Decisions, decisions... When to get a hearing aid?

[sreda]

Hi, all. I haven't been to this board in a long time, but it is good to be back and read the topics. Several of you helped me repeatedly with info. and encouragement (thank you again!) pre-and post-op since 2004 which is when i had my middle-fossa removal of a smallish AN. Anyway, my outcome continues to be good, overall, physically and mentally. But... last Dec. I had a hearing test for 2 yr. followup to surgery, and the test showed significant decline in my speech recog. in the affected ear since surgery. The ENT I saw that day - not my reglular one - recommended I consider a hearing aid. I fully understand the normal advantages of doing that, but did not understand his additional contention that a hearing aid will also help to slow down, or forestall, further loss of hearing b/cause the hearing aid 'stimulates' the hearing nerve. He sort of clarified by saying that a nerve that is understimulated will continue to decline with age, and a hearing aid will boost the level of stimulation the nerve will get. I understnad that, literally speaking, but it still doesn't seem correct that a hearing aid can forestall declining nerve function, as excercise does for a muscle, for example.
I ended up contacting the ENT surgeon who performed my surgery for his opinion" he said here is "no data" to support what my ENT said on that one point.
So... instead of feeling time pressure to rush into getting a hearing aid, I am taking my time (ha ha, it's been 8 mos.) to assess and see if the problem worsens- yet I'm still a teensy bit anxious that by doing nothing, I may make it worse!
Has anyone encountered this argument/explanation - re: reasons for getting a hearing aid - before?
THank you!
Sis is S.Carolina
     

[NF-2er]

Hello Sis in SC!

   I've read what your ENT & neurosurgeon said about lack of stimulation and worsened hearing loss. Obviously it must be a bit controversial.
   This is just my feeling, but I agree with your ENT. There are tiny muscles and bone ( ossicles ) in your middle ear of which it seems prudent ( to me at least ) to stimulate, thereby stimulating the auditory nerve also. The ENT was thinking about only the nerve, it appears.
   Re, word discrimination, a hearing aid will brighten sound and make one be better able to hear in certain situations, but from what I've learned and been told repeatedly, a hearing aid will absolutely not increase word discrimination.
   Is it speculated the loss is related to your surgery? That wouldn't be uncommon, but more common, and still not common, two years after radiation.
   Re, non stimulation, I wonder if this isn't a bit like, "use it or lose it"?
   I wonder if it's not a good idea to have another audiogram in 6 months and re-assess?
   Also, not to forget the small regrowth potential of AN.
   Best wishes!

   Russ

Hi, all. I haven't been to this board in a long time, but it is good to be back and read the topics. Several of you helped me repeatedly with info. and encouragement (thank you again!) pre-and post-op since 2004 which is when i had my middle-fossa removal of a smallish AN. Anyway, my outcome continues to be good, overall, physically and mentally. But... last Dec. I had a hearing test for 2 yr. followup to surgery, and the test showed significant decline in my speech recog. in the affected ear since surgery. The ENT I saw that day - not my reglular one - recommended I consider a hearing aid. I fully understand the normal advantages of doing that, but did not understand his additional contention that a hearing aid will also help to slow down, or forestall, further loss of hearing b/cause the hearing aid 'stimulates' the hearing nerve. He sort of clarified by saying that a nerve that is understimulated will continue to decline with age, and a hearing aid will boost the level of stimulation the nerve will get. I understnad that, literally speaking, but it still doesn't seem correct that a hearing aid can forestall declining nerve function, as excercise does for a muscle, for example.
I ended up contacting the ENT surgeon who performed my surgery for his opinion" he said here is "no data" to support what my ENT said on that one point.
So... instead of feeling time pressure to rush into getting a hearing aid, I am taking my time (ha ha, it's been 8 mos.) to assess and see if the problem worsens- yet I'm still a teensy bit anxious that by doing nothing, I may make it worse!
Has anyone encountered this argument/explanation - re: reasons for getting a hearing aid - before?
THank you!
Sis is S.Carolina
     

