Leighton Broadcasting Radio Shows

Ryan
It’s the third hour of the program on a Wednesday, and when it’s Wednesday and it’s 11 a.m. it’s time to talk about all things hearing. Dr. Kevin Fire from Fire Audiology is with us today, and Dr. Fire, your appearance on the program today is serendipitous because today is celebration of the senses day, and hearing is one of the senses, so right up your alley. How about that, huh? Excellent,

Dr. Kevin Fire
excellent. You know, it’s funny. You know, using big words like serendipitous to me. You know that that slows me down a little bit. But I keep a few big words

Ryan
in my back pocket that I know the meaning of just to impress people. But they’re just memorized. I don’t know that I could use them in a sentence. So

Dr. Kevin Fire
color me impressed. That’s for sure. Yeah. So you know, and it’s funny since you bring that up. I do. I go over every year to the AP Psychology class, mr. Myerold’s class over at Central High School, and they have a section in their Advanced Placement Psychology class about sensation and perception, and so I always go over. I think it’s always the week before the week of the Thanksgiving break, so I think it’s maybe that Tuesday, and I go over and teach a couple of different classes on the auditory system. And boy, that’s an awful lot of fun. That it’s fun seeing those you know younger students because, as as you may know, I taught at the university for just about 20 years. I taught audiology, so that kind of gives me my teaching fix to go over there and and visit with those those youngsters. And and it’s kind of fun because I’ve even had a few of them come back and shadow me at my at my clinic over here, which is which is kind of neat. And then this Friday, interestingly enough, talking about sensation. I’ll be out actually at the North Dakota School for the Deaf in Devils Lake, and I’m going to be teaching a class out there for several hours for professionals who go out as part of the early childhood program and do hearing screenings and screenings for ear health issues in the home. So there’s a number of those folks who go out kind of in the field and do some testing with very young individuals, and then what they’ll do is they’ll actually kind of photocopy those and scan them, and then and send them to me for my interpretation of them to make sure that it looks like hey everything is going well with those kids, or no maybe some additional testing may need to be done at a at a at a kind of a more thorough clinical environment than they would get out kind of doing home visits with these kids. So so when you said it’s it’s sort of senses day, I thought of that sensation and perception that I teach in, and and then going to get to teach this coming Friday morning as well over in Devil’s Lake, so I thoroughly enjoy that. All right, sounds good.

Ryan
Well, today as we start our program, and again, Dr. Kevin Fire from Fire Audiology is here. He’ll answer all your questions in regards to hearing today. So call, text, and ask your questions. Opportunity to get free advice on your schedule today from Dr. Kevin Fire from Fire Audiology at 775 5559. I wanted to to get started talking about giving our ears a break, and and I know that that sounds odd, but the last handful of years, Doctor Fire, I would assume that those that are in your industry are having some conversations about what you’re going to start to encounter about 1015, years from now, and the reason why I say that is everybody that’s in a generation younger than mine that’s walking around on the streets constantly has headphones on, earbuds in. There aren’t any breaks for our ears anymore. Nobody takes a walk without listening to the radio or a podcast. Everybody that’s on a subway car has got earbuds jammed in. You’re warming up for a basketball game, and you’ve got earbuds in while you take your warm up shots. I mean, everything is hyperstimulate the ears because we’re listening to something within our ears all the time, and I’m just wondering what kind of conversations you and your industry are having with the challenges you’re going to encounter when this generation has had earbuds stuck in their ears for 20, 25 years. What does that look like for you?

