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ADVERTISING SUPPLEMENT Published Friday August 23, 2013 m a n a gi n g THE GROWING SILENCE AMONG BOOMERS P3 HEARING LOSS FACTS AND MYTHS DEBUNKED P6 IN THE 21ST CENTURY WHY WORKPLACE NOISE COSTS EVERYONE P12 Hazard in almost all workplaces m an ag in g Editor: Louise Allan Design: Michelle Nunn Advertising: Eithne Healy 9482 3559 2 IN THE 21ST CENTURY This special magazine has been developed as a joint initiative of the Australian Institute of Occupational Hygienists (AIOH) and The West Australian. The AIOH is the professional body representing 1100 members nationwide who are found in industry, government departments, universities, consultancies, and equipment and service providers. Its primary focus is to strive to deliver a healthy workplace. Occupational hygienists do this by following the steps of recognition, evaluation and control, and applying these elements to physical, chemical, biological and ergonomic hazards in the working environment. Occupational hygienists have a strong interest in the management of noise – a physical hazard – because of its pervasive and impactful nature, and because it is present in almost all industrial workplaces. This liftout is intended to lend support for the activities that will take place in the coming days as part of National Hearing Awareness Week from August 25 to 31, an initiative of the Deafness Forum of Australia. While there are four million Australians who suffer from significant hearing loss, there are many others in the form of workmates, family, friends and casual acquaintances who are impacted in their dealings with those individuals. Communication difficulties may give rise to a breakdown in relationships, mistakes, annoyance and frustration and safety issues at work or at home. So, hearing loss affects everyone and hearing loss is everyone’s business. The following articles have been prepared by experts in their respective areas, drawn mainly from the fields of occupational hygiene, audiology, science and engineering. The intention is to cover the recognition, evaluation and control elements of noise management – the impact of noise on hearing, the measurement and assessment of noise levels and hearing loss – and importantly the solutions that are available in today’s world. By Dr Barry Chesson Immediate Past President, Australian Institute of Occupational Hygienists Warning signs of an invisible injury It has been called the most common permanent and preventable occupational injury in the world, according to the World Health Organisation. Yet hearing loss due to loud noise often goes undetected for years. In fact, victims often deny they have any problems: “My hearing is fine...you just need to talk louder!” Here are some of the characteristics and early warning signs of noise-induced hearing loss: • Causes no pain. Unlike most other workplace injuries, hearing loss due to loud noise is painless. If someone complains of pain in their ears, it is often due to medical causes such as infection or inflammation, unrelated to the noise exposure. • Causes no visible trauma, leaves no visible scars. The ears do not bleed nor bruise when they suffer a loss. Since damage from loud noise affects the receptor cells of the inner ear, the outer ear, the part visible when you look in the mirror, shows no signs of damage since all of the damage is internal. • Unnoticeable in its earliest stages. Receptor cell damage from loud noise is immediate, but it is often so minute that it is not noticed. It takes years of accumulated loss to notice a change in hearing, and by then it is too late. • Permanent hearing loss. When people lose hearing due to loud noise, it is most often a permanent injury. There is no medication, no therapy and no surgery that restores normal hearing after injury due to loud noise. • Clarity is affected more than volume. Hearing loss due to loud noise does not cause a sudden drop in volume of sound. Instead, most victims notice a gradual but significant decline in the clarity of sound. The most common complaint of a person with noise-induced hearing loss is, “I can hear you, but I just can’t understand”. • Tinnitus replaces hearing. Tinnitus is a noticeable ringing or rushing sound in the ears and is the accompanying symptom most commonly associated with noiseinduced hearing loss. A little bit of ringing in the ears is normal in most people, where it comes and goes sporadically, but those with a noise-induced hearing loss have continuous ringing that can be quite debilitating at times. While hearing loss due to loud noise is painless, progressive and permanent, it is also preventable when proper hearing protection is used in hazardous noise. By Brad Witt Director of Hearing Conservation, Honeywell Safety Products Did you know? The smallest bone found in the human body, the stapes, is located in the middle ear and is only 2.8mm long. The ear’s malleus, incus and stapes (otherwise known as the hammer, anvil and stirrup) are the smallest bones in the human body. All three could fit together on a five cent piece. Have you been told there is “nothing that can be done about it” Come and see us – we specialise in the assessment and management of tinnitus PH: 08 9388 8003 I www.hearingandaudiology.com.au I Subiaco Duncraig Geraldton Karratha 2065580ϖSLEH230813 Do you have ringing in your ears? Baby boomers’ growing silence Hearing is such a precious sense that losing it significantly affects quality of life. I remember well my mother’s hearing aid transforming family life when she lived with us. She was far from unique. Hearing impairment is an incredibly frequent problem affecting 360 million people worldwide. It affects more than 3.85 million Australians – one in six – and is predicted to impact one in four by 2050. The ageing of the baby boomers As baby boomers move into retirement, the 65-84 age group will grow 3.5 per cent each year over the next decade. There will be 6.4 million Australians over the age of 65 by 2051. Due to the loss of hearing that gradually occurs in most individuals with age (termed ‘presbycusis’), this population cluster will dominate use of the hearing health care system. A relationship between cognitive decline and hearing loss My mother was lucky to be sharp as a tack but older adults with hearing loss also have a rate of cognitive decline up to 40 per cent faster than those with normal hearing, according to a recent study in JAMA Internal Medicine. While this link is not yet fully understood, the possible impact of addressing hearing loss has the potential to be greater than hearing related quality of life improvement alone. While the study authors noted that not everyone with hearing loss will suddenly develop dementia, it appears that poorer hearing exerts some additional influence on cognitive ability. As the population lives longer, over decades this effect could become increasingly noticeable. m an ag in g 3 IN THE 21ST CENTURY It is theorised that when listening becomes more challenging with hearing loss, our brains must work harder and the increased demand has long-term consequences for brain health. Alternatively, it might be that decreasing sensory input deprives the brain of information and in turn, brings about longterm changes in brain function. Don’t suffer in silence Hearing impairment can occur for lots of reasons: loud noise, infection, disease or with ageing. Regardless, hearing checks should be part of a regular health regime especially for baby boomers, similarly to that of dental or eye examinations. There are benefits readily available with early identification and intervention, and appropriate management for the majority of people with hearing loss. Devices such as hearing aids, assistive listening devices and cochlear implants, and services that include social support, are accessible and have the potential to