Dr. Chang Mentioned on NBC News Regarding Sound of One's Voice

Dr. Chang was mentioned today in a NBC News article on their popular Body Odds section. The article entitled "why you hate the sound of your own voice" describes why people sound and often dislike the way their voice sounds on a recording.

What we hear when we speak, however, is air- and bone-conducted sounds. Vibrations from our vocal cords directly reach the cochlea. Our skulls deceive us by, in fact, lowering the frequency of these vibrations along the way, which is why we often perceive ourselves as higher-pitched when we listen to a recording.  

“When [someone] listens to a recording of their voice speaking, the bone-conducted pathway that they consider part of their ‘normal’ voice is eliminated, and they hear only the air-conducted component in unfamiliar isolation—what everybody else actually hears,” says Dr. Chris Chang, an otolaryngologist at Fauquier Ear, Nose & Throat Consultants in Warrenton, Virginia. [link]

I wrote a more comprehensive blog article on this phenomenon here.

In any case, very cool I got quoted!!!

Source:
Why you hate the sound of your own voice. NBC News 4/2/13

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A New BAHA Hearing Aid... Without the Screw Implant

For patients with a significant conductive hearing loss or mixed hearing loss, Bone-Anchored Hearing Aids (BAHA) are an option that negates the need to place anything in the ear canal.

Traditional hearing aids require some type of ear hook that is inserted into the ear canal to allow amplified sound to reach the middle and inner ear.

BAHA transmits sound to the inner ear via a different mechanism using actual bone vibration. The bone vibration can be transmitted either via direct physical coupling (traditional) or via indirect magnetic coupling (the new way).

The traditional BAHA requires a titanium screw that is drilled into the bone behind the ear. Part of this screw sticks out of the skull through the skin to which the hearing aid is attached. Sound is transmitted into the ear by direct screw vibrations which in turn vibrates the bone that gets transmitted directly into the ear thereby allowing sounds to be heard.

 

Why would anyone want a BAHA? It would be a better option than a traditional hearing aid if the ear canal is extremely small, prone to getting infected, chronically draining, and/or absence of the middle ear anatomy including eardrum and middle ear bones.

But who wants a metal screw sticking out of their head???

That's where this "new" magnetically coupled BAHA device called Sophono Alpha 1 comes in.

Rather than a screw sticking out of the bone to transmit vibrations, magnets are used instead. First, flat magnets housed within a titanium plate is surgically screwed into the skull underneath the skin. Nothing sticks out!

Over the skin, an external base plate is magnetically coupled to the surgically screwed in plate.

The hearing aid, which is held in place to this external plate, houses a bone oscillator that uses a metal disc and spacer shim to magnetically couple to the internal component in order to deliver auditory stimulation (vibration) through the closed skin.

Early studies suggest, however, that the hearing amplification is not as great as the traditional direct coupling BAHA.

Read more about this new Sophono BAHA here.

Though our office does not offer this device, please contact your local otologic surgeon to see if (s)he offers it!

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Cheerleading A Dangerous Sport from an ENT Perspective

The American Academy of Pediatrics (AAP) published its first policy statement regarding cheerleading due to the increasing rate of injuries found in this increasingly competitive sport.

Who knew that although the overall risk of injury is lower than other sports, it has one of the highest rates of catastrophic injuries including closed-head injury, skull fractures, cervical spine injuries, paralysis, and even death.

After all, cheerleaders do not wear protective gear and safety is utterly dependent on external factors such as spotters and floor protection.

From an ENT perspective of a solo private practice, cheerleading is one of the leading causes of facial fractures in a student population.

Such fractures include nasal bone and orbital blow-out fractures sustained from elbows and other flying limbs.

Although AAP made 12 recommendation to make this sport safer, I was going to suggest that all cheerleaders should wear face-guards to minimize risk of facial trauma.

Here's one called Mueller Nose Guard. Available for purchase on Amazon.com.

Reference:
Cheerleading Injuries: Epidemiology and Recommendations for Prevention. Pediatrics 2012;130:966-971.

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Why Does My Voice Sound Different on Recording and Treatment Options

Every so often, I have a patient who presents to my office with a complaint that their voice sounds different on recording than what they themselves hear.