Dr. Kevin Fire
Yeah, well, that’s that’s a very interesting question, and there’s a couple of different things that that happen from sort of long-term noise exposure. One of the very simple things that we are seeing is is impaction of earwax in the ears. That we are seeing more of that now from a couple of reasons. Number one, having something in your ear. Does stimulate the production of earwax because earwax is really designed to help protect the skin and the and the structures of the ear. And when a foreign object is in the ear, almost like when you get something in your eye and your eye waters, that’s a much faster process. We do actually start to create a little bit more cerumen or earwax, and that obviously is being potentially held in place by these earbuds that people are putting in, or maybe it’s starting to migrate out, and then they push it back down into the ear. So, from a physical standpoint, we do see more issues with the ear canal. That could be earwax. The ear itself does need to be ventilated to stay dry, so we can see more issues with itchy ears or a little bit of what we call otitis externa, which is some inflammation of the skin, or even swimmer’s ear can be made worse by having the ear plugged up because the ear won’t dry out then, and a kind of moist, warm ear canal itself can be a can be a great breeding ground for for bacteria and for fungi and so on. But then I think more of the question becomes: What kind of damage are we doing to the system, kind of in where the nerve endings are located down in our inner ear? And the answer is, you know, that’s actually been looked at since really about the 1970s. If you remember back in the old days, you’re you’re too young for this, Ryan, but I’m not. Back in the days of the Walkman, the Sony Walkman. Oh no, no, I’m not too old for

Ryan
the Walkman. I remember the Walkman. Okay.

Dr. Kevin Fire
Okay. Okay. Yeah. Cassette tape. Yeah. I’m young enough to remember the

Ryan
Walkman. Don’t you start making me too old. I remember the Walkman. All right.

Dr. Kevin Fire
I was saying you’re you’re too young for that. Oh, you’re trying to butter me up.

Ryan
Okay, I see what’s going on here. No, I had a Walkman.

Dr. Kevin Fire
They they started, you know, actually the NIOSH, the National Institute of Occupational Safety and Health, which is in Cincinnati, Ohio, that they they were studying that back then because they knew, hey, not only are people having noise exposure due to you know occupational reasons, working in loud factories, things like that, but now we are superimposing on that a bunch of additional noise doses with essentially portable audio players, which at that time were a cassette deck with wires up to earphones. Now, of course, we’ve got it so that it’s Bluetooth and it’s you know really a standalone system that people put in their ears. and And the answer is it’s all accumulative, meaning the noise that we’re exposed exposed to adds up over time. So the answer to your question, a long involved answer, is saying yes, we are seeing a greater degree of hearing loss that is occurring earlier in in the lifespan. You know, it used to be pretty rare to see people who were maybe in their 20s who had hearing loss that we could attribute to noise exposure, and there’s a particular pattern that shows up when we test hearing that makes us believe that noise exposure is the probable cause for that, and that is something that we are seeing much more commonly now. And again, I would say if if the data supports what what we have seen since the portable ear devices have been worn, we’re going to start seeing some acceleration of that because, as you say, now it’s everyone and it’s kind of all the time. So the the exposure to levels of noise are basically an accumulating effect, and some people say, you know, if you were really lived in a very quiet environment and lived into your 90s, you probably would have very little hearing loss because the changes in our hearing probably are not because we’re we’re older. It’s because as we’ve gotten older, we have accumulated more insults or damage to our ears over time. So the answer is, you know, you can look at it as a sort of, you know, hey, it’s a good field to be in because there’s a bit of, you know, people are damaging their ears, and we’re always going to have to help them. But you know, one of the thing is things we do as audiologists is also try to prevent hearing loss. So we do try to educate our patients and say, you know, if you’re wearing these devices, and when someone speaks to you, you have to raise your voice to talk back to them. You’re experiencing something called a lumbar effect. Your your noise that you are your music or sound that you’re putting in your ear is at a level that ultimately can lead to accumulating auditory damage, so very quiet sounds on the other hand don’t seem to do that. And we’ve even looked at things like how about baby toys? You know, toys that you put in cribs with kids. There has been a history of some of those producing sounds at a level that could start that accumulating. Hearing damage, even when children are, you know, infants or toddlers. So, so prevention of hearing loss is something you know. Once you lose it, it does not ever return. And just think, in addition to you know your lawnmower and what you’re getting at work and what you’re hearing, you know, whenever you are exposed to loud sounds, you are adding to that when you are streaming music or other audio messages into your ears. So absolutely, we know it’s going to be an issue. We’ve seen it happen since the first ones came out in the 70s, and the expectation now is that that will be more hearing loss appearing when people are younger and younger.