be life changing. We should make the most of the advances science offers and all try to stay ‘tuned in’. Professor Lyn Beazley Chief Scientist of Western Australia Hearing Awareness Week 2013 Sunday August 25 to Saturday 31, 2013. How loud is to loud? Hearing Awareness Week is an annual event it provides an opportunity to raise community awareness of hearing impairment and ways to protect your hearing. Deafness Council WA Inc was established in 1974 and is a coordinating body whose role is facilitating the work of Deaf and Hearing Impaired people and agencies. Deafness Council has been involved in the promotion of Hearing Awareness week since 1979. On Monday August 26, 2013 Deafness Council WA will host the Inaugural Hearing Awareness Week Keynote Breakfast, this years keynote speaker is Senator Rachel Siewert. Senator Siewert chaired the 2010 Senate Inquiry into hearing health in Australia (“Hear Us”) and will reflect on how far the Committee’s recommendations have been implemented and unfinished business that will confront the next federal government after the upcoming election. Followed by AWARD PRESENTATIONS for the Dr Harry Blackmore 2013 Award and the Better Hearing Australia Clear Speech Award 2013. When: Friday August 30, 2013 Time: 9am -12noon Address: 33 Giles Road, Padbury Contact: Christine Lee E: [email protected] P: 94026403 RSVP required for catering purposes Morning Tea provided www.waide.wa.edu.au For further information contact Deafness Council Western Australia Inc on: [email protected] or call Marisa 0414 853 365 2018743πSLEH230813 The WA Institute of Deaf Education has moved to its refurbished Padbury facility at the Statewide Services Centre and invites current and prospective parents and guests to visit and view the new premises on: m an ag in g 4 IN THE 21ST CENTURY Controlling the issue at federal level Workplace noise remains the most pervasive occupational hazard leading to hearing loss, and in turn can cause incidents ranging from misunderstood communications through to fatal outcomes. In 2012, a new legislative package was introduced at a national level to deal with occupational health and safety. The act and regulations are supported by codes of practice on a variety of topics. For noise, the code provides a step-by-step guide on all aspects of managing the issue. The regulations call up an Australian Standard (AS/NZS 1269-2005 ‘Occupational Noise Management’), which then becomes part of the legislation. The standard consists of five parts and details things like how to measure and evaluate noise, controlling noise, how to select hearing protectors, and procedures for conducting audiometric testing. The legislation spells out, in great detail, the health and safety duties of the various parties at work. It introduces the term PCBU for a Person in Control of a Business or Undertaking, whose primary duty is to ensure the health and safety of workers at work and others in the business or undertaking by eliminating or minimising risks to their health and safety, so far as is reasonably practicable. The regulations require that where workplace noise exceeds the exposure standard the PCBU must control the noise. In practice, this means in many workplaces hearing protectors are issued to exposed workers. It must be remembered that hearing protectors do not control the noise present in the workplace, but if worn correctly reduce the level of noise entering a worker’s ears. The PCBU provides the hearing protectors and requires workers to frequently wear them. He/she must also provide audiometric testing within three months of a worker commencing work and in any event at least every two years. A new aspect of the PCBU’s duties is the requirement to monitor the health of workers and workplace conditions to prevent illness or injury arising from the conduct of the business or undertaking. This requirement may have implications where industrial chemicals are used at work, which may affect workers’ hearing by themselves or in concert with loud noise. These chemicals have an ototoxic effect on hearing. Known ototoxic chemicals include organic solvents, such as toluene and styrene, asphyxiants such as carbon monoxide, pharmaceuticals of the chemotherapy kind, heavy metals such as lead and mercury, and organic pesticides and herbicides. The most common routes of entry into the body are via inhalation or skin absorption and to a lesser extent ingestion due to poor personal hygiene practices at work. Did you know? The roar we hear when we place a seashell next to our ear is not the ocean but the noises all around us, albeit altered somewhat by the shell. By Beno Groothoff Managing Director and Principal Hygienist, Environmental Directions Hearing loss prognosis for a clear rehabilitation path The first question on everybody’s lips after they learn they have a hearing loss is “will it get better?” There are two types of hearing loss: conductive and sensori-neural. The difference is what defines your chances of regaining the ability to hear. Conductive hearing loss, as the name suggests, is a defect in how sound is ‘conducted’ to the cochlear (hearing organ). Three common conductive hearing losses are due to middle ear infections, torn eardrums or arthritis in the bones of the middle ear. These have a good prognosis for the return of normal hearing. An ear infection can clear up by itself, or with the help of antibiotics, the skin of the eardrum can heal and the bones of the middle ear can be surgically released from the arthritis that is restricting their movement, called a stapedectomy, restoring the ear’s ability to conduct sound. Nerve cells are the only type of body cells that cannot heal themselves. Huge numbers of hearing nerves begin in the cochlear and once they die cannot be repaired. For this reason, sensori-neural hearing loss is commonly known as ‘nerve deafness’. Normal ageing of our bodies will unavoidably see the demise of some of our hearing nerves, but other controllable factors, such as exposure to high levels of noise, will cause these nerves to die in much larger numbers. Excessive noise causes a particularly devastating effect on hearing in two ways. Firstly, the hearing nerves get pounded by the noise. Secondly, when the battered and bruised hearing nerve dies it releases a chemical, causing a massacre of other healthy nerves close to it. Once your hearing professional has discovered the reason for your hearing loss there will then be a clear path forward to rehabilitation. But remember, a hearing aid is not the answer to all your prayers. Like crutches, it is but one component of a rehabilitation solution. By Ben Elsey Clinical Director, Hearing Conservation Australia m an ag in g Problems go undetected for many The moment we feel a tingle in our throat and a sniffle in our nose, our fate is sealed. We are falling sick. This usually sends us scurrying to the medicine cabinet to dose up on pills and vitamin C. How do we know when a hearing impairment is ‘coming on’ and what should we do? Recognising the symptoms of noise-induced hearing loss will allow us to identify the events that have exposed us to hazardous noise and help us to avoid those damaging behaviours in the future. Whether excessive noise exposure comes from work or play, experiencing a temporary hearing loss after coming from the workplace, concert or sporting event is a sure sign that our hearing organs have been overwhelmed with sound. Although this may return to normal by the next morning, hearing loss will become permanent if this becomes a regular occurrence. The temporary hearing loss is likely to sound very much like the permanent one we can expect, if we do not avoid over-exposing our hearing to noise. The most dramatic difficulty would be to hear high frequency sounds of speech – specifically consonant sounds like s, f, p, t, k, th, ch and sh. This will make a