Dear all,

Happy New Year to you!

Here at HAFM HQ we’ve been busy reflecting on our conference, looking at some initial findings from the online survey, and drafting various documents, including a revision of our patient leaflet, and drafts of a practitioner leaflet, glossary of terms and stakeholder report.

Conference materials

All of the abstracts, many of the powerpoint slides and some of the videos from the conference can now be downloaded on our conference webpage. This includes the concert by the FORTE Ensemble.

We are interested to hear your reflections on the conference four months on, so if you have two minutes, please answer three short questions here.

Extension until August 2018

Numerous NHS Trusts across the country have expressed a desire to be involved in the HAFM research, and so we have secured an extension to the project (until the end of August) to be able to do this. We have just started working with 20 Trusts, including  Aintree, Airedale, Birmingham, Durham and Darlington, Harrogate, Kingston, Manchester, Sheffield, South Tees, Southend, Sunderland, Tameside and Glossop, and Western Sussex to name a few! We are adding further sites this week. This is very exciting for us because it ensures that we can survey hearing aid users from all over the UK.

Working with the first N=1,000

We are currently analysing the first 1,000 responses to the online survey, and results summaries will be available in due course. Thanks to all who have taken the time to participate in this survey – your time is greatly appreciated.

If you know others who would be willing to complete the survey, do send on the link: http://tinyurl.com/musicandhearingaidssurvey

Your thoughts!

If you have any other reflections, or you would like to write a blogpost for our website, please do get in touch with us on musicandhearingaids@leeds.ac.uk

Best wishes from

Alinka, Harriet and Amy

University of Leeds, 23.01.18

In this blog post, Professor Pete Thomas describes how he and his wife use accessories alongside their hearing aids to help them enjoy playing in a brass band.

Despite being branded as tone deaf in schooldays, and suffering from moderate hearing loss too, seven years ago I started to play trombone. Now, aged 69, I play in a brass band. My wife, Carol, a lifelong musician who plays euphonium is afflicted with a severe hearing loss as well, a long term condition combined with severe tinnitus.

Playing music in a brass band presents a range of challenges for hearing aid users. Some opt in despair to abandon aids and make do with whatever residual hearing they have, or else to give up playing altogether. Sound levels may exceed 105dBA, although this can depend on seating position within the band, and most hearing aids do not work well in these conditions.

Players should be able to clearly hear neighbouring players, so as to be able to play in time and in tune with one another. They also need to hear other sections of the band to effect the overall tuning and timing of the music. As a trombone player, I need to be able to hear euphonium and baritone horns immediately in front, to perceive the higher pitched sounds of the cornets from the far side of the band, to be aware of the horns, all whilst not forgetting the basses (tubas) which are hard to ignore. And in rehearsal, it is important of course to hear the instructions from the conductor!

For me, playing without hearing aids is not a realistic option. With my high frequency loss, I am barely aware of the cornet sounds and much of the articulation is lost. The resultant dead and rather woolly musical environment, with no perception of commands from the conductor would preclude participation.

My aids were initially prescribed following diagnosis/treatment for benign positional vertigo; as a result the world became a more interesting place where many of the sounds diminished over the years were reinforced. Percussive sounds and cornet sounds became so much clearer and more vibrant.

However, with those first digital aids there was a major drawback. When the cornets played certain higher notes, this tended to excite feedback cancellation in the aids and it seemed as though some of the feature recognition aspects of those aids distorted the balance of the sound. Exploring this, I found that even on what was supposed to be the music setting, if I sat at home listening to my wife playing the piano, the ticking clock which is normally barely perceptible, would become a loud clacking, clearly audible above the piano. The squealing with the cornets was clearly a problem, especially as when it occurred it would take some considerable time for the aids to settle back to normal operation. I found the condition could be repeated in a quiet environment with a tone generator – a tone of approximately 2KHz from a loudspeaker would trigger it. I discussed the problem with audiologists who attempted changes of settings, changed ear moulds and generally puzzled over the problem, before concluding I was seeking the impossible.

Fortunately I encountered a more determined audiologist who appreciated the objective feedback and wanted to be of help. She prescribed some alternative aids for evaluation and following some adjustments they have proved remarkably effective. Initially, things were very confusing, as each aid made my custom-made trombone sound rather different and unpleasant to my ears. Fortunately, this was a transient situation as my brain adapted to the different hearing aids and within a few days I could switch between aids without any unpleasant perception of the sound. The new aids, whilst providing the necessary high frequency compensation, appeared less intrusive, such that apart from the useful improvement in music and comprehension of speech, I could be unaware of using them. Most importantly they were far less susceptible to excitement from those higher pitched cornet sounds!

