ATU275 – Cochlear Implants and Hearing Aids with Dr Lindsey Shine

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

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Cochlear implants with Dr Lindsey Shine | www.hearindiana.org

Facebook is giving away the software it uses to understand objects in photos http://buff.ly/2bv2Dd0
App: Using a timer to limit iPad time
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——-transcript follows ——

LINDSEY SHINE: Hi, this is Lindsey Shine. I’m the pediatric audiologist for Hear Indiana, and this is your Assistive Technology Update.

WADE WINGLER: Hi, this is Wade Wingler with the INDATA Project at Easter Seals crossroads in Indiana with your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

Welcome to episode number 275 of Assistive Technology Update. It’s scheduled to be released on September 2, 2016.
LINDSEY SHINE: Hi, this is Lindsey Shine. I’m the pediatric audiologist for Hear Indiana, and this is your Assistive Technology Update.
WADE WINGLER: Hi, this is Wade Wingler with the INDATA Project at Easter Seals crossroads in Indiana with your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist people with disabilities and special needs.
Welcome to episode number 275 of Assistive Technology Update. It’s scheduled to be released on September 2, 2016.
Today I’m going to spend some time with a friend of mine, Dr. Lindsey Shine, who is a pediatric audiologist for Hear Indiana which is an organization that happens to be located right here in our building. We are going to talk about hearing aids and cochlear implants and all kinds of technology related to hearing loss. Also we’ve got an app or actually a technique from the folks over at BridgingApps to use a timer to limit the amount of time somebody might spend on the iPad.
We hope you’ll check out our website at www.eastersealstech.com, send us a note on Twitter at INDATA Project, or give us a call on our listener line. We love to hear from you all. The number is 317-721-7124.
***
Kind of an interesting and emerging story here. The headline reads, “Facebook is giving way the software it uses to understand objects in photos.” Technologies called deep mask and shop masks are some of the things Facebook has been using for a while now to describe what a picture is or somebody is blind or visually impaired. They call it automatic alternative text. There’s a whole team called FAIR, Facebook AI Research, and they’ve decided to let those technologies become open source, available to the public to use that technology to do object recognition. I think for folks who are blind or visually impaired, this could mean a whole lot of exciting stuff. Also the article from The Verge talks about the fact that Facebook wants to take the same technology and apply it to videos. So much happening in video these days. How great would be to have self describing videos? Just a teaser there. I’ll pop a link in the show notes where you can read the technical details and see some pictures of how Facebook object technician algorithms work. Check our show notes. You’ll find a link to The Verge.
***
Each week, one of our partners tells us what’s happening in the ever-changing world of apps, so here’s an App Worth Mentioning.
TERA ROTO: This is Tera Roto with BridgingApps, and this is an App Worth Mentioning. Did you know that you can use the simple built in clock function to limit the time your child spends working or playing in an app? It’s easy. We are going to show you how. We are going to be talking about the built in clock app on an iPad, iPod touch, or iPhone. The first thing you have to do is set up a password for your device. You can do so by going into the settings and selecting passcode. Probably the greatest thing about this trick is there is no need to download a certain app to do this. You’re just going to use the clock app that’s built in on your device. Once you’re in the clock app, along the bottom portion of your screen you will see four icons. You’re going to choose the fourth icon, or the last icon, Timer, so make sure that that is selected red. You’re then going to set the timer for the amount that you want, so we will start with 20 minutes. And this is kind of the hidden secret that’s almost magical. You’re going to set the sound for when the timer goes off. On your screen, in the lower center area below the clock circle, is an icon that says Radar. You’re going to change the sound and actually change the action. Instead of playing a sound, you are going to ask the iPad to stop playing. You will tap on the word Radar, and scroll all the way down until you find the words Stop Playing. After you change this setting, once the timer runs out, instead of playing a sound, the iPad will turn off.
Make sure you tap on the start button. You will then see the time start ticking down. If you’re not familiar with the timer app already, one of the great things about it is that it is a nice visual display as well, so you see the red circle as it is slowly running out of time, so your children that are not good at reading numbers and clocks, they can see the time ticking down. Then you can get out of the clock app and go into any other app on the device and use the device freely. If you ever want to go back into the clock app, you can see how much time is left. When you run out of time, the iPad will automatically go to a lock screen. The only way you can get out of it is by entering the password.
Now that you can somewhat control how long people can be on your device, you can use it in various ways. Whether you’re a teacher of a one-iPad classroom and have your students working through the iPad in stations, or as a parent you want to give a certain amount of screen time as a reward, using the built-in timer is a great way to limit screen time. For more information on this app and others like it, visit BridgingApps.org.
***
WADE WINGLER: So it’s not unusual for me to walk around the halls of this great organization and say, hi, Lindsay. How are you today? How is your day? And to hear her say, hi, Wade, and something kind back to me. But today Lindsay is Dr. Lindsay shine – I mean, she is always Dr. Lindsay Shine. She’s the pediatric cardiologist for Hear Indiana which is actually an organization that resides in our building and partners with Easter Seals Crossroads on a ton of different projects. We are going to talk about all kinds of cool stuff today including cochlear implants, because that is a topic I feel like I need to know more about and that you guys in my audience might like to do that too. First and foremost, Dr. Shine, Lindsay, how are you?