sentence like “take four shirts to the car” sound like “ay or ert oo the ar”. Permanent change in hearing is a gradual process, so many people don’t realise they have a problem until they begin to struggle with hearing in social situations. Most commonly, people say they began struggling to understand conversation in background noise, such as in a cafe, busy restaurant or other places where many people are talking around them. Unfortunately, by the time they experience this, noise has had a permanent and destructive impact on their ears. Another telltale symptom is ringing in the ears (tinnitus). Most people will have experienced a ringing in the ears after a loud recreational activity, such as coming home from a concert or a pub, anywhere that has music turned up, or loud sports such as motor racing or shooting. This is the body’s way of telling us the delicate structures in the ear have been bruised. Again, by the next morning it is usually gone, but this ringing is a warning sign that the ears have been overwhelmed by the noise. With repeated exposures, tinnitus can become a permanent feature rather than a temporary disturbance. Excessive noise exposure can also be manifested as recurrent headaches and increased stress or anxiety levels, although the extent to which people experience these symptoms varies between individuals. If any of these experiences sound familiar, take action immediately. If the culprit is a workplace, work collaboratively with the people responsible for health and safety to address the problem. If social activities are to blame, consider wearing earplugs on those nights spent watching a band, or go to a book club instead! 5 IN THE 21ST CENTURY Did you know? Crickets have their hearing organs in their knees while cicadas have their hearing organs in their stomachs. By Ben Elsey Clinical Director, Hearing Conservation Australia Hearing Loss and Brain Decline The level of hearing loss was directly linked to the level of cognitive decline in older adults; those with more severe hearing loss developed problems with memory and problem solving on average 3.2 years before those with good hearing. The researchers suspected that the link was caused by isolation and inactivity which sets in with hearing problems. So..........keeping our hearing good through hearing preservation and good early audiological help may be important not only to our communication abilities but also our brains. Lin, F & Polley, D. (2013). Hearing loss in Older Adults: Who’s listening? JAMA Internal Medicine, 307 (11):1147-1148. Medical Audiology Services offers comprehensive Adult and Paediatric hearing assessments; cochlear implant and Baha (bone anchored hearing aid assessments); Balance assessment, tinnitus management, hearing aids and rehabilitation; protective earplugs; assistive listening devices and much more. If you would like to receive information on a specific topic, email or call us. MAS Audiologists work closely with GP’s and ENT specialists to ensure you receive the best care. A referral is only necessary if you require a medicare rebate. PHONE 08 9321 7746 www.medicalaudiology.com.au ❘ E: [email protected]. Medical Audiology Services • 51 Colin Street West Perth WA 6005 2057134πSLEH230813 In a recent study published in the journal JAMA Internal Medicine, researchers in the U.S.A found that adults with hearing loss are at a greater risk of dementia than those with good hearing. Facts and myths uncovered on hearing impairment will surprise m an ag in g 6 IN THE 21ST CENTURY Hearing loss cannot be identified until a child is at least three years old. My hearing loss is not bad enough for me to wear a hearing aid. MYTH. Hearing loss can be identified even in newborn babies. MYTH. Many people delay getting their first pair of reading glasses until their arm is not long enough to hold the newspaper far enough away. People also put off getting a hearing aid. Often an infant hearing screening is done while the mother and baby are still in hospital, within a couple of days of the baby’s birth. If there is a problem, it can be followed up as early as possible. There is no need to clean out our ears. FACT.There is only one thing that is supposed to be put into our ears and that is sweet words. The ear is a self-cleaning apparatus and doesn’t need any help from us. Earwax, called cerumen, traps dust particles and allergens and holds them until the ear goes through its self-cleaning cycle and the earwax moves out of the ear canal all by itself. It is a misconception that, like our bodies, our ears must be cleaned to remain healthy. Prodding, poking or picking earwax with cotton swabs, keys, hair pins or fingers only pushes it in deeper, causing a disruption in the self-cleaning cycle and creating a potential blockage or worse, an infection. With the exception of hearing aids and earplugs, do not put anything in your ear that is smaller than your elbow. Meeting of minds inspires centre George Jones and Winthrop Professor Marcus Atlas met in 2005 in a seemingly usual patient-doctor scenario. Mr Jones, who has a distinguished career spanning more than 35 years in mining, banking and finance, had experienced a series of collapses and had difficulty in obtaining a satisfactory diagnosis. Professor Atlas, a leading surgeon scientist with a career-long commitment to hearing and balance disorders, held a bold vision for future research, education, training and services in addition to his ongoing commitment to the delivery of quality medical care. Professor Atlas promptly diagnosed an advanced form of Ménière’s disease, an inner ear disorder affecting both hearing and balance, and performed surgery to alleviate Mr Jones’ condition. Recollecting when they first met, Professor Atlas said he was struck by the way Mr Jones tackled the terrible problems of Ménière’s disease with a single-minded determination – quiet, well prepared, carefully researched and completely decisive. Mr Jones and his family have a strong belief that those fortunate enough to be well-off have a responsibility to give back to society. This philosophy would become a cornerstone of a new relationship with Professor Atlas and what was then the burgeoning concept of the Ear Science Institute Australia (ESIA). Following Mr Jones’ recovery, he initiated contact with Professor Atlas with a generous offer of his time, skills and the support of the George Jones Family Foundation. He became an ESIA trustee, chaired the ESIA Fundraising Committee and the now highly successful Break the Silence Capital Fundraising Campaign. In addition to a supported drive of the $16 million ESIA building campaign, the George Jones Family Foundation concluded fundraising efforts with a $3 million donation. Consequently, the world-class, state-of-theart medical research and clinical facility dedicated to hearing loss, balance disorders and ear disease, was officially opened in February 2011 and proudly bears the name of the George Jones Family Centre. Professor Atlas, who considers Mr Jones pivotal to the success of the fundraising campaign, has now achieved his vision in the completion of the facility in Subiaco. “When people get to senior positions, it’s not only money they can give, it’s also expertise, knowledge and insights as to how to get things done. When different skill sets are brought to the table, exceptional things become possible in the name of a good cause,” Mr Jones said. Two hearing aids are not really necessary. MYTH. When we hear normally, we hear through both ears. There are many benefits to having two hearing aids. It allows us to localise where sound is coming from more easily, even if it is behind us. It also allows us to understand speech and keeps the hearing aids at a lower volume than if only one was being used. I can wear a hearing aid only when I need it. MYTH. Hearing aids should be worn at all waking times. It takes