July 20, 2006 Issue

             HEARING LOSS HELP E-zine
"The premier e-zine for people with hearing loss"


Volume 1, Number 6                          July 20, 2006
Publisher: Neil Bauman      neil@hearinglosshelp.com
            http://www.hearinglosshelp.com
    Copyright Center for Hearing Loss Help 2006

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                      "Hearing loss may change your life,
                        but your life need not be any less
                                rewarding and fulfilling
                        because you have a hearing loss."

                                                               -- Neil Bauman, Ph.D.

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In this issue
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1. Beware of (Ototoxic) Drugs That Can Damage Your Ears

2. Answers to Your Questions

3. Subscriber-only Special

4. Tips for Successfully Coping with Hearing Loss

5. Information on Hearing Aids, Cochlear Implants and/or
Assistive Devices



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1. Beware of (Ototoxic) Drugs That Can Damage Your Ears
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Selective Serotonin Reuptake Inhibitors (SSRIs) and the
Permanence of Their Side Effects

A man asked: "Do you have any information as to the permanence of
the side effects (especially hearing loss or tinnitus) of the
following SSRIs?

Celexa   (Citalopram)    2
Lexapro (Escitalopram) 2
Luvox    (Fluvoxamine) 3
Zoloft    (Sertraline)      3
Paxil      (Paroxetine)    4
Prozac  (Fluoxetine)     4

I'm curious as to why two of these SSRIs receive a severity
rating of 4 when the worst antibiotics receive a 5. Are the SSRIs
really that dangerous at prescribed levels? If you don't have the
answers perhaps you could recommend a place I could find further
information (i.e. The Physicians' Desk Reference, or a web site
database on drug side effects?)"

You ask some excellent questions and I wish I had definitive
answers to give you. I have scoured all the sources you mention,
and many more, and what I have reported in my book "Ototoxic
Drugs Exposed" is what I have found.

The truth is, the ototoxic side effects of drugs are seldom
specifically studied during drug trials. As a result, information
on ototoxicity is sketchy at best. That is why little or nothing
is officially known about the permanence of the ototoxic side
effects of most drugs, including the SSRIs.

When I rate any drugs for their risk of ototoxicity, it is my own
personal and subjective rating based on very incomplete data.
This rating is based on any information available to me at the
time I made it. It is typically not based on the results of
double blind, or other studies. I may be totally off the mark,
but this rating is still my best guess. You can use these ratings
as a guideline if you want, or totally ignore them. However, if
you don't have a clue about the ototoxic risk of a given drug,
this risk rating could be a good starting point in deciding
whether you might want to risk the ototoxic side effects of
taking that drug or not.

My purpose is to warn people ahead of time that many drugs are
ototoxic, and also give them the best information I have found
about any given drug's degree of ototoxicity.

"Are the SSRIs really that dangerous at prescribed levels?" This
is a difficult question to answer because there is very little
concrete data available. Furthermore, doctors are free to
prescribe drugs at any dosage they want, for as long as they
want. However, if the dose exceeds the levels used during the
drug trials, no one knows what the risk of any resulting ototoxic
side effects may be. To complicate things further, some people
are very sensitive to drugs in general so they might have an
ototoxic reaction at the "recommended" dose, while others may not
experience any ototoxic side effects even when taking the drug at
higher than recommended levels.

However, I have heard from a sufficient number of people that
have had ototoxic side effects from taking SSRIs that I believe
these drugs can be dangerous to our ears.

Unfortunately, all too often, ototoxic side effects are not
reported to the Food and Drug Administration (FDA) like they are
supposed to be. It seems that doctors very seldom report any side
effects to the FDA, so the few side effects reported actually
represent an enormous number of people who got these same side
effects. Thus, ototoxic side effects are not the rare occurrences
they might appear to be. Even the FDA estimates that less than 1%
of all the side effects of drugs are ever reported to them. In
the case of the side effects of ototoxic drugs, I believe the
true number reported is only a small fraction of 1%.

