Wednesday, 25 April 2012

Acyclovir, Famciclovir & L-Lysine: Can Anti-Viral Medication for Herpes Help Control Meniere’s Disease?


As mentioned in my page Ménières & HERPES, there are many published medical studies suggesting a link between Meniere’s Disease and Herpes Viruses.

Acyclovir & Famciclovir

Acyclovir (also known as Aciclovir) helps to stop herpes viruses from spreading to other cells. It is used to treat chickenpox, shingles, and genital herpes. Acyclovir is available as tablets, capsules, an ointment, a suspension or as an injection. Acyclovir can be used to treat recurrent outbreaks.

Like acyclovir, Famciclovir can help prevent herpes viruses from spreading to other cells. It is available as a tablet for the treatment of cold sores (herpes simplex 1) and genital herpes (herpes simplex 2). It also has a longer therapeutic effect than Acyclovir so it doesn’t need to be taken as frequently throughout the day.

You may wish to discuss with your GP or specialist the possibility of incorporating anti-viral medication into your Meniere’s management plan.

Be aware that these anti-viral medications are quite expensive and can cost anywhere from AUD$120 to $420 depending on the strength of the tablet and the quantity required. So if your GP or specialist were to let you try Acyclovir at say 2,000mg/day for a period of two weeks, you would need 140x 200mg tablets, so two packs of 90 tablets, which according to the Australian PBS would cost AUD$232.24 (the full dispensed price because this medication is not listed for Meniere’s Disease). Famciclovir is also listed on the Australian PBS for similar prices. Discuss with your GP or specialist which one will be best for you to try.

My GP, who is quite holistic, let me try Aciclovir 200mg tablets (2 to 4 tablets) taken three times a day. I found that I struggled to take the tablets, because their shape was a bit jagged to swallow & there were so many tablets* 6 to 12 (1,200mg to 2,400mg daily), so I ended up taking about 1,400mg to 1,600mg which probably wasn’t enough for me to get a good result. If my GP is in agreement, I will definitely try another round of anti-viral medication in the near future. *(in addition to my other medication.)

If you would like to incorporate anti-viral medication into your Meniere’s management plan, then discuss this with your medical practitioner. You may also wish to print the abstracts for these two studies below and show them to your GP or specialist.
“Randomized double-blinded, placebo-controlled clinical trial of famciclovir for reduction of Ménière's disease symptoms.”
“Effectiveness of Acyclovir on Meniere's Syndrome. III. Observation of Clinical Symptoms in 301 Cases.”

This is also an interesting read but if you are considering an intratympanic injection my suggestion would be to try Dexamethasone instead of Ganciclovir (see my posts on Dexamethasone): 
“Intratympanic application of an antiviral agent for the treatment of Ménière's disease”

This medical article testing Valacyclovir & Methylprednisolone for the treatment of Vestibular Neuritis (the second most common cause of peripheral vestibular vertigo) was also interesting:
“Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.”

L-Lysine

Before trying either Acyclovir & Famciclovir, I suggest you consider taking the essential amino acid L-Lysine. It is not a prescription medication and can be bought over the counter from most chemists and health food stores.

I can recommend Nature’s Own L-Lysine 500mg (200 tablets) as it is readily available in Australia, however you could order The Vitamin Shoppe L-Lysine (300 capsules) which I found much easier to swallow than the Nature’s Own tablets. Also, the Vitamin Shoppe L-Lysine capsules come in bulk which is very cost effective and worth the cost of shipping to Australia (particularly with the current strong Australian dollar).
Nature’s Own L-Lysine 500mg Tablets
The Vitamin Shoppe L-Lysine 500 Capsules

My GP recommended I try a high dose of up to 4,500mg daily, however “The John of Ohio Meniere’s Regimen” suggests up to 3,000mgs daily. I suggest you start with the recommended amount on the bottle then consult your GP before increasing to a higher amount.
The John Of Ohio Regimen - Jan 2010 UPDATE

Also you could try incorporating more dietary sources of L-Lysine into your diet, such as:
Pulses/Legumes: Soybeans, Lentils, Azuki Beans, Kidney Beans, Chickpeas and Navy Beans.
Fruits/Vegetables: Peas.
Grains: Amaranth.
Meats: Beef, Catfish, Chicken or even Eggs.
Dairy: Milk & Parmesan Cheese (although it is high in Sodium which is a bit of a Meniere’s no-no but a little would be fine).

