Healthy Hearing Expo 2018 Transcripts

DR. ERIN WRIGHT: 

Good morning, everybody.  Welcome to our ninth annual healthy hearing Expo.  We're very glad that you could all join us and excited to be able to put this on as an event in community to provide a bit of education to people around the often‑complex condition of hearing loss. 

My name's Erin Wright.  I don't know if I introduced myself already, but I'm one of four and coming up five audiologists that work at our hearing clinic and I just wanted to start by just mentioning that we are doing some free hearing screenings today as well.  If anybody is interested in a free screening, it's in this little quiet room next door called the Sooke room.  There is a woman named Zan, who is signing people up, so if anyone is interested in having the hearing screening, you can see any of us in the burgundy scarves and we'll direct you to Zan and get you signed up for a hearing test.

I would also like to thank Oticon Hearing.  Oticon is providing the captioning services for the talks today.  As you can see, we have a realtime captioner there in the corner, who's doing a fantastic job at keeping up with the speed of how quickly I'm talking.  The captioning, we've done this every year and it's wonderful because at the end they give us transcripts of the talks that we can put up on our website for anybody who wants to kind of review what the talks were about, if you forget.  They'll be up on our website in about a month. 

So the first talk today is by Alison Love.  Alison is one of the audiologists that works in our Broadmead Hearing Clinic, and Alison is going to be talking today about the effects of hearing loss on the body.  So welcome, Alison.   (Applause)

 

To view Alison's Talk please click here: 'The Effects of Hearing Loss on the Body

 

 

 

DR. ERIN WRIGHT: 

Good morning, everyone.  Thank you for coming to our ninth annual healthy hearing Expo.  My name is Erin Wright.  I'm one of the audiologists, one of five audiologists, at Broadmead and Oak Bay Hearing Clinic and we're proud to sponsor this community event so people can gather a little bit of information, learn a little bit about topics like tinnitus and hearing loss, speak directly to the actual hearing‑aid manufacturer reps, collect a bit of information.  So thank you guys for taking this opportunity.

I'd like to just start also by thanking Oticon.  Oticon sponsored the realtime captioner for the event and so we have this wonderful captioner in the corner who's so speedy, she can keep up with my speedy talking.  At the end they give us the transcripts for the talk and we put them on our website, so if you forget something, you can go back on the website and read through the transcripts of each talk.

So the next talk is being done by Dr. Lia Best.  So Lia is one of the audiologists who works in the Broadmead Hearing Clinic location.  She's been there for five years and she has researched this topic ‑‑ or this talk in collaboration with one of the audiologists that works for Widex Canada.  So Widex has a patented particular method of managing tinnitus that Lia is going to be talking about today.  So welcome, Lia.  (Applause)

 

DR. LIA BEST - 'Utilizing Widex Zen Therapy to Effectively Manage Tinnitus: 

Hi, everybody, welcome.  I first of all want to make sure this mic is positioned okay.  Everyone at the back can hear me okay?  Good, got a thumbs‑up.

Welcome.  Many of you are here because you either have tinnitus yourself or know somebody who has tinnitus or you're not sure what tinnitus is and you thought you'd come and learn a bit more about it, but hopefully you'll be able to take some valuable information away today. 

So we'll just do a brief intro about tinnitus, but I'm sure many of you do know a little bit about it already.  And we'll talk mainly about a certain type of tinnitus management called Widex Zen Therapy. 

So just briefly, what is tinnitus?  Well, tinnitus is a perception of sound that cannot be attributed to an external source.  It's often described as ringing, humming, buzzing, or roaring noises.  Could also be music.  And it's really important to note that it's involuntary, it's not something that we have conscious control over.  It can vary in volume and pitch, it can be intermittent or constant, but the point is it's coming from somewhere in the head. 

The typical causes of tinnitus are hearing loss and noise exposure and we also know that those are connected because noise exposure can also cause hearing loss.  70 to 85 per cent of people with hearing loss will report having some tinnitus and there are other kinds of conditions that can cause hearing loss other than noise exposure, such as age‑related changes in the ear and conditions like Meniere's disease or maybe a viral attack of the ear.  But it can also be associated with head injury, thyroid problems, muscle tension in the head and neck, certain medications and high blood pressure, and sometimes I put stress on this slide, but it's important to consider stress not as a cause, but as something that might exacerbate or make tinnitus worse from time to time.  And we'll talk a little bit more about that. 

So many of you are here because you are experiencing hearing loss or know somebody that is.  The most common form of hearing loss is something we call sensorineural hearing loss and this is either ‑‑ for example could be age‑related or maybe noise‑induced hearing loss, and in this case there's usually some sort of damage to the outer and possibly the inner hair cells.  So you can see in this picture healthy hair cells on one side, the damaged hair cells on the other side.

So one theory is that tinnitus might be the results of these damaged hair cells sort of misfiring, because you can see they're not gone, they're still there, but they just don't look as good as they should.  They're not standing upright, they're a little bit bent and some are, you know, missing. 

What they think might be happening is there's an increase in neural activity along the auditory nerve as a result of these misfirings of the hair cells.  But this is probably not the whole story because even people that have a severed auditory nerve, so maybe no function of the auditory nerve, are still dealing with tinnitus and it might feel like it's coming from that ear.  So the bigger answer to this, or the other theory is that it's more likely to be abnormal neural activity coming from the brain in the auditory part of your brain. 

So the current most popular theory about why somebody might have tinnitus if they also have hearing loss is that the tinnitus is sort of a reaction from the brain to the lack of sound caused by the hearing loss.  So deprivation of sound sort of triggers a hyperactivity of neural activity in the brain.  The brain is searching for sound input that it's not getting and this increased activity is interpreted ed by the brain as sound, which we call tinnitus.  And we hear a lot about neuroplasticity now and how it's a good thing, but neuroplasticity is sort of taking place in this case and it's not necessarily a good thing, because what's happening is we're getting a change in neural activity and it changes the balance between the excitation and inhibition neurons in the brain and this kind of abnormal activity is being perceived as a sound. 

That's the most technical we'll get, so if anyone has questions about that, they can ask me later.

I like to think of tinnitus as more of a spectrum problem.  On one end of the spectrum, you'll have people that report having tinnitus that's not really bothering them.  They'd obviously rather not have it, but they're functioning just fine and they report they sort of tune it out.

On the other end of the spectrum you have people who are severely impacted by it.  It's affecting sleep, concentration, it's making them irritable, and they have a really hard time coping with it.  It might affect their job and overall quality of life.  And we find that about .5 to one per cent of the population are severely affected by their tinnitus.  There's a majority of people that are on the end of the spectrum where they're sort of habituating and able to tune it out and a small percentage that's not happening.  What we say is these people are having difficulty habituating to their tinnitus.

So what is habituation?  Habituation is something we do all the time.  It's the process of ignoring or being accustomed to a stimulus without conscious effort.  So you think about getting a new refrigerator and at first you think, "Wow, this refrigerator is humming a lot, it's really annoying," but after a few days, you don't notice it any more.  That's habituation.  Our brain has decided that's not an important sound and it doesn't need to focus on it and soon after that, you don't really notice it any more.

Another habituation is maybe the watch on your wrist.  Maybe you first got a watch the first time, you probably felt it all day and kept looking at it.  After that, you don't really notice that feeling of the watch until someone like me reminds you that it's there.

So those are all forms of habituation and our brains are very efficient, we don't want to be bombarded with stimuli all the time.  That would be really hard to function.  So that's ‑‑ that's what habituation is and that's what we're trying to do with tinnitus for people that are having a hard time tuning it out.

Now, it's important to not confuse habituation with ignoring.  When someone comes to us saying that they have tinnitus, we never say, "Oh, you just have to ignore it," because obviously that's not very helpful.  And ignoring sort of implies some sort of conscious will or ability to tune it out and if it was that easy, wouldn't everyone have been able to do that? 

So we're very careful not to say that it's ignoring or that it's something that you have to consciously be thinking about.  The more you consciously think about your tinnitus or about tuning out your tinnitus, the more you actually become aware of it.  So habituation is actually an automatic process.  It's something that we want to engage and activate, but not think about too much.  That's why it requires some help, some what we call therapy. 

I have an example about this habituation where I grew up in a small town by the ocean and there was a train that would go by at all hours of the day and when I was younger, I never noticed this train, but when my cousins came to visit, they'd say, "That train is so loud.  How come you can sleep through that?"  And now, when I go back and visit my parents, because I don't live there any more, I think, "Holy cow!  That train is so loud!"  But I ‑‑ living there, I never noticed it. 

So that's another way of thinking about habituation is it's unconscious, we don't consciously think about it, and that is something that is achievable when it comes to treating or managing tinnitus. 

So why is it that some people have a harder time habituating to their tinnitus?  Well, there is a very real phenomenon that's happening.  What is happening is it's called our fight or flight response.  So when a new stimuli is around us, our brain will quickly analyze whether it's something threatening or non‑threatening and for whatever reason, the brain might have triggered to analyze tinnitus as something negative or something that's potentially threatening, because at this point in time, we don't know if it's going to harm us, we don't know if it's going to get worse, we don't know if it means there's something really seriously wrong, and so the amygdala, which is the emotional ‑‑ kind of automatic emotional control centre of the brain, attaches some negative reaction to that tinnitus and it gets labelled as something negative.  And then the body reacts with a fight or flight response, because if there's something threatening in the environment, you want to know where it is at all times.  You want to be paying attention to it, you want to focus on it and you don't want to let it out of your sight, and that's something that our brain is doing sort of unconsciously all the time. 

It's important to remember this is a primitive and adaptive process that we don't have control over and it's actually good that our bodies do this, because it's what keeps us alive.  It's what keeps us from eating a weird bug on a table that we don't know anything about.  We want to make sure that we have all the information and we know if this is threatening or not threatening.

So typical fight or flight responses are muscle tension, high blood pressure, high heart rate, quick breathing, slowing down digestion and then ultimately fatigue, because that's very exhausting.

The emotional response to an overactive fight or flight response is frustration, anger, irritation, stress, sleep problems, anxiety, despair, worry and depression. 

If you think of a time where you might be driving a car and you almost get in a car accident, but you don't, that first few minutes after that, right away, your heart rate increases and you feel your heart pounding and your palms get sweaty and you sometimes, depending on how bad it is, feel like you just have to pull over because that was so rattling.  That quick reactive response is your fight or flight response and that's a very hard state of mind or state of body to be in for a sustained period of time.  That requires a lot of energy and that's not really sustainable. 

So with tinnitus, the difference between tinnitus and a car accident, or a near‑car accident, is that it's one incident and then it goes away and then your body can recover and then you might feel a bit shaky the rest of the day, but the next day you're fine, whereas with tinnitus the threat doesn't go away like that, it's constant for a lot of people and it's there as a constant reminder of this potentially negative, threatening situation.

