Hearables

Scientists discover that eardrums move in sync with eyes

By Daniel Fink, MD, Chair, The Quiet Coalition

Aylin Woodward, New Scientist, reports on new research that shows that our eardrums appear to move to shift our hearing in the same direction that our eyes are looking. Jennifer Groh, the lead researcher, believes “that before actual eye movement occurs, the brain sends a signal to the ear to say ‘I have commanded the eyes to move 12 degrees to the right’.” Why? She opines that “[t]he eardrum movements that follow the change in focus may prepare our ears to hear sounds from a particular direction,” noting that one reason why the eyes and ears move together may be to help “the brain make sense of what we see and hear.”

My guess is that for our primate ancestors, and then for primitive humans, there was a survival advantage to hearing sound from something that had been seen. Friend or foe? Food or predator? It will be interesting to see where this research leads, particularly as Woodward writes that the study might help develop better hearing aids, “which must locate where sounds are coming from to work well.”

Research is always good. That’s how we learn about how the world works. But we don’t need any more research to know that noise is a health and public health hazard, and that we need to press our elected officials to make the world quieter now.

Because no matter how good the technology becomes, preserved normal hearing is far better than any hearing aid. And far cheaper, too.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

iBuds? Apple shows its hand in the “hearables” space

Photo credit: Bjorn Knetsch licensed under CC BY 2.0

By David Sykes, Vice Chair, The Quiet Coalition

This recent piece by Steven Levy in Wired suggests what Apple (and others) are up to in the hearables market. Levy tells us that Apple is collaborating with Cochlear to provide solutions for people with profound hearing loss. This should excite anyone concerned about the epidemic of hearing loss in America, because it suggests that hearing health has gained enough attention that corporate America is applying resources to the problem and turning it into a “technological opportunity.”

If you’ve been following outcomes from the two federal reports last year (from the Presidents Council of Advisers on Science and Technology, and the National Academy of Medicine) and the resulting bi-partisan Over-the-Counter Hearing Aid Act of 2017 (OCHA) approved by the Senate last week (earlier approved by the House), you know something’s up in the hearing health sector. And with the passage of OCHA last week, hearing health, an issue that has languished in the shadows for lack of funding for over three decades is suddenly center-stage again after three decades of neglect.

The Wired article, coupled with the legislative success in the Senate, demonstrate that hearing health is finally starting to get the attention it deserves. That Apple is trying to gain a foothold in this world shows that tech companies smell an opportunity. And the passage of OCHA clearly establishes that hearing loss is a nonpartisan issue important to both republicans and democrats, because despite the state of affairs in DC today it’s an issue on which the nation can begin to make progress even if the rest of the legislative agenda is on hold!

David Sykes chairs/co-chairs four national professional groups in acoustical science: The Acoustics Research Council, ANSI S12 WG44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group. He is also a board member of the American Tinnitus Association, co-founder of the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute, lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), and a contributor to “Technology for a Quieter America” (2011, National Academy of Engineering). A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

New hearing aid filters out noise (but not as well as your own ears and brain)

Photo credit: Steve Johnson licensed under CC by 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

Engineers at Columbia University School of Engineering and Applied Science have made an advance in hearing aid design that reportedly will allow users to better understand speech in noisy environments by combining auditory and neurological signal processing techniques. No doubt the millions of people who suffer with hearing loss appreciate the efforts to tackle this health issue. But why do we see article after article focusing on funding for treatments or cures of hearing loss but nothing about funding hearing loss prevention?

We think the better option is to prevent noise-induced hearing loss by avoiding exposure to loud noise. The human ear and brain are designed to process incoming sound well and probably do this better than any electronic gizmo can. Research shows that noise damages not just the ear but directly damages the brain as well, at least in animal models.

And for those who already have hearing loss–and even for those who don’t–quieter indoor and outdoor environments will allow everyone to converse more easily. The techniques for creating indoor quiet are well known: eliminate noise sources if possible, isolate noise sources that can’t be eliminated, use sound absorbing materials on floors, walls, ceilings, and furniture, and use architectural features to break up reflected sound waves. And while some may balk at the cost of implementing these techniques, there is one no cost option everyone can use: turn down the volume of amplified sound from rock concert levels to hearing preservation levels!

