Today is the next chapter in our Quick Questions series!

Question: What do grommets look like?

Answer: Surgically inserted into the eardrum, grommets are small flanged plastic tubes which aim to ventilate the middle ear until the body's natural breathing tube (Eustachian Tube) starts to function normally again. This means that any fluid build up in the middle ear can be drained away. They come in a variety of different sizes, colours and shapes, typically falling out after around 6-12 months. Often you won't know if they have fallen out, however sometimes you can be lucky and find it on your pillow or just on the edge of your ear. I typically describe them as looking a bit like if you sliced a small tip off the ink reservoir from a BIC ballpoint pen. 

Question: Why can't older people always hear those mosquito ringtones?

Answer: Several years ago, novel ringtones which emit very high frequency sounds similar to those made by mosquitoes were 'doing the rounds'. Often described as "secret ringtones" of around 17000 Hertz (17kHz), they were aimed at younger listeners who were able to hear it and took advantage of the natural loss of hearing sensitivity as people age.

The cochlea is our permanent hearing organ which is shaped like a tiny snail shell. How we hear is that sound travels down the ear canal, through the middle ear and into the basal end (base) of the cochlea first. The resulting movement within the cochlea results in electrical signals being sent up to the brain (and that's how we hear). Based on it's shape and tonotopic organization, lower frequencies stimulate the further end (apex) of the cochlea while higher frequency sounds effect the base of the cochlea. Through natural wear and tear as sounds regularly pass through the base of the cochlea, we can get some decreased sensitivity to higher frequencies as we age. This therefore impacts our high pitch hearing more so than the lower frequencies. 

Question: What are exostoses?

Answer: Exostoses is often described as a benign growth of new bone on the surface of existing bone. It can range in size, shape and location on the body. Exostoses in the ear is sometimes known as "surfer's ear" and typically caused by irritation to the ear canal from ongoing exposure to water and wind. While exostoses typically doesn't cause pain, ongoing growth can result in hearing loss. It is recommended for those who swim, surf or dive regularly consider using a set of protective earplugs as this may reduce the speed of exostoses growth.

Think you may need a set of protective plugs? Contact our clinic today to have a set of custom plugs made by one of our friendly audiologists!

Today’s post will be a bit different then my usual write-ups. Rather than focusing on a main topic, I thought I’d answer a couple of questions recently asked by my clients.
 
Question: How often should I have my hearing tested?

Answer: It is typically recommended for adults to have their hearing tested every 3-5 years up until the age of 50 when it drops to every 2 years. After the age of 60, it’s advised that your hearing be checked as part of your annual overall health check-up.

​For children born in Australia, their hearing will be screened shortly after birth (in NSW, it’s known as the Statewide Infant Screening of Hearing or SWISH program) and should be monitored throughout their school years. As a general rule of thumb, it is recommended children have their hearing tested prior to starting kindergarten and Year 7, and before beginning tertiary education to establish their baselines of hearing. In the case of infants who have certain medical conditions, speech/language concerns or a family history of hearing loss, more frequent hearing tests may be required.

If you think yourself or a family member is due for a hearing assessment, feel free to contact the clinic to see one of our audiologists and have your hearing checked today. 
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Question: Is it bad for me to listen to music through my headphones?

Answer: While listening to music/podcasts/audio itself isn’t bad, the bigger concern is how loud and for how long are you listening. Generally speaking, the louder the volume you are listening to, the shorter the period of time you can spend listening to it before it starts causing damage. The overall amount of daily exposure to noise is also important to be aware of as these levels take into account our exposure from both occupational and recreational settings. For example, listening to a personal audio device at a volume of 85 decibels may allow you to be exposed to it for 8 hours before it starts causing damage. Should you then decide to use some equipment with a volume around 100 decibels, then you can be exposed for only around 15 minutes.

Consider headphones which are either active and/or passive noise cancelling to reduce the volume of background noise and thus the need to increase volumes. Click here to check out our previous blog post on headphones. Being more aware of how loud noise and music can get is important too (information can be found here ). At the end of the day, if you look after your ears now and you’ll be listening to those sweet tunes for many years to come.

NB - Be environmentally aware when you are wearing headphones! Watch out for your surroundings. 

Several years back when I was returning from an overseas holiday, I had the most excruciating pain in my ears and head as we descended back into Sydney. Days earlier, I had developed a cold and didn't think much of it at the time. It wasn't until the pain struck me that I realized how bad flying can be when you are congested. Sometimes people develop pain in their ears during air travel because of an unequal pressure build up on either side of the eardrums. This is noticed most during takeoff and landing.
 
What is happening?
The middle ear (space behind the eardrum) is filled with air and connected to the nose through a channel called the Eustachian Tube. During flight, the air pressure in the sinuses and middle ear need to be equal with the cabin pressure inside the plane. As the plane ascends and descends, the pressure changes within the ear. If you have an ear infection or anything which causes a blockage in your Eustachian Tube, this restricts the ability for the middle ear to reach equilibrium, resulting in pain. 

Things such as colds, allergies, ear or sinus infections can result in an inability to equalize the ears. 

Symptoms
Although pain is the main symptom experienced, sometimes pressure change can cause tinnitus (“ringing” or “buzzing” sounds in the ears), vertigo (dizziness/imbalance) or hearing loss. In very severe cases, perforation of the eardrum may even occur. 

What to do?
Typically, most medical professionals would recommend avoiding flying while you have any active infection to reduce your chances of complications and pain.

