Tag: audiologist

CROSSSD Study – You Can Help with Vital Research!

logo-CROSSSD (2)

I recently came across an interesting research project, whilst browsing on Twitter. The purpose of the study was to help develop the research of treatments of single-sided deafness (SSD), making it easier and quicker to find out which treatments work best and why.

As someone with SSD, who has been unsuccessful in finding an aidto help overcome the difficulties imposed by this type of hearing loss – namely challenges in localising sounds and understanding speech in noise – I was keen to do whatever I could to help support this research project.

The study is part of a PhD being undertaken by the audiologist and researcher, Roulla Katiri, and is supported by the National Institute for Health Research (NIHR), Nottingham Hearing Biomedical Research Centre (BRC). I wasn’t sure whether I would be able to participate since I am currently living in Spain and the project is based in the UK. So, I sent a message to Roulla to see if there was anything I could do to help. Roulla’s reply was simple and clear – since I have been diagnosed with SSD over 12 months ago and have trialled a hearing aid, I was a perfect candidate to take part in the consensus.

Here’s a little bit more about the study…

The purpose of the study is to develop a common set of ‘outcomes’ to help researchers decide whether a treatment works. In the field of treating SSD, ‘outcomes’ are the things that should be measured when deciding if a hearing aid or an auditory implant is effective.

Examples of ‘outcomes’ are:

  • The ability to localise sounds
  • The impact of SSD on quality of life
  • The ability to hear in noisy places such as restaurants

Different research studies often measure different outcomes, meaning it can be difficult to compare or combine measurements. This makes it hard to identify which treatment works best. If all future studies measure the same common set of ‘outcomes’, research can be moved forward faster.

This is all explained really nicely in this short video (2:19 running time):

The information gathered from this study will help others with SSD; and audiologists, like Roulla, to be able to recommend the best treatment for SSD, when considering the individual requirements of their patients.

My experience completing the study…

As a participant, I was provided with very clear information about the purpose of the study, how to complete it, and how my information would be used.

The survey is comprised of tables of outcome statements like the one shown below:

Snapshot 1

All I had to do was score the outcomes as to how important I felt they were to measure, for SSD treatments according to my own experience. To do this I was required to select a score on a 1 – 9 importance scale, by simply clicking on the relevant part of the table.

Before completing the study I was a little concerned. This is a cause I am very passionate about, and I was worried about making the wrong selections. However, I soon realised that there couldn’t be an incorrect answer – my opinions were all that mattered. I was also slightly worried I might change my mind about some of my scores, after submitting the survey. But, should this be the case, there was going be a second round of the study, where I would have the opportunity to view a summary of the other participants’ scores for each outcome. If I wished to change any of my scores, after reconsidering my initial decision, I would be able to do so in Round Two. I really couldn’t go wrong!

The phrasing of the outcomes was easy to understand and the survey took approximately half an hour to an hour to complete. If I felt particularly strongly about any of the outcomes, I also had the opportunity to add a comment. If I had needed to take a break, there was the option to save my progress and to continue when I had time.

Who can take part?

You can help if you are:

  • A member of the public with severe-profound SSD for over 12 months
  • A healthcare professional with experience of SSD, such as: 
    • Audiologists
    • ENT doctors
    • Funders, relevant charities workers e.g. Ménière’s Society, researchers around the world who work in the field of SSD

If you don’t satisfy any of the above criteria, you can still help by increasing awareness of the CROSSSD study. You can share this blog post, or the relevant information, on your social media platforms. Or, you can simply mention the study to friends or family members who have SSD, or who know someone who does.

It is an international study. The more diverse the applicants, the better the overall representation of people will be – from all walks of life, all ages, and from around the world. If the survey is completed by people from a wide variety of different backgrounds, this will give researchers a better understanding of the key outcomes that will help provide effective treatment for the greatest amount of people.

A final note…

It’s so great that this research is being conducted and I am really happy to be able to help contribute to this study and to give my opinion on what really matters regarding treatment for SSD.

