November 14, 2013 | Bloomberg News
By Lydia Denworth
The toll from a decade of war in Iraq and Afghanistan is high. Almost 7,000 U.S. service members have lost their lives, with more than 50,000 listed as wounded in action.
Thanks to extensive wounded-warrior efforts, the nation is more aware of the dangers of traumatic brain injury and post-traumatic stress disorder, and of the challenges and possibilities for amputees using prosthetic devices. But military men and women, in far greater numbers than the Pentagon numbers reflect, have sacrificed something else that is too seldom acknowledged: their hearing.
As of last year, 414,000 veterans of Iraq and Afghanistan had experienced service-related hearing loss, tinnitus (ringing in the ears) or both. According to the Centers for Disease Control and Prevention, veterans are 30 percent more likely to have severe hearing impairment than nonveterans; those who served after September 2001 are four times more likely.
Tinnitus and hearing loss are the top two most compensated disabilities in the Veterans Benefits Administration. And the incidence of auditory injury among soldiers is rising by 13 percent to 18 percent a year. In 2009, 18.2 out of 1,000 Marines experienced hearing loss. By 2012, that number was 28.7 out of 1,000.
“I don’t think any young man or woman joining the Marine Corps thinks that in four years or in 40 years, you will come away from your experience serving your country deaf,” Major General Robert Hedelund said recently in an address to the American Cochlear Implant Alliance, a nonprofit organization. “Yet significant hearing loss is a big part of their lives after their service.”
Service members are exposed both to sudden, loud noises such as from improvised explosive devices (50 percent of those wounded in blasts experience permanent hearing loss) and to the sustained roar of aircraft and ship engines, which can be just as damaging. Hedelund, the commanding officer of the 2nd Marine Aircraft Wing, speaks from experience. He has flown helicopters for much of his 30-year career. Even wearing double hearing protection, he developed tinnitus in the first 10 years, and his hearing thresholds have dropped three times.
In Hedelund’s last tour, he was director of Marine and Family Programs, which meant that wounded-warrior issues were part of his portfolio. “Frankly, I’m a little embarrassed that doing all the work with wounded warriors that we did, we never delved into the hearing piece of it,” he said.
The military has had hearing-conservation programs in place for decades. Audiology got its start as a field after World War II, when an increase in hearing loss was already noticeable among veterans. Given the statistics, it would be hard to argue that prevention efforts have yielded great results.
One roadblock has been military culture. Hearing has been undervalued. For a long time, according to Hedelund and others, hearing loss was regarded as a necessary evil, even a badge of honor — an indication that someone saw combat or flew fighter planes or was otherwise close to the action. Many soldiers on the ground don’t wear their regulation earplugs because they have to listen carefully for signs of trouble.
Treatment is complicated because hearing loss may be one of several conditions soldiers bring home. Six years ago in Iraq, Mark Brogan, then an Army captain, suffered brain and spinal wounds, and his right arm almost was severed when a bomb exploded nearby. Brogan, now 33 and retired, also lost almost all his hearing, and told NBC News last year that the hearing loss and the brain injury were the worst of his injuries.
A 2006 report on noise in the military called for improving prevention and treatment. (The Department of Defense is responsible for prevention; costs for treatment fall on the Veterans Benefits Administration.) All services have increased the number of required hearing tests to better document the problem, though not all are performing those tests.
In 2012, the Department of Defense established a Hearing Center of Excellence, which calls hearing loss an epidemic and reminds soldiers that “not all injuries bleed.”
It is also pushing Congress for line-item funding for more research on all aspects of noise-induced hearing loss, to encourage the same ingenuity in hearing technology that has been employed in improving prosthetic limbs. Other priorities include expanding research on medication that could retard hair-cell damage, and cracking the mysteries of tinnitus, about which little is known and little can be done.
You can’t solve a problem until you acknowledge you have one. Hedelund called for more research cooperation between the military and academia, as well as investigation into whether there could be a role for active service members who use cochlear implants, which provide artificial hearing to those with severe to profound hearing loss, just as limited-duty jobs have been found for amputees using prosthetic limbs. These are good ideas that are beginning to catch on. A handful of active-duty service members have cochlear implants.