time to adapt to using a hearing aid and the more it is used the faster the person will adapt to using it. If it is only used for special occasions, the person is unlikely to develop very good skills using it and is more likely to abandon the hearing aid in the top drawer permanently. However, hearing works in partnership with the language areas in the brain to understand (decode) speech. The brain is like a muscle – if you don’t use it, you lose it. Studies have shown people who get hearing aids early in their hearing loss are able to return to understanding 100 per cent of speech. Those who wait until their partner threatens to divorce them unless they get a hearing aid may only return to understanding 70 per cent of what they hear. A child is never too young to be fitted with a hearing aid. FACT. Even infants less than a month old can be fitted with hearing aids. For speech and language development of the child, the earlier a hearing aid is fitted the better. Smaller the hearing aid is, the better it is. MYTH. The best hearing aid for a particular person will not be the right one for another and size really has nothing to do with it. In fact, the hearing aids that sit behind the ear (BTEs) have many benefits over smaller versions. Firstly, they have a larger case so more electronic technology can be fitted inside, such as telecoils, bluetooth, etc. Secondly, they are able to accommodate larger batteries so they can operate for longer periods and are more powerful. Lastly, because they are outside of the ear canal and away from the two things that electronics don’t like (moisture and warmth), the BTE hearing aids tend to last longer before they need servicing or replacing. Tinnitus causes hearing loss. MYTH. It is a myth that tinnitus causes hearing loss; it is more likely that hearing loss results in tinnitus. While hearing damage from excessive noise exposure is by far the most common cause of tinnitus, it may not be the only factor. By Ben Elsey Clinical Director, Hearing Conservation Australia “I can’t do what people like Marcus can do, but if I can help in some small way with my time or with financial support then it’s worthwhile.” Professor Atlas said it had been an excellent opportunity to work with Mr Jones, who through his philanthropic efforts, had contributed to advancements in medical care and altered patient outcomes that could be achieved for many years to come. “Ear and balance science has much to thank George and his family for. Personally, I have profited by a great friendship, solid advice and endless motivation for which I’m most grateful,” Professor Atlas said. Did you know? The ear continues to hear sounds, even while you sleep. It can even still hear when you die, but the brain does not process the sound. m an ag in g Connected and yet different – the lowdown on hearing and balance Hearing and balance are very closely connected. Although their function is quite different, they share the same structure. Sound must pass between three chambers in the ear before it can be converted to a format the brain can interpret as sound. First, soundwaves in the form of pressure waves are funneled into the outer ear and onto the eardrum, otherwise known as the tympanic membrane. As the eardrum is moved by the pressure waves, it in turn moves the three smallest bones in the human body called the malleus, incus and stapes. These bones can be found in the area called the middle ear. From there, the stapes push on an area called the oval window, which transmits the sound vibrations into the inner part of the ear, otherwise known as the cochlear. Inside the fluid filled cochlear are hair cells that when moving, fire off a nerve impulse up the acoustic nerve and a sound is heard. Sharing the same fluid as the cochlear is a structure called the semicircular canals, of which there are three. Together, they are called the vestibular system. This covers all three dimensions of our movement and sends information to the brain about where our body is in space. The brain then compares this information to the information it is receiving from the other two senses of sight and touch, and collates all this information. The semicircular canals of the vestibular system are filled with the same fluid as the cochlear. When we move our heads this fluid also moves causing sensory cells to bend, which also fire an electrical impulse up a nerve to be interpreted by the brain. As the cochlear of the auditory system and the semicircular canals of the vestibular system share the same fluid, any disruption to this fluid will cause both hearing and balance to be adversely affected. The most commonly known of these disruptions is called Ménière’s disease, where it is thought that the pressure of the fluid becomes unusually elevated. This causes vertigo, nausea, hearing loss and tinnitus. Although hearing and balance share the same structure, they perform very different functions, but both of these functions can be thrown into disarray when there is a complication in their host structure. By Ben Elsey Clinical Director, Hearing Conservation Australia Is your workplace too noisy? Specialists in noise management in the resources industry. • Noise surveys • Dosimetry • Noise management and control • Noise control planning • Awareness training www.svt.com.au 7 IN THE 21ST CENTURY The simple journey to treatment m an ag in g 8 IN THE 21ST CENTURY The journey of hearing loss begins with accepting that there might be a problem. However, it is comforting to know that picking up the phone and visiting your local hearing clinic is usually the most difficult step. Remember, a hearing aid is only one solution available, so people shouldn’t be surprised if the audiologist recommends some alternative devices, such as higher volume doorbells, headphones for the TV or replacing the telephone with one with a louder volume. One of the first signs people notice is they struggle to understand people over background noise. Most often people say this is a realisation they have at a restaurant or cafe when other people around them seem to be able to follow the conversation, but they themselves are merely guessing. The audiologist may feel the patient may benefit from taking an aural (hearing) rehabilitation course, consisting of a few appointments to help the patient become aware of how to make best use of their hearing. When visiting the hearing clinic for a hearing check, if possible, take a close friend or relative along. The appointment may contain lots of detail or advice that you won’t want to forget, so it’s always helpful to have a second person there to help remember. Typically, there will be three tests. Firstly, a pure tone test, where headphones will be worn, with the requirement to push a hand button when a sound is heard. Secondly, the headphones will be replaced by something similar to a head-band women might wear to keep hair out of their eyes. Vibrations through this head-band will be perceived as sounds, and again the person being tested will push the hand button as they hear tones. Thirdly, headphones will be used to play words into one ear at a time, while ‘interference’ noises are played in the other. Once the testing is complete, the audiologist will be able to explain the results immediately, and be able to start making some recommendations if they are necessary. If a hearing aid is deemed to be appropriate, the audiologist can provide guidance to a hearing aid product that will be suitable for the patient’s type of hearing loss. The patient should remember that this is a purchase like any other, so they should be satisfied with the benefits they will receive in exchange for the price of the goods. In most cases, there is still much to be gained from having some aural rehabilitation appointments after the hearing aid has been fitted and tuned correctly by the audiologist. In a case where