LINDSEY SHINE: I’m great, Wade. How are you? Hi everybody. Thanks for having me on.
WADE WINGLER: So excited to have you here. Before we start talking about technology related to hearing loss, I want to hear little bit about you. I want to hear the story about how you became interested in audiology, hearing loss, and a little bit about your job here at Hear Indiana.
LINDSEY SHINE: Definitely. For as long as I can remember, I have always wanted to work with children. All of my jobs have been related to nannying or babysitting. I’ve never worked in the restaurant business or in the retail industry or anything like that. I’ve always wanted to work with kids. So I had some in my life who was actually my dance instructor when I was in high school, and she said I’m a speech language pathologist and all I do all day is play with kids. That just really struck a chord with me. I thought that is awesome; that’s exactly what I want to do. So I was at Purdue University for undergrad, and I was taking my speech pathology courses, and in my junior year we actually had an audiology course. That was a little bit more science for me, if you will. I loved learning about the ear and the anatomy and how your ear works and what happens if it doesn’t work this way and what are the solutions. That just really seems to fit my Type A personality quite a bit more. So I ended up going with audiology and I get to work with kids every day that have a hearing loss. I love it. It’s wonderful.
WADE WINGLER: That’s cool. It’s fun that we are in my studio today because it wasn’t all that long ago when I sat in your room and you beeped in my ear and we played around with your technology a little bit. It’s fun to turn the tables just a little bit.
I know the people in my audience are aware of things like hearing loss and hearing aids and cochlear implants at least a little bit, but to sort of level of the playing field with everybody in the audience, can you give us a quick history of the kinds of technology that have been used throughout history to help folks who are dealing with hearing loss? It’s been a long time since this has been around as an issue.
LINDSEY SHINE: Absolutely. I recently found out that the first electrical hearing aid came about in the late 1800s. Prior to that, people were using ear horns or putting a megaphone up to their ear and it was just guiding and amplifying the sound that was happening in the environment around them, and then going into their ear and reaching their eardrum and further up the auditory pathway. So they were doing an electrical amplification of just sound waves, and that started in the late 1800s. Then things have progressed. That very first example of a hearing aid, or what they were using, involved headphones and this large box and a large battery, so things are getting a lot smaller. Over time, you wear them now, so it went from being something that you had to sit next to and had to be stationary while you were listening through it, and now people wear them actually on their ears or in their ears and they carry them around with them all day. It’s a pretty fascinating world.
Audiology really hit a big spike in the field after World War II when more people were coming back from the war and hearing loss was one of the top issues they found that they were having after seeings combat. Now I think men and women who are coming back from the armed forces are finding that that is still one of the top issues that they are dealing with. So the field and the technology has grown with the need for those types of devices.
WADE WINGLER: It makes sense when you talk about folks who have been in the military that there would be a need there, because hearing loss can be congenital but it can also be from loud sounds.
LINDSEY SHINE: Definitely.
WADE WINGLER: Like bombs and artillery and stuff like that.
LINDSEY SHINE: Yeah, shooting guns.
WADE WINGLER: Exactly. That makes sense. So we talked about the fact that hearing aid used to be big and not necessarily portable and that miniaturization is one of the main things that happening with hearing aid technology. It’s getting smaller and more portable. Take me to school a little bit on the basics of how a standard hearing aid works. I know there are a few different things and is making things easier to hear, but what’s going on behind the scenes?
LINDSEY SHINE: If we think about how your ear naturally works, you have your outer ear and ear canal and eardrum, and everything up to that point works with an acoustic signal. The sound wave is moving through the air. That sound wave hits your eardrum and vibrates your eardrum, and then it becomes kind of mechanical energy where the three smallest bones in your body are then vibrating. They push on your cochlea which is fluid-filled, and the vibrations from the mechanical side of things, from the three smallest bones, vibrate the fluid in your inner ear, and that creates an electrical signal. Then it takes an electrical signal and passes it up into your brain to analyze what it is. A hearing aid works by taking that acoustic signal, or the sound waves, and amplifying those. So somewhere along the line, the sound isn’t being transmitted properly, so the hearing aid takes that acoustic signal and amplifies it where it needs to be amplified.
Typically people don’t have a hearing loss just straight across the board, all of the same pitches, all the same frequencies or sounds need to be amplified the exact same. That is not typically what hearing loss looks like. The hearing aids nowadays have what is called a prescriptive formula inside them, so they are kind of program to only amplify the sounds that need to be amplified based on the individual’s hearing loss.
WADE WINGLER: That sort of makes sense. In fact, and I don’t mind talking about it, I spent some time with you because I’m experiencing a tiny bit of hearing loss. You were able to say something to me like, I bet you like to shoot shotguns and you’re right-handed, because you can figure out basically the frequency where my hearing loss was and the fact that I was probably leaning my head a certain way that you are able to pinpoint it. It makes sense I wouldn’t need and don’t need amplification at this point. But you wouldn’t need it everywhere, just in that spot where you are having difficulty.
