The roles they play

In Ontario, both SLPs and audiologists are regulated by the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO). According to CASLPO,

“SLPs are concerned with the identification, assessment, treatment, (re)habilitation and prevention of communication and/or swallowing disorders in children and adults.” They go on to explain that, “Audiologists are concerned with the prevention, identification, assessment, treatment, and (re)habilitation of auditory and balance difficulties in children and adults.”

Both professions manage a varied approach to their practice, including:

• Screening and assessment
• Dispensing of equipment
• Patient, staff, and family education
• Participation in rounds and discharge planning
• Individualized and group therapy
• Coordination of care with other staff

An interprofessional approach

Interprofessional collaboration is key to patient care at Sunnybrook. Audiologists and SLPs are vital to a variety of teams across multiple programs. At Sunnybrook’s Bayview Campus, audiologists work with otolaryngologists and hearing instrument specialists to operate a hearing aid clinic and Canada’s largest Adult Cochlear Implant Program. Speech language pathologists work in 8 of the 10 care programs at Sunnybrook, across all campuses. They provide care across acute care, transitional care, long-term care, palliative care and ambulatory care settings.

The intersection of communication

Both professions bring valuable expertise to the patient experience in different ways. What connects these roles is something that connects us all: communication! Audiologists and SLPs are dedicated to the improvement of communicative ability, both incoming and outgoing.

To that end, communicative disorders assistants (CDA) aim to support the cause by facilitating pathways for meaningful, effective communication. Jason Dallas is a CDA who works at our Veteran’s Centre and supports the audiology and SLP departments.

“Communication is a fundamental human right. I often hear how impairments in hearing or communicative ability can lead to feelings of frustration and isolation. I believe the work of Audiologists and SLPs is so important, and our residents and patients agree wholeheartedly!”

Communication strategies for everyday life

Whether you’re supporting someone with a communication disorder or seeking to enhance your own interactions, the following strategies will prove beneficial in supporting effective communication:

• Speak at a moderate pace and volume
  • Focus on speaking clearly
• Face your communication partner, and speak at eye level
  • In an environment where people are often masked, this can greatly enhance intelligibility
• Make sure important information has been heard correctly by asking the listener to repeat it back to you (e.g., appointment times; medication instructions)
• Reduce or eliminate background noise as much as possible
• To make sure that hearing aids are working:
  • Check that battery doors are fully closed OR
  • Make sure that rechargeable hearing aids are properly charged every night (cup the hearing aids in your hands and listen for feedback – feedback means sound is getting through)

At Sunnybrook, our commitment to communicative health is evident in the collaborative efforts of SLPs and audiologists. For more information, or if you think you require the services of an SLP or audiologist, visit:

• CASLPO (College of Audiologists and Speech-Language Pathologists of Ontario)
• SAC – OAC (Speech-Language and Audiology Canada)

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How are balance and dizziness linked to hearing?

The inner ear may be small, but it’s complex! It’s home to the vestibular system and the auditory system. The vestibular system has motion sensors that help us stay balanced and perceive movement, while the auditory system has hearing sensors that allow us to perceive sound. Both of these systems share nerve and blood supply pathways, so they are very interconnected. This means that many people affected by conditions of the inner ear can experience both hearing and balance symptoms, like hearing loss, dizziness, imbalance and tinnitus.

Is it often overlooked that balance and dizziness can be tied to hearing?

Absolutely. Patients often ask why we are testing their hearing when they come for balance testing. Generally, hearing health is overlooked as many people don’t get a hearing test until they have experienced several years of hearing difficulty or are persuaded by a family member or significant other to get checked.

Hearing impairment can also contribute to reduced environmental awareness and localization which can affect balance and movement. For example, hearing someone walking up from behind you or calling your name from your right or left. Also, hearing the acoustics in a room improves your understanding of your surroundings. Overall, hearing impairment can increase confusion about your surroundings and is linked to an increased risk of falls.

Which conditions can affect the health of the inner ear?

