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HEARING SOLUTION GUIDE After your hearing assessment

MARIE-JOSÃ‰E TAILLEFER Lobe Ambassador

It’s a pleasure for us to offer you this guide containing the different hearing solutions that are available to you or a loved one with hearing loss. The audioprosthetist will be happy to analyze your audiogram with you, then determine your listening and communication priorities, and verify if you’re eligible for RAMQ, CNESST or Veterans Affairs programs. This hearing solution guide was made possible with the help of audioprosthetists and specialized educators practicing in the Lobe clinics.

Because in Lobe clinics, every moment deserves to be heard.

TABLE OF CONTENTS 5

Your audiogram analysis

Anatomy and physiology of binaural hearing

A new technology featuring artificial intelligence

Types of hearing aids

Listening situations (COSI)

Connectivity accessories

Assistive devices for television viewing

Assistive listening devices

Listening and communication strategies

Hearing protection

Hearing health and communication professionals

Who is eligible for the RAMQ program?

Who is eligible for CNESST compensation?

Why must I wear two hearing aids?

Presbycusis: why deprive oneself of the joys of hearing?

Sensory deprivation

Table of technologies

CONGRATULATIONS! You have taken the first step towards better hearing health. You are now among those who have chosen to take care of their hearing. You must be proud! It is when you are deprived of a sense that you realize the best its importance. A healthy hearing is a gift, letâ€™s not forget it! All my love, Lobe Ambassador

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YOUR AUDIOGRAM ANALYSIS Now that you’ve had a hearing assessment, it’s time to analyze it.

Lowest

60 70 80 90

Loudness measured in decibels

60 70

f th s

Mild hearing loss (20–40 dB Mild HL) hearing loss (20–40 dB HL)

Moderate hearing loss Moderate hearing loss (40-55 dB HL) (40-55 dB HL) 5 Moderately severe Moderately severe hearing loss hearing loss (55-70 dB HL) (55-70 dB HL) Severe hearing loss Severe hearing loss (70-90 dB HL) (70-90 dB HL)

Profound hearing loss Profound (90 dB HL and over) hearing loss (90 dB HL and over)

100

110

110 Loud

Loud

f th s ph p g hk g k ch sh ch sh ia o r

Normal hearing Normal (up to 20 dB HL) hearing (up to 20 dB HL)

100

120

v z 30 j md b i a j mod br 40 ng n el ng n el u 50 u

30 40

Frequency in hertz Highest Frequency in hertz Highest 1000 2000 4000 8000 500 1000 2000 4000 8000

0 Soft

Soft

Lowest 250 500 250

120

Low frequencies are frequencies are responsibleLow for the responsible for the understanding of understanding of 20% of words. 20% of words.

X - X : Left

High frequencies are frequencies are responsibleHigh for the responsible for the understanding of understanding of 80% of words. 80% of words.

O - O : Right X - X : Left O - O : Right lobe.ca

ANATOMY

AND PHYSIOLOGY

OF BINAURAL HEARING

HELIX

INCUS MALLEUS STAPES

EXTERNAL AUDITORY CANAL

ENDOLYMPH AND PERILYMPH

CONCHA AUDITORY NERVE EAR DRUM ANTITRAGUS

LOBE

OVAL WINDOW COCHLEA

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FUNCTIONS

COLLECTS SOUND FROM THE ENVIRONMENT

MECHANICAL TRANSMISSION

CONVERSION INTO NERVE IMPULSES

SOUND RECEPTION AREA

OUTER EAR

MIDDLE EAR

INNER EAR

BINAURAL PR THE AUDITORY BRAIN

AUDITORY AREAS

HELIX

INCUS ENDOLYMPH AND PERILYMPH

MALLEUS STAPES

EXTERNAL AUDITORY CANAL

CONCHA AUDITORY NERVE OVAL WINDOW

EAR DRUM

COCHLEA

OCESSING OF INFORMATION BRAIN

AUDITORY AREAS

LOBE

ANTITRAGUS

CONVERSION INTO NERVE IMPULSES

MECHANICAL TRANSMISSION

COLLECTS SOUND FROM THE ENVIRONMENT

FUNCTIONS

INNER EAR

MIDDLE EAR

OUTER EAR

SOUND RECEPTION AREA

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To properly determine your listening and communication needs, tick the 5 most important situations and rank them in ascending order of priorities, from 1 to 5. Important situations

