Nothing Smaller Than Your Elbow Please

Elbows
(Photo credit)

Ear wax: We all have it. We all want it gone.

Most audiologists are often asked about ear wax. What is it? Why is it sticky? Why do I make so much? How can I get rid of it?

Say “yes” to ear wax.

Ear wax actually helps to keep your ears clean.

The wax traps dirt, dust and debris such as dead skin cells from the ear canal, dried shampoo and shave cream and possibly the occasional flea or gnat. This debris is held together by oil and wax secreted by glands living in your ear canal. The secretions also have natural antibiotic properties that help keep bad bacteria from growing in the warm dark and cozy environment of ear canals. And you thought it was just a nuisance!

What kind of wax do you produce?

Ear wax or cerumen comes in two varieties: wet (honey-colored and sticky) and dry (grayish and flaky). Ear wax type is highly heritable and considered a Mendelian trait that follows the laws of genetics. The trait of wet or dry ear wax was once attributed to a single gene but today, research has identified another gene contributing to this sticky situation. Your ear wax type was determined by your ancestry. Almost all people with European or African ancestry have wet wax. If you have northeastern Asian ancestry will most likely have the dry and flaky variety.

People have no trouble cleaning belly button lint and removing mucus from the nose, but most have no clue how to safely take care of excess ear wax. For most people the ear is self-cleaning and ear wax is removed by the natural flow of the wax out of the ear. Ear wax problems are typically self-inflicted. If you listen with ear phones for long periods of time, (at safe loudness levels please) wax can become trapped because the natural flow of wax out of the canal is blocked with the ear phone. However, most problems arise when the wax becomes impacted up close to the ear drum– down deep in the ear canal. This usually occurs from attempts to clean ear wax using implements of destruction such as cotton swabs, hair pins and tooth picks. If you choose to use these tools to clean your ears, you run the risk of puncturing the ear drum (ouch!) or impacting the wax in the canal in an area beyond the oil secreting cells. The soft wax dries up into a hard ball and can cause a temporary hearing loss or dizziness until it is professionally removed. Contact an audiologist if you think ear wax may be the cause of your hearing or dizziness problems. Audiologists will advise you on how to prepare for a professional ear cleaning. They often provide ear wax removal. And if you make more than is typical, the audiologist will schedule appointments once or twice a year to keep things under control.

Do you have too much of a good thing?

Stress (even physical exercise) and anxiety can increase wax production as well as medications that either activate or diminish the “flight or fight” response. Anatomical structures of the ear canal can cause wax to become trapped. When the ear canal twists and turns or narrows a bit, the wax will not easily flow from the canal. Even normal aging increases wax production.

Just as grandmother reminded us…put nothing smaller than your elbow in your ear and let Mother Nature do her work.

What other common questions do you get from patients in your audiology practice?

Pamela Mason, M.Ed., CCC-A is the director of audiology professional practices at the ASHA national office. She is a member of ASHA’s SIG 8, Public Health Issues Related to Hearing and Balance.

Hearing Aid Battery Precautions for Audiologists

Batteries

Photo by James Bowe

The American Academy of Pediatrics (AAP) published an article in the June issue of Pediatrics on the significant increase in pediatric button battery ingestion and resulting serious complications.

The button batteries of greatest concern are the batteries containing lithium. Batteries with lithium can cause severe burns and even death if swallowed. Lithium batteries are often found in remote controls, cameras and other household electronic devices. Two studies highlighted in the article report devastating injuries such as destruction of the wall of the esophagus and trachea and vocal paralysis. Ingested batteries need to be removed within two hours to prevent these medical emergencies.

While hearing aid batteries do not contain lithium, precautions still need to be taken to prevent accidental ingestion. Audiologists should be educating patients and families on battery safety. I remember my grandmother telling me (before I was an audiologist) that she had lined up all her morning pills to take with breakfast and had also lined up a hearing aid battery to remind her to replace the one in her hearing aid. She popped the battery into her mouth along with her medications and swallowed! As an RN she was aware of possible irritation and danger and carefully monitored her digestive system over the next few days. Apparently the battery passed safely through her gastrointestinal tract with no negative effects! This is what happens most of the time when a hearing aid battery is accidentally ingested; however, even zinc-air batteries contain trace amounts of the heavy metal mercury. Poisoning is possible after ingestion if the battery disintegrates and the casing opens.

Beginning in July 2011, some states began requiring all hearing aid batteries to be mercury-free. Mercury is considered an environmental hazard and toxic to our environment when it ends up in a landfill. Check with your state for current regulations and look for batteries that have no mercury.

Along with your hearing aid orientation and battery instructions, here are some additional tips to share with your patients:

  • Seek medical attention right away if a battery has been ingested. Children and pets may exhibit these symptoms: anorexia, nausea, vomiting and very dark stools.
  • Do not dispose of batteries in a fire…they can explode and release toxins.
  • Recycle batteries (Do you as an audiologist have this value-added feature in your practice? If not, Radio Shack will recycle batteries.)
  • Make sure that hearing aids for children are fitted with locking battery doors and activate the locking mechanism at all times when the child is wearing the devices.
  • Alert other family members to secure batteries out of reach of small children.
  • Don’t mistake the battery for a pill!
  • National Battery Ingestion Hotline: 202-625-3333.
  • Batteries in the nose and ear must also be removed quickly and safely to avoid permanent damage.