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

 

How research, technology, and finance are fueling the new world of hearables

Copyright 2016 www.hearable.world

By David Sykes, Vice Chair, The Quiet Coalition

“For the last 40 years, there’s been very little movement, if any at all on [hearing loss]… and there [are] fundamental regulatory forces in place here that are subject to inertia. …. Now, just literally within the last year, …we’ve seen more movement on this issue than essentially in the last 50 years of U.S. history.”

–Frank Lin, MD, PhD, Assistant Professor, Otolaryngology, Johns Hopkins Bloomberg School of Public Health (July 2016)

In the U.S. we grew accustomed to noise and noise-induced hearing loss being ignored. Nothing much happened for three and a half decades after 1981 when, for political reasons, noise and its effects became verboten—serious people wouldn’t talk about it and researchers couldn’t find money to explore it. But lately, what venture capitalists call a “convergence” has occurred—a confluence of research, technology development, and novel sources of financial support (i.e., crowdfunding). And this convergence is creating a surge of interest in this long-ignored subject.

What is going on? Why are some of us so excited about this? Where are we headed? How does this help (or hurt) people who are concerned with the need to control noise, peoples’ exposure to noise, and people who suffer from hearing disorders like tinnitus, hyperacusis, and misophonia? If you follow the writing of The Quiet Coalition’s chairman, Daniel Fink, MD, you may recall that he first wrote about this subject last May. In short, personal sound amplification products (PSAPs) are a positive, exciting step in the right direction. But they will not and cannot solve the larger problem of noise and noise-induced hearing loss in America.

First: What’s going on?

Did it start with research? In 2009, two researchers at Harvard’s Massachusetts Eye and Ear, Charles Liberman, PhD, and Sharon Kujawa, PhD, published a paper revealing that “synaptopathy”, i.e., permanent nerve damage to the nerves that connect the ears to the brain, actually happened at lower noise levels than previously assumed and in the neurological circuits that can’t be seen in an audiological exam (audiologists can only see the pinna, the external auditory canal and the tympanic membrane—after that all has been a big mystery).

As a result, something called “hidden hearing loss” suddenly caught the attention of the policy makers who funded the research. Abruptly, the idea that noise caused only “temporary” damage, i.e., that the ear could recover from what has for decades been called a “Temporary Threshold Shift,” appeared to be really wrong. Hearing damage to nerves is always permanent and, at least until cures are found, irreparable. This caused a shift toward neuroscience research and toward the search for potential cures in partnership with the drug industry.

Did it start with technology innovators? Sony’s phenomenally successful Walkman (launched in 1977, forty years ago) started it, but then Apple’s iPod caused an explosion in the use of “earbuds” for “personal listening.” These wired earbuds were incredibly popular but always troublesome to wear because of the wires, so R&D types began trying to figure out how to get rid of the wires. Then “wireless” arrived. Called “Bluetooth,” it was developed in Sweden (the name “Bluetooth” is a tribute to the ancient King Harald Bluetooth of Denmark who unified parts of Scandinavia). But even wireless earbuds were essentially “dumb” speakers. Eventually, other restless R&D types began exploring what else, with increasingly miniaturized circuit designs, those wireless earbuds could do for you if you thought about the ear as a “portal” for transmitting information to the brain. From that work was born the idea of the PSAP.

But how did an idea turn into a blossoming industry called “wearables” or “hearables” in which at least seventeen companies are now scrambling for your attention? The answer? Money.

Did it start with the idea of “crowdsourcing” money to develop next-generation, smart “earbuds”? Look closely at the chart above and you’ll see that many pioneering PSAP companies currently vying for your attention are financed by “crowdsourcing” campaigns (e.g., Kickstarter and others). Another funding approach now available to companies in this emerging sector is the new SEC-approved “equity crowdsourcing” venture-finance companies, which have only been able to operate since late 2016 in the USA (earlier elsewhere). In other words, now there are whole new ways to start and fund a tech company that do not rely on traditional venture capitalists—those people who traditionally funded lots of other tech companies, but who have had, until now, little interest in hearing technologies because the hearing technology market has been stuck in a rut for three and a half decades.