Priorities

Face-to-face conversation with a family member Face-to-face conversation with a stranger Conversation in group: family reunion Conversation at the table: dining room, restaurant Conversation in group: work meetings, conferences, in a classroom Hearing my grandchildren Hearing a speaker (professor, lecturer) Hearing music (playing or listening to) Hearing surrounding environment at the supermarket, grocery store or shopping mall Hearing the dialogue at the cinema, theatre or show Hearing the television or radio Hearing the person sitting beside me in the car

Hearing the radio in the car Hearing babyâ€™s crying Hearing phone conversations (familiar or unfamiliar speaker) Hearing phone ringtone Hearing doorbell Hearing smoke detector, carbon monoxide detector Hearing the beeping sounds of home appliances Hearing the alarm clock Hearing the nature (birds, river, tree leaves) Hearing at church Perceive less my tinnitus Hearing my pet Hearing my sound environment for my security NAME:

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FILE NUMBER: DATE:

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WHO IS ELIGIBLE FOR THE RAMQ PROGRAM? HEARING LOSS

CHILD

REQUIRED DOCUMENTATION

• Medical certificate issued by an ENT specialist

[under 12]

• Attestation of the need for a hearing aid issued by an audiologist According to hearing aid need in the affected ear • Overall assessment of needs issued by an audiologist

CHILD

• Medical certificate issued by an ENT specialist

[12 to 18]

• Audiogram issued by an ENT specialist or audiologist

PTA of 25 dB across 4 frequencies in the affected ear

• Attestation of the need for a hearing aid issued by an ENT specialist or audiologist • Overall assessment of needs issued by an audiologist

• Medical certificate issued by an ENT specialist

STUDENT [19 and up]

PTA of 25 dB across 4 frequencies in the affected ear

• Audiogram issued by an ENT specialist or audiologist • Attestation of the need for a hearing aid issued by an ENT specialist or audiologist • Proof of school attendance (recognized by the Ministère de l’Éducation, de l’Enseignement supérieur et de la Recherche) • Overall assessment of needs issued by an audiologist for binaural hearing aids

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs.

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HEARING LOSS

REQUIRED DOCUMENTATION

• Medical certificate issued by an ENT specialist • Audiogram issued by an ENT specialist or audiologist • Attestation of the need for a hearing aid issued by an ENT specialist or audiologist

ADULT Worker

[19 and up] PTA of 35 dB across 3 frequencies in both ears

• Attestation of the need for hearing aids and overall assessment of needs issued by an audiologist for binaural hearing aids • Self-employed worker certification–provide the documents asked in one of the two options: – Copy of work contract(s) and bills – Personal provincial notice of assessment

• Salaried employee certification: an official and recent letter with letterhead from the past year from the employer certifying that the person is employed, full-time, part-time or seasonably

ADULT

Non-working

[19 to 64]

• Medical certificate issued by an ENT specialist • Audiogram issued by an ENT specialist or audiologist

PTA of 35 dB across 3 frequencies in both ears

• Attestation of the need for a hearing aid issued by an ENT specialist or audiologist

ADULT

• Medical certificate issued by an ENT specialist

[65 and up]

• Attestation of the need for a hearing aid issued by an audiologist

Non-working

• Audiogram issued by an audiologist

PTA of 35 dB across 3 frequencies in both ears • Overall assessment of needs issued by an audiologist

• Medical certificate issued by an ENT specialist • Audiogram issued by an ENT specialist or audiologist

PERSON WITH DEAF-BLINDNESS

• Attestation of the need for a hearing aid issued by an audiologist

According to hearing aid • Overall assessment of needs issued by an audiologist need in the affected ear

• Attestation of visual impairment issued by a recognized entity (e.g. Centre d’hébergement Louis-Hébert in Quebec City or Institut Nazareth et Louis-Braille in Montreal)

Note: This table is only a summary of RAMQ eligibility criteria, as of April 2018. Additional criteria may apply. For more details, go to ramq.gouv.qc.ca.