the patient doesn’t feel they have been served well by the health professional assisting them, they have every right to take their business elsewhere. Throughout the journey, the patient should be resourced with the appropriate assessments, quality advice and options in order for them to make an informed decision about how to combat their hearing loss. By Ben Elsey Clinical Director, Hearing Conservation Australia Noise-provoked dizziness treatable Loud noise can cause a range of inner ear symptoms, including hearing loss, tinnitus and hyperacusis. Less common is the symptom of vertigo in response to loud noise and this can occur in individuals affected by a condition called semicircular canal dehiscence (SCD). Three semicircular canals, the superior, posterior and lateral, make up the part of the balance system that detects rotational movements of the head. The canals are filled with fluid and embedded in the temporal bones of the skull, creating a closed environment. A dehiscence occurs when there is a thinning of the bone surrounding the canal creating a weak spot, which allows the fluid in the semicircular canal to become mobile. This ‘mobile window’ makes the balance system sensitive to changes in pressure in the ear. The pressure is able to disperse through the semicircular canal and this causes sensations of vertigo. Additionally, sufferers of SCD may experience oscillopsia, a visual sensation that the world is oscillating or bouncing, in response to vestibular stimulation by changes in pressure. These pressure changes may be caused by high intensity soundwaves, but may also come from applying pressure to the ear canal or by increasing intracranial pressure. Interestingly, an individual affected by SCD may only experience vertigo induced by one particular trigger. As well as these vertiginous symptoms, SCD can cause changes in low pitch hearing, as it affects the transmission of soundwaves through the inner ear. There are two conditions that are required to develop SCD. The first is that the bone overlying the canal is thinner than normal, plus an event that causes the dehiscence of the already thin bone. This may be caused by a series of small traumas or knocks across a lifetime or following a sudden traumatic event, such as a head injury or a sudden change in pressure, perhaps brought on by vigorous nose blowing or suddenly straining to lift. SCD is diagnosed by an ENT specialist using high resolution CT scans. Full audiological assessment and vestibular assessment, an assessment of the balance organ of the inner ear, may also be ordered to further analyse the symptoms of SCD and to rule out other comorbid vestibular conditions. SCD is a treatable condition although many people find that once they understand the cause of their symptoms they do not need any treatment at all. For those who are not able to manage the condition with trigger avoidance and who report diminished quality of life from their symptoms, surgical intervention is an option. Surgery involves resurfacing the dehiscence to close the mobile third window or plugging the dehiscent canal and can improve symptoms. Working in collaboration with ENT specialists, the ESIA Balance Centre has dedicated audiologists specialising in vestibular conditions and provides clients with a complete, seamless service from initial hearing and balance assessment through to surgery. Visit siabalance.com.au for more information. By Lisa Giles Senior Vestibular Audiologist, Ear Science Institute Australia Balance Centre Did you know? When you go up to a high elevation, your ears pop. This is because your eustachian tubes are equalising the pressure between the outside air and the air inside your ear. Stress and tinnitus – the chicken and the egg case Does stress cause tinnitus or tinnitus cause stress? In short, both statements are true. In essence, tinnitus is any sound you can hear, which is not actually present in your surrounding environment. They are sounds that originate from within our body. People describe these sounds as a ringing, buzzing, hissing or pulsating sound. Many people talk about tinnitus as if it was a disease, but it is in fact nothing of the sort. Tinnitus is a symptom not a cause, a warning bell ringing to let us know that something requires further investigation. Among the many potential reasons why people may experience tinnitus, such as diet, blood pressure, injury, infection and exposure to high noise levels, one factor is stress. When people experience higher levels of stress than usual, this is characterised by increased levels of adrenaline in the bloodstream. When humans have this chemical in the bloodstream it causes a reaction known as the ‘flight or fight’ response. This is a complex mechanism that, apart from other things, sends blood to the muscles in the arms and legs in case we have to run away from danger (flight) or we have to turn and engage in battle (fight). This is a primitive response from when humans lived in caves, and would have to flee from predators. The ‘flight or fight’ response changes many settings in the body, one in which people describe as increased hearing acuity. Actually, the adrenaline is responsible for making our brain pay far closer attention to all the sounds it hears. Traditionally, we would use this to hear from the furthest distance possible whether a predator was hunting us. People who have had close calls cheating death will often report hearing their own heartbeat at the time. When we have adrenaline in our bloodstream but we are not being pursued or fought, we begin hearing sounds that we have not heard before, but these are sounds our bodies make all the time. We have just never noticed them before. This is how stress causes tinnitus. Interestingly, when people hear these sounds being made by their body that they don’t recognise (tinnitus) they start becoming anxious about what the sounds are and whether they are going to stop, which in turn releases more adrenaline into the bloodstream and the cycle continues. The actual answer to the question posed is that they both cause each other, but by intervening to address the stress, the vicious cycle can be broken. This is when a clinician trained in tinnitus management can be an invaluable resource. By Ben Elsey Clinical Director, Hearing Conservation Australia m an ag in g 9 IN THE 21ST CENTURY Did you know? Ears are self-cleaning. Pores in the ear canal produce cerumen or earwax, and tiny hairs called cilia push the wax out of the ear. m an ag in g 10 IN THE 21ST CENTURY Efficient earplugs continue to be preferred hearing protection The ultimate objective of all noise management programs should be to get rid of the problem which is dangerous noise levels. However, this is not always practical and sometimes may take many years to achieve. This is when personal hearing protection is needed, and noise reduction earplugs and muffs play a major role. Plugs are often the preferred choice of hearing protection because they can be easily worn with other safety equipment and are more popular for extended use, especially in hot environments. Earplugs have been used for over 100 years with rubber plugs developed for use by boilermakers in the 1880s. By the start of World War I, naval gunners were using plugs made of turned wood. However, it was not until the 1970s when big improvements were made in materials, style and comfort that earplugs became used by large numbers of workers. Did you know? If you shouted in outer space, even a person right next to you wouldn’t be able to hear. Your ears pick up sound that travels in invisible waves through the air. Because there’s no air in outer space, there’s also no sound. Connecting people with hearing loss to the services they need where they need them. Now there are three main types of earplug used by workers today. These include the popular disposable formable