So your brain, your body, can't maintain the extreme fight or flight response, but it can maintain a moderate fight or flight response which is going to maybe affect your sleep and concentration.  You might find yourself a bit more irritable, have difficulty focusing on things, it might affect your job.  So these are all symptoms of somebody that's maybe in a more mild or moderate form of fight or flight all the time and that is still very fatiguing. 

So what happens with tinnitus and stress is that your auditory cortex is focusing on the tinnitus.  It's making it stand out above all the other sounds because it's important, it's something we have to keep an eye on.  And this hypervigilance to the tinnitus will sort of trigger a stress response in the brain.  It releases certain hormones that only come out when you're under stress, which therefore increase your stress level, which therefore increase your perception of your tinnitus and then retriggers the more negative or emotional reaction to it.

So we show it in the form of a circle here because it is kind what have we call a cycle of distress where one thing triggers the next and so on.  And we want to try to stop this. 

So to summarize the reason somebody might have trouble habituating is that the brain is purposely giving the tinnitus priority and that's not something that they have conscious control over, it just happened one day.  And now the tinnitus is interfering with concentration, it's interfering with sleep, it's being perceived as louder and then we're more aware of it and this all kind of reinforces a negative tinnitus reaction.

So when we talk about what can we do for tinnitus, one of the common questions people ask me is, "Well, is there a cure?  What can I do?  What can I take?"  And because it's not ‑‑ as we've seen, it's not one specific part of the body that's affected and it's not one specific cause that's causing this tinnitus or this reaction, there is nothing.  There is no drug you can take that will make this go away.  They are working on that, they are looking into ways to try to manage this in more of a pharmaceutical or more of a medical approach, but right now the most important thing we find as audiologists is to look at the emotional reaction and the stress component.

So we talk about it in terms of tinnitus management.  So tinnitus management teaches people how to have some control over their tinnitus.  It helps manage some of the negative reactions and the thoughts occurring in response to the tinnitus and our goal is not get rid of it, but our goal is to have habituation. 

So this is done through four components and this is not necessarily unique to Widex, but this is something that at our clinic, we kind of always think about these four tiers and whether somebody can benefit from all four of them or maybe just one or two of them, but the first one is education and counselling.  That is what I'm doing right now, providing information about tinnitus and about some of the ways we can help improve it:

Hearing‑aids to treat the hearing loss, if it's present;

Sound stimulation, which we'll talk about;

And stress reduction, which we just talked about, is a pretty big component here.

So there are several types of tinnitus management programmes.  Some of these you may have heard of, but there's tinnitus retraining therapy, neuromonic (phon.), progressive tinnitus management and various sound options.  The one I'll be focusing on today is called Widex Zen therapy.

So Widex Zen therapy was developed by Dr. Robert Sweetow in collaboration with Widex, which is a hearing‑aid manufacturer.  It's clinically proven to help manage the effects of tinnitus and promote relaxation and reduce stress.  It provides systematic guidelines for audiologists and patients.  It's based upon years of experience with a certain type of music called Widex Zen.  Widex Zen therapy uses this music as the main part of its tool for managing tinnitus.  It's unique in that they have done many studies to show its effectiveness and this kind of zen therapy is only found in this particular manufacturer's products.

So just recently, in June 2017, they came out with a more up‑to‑date version.  It also has an app that works with it.  So if anyone has a smartphone or tablet can actually right now, even, it's free, download the Widex Zen therapy app.

This app is meant to be used in conjunction with working with an audiologist, but you can still kind of use it right now if you want, and you can learn a bit more about it at the Widex booth out in the lobby, there. 

So Widex Zen therapy directly addresses the problem that can contribute to the distress caused by tinnitus patients that are on the extreme end of having difficulty with it.  So it addresses the hearing loss, it addresses the excessive stress response, the sleep deprivation and unhelpful thoughts and behaviours. 

And it's using these in a holistic approach, so they actually recommend incorporating all four of these but in varying degrees, depending on how much stress that person might be under.  So these four ways of dealing with it are counselling, amplification, fractal tones, which are their zen music, and relaxation. 

And why is this unique to other ‑‑ compared to other management approaches that are out there?  The one reason that it's unique is that there is all four of these developed into one plan, whereas some of the other manufacturers have maybe components of this, but maybe not all four of them, and it also addresses the three dimensions of the tinnitus distress component, which is the auditory part, the attention part and the emotional part.

So we'll talk first about the counselling piece, and not everybody needs in‑depth counselling around their tinnitus, but just information about why they might be experiencing it and that there are some treatments available can sometimes ease some of the worry and the fear around why they have it.

So we believe that knowledge is power.  Having accurate information about your hearing loss and about your tinnitus and ensuring that we've sort of medically ruled out any other potential causes for it is important in relieving some of the unknowns and some of the stress.  And counselling helps reduce worry and just knowing that there's help available is important. 

Sometimes we have to do a bit more in‑depth counselling and we use ‑‑ with Widex Zen therapy, they use elements of cognitive behavioral therapy.  So there's something called cognitive behavioral intervention which helps a client deal with some of the negative reactions or what we call thought errors around their tinnitus.  So ‑‑ and sort of challenge the validity of those thoughts and maybe replace them with alternative and logical thoughts and behaviours. 

So for example an event might be that somebody was invited to go to a social gathering and their first thought is, "Well, I can't go.  My tinnitus will get worse," and the feeling that's a result of that thought is sort of hopelessness, despair and frustration.  And that can lead to somebody maybe having a negative thought like, "My life used to be perfect before I had tinnitus and now it's horrible."  And the thought error here is that this is sort of all‑or‑nothing thinking and maybe another way to help someone reframe this is maybe, "Life is never perfect and I had some problems before and I still have some good things about my life now, like my grandchildren."

This is a very simple example, but this is a way to kind of help somebody work through some of the more distressing or more negative thought processes as a result of their tinnitus and this is something we can help with. 

Now, the second component is the amplification piece and obviously this won't make sense if somebody has tinnitus but no hearing loss, but for so many people, they also have hearing loss and that's why it's a very important piece of this framework. 

So we want to try to correct for the hearing loss as soon as we recognize that somebody is dealing with a deficit, and by doing this, we can restore some of that neural activity in the brain.  We can give the brain the sound that it's missing, the sound that it was searching for, and we can do this through something called sound enrichment, which is bringing in some of the sounds of the environment that somebody should benefit from hearing and maybe that, in itself, might help tune out the tinnitus, because they're hearing more of the environmental sounds that are actually there.

And 66.6 per cent of people report that hearing‑aids relieve their tinnitus most to all of the time. 

I like to think of an analogy where you might be in a dark room with one candle and you think of that one candle as your tinnitus and if you walk in that dark room, that's all you see is that one candle, that tinnitus, but if you were to put a hundred candles in that room or flip on the lights, you no longer are aware of that one single candle, that one tinnitus.  There's other things to look at, there's a brightness in the room that you will not notice that any more, and that's a way that amplification works to help blend in tinnitus into the background. 

So the part that's really unique to Widex is the fractal tones, which they call zen.  It's a unique sound programme that is patented and only available in the Widex hearing‑aids.  The hearing‑aids are generally pretty discreet and inconspicuous and they provide acoustic stimulation as well as relaxation.

So they've done several studies to look at the zen tones and we'll talk about that in a moment, but one of the thoughts that comes up at this phase is sort of why would we add more sound?  If somebody is dealing with tinnitus, why would we throw in a bit more noise for them?  And there's a few reasons for that, but the main thing is that amplifying environmental sounds might not be enough to support somebody dealing with really significant tinnitus and sound therapy gives you some control over it because you can choose the volume, you can choose the type of sound, you can turn it on and off and just having a bit of control over some of these background sounds translates to that control that you might feel you're lacking from having tinnitus. 

And choosing a sound that is more positive or even just emotionally neutral can have a big difference in sort of reshaping that negative reaction to the tinnitus, turning something that is quite negative into something that's more positive. 

So fractal ‑‑ fractal zen tones are unique in that they are fractal tones, which means they are non‑repetitive, they are familiar, but they never repeat themselves and they're not predictable, and this is important because the brain is really good at tuning out something that is kind of predictable and boring, and so if it's always a little bit interesting, your brain is always a little bit interested in how these tones are changing. 

It's important that they are soft in the background and that they have a relatively slow tempo and there's no vocals.  There's no voices you have to hear. 

I'll just play a couple of examples of some of the more popular choices, but there actually are five different types of sounds. 

 

(Playing the fractal tones).

 

Okay.  I don't know how to turn it off (laughter).  There we go.  Okay.  So this is an example of the audiologist's computer programme.  So they can take a look at these different kinds of zen chimes and maybe alter the tempo and the pitch and the volume from ear to ear and we'd have the choice of maybe turning the hearing‑aid microphones on to also amplify ambient sounds or turn the microphones off if that's what we want to do.

So the point is it can be customizable to the individual and no two people are the same and no two people are experiencing this the same, so we really want to figure out what would be important to you and what can we do to make this more manageable? 

And the goal is to sort of set it so they're in the background, so you're not distracted by them when you're trying to have a conversation with somebody and theoretically you should be able to turn them off or on if you need to.

They are meant to sort of support you when you don't have other auditory distractions around, but you'll notice, even for that brief snippet, they are quite relaxing, they kind of have a slow tempo that matches sort of a resting heart rate, so even sometimes I'll listen to it when I am doing a bit of work, or preparing for this talk, I had them on in the background, because I felt that was quite relaxing to listen to.

So speaking of relaxation, this is the fourth component to Widex Zen therapy.  Stress, we know, can make tinnitus worse and reducing stress is really essential to this component.  Now, we can't avoid stress.  Stress is going to happen and it's going to exacerbate our tinnitus, but finding ways that you can manage the stress, and whatever that means for you, or whatever you can do, is worthwhile to investigate, but in the Widex Zen therapy protocol, they recommend doing deep breathing exercises, progressive muscle relaxation, guided imagery and sleep management strategies, and all of these can be found on their app, but they're also things that if you don't have a smartphone or don't have a tablet, I can still ‑‑ or we can still give you information on how to go about doing that.

And I think it's important whenever we're recommending a particular way of treating something that it's evidence‑based, that we are recommending something that we have found, you know, people have studied it, they've looked at it or we have patient reports saying that it's helped them.  So as audiologists, we're always integrating both of those things, so information from the manufacturer, information from research that's being done and then also patient feedback, I think, is one of the most important things of what's working and what's not working. 

But here are some studies that have been done to look at this Widex Zen therapy and specifically the zen chimes.  Sweetow and Henderson‑Sabes ... white noise on tinnitus annoyance, the tinnitus handicap inventory, which is a questionnaire that rates how distressing it might be and relaxation, and they looked at 14 adults with hearing loss.  They found that 13 out of 14 rated their tinnitus as less annoying and 86 per cent of them found it was easier to relax when using the zen tones. 