Initially the aids were sometimes apparently overloaded by the mellow tones of the euphonium, but presumably due to the adaptive capabilities of the aids, even this problem rapidly diminished. The aids are not perfect and I will sometimes query as to whether the conductor wants to play from rehearsal mark ‘M’ or ‘N’, and it can be frustrating to miss out on the punch line of jokes from around the band. This leads on to the consideration of Carol’s more challenging problems of playing the euphonium.

Carol has played church pipe organ and piano since childhood, but during the last three or four years she has succumbed to pressure to join the band, playing a euphonium. The expectation was that this would be easy for someone of her musical experience, but with brass band pitch being transposed from concert pitch such that notes written as C sound as B-flat, there were additional challenges for her hearing. The single line of euphonium music might have paled into insignificance compared to the complexities of the Bach and Buxtehude, with pedals and multiple manuals to cope with; however in the brass band there is someone else (the conductor) setting the tempo and all those other players to fit in with.

Carol uses two Phonak Nathos SP aids with features such as the frequency translation of higher pitched sounds, enabling her to comprehend some of those missing high frequency sounds. Early experience with these aids suggested that she had trouble precisely pitching and playing in tune and this was particularly evident if playing in a small ensemble. Fortunately, the enabling of a music program, disabling some features of the aids, made a dramatic difference and in the small ensemble she was able to play far more reliably in tune. However, in band a major problem unfolded whereby when playing her euphonium, especially when accompanied by a neighbouring euphonium, she could hear virtually nothing of the rest of the band. This problem intrigued me and I set about trying to find why the euphonium was so troublesome!

All brass instruments have characteristic spectral properties, whereby the fundamental of a note with a particular set of overtones gives the instrument its sound. The different instruments differ in size (from the tiny soprano cornet to the large B-flat tuba) and in construction with the size and degree of taper in the bore. The trombone is a parallel bore instrument, and this reflects in the sound which is rich in overtones – the FFT analysis here shows peaks extending to the 15th or even 20th harmonic of the note being played. Curiously, the trombone can seemingly be very light on the fundamental of the note being played. In contrast, the euphonium with its taper bore is very strong in the fundamental, with the overtones rapidly dying away. The similarly pitched baritone horn with a less tapered bore has a spectrum more like that of the trombone.

It is therefore no surprise when my wife encountered the problem with the euphonium and the musical director of the band suggested trying the baritone horn for a while, that Carol found this a great benefit. This enabled her to play in the band and still hear much of the music from other sections of the band. However it did not help with hearing direction from the conductor.

We therefore looked into the potential use of a microphone and loop system. Whilst this could have worked within the band room, it was clearly not a practical solution for performance venues. It was around this time we discovered the Phonak Roger pen system. Initial enquiries with a supplier were far from optimistic of its utility, but discussion with CamTAD suggested it might be worth further exploration. With a musical director keen to cooperate, a microphone and receivers were sourced. With Carol’s severe high frequency hearing loss, the bandwidth limitations of the telecoil loop interface was not seen to be a problem compared to the convenience of implementation without assistance from the NHS audiologist. However with my helpful NHS audiologist happy to enable such things we got some Roger receivers for my aids in the hope they might be a benefit.

The Roger pen proved to be a major benefit for Carol. She was able to clearly hear instruction from the musical director (wearing the microphone) and as a bonus could hear more of the cornet section music, which often provided the lead in the music. Somewhat disappointingly, we found that although I could hear the conductor more clearly with the microphone, due to the bandwidth limitations of the Roger pen and my open ear moulds, I perceived the rather tinny overlay of music rather unhelpful even with the wireless receivers giving direct audio to my aids. However I have at times found the mixed mode of normal aids and the Roger input useful. The wider benefits of the Roger pen are obvious.

Recently with more experience, Carol has been returned to playing euphonium. We have to conclude that from our experience, hearing aids and appropriate accessories can be a real benefit and enable hearing impaired users to successfully participate within a brass band. The recent HAFM conference at Leeds inspires us for further work.

In this blog post, Brian Henderson describes the trajectory of his hearing loss and how this has affected his experiences of playing the organ over time.

“I am a 70 year old church organist, now with moderate hearing loss in both ears.  I have played the organ from the age of 18.  Other relevant personal information includes a career of Physics teaching up to A level and a 10-year spell of helping a local organ builder after retiring from full time teaching.