HAVE YOU TRIED ANTI-VIRAL MEDICATION OR L-LYSINE TO MANAGE YOUR MENIERE’S? If so, please share your story in the comment section below.


Sunday, 22 April 2012

MORE on Intratympanic Dexamethasone Injections to Reduce Menieres Vertigo Attacks

If you haven't read my post, "Reduce the Frequency of Vertigo Attacks with a Dexamethasone Steroid Injection" I recommend you read that first.

Meniere's Australia - Brisbane South Meeting UPDATE
The organiser of Meniere’s Australia Brisbane South asked me to be a guest speaker at their meeting last Sunday (22 Apr 2012).

We had a good turn out and discussion. I showed the group a video showing an intratympanic Dexamethasone injection for tinnitus (see link in this post). The video will give you a better idea of the procedure; however it doesn’t show the initial incision of the ear drum or the insertion of a myringotomy tube.

I also donated a copy of the book “Let’s Get Better” by S J Blanshard (aka Meniere Man). It’s a light read about one man’s personal experience with the disease (see link in my Recommended Reading column to the right). So now both the MA Brisbane North & Brisbane South groups have a copy that members may borrow.

Below are my speaker notes for the Meniere's Australia - Brisbane South meeting last Sunday where I shared my experience with an intratympanic Dexamethasone injection.


Reduce the Frequency of Menieres Vertigo Attacks with an Intratympanic Dexamethasone Injection

What is Dexamethasone?
Dexamethasone is a synthetic version of glucocorticoid, a class of steroid drug (like Prednisone but many times more potent).
Glucocorticoids are classic anti-inflammatory compounds that are used to treat autoimmune diseases (such as lupus, multiple sclerosis & rheumatoid arthritis).
Dexamethasone prevents the release of substances in the body that cause inflammation.

How can an intratympanic Dexamethasone injection reduce vertigo attacks?
Meniere’s Disease has no known cause or cure. One theory for the cause is that it is an autoimmune disease. 
If this is the case, then an intratympanic Dexamethasone injection could reduce vertigo and tinnitus by reducing the inflammation of the inner ear caused by an autoimmune reaction. This would improve hearing function, equilibrium & quality of life for the patient.

Will Dexamethasone damage my hearing?
There are dangers involved with any procedure, so discuss these with your specialist.
Unlike Gentamicin, Dexamethasone should not damage your hearing further.

How is the Dexamethasone administered?
The Dexamethasone is administered within the middle ear (intratympanic) by injection.
The injection is undertaken by an experienced ENT, Neurotologist or Otologist.

How long does the procedure take?
The procedure takes less than one hour.

What do I need to do before the procedure?
You may wish for someone to accompany you to the procedure and drive you home afterwards. This will give you the opportunity to keep your head tilted after the procedure and maximise the benefits of the injection.
Discuss the pro’s & con’s with your specialist.
Notify your specialist if you, or anyone you are in close contact with, are unwell or have been unwell over the past several weeks.
You may wish to take an anti-nausea tablet (such as Stemetil) and half a tablet of Valium 2mg to assist in remaining calm during the procedure, though this many not be necessary.

What do I need to do during the procedure?
Follow directions. Lay still and relax.
You may benefit from visualising your “happy place” (i.e. warm beach, cool breeze, soft waves on the sand).
You will likely experience some minimal vertigo during the procedure. This will be due to the difference in temperature between your middle ear and the steroid solution. The vertigo will likely pass within a minute or two, so stay calm and try to relax.
After the injection you will be asked to roll over onto your “good side” so that the treated ear is upturned.
For the next 20 to 30 minutes you will need to keep your treated ear turned up (facing the ceiling).
Avoid swallowing, popping your ear, yawning, or blowing your nose. Any of these motions could cause much of the Dexamethasone to flow out through the Eustachian tube (which runs off the middle ear).
The aim is to keep the steroid in the ear as long as possible.

