Opinion

Looking Beyond Basic Measures

As hearing science progresses, it’s always fun to take guesses on how future discoveries will change the provision of hearing health care and amplification. This is a difficult task, of course, because you never know what the hearing scientists, clinicians, and engineers will find next. However, when viewing the way in which hearing loss is currently assessed, it seems likely that the development of future diagnostic procedures will hold at least as much promise as what we’re currently seeing at “the other end” in hearing aid development. As Bailey Wang’s article in this issue of HR points out, testing has been traditionally limited to audiometric information about the degree and shape of the hearing loss, word recognition scores, etc, resulting in broad measures like the speech reception threshold (SRT). However, relative to describing hearing loss, these types of measures can provide a false sense of security: They say very little about the etiology of the hearing loss, condition of the ear (eg, outer versus inner hair cell loss), the integrity of the nervous system (including myelination), status and effect of active cochlear amplification mechanisms, proportion of retrocochlear versus cochlear lesions, tonotopic reorganization of the auditory cortex, or the patient’s auditory stimulation (eg, deprivation/acclimatization effects), lifestyle, linguistic ability, etc.

Of course, insights into many of these factors are changing as technologies like OAE, ABR, speech-in-noise, and other tests are further researched, refined, and implemented. What seems evident is that, in the future, hearing care professionals will have a lot more information at their disposal relative to the status of the various hearing centers, and will be able to make more refined amplification decisions based on these tests. In the meantime, articles like Wang’s serve well to remind us that individual hearing loss is not easily defined by an SRT score.

OK, eh, shoot me! If you want a good chuckle, check out the December 6, 2005 article in the Canada Medical Association Journal by David A. Keegan and Susan L. Bannister titled, “A novel method for the removal of ear cerumen” (www.cmaj.ca/cgi/content/full/173/12/1496). The article describes the “off-label use of a recreational device...in the alleviation of a socially emergent ear condition”—impacted cerumen caused by too much swimming while on vacation in Canada. The authors came up with a novel approach that I’m certain Richard Craig, PhD, didn’t advocate in his many years of conducting cerumen management workshops: a 4-year-old’s Super Soaker Max-D 5000 squirt gun. Ahhh, there’s nothing quite like a photo of a doctor in swim trunks holding a big flourescent green and blue Super Soaker crammed into someone’s ear to get you thinking about summer vacations in the Northwoods. For those of you interested in the efficacy of this highly experimental technique, it took only three “load-ups” of the squirtgun to unlodge the impacted wax, and it provided great family entertainment value: “The 3 generations of family members present took turns admiring (or recoiling from) the specimen. The patient exclaimed in joy, ‘I can hear again!’” Please don’t try this at home—or anywhere! Thanks to Marshall Chasin for pointing this out to HR.

Passings. It was with great sadness that we learned of the untimely death of Carl Crandell, PhD, assistant professor at the University of Florida, who died in December. Carl was a dedicated teacher and a wonderful lecturer and writer who cared deeply about his profession and his students. He had a wide range of expertise. As only three examples, he published articles in HR ranging from FM systems and soundfield amplification (June 1999), psychosocial and functional health effects of hearing aids (April 1996), and prevailing amplification and counseling skills in the training of audiologists prior to the establishment of the AuD (September 1996). He will be greatly missed. For more information on his life, see Industry Personalities.

Karl Strom
Editor-In-Chief