LINDSEY SHINE: Exactly.
WADE WINGLER: Hearing aids and cochlear implants aren’t the same thing, right? Cochlear implants do something different. Can you tell us a little bit about what they are, how they work, and how they’re different from hearing aids?
LINDSEY SHINE: Sure. Hearing aids are awesome and wonderful and they provide amplification to a region of your hearing organ, your inner ear, your cochlea, where there is still residual hearing left. You have these little tiny hair cells that live in your inner ear. If you still have enough of them left for the acoustic implication from the hearing aid to reach and stimulate, then hearing aids are going to work well for you. If you do not have enough – and this is just typical. There may be other situations where it is slightly different or the etiology of the hearing loss or the cause of the hearing loss might warrant a slightly different situation. I’m just talking in general here.
But if in the cochlea, you do not have enough residual hearing that the hearing aid is going to do in the fore or provide enough amplification to, then the cochlear implant will come into play. That is very simply put a stronger hearing aid, but it’s different because it’s a totally different signal. Like I was talking about how your ear catches the sound and then it moves through and there is acoustic energy and mechanical energy and electrical energy. That is where the cochlear implant comes into play, when the electrical energy is coming from the cochlea itself.
The cochlear implant has an external device and an internal device. When you are wearing a hearing aid, you only have an external device. You don’t have anything else. Everything is happening either on your ear or in your ear. It’s all right there. The cochlear implant works by having an external device which collects the sound and processes the sound. Then it communicates with a magnet or through a magnet to an internal device which is the implanted part. That has an electrode array that goes down into your inner ear, and this electrode array wraps around the spirals of your inner ear, or your cochlea, and it sends the electrical signal to your auditory nerve.
WADE WINGLER: So the external part makes sense. There is something receiving the signal. I would call it a microphone, kind of.
LINDSEY SHINE: It is a microphone. That’s what we say.
WADE WINGLER: Then it uses the same kind of magnetic thing that my Apple Watch does to charge it. So that magnet then transmits to a device that – is it outside the school but under the skin?
LINDSEY SHINE: Correct.
WADE WINGLER: So it is riding under the skin but outside the skull. Then it has wires that go right down into the same place that a typically hearing person the sound are translated from the acoustic physical stuff into those electronic signals, those nerves, electric signals. So it’s doing the same job, right?
LINDSEY SHINE: Basically what you’re doing is bypassing where the damage is or the part that’s not working properly.
WADE WINGLER: I have a million questions now. What does it sound like? Does it sound different than your hearing or my hearing as we’re doing right now?
LINDSEY SHINE: That is a tough question and a very common question as well. Honestly, it depends on when you receive the cochlear implant. If you’re talking about a very young child who is identified with a hearing loss and has never heard anything, and then can hear through the miracle of the cochlear implant, it’s hard to tell what they are hearing, because they don’t have anything to relate it to. They are going from nothing to something. But it’s not normal and still an electrical signal, being digitally amplified. But that then becomes their normal, so if you asked them what does that cochlear implant sound like, they are like it sound like what you hear. However, if you ask people who were later implanted, maybe they were employed exposed to super loud sounds or there was head trauma they endured or something where they lose all their hearing, a hearing implant isn’t doing it for them, they opt for a cochlear implant. They do have normal hearing to compare it to. I have heard some of them say that at the very beginning, and maybe sounds like Minnie mouse or something like that, is what they relate it to. Or it sounds very robotic or it can sound kind of static key. It does sound like a digital signal to them. But because your brain is plastic and it’s amazing and can do all these wonderful things, it that then just reset itself, and that becomes the normal. So then that is what sounds like normal hearing to them again.
WADE WINGLER: That makes sense. I had a good friend get a cochlear implant, and he was in his late 60s, early 70s, and he said it’s on a busy for a while to get used to it.
LINDSEY SHINE: Absolutely.
WADE WINGLER: So you talked about kids. How young can a child take advantage of a cochlear implant? One is too early?
LINDSEY SHINE: I would say it’s never too early. We know there is tons of research out there that says early intervention is absolutely key. We know that you can hear in utero around 21 weeks, when the cochlea is fully formed. I guess it’s hard to tell because you are looking at brain development and how these kids in utero are hearing. But there is studies that they can recognize their mom’s voice, they can sometimes recognize their father’s voice and some studies. If we know that all of that hearing is happening then, when these kids are born, if they are born without hearing loss and are already that far behind their normal hearing peers, early intervention is key. That’s my soapbox that I’ll step off now. FDA approval in the United States is one year of age, or 12 months. We are seeing that get younger and younger, and I think in Europe the youngest child to be implanted with a cochlear implant recently was three months old.
WADE WINGLER: Wow. As a kid ages, does the cochlear implant itself have to change? Is not going to grow and change as the kid grows and changes. Speak to your cochlea itself, your inner ear, does that change. Is the size of a peek. It stays that size the whole time. What does change is your head. Where they put the cochlear implant, the surgeon has to leave a little slack, if you will, for the outside portion that’s just connecting the main internal device to the electrode array so that they can stretch out a little bit as a child is getting bigger.
WADE WINGLER: That makes sense. How long does it last?
