Hearing or Listening Test?

The people that I saw coming in for hearing tests were usually referred by the doctor, and some because they're concerned with the hearing status while some came in because it was part of the medical check-up. It can be very amusing on the replies that I get.

I would ask, "Have you done a hearing test before?"

Most of them would say, "No, it's my first time." Following that, some would say smugly, "My hearing's fine, I'm just doing it because it's part of the package (medical check-up)". Tsk tsk, lack of awareness, if I may say.

Some would say they did a hearing test before. "Yeah, the doctor was using this metal thing and hit me on the head." Tuning fork test, of course. This is the cue where I go smug, "My hearing test is better.", hehe :P

The reply that always got me laughing inside (well, I couldn't laugh out to my patient, that's mean) - "Oh yeah, I've done it before. It was during my schooldays. It was an English listening test. I did okay on that." Would you believe it, I saw to several people who actually said that. Of course, I explained to them it's a totally different thing with hearing test.

So, what's the difference with hearing and listening? I guess with Malay word, it's just "mendengar" and "pendengaran". So in that context, it'll be the same for hearing and listening. But if we really define it, hearing would be the simple act of detecting sounds, whereas listening is a more complicated act of detecting and understanding the sound.

Anyways, in the end, it's always a nice feeling to test a first-timer, because then you know you're increasing the awareness of importance of preserving your hearing and of course detection and management of hearing impairment :)

"Is This Halal?"

"Nadirah, is this ear plugs halal?"

I was taken aback when my patient asked me that. But I quickly thought over and said "I'm not sure but it should be, because it's made of silicone".

The patient was still skeptical, so I reassured her and said that there would not be any haram content inside the ear plugs, and she accepted that.

Honestly, I was taken aback because that was the first time a patient ever asked me that. All this while, I've been assuming that everything that I do is halal, never once questioning the material used. And that's a problem actually, especially with food these days. There are so many eateries, F&B outlets that is cheating consumers outright by putting up phony halal logos on their walls. And we Muslim Malaysians assume that every restaurants/cafes in this country is halal, except for those with obvious "bak kut teh" in the name of their shop. Nowadays, I seriously admit I can't be too sure with what I eat :(

Back to Audiology. So I talked this over with a colleague, and she made me think of the teachings of Islam itself. It was discussed that in Islam, as long as we don't consume pork and alcohol, then it is still halal. Meaning you can wear a pig skin lining shoes for all the care in the world. I was really skeptical of this, because this is also the first time I'm hearing it. So any wise ones, please do respond to this post if you beg to differ, or acknowledge this teaching.

Of course I googled for silicone, and rest assured everyone, there's nothing that says haram from what I read. Alhamdulillah.

Another first would be selling the ear plugs itself. The patient requested for them because she has perforated eardrums in both ears. Since she's not keen for surgery, the ENT Specialist advised her to make sure that her ears are dry all the time to allow the eardrums to heal on its own.

When I received the ear plugs from the vendor, they were really cute! One was in bright pink, while the other was in blue. It's something like the ones in this photo:


(pic taken from http://www.allamericanmold.com/html/swim_wear.html)

The patient also feedbacked that it was comfortable as well, no issues with it at all.

I also discovered that besides for protection from water and noise, you can use ear plugs to protect from snoring! LOL. I guess there are a lot of bed partner snoring at really high decibels or the company wouldn't have come up with that.

Cool stuff :)

Audiologist Gives Back to Family

How does an audiologist gives back to family?

By doing a hearing test on them.

Have I ever? Nope.

Well, I did test my parents... when they were subjects for my thesis! Hrmm... I'm sounding like I manipulated them. But anyhow, their hearing levels were within normal limits, which is awesome! I honestly think that both my parents have good genetic for hearing, hehe. Reason being, for every of their siblings that I tested, all of them qualified to be my subjects! Bravo to Abdul Rahims/Ibrahims family :)

(Suddenly I remembered a joke by my friend. He works with Widex. A friend of ours were saying something that she did well with a patient, and he commented saying "Bravo from Widex". I thought he was saying that, as in representing Widex. Apparently, he meant that it must be due to Bravo Widex that helped the patient. LOL!)

Besides my parents and my uncles and aunties, I also tested my niece. She complained of tinnitus when she was 7! And at that time, I was still unexperienced to deal with tinnitus cases... especially with pediatrics! That was and still is the first time I hear of that case actually. But now she's okay, she said she's just hearing it occasionally now. Last time she used to hear it all the time. I guess she's grown used to it. Don't worry peeps, I'm monitoring her!