In truth, all three of these phenomena—research, technology innovation, and capital–occurred independently. But now they have converged and are beginning to affect—and disrupt—existing markets, such as the market for hearing aids.  Hearing aids are over-priced, limited production devices generally aimed at older people and manufactured by a group of six companies (“the cartel” or “The Big Six”) who dominate the industry and make 98% of the world’s hearing aids—in other words, this is a market ripe for disruption.

Now add a fourth catalyst: Regulatory change. Eleven months ago (June 2016), the National Academy of Medicine published a significant report about the emerging, disruptive technology of PSAPs and attempted to warn audiologists, hearing aid manufacturers, and others who have been comfortably ensconced in this stable, profitable but uninteresting market that things are about to change. Then, a few months later two U.S. Senators introduced a bi-partisan bill intended to accelerate transformation of this market. It’s called “The Over-The-Counter Hearing Aid Act,” and it was introduced by Senators Warren (D-MA) and Grassley (R-IA). This act specifically seeks to streamline the market for “hearables”/PSAPs by exempting them from FDA regulation and enabling them to be sold direct to consumers, i.e., “over the counter,” without medical intervention.

But wait, what does this story have to do with our interest in noise control, in ending harmful exposure to noise, in your and your family’s hearing health? Do these new PSAP devices provide some relief for people who already suffer from noise-induced hearing loss? Can they prevent further damage from exposure?

Answer: A big maybe.

Keep in mind that the first word in PSAP is “personal”—these devices only address your noise problem, they don’t solve the noise problem for anyone else. If you travel to work on a noisy subway system, it’s possible some of these PSAP devices may provide you with some relief in the form of an active noise cancellation feature. If you can’t understand conversation in a noisy restaurant, some of the PSAP devices may be able to help you screen out background cacophony and focus on the person who’s speaking to you. In short, PSAPs include a wide array of features that might interest you. They are marketed as wireless earbuds that allow you to optimize “the way you hear the world,” and not as hearing aids, because they cannot be advertised as “hearing aids”—the U.S. Food and Drug Administration prohibits that. Only a “hearing aid” from one of “The Big Six” can be sold as a “hearing aid”—and only those six companies worldwide make devices that are labeled that way.

So “Caveat Emptor” (buyer beware) if you’re interested in trying one of the new PSAPs! This is exciting stuff and they cost less than 1/10th the price of conventional hearing aids. Furthermore, at least two of these companies, Doppler Labs (HERE One) and Nuheara (IQbuds), already have products on the market, so you can actually try out a pair of wireless earbuds and see for yourself.

But do they address the larger social problem that noise has gotten out of hand in America? That we’re all besieged, victimized, permanently injured by too much noise? To this, the answer is definitely “no.” You and a few others might get some relief, but PSAPs are not a solution to the noise problem in America.

David Sykes chairs/co-chairs four national professional groups in acoustical science: The Acoustics Research Council, ANSI S12 WG44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group. He is also a board member of the American Tinnitus Association, co-founder of the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute, lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), and a contributor to “Technology for a Quieter America” (2011, National Academy of Engineering). Mr. Sykes spent several decades in private equity, venture finance, and technology development and has a keen interest in how convergence and disruption affect traditional industries.

Originally posted at The Quiet Coalition.

On hearing loss and the hope for a cure

In “High-Tech Hope for the Hard of Hearing,” David Owen, The New Yorker, has written an article that gives us a good look at what scientists know about hearing loss and where they are finding possibilities for treatment and, possibly, a cure. He begins his article with a series of personal anecdotes about himself, his family, and friends and the hearing problems they’ve developed due to exposure to loud noise and other factors. Owen’s interest in this story is motivated, at least in part, by his tinnitus, which is marked by a constant high-pitched ringing in his ears.