plugs, mostly made from wax or foam. These plugs provide good attenuation of sounds, but workers need to be trained to use them correctly to ensure this is achieved. There are also pre-moulded plugs made from vinyl or silicon, which are inexpensive and can be bought off the shelf. They are easy to use but only last a couple of months and tend not to provide the same levels of hearing protection as the formable plugs. The third type are the personally moulded silicon plugs which are custom-made for each worker, involving a visit to an audiologist for ear impressions which then get sent to an ear mould laboratory for manufacture. Although personally moulded plugs are the most costly, they last for a couple of years and ensure maximum protection, ease of use and comfort for the worker. Custom plugs are recommended for workers who use plugs over long periods of time. There are also special ‘musician’s plugs’ which can be custom-made for workers in the music and entertainment industry who need to hear music without it being distorted by plugs that change its pitch composition. These plugs have filters, which can be specially selected for the individual needs of musicians, giving them the best frequency response to the music. By Dr Helen Goulios Clinical Coordinator, Master of Clinical Audiology Program, The University of Western Australia THE MOST ADVANCED CUSTOM HEARING PROTECTION IN JUST 5 MINUTES Using state of the art technology, RIDBC connects people with hearing loss, and professionals in the field, to Australia’s leading support services. &EVDBUJPO 5IFSBQZ $MJOJDBMTFSWJDFT 1SPGFTTJPOBMEFWFMPQNFOU %JBHOPTUJDT 'PSGVSUIFSJOGPSNBUJPODBMM1300 581 391 or visit www.ridbc.org.au The Royal Institute for Deaf and Blind Children (RIDBC) is Australia’s largest non-government provider of therapy, education and diagnostic services for people with hearing and vision loss. protection available, offering unrivaled custom protection for your ears. Our SonoFit process gives an acoustic seal and SHUIHFWÀWLQMXVWÀYHPLQXWHVProtect today, HEAR tomorrow. During Hearing Awareness Week, Australasian Safety Services will be providing free hearing tests throughout the metropolitan area. For locations and bookings, phone us today on 1300 766 139. Sonomax Self-Fit is approved to AS/NZS 1270:2002 ASS13569 t t t t t Nonsensical excuses increase risk You’ve heard these excuses a dozen times or perhaps even used them yourself for the reasons why we don’t want to wear hearing protection in hazardous noise. Some of the excuses are just nonsensical (“they bother me” or “they’re uncomfortable”) when compared to the risk of losing hearing for life. But other excuses have just enough credibility to almost sound plausible. Let’s review some of the common reasons for not wearing earplugs, and dispel some of the myths preventing good protection. “I don’t use earplugs because...” 1. They cause infections in the ear. Research shows no higher incidence of new ear infections among earplug wearers compared to the general population. A user is more likely to get an ear infection due to swimming in contaminated water than from earplug use. However, if a wearer has an existing infection, it is best to switch to earmuffs for a while rather than aggravate the ear canal by inserting earplugs. 2. You can hurt your eardrum if you put them in too far. The human ear canal is about 35mm long, terminating at the eardrum. Even the longest earplugs available on the market are well short of the eardrum when fully inserted in the ear canal. Indeed, very few of us have ever touched our eardrum, and we would likely be jumping in pain if we even got close. 3. I can’t hear my co-workers when I wear them. For workers with normal hearing, the signalto-noise ratio actually improves when wearing earplugs in loud noise, such that hearing a conversation is easier when both are wearing hearing protectors in loud noise. The easy answer to this complaint is to simply fast forward a few years: the unprotected worker won’t be hearing conversations very well in a few years after incurring noise-induced hearing loss. m an ag in g 11 IN THE 21ST CENTURY 4. My ears have grown accustomed to the noise. This excuse is particularly tempting. Some workers actually claim their ears have ‘toughened up’ since their first week on the job, almost as if repeated over-exposure has built up some measure of immunity from noise damage. But the ears don’t have this ability to toughen up. Workers who claim their ears have grown accustomed to the noise, and therefore don’t need the hearing protectors, have often lost hearing. Dispelling the myths surrounding hearing protection can allay the fears and address the excuses that some use to avoid good protection. By Brad Witt Director of Hearing Conservation, Honeywell Safety Products Did you know? In Africa, a tribe of people called Maabans live in such quiet that they could possibly hear a whisper from across a baseball field, even when they are very old. Workplace noise comes at a cost m an ag in g 12 IN THE 21ST CENTURY Noise in a workplace can cause three types of miscommunication, each of which impacts on the business in terms of profit potential. These can be further categorised into the areas of inaction, confirmation and deviation. Worker One: “Didn’t you hear what I just said?” (after inaction). These principles apply regardless of whether hearing protection is being worn. To illustrate, let’s consider a business containing a production line spraying paint onto curtain tracks. In this scenario, they are spraying brown curtain tracks, and Worker One shouts to Worker Two, “the next tracks have to be green”. Worker Two: “Ok, got it” and cleans the track and paints it brown (deviation). Firstly, inaction describes the situation where a worker has given a verbal instruction to a colleague in a noise filled workplace, and the intended recipient hasn’t heard the instruction, and continues working without adopting this new piece of information. The result in the curtain factory is numerous tracks will be sprayed brown instead of green. They will then have to be stripped of paint and returned to the beginning on the line. The number of tracks painted the wrong colour will depend on how soon Worker One realises Worker Two has not heard the instruction. When hearing aids are not enough Exposure to excessive loud noise can cause irreversible damage to hearing. It mainly damages the fine organs inside the inner ear called hair cells. Once the hair cells are damaged, it causes varying degrees of permanent hearing loss. Typically, the first step is to see an audiologist and have a pair of suitable hearing aids fitted. Although hearing aids are a great alternative for some people, they may not work as well for others that have very little hearing left or poor speech perception. The majority of hearing losses are partially remedied by the amplification provided by hearing aids. However, sometimes the damage is such that even the most advanced hearing aids will not resolve the problem. Hearing aids filter and amplify sounds, which in these cases would be inadequate to compensate for the damage to the inner ear. It is ultimately the role of hair cells in the inner ear to process the signal. When the hair cells are damaged the signal passing through them would be amplified and distorted giving an unclear message. Therefore, although speech is loud enough, it would not be clear. Cochlear implants bypass the damaged parts of the inner ear, stimulating the nerves that send the sounds directly to the brain. The cochlear implant system consists of two parts, the internal electrodes and the external sound processor. Incoming sounds are processed into electrical signals, which are then transmitted to the internal part. The electrodes inside the cochlear then stimulate the nerve. Hearing loss associated with noise exposure is much worse