Of course, I tested my hubby as well. He too has tinnitus! But I think it's most likely because of his sinus, and not the hearing, because the hearing is fine. He's now under follow up with the ENT Specialist.

Nobody else apart from the people above. And I have 11 siblings! None of which I tested. Plus 2 sister-in-laws, 2 nephews, 1 other niece, and now in addition to that - parents-in-laws, 2 brother-in-laws, 3 sister-in-laws and 1 nephew. Whoa. That's 25 people to test! And of course, I'll still need to check my parents' hearing again for monitoring purpose, since they're well over 40!

I suddenly felt guilty the other day when I was advocating for hearing tests from newborn itself, when I don't even do that to my own family. So I actually plan to start with the babies. I'm gonna make an appointment and make sure they come!

Let's hope I won't have to deliver any bad news to them!

Of Concerts and Noise-Induced Hearing Loss

How many concerts can you go before the NIHL starts kicking in?

Hrmmm, let's go through concerts (big scale, GangStarz doesn't count haha) I've been to:

1. Incubus
2. Hoobastank
3. Good Charlotte
4. Gwen Stefani
5. My Chemical Romance
6. Jason Mraz
7. Usher
8. Adam Lambert
9. Paramore (this was the most awesome so far)

So. The concerts were between 2004 to 2010. Of course, we'd need to consider distance, which was either at the mosh pit or the seats up above (cheap tix, what to do). Is my hearing deteriorating? Any notch at 4000Hz? I actually had temporary threshold shift during Adam Lambert's. That concert was crazy!

Just realized I haven't done any hearing test for myself this year. Will do it soon. How about you frequent-concert-goers out there?

Looking for Audiologists?

If you or your family member has been referred for a hearing assessment, and the place referred is not of your preference, check out Malaysian Association of Speech-Language & Hearing (MASH) directory for Audiologists (click on the right panel of this page under Audiology). Of course if you do check, there will be a list of Speech-Language Pathologists as well.

Listed on the directory are only members of MASH. For other Audiologists & SLPs beside the ones listed, you can check government hospitals and hearing aid centres.

Hearing Aids Promotion

Considering to get hearing aids for your elderly parents? Or hey, maybe even for yourself?

Oticon (Malaysia), a brand of hearing aids from Denmark is having a promotion on their Vigo Connect and Vigo Pro Connect series. It's a high end hearing aid, and they're offering discount with any purchase of that series. Obviously, terms and conditions apply.
(image is not of Oticon hearing aids)

As a neutral Audiologist, I am not trying to be biased by promoting this particular brand. But as a consumer, I would love to know these kind of information that I think is value for money. Of course, before you get the hearing aids, you need to actually do a full hearing assessment and go through a trial with the hearing aids. It may or may not suit you, so don't just go and buy off the rack. Give the hearing aid a listen and decide, whether it's satisfactory or not. Feedback to the Audiologist attending you so that he/she can try to adjust to your preference. Then you buy. Mind you, hearing aid is not cheap!

More information about Oticon hearing aids can be found on their international webpage. Click here.

ps: Promotion ends 30th November 2010.

Hearing Conscious Thais

Went to Bangkok on Monday. Upon checking in, saw this on the wall of the hotel.

Cool, huh? Wish Malaysian hotels are like this as well! Is Bangkok's Audiology more advanced than ours? Didn't get to check out their services :( (obviously, since the trip was a honeymoon trip, not an educational trip! lol)

Is Hearing Aid only for the Privileged?

Would anyone care to disagree?

Of course you would if you are from countries who have really good hearing services such as Australia whose citizens get hearing aids for free (seriously, lucky Australians).

I've seen or heard stories of patients who really struggled to buy just one hearing aid due to financial constraint. And then I've heard one case where the person lost his RM13,000 (or something around that amount) hearing aid, and bought another one of about the same amount. Imagine that. That particular amount of money in combination could have bought 14 digital hearing aids for different people!

And sometimes, the people with the money don't even want to spend on improving communication. As my fellow Audiologist, PM quoted (something similar to this line), "I would spend thousands of money so that I can travel overseas and show off to other people of places I've been, but I would not spend the same amount of money on hearing aids, something that could have improved my parent(s) ability to communicate better".