There is a cost to hearing loss. It’s linked to diminished earning potential, anxiety and depression. The VA spends $2 billion a year in hearing-related disability benefits — a number that is expected to rise to $5 billion in five years. Hearing aids can cost thousands; cochlear implants cost more and require considerable rehabilitation.
Noise-induced hearing loss is largely preventable. The military might succeed in reducing it by continuing to expand the amount of research it sponsors and the role of the Hearing Center of Excellence — investments that would benefit all Americans.
September 20, 2013 | Wall Street Journal
Researchers who were just awarded the “American Nobel” have opened up the world of sound to the deaf.
By LYDIA DENWORTH
There was a time when almost no respectable scientist would have anything to do with cochlear implants. In the 1970s, pioneering researchers who thought they could create a device that would allow the deaf to hear and speak were shouted down at professional conferences. The National Institutes of Health refused funding on “moral grounds”: The idea was so improbable it was deemed a “cruel incentive” for parents and possibly harmful for children.
Soon after the scientific community began to acknowledge the possibilities of implants in the 1980s, members of the deaf community rose up to protest this medical approach to deafness. They argued the prosthesis was deeply offensive because it was designed to “fix” something they didn’t believe was broken.
Things have changed dramatically. Last week, three pioneering researchers—Graeme Clark, Ingeborg Hochmair and Blake Wilson—shared the prestigious Lasker-DeBakey Award for Clinical Medical Research for their work in developing the implant. They will accept the award often called the American Nobel on Friday afternoon in New York City. The award citation says the devices have “for the first time, substantially restored a human sense with medical intervention” and directly transformed the lives of hundreds of thousands.
I’ve seen this up close. My 10-year-old son, Alex, is one of the 320,000 people with a cochlear implant.
A few days before the Lasker announcement, Alex, who got his implant when he was two, started fifth grade in his mainstream school and was nearly indistinguishable from the other children. He moves “fluently” in the hearing world, as researchers put it. The only obvious difference is the piece of brown plastic he wears on his ear and the magnet that attaches it to his head. The work of the Lasker honorees and their many colleagues enabled my child to learn to talk and read. This year he’ll even be studying Spanish.
In addition to being Alex’s mother I am a science writer. I have spent the last two years researching the scientific and cultural history of the cochlear implant, seeking to understand the ways in which our experience of sound changes our brains.
The Lasker Award honors the determination and innovation of the scientists involved, but that is only part of the story. The decades of argument over implants speak to the difficulties of grappling with a technology that intersects so intimately with human fears, desires and identities. In this moment of celebration, it’s important to be clear-eyed about what implants have changed and what they haven’t.
Alex is still deaf. When he takes off the external piece of his cochlear implant and the hearing aid he wears in the other ear, he hears very little. Even with his equipment on, the electrical hearing provided by the implant has nowhere near the nuance and detail of natural hearing. “It’s like playing Chopin with your fist,” one scientist told me. Alex misses much of what is said in a noisy classroom or around the dinner table. Music is a nonstarter for most users.
For too long, the implant was viewed rather simplistically as either miracle or menace. It is neither. It is an impressive piece of engineering that can open up the world of sound and spoken language and sometimes lead to better educational achievement. What it doesn’t do is transform a deaf child into a hearing one, belying both hopes and fears that a child will be “changed.”
Technology, then, is only one leg of the stool—albeit a critical one—supporting Alex. When he comes to me with frustrations or questions, I find myself drawing on the messages of pride and acceptance born of the deaf civil-rights movement. The idea that deafness is a difference, not a deficiency, is newly resonant for me. I remind him about the many successful implant users we know, but also about the happy, fulfilled people I have met at signing deaf schools like Gallaudet University and the National Technical Institute for the Deaf.
Cochlear implants have altered political realities for the deaf community. Ninety-five percent of deaf or hard of hearing children are born to hearing parents, and most of those parents aren’t swayed by anti-implant arguments. Despite my respect for deaf culture, I am not either. To maintain, for instance, that parents should wait until a child can decide for himself ignores the facts of child development (and parental responsibility). The earlier a child receives an implant, the better it will work.