in high frequencies. There is a type of implantable device called Electro Acoustic Stimulation, which is a combination device that allows the use of amplification to hear the low pitched sounds and a cochlear implant to detect higher pitched ones. Essentially, it’s the use of a hearing aid and cochlear implant together. Ear Science Institute Australia (ESIA) Implant Centre Clinical Coordinator Ronel Chester-Browne, who has over 20 years’ implant experience, has seen first hand how cochlear implants transform lives. “I have seen many clients with noise induced hearing loss struggle for too many years with hearing aids before having an implant,” Mrs Chester-Browne said. “Timing is crucial in auditory intervention to ensure that no further deterioration occurs in the auditory nerve as a result of hearing loss. Better hearing outcomes are seen when those receiving cochlear implants do so as soon as they are no longer gaining sufficient benefit from hearing aids.” The ESIA Implant Centre in Subiaco has a dedicated team of ear, nose and throat specialists, audiologists, radiologists, psychologists and a research team specialising in implantable hearing devices. Working in collaboration with its professional network, the ESIA Implant Centre provides clients with a complete seamless service from initial hearing assessment through to surgery, rehabilitation and ongoing care and support over the long term. For more information visit esiaimplants.com.au. By Azadeh Ebrahimi Implant Audiologist, Ear Science Institute Australia Implant Centre Secondly, confirmation describes where a worker is aware that they have not heard the instruction and asks the colleague to repeat the instruction. Curtain factory Worker Two now has to ask Worker One, “What was that?” or “Did you say…?”. Worker One has to repeat the instruction. This is a time loss of 100 per cent; if every instruction had to be repeated once, four hours of conversation would take eight hours. Thirdly, deviation describes the situation where a worker is unaware they have misheard the instruction and unknowingly sets off to do the wrong task. Worker One in the curtain factory example said, “the next tracks have to be green”, but this was heard by Worker Two as “the tracks have to be clean”. So he wipes down the curtain tracks, paints them brown and commits the tracks to the same fate of being stripped and repainted. These principles need not exist in isolation and commonly co-exist. The curtain factory example now looks like: Worker Two: “No, what did you say?” (confirmation). Worker One: “I said, the next tracks have to be green!” (confirmation). The conversation then repeats until the communication breakdown is discovered. Research shows that employees working in high noise environments lose on average between 20 to 60 minutes a day from inaction and confirmation. Deviation has not been measured, but could be argued to be a larger cost in both dollars and potential safety/injury. The solution does not need to be expensive communication headsets doubling as hearing protection, rather workplaces can create greater efficiency by providing workers with training in the art of communicating in noisy environments. By Ben Elsey Clinical Director, Hearing Conservation Australia Did you know? The oldest mummy ever discovered was wearing earrings. m an ag in g 13 IN THE 21ST CENTURY Control beats protection any day Noise is often defined as unwanted sound but there is no definition of how loud sound needs to be before it becomes unwanted. Regulations in Australia specify a noise exposure standard of 85 decibels averaged over eight hours, but this is not a completely safe level of exposure for everyone. Some people exposed to this level of noise will suffer a small amount of hearing loss. The exposure standard is therefore a balance between the risk of hearing loss and the practical challenges of implementing noise controls in the workplace. Regardless of the number of decibels, employers are bound by a duty of care to reduce hazards, including noise, to as low as is reasonably practicable. In part, this duty of care is intended to minimise the risk of hearing loss, but there are other risks that should compel employers to implement engineering noise controls instead of relying on ear muffs or earplugs. Noise interferes with concentration hindering productivity and causes fatigue. This may occur at noise levels well below the exposure standard. Fatigue can also be exacerbated by sleep disturbance, as anyone who has been kept awake by a noisy air conditioner Noise exposure is measured with a sound level meter Picture courtesy B. Groothoff. Supporting Hearing Awareness Week 25 - 31 August Australian Institute of Occupational Hygienists www.aioh.org.au Striving for a healthy workplace Occupational Hygiene The art and science dedicated to the anticipation, recognition, evaluation, communication and control of environmental stressors arising from the workplace that may result in injury, illness, impairment or affect the well being of workers or members of the community. AIOH Objectives • To promote the profession of Occupational Hygiene in industry, government and the general community. • To improve the practice of Occupational Hygiene and the knowledge, competence and standing of its practitioners. • To provide a forum for the exchange of Occupational Hygiene information and ideas. • To promote the application of Occupational Hygiene principles to improve and maintain a safe and healthy workplace. • To represent the profession nationally and internationally. Coming Event 30th Nov – 4th Dec 2013, Sydney Theme: The 4 Pillars – Anticipation, Recognition, Evaluation, Control 2024490πJEEH230813 AIOH 2013 - 31st Annual Conference & Exhibition will tell you. This is a very important consideration for employers who provide accommodation for their workers. Also, ear muffs and earplugs may help to reduce hearing damage but they do nothing to address the source of noise. They can even introduce new problems. Hearing protectors prevent us from hearing things we would normally hear but they don’t differentiate between the sounds we want to hear and unwanted sounds. They affect our ability to understand speech, make it more difficult to determine where sounds are coming from and they can block out warning signals or noise from moving vehicles. These factors increase the risk of accidents in the workplace. Engineering noise control addresses unwanted sound at its source without interfering with the sounds we do want to hear. So it is clear that engineering noise control is fundamentally superior to hearing protection in reducing risks associated with noise exposure – whatever the level. By Jim McLoughlin Business Unit Leader, Acoustics SVT Engineering Consultants m an ag in g 14 IN THE 21ST CENTURY Sensitive apparatus one to cherish The notorious practice of blast fishing, as opposed to the traditional rod and reel approach, involves setting off explosives for the thrill of reeling in a quick catch. In a split moment, an abundance of fish is yielded, but not without leaving a trail of destruction in its wake. The rubble remains of coral and affected ecology of the waterway may take years to recover or permanent damage may ensue. Sounds like a bit of overkill, doesn’t it? This analogy mirrors what our ears experience every day, especially if you are immersed in an environment with loud noise or are exposed to blaring music. The ear hosts a very sensitive environment. Just as recreational fishing requires careful and gentle handling of the fishing line as we wait to feel the tug from the first nibble on the bait, our ears were designed to pick up subtle cues. Our predecessors’ sense of hearing was primed to detect the rustling of leaves and snapping of twigs in the forest as part of the predator-prey instinct. In earlier times, the world was a quiet place