4051 or visit hearswell.com


Velox Platform

This is a product specific video. I put it up because it emphasis on cognitive process in speech recognition, and one of the more advanced systems for determining cognitive load.

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