LINDSEY SHINE: The internal device lasts for a lifetime. That’s how long they are supposed to have it. Sometimes, in some cases, it happens where there is a malfunction or something goes wrong or maybe some huge advancement in technology happens where it would warrant and no cochlear implants. But the one is nowadays – and even the axonal devices are backwards compatible with older internal devices and things like that. But because the cochlear implant in the newer technology today isn’t really that old, you don’t have very many people that get explanted for newer internal technology. But if something were to malfunction or something happens on the inside, then they can get explanted. But they are supposed to last for a lifetime.
WADE WINGLER: I know that there are some differences of opinion surrounding the use and appropriateness of cochlear implants. I’ve seen some come about this. What’s going on there? Was that all about?
LINDSEY SHINE: I think what it boils down to is the mode of communication. At Hear Indiana, we primarily work with families who choose listening and spoken language for their children. 90 to 95 percent of children born with a hearing loss are born to hearing parents. Naturally the parents want them to learn the language that they are native speakers of and use so that they can communicate in a hearing world with them. I know that there is some controversy in the deaf community about whether these cochlear implants are trying to fix these children or change who they are or – I don’t know. I can’t speak for them because I’m not a “Big D” deaf person, so I don’t entirely understand where they’re coming from. I do appreciate that and know that maybe they feel a little offended, I guess is the word, or just scared that that is infringing upon their culture and making them feel like something needs to be fixed, when it doesn’t. It is just when the family chooses whatever motive can negation they want for their child, or if someone is later deafened in life than they want to continue using listening and spoken language. That is where it is infringing on who they are as a person and taking that away from them, thinking that something – here is a solution to something that needs to be fixed, when they don’t feel like anything needs to be fixed.
WADE WINGLER: I know it’s a tricky and touchy issue. I appreciate your going there with me on it.
LINDSEY SHINE: You’re welcome.
WADE WINGLER: I have perspectives into all sides of that and totally get it. For me, my personal opinion is it’s all about choices and options.
LINDSEY SHINE: You’re absolutely right.
WADE WINGLER: What advice would you have for an individual or family who is considering a cochlear implant for themselves or their child?
LINDSEY SHINE: I would take you back on what you just said, investigate all of your choices. Look at everything that’s available to you. Look at what would be the best for your family moving forward, what goals you want for your child. If they are young kiddo and you’re getting ready to make that decision, I know it is a tough decision to make, but you kind of have to make that decision, make it quickly, and stick with it.
WADE WINGLER: What’s in your crystal ball as you think about cochlear implants and hearing aids and all that kind of stuff? I don’t swim in those waters all the time. What’s on the horizon? What are folks in your position looking for two or seeing down the pike?
LINDSEY SHINE: I think we have seen in society in general technology has really just taking this huge leap. We eventually kind of see that trickle down into assistive listening devices and hearing aids and cochlear implants. They are getting smaller, they are becoming more compatible with other devices, they are becoming more sophisticated, they can do more things. They are a lot smarter when it comes to trying to work the way the brain works. If you are I are in a noisy situation, and we have normal hearing, we are able to cut out that background noise and pay attention to what we want to pay attention to. It’s very difficult when the signal is degraded, because is coming to your brain to the hearing loss, so those devices are getting a lot smarter in being able to do that easier.
WADE WINGLER: Excellent. Getting rid of some of the background noise and letting you tune in order to add what you want to hear.
LINDSEY SHINE: All of these devices are Bluetooth compatible now, you can directly stream from your iPad or your iPhone or your music or tablet or anything, and the ghost directed to your device. Very cool.
WADE WINGLER: When I interview folks on the show, I like to figure out how my audience might take the next step that they are interested in learning more. My question is going to be, if people wanted to reach out to you and learn more about what you’re doing at Hear Indiana or if they want to learn more in general about hearing aids and cochlear implants, what kind of resources would you direct them to? Are there any good websites or anything like that that you might suggest?
LINDSEY SHINE: I would love for anyone to contact me. I would more than welcome that. My email is lindsay.shine@hearindiana.org. We also have a Facebook page. We have HearIndiana.org. There is the National Institute for the Deaf that has a lot of information out there. There is AG Bell website. There is SuccessforKidswithHearingLoss.org which is a wonderful resource I use myself all the time, so I have enough to tell families about. I would definitely encourage them to come on over to our Hear Indiana.org. We’ve got lots of versus.
WADE WINGLER: Dr. Lindsey Shine is a pediatric audiologist for Hear Indiana, a buddy of mine here at work, and has been our guest. Lindsey, thanks so much for being with us.
LINDSEY SHINE: Thanks so much. It’s been my pleasure.
WADE WINGLER: Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? Call our listener line at 317-721-7124, shoot us a note on Twitter @INDATAProject, or check us out on Facebook. Looking for a transcript or show notes from today’s show? Head on over to www.EasterSealstech.com. Assistive Technology Update is a proud member of the Accessibility Channel. Find more shows like this plus much more over at AccessibilityChannel.com. That was your Assistance Technology Update. I’m Wade Wingler with the INDATA Project at Easter Seals Crossroads in Indiana.
***Transcript provided by TJ Cortopassi. For transcription requests and inquiries, contact tjcortopassi@gmail.com***