Getting back to the permanence of ototoxic side effects, what I
included in "Ototoxic Drugs Exposed" is pretty well everything I
had found out about that drug up to that time. So if I don't
indicate anything about permanence, nothing was specifically said
about it. As time goes on, and as people tell me their stories as
to the permanence of a given drug's ototoxic side effects, I gain
more information and will include it in future editions.

For all the drugs on your (above) list, I have not seen any
studies to indicate whether their ototoxic side effects are
permanent or not. However, for Zoloft (Sertraline) and Prozac
(Fluoxetine) I have a number of anecdotal reports from people
taking them that indicates both good news and bad news. The good
news is that for some people part of their hearing loss is
temporary. The bad news is that most of these people also
reported a significant degree of permanent hearing loss. One
anecdotal report revealed that the resulting hearing loss and
tinnitus were permanent, and gave no indication that any hearing
ever came back. That is why I urge caution whenever you are
considering taking any drug thought to be ototoxic.

For general information on ototoxic drugs, read our various
articles on ototoxic drugs.

For complete information and individual listings on each of the known
ototoxic drugs and chemicals, go to Ototoxic Drugs Exposed.



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2. Answers to Your Questions
==================================================

If you have a question, or if something has been puzzling you
concerning your ears, email it to mailto:neil@hearinglosshelp.com
and put "e-zine question" as the subject. Suitable questions will
be answered here.
______________

Lipreading vs. Speechreading

A lady asked: "Is there any difference between lipreading and
speechreading?"

Yes and no. How's that for an answer?

Technically, lipreading is watching the lips to extract whatever
speech information you can, while speechreading is watching the
lips, tongue, teeth, cheeks, eyes, facial expressions, gestures,
body language and anything else that gives clues as to what the
person is saying. Thus speechreading encompasses lipreading, plus
much more.

For example, a person impatiently drumming her fingers on the
table, a person nervously shifting his weight from foot to foot,
a person pointing at a certain place or a person with a quizzical
expression on his face certainly aren't part of lipreading, but
they ARE part of speechreading as these actions are all part of
what the person is communicating.

Looking at it from the historical perspective gives a totally
different answer. This is because speechreading is the NEWER term
now used in the USA and Canada for what we formerly called
lipreading. You see, in the UK, they still use the older term
lipreading, but they really mean speechreading. Furthermore,
those of us who have talked about lipreading for the past several
decades find it difficult to give up this term. For example,
while I try to use the term speechreading, at times I slip up and
revert to calling it lipreading. Thus, in practical terms
lipreading and speechreading both really refer to the same thing.

To learn more about speechreading, read our article
"Speechreading (Lipreading)".



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3. Subscriber-only Special
==================================================


As is our custom, with each issue of Hearing Loss Help eZine we
bring you a subscriber-only special that is only available to
you, our loyal subscribers.

Since the above article is about speechreading, perhaps you'd
like to learn this invaluable skill. You can do so in the privacy
of your own home by working through the Seeing and Hearing Speech
Program on your own computer.

Look at these benefits!

--> Work at your own speed.

--> Do the lessons you want in the order you want.

--> Self-study program. The computer never gets tired or
exasperated when you ask it to repeat things until you get
them.

--> Lessons are arranged in four groups, each emphasizing a
different aspect of speech:
- vowels
- consonants
- stress, intonation and length
- everyday communication

--> Gives you practice speechreading, not with just one
instructor like you get in the classroom, but with eleven
different people--6 women and 5 men. Some are very easy to
speechread and others are more difficult. This way you learn
to speechread all kinds of people, not just the easy ones.

--> Replay speech segments in slow motion so you can better see
the nuances of speech movements. This greatly helps you learn
to speechread if you are having trouble "catching" speech at
normal speed.

--> Combine speechreading with speech. You will be amazed how
well you can speechread if you can hear some of the speech at
the same time. Set the volume anywhere from normal speech
volume to a faint whisper.

--> Over 100 interactive lessons containing more than 1,200
speech utterances. This will give you endless hours of
practice.

--> Choose from practice mode and test mode.

This computerized program on a CD comes with a printed
instructional manual.