There are many, but here are some of the most common:

• Benign paroxysmal positional vertigo (BPPV): inner ear crystals dislodge and their movement causes vertigo/dizziness symptoms
• Meniere’s disease: fluid builds up in the inner ear structure often affecting both hearing and balance systems
• Vestibular neuritis: inflammation happens in the balance system nerve
• Labyrinthitis: inflammation of the inner ear affects both balance and hearing systems
• Superior semicircular canal dehiscence: a hole or thinning of the bone surrounding the inner ear
• Vestibular schwannoma: a tumor on the balance system nerve

How can balance and dizziness affect everyday life?

Dizziness and balance symptoms can range from mild to severe. Mild symptoms may mean you avoid specific activities, like bending over. Severe symptoms can result in a detrimental loss of abilities across all activities of daily living, including walking, bathing, lying down, getting up, using stairs, exercising, driving, concentrating, reading and working. In addition to the physical challenges, this can also place a huge burden on your mental health.

Dizziness is also a major risk for falls. In fact, adults with some form of inner-ear dysfunction are up to 12 times more likely to have a serious fall (Balance & Dizziness Canada). That’s why people experiencing dizziness or falling should absolutely be referred for testing.

What kind of testing and treatment is offered at Sunnybrook?

We have a team of audiologists that assess you and determine which parts of the ears are impaired. These assessment results are important for your physician to determinea diagnosis, treatment plan, or need for further testing.

A number of hearing tests are used to measure hearing sensitivity to a variety of sounds for each ear, and also check how well the ear drum is functioning. You need a referral from a family doctor for this type of testing.

Our team also offers many different types of balance tests. Most of these tests use goggles with built in eye-tracking cameras. Our tests compare eye and head movements during visual tasks. Some tests also stimulate the motion sensors of the ear with water or air to measure and compare the results from each ear. An ear, nose and throat (ENT) physician or neurologist referral is needed for the full diagnostic balance assessment.

In addition, we have added a new balance screening program to our available services. Audiologists screen patients for the most common dizziness and balance issues and provide them with education to help them manage their symptoms. To access this service, you need a referral from a family doctor.

If you’re interested in doing a quick hearing test at home, use this online tool. It only takes five minutes to complete, and is brought to you from Sunnybrook’s audiology services department and Shoebox.

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Why is hearing loss impactful?

Hearing loss can make it difficult to understand what others are saying, especially in noisy environments or when multiple people are talking. This difficulty can quickly lead to frustration and isolation from social situations. This social isolation can then further lead to anxiety, depression, and other mental health issues.

Hearing loss also affects others around you. Misunderstandings and miscommunication as a result of hearing loss can contribute to frustration and conflict, which can affect the quality of relationships over time.

Overall, untreated hearing loss can have impacts on mental health and quality of life. It is recommended that you seek assistance sooner rather than later to help mitigate these effects.

What steps can you take to prevent hearing loss through your lifetime?

One avoidable cause of hearing loss is noise exposure. Try to limit exposure to loud noise, and in situations where it is unavoidable, wear hearing protection. This can take the form of generic ear plugs from your local drug store or even custom-made ones molded to the shape of your ears. This also applies to music, so don’t set the volume too high! If you do attend concerts or play any instruments you can get specialized earplugs, referred to as musician’s plugs. Musician’s plugs maintain the same quality of sound while reducing the overall volume.

Avoid inserting anything into your ears, as it can cause irreversible damage to the structures in your ear! If you have concerns about ear wax, seek the help of a professional to help you manage it.

Certain conditions such as diabetes and heart disease have been connected to hearing loss, so maintaining a healthy lifestyle can help reduce their effects as well.

When should you have a hearing test?

You may try out our online hearing screener to see if you might have a hearing problem. If you are often asking people to repeat, or if people are having to speak up for you to hear them, it may be a good idea to get your hearing tested.

What’s the latest in the world of hearing devices?

