AUDIOLOGY PROFESSIONAL DEVELOPMENT NEWSLETTER-OCT 2018
Binaural interference: Are two ears always better than one?
The short answer is almost always yes when hearing is normal in both ears. However, when one ear is affected by an ear or hearing condition, it may not be as staright forward. Consequently, audiologists have to be consicous of ear conditions that may imply that giving their clients one hearing device is sometime better than two.
The common reasons why an audiologists will choose for one device are discharging ear or other middle ear issue on one side, acoustic neuroma, unilateral auditory neuropathy, asymmetrical hearing loss with suspected dead regions in one ear; and/or a phenomenon know as binaural interference.
Binaural interference refers to the phenomenon in which the potency of binaural cues conveyed by a “target” stimulus occupying one spectral region is degraded by the presence of an “interferer” stimulus occupying a spectral region remote from the target.
Jerger and Silverman (2018) have illustrated this handsomely in their very latest book with subjective and objective findings (correlates involving late auditory potenials and cortical evoked responses). The knowledge of it, however, has been in the literrature for at least about 80 years now when Knudsen (co founder JASA) first referred to it in his seminar paper ‘An ear to the future’ in 1939. There has been considerable research in last 40 years or so.
The first level testing tecnique is to measure Quick SIN scores via soundfield (with speech and noise spatially separated rather than headphone testing) in monoaural (by plugging the non-test ear) and binaural conditions along with administration of speech spatial qualities questionnaire. Any suspicions of binaural interference should be referred for further testing for dichotic listening assessment and objective electrophysiological testing, where indicated.
Furthermore, field trials (Cox, 2012) have indicated that up to 46% of the subjects preferred to use one hearing device rather than two and contrary to conventional wisdom, audiogram and auditory lifestyle may not be predictive of aiding preference for up to a third of clinical population. Therefore, clinicians are encouraged to think holistically about thier hearing care pathways that work for each individual rather than a group.
Non-invasive, zero cost, and self-administered therapy for tinnitus due to Middle Ear Myoclonus (MEM)
Rhythmic objective tinnitus may be present due to glomus tumours, vascular anomalies such as vascular loop, or palatal myoclonus associated with central pathology: brainstem or cerebellar vascular, infectious, demyelinating disease, tumours, trauma, iatrogenic surgical complications or aneurysms, or middle ear myoclonus.
Myoclonus refers to the rhythmic jerky contraction of a muscle or group of muscles e.g. Hiccups are also a form of myoclonus. Middle Ear Myoclonus (MEM) is a rare form of objective tinnitus can occur in the two smallest muscles in the body behind the eardrum and in front of the cochlea namely, tensor tympani and stapedius.
Tensor tympani myoclonus makes noises like thumping of a drum or clicking. It is generally faster than pulse and could be as much as 90-100 times per minute. Most of the times the vibrations are visible on the eardrum.
Stapedius muscle myoclonus can usually be heard as high frequency tic, crackling, or buzzing noise in the ear; and is usually audible to examiner. Stapedius muscle spasms may be recorded during reflex decay test using a tympanometer in the form of bumps on the trace.
Lastly, irritability of the 8th nerve can cause an intermittent tinnitus representing itself as a staccato quality (‘like a typewriter in the background, pop-corn or Morse code’), known as typewriter tinnitus.
Pharmacological treatment of the middle ear myoclonus does not have convincing evidence. However, typewriter tinnitus is responsive to carbamazepine. Botox injections in the middle ear have been reported to help in some cases. Surgery is tried as a last resort where the middle ear muscles are divided. Tinnitus retraining, sound enrichment, cognitive behavioural therapy, and mindfulness training are useful.
There is an interesting paper on non-invasive, self – administered zygomatic pressure technique that showed some promising early results. Although it is difficult to generalise this management approach however, with zero cost involved, it may be something easy to try in cases of middle ear myoclonus. The details are available in the below full text reference:
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4. Ending 40-year quest, scientists reveal ‘hearing’ protein
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Jay Jindal is a highly qualified independent audiologist, specialising in hearing care for both children and adults, auditory processing disorders, balance & dizziness and tinnitus management. His clinics are in Bromley, Orpington, Sevenoaks, Tunbridge Wells and Maidstone.
Jay speaks on various audiology related topics at national and international events. He also organises world class paediatric and adult audiology events with speakers from all over the world via www.audiologyplanet.com
Jay is associated with several national bodies related to audiology, which have a great influence on how the hearing healthcare services are provided in United Kingdom. He is the Professional Development Consultant for British Society of Hearing Aid Audiologists (BSHAA) which is the professional body of hearing aid audiologists in UK and has around 1600+ members. He is also a member of the prestigious national level Document Guidance Group of British Society of Audiologists (BSA). This group produces guidance and recommended procedures that are used by audiologists in the NHS and independent clinics throughout the UK. He is also a member of regulatory body’s (Health and Care Professional Council) fitness-to-practice panel formulated to investigate the malpractices of hearing aid audiologists