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Thursday, October 18, 2018

Critics have called A Star Is Born a "modern classic" in its retelling of the 1937 film of the same title—but this time alluding to the adverse impact of tinnitus and hearing loss. Interestingly, the film's director and main character, Bradley Cooper, cast his own ear doctor, William H. Slattery III, MD, from the LA-based House Clinic, to play his character's ear doctor. But beyond the silver screen, Dr. Slattery has been fighting the good fight to help patients—Hollywood stars or not—whose struggles with tinnitus are very real. For Audiology Awareness Month, The Hearing Journal (HJ) spoke with Dr. Slattery on the challenges and opportunities in managing tinnitus. (Be warned: The Q&A contains spoilers.) 

HJ: A Star is Born takes the audience to a complex, multi-layered journey. Though staged in fiction, how much of the character's experience with tinnitus and its impact on one's mental health and quality of life would you say reflects the true challenges of people with tinnitus?

Dr. Slattery: There are many millions of Americans suffering from tinnitus, but the severity varies from individual to individual. Jackson Maine in A Star Is Born has very significant tinnitus and, as the character is also dealing with alcohol problems and some other issues, he's not handling it very well. So, it's a portrayal of someone with very significant tinnitus that's really affecting his career, which has sadly been the case in real life in the past as well.

                                           A Star is Born, Bradley Cooper, Lady Gaga

                                      Dr. William H. Slattery III at the set of A Star is Born starring Bradley Cooper and Lady Gaga 

HJ: In the movie, you play the physician of someone who's resistant to wear hearing technology that may help his condition. I imagine such resistance is not only among rock stars. How have you handled these patients?

Dr. Slattery: First, I think we have to differentiate between hearing loss treatment and tinnitus. Many who are bothered by tinnitus are frustrated that they're not being offered adequate treatment options and are being told to just "live with it," or frustrated that the treatment options are not good enough. On the other hand, patients suffering from hearing loss are often resistant to treatment or tend to delay the treatment for years.

HJ: So, what do you think is the most challenging aspect(s) of treating and managing tinnitus today?

Dr. Slattery: The big issue is the lack of success in treating tinnitus, as there is no definitive cure. There is, however, an opportunity for new types of tinnitus treatment. Though it's frustrating that the present treatments are not always as successful as we'd like them to be, it's one of the core things we're focused on improving at House Clinic.

HJ: The film shows how serious and destructive tinnitus can be—and, at the very least, informs the public of a condition they may have never heard of. How can hearing health professionals like yourself effectively contribute to this conversation and promote awareness?

Dr. Slattery: I have to give Bradley Cooper credit for being brave enough to put hearing loss and tinnitus in a movie as a subplot. That's how we raise awareness for issues like this: We continue to talk about it, find avenues where we can make it relevant to a wider audience, and give people the information they need to treat themselves better and recognize a problem if it arises.

For more information on tinnitus, visit our online collection.

Monday, October 15, 2018

By Sophie Cheng Xiaolin

Hearing loss is the third most prevalent impairment among children in Singapore (Chihiro, 2011; Low, 2005). Recent advancements in technology has enabled 80 to 90 percent of children with hearing loss to receive education in mainstream schools (Low, 2005). However, there are issues related to the acceptance of these children in society, such as stigma and loss of self-worth (Poon, 20010; Vergrugge et al., 2005). In fact, Singaporeans still hold negative feelings toward assistive devices in general (Verbrugge et al, 2005). Studies have also shown that there is a 65 percent chance that a child with special needs experience bullying on any given day (Taylor, 2010). However, there is limited research findings on the experience of both children with hearing loss and their caregivers. Leiter et al (2004) have advocated for the experience of mothers to be further explored as they are profoundly affected by their experience of caring for their child with special needs. Notably, the term "mother-blame" was coined to describe the prevelant culture of blaming mothers for the poor outcomes of their children (Ryan, 2012).

Noting the above-mentioned context, we investigated the following the question: What is the experience of caregiving mothers (referred to as “caregiving mothers” in this study) with hearing-impaired children who are enrolled in regular schools. Improving our understanding of the experience of these caregiving mothers will help health and hearing care professionals better support this patient population as well their caregiving mothers with regard to the child’s experience in mainstream education.
To understand their experience, qualitative interviews were conducted for this IRB-approved study. Participants were recruited based on inclusion and exclusion criteria (i.e., cargiving mothers of children aged 7-12 who require hearing devices and enrolled in mainstream schools). Informed consent was taken and individual interviews, conducted in English or Mandarin. Interviews were recorded, transcribed verbatim or translated, coded, and analyzed. The following questions were explored from the point of view of caregiving mothers:

1. Should my child receive hearing device intervention?
2. Should I enforce compliance?
3. What can I hope for in my child?
 
