A psychiatrist and an audiologist opened up a joint office…
So some of the patients go there cause they hear things, while others, cause they don’t!
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Three old guys are out walking. First one says, “Windy, isn’t it?”
Second one says, “No, its Thursday!”
Third one says, “So am I. Let’s go get a beer.”
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A man was telling his neighbor, “I just bought a new hearing aid. It cost me four thousand dollars, but it’s state of the art. It’s perfect.”
“Really,” answered the neighbor. “What kind is it?”
“Twelve thirty.”
A man was telling his neighbour, “I just bought a new hearing aid. It cost me two thousand pounds, but it’s state of the art. It’s perfect.”
“Really,” answered the neighbour. “What kind is it?”
“Twelve thirty.”
Yesterday I met Mr Hendricks who attended for a reassessment of his hearing. Prior to calling him, I read in his journal that has a severe sensory-neural hearing loss and wears Digital Super Power hearing aids. He is 33 years old.
Interviewing Mr Hendricks, I was surprised at how well he lip-reads, but more so, how well he speaks, enunciating high frequency speech sounds with ease and having near normal intonation. I learnt he is a tax accountant and his idiopathic hearing loss developed from the age of five stabilising at the end of his teens. Even though he functions at such a high level (giving his degree of hearing loss), he currently finds conference calls with foreign clients very difficult and his hearing loss is having an increasing negative impact both professionally and personally.
We discussed cochlear implants and apparently thought the invasive procedure of “destroying the cochlea” sounded too aggressive when he investigated it a good few years ago. He therefore never pursued the idea. My own knowledge of cochlear implants are somewhat rusted but I told him the basics as well as the fact that research indicates the enormous success of it. I stumbled upon this short youtube video which I found quite useful to explain the basics.
I have referred him for a full assessment and only time will tell about his candidacy and whether he indeed will decide to proceed with surgery. Personally I do hope he has the implant as I believe it will prove life changing to him in the end!
What if humans can be taught to echolocate (the ability to distinguish objects in the dark), the same process that dolphins and bats use to tell if there are obstacles in their path? This can proof to be very useful.
Ben Underwood lost his eyesight at age three due to cancer but he has learned himself the amazing technique of echolocating. Here is a 3 min video (best with sound) to demonstrate how he did it. Unfortunately Ben died of cancer early this year.
Take a moment and share this:
To read more on echolocation here an article from wired.com
Make Like a Dolphin: Learn Echolocation
With just a few weeks of training, you can learn to “see” objects in the dark using echolocation the same way dolphins and bats do.
Ordinary people with no special skills can use tongue clicks to visualize objects by listening to the way sound echoes off their surroundings, according to acoustic experts at the University of Alcalá de Henares in Spain.
“Two hours per day for a couple of weeks are enough to distinguish whether you have an object in front of you,” Juan Antonio Martinez said in a press release. “Within another couple weeks you can tell the difference between trees and pavement.”
To master the art of echolocation, all you have to do is learn to make special clicks with your tongue and palate, and then learn to recognize slight changes in the way the clicks sound depending on what objects are nearby. Martinez and his colleagues are developing a system to teach people how to use echolocation, a skill that could be particularly useful for the blind and for people who work under dark or smoky conditions, like firefighters — or cat burglars.
Most animals that use echolocation have organs that are specifically adapted to emit and receive sonar signals, but we humans have to rely on our rather clumsy mouth and ears. For instance, while dolphins use a special structure in their nose to generate up to 200 clicks per second, people can make only three or four clicks per second.
By studying the physical properties of the many different sounds the human mouth can produce, the Spanish researchers hope to maximize the power of human echolocation. In their latest study, published in a recent issue of the journal Acta Acustica united with Acustica, the group taught 10 of their students and colleagues to use basic echolocation. Then they compared different noises and clicks to determine the best type of sound for “seeing” your surroundings.
“The almost ideal sound is the ‘palate click,’” said Martinez in a press release, “a click made by placing the tip of the tongue on the palate, just behind the teeth, and moving it quickly backwards.” The palate click is better than other sounds, because it can be made in a uniform way, works at a lower intensity, and doesn’t get drowned out by ambient noise.
But there are a few drawbacks to human echolocation – like cotton mouth. “The quality of the sound tends to degrade after a few minutes of constant performance,” the researchers wrote, “due to progressive dryness of the mouth.” Luckily, clicks cause less dryness than other sounds, because you don’t have to exhale to make a click – which also means the sound doesn’t interfere with breathing.
Martinez isn’t the first to recognize the potential for echolocation in humans. At least two examples of blind people who have taught themselves to echolocate (see video above) have made headlines in the past few years, and audiologist Peter Scheifele of the University of Cincinnati has studied these unusual cases.
“Acoustically, according to laws of physics, it’s certainly possible to make a pulse that will tell you something about objects in front of you, such as fences, garbage cans or basketballs,” Scheifele said. How much detail a person can “see” with echolocation depends not only on the speed of their clicks, he said, but also on the frequency. The higher the frequency, the more precise details you can see.
Scheifele has only worked with blind people who can echolocate, but he agrees that others could probably learn the skill. “My gut tells me if you can do it if you’re blind, you can do it if you can see,” he said. “Half the battle is really trying to get yourself in the groove of ‘I can do this if I try.’ We tend to be more visual animals than acoustic, and people don’t usually do it because there’s not a need for it.”