Ryan
All right, now text messenger rights to 775 5559. I ended up with a head cold this past spring, heavy sinus. Didn’t last more than seven or eight days. Since then, it seems like my left ear acts like it does when a person gets water in it from swimming. Hasn’t improved over a couple of months.

Dr. Kevin Fire
Yeah, that that sounds to me the what we would call that most likely is a condition called serous otitis media. Otitis just means it’s an inflammation somewhere in the ear. Media means it’s in the middle ear, and serous means that it’s probably a fairly sterile fluid. If you think about the middle ear space, the middle ear space is that space behind your eardrum. It really is one of our sinuses. It is an air-filled space that is lined with mucosal tissue. Mucosa is is the tissue that lines your nose and your mouth and your throat. And what can happen in the cases of head colds or allergies, is the tube that normally equalizes the pressure of air in the middle ear space with that of the outer environment? It’s a tube called the eustachian tube. It can get swollen and not ventilate that ear very well. Doesn’t let the air exchange between the outer environment and the middle ear. That can then lead to an irritation of that tissue, and you usually don’t even feel this. And when that tissue gets irritated, just like when you have an allergy and your nose runs, that irritated mucosal tissue will start to seep fluid. The fluid is actually blood serum, which is why we call it serous otitis media. And that fluid has nowhere to go because that opening between your ear and your throat, these station tubes, kind of swollen shut, and so you end up with a fluid-filled middle ear, as opposed to after you go swimming or a shower, where you might have fluid filling your ear canal or your outer ear. What to do about it? Generally, a lot of times, a nasal corticosteroid like Nasacort works very well. That’s over the counter now, so you can get that without a prescription. It does take a little while to work because it actually changes that mucosal tissue at the eustachian tube. But if you use Nasacort, generally one time a day is all it takes, and then several times a day, plug your nose and swallow. That’s actually called a Toynbee maneuver, and then follow that by plugging your nose and gently blowing. That’s called a Valsalva maneuver. That’s what divers learn to do to equalize air pressure in their ears, and by doing that, you’re actually reducing the air pressure in the middle ear and then increasing it. You tend to have the effect of kind of pumping that fluid out through the eustachian tube. And if you can’t get that ear cleared in a couple of weeks, we could certainly see you here. We could do a test called a tympanogram, which would tell us is there in fact fluid behind the middle in the middle ear space behind the eardrum, and if it’s chronic and you just can’t get rid of that, we probably refer you on to an otologist who might consider actually draining the middle ear. You can do it through something called a myringotomy, which is just a little incision where they can suck the the fluid out, or they can actually make a little incision and put a tube in, which is called a myringotomy and tympanostomy tube, which then keeps the ear ventilated. So that’s the problem. That’s why so many kids have so many ear problems. Is their eustachian tubes just don’t work as well as they do in adults. But my guess is you still had inflammation of that eustachian tube, and you’ve got a fluid-filled middle ear that’s not infected, but still filled with fluid and bothersome, so I’d try nasacord and then those nasal plug your nose and swallow, followed by plug your nose and gently blow. That’s what I would do.

Ryan
Text your rights to 775 5559. Again, your questions for Dr. Kevin Fire from Fire Audiology. Hearing related questions today, all welcome 77555559. Call or text. Texter writes, “My ear canals feel like they are too small to put hearing aids in. What can I do?