“Should my child receive the hearing device intervention?”
 
Participants verbalized their hesitation for using hearing devices. Some felt worried about disturbing their pre-operation homeostatic situation as they have found a way to cope. They verbalized fears on the success of the cochlear implant operation, future costs of hearing device(s) and the unknown future. One participant said “Now we get funding. The equipment spoils easily. How is she going to afford it next time?”
 
“Should I enforce compliance?”
 
Participants felt a sense of ambivalence about the use of the device. While they knew the device helps in hearing (ensures communication, learning, social interaction and safety), they were aware of the stigma, cost of use, and difficulty of use. A participant shared candidly “Sometimes I know they are talking about my children nonetheless. I will always feel sad about that.”
 
“What can I hope for in my child?”
In this study, most participants have accepted their child’s hearing problems, though one shared her hope for her child’s hearing loss to be cured. She shared: “Sometimes when she is sleeping(without any hearing device), she will (say) ‘mummy mummy I can hear from this ear.’ I (felt) so happy…”.

The other participants shared their hope for normalcy for their children, particulalry in becoming independent, finding employment, and getting married in the future. One participant shared, “I asked [my child], ‘What about the future? Wouldn’t you work?’ He asked if he could always just accompany me. I said that he will to find work someday. He remained silent. I said your parents will grow old, so if you want to survive you have to work.”
 
KEY THOUGHTS FOR CARE PROVIDERS
 
The study uncovers three key thoughts for health and hearing care providers. First, we need to be patient with parents’ ambiguity in making clinical decisons (e.g., to operate or not) regarding the care of their children. This speaks to mother-blaming where mothers are blamed and deemed responsible for the outcomes of their children (Green, 2007; Ryan, 2012). Caregiving mothers may feel the burden of making vital decisions as they may feel responsible for any possible outcomes. As practitioners, we should think about the support they may need in making decisions, such as financial assistance (e.g., insurance to obtain a hearing device), knowledge (e.g., trajectory of hearing loss),  and advocacy (e.g., anti-stigma). This will help reduce the ambiguity of outcomes so that mothers can be in less distress when making these decisions. In the event where these mothers still feel the weight of ambiguity, empathy extended to these mother may prove to be the support they need.

Second, we need to appreciate the ambivalence on compliance. The concept of cyclical grieving can be applied here (Blasca, 1998). As caregiving mothers become unsure about what to hope for (i.e., healing? normalcy?) and deal with the cyclical grief, it might be difficult for them to ensure compliant use of the devices. This study showed that while caregiving mothers were aware of the benefits of compliance, they had their reservations due to stigma and their continued hope for healing. The idea of normalcy is also challenging for them to grapple with. While the hearing device helps their child hear, the device itself is a physical symbol and reminder that their child is different.

Lastly, we need to consider the anxiety surrounding the ability to hope. Young & Tattersall (2007) found that the joy of motherhood was often over overshadowed by the parents’ need to deal with a child’s diagnosis of hearing loss, in this case. While the participants in this study verbalized fears about their child’s future, they also held hopes for their child’s future. Being associated with someone with a stigmatized condition (i.e., hearing loss), these mothers may experence courtesy stigma (Green, 2003). While hearing care providers would want to promote positivity and hope to these caregiving mothers, it is important to recognize their anxiety and experience of being stigmatized. We can provide more appropriate interventions through empathy and supportive services (e.g., adult services for those with hearing impairment, advocacy, etc.).

This study had a small sample size so it’s difficult to generalize the findings. In addition, because of the need to translate some interviews from Mandarin to English, some data could have been inadequately translated. Nonetheless, the experiences of these caregiving mothers shed light on their complex dilemmas despite the success of their children with hearing devices and attendance in mainstream schools. With these findings, hearing care providers can better design interventions that fully address the needs of the patients and their families.

About the Author: Sophie Cheng is a senior medical social worker at Sengkeng General Hospital in Singapore, working primarily with with patients with hearing loss and their families. 

ACKNOWLEDGEMENTS: This study was supported by the Medical Social Workers, Ms. Elcoe Wan and Ms. Koh Poh Lin.   
 