Many hearing aids now have Bluetooth built into them, which allows you to do a few things once you have them connected to your phone. For example, you can:

• Stream audio: Any audio from phone calls, video, or music apps can be sent directly to the hearing aids like a pair of headphones.
• Use handsfree calling: Some hearing aids now allow you to use them as a handsfree headset; you can use the button on the hearing aid to pick up or hang up a call. The microphone on the hearing aid can pick up your voice, so you can engage in a phone conversation even if your phone is away (but within Bluetooth range).
• Try out remote control functions: Use the manufacturer’s app to control things such as the volume or bass/treble balance of your hearing aids.

Have virtual appointments: You can have the hearing aids adjusted remotely by your audiologist over the internet, saving you a trip to the clinic.

The post Good hearing matters: Tips from a Sunnybrook audiologist appeared first on Your Health Matters.

Ricky Chow, Sunnybrook audiologist, explains how the virtual hearing care service can help patients.

What is the Virtual Hearing Care Service?

The Virtual Hearing Care service is available to patients with hearing aids and a smart phone. The benefit is that, through this virtual service, patients can have the convenience of having their hearing aids checked and adjusted remotely.

How does it work?

Once the patient has been fitted with hearing aids, their audiologist can make any further adjustments to the devices over the internet.

The patient will need to connect the hearing aids to their smart phone using an app provided by the hearing aid manufacturer. The audiologist will help the patient with set up before their first virtual appointment.

If a patient needs to have adjustments made to their hearing aids, they can either come in-person or opt for virtual care instead. If they opt for virtual, we would “call” them through the manufacturer’s app, and the patient would be in a video call with the audiologist.

The audiologist will make whatever changes are necessary while talking to the patient. The new adjustments will be noticed almost instantly. Once the patient is satisfied with the settings, the hearing aids are updated, and the call is disconnected.

Who is eligible?

Patients who are interested and have a smartphone are eligible for the Virtual Hearing Service. Please check with your audiologist regarding compatibility.

How do they sign up? Is a referral needed?

The audiologist will mention this service being available, and the patient can choose to decline or consent. The patient has the option of coming in-person if they choose to. A referral is not required.

Learn more about Sunnybrook’s Audiology Services

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Dr. Vincent Lin is an otolaryngologist (head and neck surgeon). He has worked at Sunnybrook Health Sciences Centre since 2008.

You definitely know to avoid loud noises today. Was that always the case?

My family has a musical background, so I took piano when I was growing up. Music was a big part of my life, but I’m guilty of listening too loudly. Today, I have high-frequency tinnitus which causes a constant ringing sound.

How about concerts—pre-COVID, of course!

I’ve never gone to an actual rock concert, but remember going to a few loud clubs when I was in university. You know, the kind that leave your ears ringing afterwards. That for sure played a part in my developing tinnitus.

Does that mean you’re pretty strict with your three kids when it comes to limiting loud music?

Being around the teen years, I try to highlight how important it is for them to listen to things at a reasonable volume. Every once in a while, I’ll check the volume on their earbuds.

So what do you do day-to-day to safeguard your own hearing?

I still enjoy listening to music and watching movies, but try to keep the volume lower. With a lot of earbud devices, you can set volume limiters, which are really helpful. When I’m on a call, I try to put it on speaker phone when possible. Doctors are not always great at practicing what they preach, but I’m trying!

We go to our cottage regularly, and the maintenance on that property requires the use of a lot of power tools. I use muffs or ear inserts when I’m using those. They protect from further damage, and also show my kids that hearing protection is important. When I’m not working, I cherish those quiet moments at the cottage so much. When you get up there, you realize how much environmental noise we are constantly surrounded by in the city.

What’s your top piece of advice for the rest of us?

Seeing how disabling hearing loss or tinnitus can be, even little protective steps done over time can make a big difference. As I can attest to, you often don’t think about hearing loss until it happens to you.

The post How to live like the experts: Protecting your hearing with Dr. Vincent Lin appeared first on Your Health Matters.

“You don’t realize how often you’re saying, ‘I’m sorry. What was that?’” Larry says.

He also plays guitar in a band and would turn up the volume on his monitor on stage to try to hear the high notes better.

“Playing loudly didn’t solve the problem,” he remembers.

Larry eventually went to Sunnybrook’s Audiology Clinic which led to a turning point that helped improve his hearing.