And then a similar study found similar results.  They had clinicians that were experienced with tinnitus treatment.  They were asked to apply the treatment to hearing‑impaired subjects with tinnitus and measure the pre‑ and post‑treatment with the tinnitus reaction questionnaire, and a hundred per cent of the 49 respondents indicated a reduction in tinnitus distress.  But what I thought was most interesting is that the subjects that had the most severe tinnitus distress prior to treatment had the most beneficial effect. 

And then finally, a study by ... and colleagues found when they assessed effectiveness of zen tones on 48 tinnitus subjects with a range of tinnitus handicapping distress, the results showed a clinically significant reduction on the TRQ questionnaire on 90 per cent of the subjects and there was also, similar to the previous one, a greater trend for people that were having more distress to benefit more.

The ten per cent of people that didn't show any significant reduction also ended up having a really low score prior to treatment, so it wasn't distressing them as much as some of the other people. 

So when they did all these studies, they realized that zen tones can be effective for tinnitus management and that's kind of what inspired them to include them in the Widex Zen therapy. 

And so just to recap, the Widex Zen therapy uses four elements in one programme:  Counselling, amplification, fractal tones, which we call zen, and relaxation, and the goal is that we want to make tinnitus an irrelevant sound.  We want to try to induce habituation automatically.  And this helps reduce the negative thinking and improve quality of life. 

It's important to know that this isn't the only tinnitus management treatment that we do at the clinic.  We do elements of this and we pull from other areas as well, but this is one that is a bit newer and it's something that we're definitely paying a bit more attention to lately. 

And the important thing about managing your tinnitus is if you know that it's impacting your quality of life, it's important to schedule a comprehensive hearing test.  That's the number one most important thing to do.  From there we can figure out if there's any underlying medical issue or if it is hearing loss that might be attributing to your tinnitus.  So having an audiologist or somebody that can do a very thorough examination is probably the first thing you'd want to do and then you can be referred on to further medical investigation if needed. 

And an experienced hearing‑care professional that's trained in tinnitus management can really help you with this and the point is that there is something that can be done and that tinnitus management really does work. 

Thank you.  (Applause)

 

FROM THE AUDIENCE:  How do you know whose tinnitus is more severe? 

DR. LIA BEST:  Okay.  Good, yes.  I'm going to repeat some of the questions, but if anyone wants to duck out, they can.  The question was how do we know if someone's tinnitus is more severe?  And that's a great question.  So usually what we do when somebody comes in, if we know they're dealing with tinnitus, because that might be the main reason they phone, they'll say, "I have tinnitus," so we label it in the calendar so we know this person coming in has tinnitus.

And very first thing we often do is have you do a questionnaire called the tinnitus functional inventory or the tinnitus handicap inventory, there's two of them, and they just help us get a sense of how ‑‑ how much the tinnitus is impacting you in various aspects of your life.  So is it affecting sleep?  Is it affecting your social life?  Is it affecting your hearing?  And so there's little subcategories and we do that questionnaire to get a total score and we get some sub‑scores in the different areas to get a sense of how much it's distressing.

But generally speaking, people will tell you how much it's affecting them the minute they walk in.

FROM THE AUDIENCE:  Right. 

FROM THE AUDIENCE:  I have two questions for you, please.

DR. LIA BEST:  Okay.

FROM THE AUDIENCE:  One is you speak about a lot of research that's going on.  Where is the funding for the research coming, government versus industry? 

DR. LIA BEST:  So the question is where is the funding coming for the research, is it government versus industry?  I would say probably both, but I would say industry has a pretty heavy influence on some of the research because most of the products are coming from hearing‑aid manufacturers.

FROM THE AUDIENCE:  Yes. 

DR. LIA BEST:  But the government is very interested in this kind of research, so I guess they'd be the second most common.

FROM THE AUDIENCE:  The second question is if you note an increase in tinnitus, have you found out whether it's habitual or physical? 

DR. LIA BEST:  Okay.  If you note an increase in tinnitus, have we found out whether it's habitual or physical?  As in is it something the person's doing or something that is changing in their body; is that what you mean? 

FROM THE AUDIENCE:  Yes.

DR. LIA BEST:  Okay.  Well, I think it can depend on the person.  So we know that stress can sometimes aggravate somebody's tinnitus and make it seem louder.  Noise exposure can spike up tinnitus.  There's a lot of environmental factors that can make it louder, but also if somebody is dealing with a decline in hearing, that can also seem to make their tinnitus louder.  Or if somebody has something called Meniere's disease, which is characterized by sort of fluctuating hearing loss, when their hearing loss is down, their tinnitus is often up and then it kind of changes. 

So I'd say both would be the answer to that question. 

FROM THE AUDIENCE:  Would some of the funding in that regard, in this particular subject, come from insurance companies? 

DR. LIA BEST:  So the question is would some of the funding for that kind of research come from insurance companies?  I don't know the answer to that.  Yeah. 

FROM THE AUDIENCE:  What does ...

DR. LIA BEST:  What does zen therapy involve?

FROM THE AUDIENCE:  Yeah.

DR. LIA BEST:  All four of those components, so the counselling, amplification, the introducing the zen tones through the hearing‑aids and relaxation.  So usually we cover all of that in sort of the first appointment and then as the follow‑up visits go on, we introduce more layers to that protocol.  And it's unique to the person, so we wouldn't just throw it all at somebody if they weren't dealing with the hearing loss piece or if they weren't ‑‑ with the distress for their tinnitus, they may not need the counselling piece, but they may benefit from the sound therapy.  So it's sort of customizable.  Okay, go ahead.

FROM THE AUDIENCE:  Okay.  Two parts to the question:  Number one, if it is only within the Widex hearing‑aids, I mean my tinnitus is most noticeable at night when my hearing‑aids are out.

DR. LIA BEST:  Right.

FROM THE AUDIENCE:  So you take your hearing‑aids out at night, right? 

DR. LIA BEST:  So that is a good question.  So if this therapy is only built into the hearing‑aid, but at night you take the hearing‑aids out, you're kind of lost without it.  That's ‑‑ that's one of the reasons they came out with the app is that through the app, they can still play the sounds in more of an ambient way.  You can play it through a Bluetooth speaker or headphones that you sleep with or even just from the device itself on a low level.  But that's ‑‑ that's one way of kind of bridging the gap between taking them out and then going to sleep, because it does affect sleep quite a bit for a lot of people.

FROM THE AUDIENCE:  So if you get the app, download it into your iPad, for example, you really would just use that at night.

DR. LIA BEST:  Yes, generally.  Or just have a bit more options, because the ones that we programme in, there's only a few of them, but with the app, there's a whole range of different sounds, and the nice thing I like about the app, and it's a tool that ‑‑ excuse me, it's a tool that I use almost daily with people that have tinnitus, is that it's free.  You don't have to have Widex hearing‑aids to use the app and there's a lot of really good information on there, good counselling information, good research and good relaxation strategies.  I have it on my phone.  I don't have tinnitus, but I still throw on some of those sounds for relaxation and I do the deep breathing relaxation before I go to bed, so ‑‑ yeah.  You're welcome.  Roger? 

FROM THE AUDIENCE:  Yeah, you mentioned that ‑‑

FROM THE AUDIENCE:  What's the name of the app?

DR. LIA BEST:  It's called the Widex Zen Therapy app.  Sorry, go ahead.

FROM THE AUDIENCE:  You mentioned that tinnitus can take several forms.  You also mentioned it can sound like music?  So if you get a song stuck in your head for three or four days at a time non‑stop, is this an example of tinnitus? 

DR. LIA BEST:  That's a good question.  He's asking if you get a song stuck in your head for two or three days at a time, is that a form of tinnitus?  And I would say probably not, but I have had a few clients say they have the same piece of a ‑‑ like maybe they're a musician and it's the same piece of this composition over and over and over with no break from it.

FROM THE AUDIENCE:  Yeah.

DR. LIA BEST:  That I think would be.  If you feel like you can't tune it out with other kinds of things, or if you don't have any relief from it, I think that would be probably a form of tinnitus.  Yeah.  Yeah?  Go ahead.

FROM THE AUDIENCE:  You mentioned in one of the slides that there's actually a disappearance of some of the ear hairs when they've been damaged.  What happens to them?  Where do they go? 

DR. LIA BEST:  So what happens to those hair cells?  Well, they kind of degrade, so they're actually ‑‑ they're highly metabolic cells.  We call them hair cells, but they're not hair at all, so if they are being damaged and they lose the nutrients they need to stand upright, they eventually wither away and they actually degrade or disappear.  Yeah.  I don't know where they go exactly, but they probably just get absorbed by the rest of the ear.  Yeah.  Yeah? 

FROM THE AUDIENCE:  Something that I didn't mention when I had a consult with you:  Has anyone experimented with either behavioral or cognitive therapy, trying to let you learn to love your tinnitus? 

DR. LIA BEST:  Yeah.  So (laughter) that's a great question.

FROM THE AUDIENCE:  It seems reasonable.

DR. LIA BEST:  He's just asking if there's been any kind of therapy, instead of trying to ignore it or trying to change it, but to maybe learn to love it, and I would say yes.  So there is a form of ‑‑ you might have heard of mindfulness as a kind of a way of counselling or a way of being present or being, you know, accepting of a difficult situation, and there is a programme geared towards tinnitus called mindfulness‑based stress reduction and it's kind of along those lines.  It's, "Well, we can't get rid of this, so how can we make the best out of this situation?"  And it's about sort of being present and being okay and maybe positively looking at it, and I think there's a lot of validity to that and a lot of people that are really finding it effective.

So we did a talk, actually ‑‑ if you go on our website, I think not last year, but the year before, we did a talk on mindfulness‑based tinnitus reduction.  So that is ‑‑ you will find some resources on the website, but if you even just Google that, you'll probably see a few people that are talking about that and doing that and it's something we recommend when people come in, too.  Yes, in the back, there? 

FROM THE AUDIENCE:  I believe your tinnitus ...  tinnitus being activated with changing weather or ‑‑

DR. LIA BEST:  The question was has anyone reported that their tinnitus has been affected by changes in weather or air pressure?

I've had people say that.  I don't know exactly the mechanism of that, because I think there's so many different potential underlying reasons somebody might have tinnitus, but yeah, I think that I've had that case before and with Meniere's disease, we had some people report that, you know, changes in pressure, seemed to affect them with their hearing, so it makes sense.

FROM THE AUDIENCE:  And air travel, too? 

DR. LIA BEST:  Yeah, with air travel.  Mm‑hmm.

FROM THE AUDIENCE:  Is music ear syndrome the same as tinnitus?

DR. LIA BEST:  Music ear syndrome? 

FROM THE AUDIENCE:  Yeah.  When you hear "Silent Night" all the time.

DR. LIA BEST:  That was similar to a question that was just asked about if you have a song stuck in your head.  I can answer the question.  And we can talk about that, too.  We've talked about that in clinic, too.