If only people realize how much a person needs hearing aid like a person needs his/her glasses.

Awareness and exposure, dear people. We need to do more of it!

A Promise

I promise myself I will update this blog. For real. So many people out there are looking for answers related to audiology and I am not helping by keeping silent or crapping about my personal life (that should be just a side story).

Yes, I will try to update on a more frequent basis. Wait for it!

And thank you for the questions. That just motivates me further.

Risk Factors for Hearing Loss in Children

Below are some of the common risk factors for hearing loss. You should contact your pediatrician immediately if you have any concerns about your child's hearing.

* Family history of childhood hearing loss
* Parental or caregiver concern
* A congenital infection, such as CMV
* A syndrome associated with permanent or progressive hearing loss
* Craniofacial anomalies, including those with anomalies of the pinna and ear canal
* Chronic middle ear problems
* Birthweight of less than 1500 grams
* Severe hyperbilirubinemia requiring exchange transfusion
* Exposure to ototoxic medications
* Bacterial meningitis
* APGAR scores of 0 to 4 at 1 minute or 0 to 6 at 5 minutes
* Mechanical ventilation for greater than 5 days
* A stay in a Neonatal Intensive Care Unit (NICU) for longer than 5 days
* Head trauma

source: seattlechildrens.org

Koklear Implan

This article is about cochlear implant, but in Malay language.

Masalah pendengaran boleh terjadi kepada sesiapa sahaja. Ia boleh berpunca daripada pelbagai faktor. Antara yang paling lazim adalah kongenital ( bayi dilahirkan dengan kecacatan ), jangkitan telinga tengah, meningitis, pendedahan kepada bunyi yang terlalu kuat dan faktor usia.

Sekiranya hanya telinga tengah yang terjejas, tetapi tidak teruk, penggunaan alat bantupendengaran untuk menguatkan bunyi sudah memadai. Bagaimanapun, jika kerosakan membabitkan keseluruhan telinga tengah atau berlaku kehilangan sel-sel rerambut di dalam koklea ( tetapi sarat auditori/saraf pendengaran masih berada dalam keadaan sempurna, implan koklea mungkin berupaya mengembalikan semula sebahagian daripada pendengaran.

Hari ini, para pengguna alat prostetik itu mampu berkomunikasi secara normal tanpa perlu membaca pergerakan bibir atau menggunakan bahasa isyarat lagi. Malah, sesetengahnya boleh bercakap menggunakan telefon. ” Implan koklear atau telinga bionik, tidak mengembalikan pendengaran seperti manusia normal. Kebanyakan pesakit menggambarkannya sebagai bunyi yang mekanikal. ”Bagaimanapun, bersama masa dan amalan yang berterusan, otak akan melakukan penyesuaian terhadap bunyi-bunyi baru dan isyarat pertuturan.

Bunyi-bunyian alam akan mula kedengaran lebih semula jadi, ”kata Ketua Pakar Audiologi, Pusat Perubatan Sunway, Mazwin Omar.Sejak mendapat kelulusan Pentadbiran Makanan dan Ubat-ubatan (FDA) pada awal tahun 1980-an, sebanyak lebih 60,000 pemasangan implan koklear dilakukan diseluruh dunia. Sebahagian besar darinya terdiri daripada kanak-kanak yang pekak sejak dilahirkan, seawal usia 12 bulan dan paling tua berusia 93 tahun. Implan koklear juga berjaya dilakukan ke atas pesakit yang mempunyai masalah perubatan lain seperti cerebral palsi, diabetes, tekanan darah tinggi, tinitus, ketidakupayaan pembelajaran dan sebagainya.Telinga terdiri daripada tiga bahagian iaitu telinga luar, telinga tengah dan telinga dalam.

Ketiga-tiganya saling berkerjasama di antara satu sama lain untuk menghantar bunyi ke otak. Telinga luar akan mengambil bunyi-bunyian yang kemudiannya dihantardalam bentuk gelombang melalui kanal/terowong telinga, ke gegendang telinga. Gelombang bunyi ini akan menyebabkan gegendang telinga bergetar, seterusnya menyebabkan sel-sel rerambut halus di dalam koklea bergerak. Sel-sel rerambut ini akan menyerap pergerakan dan mengubahnya ke dalam bentuk impuls elektrik, dihantar ke serat-serat saraf pendengaran dan otak dan menghasilkan bunyi.Menurut Mazwin, implan koklear merupakan alternatif kepada alat bantuan pendengaran konvensional yang berfunfsi meningkatkan tahap pendengaran dengan meransang saraf-saraf telinga dalam, secara elektrikal. Bayi, kanak-kanak serta orang dewasa yang mengalami masalah pendengaran teruk hinggalah ke sangat teruk di kedua-dua belah telinga, boleh mendapat manafaat darinya.