“You don’t know what you’re not hearing,” explains Larry. “I didn’t realize how hard I was working to hear things.”

Hearing check

“It’s important to get a hearing test if you suspect you are having difficulty hearing,” says Michael Lam, a hearing instrument dispenser in Sunnybrook’s Hearing Aid Centre. “Untreated hearing loss often leads to patients avoiding social situations and conversations.”

Michael Lam is a hearing instrument dispenser in Sunnybrook’s Hearing Aid Centre.

A physician’s referral is needed for a hearing test. From there, an appointment will be made with an audiologist, who specializes in the prevention, identification and management of hearing loss and balance disorders.

“An audiologist will ask the patient about their hearing ability and how it impacts their life at home and work,” explains Juljia Adamonis, Sunnybrook audiologist. “From there it’s about working with the patient to personalize what hearing aid style and features will work best for them, and then following up in the future to help with any changes.”

Larry has been seeing the team at the Sunnybrook’s Hearing Aid Centre for several years and feels supported by the experts he has worked with, including Michael.

“It’s a diamond in the rough to have that centre,” says Larry. “The team is outstanding. There is great continuity of care. When I go there, they know who I am. It’s refreshing.”

“Hearing is crucial,” says Michael. “I am involved with fitting hearing aids and counselling patients on how to use and adapt to their hearing aids. I see them regularly to help them maintain their hearing devices and ensure they are hearing to the best of their ability.”

“He explained details in a way that was easy to understand. It was a good process,” says Larry.

How hearing aids have changed over the years

“When it came time to consider hearing aids, I first thought of the ones I saw growing up. They were big and clunky,” Larry recalls.

Michael says hearing aids today are much different than those of the past.

“Hearing technology has come a long way!  Most hearing aids are very discreet. They can easily connect and stream with phones, tablets, and televisions,” Michael explains. “They can help streamline a patient’s communication and technology use. We can also make custom fit musician plugs to help minimize noise damage to a person’s hearing.”

Larry says it took a little while to get used to the hearing aids but in the end, they made a huge difference.

“I didn’t realize how hard I was working to hear before. I was struggling trying to hear certain letters and sounds. You get tired. In social situations, it could be exhausting,” says Larry. “After getting the hearing aid, I wasn’t struggling to hear. I didn’t need the extra effort. I didn’t have to concentrate on a person’s face so hard. It’s a very subtle thing, but I could just hear better. I felt a lot better in social situations.”

“It is rewarding when you can help someone,” says Michael. “Pursuing hearing aids can help an individual engage more fully and confidently with the people in their lives. It has been exciting to help patients use new hearing aid technology to help them hear and communicate with the world.”

Larry says over the years, he has found a good fit with his hearing aids, which he adds, have made a big difference in his day-to-day life.

“They’re really comfortable and most people, even close friends, don’t know I have them,” he says. “It’s been a huge breakthrough for me.”

The post How improving your hearing can make a difference in daily life appeared first on Your Health Matters.

The Cochlear Implant Program at Sunnybrook Health Sciences Centre is the largest adult program in Canada. Test your knowledge about these devices, which an increasing number of Canadians are receiving.

Time's up

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How much do you normally lip read to communicate?

J&D: Both Debbie and I have one cochlear implant, which has changed the amount of lip reading we do. Before receiving our devices, Debbie would lip read about 90 per cent of the time, and I did about 70 per cent of the time. Since receiving our implants, however, we are forcing ourselves to rely more on our devices. That being said, lip reading is another cue that helps in difficult listening situations, and for the most part masks eliminate that visual cue.

What tips can you offer to improve communication while wearing a mask?

J&D:  There are few things to consider. Communication is a two way street after all!

For people with “normal” hearing who are speaking to a hearing impaired individual through a mask, speak slowly, a little louder than normal, and rephrase your remarks if they are not understood. It is also helpful to have easy access to a notepad and pen so you can jot things down as a last resort.

If there is a group interacting with a hearing impaired individual, make sure only one person speaks at a time. If possible, eliminate any background noise, such as turning off music or moving to a quieter area. Above all, remain patient!