Today I’m going to spend some time with a friend of mine, Dr. Lindsey Shine, who is a pediatric audiologist for Hear Indiana which is an organization that happens to be located right here in our building. We are going to talk about hearing aids and cochlear implants and all kinds of technology related to hearing loss. Also we’ve got an app or actually a technique from the folks over at BridgingApps to use a timer to limit the amount of time somebody might spend on the iPad.

We hope you’ll check out our website at www.eastersealstech.com, send us a note on Twitter at INDATA Project, or give us a call on our listener line. We love to hear from you all. The number is 317-721-7124.

***

Kind of an interesting and emerging story here. The headline reads, “Facebook is giving way the software it uses to understand objects in photos.” Technologies called deep mask and shop masks are some of the things Facebook has been using for a while now to describe what a picture is or somebody is blind or visually impaired. They call it automatic alternative text. There’s a whole team called FAIR, Facebook AI Research, and they’ve decided to let those technologies become open source, available to the public to use that technology to do object recognition. I think for folks who are blind or visually impaired, this could mean a whole lot of exciting stuff. Also the article from The Verge talks about the fact that Facebook wants to take the same technology and apply it to videos. So much happening in video these days. How great would be to have self describing videos? Just a teaser there. I’ll pop a link in the show notes where you can read the technical details and see some pictures of how Facebook object technician algorithms work. Check our show notes. You’ll find a link to The Verge.

***

Each week, one of our partners tells us what’s happening in the ever-changing world of apps, so here’s an App Worth Mentioning.

TERA ROTO: This is Tera Roto with BridgingApps, and this is an App Worth Mentioning. Did you know that you can use the simple built in clock function to limit the time your child spends working or playing in an app? It’s easy. We are going to show you how. We are going to be talking about the built in clock app on an iPad, iPod touch, or iPhone. The first thing you have to do is set up a password for your device. You can do so by going into the settings and selecting passcode. Probably the greatest thing about this trick is there is no need to download a certain app to do this. You’re just going to use the clock app that’s built in on your device. Once you’re in the clock app, along the bottom portion of your screen you will see four icons. You’re going to choose the fourth icon, or the last icon, Timer, so make sure that that is selected red. You’re then going to set the timer for the amount that you want, so we will start with 20 minutes. And this is kind of the hidden secret that’s almost magical. You’re going to set the sound for when the timer goes off. On your screen, in the lower center area below the clock circle, is an icon that says Radar. You’re going to change the sound and actually change the action. Instead of playing a sound, you are going to ask the iPad to stop playing. You will tap on the word Radar, and scroll all the way down until you find the words Stop Playing. After you change this setting, once the timer runs out, instead of playing a sound, the iPad will turn off.

Make sure you tap on the start button. You will then see the time start ticking down. If you’re not familiar with the timer app already, one of the great things about it is that it is a nice visual display as well, so you see the red circle as it is slowly running out of time, so your children that are not good at reading numbers and clocks, they can see the time ticking down. Then you can get out of the clock app and go into any other app on the device and use the device freely. If you ever want to go back into the clock app, you can see how much time is left. When you run out of time, the iPad will automatically go to a lock screen. The only way you can get out of it is by entering the password.

Now that you can somewhat control how long people can be on your device, you can use it in various ways. Whether you’re a teacher of a one-iPad classroom and have your students working through the iPad in stations, or as a parent you want to give a certain amount of screen time as a reward, using the built-in timer is a great way to limit screen time. For more information on this app and others like it, visit BridgingApps.org.

***

WADE WINGLER: So it’s not unusual for me to walk around the halls of this great organization and say, hi, Lindsay. How are you today? How is your day? And to hear her say, hi, Wade, and something kind back to me. But today Lindsay is Dr. Lindsay shine – I mean, she is always Dr. Lindsay Shine. She’s the pediatric cardiologist for Hear Indiana which is actually an organization that resides in our building and partners with Easter Seals Crossroads on a ton of different projects. We are going to talk about all kinds of cool stuff today including cochlear implants, because that is a topic I feel like I need to know more about and that you guys in my audience might like to do that too. First and foremost, Dr. Shine, Lindsay, how are you?

LINDSEY SHINE: I’m great, Wade. How are you? Hi everybody. Thanks for having me on.

WADE WINGLER: So excited to have you here. Before we start talking about technology related to hearing loss, I want to hear little bit about you. I want to hear the story about how you became interested in audiology, hearing loss, and a little bit about your job here at Hear Indiana.