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WHO IS ELIGIBLE FOR CNESST COMPENSATION? According to the statistics available, there are 3.1 million workers in Quebec. More than 400,000 of these workers are exposed to potentially harmful noise levels in the workplace (over 75 dBA, which is the equivalent of the noise made by a vacuum cleaner). Prolonged exposure to such sound levels can lead to occupational hearing loss, sometimes with tinnitus. Each year in Quebec, approximately 1,500 new cases of occupational hearing loss are recognized and compensated by the Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST). If a worker is suffering from hearing loss and has a history of exposure to noise in the workplace, he or she may file a claim with the CNESST for compensation. The worker must meet the following conditions: • Have a hearing loss that is consistent, in whole or in part, with occupational hearing loss. • Have worked for many years in noisy environments, mainly in Quebec. • Have contributed to the CNESST plan. Note that retired workers can file a claim with the CNESST to have their hearing loss recognized as work-related, no matter how long ago they retired. The same goes for people who worked for companies no longer in business. It is also possible for workers to file claims with the CNESST even if they did not wear hearing protectors (e.g. earplugs) during their careers.

Once a worker’s hearing loss is recognized as work-related, the CNESST covers the costs for one or two hearing aids every five years, as well as hearing aid cleaners and batteries. Depending on the worker’s needs, the CNESST may also cover the costs for assistive listening devices (ALDs), such as television listening systems and amplified telephones. Furthermore, if a worker’s degree of hearing loss is at least 30 dB HL at 500, 1,000, 2,000 and 4,000 Hz in the affected ear, the CNESST may also award financial compensation. However, even if a worker is not eligible for this compensation, he or she may still be eligible for the hearing aids covered by the CNESST. If you have any questions or want to file a claim with the CNESST, make an appointment with an audiologist practicing in a Lobe clinic, who will guide you.

References - INSTITUT NATIONAL DE SANTÉ PUBLIQUE DU QUÉBEC (2004). Étude exploratoire de la relation entre l’exposition au bruit en milieu de travail, la perte d’audition permanente et la sécurité routière. routière. Online. www.inspq. qc.ca/pdf/publications/341-BruitMilieuTravailSecuriteRoutiere.pdf

- INSTITUT NATIONAL DE SANTÉ PUBLIQUE DU QUÉBEC (2007). Le bruit en milieu de travail : une analyse des coûts pour le régime d’indemnisation. d’indemnisation. Online. www. inspq.qc.ca/pdf/publications/712-BruitMilieuTravail.pdf

- LAROCHE, C., M. VALLET and D. AUBRÉE (2003). Bruit,, in Environnement et santé publique – FondeBruit ments et pratiques, p. 479-497, Edisem / Tec & Doc, Acton Vale / Paris. Online. dsest.umontreal.ca/documents/24Chap18.pdf

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WHY MUST I WEAR TWO HEARING AIDS? People with bilateral hearing loss to whom we recommend wearing two hearing aids frequen tly ask questions: “I know someone who only wears one hearing aid, so why should I wear two? Can I start with one ear and see about the other one later?” There are good reasons why humans are born with two ears. Both are essential for determining where a given sound is coming from and to understand speech, particularly in noisy places.

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SPEECH COMPREHENSION When the brain receives sound through both ears rather than just one, it has a greater selection of acoustic information to process. Decoding words thus becomes easier, particularly in loud settings.

ADVANTAGES OF WEARING TWO HEARING AIDS Wearing only one hearing aid is rarely satisfying, even with top-of-the-line hearing aids. With binaural amplification (wearing two hearing aids), we maintain the natural advantages of binaural hearing. It allows both ears to receive sound at the same time, meaning that you pick up sounds and speech coming from both your left and your right. This leads to more balanced sound quality, which in turn makes it easier to understand speech.

With binaural amplification (wearing two hearing aids), we maintain the natural advantages of binaural hearing. BETTER SOUND QUALITY Having two hearing aids instead of one increases the range of sound perception from 180° to 360°. Sound is richer in tone and feels more natural.

SOUND LOCALIZATION Sound localization refers to the human auditory system’s ability to pinpoint the location or origin of a detected sound through a range of physical cues including interaural time difference or ITD.

