Wednesday, April 18, 2012

Living with hearing damage - Part III

“Grandpa, time for dinner.”



“You don’t need to shout. I’m not deaf you know.”

Well, actually grandpa is deaf. He also suffers from a condition called recruitment. And he’s not alone. Most people with hearing loss have recruitment, whether that hearing loss is from noise damage or normal wear and tear. Recruitment is both a marvel and a menace, and dreadfully difficult to understand. It can also be a challenge to live with.

When the hearing cells in a certain region of the cochlea have died off, they can no longer capture and process sound. When sounds in the damaged range hit the ear, the hearing mechanism does a wondrous thing: it recruits other cells to help out. Trouble is, those cells are already working full time interpreting sounds in their own range. The result is that the recruited cells have to put out more energy. The more cells that are recruited, the more energy created and the more the cells are overworked. Hence the impression that the sound is abnormally loud. In extreme cases, the recruited cells will also push the ear into pain.

Dead hearing cells stay dead. Your hearing in that range stays dead as well. And if this hearing loss is accompanied by recruitment, then the recruitment is also permanent. There is no solution other than to keep those sounds away from the ear or within limits that don’t cause distress. In my own case, I have “profound” damage in the region from 2400hz to 3000hz. Sometimes this is called a ‘hi-hat hole’, and for good reason. A hi-hat puts out a lot of energy in this range and is usually just inches from a drummer’s head. I have hi-hat damage in both ears, though less so on the non-hi-hat side. (I attribute the damage there to a succession of screaming lead guitar players, to remain un-named -- but it was very nearly worth it to have played with those people.)

So, what can we do about this?

Unfortunately, there are not many options. Recruitment is permanent and may worsen as more hearing cells die off with age. The only treatment is to prevent sounds from reaching the affected area of the inner ear. This can be tricky. If the damage is in a critical area, such as the area responsible for hearing speech, then cutting off these sounds can have unfortunate consequences. But we don't need to go to drastic lengths here. You may be able to live quite nicely by adopting a quiet lifestyle. I went from professional drummer to computer programmer, working with nice, quiet computers. Not my first choice, but I wasn’t in a position to argue.

You can also get ear moulds that filter out certain frequency ranges. It's not a very flexible approach but it might be sufficient. Ear moulds can be a bit pricy but are well worth it if they help you get through the day without distress. Think of the initial cost as about a dollar a day Рless than your daily hit of latt̩.

Monday, April 9, 2012

Living with hearing damage - Part II

When I was first diagnosed at the Musicians Clinics of Canada years ago, one of the terms thrown out was hyperacusis. It simply means a hypersensitivity to sound (or anything else, actually). It's as if the whole world's volume control, normally set at 3 or 4, has been jacked up to 5 or 6. The cause is unknown, although people with tinnitus frequently complain of hyperacusis as well.

I tend to think of it as possibly unrelated to noise exposure. I frequently found my snare drum too sharp sounding, and I always sought out quieter gigs. Lately I've taken to cutting the labels out of my shirts because they drive me nuts. I guess I’ve always been a sensitive guy. But let's get back to the ear thing.

Again the people at the Tinnitus Centre shed light on this for me. Like tinnitus, hyperacusis is mainly a benign, stable, non-life-threatening condition. That doesn't mean it can't be bothersome or even distressing. It's also a condition that can feed off itself. That leads me to two other conditions: phonophobia and misophonia.

Misophonia is a dislike of a sound. Interesting, but hardly a problem – I just thought I'd throw it in to keep things scientific. Phonophobia is a fear of sound. Neither ailment seems like it might be relevant to a musician, but they can trigger a snowball effect.

If you are concerned about your ears -- perhaps you have a bit of tinnitus or hyperacusis, or you’re finding certain sounds uncomfortable lately -- you may have decided to take a proactive approach and protect your ears from routine sounds. It seems like a good theory, but your ears are self-regulating, and they can't do that if they're detached from reality. If you habitually wear hearing protectors in ordinary circumstances because you're afraid of harming your hearing, you are conditioning your ears to live in a quieter world. In effect, you're teaching your system to have hyperacusis.