LINDSEY SHINE: Definitely. For as long as I can remember, I have always wanted to work with children. All of my jobs have been related to nannying or babysitting. I’ve never worked in the restaurant business or in the retail industry or anything like that. I’ve always wanted to work with kids. So I had some in my life who was actually my dance instructor when I was in high school, and she said I’m a speech language pathologist and all I do all day is play with kids. That just really struck a chord with me. I thought that is awesome; that’s exactly what I want to do. So I was at Purdue University for undergrad, and I was taking my speech pathology courses, and in my junior year we actually had an audiology course. That was a little bit more science for me, if you will. I loved learning about the ear and the anatomy and how your ear works and what happens if it doesn’t work this way and what are the solutions. That just really seems to fit my Type A personality quite a bit more. So I ended up going with audiology and I get to work with kids every day that have a hearing loss. I love it. It’s wonderful.

WADE WINGLER: That’s cool. It’s fun that we are in my studio today because it wasn’t all that long ago when I sat in your room and you beeped in my ear and we played around with your technology a little bit. It’s fun to turn the tables just a little bit.

I know the people in my audience are aware of things like hearing loss and hearing aids and cochlear implants at least a little bit, but to sort of level of the playing field with everybody in the audience, can you give us a quick history of the kinds of technology that have been used throughout history to help folks who are dealing with hearing loss? It’s been a long time since this has been around as an issue.

LINDSEY SHINE: Absolutely. I recently found out that the first electrical hearing aid came about in the late 1800s. Prior to that, people were using ear horns or putting a megaphone up to their ear and it was just guiding and amplifying the sound that was happening in the environment around them, and then going into their ear and reaching their eardrum and further up the auditory pathway. So they were doing an electrical amplification of just sound waves, and that started in the late 1800s. Then things have progressed. That very first example of a hearing aid, or what they were using, involved headphones and this large box and a large battery, so things are getting a lot smaller. Over time, you wear them now, so it went from being something that you had to sit next to and had to be stationary while you were listening through it, and now people wear them actually on their ears or in their ears and they carry them around with them all day. It’s a pretty fascinating world.

Audiology really hit a big spike in the field after World War II when more people were coming back from the war and hearing loss was one of the top issues they found that they were having after seeings combat. Now I think men and women who are coming back from the armed forces are finding that that is still one of the top issues that they are dealing with. So the field and the technology has grown with the need for those types of devices.

WADE WINGLER: It makes sense when you talk about folks who have been in the military that there would be a need there, because hearing loss can be congenital but it can also be from loud sounds.

LINDSEY SHINE: Definitely.

WADE WINGLER: Like bombs and artillery and stuff like that.

LINDSEY SHINE: Yeah, shooting guns.

WADE WINGLER: Exactly. That makes sense. So we talked about the fact that hearing aid used to be big and not necessarily portable and that miniaturization is one of the main things that happening with hearing aid technology. It’s getting smaller and more portable. Take me to school a little bit on the basics of how a standard hearing aid works. I know there are a few different things and is making things easier to hear, but what’s going on behind the scenes?

LINDSEY SHINE: If we think about how your ear naturally works, you have your outer ear and ear canal and eardrum, and everything up to that point works with an acoustic signal. The sound wave is moving through the air. That sound wave hits your eardrum and vibrates your eardrum, and then it becomes kind of mechanical energy where the three smallest bones in your body are then vibrating. They push on your cochlea which is fluid-filled, and the vibrations from the mechanical side of things, from the three smallest bones, vibrate the fluid in your inner ear, and that creates an electrical signal. Then it takes an electrical signal and passes it up into your brain to analyze what it is. A hearing aid works by taking that acoustic signal, or the sound waves, and amplifying those. So somewhere along the line, the sound isn’t being transmitted properly, so the hearing aid takes that acoustic signal and amplifies it where it needs to be amplified.

Typically people don’t have a hearing loss just straight across the board, all of the same pitches, all the same frequencies or sounds need to be amplified the exact same. That is not typically what hearing loss looks like. The hearing aids nowadays have what is called a prescriptive formula inside them, so they are kind of program to only amplify the sounds that need to be amplified based on the individual’s hearing loss.

WADE WINGLER: That sort of makes sense. In fact, and I don’t mind talking about it, I spent some time with you because I’m experiencing a tiny bit of hearing loss. You were able to say something to me like, I bet you like to shoot shotguns and you’re right-handed, because you can figure out basically the frequency where my hearing loss was and the fact that I was probably leaning my head a certain way that you are able to pinpoint it. It makes sense I wouldn’t need and don’t need amplification at this point. But you wouldn’t need it everywhere, just in that spot where you are having difficulty.

LINDSEY SHINE: Exactly.

WADE WINGLER: Hearing aids and cochlear implants aren’t the same thing, right? Cochlear implants do something different. Can you tell us a little bit about what they are, how they work, and how they’re different from hearing aids?