If flying is unavoidable, then there are several tips that may help:
⦁ Sucking on lollies: swallowing, yawning or chewing can assist in allowing air to flow up the Eustachian Tube more easily. Chewing gum can also help. For younger children and babies, feeding, drinking or giving them a dummy will encourage them to swallow. 
⦁ Valsalva Manoeuvre: this technique can assist in equalizing the ears. Breathe in, then breathe out gently with your mouth closed and pinching your nose. By not allowing the air to escape, it’ll be pushed into the Eustachian Tube and you’ll feel your ears “pop” as air rushes in. This technique can be repeated whenever you feel any ear discomfort. 
⦁ Saline nasal sprays: can assist in keeping the nasal passages clear of mucus. By keeping the nasal passages clear, this may assist in keeping the Eustachian Tube clear. 
⦁ Air pressure-regulating earplugs: can be purchased from pharmacies and at the airport. These slow the rate of air pressure change on the eardrums, reducing the chances of a build up in pressure. 
⦁ Nasal balloons: these balloons can be blown up with your nose (blocking one nostril at a time and blowing through the other) and have been found to help relieve pain during flights and unblock ears. These can also be purchased from chemists.
⦁ Antihistamines: can be taken ahead of time to reduce the amount of mucus you make.
⦁ Decongestants: can assist in relieving the blockage by drying up the nose. Both oral medication and nasal sprays can assist.
⦁ Over-the-counter pain relievers: can help control discomfort.

For me, I think I'll have to pack some chewing gum next time I fly. 

This information is strictly to be used as a guide only; please consult for doctor or other professional health care provider for specific medical advice regarding your situation. 

While over at my sister-in-laws place, I noticed she had this lovely decorative potted plant with spiky leaves. A native of the Americas, the Yucca plant is favoured in many gardens around Sydney for it's bold, architectural shape. However, while fashionable in look, the Yucca plant has been known to cause ear (and eye) injuries due to its sword-shaped leaves.
 
Many gardeners are aware to protect their eyes when handling this plant, but some don't realize the potential damage which can be done to their ears by those thin leaves. As beautiful as this plant is, it has been known to cause eardrum perforations (1), vestibular (balance) symptoms and even permanent hearing loss (2). Although perforations can heal over with time or be fixed with surgery, damage further within the ear is not so easy to fix. 
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What should you do if you do have an ear injury? We recommend you seek medical help as soon as possible to ensure appropriate treatment is given and to reduce the risk of any further complications.

And a general gardening tip from us would be to not only protect your eyes, but also your ears when handling Yucca plants (and indeed, any spiky plant).
 
1. Talmi, Y. P., Wolf, M., Migirov, L., & Kronenberg, J. (2009). Ear trauma caused by a yucca plant leaf spine. ENT: Ear, Nose & Throat Journal.
 2. Vartanyan, M., Orimoto, K., Dragovic, A. S., Crock, C., Dobson, M., & O'Leary, S. (2018). Garden terror—Case series of twenty‐eight serious ear injuries caused by yucca plants. Clinical Otolaryngology, 43(2), 749-753.

Several months back, we discussed hearing loss in children and one reader commented about how significant damage can be done from even innocent and child-friendly sources of noise like party balloons.

This is indeed true.

While the humble balloon may seem benign enough, recent investigations found that at close range, the noise produced from a rupturing balloon can be louder than a shot from a shotgun or a rifle (1). At 167.8dBSPL (sound pressure level), a balloon burst was only slightly lower than the volume of a .357 Magnum pistol shot! The Australian Government's National Occupational Health and Safety Commission reports that "for peak noise, the national standard is a peak sound pressure level of 140dB" (2). So the level of impulse noise produced from a rupturing balloon is not only hazardous for children, but also adults too. The high-intensity impulse noise caused by the balloon popping creates large changes in air pressure which can damage the little hair within the delicate inner ear leading to hearing loss. Although the results from this study are indeed alarming, this post is not aimed to scare people into no longer using balloons, but rather to encourage greater awareness and education into the impact noise can have even from something as simple as a balloon.

The difficult thing with hearing loss is that it is often described as an “invisible problem”, with people rarely putting too much thought into their ear health or listening environments. Even the World Health Organization (WHO) acknowledges their concerns for about 1.1 billion young people worldwide from hearing loss due to 'unsafe listening practices' (3). What we need to understand is, is that cumulative noise exposure (noise exposure over an extended period of time) can be viewed the same way that sun exposure is (4); that is, to realize that damage done today can impact us in the future.
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So where to from here? Prevention is always better than cure. By making some smart changes to our attitudes and to how conscious we are of our listening environments today, our choices can significantly impact how well we hear into the future. If you have any concerns about your hearing or of your child’s hearing, feel free to contact the clinic for further investigation today.
 
For more information about hearing protection, check out our previous blog post here.

1. Hodgetts, B., & Scott, D. (2016). Did You Know How Loud Balloons Can Be?. Canadian Audiologist, 3(6).
2. Australian Government. National Occupational Health and Safety Commission. (2000). National Standard For Occupational Noise. NOHSC: 1007 (2000). 2nd ed. Accessed via: https://www.safeworkaustralia.gov.au/system/files/documents/1702/nationalstandardforoccupationalnoise_nohsc1007-2000_pdf.pdf
3. World Health Organization. (2015). Hearing loss due to recreational exposure to loud sounds: a review. Accessed via: http://apps.who.int/iris/bitstream/handle/10665/154589/97892?sequence=1
4. Karagas, M. R., Zens, M. S., Nelson, H. H., Mabuchi, K., Perry, A. E., Stukel, T. A., ... & Linet, M. (2007). Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage. American journal of epidemiology, 165(6), 719-726.