SENSORY DEPRIVATION

Sounds reach each ear at slightly different times and amplitudes: tiny differences that tell us whether the sound is coming from the right, left, front or rear. This information is vital in many situations. For example, in traffic, it’s what lets the driver determine which direction the blast of a horn from another vehicle is coming from.

Depriving oneself of hearing has consequences on the entire auditory system, from the ear to the brain, which is called sensory deprivation. In the presence of hearing loss, there’s a decrease in the amount and quality of messages sent to the brain. The risk of Alzheimer’s disease is 2.5 times higher in hearing-impaired people who are not treated.1

BILATERAL HEARING LOSS

Our two ears are precious, let’s be attentive to their needs!

Hearing loss in both ears is said to be bilateral (hearing loss in one ear called unilateral). The most common type is presbycusis (caused by natural aging of the ear), followed by occupational deafness and congenital deafness (from birth).

Reference

1. Study (AcouDem) conducted at the initiative of GRAP (Groupe de recherche Alzheimer Presbyacousie) between August 2004 and February 2007.

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs.

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PRESBYCUSIS: WHY DEPRIVE ONESELF OF THE JOYS OF HEARING? Presbycusis is the leading cause of hearing loss in humans. It is the slow, gradual loss of hearing. Hearing acuity, the capacity to hear sounds at a normal level, decreases in time and years, in different intensities and rhythms depending on people. This decrease of hearing acuity can be explained by degeneration of nerve cells in the inner ear (cochlea) responsible for sound selection. This phenomenon is comparable to vision (presbyopia). If they pay close attention, people realize that it is much more difficult to hear what a woman is saying, while men’s voices are still audible. These difficulties become even more pronounced when there is a great deal of background noise or when several people are talking at once. Similarly, it can become harder and harder to hear the television (lack of sound clarity, even when the volume is turned up).

WHY ARE SOME SOUNDS HARDER TO HEAR THAN OTHERS?

The energy (power) behind speech comes from low frequencies, which people with presbycusis are capable of hearing rather well. The person then continues to understand speech and easily hear when someone talks. However, they will struggle to understand the words themselves, which are produced at higher frequencies (consonants). This is why it can be so difficult to carry on a simple conversation if, say, the refrigerator, whose sound is still audible, is making noise in the background— it’s hearing without understanding.

The person will struggle to understand the words themselves, which are produced at higher frequencies (consonants).

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SENSORY DEPRIVATION It is common for people with hearing loss to underestimate this problem, in light of the embarrassment they may endure as a result of existing prejudices. Hearing-impaired individuals wait an average of seven years before seeking professional help. Not only does that long wait force them to struggle with daily hearing difficulties, but depriving themselves of proper hearing also has repercussions on their entire auditory system, from the ear to the brain. This situation is called sensory deprivation.

Our nervous system, including the brain, has the capacity to adapt and change the way it organizes its functions. This is referred to as brain plasticity. The more information the brain receives from a specific part of the body, the more effectively it processes that information. So if a part of the human body begins sending fewer messages than before, the nervous system’s ability to process that information correctly diminishes. When a person experiences hearing loss, the quantity and quality of the messages sent to the brain is effectively reduced, and in turn, the auditory system’s pathways from ear to brain are used less frequently. Sensory deprivation leads to a decline in the brain’s ability to recognize and understand speech, a problem that can grow worse over time. This condition can affect people of any age, and is found in hearing- impaired individuals who don’t wear hearing aids, as

well as in those with hearing loss in both ears who wear only one hearing aid. In the latter case, sensory deprivation is experienced in the unfitted ear.

SOLUTION If diagnosed and treated in time, comprehension difficulties can be alleviated, which is why it is critical not to wait until hearing problems become unbearable before taking action. To improve speech intelligibility, stimulation of the auditory system must be increased as soon as possible. Hearing aids can reduce the auditory system’s sensory deprivation in two ways. In the short term, they improve speech intelligibility through better audibility, by amplifying words. Then, in the long term, they improve sound representation thanks to perception. Hearing aids continuously solicit auditory system pathways, helping maintain their effectiveness.

When a person experiences hearing loss, the quantity and quality of the messages sent to the brain is reduced.