 

Interested in Public Health Issues Related to Hearing and Balance? ASHA’s Special Interest Group on Public Health Issues Related to Hearing and Balance’s  mission is to address public health issues related to hearing and balance through a transdisciplinary approach. SIG 8 sponsors continuing education via Perspectives  and short course and panel presentations at the ASHA convention, and SIG members have access to a private group in the ASHA Community for professional discussion and resource sharing. Consider joining SIG 8 today!

 

Pamela Mason, M.Ed., CCC-A is the director of audiology professional practices at the ASHA national office. She is a member of ASHA’s SIG 8, Public Health Issues Related to Hearing and Balance.

What is EHDI-PALS?

Baby Profile


Photo by PinkStock

The first few days after a baby’s birth can be some of the happiest for a growing family. Even so, the parents can have a certain amount of anxiety associated with caring for the newborn once it is home.  They worry about the car seat placement, feeding and nursing issues, whether the baby sleeps through the night…and on and on.  Today, infant hearing screening prior to hospital discharge is the standard of care because of the recognized benefits of early detection of hearing loss within the first year of life.

So imagine the increased concern parents have when bringing home an infant who may not hear well.  Modern society provides ready access to health information online.  Families may jump onto the internet searching for information without much prior knowledge of hearing loss.  Information gathered this way may be outdated, biased or incorrect.  By the time a family reaches an appropriate pediatric audiology facility they may well be armed with poorly-filtered information that could be confusing or just plain wrong.  At this point in time, it may be necessary for audiologists to provide additional informational and adjustment counseling.

Audiologists and speech-language pathologists know that improved speech and language communication outcomes are possible when hearing loss is identified and managed early in life. The Early Hearing Detection and Intervention process (EHDI) guides professionals and families in reaching these outcomes.  The goals of EHDI are to identify the hearing loss before hospital discharge, diagnose and confirm the hearing loss using advanced testing equipment and provide early access to auditory sounds through modern technology such as hearing aids and cochlear implants within six months of age.

How does a family locate audiology services?

EHDI-PALS will be a national web-based directory of pediatric audiology facilities designed to assist families and professionals in the EHDI process. Not all pediatric facilities are alike or have the equipment or services required by a child at a given time. For example, some facilities do not provide cochlear implant services and others only to children over three years of age.  The directory will contain detailed descriptions of pediatric audiology facilities and centers and will facilitate searching for appropriate services across the country.

The EHDI-PALS website development is in progress and is expected to go “live” in mid-2012. The site will contain links to reliable web information on childhood hearing loss, questions for families to ask the audiologists about where to go for hearing services and the EHDI process, and the EHDI-PALS directory.

The desired outcome for EHDI-PALS is to connect families with services that are family-centered and that create seamless professional audiology service provision across the early years of a child’s life.  Go to www.ehdipals.org and watch the website grow and build.

 

Pamela Mason, M.Ed., CCC-A is the director of audiology professional practices at the ASHA national office. Before working at ASHA, she directed the Audiology Center at the George Washington University Hospital in Washington DC.

Is that iPad Hazardous to Your Health?

Dizzy

Photo by dospaz

The iPad revolution has engulfed the communication disorders field. We love our iPads and other handheld devices. Just ‘flipping’ through the cornucopia of apps related to speech, language and hearing in the App Store, it is no wonder these devices and the apps they hold are becoming therapy toolbox essentials.

As our younger clients have become more engaged in activities that utilize technology, therapy programs that are supported by apps have become increasingly popular. Young people often use other, similar technology after school to play computer games, do homework or interact on social networking sites.

Whether it’s watching TV, doing homework or playing games on a computer, or using a mobile device to play games or send or receive text messages, there is a common denominator among activities many people regularly engage in: screens.  Some are large and some are the size of the palm of your hand. We spend hours viewing screens on computers, iPads and other tablets, TVs, iPhones and other handheld devices. And sometimes we view these screens in less than optimal conditions.

As an audiologist and ASHA National Office staff member, I often receive consumer questions regarding dizziness and balance problems. These complaints commonly arise from problems within the inner ear. I typically send consumer information on dizziness and balance and recommend a visit to the audiologist for hearing and balance assessment as a good first step in understanding the causes of these symptoms and to begin a plan for rehabilitation treatment for inner ear balance issues.

But I digress….back to screens. The Internet houses many discussion forums on dizziness, headaches and vision problems while viewing screens. Enough people are complaining that a term for the syndrome has been coined; the American Optometric Association refers to this group of symptoms as “Computer Vision Syndrome.” These symptoms are not related to inner ear problems or more serious neurological problems but rather to eyestrain and can include:

  • headaches
  • dizziness
  • nausea
  • confusion and fuzzy thinking

Apple does have some warnings within the iPad manual about complaints of headaches, dizziness, and eyestrain. These warnings are not highlighted, though–you have to do a thorough search to find them. There is also a discussion about these symptoms on the Apple support community.

There appears to be little scientific evidence about screen/vision safety but I have seen some recurring suggestions on the discussion forums and from ophthalmologists:

  • use task lighting and turn off the overhead fluorescent lights
  • take frequent breaks…look away from the screen and focus on something about 20 feet away for about 20 seconds
  • use special lens/glasses for computer use
  • adjust the lighting of the screen, some folks lower the backlit screens and get improvement
  • increase font size
  • adjust the ambient room lighting
  • position computer screens slightly lower than eye level (about 4 inches)
  • remember to blink. This will reduce dry eyes.

Have you or any of your clients noticed any of these symptoms when using iPads or other mobile devices?

Pamela Mason, M.Ed., CCC-A is the director of audiology professional practices at the ASHA national office. Before working at ASHA, she directed the Audiology Center at the George Washington University Hospital in Washington DC.