The unique challenges that come with living with SSD are not limited to hearing difficulties. People with SSD may also be living with other related issues such as tinnitus, sound sensitivity and fatigue. Those affected may experience psychological and social issues due to difficulty following conversation, which can make communication at social events exhausting, causing stress, anxiety, and reduced self-esteem. Hearing difficulties and mental health issues can also put stress on professional and personal relationships. And, possibly the most difficult issue is that SSD is invisible; people with SSD may feel alone and isolated in their daily struggles.

Please, take a moment to share this post or the information below. And, if you satisfy the criteria to participate, please take the small amount of time to complete the study. It’s quick. It’s simple. Your help could vastly improve the lives of people with single-sided-deafness.

For more information, visit the following website: www.nottingham.ac.uk/go/CROSSSD

Or contact Roulla to register your interest: roulla.katiri@nottingham.ac.uk

The study will close beginning of November 2019.

My New Ear

A week later I returned to the private hearing healthcare centre to receive my Contra Lateral Routing of Signal (CROS) hearing aid; my new ear!

The audiologist came to greet me, and she took me into the room with the desk, where I had previously had my consultation the week before. She introduced me to another man who was going to be my translator. On meeting him, I did not feel the immediate sense of trust, or reassurance that I had felt with my previous translator. I asked him if he would like to sit down next to me, and he declined; choosing to spend the entire time standing up near the door, where he paced around a small area of floor, occasionally pausing to lean against the wall.

Immediately I was shown the hearing aid. The CROS hearing aid helps one ear, yet comes in two small parts: a single microphone and a single receiver contained in two individual devices. They were the sandy brown colour I had chosen with the guidance of the audiologist. They were very small with clear little tubes and buds on either end to fit into my ear. The first thing the audiologist showed me to do, was how to insert the batteries. She opened a small compartment, pulling gently at the bottom of the aid, and carefully placed in the circular battery. She peeled off the protective sticker that was covering the battery and told me that as soon as the paper was off, the battery would start to use power. I then took the other hearing aid to insert the battery, and copied her demonstration carefully. She told me to open the battery compartment when I take the aids out at bedtime, so as to reduce the power drainage. She fitted them both into my ears, and they were connected to wires and her computer. She then played sounds into my good ear and I had to do the usual test of putting up my hand when I could hear the beeps. Then she did the test of my deaf ear. There was a constant noise that sounded like a fan in the room coming from somewhere I couldn’t identify, and also background noise of people talking outside. It was difficult to focus. I could hear some of the beeps. I occasionally put my hand up when I thought I could hear something but wasn’t sure; due to the background noise distractions. But I could hear some quiet beeps, which was an improvement. She asked me how the hearing aids felt, and I told her that the sounds seemed to be a little too loud. She adjusted the program on the computer and the volume of the hearing aids reduced.

The audiologist then challenged me to insert the aids into my ears, without help, and she handed me a mirror. The right hearing device fitted easily into my ear. The left side, however, proved much more difficult. Since losing my hearing I have noticed a change in the shape of my left ear. If I put my finger in my ear as far as the little piece of cartilage that covers the entrance to my auditory canal, it feels as though the bony floor of my ear is raised. Hence the small hole that leads to the rest of my ear seems very much reduced in size. I used to wear foam earplugs in my ears at night to sleep with, as I am a very light sleeper. The earplugs used to mould and fit easily into my ears and would stay in place all night. Now, when I try to put a plug into my deaf ear, it is difficult to find a successful position to insert it, and it almost always very quickly pops back out. I failed twice at trying to fit the ear mould of the hearing aid into my left ear. My ear was now red and my hands were shaking nervously as the audiologist and translator watched me intently. I figured out that I had to push the fitting down and then upwards whilst twisting it at the same time, to make sure it was fitted correctly inside my ear. When fitted, the hearing aids could hardly be seen, and the audiologist told me they were invisible.