[sreda]

Hi Russ,
 Thanks for your reply to my ?. Yes, the speculation is that afteraffects of surgery - even scar tissue that grows along the affected nerve(s) - may be responsible for decline is this area.
Yes, I agree - another hearing test is in order to see if speech discrin. is steady or has worsened.
And very intersting to me is the report that a hearing ad may not aid speech discrim. I will dig further! Thanks again!
Sis in SC

[sgerrard]

My ENT/otologist said two things to me about my hearing loss that might be of interest to you.

One, that getting a hearing aid would help retain whatever hearing I still have after treatment. I don't know if it is just an old wive's tale, or has some medical basis. Besides the nerve itself, there is the whole hearing apparatus to consider.

The second thing was that removing the tumor, even if the hearing nerve is functional right after surgery, can lead to further loss because of the dramatic change in the blood supply to nerves that results. By the time you have surgery, the nerve is depending on the tumor for part of its blood supply, since the pesky AN has hijacked some of the supply. Removing the tumor can reduce blood flow to the nerve, and to the cochlea itself, reducing hearing.

My ENT sent me to a vestibular lab, where they did ABR tests that measure the signal in the hearing nerve. It showed that my nerve was functioning well, suggesting that some of the hearing loss may be due to "cochlear ischemia", which is reduced blood flow to the cochlea. You might see if your ENT would refer you for these tests, they might provide useful information on the condition of your hearing nerve, separate from your overall hearing as measured by the audiogram.

If it were me, I would get a hearing aid anyway if possible, just to get the extra hearing while it lasts, even if it did continue to decline. But I'm headed for two of them anyway, sooner or later.

Best wishes, Steve

[aardvark]

Hmmmmm....   that's really thought-provoking, Steve.  About the hearing nerve being denied a portion of its blood supply when the tumor is removed, I mean. 

Could one extrapolate that the same thing happens when a tumor is killed by radiation, even though it's not removed from the premises? 

[sgerrard]

I also thought it was pretty interesting when the ENT said that. I would think the same would apply to radiation, but with one big difference: with radiation, the loss of blood supply from the tumor is more gradual. I would expect that the nerves would have more time to develop new connections as the tumor ones died off, so the overall impact might be quite a bit lower.

Steve

[sreda]

Steve, what a thoght provoking and interesting explanation. Thank you for sharing what you learned from your ENT. I find this much easier to digest than what I was told direct; and I will explore it.
Thank you,
Sis

[Dana]

Another input about all these questions --  the audiologist who did my original hearing test (before diagnosis of my AN) suggested that I get a hearing aid "sooner rather than later" because "there's some evidence" that use of a hearing aid helps you keep your speech discrimination abilities sharper.  He said that speech discrimination is a brain function, not really just an ear function, so that if you hear better with use of a hearing aid, the brain better retains its 'sharpness' at speech discrimination.  The brain gets out of the practice of discriminating clearly if your hearing declines.  That might be what the ENT was trying to say.

It made sense to me, so I'll be pursuing a hearing aid soon.
Ciao,
Dana

[Boppie]

Dana, I have been following this thread.  I have to agree with you... I discussed this idea of speech recognition with my audiologist during the first hearing aid evaluation.  She told me that many older "hard of hearing" folks have forgotten so much about sounds of consonants and word endings that they have a very difficult time adjusting to the newfound help from an aid.  Many of these people give up on their aids and expect a refund.  It can take several weeks for the brain to recognize speech sounds if the hearing has been "dormant" so to speak. 

So, it makes sense to keep the brain busy and actively processing speech as long as possible.  I tolerated my deaf ear for 9 months and then purchased the TransEar.  I didn't want to wait longer.  I have a small loss in the upper range in my one good ear.  So, it is important to me to "gather my resources" with a hearing aid for the deaf side.