DR. ERIN WRIGHT:  Okay, thank you very much, Lia.  If anybody has any other questions for Lia, she is going to duck out that side door and you can go over there.  We're going to have the next talk by Gael (applause).

 

(BREAK)

 

DR. ERIN WRIGHT: 

I'm glad to see this turnout for Gael's talk today.  Before I introduce Gael, I just want to tell you guys about the captioning services.  So we have something called realtime captioning and it's sponsored by Oticon Hearing and we have this wonderful captioner in the corner who's keeping up with the speed of how everyone talks, how fast we all talk, and she gives us the transcripts at the end that we are able to put up on our website, so if you want to review any of the talks, you can go in to our website and read the transcripts.

My name is Dr. Erin Wright.  I am an audiologist and owner of Oak Bay and Broadmead Hearing Clinics.

FROM THE AUDIENCE:  Yay! 

DR. ERIN WRIGHT:  I have a fan!  And we're very, very happy and proud to be able to put on this healthy hearing expo to provide a little bit of education to the community about options around hearing‑aids and managing hearing loss.

So this year, for the first year, we have author, humourist, public speaker, Gael Hannan.  Gael has done talks in the audiology conference circuit for a long time and she's recently written this book called The Way I Hear It.  We have some of these books at our Broadmead clinic.  She also has them for sale if you are interested.  She's brought some books today to do ‑‑ to sell at the talk here if anybody's interested. 

So I'd like to welcome Gael.  Thank you.  (Applause)

GAEL HANNON: 

Thank you, Erin.  I always like to give a smile to the captioner before I start.  Kelly has captioned for me many times and she usually has to have a shot of chocolate before we start (laughter).  Or if it's in the evening, a shot of whiskey.  I think today it's chocolate.

So I'm really delighted to be here.  Hearing loss changes lives.  First of all I want to ask, can you all understand me?  Can you hear me at the back?  Can anyone not hear me?  (Laughter)  You know what?  You're the first audience that has ever laughed at that.  I think it's hilarious, but no one's ever laughed.  Okay, great crowd.  Hearing loss changes lives because ‑‑ I know it changes lives because if I didn't have hearing loss, I'd be married to a completely different guy, my son would look completely different, and I know this because at least one other fellow in my past wanted something permanent with me.  I'm just not sure I heard them correctly (laughter). So those romances fizzled, you know? 

Do you remember ‑‑ how many of you have hearing loss?  How many of you are here with someone who has hearing loss?  Some people are putting up both hands (laughter).  And how many of you are here because you have nothing else to do on a Tuesday afternoon in Victoria? 

So do you remember, those of you with hearing loss, that moment or the series of moments when you realized that you had hearing loss or that you were hard of hearing, as some of us call it?  Yeah.  Now, the acronym for hard of hearing is HOH.  Ladies and gentleman, I am a Ho (phon.)  (Laughter).  How life‑changing is that?  Hmm? 

So why did these romances fizzle?  It's because I ‑‑ well, do you know what bluffing is?  Bluffing is when you pretend that you understand what's being said and you haven't got a clue.  Eh?  Now, bluffing can be seriously life‑changing.  You know, we try and try to keep up, but because we can't understand or can't hear or haven't told we have hearing loss, we fall farther and farther behind, so we resort to a few tactics to make it look like we're understanding. 

One of them is the HOH nod.  (Laughter) The other one is the Mona Lisa smile.  I don't know if you can see me from the back, but I'm doing this little Mona Lisa smile.  And the other one is that ‑‑ well, we have little interjections that we use to help make people think we're understanding:  "Really!  Oh?  Hmm."  And what we also do is we copy other people.  If you're in a group situation, you're not following, but you see that other people are laughing, we laugh, too!  If they look serious, we look serious.  So we're always copying.  They stand up, we stand up.  We keep copying.

The other thing we need to know, those of us who have hearing loss, if we think that our family and friends don't realize that we have hearing loss or that we're not following, think again.  There's all sorts of things that we do that give it away to the people who know us really well.

One of them is our eyebrows go up.  Can you see that in the back?  The eyebrow raise.  Or this, what I call the upward jab of the chin, where we go ‑‑ these are things we do when we're trying to understand, or we put our neck closer and closer and closer.  Now, I call this the turtleneck.  So you're doing this.  I'm going to do it from a side view, so you get a better idea (laughter).  You may not realize that you're doing that, but you are. 

Now, I want to share two stories with you, true stories, a yes story and a no story, and this is how bluffing changed my life.  First of all the no story:

So a few years ago, in the Dark Ages, when I was in my 20s, when I was living in Vancouver, and I was going out with a nice fellow and I can't remember his name, so I'll just call him "This Nice Fellow".

So This Nice Fellow and I go out one evening, we'd been going out for a while, and we were going for a walk along the beach, English Bay.  Now, if you have hearing loss, you understand the problems in going for a walk along the beach at night.  First of all, it's dark and we can't read lips.  Secondly, we're walking in the same direction, which makes it difficult to read lips.  And thirdly, the waves are rolling in and waves are at the speech frequency.  So it was challenging. 

And This Nice Fellow said something and I'm not sure what he said, so it sounded like a yes‑or‑no answer, so I picked one (laughter), 50/50 I was going to get right, so I said, "No".  And by the look on the nice fellow's face, you could tell ‑‑ I could tell that it was the wrong answer. 

Now, the me now would have said, "Oh, I'm sorry, Nice Fellow, I didn't catch what you said.  Would you mind repeating yourself?"  But not me, not then.  I repeated, emphatically, "No!"  End of relationship.  Never saw that nice fellow again.  And to this day, I have no idea what he asked me, but I can guess.  He probably said something like, "I really like you, Gael.  Do you like me?"  "No."  (Laughter) "We've been going out for a while now, Gael, do you want to keep going out?"  "No".

Fast forward whole bunch of years and another nice fellow whose name I know, his name is Doug, and Doug and I were ‑‑ had been together a long time, we were actually living together, and one morning I woke up ‑‑ now, if you're like me, when you wake up in the morning, you haven't got your hearing‑aid in or your contact lenses, we're kind of vulnerable, so ‑‑ but I opened my eyes and he was on a pillow next to me, he was facing me and this is what I saw (demonstrating).  I'm not saying anything. 

So I said, probably very loudly, because I didn't have my hearing‑aids in, "Doug, I think I just saw your lips say, 'Let's get married.'  Did your lips just say, 'Let's get married,' Doug?"  And he went, so I said (mouthing with no vocal).

Well, I really love my husband.  If I hadn't been bluffing, I'd be married, maybe, to some nice fellow in Vancouver some years ago.  So, you know, think about bluffing.

How many of you have hearing‑aids?  Wow!  How many of you are here because you're thinking of getting hearing‑aids for the first time or getting new ones?  Wonderful!  And how many of you are here because you need them, but you don't want them, but somebody made you come?  (Laughter) One, two, three ‑‑ honest people.  You're not bluffing.

You know, I didn't start wearing a hearing‑aid until I was 21.  I was born with hearing loss that was diagnosed at two and the doctors would never let me try a hearing‑aid.  They say, "It won't help her."  My hearing loss was mild as a child, moderate as a teenager and simply profound now, but in their defence, in those days, the hearing‑aids were big, the size of a T.V. that you wore on your chest (laughter), and they felt it might hurt what hearing I had.

Anyway, at age 21 a new doctor said, "You should be wearing hearing‑aids," and again my life changed.  So I want to tell you about the day I got my first hearing‑aid, and I'm sure those of you who have hearing‑aids remember that first time, that first one.  And it was in Toronto and I went ‑‑ I was fitted, you know, the goop in the ear and all that sort of thing.  Then the day came.  The day came.  I was going to pick up my very first hearing‑aid.  And I went to the office and the hearing specialist's name was Miss Rowena Fothergill, and you never, ever forget a name like Miss Rowena, Fothergill, so I said, "I'm here, Miss Fothergill, I'm here to pick up my very first hearing‑aid."  And she smiled at me, opened a box, put it in my hand and I looked at it and said, "Damn, that's ugly!"

She put it in my ear and I said, "Whoa, is that loud!"  It was loud.  I hadn't been hearing like that, ever, so she said, and I swear to heaven she said this, "Go, Gael, go out there in the world and hear."  She might have been a minister, you know, in another ‑‑ part time, so I said, "Yes, Miss Fothergill," and I walked out ‑‑ I don't know if any of you know St. Claire Avenue in Toronto.  I'm seeing heads nod.  It is probably the winner of the noisiest street in Canada.  It's cars, buses, cars, all sorts of noise going on, and it was three blocks to my father's office, where they were all waiting because Gael was getting her first hearing‑aid, and I walked along St.  Claire Avenue like this (laughter).  I'm sure you know what people thought of me as I jerked and lurched toward my father's office.

So I wore that hearing‑aid for two days and it hurt my ear, it was loud ‑‑ didn't really hurt my ear, but it felt funny ‑‑ so I did what I'm sure many of you have done:  Put it in a drawer.  How many of you put your first hearing‑aid in a drawer for a while?  Very honest people here, just a few.

So I put it in the drawer and then a little while later, I could hear this sound as I passed the drawer, saying, "Let me out!  Let me out!"  So I did, I put it in again and I was determined to stick with it, and wow, within just a few days, it started to sound okay, felt good.  By a month it was really great and just by the time I thought ‑‑ I wasn't even aware that I had it in my ear, the dog ate it. (Laughter).  And despite what you've heard from other sources, most hearing‑aid‑swallowing dogs do not swallow it and pass it out intact at the other end (laughter).  Mine was a jumble of wires. 

Through the years, I wore a succession of hearing‑aids, different types.  I think out there with the hearing‑aid manufacturers, I think ‑‑ I believe that I have worn one of each of their products through the years.  At age 40, I started wearing two hearing‑aids, which again I should have done right from the beginning, and then, wow, things really got loud with two hearing‑aids.

Last year, I received a cochlear implant on the right side.  Do we have any cochlear implant users here?  Okay.  Just Leslie?  You and me, babe.  You know? 

But when I got involved ‑‑ at age 40, I was expecting a baby.  I'm slow, but better late than never.  And for the first time, I ‑‑ my hearing ‑‑ I was worried about my hearing loss because it was going to affect someone else.  Well, there was Doug, but this was a baby (laughter).  I mean what if I didn't ‑‑ what if I didn't hear him crying in the night?  What do I do about that?  And I quickly discovered, like most women, that when the baby cries in the night, the husband goes, "Baby's crying," and up you get (laughter).  What if I didn't hear my baby burp?  Would he blow up?  Who tells you these things? 

So for the first time, I reached out to other people with hearing loss and that was life‑changing.  I don't know if you've taken the opportunity to talk to other people today, because the things that you learn from other people with hearing loss is amazing.  Erin and other audiologists will tell you lots, but it's from the life experience of other people that you learn the little tricks of the trade.  And you'll be inspired by them the way I was.