The translator asked me how I had lost my hearing, and I told my story yet again. He asked the usual questions: Why did it happen? Was I receiving treatment for the pressure? How long ago did it happen? He asked me what my expectations were of the hearing aid: When are my difficult times? How do I think the hearing aid could help me? He commented on how I wasn’t a ‘typical’ customer, who he described as old, with some hearing loss in both ears. He kept telling me to not expect too much. I know that it would have been unprofessional of him to raise my hopes, but he was doing the opposite. He was making me feel naïve in my understanding of the magnitude of my situation. I wonder if he realised how far I had come in my story. I wonder if he realised how much effort and courage it had taken to walk into the audiologists, make the appointment and talk yet again about what had happened; all in a foreign language… and still keep a smile on my face whilst speaking to them.

With my hearing aids in place, I said my goodbyes and thanked the audiologist and translator for their help. I was to contact my audiologist if I had any questions or needed any help with anything. My next appointment would be in a months time. I was to use the hearing aids for 2 or 3 hours each day for the first week, unless they felt OK, in which case it was fine to wear them all the time through the day.

I left feeling less optimistic than after my first appointment, but I was still hopeful.

The walk home was a noisy adventure. The beep of the traffic lights sounded uncomfortable and distorted. I walked past a big group of students who were all talking and who sounded like screeching bells. At that point, I remembered what an old friend of mine told me when he first received his cochlear implant. He told me that the chirping of birds sounded like bells, and the noise of peoples voices sounded like Mickey Mouse. I knew this wasn’t exactly the same type of circumstance, but it was similar. I was sure it would take time to adjust to the new types of sounds I was hearing through the hearing aid. I spent my time on the walk home, pressing the volume button up and down to see which level felt most comfortable.

When I arrived home I didn’t really know what to do with myself. I think I was feeling a little bit in shock. I was also feeling some disappointment due to the fact that the sounds from the aids were making me feel very uncomfortable. I was scared they weren’t going to help me. I was still hopeful though. I was home alone and wanted to test my new ear by talking to someone.  I kept trying to test the hearing aids out. I clicked my fingers near to my ear, but couldn’t hear the sound. Then I tried playing a YouTube song on my phone – Don’t Think Twice Its Alright, Bob Dylan – holding it to my deaf ear, as if it was a phone call. I could hear some of the song, but I wasn’t sure which ear I was hearing it in though. I wanted someone to call me on my phone to try out my new ear. I waited for my boyfriend to return home from work, eager to have a conversation with him.

Testing and Hope

Less than a week following my consultation with the new specialist, I went to meet with a private hearing healthcare professional to discuss hearing aid options. When I’d made my appointment I had asked if there was anyone who spoke English. My hearing loss in itself has brought communication difficulties. Trying to manage it and to make advances with consultations in a second language has added extra challenge; an extra layer to tackle and deal with. The receptionist said she only spoke a little English. I wasn’t sure if I had managed to convey my question clearly as to whether there was an audiologist who I could consult with, in English; not whether she, the receptionist, spoke English. Of course, I am trying to learn Spanish and always try to communicate with people in shops, restaurants and cafes in Spanish. But when discussing something as important as my health, and what could possibly also be a big investment (hearing aids can be very expensive), I wanted to make sure I had the optimum chance of comprehension and the ability to ask questions and to communicate my needs and feelings successfully.

I arrived alone and very nervous. Not only was I anxious at the prospect of yet again trying to convey, in Spanish, the fact that I had ‘suddenly’ lost my hearing in my left ear, but also because this was the first step to a possible big change in the way I live my life. I was admitting to myself, and making peace with the fact, that I wasn’t going to be able to hear again in my left ear. I hoped to gain some support. I hoped to gain some closure. I was also putting myself again, in the vulnerable position to perhaps be told that there would be nothing I could try that could help.

I sat in the waiting room, for about 5 minutes, and then was greeted by a friendly looking Spanish woman in a white jacket who said ‘hello’ to me in unconfident-sounding English. A man followed the woman, and he shook my hand and greeted me with a much more comfortable version of ‘hello’.

