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Tuesday, December 20, 2022

By King Chung, PhD, CCC-A, and the Heart of Hearing Team

Ukraine_Image 1.jpg

War, a word that evokes so many memories of destruction and grief, has been a staple in the news since February 2022 when Russia invaded Ukraine. Russia has since carried out numerous air strikes destroying civilian buildings, infrastructure, and power grids in Ukraine. These conditions have left many Ukrainians internally displaced, while many women and children have fled the country. Millions of Ukrainians have sought shelter and safety in Poland.

Poland is located on the west side of Ukraine, and the two countries share a long border. As of December 2022, Poland has recorded more than 8.4 million Ukrainian refugees since February 2022. While many refugees have subsequently traveled to other countries or returned to Ukraine, approximately 1.4 million refugees registered for Temporary Protection in Poland as of August of 2022.1  

During the Thanksgiving break, a group of students and faculty from Northern Illinois University and Federal University of Rio Grande do Norte in Brazil embarked on a humanitarian trip to Kraków, Poland. During the trip, we collaborated with professors at Jagiellonian University in Kraków and the staff at Jewish Community Centre (JCC) of Kraków to provide free hearing services for school children and Ukrainian refugees. The services were much welcomed by the parents of the school children and our experiences with the Ukrainian refugees left us forever changed.

HEARING HEALTH CARE CRISIS

JCC is a nonreligious, nonprofit organization located in the Jewish part of Kraków. It connects visitors to modern Jewish life and provides community services to Jewish descendants and surrounding people. Since Russia invaded Ukraine, JCC has also extended its services to care for Ukrainian refugees.

Our initial intention was to examine the hearing status and the hearing health care needs of the refugees. After unsuccessful attempts to obtain rechargeable hearing aids from manufacturers, we brought four pairs of older lab hearing aids with us and planned to fit them to refugees with hearing loss.

During the trip, we conducted otoscope exams, tympanometry, distortion product otoacoustic emissions, and pure-tone audiometry. Among the estimated 150 refugees we tested, approximately 70 of them need hearing aids and some of them needed cerumen management in one or both ears. After testing, the JCC team provided translations so we could talk with the refugees to let them know about their hearing status and to counsel them for the next step. During the process, we got to know some of their stories.

STORIES OF HEARING LOSS AND SURVIVAL

A 20-year-old woman with intellectual disability had hearing aids in Ukraine that were accidentally left behind while she and her family fled the country. She had severe to profound hearing loss in both ear and did not have verbal language. Although the Polish government gave all the Ukrainian refugees two years of access to the Polish health system, which provides free hearing tests but hearing aids are not covered. As refugees, her family cannot afford to buy hearing aids. Now she is living without hearing aids, and communication with family has been very difficult.

Ukraine_Image 2.png 

Several women and older men were found to have perforated ear drums or have the look of a perforated ear drum during otoscopy, and many had sloping hearing loss in both ears. The patients with perforated ear drums were confirmed by Type B tympanograms, and some of the ear drums were healed as indicated by Type A tympanograms. One patient still had a blood rim on one ear drum. When we talked to them, they said their hearing was damaged by the shockwaves of the bombings. Some of them reported to have lingering tinnitus, and all had hearing loss in both ears. We referred the ones with perforated ear drums to otolaryngologists. When we advised them to seek hearing aids, they said they did not have the money to do so.

A father we tested had asymmetric hearing loss with mild-to-severe hearing loss in the left ear and mild-to-profound hearing loss in the right ear. When we inquired about possible reasons for having better hearing in one ear than the other, he said he and his son were both in a missile attack. He fell on his left side, leaving the right ear more exposed. Now he has tinnitus in the right ear. He said it was too painful to think about the event. We wondered what happened to his son, but the JCC staff said they didn't dare ask him in fear of triggering deep grief.

Two of the older women we tested sobbed constantly during their time at the testing sites. They said they missed their homes and their family members. The mere thought of the war elicited sorrow. They had aidable hearing loss, but they did not have money to buy hearing aids.

RAISING AWARENESS

As we were overwhelmed by the number of people with hearing loss, the testing process took much longer than anticipated. We did not have time to fit the hearing aids. Instead, we left the devices with the staff at JCC and are now in the process of seeking hearing health professionals in Kraków who can help us fit the hearing aids. The problem is that the need is so great that four pairs of hearing aids were not nearly enough to meet their needs.

While the impact of the war is often expressed the number of casualties in the media, the damage to people's hearing is not mentioned. Ukrainian refugees are not only displaced by the war, but many are also left with a permanent disability that can negatively affect their communication abilities and cause long-term disability. Studies have shown that adults with hearing loss are more likely to have communication difficulties, lower employment rates, and lower income. A report published in The Lancet also stated that hearing loss in mid-life would increase the risk of cognitive decline by 9% later in life.2 As a recent publication indicated that hearing aids can slow down the cognitive decline among people with hearing loss3, we hope these stories raise the awareness of the great hearing care needs of the Ukrainian refugees. We also hope to obtain enough rechargeable hearing aids so that we can return to Kraków to provide the much-needed amplification services.