Among the advances that Owen examines, he discusses the discovery of hidden hearing loss and introduces us to Charles Liberman, who, with his colleague Sharon Kujawa, “solved a mystery that had puzzled some audiologists for years: the fact that two people with identical results on a standard hearing test, called an audiogram, could have markedly different abilities to understand speech, especially against a background of noise.” He writes that “[s]cientists had known for a long time that most hearing impairment involves damage to the synapses and nerve fibres to which hair cells are attached, but they had assumed that the nerve damage followed hair-cell loss, and was a consequence of it.” What Liberman and Kujawa discovered is that “the connections between the sensory cells and the nerve fibres that go first.” And the reason this early damage isn’t picked up by a standard hearing test is because it measures “the ability to detect pure tones along a scale of frequencies [which] requires only functioning hair cells…and is unaffected by nerve damage until more than eighty per cent of the synapses are gone.”

“A disturbing implication of [Liberman and Kujawa’s] finding is that hearing can be damaged at decibel levels and exposure times that have traditionally been considered safe,” writes Owen, but he is reassured by the researchers that the discovery of hidden hearing loss is cause for optimism. Why? “[B]ecause reconnecting nerve synapses is almost certain to be easier than regenerating functioning hair cells inside human ears.” In fact, Owen tells us that Liberman and others “have successfully restored some damaged connections in lab animals, and [Liberman] believes that far greater advances are to come.”

While cause for optimism is welcome, Owen notes something early in his article that is particularly frustrating to those advocating for regulation of noise:

There are also increasingly effective methods of preventing damage in the first place, and of compensating for it once it’s occurred. The natural human tendency, though, is to do nothing and hope for the best, usually while pretending that nothing is wrong.

Click the link above to read this interesting and hopeful article in full.

 

 

Consumer Reports looks at affordable solutions to hearing loss:

No More Suffering in Silence? Julia Calderone, Consumer Reports, has written a thoughtful piece about hearing loss and the toll it takes on those who suffer from it.  Calderone states that hearing loss “has long been thought of as an inevitable part of getting older, more a nuisance than a life-altering medical condition—at least by those not experiencing it.”  But that opinion is changing, she asserts, as “the President’s Council of Advisors on Science and Technology (PCAST) and the National Academy of Sciences (NAS) have published reports calling untreated hearing loss a significant national health concern­, one that’s associated with other serious health problems, including depression and a decline in memory and concentration.”

Calderone not only treats hearing loss with the seriousness it deserves, she offers solutions to sufferers, particularly those who can’t afford to buy hearing aids, which “cost an average of $4,700 per pair in 2013.”  This is a very steep price, particularly since hearing aids are usually not covered by health insurance or Medicare.  To help with those who need hearing aids but can’t afford them, Calderone reviews a handful of hearing aid alternatives, namely personal sound amplification products (PSAPs), to see if they can fill the gap for those who need hearing aids but can’t afford to buy them.

Two PSAPs not covered in Calderone’s review are also worth considering: Doppler Labs HERE One and Nuheara’s IQbuds.  Neither company markets their PSAPs as a hearing aid or hearing aid substitute, but at around $300 a pair they offer personal amplification and soundscape management to people who might have no other options.

And a final thought about the sorry state of hearing health in the U.S.: For people who are suffering noise-induced hearing loss (NIHL), the personal and economic costs could have been avoided in the first place because NIHL is 100% preventable.

 

T-coil makes the world more accessible for the hearing impaired

Terry Byrne, The Boston Globe, writes about how the New Repertory Theatre is helping the hearing impaired enjoy the theater.  Byrne reports that the New Repertory Theatre installed a new assistive listening system before the start of the fall season that uses a hearing induction loop that “directly and wirelessly receives amplified sound from the stage without background noise.”  Audience members with hearing aids or cochlear implants that have T-coil receivers can “simply press a button on their hearing aid to take advantage of the theater’s system.”

Kayla C. Leed, Mountain Xpress, reporting on a presentation by Juliette Sterkens, national hearing loop advocate for the nonprofit Hearing Loss Association of America, writes:

A hearing loop is a wire that circles a room and is connected to a sound system. The loop transmits the sound electromagnetically, and its signal is then picked up by the telecoil in the hearing aid or cochlear implant.”

Hearing loops are becoming more popular in the U.S., Sterkens pointed out. They’re available in airports, train stations, places of worship, stadiums, auditoriums, grocery store cash registers and libraries. New York City subway stations and taxis are required to have hearing loops installed.