So I learned that we need help to hear.  It's not like you can do exercises and your muscles will get better.  You just can't kind of strain and your hearing system gets better.  We need help.  And that help comes from technology, it comes from knowledge, it's what you're all doing here today, you're listening to talks on tinnitus and how hearing loss affects it.  You need that knowledge to live more successfully with your hearing loss. 

So I love my technology, I love my hearing‑aids and my cochlear implant.  Takes a bit of time to get used to them, yes, but that's part of success.  That's part of the process.  You do it.  Your brain adapts, your family adapts and bit by bit, things get better.

I love my technology.  I even have names for them.  I call this one Billy and this one Bob, short for William and Robert, and anyway, I talk to them and I tell them how I feel about them.  It's odd.  I'm not saying that you'll do that with your next hearing‑aid, but, you know, they're part of my life.  So I'm going to tell you this little piece that I wrote called "Ode to an Aid".  I love that title.  I worked hard on that.  So:

"You're lying beside me on the bedside table and before I go to sleep, I am looking at you for the first time in a long time and I'm thinking how much, to my surprise, I love you and why.  Well, it's not because of your looks!  One square inch of plastic and wires, your colour referred to, professionally, as "flesh tone", by people with no imagination as beige and by me sometimes as ugly.  Your shape is a cross between an extracted tooth and a kidney bean and your shiny surface reflects light except where I've forgotten to wipe the wax off it.

"You know, for a small creature, you sure have a lot of openings that suck sound in one end and lets it loose in my head.  But my favorite opening is that battery cage and when I open it and you grab a fresh battery and disappear back inside and you chime your delight, immediately changing from a lifeless lump of plastic to a life‑changing spark plug. 

"You know what they say about beauty:  It's what's inside that counts.  And I get that, too, about you, but I don't really want to see inside you, because I'd be disappointed not to see little tiny hearing elves make magic happen.

"I do love you, you know, and for all the times that I've cursed you, dropped you, stepped on you, I'm sorry.  I had expected more than you can deliver, yet, and I have not thanked you when you delivered more than I ever expected, giving me sounds that my memory had forgotten and new sounds that I never knew existed, like my baby breathing. 

"No, you're not pretty.  You cost money.  You take some work, but if I didn't have you, I would be isolated, cut off from my people.  So no, you're not pretty, you're beautiful, and I love you.  Goodnight."  (Applause)

So hearing loss, whether you realize it or not, touches every aspect of your life, even if it's a mild hearing loss, and the most important impact of hearing loss, and I'm sure you'll agree with me, is on relationships.  Relationships change a little bit when you have hearing loss. 

So communication is the glue that binds us together as people, and hearing loss can impact that, so what we have to do is learn, with our families, with our friends, some new ways of communicating, and you've learned this from your hearing professionals and from other people with hearing loss.

You know, my husband and I have been together for 30 years and even now, he sometimes breaks the rules of communication.  He will walk away from me while I'm talking and then that is always good for an argument. 

FROM THE AUDIENCE:  Yup.

GAEL HANNON:  So if he doesn't follow the rules of our communication and I don't manage to keep my temper in check, things are going to happen. 

So there are just a few basic rules and these are the basic ones of improved communication:

Get my attention.  If you start talking to me before I've tuned in, I tune in halfway through and I've missed part of the message.  Get my attention.  Don't say my name loudly, because I'll jump, because, you know, sometimes it's not how loud something is, it's just the clarity of speech.

Face me.  Always face me when you speak.  Some people don't need to read lips; many of us do, even with technology, so face me with you speak or don't speak at all.  Especially from another room.  (Laughter).

Oh, I know!  Don't you hate that?  People with hearing loss do not hear through walls or around corners, but let me tell you, people with hearing loss, aren't we guilty of the same thing sometimes?  I'll go, "Doug," and he'll go, "Yes," and I'll go, "Where are you?"  "Here."  (Laughter) "Where here?"  "In the bathroom."  "Which bathroom?"  It could go on like this.  Actually, I don't let it go on that far, but whoever starts the conversation goes to that person.  That's a basic rule.  You don't have to write it down, but you maybe should. 

And don't over‑emphasize your lips when speaking to me.  Sometimes I'll say, "Oh, pardon," so even my husband will repeat it (demonstrating).  No, we don't understand that.  We don't understand over‑emphasized lips and it makes you look really silly.  So no over‑emphasizing. 

And don't roll your eyes when I ask for repeats.  "I've already told you two times."  Well, try it for a third time.  Don't roll your eyes. 

There's lots of other communication.  You know, you want to have the lighting up and the noise down.  So we people with hearing loss, sometimes romantic ambience means something different for us.  The lights ‑‑ it's always bright in my house.  When we go out for dinner, you know, you might have one candle on the table, low lights, a little music playing.  I have all the candles the restaurant has in the back on my table and you know, by the way, that you have every right to ask for the music to be turned down when you go into a restaurant, because if you do, you'll hear other people going, "Oh, my gosh, I'm so glad they turned the music down!"

So even if you have a mild hearing loss, technology will help you.  Knowledge will help you.  There's a lot of companies out there that will help you with communication strategies, teach you speech reading, give you all sorts of wonderful things to work with your hearing‑aids and cochlear implants. 

Text interpretation:  Isn't this wonderful?  I've used captioning on T.V.  Some people say, "Well, it's so hard to get used to, it moves too fast."  You will get used to it.  You will get used to it.

We have ways to connect us to the television, to the phone, watching your iPad.  Whatever issue you have, there is an app for that.  There is a way to help you hear better and you just ask anyone out there and they will help you. 

Anyway, that is my short talk for today.  Thank you for letting me spend time with you, I really appreciate it.  Hearing loss is both my issue and my passion and I will talk about it 'til the cows come home.

So I think we'll just end there.  I'm going to be outside.  Do not feel you have to buy a book, by any means.  If you have any questions for me, we could ‑‑ let's take it outside, okay?  Thank you very much.  Have a happy hearing day.  (Applause)

DR. ERIN WRIGHT:  Yeah.  Feel free to head out and Gael's books will be on the table and if you'd like to purchase one, that would be fantastic.  And the next talk is going to be by me at 1:30. 

 

(BREAK)

 

DR. ERIN WRIGHT: 

Good afternoon, everybody.  Welcome to our ninth annual Healthy Hearing Expo.  Can everybody hear me back there?  I've got ‑‑ if I do this, is it too echoey if I have both of these?

My name is Dr. Erin Wright.  I'm an audiologist and I was just doing the math; I've been an audiologist for 22 years.

FROM THE AUDIENCE:  Wow! 

DR. ERIN WRIGHT:  Wow, that makes me feel old!  I'm a native of Carman, Manitoba, and got my undergraduate degree in University of North Dakota, then I went to Portland State University in Oregon and health sciences to get my doctorate in audiology.

So I started out my profession working with kids at the Clark County School District in Las Vegas Nevada, where I was an audiologist there for seven years, and then I moved to Victoria with my husband with the dream of opening our own clinic, our own private practice.  So we opened up Broadmead Hearing Clinic July 4th, 2006, and then we opened up our Oak Bay clinic in February of 2011. 

So I'm very proud to be able to put on this seminar to the people in our community.  I'm a ‑‑ I'm proud to be an independent hearing clinic and to be able to have the support of all of the manufacturers to come to this event to provide information to everybody and give everybody a chance to really get an unbiased piece of information and, you know, do a little bit of your own research about hearing‑aids.  So thank you very much for coming. 

I just wanted to go through the manufacturers ‑‑ the big six manufacturers.  The percentages that I have on this screen just talks ‑‑ oh, I'm sorry, I forgot to thank the captioner.  I wanted to thank the captioner and I also wanted to thank Oticon for sponsoring the captioner today.  She's doing an amazing job.  She's going to have hand cramps by the end of the day, but she is giving us the transcripts, which we are going to be putting on our website after we get them.  So about a week or two from now, after we get the transcripts, we'll have them on the website, so if you forget anything, you know, you can refer back to the transcripts on the website.  So thank you. 

Okay.  So these are the big six manufacturers, so the industry ‑‑ all of these manufacturers outside of Starkey are Europe‑based companies, most of them in Germany or Switzerland or Denmark.  The little percentage again is the market share that each of these manufacturers hold worldwide.

So Phonak is one of the major manufacturers.  They're based in Switzerland, their parent company is called Sonova.  They also own Unitron Hearing and Connect Hearing, so Connect Hearing being a clinic that provides hearing‑aids like our own hearing clinic, Broadmead Hearing Clinic.

Oticon is right up there with Phonak.  Their parent company is called William Demant.  They own Bernafon, a little lesser known.  As well they have ownership stake in companies like NextGen and they completely hundred per cent own Hearing Life Canada, and on the east coast it's called Listen Up Canada.

Widex is Denmark, from Denmark.  They have a side business off their parent company called Helix and Helix owns certain hearing‑aid clinics as well, and in our community the clinic they own is McNeil Audiology.  McNeil Audiology was an independent clinic for years and years until Brent retired and then they sold to Widex. 

GN ReSound is another manufacturer from Denmark.  They own Beltone hearing centres, so Beltone hearing centres, if you got a hearing‑aid from their clinic, it would be labelled Beltone, but it's identical technology to the ReSound technology.  So ReSound supplies hearing‑aids to clinics like mine, but if you're a Beltone clinic, you're using Beltone hearing‑aids entirely.

Then Siemens, which is a German company.  Siemens actually sold to a private equity group about three years ago called Sivantos, so they're in the process of changing that brand from Siemens to Sivantos.  They own a company in town called Miracle Ear. 

And Starkey, which is an American ‑‑ the only American‑based company.  They don't have any particular clinic ownership; they're not in that business.

Okay.  So in Victoria, there are 22 locations where you can buy hearing‑aids.  Four of those locations are independently owned or have no manufacturer stake and our clinics, Oak Bay and Broadmead, are two of those four clinics.

So one of the things ‑‑ and a couple of questions that I've been asked today, really good questions, is, "Where do I start?  Like I'm here, I'm talking to these companies.  I don't know.  I don't know what I need.  I don't know if I need this one or that one.  I don't even know what's going on."  And it's a very difficult industry to really do your research in, because it's hard to know what it is that you need unless you have a little bit of background about what these hearing‑aid manufacturers do and why one is better than another. 

And so one of the things that I'm very proud of, and somebody, just before I walked in ‑‑ I don't know if you're in this room, but you said, "Thank you for staying independent."  And it's because it's important to me, you know, and it's important to me that we provide that service to the community without any bias at all. 

So what factors you need:  So one of the things when you're looking for hearing‑aids is to find an audiologist that you trust so that they can take a look at the ‑‑ your particular needs, and some of the things that we consider are things like dexterity.  There's niche products out there that suit different people when they have different challenges. 

So for example, dexterity is a challenge.  I have a couple of people who have really severe tremors and have difficulty with inserting their hearing‑aids.  So there's a niche product by Phonak called the Lyric which can be inserted into the ear and stay in there for six weeks to three months and that person doesn't have to then deal with their hearing‑aids on a regular basis.  So we would take a look at, you know, what's happening in terms of dexterity. 