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19 Remember, your ears work all day long: even when you are asleep, they continue to send messages to your brain. In this fashion, amplification helps recreate the wealth of auditory input we receive every day. Obviously, brain plasticity cannot be regained overnight with auditory stimulation: it’s a gradual process that varies from person to person. Bear in mind that people have an average of seven years of sensory deprivation to make up for, since they wait an average of seven years before seeking professional help.

Hearing aids continuously solicit auditory system pathways, helping maintain their effectiveness.

References - ARLINGER, S. Negative consequences of uncorrected hearing loss – a review, review, International Journal of Audiology (2003); 42(2), 17-20.

- KAPPEL, V. et al. Plasticity of the auditory system: theoretical consideration, consideration, Brazilian Journal of Otorhinolaryngology (2011); 77(5), 670-674.

- CORNA, L. et al. Corrected and uncorrected hearing impairment in older Canadians, Canadians, Gerontology (2009); 55, 468-476.

- PALMER, C. et al. The functionally and physiological plastic adult auditory system, system, Acoustic Society of America (1998); 103(4), 1705-1721.

- FRISINA, R. and J. WALTON. Age-related structural and functional changes in the cochlear nucleus,, Hearing Research (2006); 216-223. nucleus

- PHILIBERT, B. et al. The auditory acclimatization effect in sensorineural hearing-impaired listeners: Evidence for functional plasticity, plasticity, Hearing Research (2005); 131-142.

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TABLE OF TECHNOLOGIES* Here is a table that summarizes the benefits of different technologies.

QUIET

ECONOMY LEVEL

ENTRY LEVEL

MID-LEVEL

ADVANCED LEVEL

PREMIUM LEVEL

ONE-ON-ONE

FAMILY DINNERS

20 SOUND CONDITIONS

PLAYS AND CONCERTS

OUTDOOR ACTIVITIES

MEETINGS

NOISY

RESTAURANTS

PARTIES AND SOCIAL GATHERINGS

COMFORT *These scenarios assume good speech recognition abilities and the use of binaural hearing aids.

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A NEW TECHNOLOGY FEATURING ARTIFICIAL INTELLIGENCE New, versatile hearing aids provide exceptional sound quality while also allowing users to track their physical, mental and cognitive health. This technology stands out from all currently available hearing aids, helping users improve their listening experience while sharing important health information with their audioprosthetist. BODY AND BRAIN MONITORING

These hearing aids are the first in the world to use artificial intelligence to help people of all ages adopt a proactive approach for their overall well-being. 3D motion sensors that detect movement, activity and gestures are integrated in every hearing aid. These sensors provide information on physical and mental health. Users can easily view and manage this information with an app on their smartphone. They can also see the progress of their physical activity, as well as the benefits that wearing hearing aids can have on their mental health.

NATURAL USER INTERFACE WITH TOUCH CONTROL

The user interface can be programmed to start or stop audio streaming from a TV or a remote microphone. You just need to double-tap on a specific area of the hearing aid to use this feature. TRANSLATION

For the first time ever, a hearing aid feature helps users communicate with people who speak another language—27 languages—thanks to a translation tool in the mobile app. FALL DETECTION

These hearing aids are also able to detect falls and send emergency alerts.

CONNECTIVITY Connectivity accessories make it possible to broadcast TV programs and music directly in the hearing aids. Ask your audioprosthetist if these hearing aids suit your needs.

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs. © Lobe Guide 2019

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TYPES OF HEARING AIDS

INVISIBLE-IN-THE-CANAL (IIC)

COMPLETELY-IN-CANAL (CIC)

IN-THE-CANAL (ITC)

Nearly invisible hearing aids are very discreet and lie far in the ear canal. They’re suitable for people with mild to moderate hearing loss. They require good manual dexterity and are not recommended when earwax production is abundant.

Completely-in-canal (CIC) hearing aids lie deep in the ear canal. They’re discreet and suitable for people with mild to moderately severe hearing loss. They require good manual dexterity and are not recommended when earwax production is abundant.

In-the-canal (ITC) hearing aids lie in the ear canal. They’re suitable for people with mild to moderately severe hearing loss.

IN-THE-EAR (ITE)

RECEIVER-IN-THE-EAR (RITE)

BEHIND-THE-EAR (BTE)

In-the-ear (ITE) hearing aids lie in the ear canal. They’re suitable for people with mild to severe hearing loss.