“My first experience of hearing loss was sudden and traumatic.  I was making a mobile phone call in 2011 in a busy shopping street and put the phone firmly to my ear to hear it answered.  At that exact instant someone called me and the phone rang while against my ear.  My head seemed to explode.  Luckily I was with family members who helped me to a seat and half an hour later I felt able to move on, but with the realisation that hearing in my left ear was damaged.  A visit to my GP the next day brought the news that my hearing might or might not recover.  It didn’t.  Hospital ENT consultation and an MRI scan followed but produced no answers, and an NHS hearing aid was soon supplied.  The loss was worst from 1kHz upwards, so consonants were missing from speech and the organ upperwork (the higher pitched stops) lost from my left ear.  But I still had a good right ear and I thought life was still mostly fine in spite of the chance in a million that had deafened me.

“I used the aid for conversation, but I took it out for playing as it distorted the organ sounds badly.  I read that one of the consequences of sudden hearing loss could be hyperacusis, increased sensitivity to some sounds.  This explained why organ notes in the tenor octave were now sounding thick and unpleasant, with tenor A and B booming out from what had been a well-regulated quiet flute stop.  After a year or so I realised I was not hearing this.  This was my first taste of the ability of the brain to gradually improve an initially troubling situation but little did I know that I would come to rely on this property of the brain to help me a few years on down the line.

“In mid 2015 I became aware that my right ear was not hearing as well as before.  It showed up most on the organ where I could no longer hear the highest notes of a 2 foot stop (a stop which plays 2 octaves above piano pitch) and I realised that sounds around 6 kHz and above were gone.  There was also a strange blocked feeling in my right ear, with intermittent popping, and I was aware that this right deafness did not feel the same as the left deafness.  A GP investigation started, I tried a nasal spray and inhalation.  I used olive oil and later sodium bicarbonate solution but the blocked feeling persisted even though the ear drum was visible.  I had an audiogram and a right aid was supplied for what was then described as slight deafness.

“The GP investigation into the blocked feeling continued (now 6 months after it started) and in February 2016 microsuction was performed to remove the small amount of wax that was visible.  Initially all seemed well, but 3 hours later I realised my right hearing had gone the same way as my left.  Organ experimentation showed a fall off at 2KHz, not quite as bad as the left but bad enough to make the organ sound dreadful.  The hearing loss was described now as moderate in both ears and I found conversation difficult and TV listening often unintelligible.  My life seemed to collapse around me.  To lose the left hearing had been an accident, but the right deafness seemed the direct result of a GP procedure.  I felt bitter and defeated.  And my greatest relaxation and my defining role – as church organist – was lost.

“There were two separate but overlapping strands to my life with hearing loss.  One was searching for advice about hearing loss and music.  The other was an NHS investigation into my sudden right hearing loss.  This investigation took the form of two hospital ENT consultations, several audiograms and an MRI scan.  The noisy MRI machine accentuated the hyperacusis now present in the right ear but revealed no reasons for my problems.  The three audiograms were wildly inconsistent, one even showing normal hearing in the right ear, possibly because my tinnitus and hyperacusis were masking the true situation.  This was a time of fear and frustration until in May I was finally passed on to a wonderful senior audiologist who listened intently to my descriptions.  I could tell from the way she conducted my hearing test  (with quick repetitions and surprising frequency jumps) that she was using her considerable experience to “catch me out”.  I was delighted that she produced an audiogram that matched the view I had gleaned from listening note by note on the organ.  The aids were reprogrammed and at least speech in a quiet space became easily intelligible.  Furthermore the senior audiologist understood the importance of music in my life and ordered for me a pair of Phonak Nathos S+ MW aids which she said had better musical capabilities than the standard NHS aids.

“I felt I was making real progress now with audiology, but frustration soon set in with delay in the delivery of the aids, the substitution by management of a locum at one appointment resulting in a mis-setting of the aids, and repeated difficulties in ensuring that future appointments were made with the senior audiologist who had rescued me (and actually asked that all appointments be made with her).  There is a real personal difficulty here – does one complain and risk alienating the organisation that is trying to help?  In the end I have been quietly persistent and have eventually seen the person I need, but the missed opportunities and time lost have led to a roller coaster of hopes and disappointments lasting over 6 months.