Slope and degree of hearing loss are huge factors.  A lot of people who have noise‑induced hearing loss have really good hearing in the low frequencies and then it drops off the charts to the high frequencies and that's a very difficult hearing loss to try to fit.  Some of the manufacturers I'll talk about, some of the features coming up, have little features and products that can help with those type of challenging hearing losses. 

Cosmetics:  There are some super tiny hearing‑aids out there right now; Starkey in particular makes the smallest hearing‑aid.  They have an excellent shell lab and they're able to fit all of their little circuits and components into a tiny shell that can fit right down into the ear canal where most people wouldn't notice that you're wearing one.

Ease of use:  Some people want to just put it in and let it work.  Other people want to control it and change the programmes and play with it and have it work with their iPhone. 

Tinnitus is a huge one.  If somebody's suffering from tinnitus, we need a product that's going to have a feature to manage that particular issue.

The size and the shape of the ear:  I've had two people in the last month who've had the complete top of their ear surgically removed because of skin cancer and now what are we going to do?  We don't have anything to hang the hearing‑aid on.  So we have to figure out what is happening with your ear and what's going to fit on that challenging ear. 

And also the need or the desire to have your hearing‑aid connect.  So connectivity is an exciting new development with a lot of these manufacturers that help with really anything that you're listening to.  So if there's anything out there that you listen to on a regular basis, we can get it connected to your hearing‑aids.  So I'm thinking of somebody who I know who listens to CBC radio and we have a little microphone plugged into a radio and the radio's in her kitchen.  It's just a little basic kitchen radio, but she plugs this little thing into the kitchen radio and it streams the CBC radio right into our hearing‑aids so she can go off to the bathroom, she can go to the garden, she can do all these things and still be catching that radio signal.

So it's good to think about, "What do I need?  What do I listen to?  What is my life like?"  And all of those things kind of come together to ‑‑ to become really important little bits of information to communicate with your audiologist so the audiologist can make the right recommendation from all of these hearing‑aid manufacturers. 

The wonderful thing about these hearing‑aid manufacturers is all of them provide us with a three‑month trial period.  So they give you three months to make sure that the product is the right product and if it's not, if it's not working for this and that, we can move on and each new product comes with a new three‑month trial.  So the end result being that in the end, the person has something that they're wearing 12 hours a day and they love it.  So that's the ultimate goal. 

So not all of these hearing‑aids are the same.  Somebody asked me today, "Is this the same hearing‑aid kind of repackaged in different brands?"  No.  They have proprietary fitting formulas, they have different ways of doing things, a different little niche product, and so they're not all created equal. 

So the first part of my talk ‑‑ was anybody here last year?  To this talk?  So in the last year, last year and the year before that, I broke this talk down into talking specifically about features, what features are available in hearing‑aids and what they do.  This year I'm going to do it a little bit differently.  I'm going to talk about the new product launches.  So I'm going to break down each manufacturer and talk about the product that they have just released, their latest product on their portfolio, and we'll talk a little bit about some of the pros and cons of each of those things and then if ‑‑ you know, and for you guys, if it sort of resonates with you, you can think, "Oh, yeah, I like the idea that that one connects to an android phone because that's what I have and that's what I want." 

So this year, instead of breaking it feature to feature, I'm going to talk about each manufacturer and what they've just launched and after that we are going to talk about what is to come, you know, in the next year or two. 

So I'm going to start with Phonak.  In August of 2017, Phonak launched a new platform that they call Belong.  It's called Belong because it's their first iteration of a rechargeable product, so like "be" "long".  So Phonak is using a lithium ion product to ‑‑ they say this battery's going to last about three years, which is great because they have a three‑year warranty, so we can get it replaced at the end of the three‑year warranty and hopefully have it done in the warranty period and then you get another three years out of that battery.  So it's wonderful, these lithium‑ion batteries.  Kind of takes a lot of issues away around batteries.

So they have ‑‑ they were the first company to introduce connectivity to an android phone.  So since 2012, we've had hearing‑aids connect to iPhones, but the new Phonak Belong product is the first android‑capable hearing‑aid that came out in August '17.

One of the features that I really like about this Phonak product is their second ‑‑ their 2.0 version of something called frequency transposition, or frequency shifting.  So Phonak is the only company right now to be on their second iteration of this and they're doing it better than the other manufacturers. 

What this means is for people who have hearing loss in the high frequencies ‑‑ so high‑frequency sounds are going to be "s", "f", "th", "sh", "p", "k", those sounds that don't have a lot of voice behind them, they're just sort of air flow.  If the person's hearing loss is quite severe in those regions, they don't have a lot left in their ear to hear.  So a hearing‑aid is going to make it louder, but when that part of the ear is so damaged, it doesn't really respond very well; even if it's louder, it doesn't really matter, it's not clear.

What this frequency shifting is is it takes those high frequencies and shifts them to a lower frequency region of the ear, so some of the bass tones.  It takes those treble sounds, moves them to the bass area of the cochlea, where the hearing is generally better, so the better part of the cochlea that's more preserved can take advantage of those cues and be able to then distinguish between the "s" and the "sh" sound.  So that's a hard thing to do when you have severe high‑frequency hearing loss and this new 2.0 version of Phonak's frequency shifting is doing the best job that we've seen so far in this.

It reminds me of a little story.  The first time this came out was when I was a school district audiologist and I was dealing with this girl that was 12 and she had really deaf speech because she was born with that type of a hearing loss where she could hear all the vowels really well, but had no hearing in the high frequencies, and I fit her with the first version of this frequency transposition and within six weeks, she became so clear in her speech, you could hear these sounds coming through her speech again, and that was in, I would say, like 2000, so this is now 18 years later and they've done a good job at sort of keeping on tweaking that particular feature. 

The other great thing about the new Phonak Belong is their product that they call Naida.  Naida is their power hearing‑aid; comes in three different versions.  Phonak has long been the go‑to company for people who have severe to profound hearing losses.  The way that that hearing‑aid can represent that sound, it's the best power product so far and this new one just was released on March 26th and the new one has a new proprietary fitting formula, which is why it took longer.  So they originally released the whole product line, the family, in August of 2017, but it took them until March of this year to release the power version of the Belong ‑‑ of this Belong product.

So they have a proprietary fitting formula called adaptive Phonak digital contrast, which is really good if your hearing loss is severe, because it helps to distinguish ‑‑ or discriminate between the vowels and the consonants.  It's also a rechargeable version of a power product, which has been something we've been waiting for.  So Phonak does a great job with this particular area of need. 

Unitron has come out with a new hearing‑aid as well just this past February, February 2018, that is called the Moxi All.  So if you can remember, Phonak and Unitron are both owned by the same parent company, Sonova Corporation, and they often share technologies.  So Unitron also has an android‑connected phone (sic).  So now if you have an android phone, you can connect it using a phone app or a Unitron hearing‑aid, and the way it works is it's actually a true hands‑free option, which is different from the iPhone hearing‑aids.  So the iPhone hearing‑aids, you still need the iPhone to talk into it so the other person can hear you.  With the Unitron Moxi All and the Phonak hearing‑aid, it's called the direct hearing‑aid, when you get a call, you don't have to be near your phone.  You push a button on your hearing‑aid to answer the call and the microphone on that hearing‑aid picks up your voice for the caller on the other end. 

So the call is coming into one ear, but you don't have to hold your phone at all.  Your phone can be, you know, 30 feet from you, and it's the hearing‑aid microphone that is picking up your voice through their call and streaming their call into your hearing‑aid.  So it's really cool to be able to answer and hang up like that.  Unitron has a little bit of an edge over the Phonak product in that their android‑connected product is also rechargeable and Phonak's is not.  So if you want rechargeability and android connectivity, this is a great option.

Starkey is another manufacturer.  They're an American company and Starkey, as I had mentioned earlier, in my opinion does the best job at the smallest hearing‑aid.  So the little one inside, this is called completely in the canal, and the other one is called invisible in the canal, so we can make a deeper ear impression and get that hearing‑aid to sink right down the ear canal and, you know, they ‑‑ I've seen some of the hearing‑aids that they come back with the impressions I send, they come back and I'm like, "Wow, that is a small hearing‑aid."  I'm impressed all the time with the size we can get those hearing‑aids.

Starkey also has a new product family that they just recently launched in the last two months called their Muse iQ, and it's ‑‑ you know, remembering all these names are kind of difficult; imagine how it is for us.  But the Muse iQ, what I really like about the Muse iQ is a couple of things:  They have the most beautiful chargeable.  The charger is that black case, there.  I mean it might seem like no big deal, but it's really well designed and it has a dehumidifier in there and it lasts for three days and it's easy to open, it's easy to put in.  So they've really done a great job at designing that charger.  That is lithium‑ion battery.

And what's niche and unique about this Starkey product is that it's the first and only hearing‑aid that is rechargeable that can also function as a CROS hearing‑aid.  I know somebody in here with a CROS.  A CROS hearing‑aid is when you have one ear that has no hearing at all and one ear that has hearing loss, and what we do is we can't really aid an ear that is completely gone, so we put a microphone on one ear and the sound coming into that side of the head is routed wirelessly to a hearing‑aid on the other ear so that when somebody is sitting on that side, the person can still hear them without turning their whole body and ‑‑ you know, turning their better ear towards that person.

So the CROS‑style of technology has been available for a long time, but the battery drain on it is horrific.  Three days, two days sometimes, because it's constantly streaming audio to another hearing‑aid.  So the ‑‑ you know, having a rechargeable CROS hearing‑aid is really great for people who are changing batteries every two days. 

ReSound is another manufacturer.  ReSound is the hearing‑aid company that was the first company to launch their ‑‑ the iPhone product and they were sort of alone in the market in 2012 for almost a year.  So, you know, they have some really interesting sort of forward thinking about their company.  They often ‑‑ they often come out with things first. 

They have a different new product called the Linx 3D, so that's their third version of the Linx.  The first version of the Linx was the one to connect to the iPhone and now they're on the third version of the Linx, the Linx 3D.

So ReSound has a different philosophy of processing the signal when the environment is noisy.  So what they believed their philosophy ‑‑ what they call it is binaural directionality.  What they've shown in studies is people hear better when the microphones on the hearing‑aid are picking up sound from all directions, when they get that full soundscape, so ReSound is trying to keep the hearing‑aid ‑‑ is trying to keep it in an ‑‑ to preserve the sound cues and keep the listen.

Their binaural directionality is a little bit different because they have a true dual core processing system where both hearing‑aids are working together as a system.  So now you have four microphones, two on each hearing‑aid, that are sending information continually back and forth to figure out what is the best directional set‑up for this person in any given environment.

So there's four options:  You can have both hearing‑aids in an omnidirectional position, both of them in a directional or forward‑focused position, or you can have one be omni, one be directional, depending on where the primary speech signal is coming from. 