Receiver-in-the-ear (RITE) hearing aids have a discreet case that sits behind the ear pinna and a receiver that goes inside the ear canal with a thin wire. They’re suitable for people with mild to severe hearing loss.

Behind-the-ear (BTE) hearing aids lie behind the ear, as their name suggests. A tube is attached to the earmold in the ear. They’re suitable for all degrees of hearing loss.

RECHARGEABLE HEARING AIDS

Rechargeable hearing aids are gaining popularity. After all, they do have many benefits, such as ease of use for people with visual or motor issues and the environmental benefits of reducing the number of discarded batteries. An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs. The model is chosen according to the degree and configuration of the hearing loss, as well as other criteria such as the condition of the auditory nerve.

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CONNECTIVITY ACCESSORIES THE DIGITAL REVOLUTION IS ALSO FOR HEARING!

Connectivity accessories incorporate technologies that let you receive sound from different sources— televisions, MP3 players, cellphones, conference speakers, and so on—directly in your hearing aids, just as if you were wearing headphones. Some devices are compatible with Apple products, and others with Android products.

Wireless transmitter for television

Mobile app

Remote microphone

Wireless transmitter for television

Remote microphone +

Remote control

Wireless transmitter for television

Transmitter for cellphone

Remote control

EVERY CONNECTIVITY ACCESSORY HAS ITS CHARACTERISTICS. YOUR AUDIOPROSTHETIST CAN HELP YOU CHOOSE THE ONES THAT BEST SUIT YOUR NEEDS.

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TIP Next time you go to the movies, find out if listening systems are available for hearing-impaired people.

ASSISTIVE DEVICES FOR TELEVISION VIEWING 24

TV listening systems are designed to help you enjoy your favourite shows. These systems improve the signal-to-noise ratio by enabling binaural listening (hearing with both ears) and lessening the gap between the speech source and aural perception of the audio signal. Independent volume control lets you set the sound to the level that suits you best, without disturbing others in the room. These systems can also be directly connected to your stereo system or radio.

Receiver Transmitter

SET 860 The Set 860 captures the sound of your TV with an extremely light stethoscope receiver. It comes with standard earmolds and with other conical earmolds designed for narrow ear canals.

TV listening systems are transmission systems with frequency modulation. They transmit audio signals from televisions, computers and other media through a transmitter that amplifies the sound and a receiver that picks up the amplified signal. Users wearing the receiver can move around the house without cutting the sound. The wireless system has a range of 30 metres, and waves can easily go through walls and ceilings. When the battery is fully charged, the device can operate 10 to 12 hours, depending on how it is used.

Receiver Transmitter

FLEX 5000 AND HD 2.10 Some models may be eligible for coverage by agencies like RAMQ, CNESST, Veterans Affairs or private insurers. For more information, consult an audioprosthetist or a specialized educator.

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The Flex 5000 has a receiver with an earphone jack for connecting to other audio accessories (e.g. headphones or earbuds). It is also equipped with a clip to attach to clothing.

ASSISTIVE LISTENING DEVICES Assistive listening devices (ALDs) ease day-to-day living for people with hearing loss. The wide range of ALDs available is designed to address specific needs such as using the telephone, watching television, participating in conferences, and seeing shows. They can be covered by agencies like RAMQ, CNESST, Veterans Affairs, according to eligibility criteria.

AMPLIFIED PHONE

ADAPTED ALARM CLOCK

VISUAL AND TACTILE RECEIVERS

Enables better speech perception by increasing the volume and adjusting bass and high sounds.

Has a vibrating pad that can be placed under a mattress or fitted sheet. When it is time to wake up, the pad vibrates.

The visual receiver flashes when the detector is triggered. There are smoke, doorbell and phone ringtone detectors. An image appears on the receiver indicating which detector is active. The tactile receiver works the same way, but instead of emitting a flashing light, it vibrates when a detector is triggered. For nighttime security, a vibrating pad connected to the receiver can be placed under the mattress to wake the person up.

SMOKE DETECTOR

Sends a signal to the visual or tactile receiver to indicate there is smoke in the room.

PHONE RINGTONE DETECTOR

Sends a signal to the visual or tactile receiver to indicate the phone is ringing.