Calon paling ideal adalah kanak-kanak mahu pun orang dewasa yang baru mengalami hilang pendengaran, dalam jangka masa yang singkat. Bayi yang dilahirkan dengan masalah ini disaran melakukan implankoklear seawal mungkin, sebelum proses pembelajaran bahasa bermula pada usia dua atau tiga tahun.Untuk mengetahui sama ada bayi yang baru dilahirkan mengalami masalah pendengaran atau tidak, ibu bapa atau penjaga boleh melakukan program imbasan pendengaran di hospital-hospital yang menawarkan perkhidmatan itu.Implan koklear terbahagi kepada dua iaitu bahagian dalaman yang dikenali sebagai implan koklear itu sendiri dan bahagian luaran, pemproses pertuturan yang dicangkuk pada cuping telinga.

Pemproses pertuturan dilengkapi dengan mikrifon kecil yang mengambil bunyi,, menukarkanya ke dalam bentuk isyarat dan menghantarnya ke alat pemancar. Alat pemancar itu seterusnya akan menghantar isyarat-isyarat berkenaan melalui kulit ke implan dalaman. Implan dalaman kemudiannya akan menukar isyarat-isyarat berkod kepada tenaga elektrik dan menghantarnya ke elektrod.Keadaan ini akan meransang serat-serat saraf di dalam koklea dan isyarat tersebut akan dikenal pasti oleh otak sebagai bunyi. Pembedahan implan koklear mengambil masa di antara dua hungga tiga jam dalam keadaan bius sepenuhnya.

Pakar bedah akan memotong kulit di belakang telinga, mengangkat kulit dan tisu itu dengan berhati-hati.Satu lubang akan dibuat pada tengkorak dengan menggerudi bahagian tersebut bagi menempatkan komponen implan dalaman.Satu lubang lain akan ditebuk dan sampai kepada koklea untuk memasukkan elektrod.Setelah selesai, bukaan kulit akan ditutup dan kepala pesakit akan dibalut. Lazimnya pesakit akan ditahan diwad selama dua atau tiga hari sebelum dibenarkan pulang. Selepas tiga atau empat minggu dibedah, pesakit kini telah bersedia disambungkan ke komponen luaran untuk diaktifkan.Pemproses pertuturan akan diprogramkan dengan sejumlah program penghantaran bunyi individu yang dipanggil sebagai MAPs.

Proses pemetaan ini bertujuan menyesuaikan alat berkenaan dengan tahap pendengaran terbaik seseorang dalam persekitaran bunyi yang berbeza. Sejauh mana keupayaan seseorang untuk mendengar bergantung kepada gabungan faktor-faktor seperti faktor fizikal atau jangka masa seseorang itu mengalami masalah pendengaran atau pekak.Belajar untuk mendengar dan bercakap semula atau buat pertama kali merupakan satu proses yang berterusan. Bagi seseorang yang sudah lama tidak dapat mendengar atau kanak-kanak yang tidak pernah mendengar, ia akan mengambil masa bagi otak membiasakan diri dengan ransangan daripada implan. Ini sudah tentu melibatkan program pemulihan semula atau pemulihan bagi yang tidak pernah mengenal bunyi.

Bukan semua kanak-kanak yang mengalami kecacatan pendengaran boleh menerima implan koklear. Implan koklear hanya sesuai bagi masalah hilang pendengaran yang berpunca daripada masalah di dalam koklea seperti kerosakan sel-sel rerambut. Yang penting, saraf-saraf pendengaran tidak rosak bagi memastikan implan dapat berfungsi. Kelayakan hanya boleh ditentukan selepas penilaian menyeluruh oleh pasukan implandari pelbagai bidang. Pasukan implan yang dimaksudkan termasuklah pakar bedah telinga, hidung dan tekak, pakar terapi pertuturan dan bahasa serta pakar audiologi.

Source: Portal Rasmi Pendidikan Khas LMS