in contrast to today’s standards where we are constantly over-stimulated and bombarded by sensory information. We work in environments where we struggle to hear other people talk and at the same time, continue to turn up volumes to drown out background noise with music. As a result of this auditory onslaught on our ears our precarious apparatus, specifically parts of our cochlear (inner ear), dies. Akin to dynamite fishing, sometimes the damage done is everlasting. As more areas of the ear become unusable, our hearing ability diminishes, just like those fish that we have made extinct in the lake from our TNT fishing. Unlike the lake, however, once our hearing is destroyed, we don’t have the option of moving on and finding a new lake to exploit. We only get one set of ears, and with it one chance at hearing. By Ben Elsey Did you know? Your ears are more than just necessary for hearing; they also help keep your balance. Clinical Director, Hearing Conservation Australia Speech-friendly protectors come to the rescue of hearing impaired For people with normal hearing, wearing earplugs or muffs in loud noise typically makes it easier to hear warning signals and conversations. But the same is not true for workers who have already lost some hearing. For them, wearing hearing protection produces a double loss: the attenuation of the earplug overlaid on their existing hearing loss. Fortunately, manufacturers have responded with a number of speech-friendly hearing protectors for those with existing hearing impairment. 1. Uniform attenuation A conventional earplug blocks high-pitched (treble notes on the piano) noise better than low-pitched noise (bass notes). But this distorts the incoming sound and makes it difficult to understand speech and conversation when wearing these conventional protectors. Manufacturers now make hearing protectors that have uniform attenuation across all frequencies, so that wearing the earplug reduces volume without distorting conversations from a co-worker and speech sounds more natural. 2. Sound restoration ear muffs Several models of electronic ear muffs are designed to optimise protection for those with pre-existing hearing loss. These ear muffs have built-in amplification circuits to amplify speech in low level noise. However, as soon as hazardous noise is detected, a control circuit in the ear muff instantly compresses the incoming signal. The hearing impaired worker still hears what he needs to hear – warning signals and conversations – but at safely reduced levels. 3. Speech enhancement Some new technologies borrow from military applications where incoming sound from a communication radio is digitally enhanced to make speech more audible, while background noise is electronically suppressed. These ‘intelligent protectors’ are designed to pull speech out of intense background noise to make it more intelligible where communication on a noisy job is critical. These solutions run the gamut in terms of cost, from about a dollar per pair to several hundred dollars for the electronic intelligent protection. But they offer the hearing impaired worker a number of valuable options for protecting hearing without sacrificing situational awareness, warning signal detection and speech intelligibility. By Brad Witt Director of Hearing Conservation, Honeywell Safety Products Win-win situation for all parties Fitness for work can be a sensitive topic at any time and no more so than when there is potential for launching a discrimination case. Where a governing organisation has not set a specified medical standard, a person with significant hearing loss needs to be assessed on their ability to undertake the basic requirements of the job safely and effectively, and which do not cause undue hardship on the employer. However, the real crime may be a company missing out on a quality employee. To illustrate this, I will share two stories from my career. The first anecdote is an employer who had safety concerns for an employee with a significant hearing loss who was working around moving machinery. In order to wear hearing protectors, she would remove her hearing aids, which made it impossible for her to communicate with her colleagues or hear the warning beeper of a reversing vehicle. The workplace described this worker as “brilliant at her job” and was desperate for a way to solve this problem. Technology came to the rescue. With the purchase of a specific ear muff and a visit to the audiologist to have a function activated on her hearing aids, she could wear the aids and the earmuffs at the same time. For a solution costing less than $100, this employee could now work safely on the job. The second scenario was a workplace that thought outside the box. They decided to install ‘modifications, which cause undue hardship on the employer’. They did this so they could safely employ a job applicant who was deaf. Visual and tactile (vibrating) warning devices were installed at the company’s expense and the man was appointed. The company described this employee as “one of our best workers” because he was one of their most productive. This was a true win-win situation. For a small outlay in equipment, the company was reimbursed many times over by this employee’s productivity, and the worker was able to do a job he loved. Teaming up with an expert to design low cost solutions for fitness for work issues has the potential to change the landscape of how companies think when considering the feasibility of employing a hearing impaired worker. By Ben Elsey Clinical Director, Hearing Conservation Australia m an ag in g 15 IN THE 21ST CENTURY Holistic approach to rehabilitation Noise induced hearing loss is an unseen problem: No one says, “I got industrially deafened today”. Noise injury is gradual in nature and workers affected by hearing impairment may experience significant communication difficulties and reduced quality of life. The belief that simply buying a hearing aid/s will solve all of these difficulties is a false one. The best outcomes for most people with hearing impairments are achieved when hearing aids are included as part of a holistic hearing rehabilitation program. This involves a client receiving a full diagnostic audiological assessment, an evaluation of their communication needs, negotiating a suitable rehabilitation program with their audiologist (which may include the prescription of hearing devices), postdevice fitting follow-up including counselling, communication training, group work and other assistive devices. Hearing loss is not the same as most vision loss, which can be immediately solved through use of glasses that can be purchased through pharmacies or optometrists. Damage to the hearing organ may also result in problems in the auditory nerve pathway and for this reason a specific rehabilitation program provided by a professional audiologist is necessary to ensure optimal benefit from hearing aids. Most audiology clinics recommend clients bring a family member or a friend to appointments. This not only assists clients in their selection of any devices, but also increases awareness in family and friends of the difficulties experienced by their hearing impaired partners and the strategies to overcome these. The significant benefits of a comprehensive hearing rehabilitation program are not readily available if hearing aids are purchased overseas or online, and Audiology Australia encourages individuals to actively discuss all the components of a rehabilitation program with their local Australian audiologist. By Dr Helen Goulios Clinical Coordinator, Master of Clinical Audiology Program, The University of Western Australia MANAGE YOUR Ptreofessional, chnic comp ally RISK PROFILE fo soluteiotnesnt, AURORA ENVIRONMENTAL – EXPERIENCED IN MANAGING WORKPLACE AND ENVIRONMENTAL RISKS cusse exper d local tise. 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