Until August 8th, you can get this wonderful speechreading
program for only 76.50, a savings of 10% off the regular price of
$85.00.

Take advantage of this discount offer and get your very own copy
of "Seeing & Hearing Speech". NOTE: You MUST click on the above
link before August 8th to take advantage of this special offer.



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4. Tips for Successfully Coping with Hearing Loss
==================================================

Effectively Communicating with Your Hard of Hearing Spouse

A lady wrote: "My husband's hearing has been deteriorating over
the years. Within the last year or so it has gotten considerably
worse. He now wears hearing aids in both ears.

We are struggling to find new communication skills. Frankly we
get frustrated with each other, and at times irritated. For
example, he will ask me something from 3 rooms away, or when he
is at the kitchen sink with water running and then get annoyed
with me because he can't hear my answer. I am willing to make
adjustments and do whatever I can to help my husband, but there
are times when it seems he expects me to do all the adjusting.
How should I handle these situations?"

There are many communications skills that both of you need to
learn in order to have effective, yet frustration-free
communication. Unlike before, communication won't be effortless
any more, but when you apply proper coping strategies, it will be
effective.

As you already know, if you don't use effective ways of
communicating with each other, the frustration mounts. This is
not good for your marriage. In fact, if the irritation becomes
too great, it can (and too often does) lead to divorce. That is
why it is so important to take steps now to avoid a
communications breakdown. The good news is that you already
recognize that there are problems, and you are trying to find
proper solutions.

With that in mind, let's look at the specific example you gave.
Your husband asks you something from 3 rooms away and then gets
annoyed because he can't hear your answer when you call out to
him.

Talking to each other from three rooms away is easy for people
with normal hearing. However, now that your husband has a
significant hearing loss, that ease of communication is gone
forever. You now have to scrap your old ways of communicating
that no longer work, and find new ways that will work for both of
you.

When your husband calls to you from a greater distance than he
can hear, he is setting himself up for communications failure. In
addition, he is being unfair to you, Since his voice is just as
good as it always was, talking to you from a distance like he has
always done is not the problem. The problem is that he can't hear
your reply from that distance. Running to him every time this
happens is not fair to you.

Here is the proper way to handle this situation fairly. The hard
of hearing spouse must never call out or talk to the hearing
spouse if the distance is greater than he will be able to hear
the reply (except in emergencies).

The rule is if he wants to talk to you, it is his responsibility
to come close enough to you before he begins talking so that he
will be able to hear your answer the first time when you reply.
(This may mean getting right in your face, but that is ok.) If he
doesn't do this, you simply ignore him. Never answer until he is
close enough to hear you. Otherwise you will be enabling him to
continue with his bad communication habits, not to mention your
becoming more and more upset every time this happens.

By the same token, if you want to talk to him, you need to go to
him and get close enough to him so that he will hear you
correctly the first time before you start talking. (Again, this
may mean getting right in his face.) If you fail to do this, he
is to ignore you--and he will because he can't hear well in the
first place.

To recap, the fair way to communicate is the one who initiates
the communication needs to go to the other spouse before talking.
It is not fair to make the hearing spouse do all the adjusting.
Communication is a two-way street, so both of you have to do your
parts.

If both of you agree to these rules, and refuse to reply if the
other person doesn't follow them, you will soon be on the path to
communications success. (Of course, there may be a bit of trouble
at the outset while you change your deeply-ingrained
communication habits of many years. Habits take time to break—so
don't be nasty or impatient with each other if one of you forgets
and doesn't follow the rules—just gently remind the offender
that this is not how we communicate any more.)

There are all sorts of variations that can also work. For
example, if I want to ask my wife something and she is some
distance in front of me, I either have to go to her and get in
front of her, or I could ask her to turn around and look at me
(which really isn't her responsibility), or I could do something
entirely different. What I do sometimes is ask her a question
that she can answer by nodding or shaking her head. I just have
to preface my question, "Just nod or shake your head to reply."
Then it is MY responsibility to be watching her head to see what
her response will be. I do this so often that she knows enough to
nod or shake her head, and knows that I will be watching for
that.