Dr. Kevin Fire
Yeah, that’s an interesting question, and the answer is everybody’s ear canals are kind of differently shaped. I have extremely small ear canals, very very small. When I do a tympanograph. On myself, it measures the volume of air in your ear canal, and my ear canal volume is about 0.6 cc’s. So I have the ear canals of about a one-year-old child, and I know why. It actually is because I grew up in northern Ohio with a home on Lake Erie, and I would start swimming in Lake Erie when it was like in the 50s, the water temperature, and I’ve developed something called osteomas, which are growths of bone, kind of almost like bony calluses in the ear that we get when we expose ourselves to cold water. But other people just tend to have very small ear canals. There often is a way around that. Number one, the outer one half of your ear canal is cartilage, so we can actually take an impression of that cartilaginous area of your outer ear, and if you are a candidate for amplification or for hearing aids, we can actually have a custom earpiece made that will go into that cartilaginous area, and since it’s custom fit to that small ear canal, it doesn’t feel uncomfortable at all. And then we can couple a hearing aid to that custom earpiece. There are also kind of what what we would call custom complete hearing aids, like in the ear or in the ear canal hearing aids, and you’d be shocked how small they can actually make those. What the what the technicians do at the manufacturing facilities is the part that goes down into the ear canal they make sure has no electronics in it at all. So it has basically just a sound delivery tube, and the electronics are actually built in what’s called the contrabowl, which is kind of that bowl-shaped depression of the of the outer ear, so it’s very very very rare. I can’t actually remember a time when we could not get something custom made that could fit even the ear canals of a newborn. I mean, I put hearing aids on children who are two months old, and they have very teeny tiny ear canals, as you would imagine, and we can really kind of customize that and make that for them because we take a cast of the ear, it gets laser scanned in, and then the computer actually builds the device to not be too tight for those small ear canals. So I would still come in and have us take a look, and probably something can be custom made for virtually any ear canal, even my own. All right, I’ve had them made for myself.

Ryan
775 5559 is how you join us. A texter writes: Does bone conduction headphones will it still hurt if you’re hearing, or will it hurt your hearing?

Dr. Kevin Fire
If if you’re hearing it too loudly, the answer is yes. There’s actually, again, it’s just an alternate pathway to the inner ear, and where the damage occurs is in the inner ear, and so we have the air conduction pathway, which is the pathway that goes down our ear canal and goes into our eardrum and into our inner ear that way, and then the bone conduction pathway, which basically sets vibrations of the of the skull bones, or the bones in the skull get set into vibration, which then vibrates the fluids and the tissues in the inner ear, and you hear that as sound. If you turn that up too loudly, you know, if you have too much power, a bone conductance signal can reach the inner ear at a level that can be damaging. Again, my general rule is: is if you’re listening to that and someone talks to you and they say, “Hey, you don’t have to shout back at me to talk, you are probably exposing yourself to damaging levels of noise. The other issue can be you can experience something called an occlusion effect, and if you do have any earwax in your ears or fluid in your middle ears or negative pressure, that bone-conducted signal actually gets amplified because it normally vents out through an open ear, and if your ear is plugged up, those bone-conducted signals actually do get amplified even more in the inner ear. Surprisingly enough, if you plug your ears and talk, you will lower your vocal intensity simply because you are hearing yourself through bone conduction. So anything that blocks the ears makes that worse. So yes, it can be at a damaging level. That was kind of what the question was.

Ryan
775 5559 is how you join us here on the program. You’re on KNOX with Dr. Kevin Fire.

Speaker 1
Dr. Fire, hey, I think maybe I’ve talked about this with you before, but I want to ping you again on this. So, as as many of you know, like I play in an orchestra, and I’m not so concerned necessarily for myself, but I am. Down deep inside me, I do have a heart, and I’m concerned with the people on the front end of my bell that have to absorb all the wattage that that comes out of there. So, because you play an annoying instrument like

Ryan
the trumpet, but that’s okay. It’s fine.

Speaker 1
It’s no big deal. You know what? This is this is the segment with Doctor Fire, Ryan. Can you pipe down a little bit? I can. I need to ask him. I just I felt compelled to get

Ryan
that out there. I apologize. I stand corrected. Please go ahead. Okay.

