Interview with Dr. Adam Enock

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If you find yourself saying “What did you say?”, turning up your DVD player, or thinking

that everybody mumbles more than you’re used to, you may be among the many people

in the United States who are experiencing some kind of “trouble” with their hearing,

with a large share of these being over the age of 65 (when an estimated one in three

people suffer from hearing impairment). While the extent of hearing impairment in any

community is hard to measure, with much of it unreported, experts agree that figures

worldwide are on the rise. A relative newcomer to Lakewood’s large and diverse team of

health professionals is Dr. Nosson Enock, a local audiologist, who gladly agreed to take

us inside his office on East County Line Road to tell us about hearing impairment and

its treatment.

 

Firstly, for those of us who aren’t that clear about what an audiologist does, can you

give us a brief outline of your work?

 

Audiology, literally means the ‘study of hearing’. Audiologists deal with every aspect

of ‘hearing’ (which includes balance) and can work in varied fields, such as in hospitals,

schools, private practice, as well as in certain occupational settings where noise level

may be a threat to hearing; I work in the U.S. Navy twice a week. Employing numerous

testing devices, we determine whether a person’s hearing is within the normal range,

and, if not, what portions of hearing are affected and to what degree. If an audiologist

finds that hearing loss is present, he recommends patients to the options that will

benefit him.

 

Can you tell us why you chose to go into this field, and what training you required.

 

My mother is a practicing audiologist in Pittsburgh, so I was familiar with the profession

from my youth. While learning in B.M.G., I became aware that there was a shortage

of frum audiologists in the area, and no frum audiologist who treated adults and

subsequently decided to pursue audiology as a career. An audiologist requires a

bachelor’s degree, followed by 4 years of postgraduate study, which I completed at

Montclair State University, receiving a Doctor of Science and Communications (Sc

D) degree. After graduation, I worked in several prestigious hospitals, namely Robert

Woods Johnson in New Brunswick, The Brooklyn Hospital Center, the VA Hospital in

Brick, and the Bacharach Rehabilitation Institute in Pomona, as well as in a private

practice in New Jersey. As a licensed hearing aid dispenser, I also sold hearing aids in

Lakewood as a convenience to the community. At the request of many local doctors, I

opened my own private practice in Lakewood last year. Until then, many people were

going to Philadelphia and New York for evaluations and for hearing aids, a trip of more

than an hour that certainly put pressure on parents of hearing impaired children whose

hearing aids needed adjustment or repair. Now they can see to all their needs only a

few minutes from home.

 

Your patients vary from pediatric to geriatric. How do parents know that if their young

child has a problem hearing, and what can be done about it?

 

There are two primary categories of hearing loss in children, congenital, that are present

at birth, and those acquired after birth.

Most states have mandatory hearing screenings for newborns, so the majority of babies

are screened before leaving the hospital. If an infant doesn’t do well on these tests, he’s

referred to an audiologist for further testing.

Children should have their hearing tested before they start school or any time there is a

concern about their child’s hearing. Many parents tend to ignore the pre-school testing

if the child seems to be doing well, not realizing that hearing tests take no more than

45 minutes, are non-invasive and are covered by most insurances. As a result a child

can have a mild hearing impairment in one or both ears for quite a while before anyone

notices it. Bear in mind that in these circumstances the child himself probably won’t

realize what ‘normal’ hearing he’s lacking.

Although this interview is not an adequate forum to discuss the multitude of reasons that

cause hearing loss, either in children or in adults, parents should be aware that many

hearing problems in children only become apparent as the child matures. Until the child

is able to verbalize that he’s finding it hard to hear his Rebbi or his friends, the parents

have to be the ones to spot a hearing problem. Signs of hearing loss in babies include

not being startled at loud noises; not turning to the source of the sound from birth to 3

or 4 months of age; not saying single words such as “dada” and “mama” by one year

of age; not responding to his name if he doesn’t see you; and appearing not to hear

certain sounds.

Signs in children include delayed or unclear speech; not following directions (which may

be mistakenly interpreted as lack of attention, but could be the result of hearing loss);

often saying “huh?” or switching on the volume high when listening to music.

It is obviously harder to detect hearing loss in a child who is otherwise developmentally

delayed.

Although these signs don’t necessarily prove that a child is hearing impaired, immediate

attention should be given to any indication of hearing loss.

 

Why is it important to seek prompt professional help if a problem is suspected,

especially if, as you say, the child is otherwise doing well?

 

For a child, hearing and speech are essential tools for learning, playing and developing

social skills. If hearing loss is severe it affects speech development absolutely. A

baby who begins to babble at about 6 months and does not hear the sound of his own

babbling will normally stop babbling and end up not talking. Interestingly, if -as would be

rare today- he receives no treatment until the age of 12, he will never be able to acquire

the ability to speak.

In cases where hearing loss is evident, but less severe, the child will miss a lot of the

speech and language around him if the loss is undetected or untreated, especially if

severe hearing loss occurs at birth or before speech and language are acquired. A likely

result of this will be emotional difficulties and low self esteem, and learning and social/

behavioral issues in school.