My hard of hearing daughter and her husband use a two-tone, high-
low whistle to get each other's attention rather that calling to
each other. They often do this while out hiking. For example, my
son-in-law will give their special whistle to get my daughter's
attention, and when she turns to face him, he points to some
animal or bird. This works well for them (and me too).

Do whatever works for both of you. Just remember to be fair.

Since I speechread all the time, my policy is, "if you're not
looking at me, you're not talking to me" (even if I am the only
one present)! Anything else is basically an exercise in futility.

I give these and many other effective communication tips in my
short book, "Talking with Hard of Hearing People—Here's How to
Do It Right!".



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5. Information on Hearing Aids, Cochlear Implants and/or
Assistive Devices
==================================================

Problems with T-Coils and Telephones

A man wrote: "My recent installation of your hearing loop pad is
working remarkably well, leading me to believe that the t-coil in
my hearing aid is in good shape. Prior to this, I thought the t-
coil was defective because it had no effect when trying to use it
with my "hearing aid compatible" cordless telephone or any of my
telephones. May I have your comments, please?"

I'm glad to hear your loop system is working out so well for you.
Loop systems are such wonderful devices and produce such clear
sound, I'm surprised more people don't use them. You can see
these wonderful loop systems at Univox 2A Loop Systems.

The fact that you hear well on your loop system proves that your
t-coils are working great. So why don't they work with your
various phones? Good question.

There are a couple of possibilities.

First, you need to realize that t-coils are very directional
"beasties." If they are not aligned in the same plane as the
transmitting coil in the phone, the signal can fade away to
almost nothing. The further they are out of alignment, the worse
you hear.

Manufacturers orient the t-coils in hearing aids in various
planes. If they mount them vertically, they work best with floor
loops, but not with neckloops or phones. If they mount them
horizontally, they work best with phones and neckloops, but not
with floor loops.

To try to serve both worlds, some manufacturers split the
difference and mount the t-coils diagonally. This lets them pick
up both horizontal and vertical loop signals—but these signals
are far from optimal.

Second, the strength of the coil in phones varies. So does their
placement. If the coil is nearer the back of the handset, then it
isn't as close to the t-coil, and thus the signal is fainter than
if it was mounted closer.

It takes a bit of experimenting to get around these problems. If
you are having problems hearing on the phone with your t-coils,
you need to find the position such that the phone's coil and your
hearing aid's t-coil are closest together and at the same time,
both coils are aligned in the same plane.

Doing this can be a finicky business. You have to move the phone
handset around in relation to your hearing aid until you find the
"sweet spot" where the signal is the loudest. With one phone, I
actually had to turn the handset over and listen to the back of
it in order to hear well!

The best way to experiment is before you make a phone call. Pick
up the handset and listen to the dial tone while you move the
handset around, and also tip it up and down to see where you get
the loudest signal. That is where you want to hold it every time
you use that phone in the future. This position is a bit
different for every phone.

Another problem is that your t-coils may not have been set up
properly in the first place. If you have to turn the volume way
up on your hearing aids in order to hear when using your t-coils
with phones, you know your t-coils are not set up properly. Your
t- coils should be set so that when switching from microphone to
t- coil mode the volume should appear to stay approximately the
same to you. If the volume drops significantly when switching to
t-coil mode, then your audiologist needs to readjust them.

The way I like to use t-coils with phones is to use the T-Links
and plug them into the phone. This only works with phones that
have 2.5 mm headset jacks--but all cell phones and cordless
phones have such jacks, and so do some desk phones. With the
T-Links, I can hear with both ears which greatly improves
understanding, and I don't have to fool around looking for that
"sweet spot."



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                       HEARING LOSS HELP E-zine

Neil Bauman, Publisher               Center for Hearing Loss Help
49 Piston Court                       Stewartstown, PA 17363 USA
Phone: (717) 993-8555                       Fax (717) 993-6661
http://www.hearinglosshelp.com     neil@hearinglosshelp.com

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