Speaker 1
All right. So I picked up a set of Apple. AirPods, and I think they’re the you know Gen 2 pros, whatever they are. Anyway, there’s a function on there of hearing safety where I can still hear ambient noise around me, but similarly to kind of like gun muffs when you go out shooting, where you can hear everything around you, then it cuts the noise. There’s a noise gate. So on my on my phone, I can set this to you know 80, 85 decibels, 90, whatever it is. I can set the limit coming in, and so I’m wondering, is this kind of the ticket for you know the people in the orchestra then to to be able to use technology like this so they can still hear around them? All of us have experimented with earplugs, and of course, you know that really throws off balance and and all this, and you don’t hear your yourself the way that you need to. All this sort of thing, is is there another device like this that you know of that limits the hearing or limits the decibels coming in, but where you can still hear the ambient noise around you, or or is it maybe the best idea to go get a bunch of earbuds like this.

Dr. Kevin Fire
Well, and what what that’s doing is something called electronic compression, where basically it is the quieter sounds are being left alone and and not being attenuated or reduced, and then as the loud sounds come in, it then squeezes those loud sounds down. Hence the name compression. It is compressing those sounds. That’s a way to do it. The question I would have is: Is does it sound as though the the world gets somewhat muffled with those? Simply because when those are in your ears, it is going to be changing some of the resonances of the ear canal itself. So anytime you put something in the ear canal, that natural resonance, which is, by the way, how a trumpet changes that that buzzing sound at the mouthpiece into the musical sound at the bell, it’s actually resonances because of the air-filled chamber there. So they do make something called musician earplugs that are designed. Basically, again, you do get a custom impression of your ear, and they have different essentially chambers that can be plugged into those. These will reduce the amount of sound by either nine decibels, 15 decibels, or 25 decibels. But what’s nice about them, as compared to other hearing protection devices like standard earplugs or just compressing devices, is the relative intensity of all the other sounds remains exactly the same because that valving system they put in it is like an artificial ear canal. It’s actually a little resonating chamber that’s in there. So I would say still a better solution is actually custom-made musician earplugs because the idea there would be it would sound at a lower intensity level, but at normal relationship of all those sounds. Again, if you put something in the ear canal that doesn’t have a resonating chamber with it, unless they and software are creating an artificial sort of resonant cavity in electronics, I would think it would still sound a little imbalanced to somebody who’s listening to that. And by the way, some of the manufacturers we work with with musician earplugs, they’ll let you try them, and if they don’t work, they’ll give you your money back. You know, they they say, you know, you have 60 days to determine is this solving your issue, which is you want that volume at a safe level to you. So that’s what I would think of. I just don’t know if you put those earbuds in, does that change the ear canal resonance, therefore putting other sounds out of balance for you? I believe it could protect you, though. It just might sound a bit abnormal to you. Musician earplugs are designed to get rid of the abnormal sound sound qualities while still protecting you.

Ryan
And the trumpet’s an abnormal sound, so that should help you out. Hey, listen.

Speaker 1
So yeah, I stopped by your office. I picked up a set of those vibes a while back. I need to do more testing with with those. Is that are those the ones that you’re talking about, or is those non-catching

Dr. Kevin Fire
ones? Those those vibes are the ones where they put they do have a resonating cavity in them, and so they only have one degree of attenuation or reduction, and then you kind of self fit that to your ear with different tips on it, but it’s it should be better than just standard ones. But having custom ones made would be the best of all. That’s what you see the people who are performers wearing when you see those earpieces in that look like they fit down in their ears. They’ve had custom musician earplugs made for them.

Speaker 1
Okay, gotcha. Thank you very much. I might have to stop by and chat a little bit more with you. Maybe try a set of those. You thank you very much.

Ryan
All right, thank you for the call. It’s a resident trumpet player. I mean, he hasn’t figured out he hasn’t figured out the cool instrument to play as the tuba yet. That’s fine. It is what it is. You know how it goes. We got to go rapid fire in a couple of these doctor fire. We got a couple of text messages waiting for you. Texter writes: When my wife turns 65, she got a flu shot. Next day, she lost hearing in her right ear. Went to the family doctor, later ear specialist. Three steroid injections in the ear. Still not hearing. Now has to use hearing aids. This is permanent now.