Hearing loss will likely to be one of the most prevalent noncommunicable disabilities among the people who stayed in Ukraine, because of the continuous and relentless missile attacks. We strive to raise awareness of the great hearing health care needs among the people in Ukraine and hope to reduce the negative impact of untreated hearing loss on their cognitive and communication abilities and their quality of lives. We also hope more people will join our cause to provide hearing and amplification services and devices to the Ukrainian people.   


For monetary donation to support students traveling to Poland to provide services, please: 

      1. Use the Northern Illinois University donation website: https://foundation.myniu.com/give.php and choose "Audiology General".

      Then (very important!

      2. Send an email to NIU Foundation at [email protected] to specify your name and donation amount for 
      Heart of Hearing for Ukrainian Refugees.​

For hearing aid donation, please contact:

Dr. King Chung @ [email protected] 



Dr. King Chung is a professor of audiology and the program director of Northern Illinois University's Audiology program. She is the Best Practice Director at the Coalition for Global Hearing Health, a Fulbright Scholar, and the recipient of the 2020 AAA Humanitarian Award and the 2020 NIU College of Human and Health Sciences Service Award. The Heart of Hearing team is a group of faculty and students from Northern Illinois University and other universities led by Dr. Chung to provide humanitarian services. They have traveled to eight different countries and served more than 3,000 unserved and underserved people in the past 12 years. 


References:

1. Statista. Estimated number of refugees from Ukraine recorded in Europe and Asia since February 2022 as of December 6, 2022, by selected country. Retrieved from: https://www.statista.com/statistics/1312584/ukrainian-refugees-by-country/

2. GDB 2019 Hearing Loss Collaborators. (2021). Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019. The Lancet, 397:996-1009. https://doi.org/10.1016/S0140-6736(21)00516-X

3. Yeo, B.S.Y., Song, H.J.J.M.D., Toh, M.S. (2022). Association of Hearing Aids and Cochlear Implants with Cognitive Decline and Dementia: a systematic review and meta-analysis. JAMA Neurologyhttps://www.doi.org/10.1001/jamaneurol.2022.4427  


Monday, October 10, 2022

October Is National Audiology Awareness Month. In recognition of all that you do for your patients, The Hearing Journal Podcast brings you a special edition covering the FDA final rule on over-the-counter (OTC) hearing aids. This 4-part series shares important information on the changing hearing aid landscape, what it means for you, and how you can help secure audiology's future. Listen now.

Part 1: An Overview of OTC Devices
Part 1 - Bray Akbari Graphic for Social Media.pngPart 1 of our series interviews Victor Bray, PhD, and David Akbari, AuD, on a review of the FDA final rule and how it defines an OTC device.

Dr. Bray is an Associate Professor of Audiology at Salus University and the Past President of the Academy of Doctors of Audiology. Dr. Ackbari is the Senior Medical Science, Clinical and Regulatory Affairs Liaison at Intricon Corporation and serves as the current Chairman of the ANSI/ASA S3 WG48 working group that develops and maintains standards for the objective measurement of hearing aids.

“In my opinion, audiologists have an historic and unprecedented opportunity to reimagine the service delivery model that we use," said Ackbari.

Part 2: The New Category of Prescription Hearing Aids
Part 2 - Spoor Graphic for Social Media.pngPart 2 of our series interviews Alicia Spoor, AuD, on the creation of a new category of prescription hearing aids and the need for all states to review their licensure laws.

Dr. Spoor is the owner of Designer Audiology in Highland, Maryland. She serves as the Advocacy Chair for the Academy of Doctors of Audiology and is the Legislative Chair for the Maryland Academy of Audiology. She is also Past President of both organizations.

“You have to take action. If you don't agree with something that the associations and organizations do, you need to stop being a member because that gives them credit when they speak on your behalf. You need to stop paying dues, going to conventions, and being certified by those organizations," said Spoor. “Then, you need to find those people that do believe what you believe at the association and organization level. That's where you become a member, you attend their conferences, and you donate your time, talent, and treasure to their committees' advocacy funds and more."

Part 3: The Outlook Among the Obstacles
Part 3 - Czuhajewski Graphic for Social Media.pngPart 3 of our series interviews Stephanie Czuhajewski, MPH, CFE, on the current and potential obstacles audiologists face due to the FDA final rule.

Stephanie Czuhajewski is the Executive Director of the Academy of Doctors of Audiology. She has two decades of nonprofit leadership experience, with a focus on outreach and stakeholder relations.

“The entire health care landscape is changing, not just in the area of audiology," said Czuhajewski. “And it's increasingly important to be able to measure outcomes as a means of measuring value."

Part 4: A Call to Action
Part 4 of our series interviews Kristin Davis, AuD, on how audiologists can spring into action and look forward to a positive future with new opportunities for the profession.

Part 4 - Davis Graphic for Social Media.pngDr. Davis is the owner of Davis Audiology, which includes three successful practices throughout South Carolina. In 2017, she was co-awarded the Academy of Doctors of Audiology's Craig W. Johnson Audiology Advocate Award. She currently serves as President of the ADA Board of Directors.

