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.