Dr. Kevin Fire
Depends on how long. That was. I don’t think that was due to the flu shot, though, because the flu shot is actually an inactive virus, and that that person probably experienced something called a sudden idiopathic sensorineural loss. More commonly, that’s from an active virus that occurs or a small interruption in the blood in the in the blood supply. If it’s been longer than six months, that’s probably where she’s going to be, unfortunately. But but if it’s not been to six months yet, we do see recovery of these losses for a period of about six months after the event occurred. I don’t think it was due to that to that vaccination, though.

Ryan
Okay, sounds good. Let’s take a call for you. You’re on KNOX with Dr. Kevin Fire.

Speaker 2
Hey, good morning. Thanks for taking my call. Hey, Dr. Fire, I was in a couple of years ago and had gotten some hearing aids to aid in my hearing, and they were resound aids. And about six months ago, I was in for a checkup, and after that, I don’t know exactly if they made some changes or anything like that. I cannot use my phone and answer through my hearing aids any longer. Oh, they are. It sounds like I’m in a tunnel, and I have called a couple times, and they said that they’re having some issues with that. I was just wondering if you found any corrections yet or anything.

Dr. Kevin Fire
And the expert for that is Sydney because sometimes what it requires is the actual app that’s in your phone itself needs to be deleted and then re-downloaded and repacked to the hearing aids. But you could just do that on a walk-in basis. You don’t need to call for an appointment or anything. If you stop in, ask to see Sydney, and she is our phone talking to hearing aids expert, and she should be able to get that fixed. There may be also an update in the software of the hearing aid itself, what’s called a firmware update, and she would be able to download that for you as well. There’s no cost to do that; just stop by. Sometimes, again, phones do updates and hearing aids do updates, and they don’t tell the other side of that connection what they’ve done, so it gets you know the phone either doesn’t talk to the hearing aid or the phone’s talking to it, but the hearing aid doesn’t hear the phone. So I’m very confident that she’d be able to get that fixed very quickly.

Speaker 2
Perfect. I’ll stop in. Thank you very much. Thank you. And then

Ryan
final question for you, Doctor Fire: How can you tell if a two-month-old needs hearing aids? How do you test for that?

Dr. Kevin Fire
Yeah, the first test we do is a test called distortion product evoked otoacoustic emission testing. There’s a mouthful, and what that is is basically a test where we put sounds into the ear, and if the ear is functioning correctly, when we put sounds in, we then measure sounds that the ear itself creates coming back. Those are the otoacoustic emission responses. If we don’t see those responses, the next thing we do is a test called high-frequency tympanometry to make sure there’s no blockage in the ear. And if that one comes back normal, then we will do a test called a auditory brainstem response, where a child is actually sleeping, and you put little electrodes on them, and they listen to clicks. And what we can do is turn the volume of the clicks down until this particular brain wave vanishes. It’s called wave five, like the number five. And what we look for is how low can we present these clicks and still measure a wave five, and that allows us to tell what that child’s hearing level is. So we start with otoacoustic emissions. If those are abnormal, we go to tympanometry. If that is normal, we then go to an auditory brainstem response. And at the end of those batches of tests, we know pretty darn well where that child is hearing.

Ryan
All right, sounds great, Doctor Fire. If you have any, if we have any additional questions, how can we get in touch with you?

Dr. Kevin Fire
Yep, you can always stop by our our clinic, 121 North Washington Street. You can go to our website at Hearing ND. That’s H E A R I N G Hearing N d.com. N D is like North Dakota and our phone number is 701-787-5862

Ryan
all right sounds great Doctor Fire thank you for joining us today

Dr. Kevin Fire
thanks Ryan you take care yep we’ll see ya

Ryan
Doctor Kevin.