Permanent hearing loss, in varying degrees, affects two in every 100 children, wit

many more enduring temporary loss due to fluid in the ear. The most effective treatment

for all forms of hearing loss is achieved through early intervention. The longer the delay,

the harder it will be for the child to make up for lost time.

 

What type of treatment is available for children with hearing loss?

 

When hearing loss is identified, a thorough search for its cause must be undertaken.

If the hearing loss is attributed to infection or to fluid trapped in the middle-ear, the

pediatrician will prescribe antibiotics to treat the infection. If the infection persists, or

the hearing loss remains after treatment, the child is referred to a medical doctor who

specializes in diseases of the ear and auditory system (an otolaryngologist or ENT). The

otolaryngologist administers further testing, and may subsequently recommend surgery

(ear tubes) where an excess of fluid occurs. (However, many doctors are of the opinion

if no infection exists, it is advisable to see if the problem will clear as the child matures).

If the hearing loss is related to a nerve or inner-ear problem, the otolaryngologist will

often refer the patient back to the audiologist who will evaluate his suitability for hearing

aids and rehabilitative (social and language) therapy. In some cases the ENT, together

with the audiologist deems that it is preferable to insert cochlear implants through a low-

risk surgical procedure

 

Can you explain for readers like myself what cochlear implants are?

 

Cochlear implants are electronic devices that transform speech and other sounds into

electrical impulses that stimulate auditory nerve terminals in the inner ear (or cochlea).

Cochlear implants do not restore normal hearing, but they simulate the recognition

of sound and thereby improve communication for children with severe to profound

sensorineural hearing loss in both ears who get little or no benefit from hearing aids.The

younger deaf and hearing-impaired children are when a cochlear implant awakens their

hearing, the better they will do.

Parents of children with cochlear implants report that their child can function socially

and academically on the level of their peers. Incidentally, they are often distinguished by

their heightened sensitivity and understanding of the problems and issues of others!

 

We’ve been looking until now at pediatric audiology. At the other end of the scale, why

do many people suffer from some degree of hearing loss as they age?

 

Hearing loss is actually part of the aging process and can begin when a person is as

young as forty. Apart from the affect of age, it can be caused by several other factors,

including genetics, illness, ototoxic (ear damaging) drugs, tumors, head injury and

exposure to loud noise. Impairment can range from mild to complete deafness.

Many people experiencing hearing loss are loathe to visit an audiologist because they

want to feel that they’re ‘still young’! They anyway don’t like the idea of wearing a

hearing-aid ( commonly dubbed as a ‘beige banana’;), or feel that depending on hearing

aids will ultimately worsen their condition. Studies have shown that the opposite is true!

Even if there is a small possibility of hearing loss, it is worthwhile to have a ‘baseline

hearing test’ to determine if a problem exists; this allows a person to gauge the extent of

hearing deterioration that may occur later. When hearing becomes difficult, people often

find themselves cut-off from the flow of life and become depressed, and this can have a

harmful effect on their health. If a person is rehabilitating after an illness, it’s important

to check his hearing and supply hearing aids if required; social interaction is known to

promote recovery.

It’s far easier to begin wearing a hearing aid before serious impairment occurs as it

can then be difficult for a person to adjust to its ‘sound’. Ironically, a person who has

impaired hearing is more irritated by noise.

(It should be noted that in cases of sudden hearing loss a person of any age should

seek treatment without delay; the condition may be due to a virus that can cause

permanent damage if left untreated).

 

Are hearing-aids still beige bananas?

 

Not at all! There have been remarkable advances in hearing-aids. Today they are small

and hardly noticeable; there is also an invisible hearing aid worn inside the ear that only

has to be removed every four months.

 

Finally, a hot topic for everyone. You mention loud noise as a cause of hearing loss in

older adults. Many people aren’t altogether happy with the blasting music that we hear

at chasunas and are afraid it will affect their hearing. Can noise be harmful for younger

people also?

 

Numerous studies have shown that loud and prolonged noise can endanger hearing

by damaging the hair cells in the inner ear. As a general rule, noise is dangerous if you

have to shout over background noise to be heard, if the noise is painful to your ears, if

the noise makes your ears ring, or if you have decreased or ‘muffled‘ hearing for several

hours after exposure. One or more of these factors apply to our chasunas.

Harmful noises can come from many everyday sources such as lawnmowers, leaf

blowers and shop tools; those working in some industrial environments or living near

airports have it worse (although there are rules to regulate this somewhat). People who

listen to loud music for several hours a day are also at risk.

While we live in an ‘age of noise’, much of it beyond our control, in this case at least we

can protect ourselves by turning down the volume. Chasunas are another story. I would

recommend wearing ear plugs and not getting too close to the electronic speakers. I

recently heard that in some places in Eretz Yisroel a person with a sound level meter

is appointed to enforce that the music isn’t too loud. If the band doesn’t listen, the baal

simcha pays less! Perhaps, for the sake of our hearing, this takona could be adopted

here.

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Contact

Ocean County Audiology Center
921 E County Line Rd
Lakewood, NJ 08701
Tel: (732) 987 6590
Email: ocacdr@gmail.com

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