For example people in noisy restaurants:  For a lot of years, hearing‑aids have had adaptive directional microphones; that means when the noise gets loud enough, the hearing‑aid microphones start to do that.  Even with Phonak, it's a super tight zoom with Phonak.  So the microphone directionality is going to be dependent on the environment around you.  So when you're in a restaurant and your microphones are in a really tight directional zoom and a waiter comes up behind you and says, "Do you want another drink," you're going to miss that.  You're only going to know that because your partner is going to look up over your shoulder and then you're going to go, "What are you looking at?"  Then you'll get that cue.  ReSound, in their binaural feature, would keep that one ear in an omnidirectional position so you can continue to hear what's going on in that direction as well.  So they are using the 2.4 gig ... platform to do that.  That's the name of the wireless technology that works ear to ear. 

The other thing they're working on, and they're on their second version of it and I talked little bit about this last year, was cloud‑based adjustments. 

So ReSound has its own cloud that apparently is in Ireland (laughter), and what this means is that if you have a ReSound hearing‑aid and you have it connected to your iPhone, you will have an app on your iPhone that you download and it's the ReSound app and that ‑‑ all these manufacturers have apps for their hearing‑aids, but with the ReSound app, you can use the app like you would to make volume adjustments or change your programme or even change your microphone directionality.  If you don't like what it's doing, automatically you can decide, "I want it to be in the forward directional position," or, "I have kids in the back of the car, I want it to be reverse directional."   That kind of thing is consistent among all the apps, you can play around with all the settings if you want to.

What's a little bit new with ReSound is this cloud‑based technology.  So if you are at home or you're at a restaurant and you think, "I don't really like how it sounds here," you can open up the app and sort of answer a few questions that they've designed on the app and you can even type in some words saying, "Hi, Erin, I'm just at Pagliacci's and it's horrible here and what I'm noticing is that the dishes and the knives and forks are really, really tinny when I'm in this high‑noise environment," and then you can send that message and when I get to my computer, I open up my computer and I get an e‑mail saying, "Julia's just sent you an e‑mail."  Then I will open up that e‑mail and it has a link and I click on the link and it goes right to your particular software page.  And anybody who's had hearing‑aids remembers you go in to the audiologist's office and you can see her working on the computer and making little adjustments.  Well, that's called your profile, your NOA profile, so the e‑mail sends a link right to your profile and then I can make some adjustments based on that e‑mail you just sent me.  I can say, "Okay, Julia's having a hard time with these knives and forks, so she must be in the restaurant programme," so I'm going to go into the profile, make an adjustment through the programme and send it through this cloud back to her iPhone and then she'll get a message, a notification on her phone saying, "Erin just responded to your message.  Do you want to accept these changes?"  And then she'll say yes and the changes load into the hearing‑aids, and then she might say, "Oh, God, this is horrible!  What was she thinking?"  And then you can reject it:  "I don't like those, I'm rejecting it, I'm going back to the way it was." 

So it's ‑‑ you know, it's obviously great for people who go to Palm Springs after they get their hearing‑aids for six months and then they don't have any way to get them adjusted.  It's great for people who have difficulty getting into the clinic and they can kind of do these things remotely.  It's great for the audiologists because we can help people more instantaneously than having to wait a week or two to come in and get an appointment.

So there are some real advantages to this type of technology and I can only assume all of these manufacturers are going to follow suit, where you're going to have more ability to have the hearing‑aids adjusted sort of, you know, within a shorter timeframe. 

So Siemens:  Siemens isn't here today, if you noticed.  They ‑‑ the rep from Siemens, she couldn't make it today, she had a different thing going on, so for the first time, they're not here, but they do have a new product that's excellent.  It was released in October of 2017 and what they're really focusing on with Siemens is people's own voice.  So their product is called the Nx and their main feature is called own‑voice technology.

So if anybody ever has had the experience of putting hearing‑aids in for the first time and saying, "Oh, my voice sounds different.  It sounds louder or echoey or it feels like I'm in a tunnel, I'm just not used to the way my own voice sounds."  I mean everybody has that feeling.  When people come and say to me, I say, "A hundred per cent feel how you're feeling right now.  We'll just gradually make the sound louder, you'll adjust to it."  Some people don't, some people have a hard time adjusting to the way their own voice sounds.

Siemens is trying to tackle this problem using a different processor to amplify the person's own voice as compared to speech around them.  So it's got sort of learning in that it's going to learn that person's own voice and apply different levels of volume or amplification or not amplify the person's own voice, like it would if there was a voice next to them. 

So they've patented this technology, it's working really well.  Again, like anything, there's niche areas for this and for some people ‑‑ some people have hearing loss that's in the low frequencies and their hearing gets better in the high frequencies, and those people have a harder time with their own voice because we need to give a lot of volume in the low frequencies and it's a harder adjustment for sure.  So this is a really good product for that type of a hearing loss. 

What they're also doing is they have a hearing‑aid that connects to your iPhone, but they're using the iPhone a little bit differently than any other manufacturers because they have these motion sensors that they are picking up from the iPhone.  So if you have your phone with you and your phone is connected to your hearing‑aids and you're in the car, your phone knows that you are travelling at a certain miles per hour, so it's going to make the assumption that you're in a car and it's going to send that information to your hearing‑aid to affect the settings, the programme, so you can hear speech in a car better. 

So it's using the information from the gyroscope ‑‑ the accelerometer, sorry, of the phone to figure out are you sitting still, are you walking, are you in a car?  Are you jogging?  What is going on in your environment?  It's just another little piece of data that the hearing‑aid can use to better adjust for the automatics in all of these hearing‑aids. 

When I said the data, it made me think of something I didn't tell you about the ReSound hearing‑aid.  One of the things they're doing with that cloud‑based adjustment is they're going to be able to use the data of people sending in these adjustments.  So if everybody's saying the same thing, "These hearing‑aids are too tinny," it's going to give them information on a large scale of, you know, what are people having problems with and then they are going to use that data to better design the next iteration of hearing‑aids.  So it's ‑‑ it also adds that particular component to it. 

Siemens ‑‑ this little box, here, is a T.V. streamer, so every hearing‑aid, now, has a box about that size that plugs directly into your television and can wirelessly send that audio to your hearing‑aids, so you don't have to wear a thing around your neck called a streamer, like we've had to have people do for years.  That sound can go right from A to B, it doesn't have to go through a middleman.  So those T.V. streamers are pretty consistent among the manufacturers.  Most of them have a version of it where you can press the button on your hearing‑aid or your remote control to directly feed that audio into your ears, which is really great if you have somebody else in the room who doesn't want to watch that show.  You can mute the television and be the only one to hear it.  So if your partner is asleep, you know, you can turn the volume right off, or if you have, you know, two people living in the same house and one of them wants to watch CNN all day and the other one doesn't, you don't have to both do the same thing.  One person can watch T.V. all day long and have it streaming right into their ears.  It's really ‑‑ it's almost a really nice thing for the partner of the person with hearing loss.

It's also fantastic with those British shows!  Those accents are crazy!  So many people have a hard time hearing those British accents.  It really helps with that.  And again that's not just Siemens; all manufacturers have that same kind of T.V. adapter.

So Widex is another manufacturer.  Their new platform of hearing‑aids is called Beyond.  So what I really like about that Beyond hearing‑aid is how it's processing music.  So Beyond Widex, for a few iterations of their hearing‑aid now, has been a choice product for musicians because of their microphones.  They have a different microphone set‑up in there and so the microphones aren't confusing music with noise and trying to compress it.  So it really does a nice job at processing and amplifying music. 

And, you know, if you were hear for Lia's talk, she talked a lot about their new zen therapy.  It's not necessarily new.  We've had that zen option in the last couple of versions of their hearing‑aid, but Widex has gone above and beyond with doing research about how to help audiologists properly programme these programmes for people who suffer from tinnitus and help people to manage their tinnitus using different counselling strategies, different sound therapy in their ears.  So Widex has really put a lot of effort into helping audiologists help people manage tinnitus. 

So I personally have had a lot of really great success with people who have been told by countless doctors and other people, "There's nothing you can do about it," and that's just totally not true.  There's absolutely something you can do about it.  I'd say in my practice, 85 per cent of people with tinnitus, we can help manage that using this type of a product, here.  By manage, I don't mean go away completely and have absolute silence, I mean manage it to the point where you don't notice it, it's not as front and centre.  It's called habituation.  It's like this projector is making a fan noise, but I don't hear it unless I draw my attention to it. 

It's okay, I'm going to take questions at the end, if that's okay.  Okay.

So Widex is also releasing a new product in ‑‑ April 21st.  So April 19th to the 21st in Nashville, Tennessee is our American Academy of Audiology conference and Widex is releasing a new product at that conference, which they're kind of keeping their lips sealed about right now, but from my understanding about it, it's going to involve a little bit more machine learning.  Machine learning meaning that if you're inputting information into your phone with the ones that are connected to the iPhone, it's going to learn your preferences and, you know, be able to monitor your environments just that much more accurately.  But I don't have a lot of information about that product.  We'll know more after the launch in April.

What they have told me is that in the fall of this year, they are planning to release the first fuel cell hearing‑aid.  So I talked about this a little bit last year about what's coming up in 2018.  So I'm going to talk a little bit about rechargeable batteries, but Widex is hoping to launch a fuel cell, meaning that it takes three seconds to charge your hearing‑aid and it's going to last for three days, and it's battery free is what a fuel cell is. 

So we'll see.  I mean it's new technology, it hasn't ‑‑ you know, they're trying to take that technology from the automotive industry and put it into some hearing‑aids, so we'll see what kind of problems come up with that and how it actually works, but it's an exciting advancement, though.

The Oticon Opn hearing‑aid.  It's not a new release this year, it's been out for a little while, but they have released a few new software updates to this hearing‑aid.  So the software updates are available to you if you have an Opn hearing‑aid.  You have to come into the clinic to see the audiologist, we plug your hearing‑aid into the computer and just load the new updates into the hearing‑aid.  So the updates are helping the hearing‑aid connect to new devices.  There's a little microphone they've come up with, it can stabilize some of the connection to the iPhone.  So it's always good to have the new update in this hearing‑aid.  If you have it, you want to make sure you have the newest update.

The Opn hearing‑aid has a different way of processing sound and so it ‑‑ it's really doing a great job of managing noisy environments, and this is probably the biggest problem that most people have is hearing in noise.  So when they rereleased this technology, they really emphasized they were doing noise management differently than the other manufacturers, and they really are.  It's a different theory, a different philosophy around processing noise and it's moving away from that directional microphone strategy. 

So I talked about the directional microphones a little bit, with adapting when the environment gets noisy and how the manufacturers are doing that different.  The Oticon Opn product is not even using directionality at all, so they're using, you know, different cycles in that processing.  So the hearing‑aid picks up the sound and the hearing‑aid analyzes it and then it balances it and then it cleans it from noise, and so it kind of goes through ‑‑ like I imagine it kind of goes through like a car wash cycle until the ‑‑ until the sound is spit out the end, all the while trying to clean up that signal to help that signal be a little bit more speech and a little bit less noise.