Do you or someone you know have a hearing aid or cochlear implant with a T-coil receiver?  Download this loop finder app to help find nearby loop-enabled venues.

Thanks to Charles Shamoon for the links.

Computers in your ears?

Doppler’s Futuristic Earbuds Sound Great. They Also Speak Spanish.  Brian Flaherty, writing for Wired, reviews the newest iteration of the HERE earbuds, HERE One, and pronounces it “one of the wildest gadget experiences I’ve ever had.”  In a good way.  He also is given a glimpse of what is to come, like the ability to have the English translation of a foreign langauge in your ear in real time.  Click the link for more.

Cheaper and better hearing aids are coming:

Why isn’t there a Warby Parker for hearing aids?  Sean Captain, writing for Fast Company, looks at the current market for hearing aids, a market that is dominated by six companies charging anywhere from $4,500 and upward a pair–out of reach for most people who need them–and the new players who are shaking up this industry.  First, Captain introduces us to “Audra Renyi, a 34-year-old former investment banker who’s been a hearing care advocate since 2007, [who] is launching a company called Hearing Access World that aims to cut the price of hearing aids by 75%.”   He writes:

Renyi knows her market well as executive director of World Wide Hearing. The Montreal-based nonprofit provides testing and low-cost hearing aids in poor countries like Guatemala and Vietnam. She hopes to bring prices down globally by playing directly in the market with her new social venture.

Interestingly, there are other players interested in this market who aren’t from the nonprofit world, namely tech startups. These startups are avoiding the cost, in both time and legal fees, they would have to bear navigating the Food and Drug Administration for approval of a new hearing device by selling their products as consumer electronic components.  Captain reports that:

While hearing aid sales are minuscule, consumer electronics companies are selling hundreds of millions of audio devices, such as Bluetooth headsets, that do many of the same things. Mass-market CE components are going into devices called personal sound amplification products, or PSAPs, which have become unofficial budget hearing aids.

Captain looks at one startup offering a PSAP, Doppler Labs.  Doppler Labs started out with a Kickstarter campaign for their product Here Active Listening, a $249 set of AI-driven wireless earbuds.  The earbuds “recognize and filter ambient sounds, such as bringing down background noise in a subway or boosting voices during a conversation, [and a] smartphone app lets users pick filters and effects (like simulating the ambience of a concert hall), adjust volume, and tweak a five-band equalizer.”  Doppler Labs is coming out with a new product, HERE One, which is shipping in time for the 2016 holiday season.

Captain reviewed the then current model of HERE One and had some reservations, but he didn’t have the opportunity to review the latest iteration and the Doppler spokeswoman offered that he may have needed different sized tips to better fit his ear canals.  Long and short, PSAPs are in their infancy, but the future looks promising for them and us.  As Captain states:

As consumer electronics companies nudge into the hearing-aid space with PSAPs, and as hearing-aid companies nudge into the CE space, a new wearable tech category may be emerging. Called “hearables” by their boosters, the gadgets could encompass a range of over-the-counter, in-ear devices that allow people to hear better—either by making up for diagnosed hearing deficiency or tweaking how live music and voices sound.

In the end, people with hearing loss who have been denied access to hearing aids due to their prohibitive cost should very soon be able to purchase reasonably priced PSAPs that will give them some relief.  While it would be better, of course, for everyone with hearing loss to be properly fitted with hearing aids that are adjusted by audiologists, this cheaper alternative addresses a critical need now.  For those who feel isolated by hearing loss, PSAPs will be a godsend.

Click this link for the full article to read about the full range of products and services that are or will be available shortly.

Amazon addresses the glaring weakness of noise-canceling headphones:

How to balance the benefit of noise cancellation with the danger of not hearing potential warning signs?

And the answer can be found in a new patent that Amazon received this month for “noise-canceling headphones that will allow critical, hand-picked words to be heard by the headphone-wearer.”  While not perfect solution, it’s a start.  Of course, the alternative solution is for government to regulate noise so that noise cancellation headphones are unnecessary, but that is sadly unlikely in our current political environment.