REFERENCES:
Blasca, J.K. (1998).  Cyclical Grieving, Recurring emotions experienced by parents who have children with disabilities.
Chihiro, Y (2011) Maternal Stress in Mothers with Children with Special Needs. Green, S. E. (2007). “We’re tired, not sad”: Benefits and burdens of mothering a child with a disability. Social Science and Medicine Vol 64: 150-163.
Leiter, V; Kraus, M. W.; Anderson, B; Wells, N (2004) The Consequences of Caring Effects of Mothering a Child with Special Needs. In Journal of Family Issues April 2004 29(3): 379-403.
Low, W.K. (2005). Managing Hearing Loss in Children and Adults: Singapore Context. Annual Academic Medicine Singapore 2005;34:295-300.
Poon, C.H. (30 September 2010) Hearing Loss - The Stigma. The Straits Times - Mind Your Body.
Ryan, H.A.M. (2012). Mother Child Attachment Development in Children with Hearing Loss: Effects of Early versus Late diagnosis of hearing loss.
Taylor, J. (2010) Supporting Children with Special Needs: Bullies, Victims, Bystanders. In Ng, E & Rigby (Eds) Breaking The Silence: Bullying In Singapore. Singapore: Armour Publishing. Pp. 183-206.
Verbrugge, L.; Mehta, K.K.; & Wagenfeld-Heintz, E. (2005) Working Paper Series: Views of Disability in the U.S. and Singapore. Singapore: Asia Research Institute, National University of Singapore.
Young, A., & Tattersall, H. (2007). Universal newborn hearing screening and early identification of deafness: Parents’ responses to knowing early and their expectations of child communication development. Journal of Deaf Studies and Deaf Education 12 (2), 209-220.

Friday, September 21, 2018

Dr. Mango.JPGOver 69 million people in the United States suffer from vestibular disorders that adversely affect their quality of life. As such, for this year's Balance Awareness Week, we highlight the invisible yet debilitating challenges of imbalance and dizziness to promote proper intervention and awareness of the complexities of vestibular conditions.

Addressing these issues are at the forefront of the practices led by Howard T. Mango, AuD, PhD, in Newport Beach and Ladera Ranch, CA. Since embracing the growing field of vestibular testing in the late 70s, Dr. Mango has become an expert in the field and pioneered the latest technology and techniques in vestibular rehabilitation. But his vocation comes with challenges—and opportunities that he gladly explored with The Hearing Journal.

Hearing Journal: Dizziness and balance disorders are invisible but serious disabling concerns. What has been the top challenge in managing patients with these conditions?

Dr. Mango:One of the top challenges is seeing patients who have been previously tested and deemed not having vestibular dysfunction. Following our comprehensive evaluation, we often discover these patients have pronounced vestibular deficits. 

 
Test batteries where only a VNG is performed, which is widely accepted as standard diagnostic procedure, misses up to 68 percent of patients who actually have vestibular deficits. This is confirmed in the 2010 study by Chung and Chu. ​ Our practice utilizes a comprehensive approach to diagnostic testing, which assesses all ten end organs of the inner ear in both a static and dynamic state.
  ​

Hearing Journal: How would you characterize a patient-focused care in managing balance/vestibular issues?

Dr. Mango: At the Newport-Mesa Audiology Balance & Ear Institute, patient-focused care starts with a differential diagnosis of each individual patient and establishing a treatment program customized for each patient's individual vestibular deficits. 

Through comprehensive testing, we can focus our care to each patient's specific vestibular dysfunction. Then, individualizing our proprietary Advanced Vestibular Treatment (AVT) to each patient, we can provide truly patient-focused care versus a 'one-size-fits-all' approach. 

Hearing Journal: We've been seeing impressive innovations in hearing technology. What technological updates in vestibular treatment are you most excited about?

Dr. Mango: We're most excited about our "Vestibular Virtual Reality" (VVR) technology that we're developing in conjunction with Mark Cuban. Our use of propriety optokinetic stimulation and eye-tracking software delivered through customized AVT enables us to treat patients remotely from around the world. It's very rewarding to have such substantial results in patients' quality of life, with the convenience of tele-medicine.  

Friday, June 29, 2018

GENEVA, July 5 — "How do we collectively—as the hearing community—transform actions into concrete results at the country level for those who so much need it?" This was the challenge posed by Etienne Krug, MD, director of WHO's Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, at the 3rd stakeholders' meeting on the prevention of hearing loss and deafness. With the launch of the World Hearing Forum and mobilization of the World Hearing Report, among other critical outcomes, the meeting gave a new impetus to strengthen global collaboration and advocacy in ear and hearing care.

"Going forward, we want to develop a global movement that all stakeholders in this field can identify with and participate in," Shelly Chadha, PhD, technical officer of WHO's program on hearing care, told The Hearing Journal at the close of the two-day consultation. "The ultimate goal is to keep more and more people in civil society, general public, and policymaking aware about hearing loss to prioritize it in both their personal lives and in policies."