The success of cochlear implants owes much to scientists’ evolving knowledge of brain plasticity. Blake Wilson, who designed an innovative speech-processing strategy, has said the device really worked when they were able to set it up well enough to “get out of the way” and let the brain take over. That was certainly true for adults who lost their hearing after years of talking and listening, but it also turned out to be true for many young children who used the cochlear implant to develop spoken language.
“What’s that thing on your head?” I heard a new friend ask Alex recently.
“It helps me hear,” he replied, then added: “I think it’s pretty cool.”
“If you took it off, would you hear me?” she asked.
“Nope,” he said. “I’m deaf.”
“Cool,” she agreed. Then they talked about something else.
Moments like that make me deeply grateful for the technology that allows Alex to have such a conversation, but also for the hard-won aplomb that lets him do it so matter-of-factly.
Ms. Denworth is the author of the forthcoming “I Can Hear You Whisper: An Intimate Journey through the Science of Sound and Language.” (Dutton)
January/February, 2013 | Scientific American Mind
Playing violent video games can sharpen our focus, reasoning and decision-making skills. But do we really need the weapons?
By Lydia Denworth
I am in an overgrown lot leaning against an eight-foot tall shipping container. I look both ways, weighing my options. A man with an assault rifle is looking for me, just as I am looking for him. Hoping for a better vantage point, I run toward the abandoned car to my right. A metallic bang rings out as my opponent’s shot hits the wall I have just left. I dodge around the next container then circle behind it. Raising my M-16, I peer through the scope as I run. There he is! I hit the track pad of my laptop hard and fast, but my aim is wobbly. I miss. He spins, fires, and I’m dead.
So ended my introduction to first-person shooter video games. Clearly, I was not very good. With practice, I would probably get better. What is less obvious is that a decade of research has shown that if I spent a few more hours playing Call of Duty, I could improve more than my aim and the life expectancy of my avatar. Aspects of my vision, attention, spatial reasoning, and decision-making would all change for the better.
These striking findings have contributed to a shift in the national conversation about video games. Not long ago, a few lone voices contested the conventional wisdom that they were at best frivolous and at worst a dangerous waste of time and brainpower. Yet more than 90 percent of children play them, and adults do, too. In fact, the average gamer’s age is 33 years. Along with continuing popularity has come a surge in acknowledgement of the positive sides of gaming. Game designer Jane McGonigal’s 2011 book Reality is Broken even argued that games can change the world and the book became a bestseller. In a 2011 speech to students, President Barack Obama recognized the potential and called for investment in educational technology, although with a caveat: “I want you guys to be stuck on a video game that’s teaching you something other than just blowing something up.”
Teaching is the critical word. The most consequential conclusion of the research is that videogames have a power few other activities can claim. With practice, a violinist can play a Mozart string concerto beautifully, but that will not make her better at much else. Gamers, though, do not just learn to be good at shooting. In neurological terms, action videogames seem to “retune connectivity across and within different brain areas,” according to neuroscientist Daphne Bavelier of the University of Rochester and the University of Geneva. That means that gamers “learn to learn.” The ability to apply learning to broader tasks is called transfer, and it is the holy grail of education.
So far the games shown to have the most potent neurological effects are the ones parents hate the most: violent first-person shooters. Scientists are trying to figure out how and why these games affect players so as to create products that emphasize benefits but have fewer drawbacks. “I’m really interested in how the brain learns and how we can promote brain plasticity for learning,” says Bavelier. “The issue is trying to understand how technology can be leveraged for the better.”
Lydia Denworth is a writer based in Brooklyn, New York.
She is the author of Toxic Truth: A Scientist, A Doctor, and the Battle Over Lead (Beacon Press, 2009) and the forthcoming I Can Hear You Whisper (Dutton.)
Lydia is a former reporter for Newsweek and bureau chief for People. She is currently working for such magazines as Scientific American Mind and Parents. Her writing on science, education and social issues has appeared in The New York Times, Redbook, Health, and other publications. She has also been an adjunct professor of journalism at Fordham University and Long Island University.Read more