*”Doctor, I have an ear ache.”
2000 B.C. - “Here, eat this root.”
1000 B.C. - “That root is heathen, say this prayer.”
1850 A.D. - “That prayer is superstition, drink this potion.”
1940 A.D. - “That potion is snake oil, swallow this pill.”
1985 A.D. - “That pill is ineffective, take this antibiotic.”
2000 A.D. - “That antibiotic is artificial. Here, eat this root!”
* Adam and Eve had an ideal marriage. He didnt have to hear about all the men she could have married, and she didnt have to hear about the way his mother cooked.
* Why can Captain Kirk hear so well?
Because he has three ears: a left ear, a right ear, and a final frontier.
This morning I saw Ms Brown on a follow-up appointment. She has a mild to moderate sensory-neural hearing loss and has been fitted with digital aids binaural a year ago. From the notes it appeared that Mr P was not keen to have the hearing aids and the previous appointment was marked with stress and anger between patient and audiologist.
Today Ms Brown was complaining she can’t hear well with the aids and that it doesn’t seem helpful at all. On close examination it appeared that she doesn’t have the ear mould in properly and I instructed her again how to do this correctly.
While I was reprogramming her aids, I broached the subject of realistic expectations and that sparked her underlying emotions. She exploded in anger shouting she is NOT stupid and off course she doesn’t expect it to restore her hearing. Fortunately I have been through such scenarios before and I calmly held my tongue and had her vent her anger. She eventually burst into tears. Initially just sobbing without words and later finally admitting she finds her deafness a tremendous struggle.
This reminded me how important our role as counsellors, are and that we need to equip ourselves in Hearing Loss Counselling that enables patients to identify their difficulties. As in bereavement, a hearing loss may involve the process of grief, denial and anger before final acceptance. It is important for us to give our patients support.
When Ms Brown left unfortunately I could still feel her antagonism but appreciated that for her, it may be a long process of acceptance.
This morning I saw a very interesting case of Barotrauma whilst covering an ENT clinic. Mr Naui has been diving in a 10meter pool as part of his SCUBA training five days ago and whilst he was doing bounces (quick up and down movements at three meter depths) he suddenly experienced severe ear ache on the right. He suffered a significant decrease in his hearing, some vertigo and some mild tinnitus on the right. He has seen his GP the next day that referred to the emergency ENT. His audiogram today looked like this:
Mr Naui reported that his hearing has subjectively improved since the incident and although the GP noted a tympanic perforation on Sunday, none was visible today. His vertigo also improved.
I discussed this patient with the ENT consultant who said Mr Naui clearly had cochlear damage (given the sensory-neural hearing loss,tinnitus and vertigo) likely caused by the a dislocation and rupture of the Reissner’s membrane and/or basilar membrane. He also said it could be inner ear decompression disease which is the result of a gas bubble forming in the inner ear. According to the consultant a fistula is unlikely as all his symptoms are improving and his hearing isn’t fluctuating. He prescribed Mr Naui steroids and antihistamine in an effort to decrease inflammatory changes and increase the delivery of oxygen. He will be reviewed in a few days but the consultant says his hearing loss is likely to remain significant at the high frequencies.
I then googled “Barotrauma” and came across this a very interesting summary of Barotrama of the middle and the inner ear http://www.bcm.edu/oto/grand/32395.html
According to this article, Mr Naui certainly didn’t have inner ear decompression sickness (IEDS) as:
1)its commonly seen after dives at extreme depths when divers use helium/oxygen mixture and Mr Naui was diving at only at 3 meter depths
2)Mr Naui didn’t have any central neurological signs
3)Inner ear decompression sickness patients needs recompression immediately.The hearing can return to near normal levels if treated immediately.
I wonder if Mr Naui will pursue diving as a hobby after this incident.
A guy walks into work, and both of his ears are all bandaged up.
The boss says, “What happened to your ears?”
He says, “Yesterday I was ironing a shirt when the phone rang and shhh! I accidentally answered the iron.”
The boss says, “Well, that explains one ear, but what happened to your other ear?”
He says, “Well, jeez, I had to call the doctor!”
This morning I’ve seen an interesting case of a chap with middle-ear trauma. He had a perforated eardrum in December last year and came for a follow-up today. He was somewhat reluctant to tell me what happened (understandably, if it was self-inflicted!) Apparently he was cleaning his left ear with an ear bud when his telephone rung. Oooooops….. He says the person on the other end quite possibly ended up with noise trauma!
Interestingly enough, his audiogram in December indicated a mixed hearing loss and today, with the perforation closed up, the audio indicates a significant sensory-neural dip at 2kHz (down to 50dB!). The conductive component has disappeared altogether. I had a chat with the ENT consultant who says this is quite interesting and is sending the patient for a MRI scan. He wondered if the guy hasn’t had a loss prior to the trauma. In the absence of other symptoms, the ENT doesn’t feel the need to explore the middle ear as such, but the sensory-neural component certainly is interesting (and could benefit from a hearing aid!).
This is just reiterating the golden rule: “nothing smaller that your elbow in your ears please!”
Dezi Belle
P.s. I’ve managed to locate an interesting article of two similar case studies:
Penetrating middle ear trauma: a report of 2 cases
Abstract
Penetrating middle ear injury can result in heaving loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia, in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity, associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.