“On the musical side things have at least been more under my control.  When the right hearing loss occurred the unpleasant sound of the organ made it impossible to continue playing for services.  With hearing aids (even the later Phonak pair described above) the distortion was more than I could bear, and I tried playing with no aids.  Quiet music on 8’ flutes¹  was similar to what I remembered.  Louder music on 8’ and 4’ diapasons²  sounded thick and muddy, and adding further upperwork (2’stops and mixtures) was simply frustrating because there was no change.  All the majesty of the brighter sounds was lost, but I persisted in playing to myself frequently and for short times using only the quiet foundation stops.  Over a period of time my musical memory and the adaptability of the brain enabled me to hear (or imagine) brighter sounds as the higher pitched stops were added.  Separately these stops were almost inaudible, and different notes had no discernible pitch difference.  But in the chorus there was an unmistakable element of brightness that enabled me to get some enjoyment from my playing and even contemplate returning to service playing a month or so after the sudden loss.  At this time I was still taking my aids out as I approached the organ, so my initial service playing showed up the inevitable problem – I did not know what was going on in the service.  I sometimes only knew when to play a hymn after a gesture from my wife in the front row of the congregation!

“This situation could not continue.  I persisted without aids but with the help of a small loudspeaker placed as close to my ear as possible.  It was driven from the church microphone system using its own amplifier with bass turned down and treble up to max.  In this way I played for some services although most were covered by pianists in the church doing a good job on the organ in spite of their initial fears.

“As time went on I got more used to the various programmes in the aids, and began to play to myself with aids in, music programme selected, volume set almost to lowest.  The distortions were many and varied.  All sounds above 500 Hz had a strange edge to them.  Soft flutes (with an almost pure sine waveform) had a curious repetitive hiccup caused I believe by the digital signal processing.  Rapid passages of music did not sound too bad, as individual notes did not last long enough for the distortion to offend, but slow sustained notes were horrid.  It was almost impossible to balance a solo stop with a suitable accompaniment on a different manual.  For instance an oboe stop did not sound as it used to because so much of its energy is in the upper harmonics.  The accompanying flute stop will have much of its energy within the fundamental, and the differing amplification of high and low frequencies, intended to correct my hearing, is not done precisely enough to judge the balance between a distorted oboe and a distorted flute.  Much of my playing is done by remembering combinations that used to work, but when I try a new piece (or harder still a different organ) it is almost impossible to judge whether I am producing reasonable sounds.

“There are some other aspects that make practising harder work than before.  Hyperacusis presents itself in odd and initially unsettling ways.  Treble F on a stopped flute is hugely louder than its neighbouring notes.  It actually shouts out and unbalances any chord containing it.  The same note played on a stop with a differing harmonic make up, such as a diapason rank, or an open flute, fits perfectly with its neighbouring notes.  Pitch discrimination has suffered.  Any given note sounds slightly sharper in one ear than in the other!  Chords which contain close harmonies can now set up a beating effect, presumably because of this discrepancy.  So all practice is now punctuated by repeated checks of strange out of tune sounds.  They are often caused by wrong notes, but they are equally often caused by my wrong ears.  In some cases repeated playing of a nasty sounding chord has taught my brain to accept it, and I can even return to a piece several weeks later and find that the chord I battled with and beat into submission has stayed reasonable.

“I do not expect the lost hearing to magically return, but I do hope that somehow in the future I will find better settings for the existing aids, or perhaps better aids, that might help me hear more of the organ as it really sounds.  The present problems are still considerable.  So should I have given in and stopped playing?  My answer is an emphatic no.  I am back to playing for about 3 services a month. I have dispensed with my local treble enhanced loudspeaker.  I use my aids on the music setting and have found a volume setting which is reasonably appropriate for organ sounds and much of the spoken word, and clergy have helped by giving clear announcement of hymns.  I do get satisfaction from playing the right notes in the right order, even if the practice has taken longer and even though the sound of the instrument has lost a lot of beauty and majesty.  I can still get my excitement from a loud conclusion with several ranks of mixture and pedal reeds.  And above all I once again get a buzz from leading a congregation which sings with enthusiasm and sensitivity as I play.

“And of course there is more to musical life than playing the organ.  I enjoy singing (although sometimes with difficulty) in a community choir.  Pitching notes is far more uncertain than it used to be, and the trick of checking by putting a finger in an ear is not possible with a hearing aid in the way!   I nearly stopped attending concerts in Birmingham Symphony Hall after a couple of disappointments, but then experimented with different seating positions.  Concerts have once more become enjoyable provided I pay for the best seats in the house.  Now that I can see the full orchestra clearly I find that I can hear and recognise individual instruments much better; another example of the brain’s remarkable ability to adapt and improve distressing situations.”

1. the organist’s term 8’ means organ pipes at piano pitch (ie middle C key plays a middle C sound)
2. 4’ refers to pipes sounding one octave above piano pitch. Diapasons are the family of open metal pipes which give the basic organ tone, and they have more harmonic development than organ flutes.

Brian Henderson

Bromsgrove

March 2017