[Windsong]

This thread is interesting in all sorts of ways. For one it seems that not having enough stimulation in hearing (i.e. sound) can negatively affect hearing. (how many of you have had a hearing place tell you that you should keep sound around in your environment).  Then again, there are those here who suffer from times when sound is gosh awful and hurts. In fact have a hard time dealing with boom boxes in a car next to theirs (i have had this happen and it's awful)... so that's called hyperacusis and I still don't know how to "cure" that.  Then there are those who have some tinnitus in the earlier stages which is not all that hard to cope with. ( it becomes  a kind of background noise...until it goes into a cacophany of sound that is worse than opera at a loud volume  and distorted... and hey I love opera) Then the tin gets really bad in various stages and length of time with having an An. (ringing telephones are only one thing here) ... and so it goes on.....

The blood vessel aspect is interesting also.  What nurtures the growth of an An? Blood vessels? Something else? Yes, blood vessels  are cut in surgery and I guess that blood vessels are also changed more slowly with radiation treatment.

Hearing is really strange when one loses bits and pieces and hears weird sounds in the tinnitus.

I suppose word endings and consonants are in a different frequency hearing-wise than the rest of the word(s). Aners do lose hearing in different frequencies. It can really garble sound.... that probably explains why some voices are heard and others are as if they under water and wavy.

The good thing is that hearing research has gone beyond looking at hairs and such and is looking at all the other stuff that goes into hearing perfectly. (why else would we have bone conduction hearing aids...

It's true that hearing is made up all sorts of things. I can still remember as teen ager dancing with a deaf person who danced so well that I was amazed when he said in answer to a question from me that he could do it by feeling the vibrations from the floor.....

It would be a wonder that any hearing aid could deal with all the things that can happen in loss of and change of and distorted thing of hearing....

Good to see this thread.

W.

[sgerrard]

  My father went through the experience that Boppie described, of trying hearing aids, and wanting to return them because he couldn't get used to them. He did get them again later, but only uses them for certain situations. I'm sure it was because of the trouble with word recognition.
  I wonder if it would be different with just a single ear. The good ear should still be sending in all the right signals, so the word recognition system chould still be getting its exercise from the good ear. But it might also be that if the brain gets poor signals from the bad ear, it tends to want to ignore that ear, even to encourage it to shut down. Something like the way the balance system compensates for poor signals from one side by focusing on the other side.
  So the recommendation from Dana's audiologist makes sense to me. Get a hearing aid to keep your speech recognition sharper, even if it doesn't keep the nerve itself stronger. Even though my word recognition on the AN side is down only a small amount, I can already notice that if I try to listen to speech with that ear, it is harder to make out words. This discussion is making me think that if I retain some hearing on that side, I should get a hearing aid for it shortly after treatment. I think I will put that on my Christmas list.
  The blood supply concept also makes sense to me, because I have read about research on controlling formation of new blood vessels in tumors, especially cancer. The official term is "angiogenesis", and Googling that will get you all sorts of links and explanations.

Steve

[Boppie]

I think it works this way for SSD...When the hearing nerve is severed (as in Translab) the brain will depend on the good cochlea side for hearing. There isn't any compensating help coming over from the dead side.  When my bone conduction aid was introduced (after 9 months of Right total deafness ) it took a month or so for my brain to recognize and make sense of the sounds coming into my good left ear from the dead side. There is a wonderful AHA moment when this occurs. 

 

[Boppie]

Yes, in the science of speech we know that certain consonants make higher frequencies, mainly the sibilants (s,sh,z,sh,j,,&ch).  Then there are the soft sounds of b,d,p,m,n,etc.  Language is a challenge to the hard of hearing. 

I have noticed lately that when people speak to me I unconsciously analyze their consonants and think they have an impediment.  I still forget to take off my teacher's hat.   How could I know if they sound right with one dead ear and high frequency loss in the good ear?  I am a new learner!