And it's even doing that in between syllables of a word.  So it's processing things quite quickly.  It has, you know, 64 frequency bands in it and it is doing a better job in noise than I've seen historically for a while.  So for people who have difficulty with that environment, this is a good product.

So I just want to touch a little bit about batteries.  I kind of talked about the changing landscape of hearing‑aid batteries a wee bit.  Things are really changing in the last year.  We've always had disposable batteries.  So with batteries, we've always been using these sync air disposable batteries that last 25 days depending on the size of your hearing‑aid.  That's because the hearing‑aid industry and battery industry hasn't been able to find a battery that has enough power to power the hearing‑aid all day long or be small enough to fit into a hearing‑aid.

So the rechargeable options currently are the initial nickel metal hydrate which was released by Siemens a long time ago.  It was the first version of a rechargeable battery; good if we really needed to use it, but it was only lasting like ten hours in the day.  People would have low battery beeps towards the end of the day, so it wasn't really a good solution.  It wasn't really getting people through the whole day.  So the other manufacturers went on board with that nickel hydrate battery. 

So then a company came out called Z Power ‑‑ or Zee (phon.), it's an American company ‑‑ and Z Power is using a different battery called a silver zinc battery, and a silver zinc battery is apparently a spin‑off technology from NASA.  These four manufacturers, Unitron, Oticon, Widex and ReSound, had all contracted with Z Power to have Z Power make new battery doors for their hearing‑aids and chargers so we can retrofit those hearing‑aids and make them into a rechargeable product.  So it's kind of, you know, two different companies coming together to try to provide a rechargeable solution. 

So these rechargeable batteries are lasting about six to eight months.  We're sometimes seeing battery failure; I would say about 20 per cent of the time people come back before six months and say, "My battery's dead," so there is some times where we see that the battery isn't fully lasting the amount of time that they say it's going to last. 

The great thing about these, though, is that you can replace it with a disposable battery if you want.  So if you're going away on holiday and you don't want to take your charger or you're worried about the power source, you don't have to take the charger, you can take a package of regular, disposable batteries and take the chargeable battery out and put a regular battery in that's going to last a week like normal regular batteries do.  So you have the flexibility of going back and forth and if your battery dies before you're expecting it to, you're not without your hearing‑aids until you can get another rechargeable battery.  You can just put another battery in until you get around to go to the clinic to get another battery.

And then there's the philosophy of the lithium‑ion batteries.  So Siemens, Starkey and Phonak have all decided to choose to use the rechargeable lithium‑ion batteries and ReSound is saying their product in the fall is going to have a lithium‑ion battery as well. 

The lithium‑ion battery is integrated into the hearing‑aid, so you can't get at it.  You have to send it back to that manufacturer to have it changed, so if there's a problem, you have to get a loaner hearing‑aid from the clinic until we can get that battery changed, although I haven't seen a problem with those batteries since they've been released.  I haven't seen the hearing‑aid since September of 2016, that lithium‑ion battery, I haven't seen one that's had to go back so far, so it's a good sign. 

But when the battery dies, it's going to be an expensive thing to repair, you know?  Probably a couple of hundred dollars, like $300, to get a new battery in there.  But like I said earlier, we can hopefully sneak it in under the warranty and get a new battery before the warranty expires.  So if you have a lithium‑ion battery, keep your warranty date in mind so you can bring it back to us so we can get a new battery in there.  We're finding they're just a little bit more stable.  If you forget to charge it, you can't use it.  So that's kind of a down side there.  You have to wait for, I think, a three‑hour charging cycle in order to use it.  So you have to be pretty diligent about recharging it every night.

And then finally I'd just like to take a little quick peek into what's coming up in the next couple of years in terms of hearing‑aid iterations and what these manufacturers are working on currently.

Artificial intelligence is kind of what they're working on right now and artificial intelligence, you know, there's ‑‑ the world is a little bit on fire with applications for artificial intelligence and I read an article that said hearing‑aids are now where cell phones were 25 years ago.  So they're just starting to start to use some of this information and data and they're be able to miniaturize it to get it into a hearing‑aid, so it can use a little bit more advanced technology to help people to hear a bit better.

The first sensors are going to be called inertial sensors.  They're going to put sensors into your hearing‑aids.  These inertial sensors will allow the person to control it by tapping it.  So Starkey says they're currently working on this right now for a product to be released later this year.  So these sensors will include an accelerometer and a gyroscope so it knows where you are ‑‑ how fast you're moving and where you're facing.

So we can use these inertial sensors to complement the body's vestibular system.  With an inertial sensor in a hearing‑aid, you can do physical activity tracking, so it can be your new Fitbit, and you can programme things into it, like, "I want to do 10,000 steps in a day," and your hearing‑aid might say, "You've only done 8,000 steps.  Do you want to do another 2,000?"  You can send that information, if you want it.  (Laughter) So you can do these kind of things, you know, coming up in your hearing‑aid, obviously if you want it.

Fall detection is another one.  The first version of these inertial sensors are going to help to be able to indicate a fall.  So falls are happening quite often and with this artificial intelligence, what they're going to be able to do is alert somebody if somebody else has had a fall.  But hopefully in the future, they're going to be able to use these sensors to actually predict falls.  So the inertial senators in the hearing‑aid will be able to quantify gait changes and, you know, predict someone's propensity to fall and then hopefully give an alert to that prior to the actual fall. 

And then imagine language translation.  You know, that would be amazing and something that they're working on where you can have realtime language translation.  You can go to Japan and, you know, have that being fed.  Obviously, probably, with the help of your phone, but having those kinds of technologies marrying with the hearing‑aid technology just makes them more usable.  Like phones used to be just phones, and now they're everything.  You know, they're your entertainment device and texting and communication and videos and photos and it's camera.

So where hearing‑aids are now, they're just hearing‑aids, but where they're going to be is they're going to have those multipurpose devices in addition to these faster processors, which are going to help people to hear better in noise as well as provide other sort of added things. 

So I know that there's a ton of options out there and it's kind of dizzying to know what's appropriate for you, and one of the things that we sort of pride ourselves on with our education and our clinic, we only hire audiologists and we all keep up‑to‑date on all of this technology so you don't have to.  So you can come and say, "This what I'm looking for, this is what my life is like," and then we can help you.

I mean it's a lot easier when you're owned by one hearing‑aid company to keep track of one type of hearing‑aid.  That's easy.  It's easy for me, but it's not about me, it's about you and what you need and so we are dedicated to keeping up with all of this technology and making sure that, you know, we are able to use it for people who want ‑‑ who want this type of technology. 

So thank you guys for coming and listening.  I know that's a lot of stuff to hear.  I'm just going to sneak out that door on the side, so if you have any questions, we can ‑‑ oh, we can do questions.  Let's do a couple questions right now.  Julie, did you have a question? 

FROM THE AUDIENCE:  I did.  I can't remember if I remember it now, though (laughter).  If you have really high tinnitus and you get fight‑or‑flight thing from it ‑‑ oh, is that the question I wanted to ask? 

DR. ERIN WRIGHT:  I won't put you on the spot.  I'll just take a couple of questions and if anybody wants to leave, go ahead and then I'll just sneak out the door and we can do more of a one‑on‑one question, if you are ‑‑

FROM THE AUDIENCE:  Can you comment just a little bit on which of the hearing‑aid providers have outlets in different parts of Canada and the U.S.?  Like clinics in different parts of Canada?  I know Connect Hearing does.

DR. ERIN WRIGHT:  Right ‑‑

FROM THE AUDIENCE:  When you're in Canada, you can find Connect Hearing. 

DR. ERIN WRIGHT:  If you're going to go to, like, a big chain store, it would be like any other chain.  Like if you're going to go to ‑‑ you know, there's a ton of examples like that, right?  So you can go to different clinics, but all of these companies provide hearing‑aids all over the world, so if you didn't get your hearing‑aids from a company ‑‑ from a chain company, you can still get them dealt with if you went to Europe or Palm Springs or wherever, because there's only six companies, you know, and clinics all over the world have access to the software and the ability to adjust them for you.  Yeah. 

FROM THE AUDIENCE:  So the warranties ‑‑

FROM THE AUDIENCE:  I'm not hearing the question.

DR. ERIN WRIGHT:  Yeah.  Right.  And in fact I've seen quite a few people in the last year who've come up from Seattle because the hearing‑aids are ‑‑ you know, our premium technology's around 5,000 and they're 8,000 in the U.S., so people come over to see me to get the hearing‑aids, have the initial adjustment and then they're paying for service down there, but the cost of the hearing‑aid is far less here.  It's 8,000 American compared to 5,000 Canadian.  Yeah. 

FROM THE AUDIENCE:  What causes the mumbled nature of your hearing when you're starting to have hearing loss, where you can't hear the words succinctly?

DR. ERIN WRIGHT:  That comes from high‑frequency hearing loss.  So why does it sound mumbly?  It's because you're not catching "s", "f", "th".  So it sounds like people are talking with a sock in their mouth because those sounds are very quiet.  Like an "f", there's nothing to it, it's just air flow.  So when you're only hearing the vowel, you're missing the consonants, you're missing a lot of the clarity, so it is a result of high‑frequency hearing loss.

FROM THE AUDIENCE:  Apparently most of us are not hearing the questions.

DR. ERIN WRIGHT:  I'm sorry, Hal, I'll repeat the questions.  Thanks.

FROM THE AUDIENCE:  Can you comment on which companies are going to support android devices again?  You said there's only one right now.

DR. ERIN WRIGHT:  There's two, Phonak and Unitron are working with that android platform, but my understanding is there's so many different types of platforms, it's difficult, so they're finding it difficult, but I think eventually they'll all break into that market.  But if you're looking for that right away, it would be Phonak or Unitron.  Yeah.  Yeah, Julia.

FROM THE AUDIENCE:  When you have those little tiny in‑the‑canal hearing‑aids, the invisible in‑the‑canal, keeping something like in there that long, does ‑‑ like I don't have wax in my ears, as you know, so I don't have to worry about that, but does it still block humidity or mould grow?

DR. ERIN WRIGHT:  She's wondering if you have those little ones all the time, is it going to be a problem with the health of your ear canal, is it going to get mouldy, and no is the answer, because what they do is they put these little vents, so there's a hole that runs right through the hearing‑aid that allows for normal air in and out and sort of ventilates the ear in that way.

FROM THE AUDIENCE:  But wax? 

DR. ERIN WRIGHT:  It's not bad for wax, because it pushes up against the sebaceous glands of your ear canal and it almost prevents the ear canal from secreting wax, because it's pushing up against those glands.

Thank you guys for coming.  Again I appreciate your attendance, if you have any questions.  (Applause)