From the point-of-view of the person with a hearing loss, be up front with the individual, and tell them you have a hearing loss and would appreciate them speaking a bit slower and louder. We’ve even seen masks and buttons with the words “I am hearing impaired” or something similar written on them, which we think is an excellent way to let people know you need extra help. If it is safe to do so – for example the person is behind a barrier and/or is at least 2 meters away – perhaps ask them to briefly remove their mask and repeat what they are saying. Even though there may be challenges, try to remain patient during the interaction.

If it is safe to do so, have a reliable friend or family member be present at a safe distance for the interaction to help interpret the conversation. If you are visiting a clinic or hospital, be sure to check in advance about their visitor policies.

Any other tips?

J&D: Something we hope will become more widespread is the use of accessible face masks. These masks have a transparent window where the mouth is, and would be especially beneficial in circumstances where there is a high degree of hearing loss and lip reading is necessary.

Signage can also be incredibly helpful, especially in situations where a repetitive question is being asked. For example, screening is now common before entering certain stores, so having an image or simply worded sign at the point of interaction can act as a backup if communication is difficult.

There are also various apps available that can help convert speech to text on your mobile device. These would need to be applied in a quiet space, however, to ensure proper social distancing is possible.

Dr. Lin, how are you and your team at Sunnybrook overseeing communication with patients?

Dr. Lin: Mandatory mask wearing is definitely important, and we have come up with a few solutions when challenges may arise. For those patients who have good lip-reading abilities, our clinical staff now wear special masks with a transparent window placed near the lips, as Jeff and Debbie mentioned earlier. We have also done our best to eliminate ambient and background noise in our clinic environment during patient encounters. For patients who can sign, we continue to offer access to sign language interpreters.

For patients who have new onset hearing loss and cannot read lips, we have always had the ability to type for them on our computer screens. This allows us to interact without actually having to speak.

What advice and tips would you provide for improving communication while wearing a mask?

Dr. Lin:  During these challenging times, let’s be patient and considerate of others! If there are individuals having trouble hearing you, try and find a quiet environment free of background noise and then speak slowly and clearly. Remember that hearing loss is really an invisible disability, so an ounce of kindness and consideration will go a long way

The post Face masks and hearing loss: Tips for supporting individuals with hearing loss during the pandemic appeared first on Your Health Matters.

What do you hear?! Yanny or Laurel pic.twitter.com/jvHhCbMc8I

— Cloe Feldman (@CloeCouture) May 15, 2018

To understand why this is, we sought the expertise of Dr. Andrew Dimitrijevic, Research Director of the Sunnybrook Cochlear Implant Program. Here’s what he had to say:

The audio clip is an example of a bistable auditory perception. It’s kind of like tick-tock versus tock-tick.

Why are people in Laurel and Yanny camps? There are probably two factors:

Pitch differences between “L” and “Y”

Different speakers (such as computer speakers or cellphones) will accentuate frequencies differently. If your speakers can’t play high frequencies clearly you might hear “Laurel” because there’s more low frequency in “Laurel.” Conversely, “Yanny” has more high frequencies, and if your speakers are better at high frequencies then you will hear “Yanny.”

Environmental noise is also a factor. Different frequencies will get drowned out differently. A subway might drown out lower frequencies, and you might hear “Yanny.”

Your brain

Your brain is always trying to interpret the environment and give meaning to sound. We hear with our ears but listen with our brain. When we hear a sound, our brain is comparing it to a template in our brain that we have developed and stored from childhood. So if the “Yanny” module or brain representation in your brain is bigger than “Laurel” because you grew up listening to Yanny, you might hear “Yanny.” Context is important. If you heard the audio-clip in a record store or in line at a Yanny concert you would probably hear “Yanny.”

Ultimately, what’s probably happening is combination of the two factors: acoustics and brain interpretation. The audio clip is poor quality. So right off the bat your brain is in “guessing mode.” With no context (such as a sentence or a scene) you brain is guessing more. If your brain’s representation of “Laurel” happens to be more sensitive than “Yanny,” your brain would latch on to “Laurel.”

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