In particular, singers who come in state specifically that their vocal recordings sounds slightly flat when they thought they were singing in perfect pitch.

So why does this happen? Unfortunately, it is physics and fundamentally integrated to how the ear, skull, and sound transmission work. In other words, it can't be "treated" with surgery or medications.

What other people hear when you sing or talk is air conducted sound that gets transmitted through the ear canal, eardrum, middle ear bones, and ultimately to the cochlea hearing organ (pathway A).

Image by Chittka and Brockmann Modified from Wikipedia

The sound the individual singer/talker hears is not only sound transmitted via the air (pathway A) but also by vibration of the skull itself directly to the cochlea hearing organ bypassing the outer and middle ear completely (pathway B). The mechanical properties of the skull enhance the deeper, lower-frequency vibrations.

Therefore, when a talker/singer listens to a recording of their voice speaking/singing, the bone-conducted pathway that they consider part of their “normal” voice is eliminated, and they hear only the air-conducted component in unfamiliar isolation (what everybody else actually hears).

SO... what is a singer/talker to do if they are disturbed by the way they sound to others? Particularly, what is a singer to do when they always sing a little flat when they truly think they are singing in pitch?

One can wear earplugs in order to hear only bone-conducted vibrations and get used to their alter-voice and undergo speech/voice therapy. OR... accept that their voice IS different.

For singers, I highly recommend using HearFones Headsetwhich is a funny looking head device that allows an individual singer to hear what they really sound like and more importantly what the audience would hear! In addition, while using HearFones, the singer would be able to hear himself more predominantly over the rest of the ensemble thus helping him to improve the quality of his/her individual vocal quality output.

Over time, singers will be able to automatically adjust their singing such that they no longer will need such a device to sing in tune with others when in familiar surroundings. BUT... in new environments (new concert hall, outdoor arena, etc), it is not unusual that their singing may become off again...

This is why professional singers often wear earpieces that convey sounds recorded by microphones placed in the audience... and also why they sometimes sound flat and out-of-tune when they don't!

It's also why it is VERY important to rehearse in a new place before a concert.

On a related note, most individuals state that they do not "like" they way they sound on a recording. However, according to one study, people unconsciously prefer their recorded voice over others.

Of note Dr. Chang was mentioned on NBC news regarding this question in this story.

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Kissing the Ear Can Cause Permanent Hearing Loss

MSNBC reported 3/29/12 about a phenomenon called cochlear ear-kiss injury. This condition is when hearing loss occurs after a person kisses someone else over the ear, usually a mom over a baby's or child's ear.

Right after the kiss, a person can suffer from immediate and potentially permanent hearing loss along with other symptoms including ringing, sensitivity to sound, sound distortion, and aural fullness.

How or why does this occur?

With a kiss, a strong suction is created within the ear canal that pulls on the eardrum which tugs on the middle ear bones that can lead to turbulence within the inner ear.

Infants are particularly susceptible to this condition given their ear canals are SO small and the suction created by an adult kiss over the ear can be so strong.

There are other variations of this type of ear/hearing injury.

Barotrauma of the ear can lead to similar type issues due to sudden pressure changes from flying, parachute jumping, diving into water, SCUBA, snorkeling, etc.

Getting slapped over the ear can do the same thing as cochlear ear-kiss injury, but in reverse. Rather than suction from a kiss creating strong negative pressure within the ear canal, a slap over the ear creates sudden strong positive pressure.

At times, such pressure changes can get so severe that the eardrum can rupture.

Source:
Innocent 'kiss of deaf' can cause permanent hearing loss. MSNBC 3/29/12

The kiss of deaf: Four-year-old's big smooch left her mom with partial hearing loss. Newsday. June 7, 2008

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Head MRI and CT Scans Explained!

@ENTHouse brought to my attention a FANTASTIC website that literally identifies and goes through all anatomic structures on every slice of a CT or MRI scan of the head.

Sinus cavities, blood vessels, nerves, bone, suture lines, etc...

Wish I thought of doing it first...

It may be a bit confusing for a layperson, but if you have a copy of your CT/MRI scan and wonder where the maxillary sinus or optic nerve is located on your scan, check this website out and you probably can figure it out!

headneckbrainspine.com

Check it out!

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