The treatment for hyperacusis is to reaccustomize the ears to normal sounds. If you are disturbed by normal sounds, try slowly reintroducing sound into your life. Put the earplugs away when you're in a quiet place. Try to go without them for ten minutes, half an hour, an hour. Work your way up to the point that you only need the plugs for extremely noisy situations. Even then they may not be necessary. I sat through half a Jeff Beck concert before I realized I didn’t have my earplugs in, at which point I figured, why not just enjoy it?

Here's an important tip: If you decide to try using sound to 'recondition' your hearing and you have tinnitus, make sure you can always hear your tinnitus. Do not use sound therapy to mask the tinnitus. Although it cannot make your tinnitus worse, it can interfere with your brain’s ability to cope with it.

Monday, April 2, 2012

Living with hearing damage - Part I

Now that I’ve decided to ‘come out’ about my hearing issues, a lot of people have been asking me for some insight. It seems I’m not the only one who has paid a price for playing too loud for too long. And let’s face it, you will have a tough time finding a musician who has not had at least some hearing damage; it’s a risk of the trade. So I thought I’d spend a bit of time sharing what I’ve learned about what can go wrong and what can be done about it. There is some good news and some not so good news, but I think the most important thing is to be armed with accurate information so you know what you’re dealing with.

First up: Tinnitus (TIN -i-tus)

Tinnitus is defined as any sort of a sound than you can hear but is not caused by an external source (that’s my own definition; the specialists are still arguing about the technical minutia and are using words even weirder than ‘minutia’). Tinnitus can range from a short-lived ringing that lasts just a few seconds, never to return, to a sheet metal works living inside your head. It can be caused by a variety of things including certain diseases and drugs as well as head injuries. It also seems to be tightly linked to noise exposure.

The range of potential phantom noises is quite something. I remember once going from room to room looking for a radio someone had left on – it was playing oldies from the late 50s – only to discover that it was in fact my tinnitus. Sports professionals talk about freight trains, bells and explosions, but more often it comes down to a simple ring or hiss.

Medical professionals, for the most part, have no clue. They fall back on two remedies: live with it or cover it up. Well, it’s easy for someone who doesn’t have it to tell someone else to live with it. The other ‘solution’ is to hide it under designer noise. One audiologist I visited early on in my venture prescribed masking devices. Looking like hearing aids, they would be tuned to my tinnitus and then produce a noise that would block out the ringing. And they cost a mere $400 each. On the way home that day, I stopped at Canadian Tire and bought a $20 fan that produced enough sound to ‘mask’ my tinnitus enough to let me sleep.

Incidentally, that fan was a great revelation. I later wrote an article for a tinnitus newsletter about the fan and my take on why it worked. The sound it produced was nowhere near loud enough to block out the noise, but it did give my brain something else to focus on, and that was the gist of my article. What I also got from the article, and my brief subscription to the newsletter, was that focussing on the tinnitus was actually a large part of the problem.

So my solution has been to try to ignore it. Doesn’t sound like much of solution, but it turns out to be the core of a successful tinnitus treatment. Tinnitus Retraining Therapy (TRT) attacks the problem by teaching the brain to focus on something else. I won’t go into details here, but the retraining helps the brain rediscover how to ignore sounds that don’t matter, and to apply it to the tinnitus. The Tinnitus Centre in the UK reports an 80% success rate, so it may be worth looking into.

I think the main message I want to get across here is that tinnitus is a permanent condition, but it is not a death sentence. It also is not a degenerative disease. If you are no longer mistreating your hearing, there is no reason your tinnitus should get any worse. While saying ‘live with it’ may sound facetious, it really is the only option. Most of the people I’ve talked to are bothered by their tinnitus, and often their degree of distress is as much a problem as the tinnitus itself. If they can find a way to not worry about it, things will improve. The one piece of advice I can give is this: Don’t hide from every day sounds. They give you something else to focus on.

And when the tinnitus is bothersome, maybe it’s time to head to Canadian Tire.