DOORBELL DETECTOR

Sends a signal to the visual or tactile receiver to indicate there is someone at the door.

PERSONAL AMPLIFIER

Picks up a conversation partner’s speech when a person is not wearing hearing aids. It is simply a microphone connected to earphones. The volume can be adjusted to a comfortable level.

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LISTENING AND COMMUNICATION STRATEGIES Hearing-impaired people and their friends and family frequently face communication problems. Listening and communication strategies can help improve comprehension. Hearing-impaired people and their conversation partners share the responsibility for using these strategies. 26 ADVICE FOR FRIENDS AND FAMILY

Make sure you’re in the same room as the hearing-impaired person when speaking.

Get the person’s attention before speaking (e.g. by calling their name, tapping their shoulder, etc.).

Stand near the person and face them to make lip-reading easier.

4 5

Speak slowly and clearly, but don’t overdo it. Do not shout.

If certain words are misunderstood, repeat using different words.

Turn off any background noise sources (TV, radio, dishwasher, music, etc.).

Make natural gestures and avoid covering your lips.

Indicate the topic of conversation and clearly signal a change in topic.

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ADVICE FOR HEARING-IMPAIRED PEOPLE

1 2

Wear your hearing aids. Let it be known that you have difficulty understanding.

Look at the person you are speaking to and watch their lips. Observe them as they speak.

Turn off any background noise sources (TV, radio, dishwasher, music, etc.).

5 6

Ensure that the face of the person you’re speaking to is well lit.

In a meeting, ask people to speak one at a time.

8 9

Ask about the topic of conversation.

Ask people to speak slowly. Ask questions.

Ask questions.

Other strategies might be helpful: • It’s important to tell your discussion partners about your hearing loss. They will then make sure you understand well. • Moving closer (one or two meters from discussion partner) reduces communication problems. Indeed, sound loses intensity when crossing obstacles in its path. • Talking face to face facilitates lip-reading and helps understanding emotions through facial expressions. • Your conversation partners should never speak with a hand in front of their face.

• Choosing the place where you sit may also facilitate communication. At the restaurant, ask to sit at a table close to a wall. Upholstered benches also absorb noise. If you are one-on-one, face each other. If you are with a group, make sure to see as many faces as possible, or sit near the people most likely to talk to you. • Prioritize private rooms in restaurants. • To improve your understanding or reduce your discussion partners’ impatience, avoid words like What? or Sorry? Instead, mention the part that you understood or ask to repeat using other words. You can ask for a sticker of the International Symbol for Deafness in a Lobe clinic.

• It’s important to pronounce well, without exaggerating, which may alter lip movement. • Yelling is not recommended since it alters pronunciation. The auditory system may also distort words, due to hyperacusis. Just raise your voice slightly.

• You can inform your municipality of your hearing loss, in order to facilitate communication, especially in case of an emergency.

• Speaking slowly makes it easier to follow lip movement and to understand speech. • Well-lit places help to see the face better. • The person talking to a hearing-impaired person should never stand against the light, back to a window for example, because it creates a shadow on the face. • Ambient noise is the enemy of communication, so it is essential to reduce it. For example, background music at a dinner party may affect the understanding of a hearing-impaired person. Turning the dishwasher or range hood off is another way to facilitate communication.

Read the guide Communication Strategies for Hearing-Impaired People, which is available in all Lobe clinics.

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HEARING PROTECTION Our ears are precious! Let’s protect them from loud sounds with custom earmolds or earmuffs. Here are the different types of earmolds to meet all needs.

ADAPTORS FOR EARBUD HEADPHONES OR CUSTOM-FIT AUDIO MONITORS

A good solution if your earbud headphones are causing your ear canal discomfort or if your ears are simply too small for these types of devices.

28 SWIM EARMOLDS (post-myringotomy earmolds)

Silicone earmolds that prevent water from getting into the ear canals when swimming, showering or bathing. Recommended following the insertion of CIC tubes or for those prone to ear infections. Earmolds are available in a range of colours, based on type. * Combination of two colours

EARMOLDS FOR WORKERS IN NOISY ENVIRONMENTS

Silicone earmolds that greatly reduce all types of ambient noise. Recommended for loud workplaces or high-decibel recreational activities.