LINDSEY SHINE: Sure. Hearing aids are awesome and wonderful and they provide amplification to a region of your hearing organ, your inner ear, your cochlea, where there is still residual hearing left. You have these little tiny hair cells that live in your inner ear. If you still have enough of them left for the acoustic implication from the hearing aid to reach and stimulate, then hearing aids are going to work well for you. If you do not have enough – and this is just typical. There may be other situations where it is slightly different or the etiology of the hearing loss or the cause of the hearing loss might warrant a slightly different situation. I’m just talking in general here.

But if in the cochlea, you do not have enough residual hearing that the hearing aid is going to do in the fore or provide enough amplification to, then the cochlear implant will come into play. That is very simply put a stronger hearing aid, but it’s different because it’s a totally different signal. Like I was talking about how your ear catches the sound and then it moves through and there is acoustic energy and mechanical energy and electrical energy. That is where the cochlear implant comes into play, when the electrical energy is coming from the cochlea itself.

The cochlear implant has an external device and an internal device. When you are wearing a hearing aid, you only have an external device. You don’t have anything else. Everything is happening either on your ear or in your ear. It’s all right there. The cochlear implant works by having an external device which collects the sound and processes the sound. Then it communicates with a magnet or through a magnet to an internal device which is the implanted part. That has an electrode array that goes down into your inner ear, and this electrode array wraps around the spirals of your inner ear, or your cochlea, and it sends the electrical signal to your auditory nerve.

WADE WINGLER: So the external part makes sense. There is something receiving the signal. I would call it a microphone, kind of.

LINDSEY SHINE: It is a microphone. That’s what we say.

WADE WINGLER: Then it uses the same kind of magnetic thing that my Apple Watch does to charge it. So that magnet then transmits to a device that – is it outside the school but under the skin?

LINDSEY SHINE: Correct.

WADE WINGLER: So it is riding under the skin but outside the skull. Then it has wires that go right down into the same place that a typically hearing person the sound are translated from the acoustic physical stuff into those electronic signals, those nerves, electric signals. So it’s doing the same job, right?

LINDSEY SHINE: Basically what you’re doing is bypassing where the damage is or the part that’s not working properly.

WADE WINGLER: I have a million questions now. What does it sound like? Does it sound different than your hearing or my hearing as we’re doing right now?

LINDSEY SHINE: That is a tough question and a very common question as well. Honestly, it depends on when you receive the cochlear implant. If you’re talking about a very young child who is identified with a hearing loss and has never heard anything, and then can hear through the miracle of the cochlear implant, it’s hard to tell what they are hearing, because they don’t have anything to relate it to. They are going from nothing to something. But it’s not normal and still an electrical signal, being digitally amplified. But that then becomes their normal, so if you asked them what does that cochlear implant sound like, they are like it sound like what you hear. However, if you ask people who were later implanted, maybe they were employed exposed to super loud sounds or there was head trauma they endured or something where they lose all their hearing, a hearing implant isn’t doing it for them, they opt for a cochlear implant. They do have normal hearing to compare it to. I have heard some of them say that at the very beginning, and maybe sounds like Minnie mouse or something like that, is what they relate it to. Or it sounds very robotic or it can sound kind of static key. It does sound like a digital signal to them. But because your brain is plastic and it’s amazing and can do all these wonderful things, it that then just reset itself, and that becomes the normal. So then that is what sounds like normal hearing to them again.

WADE WINGLER: That makes sense. I had a good friend get a cochlear implant, and he was in his late 60s, early 70s, and he said it’s on a busy for a while to get used to it.

LINDSEY SHINE: Absolutely.

WADE WINGLER: So you talked about kids. How young can a child take advantage of a cochlear implant? One is too early?

LINDSEY SHINE: I would say it’s never too early. We know there is tons of research out there that says early intervention is absolutely key. We know that you can hear in utero around 21 weeks, when the cochlea is fully formed. I guess it’s hard to tell because you are looking at brain development and how these kids in utero are hearing. But there is studies that they can recognize their mom’s voice, they can sometimes recognize their father’s voice and some studies. If we know that all of that hearing is happening then, when these kids are born, if they are born without hearing loss and are already that far behind their normal hearing peers, early intervention is key. That’s my soapbox that I’ll step off now. FDA approval in the United States is one year of age, or 12 months. We are seeing that get younger and younger, and I think in Europe the youngest child to be implanted with a cochlear implant recently was three months old.

WADE WINGLER: Wow. As a kid ages, does the cochlear implant itself have to change? Is not going to grow and change as the kid grows and changes. Speak to your cochlea itself, your inner ear, does that change. Is the size of a peek. It stays that size the whole time. What does change is your head. Where they put the cochlear implant, the surgeon has to leave a little slack, if you will, for the outside portion that’s just connecting the main internal device to the electrode array so that they can stretch out a little bit as a child is getting bigger.

WADE WINGLER: That makes sense. How long does it last?