WORLD HEARING FORUM

Twhf.jpghe World Hearing Forum was officially announced to run from September 2018 through 2025. Input from the stakeholders' meeting will be reviewed and used to refine the forum outline. This a global network of stakeholders in ear and hearing care will include representatives from NGOs, academic institutions, organizations of disabled people, governments, professional societies, and others. ​​The members will have the mandate to ensure the implementation of the WHA70.13 resolution on hearing loss prevention through networking and sharing of knowledge, skills, and experiences from the field.

"The challenge is to take existing scientific evidence and translate it into something useful for professional bodies and civil societies to lobby with their policy makers," explained Dr. Chadha.

While making hearing health a political priority is at the forefront, Dr. Chadha noted an additional goal. "The aim is also to set a context—a cohesive and consistent narrative on hearing loss—and to have a uniform understanding of what we all mean by 'hearing care'."

​The forum will also bridge the critical gap between drawing a collective vision and transforming plans into concrete actions, such as raising awareness on safe listening and improving early identification and management of hearing loss in regions with limited human resources and inadequate health services.

WORLD HEARING REPORT

Central to the WHA70.13 resolution is the creation of a World Hearing Report, which will be released by March 2020. Dr. Chadha provided a glimpse of WHO's approach to developing this report sections outlines, including one on the challenges to hearing care access. This section will include key epidemiological data on people's access to hearing care services, assistive devices like hearing aids, and educational services for sign language. Each section will advance a key message, which in this case is that challenges can be fully addressed. The report will also present evidenced-based solutions to reduce the social and economic burden of hearing loss, as well as emerging issues including early detection, scientific and technological advancements, and preventable noise-induced hearing loss.

To set the stage for this report, organizers of the World Report on Vision shared some verified strategies in building optimal momentum for the report's launch and dissemination through relevant messaging, with clear instructions on where stakeholders can find certain information and how to use them.

Learn more about the WHA70.13 resolution here

Read Dr. Jackie Clark's commentary on the WHO stakeholders' consultation 

Friday, June 29, 2018

Harnessing the power of collaboration has been a proven strategy in addressing global health issues like vaccination and lead exposure, among many others. How can this strategy effectively work to promote safe listening habits and better hearing care across countries with varied resources and needs? This was one of the critical questions that stakeholders braved at this week's consultation on hearing health at the World Health Organization (WHO) headquarters in Geneva, Switzerland.

The Hearing Journal spoke with De Wet Swanepoel, PhD, president of the International Society of Audiology (ISA) and professor of audiology at the University of Pretoria in South Africa, to explore a practical and efficient approach to forming a global alliance in hearing health care. With his extensive research, clinical, and humanitarian work in audiology, Dr. Swanepoel reflects on the challenges and opportunities to achieving this goal.

HJ: How would you define or envision, in practical and actionable terms, an effective global alliance in hearing care?

Dr. Swanepoel: By its nature a global alliance should be a wide international platform representing all world regions and involve all stakeholders, including persons with hearing loss and their families, hearing health providers, industry, non-government organizations (NGOs), administrators and funders to convene and rally around the pressing priorities in global hearing care. Positioning such an alliance within an influential global organization like the WHO gives it the credibility and inertia to pull the right groups together and facilitate a global agenda that sees hearing care prioritized at the highest levels right through to implementation at grassroots.

HJ: On the goal of establishing a global alliance, what do you think is the biggest challenge(s) to forming this collaboration? And on the flipside, what are you most excited about as the WHO and various stakeholders move closer toward establishing and mobilizing this alliance?

Dr. Swanepoel: A major challenge in these alliances is to truly engage all stakeholders across world regions and organizations, allowing an equal opportunity to be heard whilst uniting them around a shared vision that is owned by all. On the flipside, this kind of shared vision and ownership is the only way in which to influence decision-makers across the globe toward an acknowledgement of and commitment towards global hearing health priorities.

HJ: You've done significant work in demonstrating the value of m-health in bringing hearing health care to underserved patients. What would you say is the place of m-health in this global alliance and its plan of actions?

Dr. Swanepoel: A global health alliance should provide a clear agenda for addressing global hearing care issues with clear recommendations on proposed solutions. mHealth is an important strategy that touches on a number of these priorities. For example, mHealth surveys and hearing tests are invaluable tools that can support population-based surveys in low- and middle-income countries (LMICs) to ensure accurate prevalence data is collected to inform national strategies around hearing care. Furthermore, mHealth solutions can support decentralized programs to detect hearing loss in underserved areas through the assistance of local community workers. Looking at the connected global community and the way in which technology and connectivity is changing industries such as banking and agriculture in LMICs, it is only reasonable to expect the same in hearing health care.