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MUSICIANS’ EARMOLDS

Earmolds with a special filter (9, 15 or 25 dB attenuation) that reproduce the ear’s natural amplification. The sound quality is similar to what you hear without them, but much softer. Perfect for musicians and concertgoers!

SLEEP EARMOLDS

Earmolds that reduce ambient noise when sleeping. A good solution for light sleepers!

CHILDREN EARMUFFS

Earmuffs that protect children’s hearing in noisy environments such as concerts or festivals.

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HEARING HEALTH AND COMMUNICATION PROFESSIONALS The mission of the professionals practicing in the Lobe clinics is to make a difference in people’s lives. They do so through a multidisciplinary, patient-centred approach and by providing people with hearing, language and speech disorders with the necessary resources to improve their quality of life. 30 ENT (ear-nose-throat) specialist

Specialized educator

Treats illnesses of the head and neck (ears, nose and throat). The services of ENT specialists are reimbursed by RAMQ.

Working with an audioprosthetist, educates hearing-impaired patients on their hearing aids and offers hearing re-education. The services of specialized educators are free of charge.

Audiologist Fully evaluates hearing (hearing test) and central auditory processing disorder (CAPD). The services of audiologists are reimbursed in part by CNESST (with medical prescription), Veterans Affairs Canada, and most private insurance plans. All recommendations from health professionals are accepted.

Audioprosthetist Helps hearing-impaired patients select hearing aids and assistive listening devices, and makes required adjustments during fitting. The services of audioprosthetists can be reimbursed by RAMQ, CNESST, Veterans Affairs Canada, and most private insurance plans.

Hearing health nurse Participates in awareness activities, runs auditory screening tests, and gives presentations on hearing to workers and the general public. Handles all aspects of tailored hearing protection devices. The services of hearing health nurses are available for a fee.

Speech-language pathologist Assesses and treats disorders related to speech, spoken and written language, and swallowing. The services of speechlanguage pathologists are reimbursed by most private insurance plans.

Just one call. We listen. We care.TM

An assessment by an audioprosthetist is required to determine which hearing aid suits the patient’s needs. lobe.ca

80% OF PEOPLE WITH HEARING LOSS AREN’T DIAGNOSED OR TREATED* *Ordre des audioprothésistes du Québec

This statistic clearly shows the need to make people aware of the importance of maintaining good hearing health and point them toward a hearing health professional when they have questions about their hearing. These objectives gave rise to Lobe Magazine, a free informational publication that is distributed across Quebec, in English and in French.

is meant to inform people of the various issues tied to hearing, language and communication. Our ambassador, Marie-Josée Taillefer, also writes a column in each issue of the magazine. Lobe Magazine offers readers accurate, relevant information that will help them improve their lives and break the isolation caused by hearing loss.

Lobe Magazine features articles by hearing health and communication professionals. Each article

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Email us at courrier@lobe.ca

SUBSCRIBE TO THE LOBE MAGAZINE

£ Mr. £ Ms.

Fill out and cut the form and send it to the address below, with your payment if applicable. The cheque must be made to the order of “Publications Lobe”.

Lobe Magazine, Complexe Vision, 725, boulevard Lebourgneuf, suite 303 Québec (Québec) G2J 0C4

Name:

£ French version

£ English version

Subscription for general public £ One year (4 magazines): $10,00*

Organization / Association:

Address: Postal Code:

£ Two years (8 magazines): $20,00*

City:

* To cover mailing costs

Province :

£ Free of charge subscription for

associations, schools, organizations, health professionals, etc.

Phone #: Number of copies:

Email address:

lobe.ca

TRUST US WITH YOUR LOVED ONES If you have a loved one with hearing loss, invite them to make an appointment for free hearing screening* in a Lobe clinic.

* Permanent offer.

Hearing health and communication clinics To find the nearest clinic: lobe.ca411-LOBE 1 866 (5623) | lobe.ca lobe.ca

ENT SPECIALISTS

HEARING HEALTH NURSES

AUDIOLOGISTS

SPECIALIZED EDUCATORS

AUDIOPROSTHETISTS

SPEECH-LANGUAGE PATHOLOGISTS