LINDSEY SHINE: The internal device lasts for a lifetime. That’s how long they are supposed to have it. Sometimes, in some cases, it happens where there is a malfunction or something goes wrong or maybe some huge advancement in technology happens where it would warrant and no cochlear implants. But the one is nowadays – and even the axonal devices are backwards compatible with older internal devices and things like that. But because the cochlear implant in the newer technology today isn’t really that old, you don’t have very many people that get explanted for newer internal technology. But if something were to malfunction or something happens on the inside, then they can get explanted. But they are supposed to last for a lifetime.

WADE WINGLER: I know that there are some differences of opinion surrounding the use and appropriateness of cochlear implants. I’ve seen some come about this. What’s going on there? Was that all about?

LINDSEY SHINE: I think what it boils down to is the mode of communication. At Hear Indiana, we primarily work with families who choose listening and spoken language for their children. 90 to 95 percent of children born with a hearing loss are born to hearing parents. Naturally the parents want them to learn the language that they are native speakers of and use so that they can communicate in a hearing world with them. I know that there is some controversy in the deaf community about whether these cochlear implants are trying to fix these children or change who they are or – I don’t know. I can’t speak for them because I’m not a “Big D” deaf person, so I don’t entirely understand where they’re coming from. I do appreciate that and know that maybe they feel a little offended, I guess is the word, or just scared that that is infringing upon their culture and making them feel like something needs to be fixed, when it doesn’t. It is just when the family chooses whatever motive can negation they want for their child, or if someone is later deafened in life than they want to continue using listening and spoken language. That is where it is infringing on who they are as a person and taking that away from them, thinking that something – here is a solution to something that needs to be fixed, when they don’t feel like anything needs to be fixed.

WADE WINGLER: I know it’s a tricky and touchy issue. I appreciate your going there with me on it.

LINDSEY SHINE: You’re welcome.

WADE WINGLER: I have perspectives into all sides of that and totally get it. For me, my personal opinion is it’s all about choices and options.

LINDSEY SHINE: You’re absolutely right.

WADE WINGLER: What advice would you have for an individual or family who is considering a cochlear implant for themselves or their child?

LINDSEY SHINE: I would take you back on what you just said, investigate all of your choices. Look at everything that’s available to you. Look at what would be the best for your family moving forward, what goals you want for your child. If they are young kiddo and you’re getting ready to make that decision, I know it is a tough decision to make, but you kind of have to make that decision, make it quickly, and stick with it.

WADE WINGLER: What’s in your crystal ball as you think about cochlear implants and hearing aids and all that kind of stuff? I don’t swim in those waters all the time. What’s on the horizon? What are folks in your position looking for two or seeing down the pike?

LINDSEY SHINE: I think we have seen in society in general technology has really just taking this huge leap. We eventually kind of see that trickle down into assistive listening devices and hearing aids and cochlear implants. They are getting smaller, they are becoming more compatible with other devices, they are becoming more sophisticated, they can do more things. They are a lot smarter when it comes to trying to work the way the brain works. If you are I are in a noisy situation, and we have normal hearing, we are able to cut out that background noise and pay attention to what we want to pay attention to. It’s very difficult when the signal is degraded, because is coming to your brain to the hearing loss, so those devices are getting a lot smarter in being able to do that easier.

WADE WINGLER: Excellent. Getting rid of some of the background noise and letting you tune in order to add what you want to hear.

LINDSEY SHINE: All of these devices are Bluetooth compatible now, you can directly stream from your iPad or your iPhone or your music or tablet or anything, and the ghost directed to your device. Very cool.

WADE WINGLER: When I interview folks on the show, I like to figure out how my audience might take the next step that they are interested in learning more. My question is going to be, if people wanted to reach out to you and learn more about what you’re doing at Hear Indiana or if they want to learn more in general about hearing aids and cochlear implants, what kind of resources would you direct them to? Are there any good websites or anything like that that you might suggest?

LINDSEY SHINE: I would love for anyone to contact me. I would more than welcome that. My email is lindsay.shine@hearindiana.org. We also have a Facebook page. We have HearIndiana.org. There is the National Institute for the Deaf that has a lot of information out there. There is AG Bell website. There is SuccessforKidswithHearingLoss.org which is a wonderful resource I use myself all the time, so I have enough to tell families about. I would definitely encourage them to come on over to our Hear Indiana.org. We’ve got lots of versus.

WADE WINGLER: Dr. Lindsey Shine is a pediatric audiologist for Hear Indiana, a buddy of mine here at work, and has been our guest. Lindsey, thanks so much for being with us.

LINDSEY SHINE: Thanks so much. It’s been my pleasure.

WADE WINGLER: Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? Call our listener line at 317-721-7124, shoot us a note on Twitter @INDATAProject, or check us out on Facebook. Looking for a transcript or show notes from today’s show? Head on over to www.EasterSealstech.com. Assistive Technology Update is a proud member of the Accessibility Channel. Find more shows like this plus much more over at AccessibilityChannel.com. That was your Assistance Technology Update. I’m Wade Wingler with the INDATA Project at Easter Seals Crossroads in Indiana.

***Transcript provided by TJ Cortopassi. For transcription requests and inquiries, contact tjcortopassi@gmail.com***