The Vital Link: Auditory Function and Fall Risk in Older Adults

Presbycusis is the term used to define age-related hearing loss. The longer we live on this planet, the more toxins and noise we are exposed to. There is research that suggests that presbycusis is a first-world problem because we spend more of our time in environments full of ear pollutants, noise, pollution, and POOR HEALTH choices.

Hearing loss that comes on suddenly or over a three-day period is considered a sudden onset hearing loss and is treated as an audiologic emergency. Correct treatment within the first five to 14 days of sudden onset hearing loss is crucial to the outcomes that a person might experience.

What to do if you have a patient with a sudden or rapid onset hearing loss:

1. Complete otoscopy to rule out cerumen impaction, acute otitis externa, or foreign object.
2. Contact GRH Otolaryngology to reach Dr. Funk, Dr. Pinther, or one of the nurses to consult on recommended treatment options.
3. Order a hearing examination. Fax the urgent referral to (208) 639-9581, and have someone call the office to verbalize to the staff that there is an incoming urgent referral for a sudden hearing loss. The audiology office will do everything in their power to see that patient within 48 hours to provide assessment.

Tinnitus is the subjective perception of sound coming from the ear(s) or head that may be described as a faint to loud ring, roar, whoosh, buzz, or other descriptor, or any sound that the person hears but is not otherwise present in the environment and audible to others.

Common injuries, diseases, and disorders that have tinnitus as one of their symptoms:

• Noise exposure
• Acoustic trauma
• Earwax
• Ear infection
• Hair on the eardrum
• NSAID usage
• Dehydration
• Stress
• Alcohol consumption
• THC/CBD product consumption
• Head trauma
• Medications
• Cardiac conditions
• High blood pressure
• Hearing loss
• Vestibular disorders

Tinnitus is a symptom, not the disease. If the underlying etiology can be addressed then the presence of the tinnitus will likely resolve. Some people benefit from coaching in conjunction with sound therapy and/or other therapies to manage their reactions to tinnitus.

Tinnitus can be evaluated and managed by a qualified audiologist. If the tinnitus that the patient presents with matches their heartbeat or is referred to as pulsatile, cardiac and heart-related conditions should be evaluated and ruled out prior to referring to an audiologist.

Vertigo is the term used to describe the spinning sensation or other hallucination of movement (falling forward or moving backward while remaining stationary). It is accompanied by nystagmus (rapid eye movements). It is most commonly caused by vestibular disorder or impairment.

Most common causes of vertigo:

• Post alcohol nystagmus
• Benign paroxysmal positional vertigo (BPPV)
• Meniere’s disease
• Vestibular neuritis

How to tell them apart:

BPPV is triggered by changes in head position, like looking up, leaning head back, rolling over in bed, or sitting up from a prone position. Rotational spinning is violent with rapid onset and lasts 10-60 seconds. Any residual symptoms are likely a psychosomatic response to the violent onset of the symptoms.

Meniere’s disease is triggered by fluid incompatibility in the inner ear. Perilymphatic and endolymphatic fluids are ionically opposite. In cases of hydrops in the inner ear they may mix, causing rapid onset of vertigo along with aural fullness, presence of roaring tinnitus, and loss of hearing. It can be one or both ears and is often described as a drop attack lasting several hours.

Vestibular neuritis is an infection in the inner ear that comes on rapidly. There is often, but not always, a previous or recent viral illness. The spinning sensation lasts for hours to days and is sometimes accompanied by changes in hearing. A high-pitched tinnitus is occasionally reported in conjunction with symptoms. When the spinning resolves, a vague sense of disequilibrium and listing to the affected side may persist for several weeks.

Vertigo and dizziness are the most common complaints that result in emergency room visits. There are many causes; peripheral vestibular causes of vertigo can be easily identified and managed when medical teams know what to look for and where to refer after an emergency room or urgent care visit.

Complaints of dizziness and vertigo need to be described by the patient without using the words “dizziness” or “vertigo” to help categorize.

A rotational spinning sensation with presence of nystagmus (rapid eye movement) is likely caused by an abnormality of the inner ear. Nausea, vomiting, syncope, and lightheadedness do not typically have vestibular origins and would follow a separate diagnosis pathway that is not covered here.

Meclizine will suppress the vestibular response, but when it is used for more than a day or two for suppression of active attack or for management of motion sickness the depression of the vestibular response may become permanent and can negatively impact vestibular rehabilitation.

An improperly performed Dix-Hallpike or Epley maneuver can move otoconia into a different canal, making it more difficult to clear and resolve BPPV.

Definitive diagnosis of a vestibular etiology is done by a qualified audiologist in conjunction with a physical therapist and otologist/otolaryngologist.

I’m Erika. I love learning about new technology, particularly with technology designed to help people hear and connect to their families, friends and community. I first learned about the Jabra Enhance Plus 18 months ago in a tech talk related to OTC hearing aids. OTC stands for “over-the-counter”; this was driven by the PCAST report (President’s Council of Advisors on Science and Technology) that was published in 2016 and was rejuvenated by Biden’s Executive to the FDA to develop regulations and labeling on a new classification of non-prescription hearing aids that would be available to purchase by consumers without professional engagement.