I was led directly into a hearing testing booth. The woman who I assumed was the audiologist, went through the door to the other side of the booth, and sat opposite me; observing me through a transparent screen. The man came into the room with me and began to explain the procedure in English. I was incredibly relieved – this man was here solely to translate for me. He explained that they were going to do different hearing tests to see if there was any type of hearing device that could help me. The man then joined the woman on the other side of the glass. Next proceeded a series of different tests.

I carried out the usual Pure Tone Audiometry hearing test; raising my hand every time I heard the ‘beep’ sound in my hearing ear. The man gave me a thumbs-up gesture after my first test – the testing of my right ear. Then they tested the left (deaf) ear. As usual, they had to play the sound of wind into my good ear, whilst testing the deaf ear. My head was conducting the sound. My good ear could hear the sound that was being played into my bad ear, when there was sound played at loud levels.  The wind noise was to distract my good ear from hearing the sound and confusing the results of my left ear. As usual, I could only hear a few beeps. They then carried out the Bone Conduction test. This tests how well sounds transmitted through the bone are heard. As usual, I could not hear anything for this test, in my left ear. Next, they did a Loudness Discomfort test. For this test, the audiologist played increasingly loud sounds into my ear, and I had to say when the sound was uncomfortable. I was glad they were carrying out this test; one which I hadn’t previously done. I had been struggling with everyday sounds, and my tolerance of noise, especially when loud, was noticeably lower than before I lost my hearing. I guess it is important for audiologists to perform this test when deciding on appropriate hearing aids: since hearing aids amplify sound, the audiologists need to ensure this sound is within the comfortable range for their customers. Next, they performed a Word Recognition test which tested my ability to correctly repeat back words at a comfortable loudness level. The audiologist said words and I had to repeat them. The words were in Spanish, and I joked that it was like a Spanish language test. They assured me jokingly that I wouldn’t be marked on pronunciation. I carried out the test, in a language that I am still learning; I struggled with the rolling of my r’s for some of the words.  My right ear seemed to cope with this test with ease. My left ear struggled. All I heard in my left ear were some distorted noises; high pitched and mostly two syllables.  I couldn’t relate the noises to letter sounds or words. I couldn’t verbally make the strange noises I was hearing. I just shook my head after each distorted word. Then the audiologist changed a setting, and I could hear every word she said in my left ear! It was an extremely painful level of loudness and seemed high pitched. But I could hear, and this was amazing! I was hearing words! Brimming with emotion, I repeated back, in my best Spanish, the words she was saying. The audiologist and translator spoke to me through the glass about how the audible sound in my left ear felt. I told them that it was wonderful to be able to hear, but that it was very uncomfortable.

Next, we went into a room with a desk, and the audiologist and translator spoke to me about what they thought would be my best option. The audiologist told me that the only option she thought that would work for me would be a Signia Siemans Pure Contra Lateral Routing of Signal (CROS) hearing aid.  I was told that as there was only the tiniest bit of hearing in my left ear, they couldn’t promise it would be a great help. But they said they might be able to get me 30 per cent hearing…maybe 40 per cent. The main benefit would be that I would have more chance of being able to hear better in background noise. Using this technology, a hearing aid-like device on my deaf side would use its microphone to pick up sound from that side and send it to another instrument at the better ear; wirelessly via Bluetooth. The sound would then be introduced into the good ear. Wow! It sounded perfect! They showed me an app I could get on my phone that I could use to change the settings. If I was in a restaurant I could make the microphone focus on where the people were sitting, e.g. if they were positioned in front of me, I could press the corresponding areas of a diagram on my phone, and the microphone would focus on these areas. There was a setting for music. If I wanted to go to a live music show, I could press a button and it would pick up the music in surround sound. I told them I would like to try the device, and they asked me what colour I’d like. I hadn’t even thought of this! I asked the audiologist’s opinion, and she suggested one that matched my hair colour.

I had moulds taken of my ear and was given an appointment for a week later, where they would fit the hearing aid and show me how it works. I would be trying to use it for an hour or so each day, and then increase the time every day, and would have regular updates with the audiologist.

Finally, some hope.