“Think about it as a time of great change and also as a time to create the future that we want," said Davis. “We just have to be actively involved in it."

​Listen now!

Listen and subscribe to The Hearing Journal Podcast with any of the following streaming websites or mobile applications:

Google: bit.ly/THJgoogle

Apple: apple.co/THJapple
Stitcher: bit.ly/THJstitcher
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Friday, September 23, 2022

The findings of a National Institutes of Health (NIH) study reveal a specific network of proteins capable of hearing restoration in zebrafish. National Human Genome Research Institute (NHGRI) scientists who led the study theorize that this discovery may lead to future treatment options for hearing loss in humans. The study was published in Cell Genomics this August. 

The study identified two families of transcription factorsSox and Six transcription factorsthat together activate hair cell regeneration.

Hair cell loss can't be replaced in humans, but in several animals, such as zebrafish, hearing can be restored after injury by hair cell regeneration. Scientists hope to gain valuable insights about regeneration by investigating the regenerative properties of zebrafish hair cells.

Humans and zebrafish share more than 70% of their genes, which offers hope that the recent findings in zebrafish could one day be translated to humans.

“Humans and other mammals are born with a set number of hair cells that are slowly lost through aging and trauma. However some animals, such as zebrafish, can regenerate hair cells and recover hearing after injury," said Shawn Burgess, PhD, investigator in the NHGRI Translational and Functional Genomics Branch. “How and why regeneration happens in these animals remain a mystery that many scientists would like to unravel." Burgess co-led the study with researchers from the National Library of Medicine's National Center for Biotechnology Information.

Learn more about this ground-breaking scientific discovery.

Monday, September 12, 2022

In Case You Missed It.PNG
Portrayals of individuals with hearing loss have become a trend in recent films and TV shows. Characters with hearing loss have recently appeared in titles such as “A Star is Born," “Sound of Metal," “CODA," “El Deafo," and Marvel Studios' “Hawkeye."

Coauthors Dr. Alexander Chern, a resident physician in otolaryngology-head & neck surgery at New York-Presbyterian Hospital (Columbia and Weill Cornell), and Michael W. Denham, a fourth-year medical student at Columbia University's Vagelos College of Physicians & Surgeons, highlight this connection in their column “Hollywood Helps Fight the Stigma of Hearing Loss," which appears in the September 2022 issue​ of The Hearing Journal.

“Children often look to superheroes as role models," write the coauthors, “and the entertainment industry can play a valuable public health role by giving children with deafness more figures to look up to."

Positive portrayals of hearing loss in popular TV shows and movies can have a big impact on pediatric patients. Audiologists should embrace this trend as a helpful tool when looking for ways to care for both the physical and emotional health of pediatric patients.

Read the full story in our In Case You Missed It column.​

Thursday, September 1, 2022

​On August 16, 2022, the U.S. FDA issued a final rule establishing a new category of over-the-counter (OTC) hearing aids. Read the final rule here. Consumers with perceived mild-to-moderate hearing loss may purchase hearing aids from physical and online retailers without a medical exam, prescription, or audiologist fitting. The FDA says the goal of this final rule is to increase access to hearing aids by lowering the cost to obtain hearing aids.

“Hearing loss is a critical public health issue that affects the ability of millions of Americans to effectively communicate in their daily social interactions," said FDA Commissioner Robert M. Califf, M.D. “Establishing this new regulatory category will allow people with perceived mild to moderate hearing loss to have convenient access to an array of safe, effective and affordable hearing aids from their neighborhood store or online."   

The new OTC hearing aid category only applies to certain air-conduction hearing aids for use by patients 18 years or older with mild-to-moderate hearing impairment. All other hearing aids that do not meet these criteria will still require prescriptions.

The impetus for the final rule came back in 2017 when Congress passed bipartisan legislation requiring the FDA to create a category of OTC hearing aids. The law was finally implemented last month. OTC hearing aids may become available in retail stores and pharmacies as early as mid-October, which is when the final rule takes effect.

After a proposed rule was issued on October 20, 2021, the FDA reviewed more than 1,000 public comments from a mix of consumers, professional associations, hearing aid manufacturers, public health organizations, advocacy groups, members of Congress, state agencies, and other stakeholders. The final rule includes several revisions from the original proposed rule to better ensure safety and effectiveness of OTC hearing aids, such as lowering the maximum sound output, revising the insertion depth limit in the ear canal, requiring user-adjustable volume control, and simplifying device labeling for ease of use. The new OTC category repeals the traditional conditions for hearing aid sale, such as the prescription requirement.

The FDA has also issued the Regulatory Requirements for Hearing Aid Devices and Personal Sound Amplification Products (PSAPs), to clarify the differences between hearing aids, which are medical devices, and PSAPs, consumer products that help people with normal hearing amplify sounds.  

The final rule goes into effect 60 days after publication in the Federal Register. Hearing aid manufactures who sold devices prior to the final rule's effective date must comply with the new regulations within 240 days after the final rule's publication. Manufacturers who have not yet sold devices must comply with the final rule before selling and marketing their new devices.