The purpose was to introduce lower cost entry to hearing aids for consumers. This is opening a whole new pipeline of devices from manufacturers of consumer electronics to manufacturers of medical devices to get into the lucrative market of entry level amplification. Bose had launched their new “hearing aid” which was a terrible flop, it didn’t have rechargeability, it had a ton of feedback (whistling), it didn’t even have basic streaming features. Signia launched a product, Apple Air pods added transparency mode and developed an app to “test” your hearing to apply mild gain to your Air Pod Pros, and Resound’s research team partnered with GN’s consumer electronic group that makes Jabra products to develop a hybrid hearing aid/consumer electronic sometimes referred to as a Hearable, PSAP (Personal Sound Amplifier), or and OTC hearing aid. Other companies have come out with products that they are marketing as hearing aids, the FDA has been playing whack-a-mole with these illegally labeled products. Whatever you may call the widget, it is an electronic device that is not programmed by a licensed hearing health care professional.

I was awarded a slot to participate in a pilot project to evaluate the Jabra Enhance Plus product before it was released commercially to the public. I have been wearing the device for the last 10 days. I have about 4 pages of feedback for the developers for the app and also the device itself. Here is my pro/con list.

Pros: The size and fit. It doesn’t look anything like a hearing aid, it is like a small button Bluetooth or wireless earbud. There is nothing hanging out of the ear to catch on masks. The green, faded yellow and red indicator lights on the device and the charger are intuitive ways to alert to battery life. The little charging case holds a charge even when it is not plugged in. It is easily portable, fits great in a pocket of my purse so I have them with me. The streaming is pretty seamless. The app controls are deceivingly simple, it seems like there should be more, but it is really just the volume up and down. They were a lot more comfortable to wear while reclining and listening to streaming audio than other wireless earbuds that I have used. It was easy to switch to a call while streaming. They enhanced listening when I was watching TV.

Cons: The built-in personalization didn’t seem to customize the sound; The filter setting was something that I wanted to change frequently, but it is a buried feature in the app. The fit was sort of uncomfortable in one ear and the selection of domes were not adequate. The occlusion effect for my own body noises was significant. My voice sounded too far away for people on the other end of the phone call. The sound quality for phone calls and streaming audio was inferior to other wireless earbuds that I use. I struggled in noisy situations to hear other people over my own body sounds. They move a lot in my ears with talking. They don’t connect to my computer, so going between zoom meetings and phone calls or other activities was cumbersome and I have to switch devices.
My overall assessment is that there is a place in the consumer electronic world for these cute little hearing enhancers, but they will not yet replace my wireless earbuds. I look forward to future software updates that will hopefully improve and expand usability (like connecting to my PC for zoom calls).

Tom was not as happy as Donna after his 10 days with the devices. He much preferred his own hearing aids. He did like that his mask never got caught on them. His biggest issue was that he got whistling from them when he turned them up loud enough for him to hear the TV. He did enjoy the streaming capabilities. He struggled the most with pairing the devices, which may have been because he used his Bluetooth a lot for other things and the Jabra devices did not seem to respond well to intermittent connectivity.

Donna wore the devices for 10-12 hours everyday for ten days. She loved how much better she heard in group settings and in conversations with friends and family.

She mentioned that after a long day she did notice that her ears would get a little sore and she thought maybe a smaller prescription hearing aid would be better for her long term, but she thought these self fitting hearing aids were great and easy to use. She would definitely consider buying them and even had several of her friends ask where they could buy them.

Linda wore the Jabra Enhance Plus 5-6 hours a day. Mostly while watching TV. She loved how much easier it was to hear the dialogue on TV. She also enjoyed hearing her husband more easily while they were having conversations. She had little difficulty connecting the devices to her app, the most difficult part of the connection that Linda had was remembering her apple password. She was really impressed with the product and the price.

Beth wears the Jabra Enhance Plus about an hour a day, primarily for streaming while exercising. She loves the quality of the streaming for phone calls and listening to audio books. She tried the devices in a restaurant with friends, but really struggled to adapt to her own voice and thought that it was actually harder to focus on the voices she wanted to hear over some of the other environment sounds being amplified. She really didn’t find them helpful in the classroom like she had hoped, but she admitted that only tried them once in that setting.

I'm Jan. I have enjoyed being part of this new technology. After day two I did experience right ear canal discomfort and was not able to wear the device for a few days. I feel if the device was a little bit smaller it would be more comfortable for me.

I felt muffled and my own voice was hollow. After a few days I didn't notice it as much. I am not totally comfortable with new technology but found the setup for Jabra to be easy. The charging was easy, and the hearing test was relatively easy. I have normal hearing, therefore did not experience a lot of amplification. I found the app was user friendly. I would recommend them to someone who had a mild to moderate hearing loss that could not afford hearing aids.