Is it painful?
In my experience the procedure wasn’t painful although it could be for some people. Temporary discomfort &/or a dull ache will likely be experienced; however this is outweighed by the potential benefits of reduced vertigo and tinnitus.

What do I need to do after the procedure?
Keep your treated ear tilted upward for at least 30mins.
Keep the treated ear dry until the incision in the ear drum healed (about 3 to 4 weeks). When showering, use ear putty & a shower cap from the chemist to keep the ear drum dry. 
Steroid medication can weaken your immune system  so avoid people who have, or recently had, an infection. Also try to avoid stress.

Will I benefit and, if so, how long will the benefits last?
Results will vary between individuals and some may require follow up injections every three to six months.
According to one study from 2005*, after five consecutive daily intratympanic injections of Dexamethasone (4 mg/mL), 82% of patients achieved complete control of vertigo at the 2 year follow up, while the remaining 18% showed substantial control of vertigo. There was also a subjective improvement in tinnitus (48%), hearing loss (35%), and aural fullness (48%).

* “Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial.” Garduño-Anaya MACouthino De Toledo HHinojosa-González RPane-Pianese CRíos-Castañeda LC. Department of Neurotology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico. 

How much does the procedure cost?
The procedure costs approximately AUD $275 (less Medicare & private health care rebates). This cost would vary between specialists.

For more on the Intratympanic Dexamethasone Injection procedure contact your ENT, Otologist or Neuro-tologist. If you’re in Queensland, Australia, I can recommend Dr Chris Que-Hee.

CONTACT DETAILS
Dr Chris Que-Hee - ENT / Neurotologist. 
Ph: +61 (0) 7 3831 4400
Watkins Medical Centre,
Level 10, 225 Wickham Tce, Brisbane,
Qld. Australia. 4000



This HD video demonstrates how steroid injection is performed into the ear for patients suffering from sudden sensorineural hearing loss.
As mentioned, the video will give you a better idea of the procedure; however it doesn’t show the initial incision of the ear drum or the insertion of a myringotomy tube.
Copyright owner http://www.FauquierENT.net 


DO YOU HAVE EXPERIENCE WITH INTRATYMPANIC DEXAMETHASONE INJECTIONS, OR A QUESTION? Please post a comment below as I’d love to hear your thoughts.


Disclaimer
This website contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such. The medical information on this website is provided without any representations or warranties, express or implied. Beatrice T via the Inner Ear Journey blog makes no representations or warranties in relation to the medical information on this website. Without prejudice to the generality of the foregoing paragraph, Beatrice T via the Inner Ear Journey blog does not warrant that:
§   the medical information on this website will be constantly available, or available at all; or
§   the medical information on this website is complete, true, accurate, up-to-date, or non-misleading.
You must not rely on the information in this document as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediately medical attention.
You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. Nothing in this medical disclaimer will limit any of our liabilities in any way that is not permitted under applicable law, or exclude any of our liabilities that may not be excluded under applicable law.

Wednesday, 11 April 2012

Becoming the Bionic Woman – Part Two


If you haven’t read my original post Becoming the Bionic Woman, you may want to read that first.
Becoming the Bionic Woman

If you’ve read my post “Becoming the Bionic Woman”, you would know that I’ve been trialling the Phonak  Audéo S IX SMART (a micro Behind-The-Ear hearing aid). The trial was originally intended to be seven days however as it was the long Easter weekend, my audiologist very kindly let me borrow the device for an extra six days. Yay!

However, about eight days into the trial, the hearing aid battery died and I was abruptly thrust back into a world of partial hearing & decreased orientation. Suddenly I felt like an addict that needed to score. I was thinking, “Where can I get a hearing aid battery on a holiday weekend? Will the chemist be open? Will they have the battery I need?” Getting that battery became my number one priority. The shops were closed, so I spent an evening without a working hearing aid. Needless to say, I was strung out.

The following day I made a bee line for the chemist and the sales lady found a new battery that matched the one in the hearing aid. I put the hearing aid back in and sighed a relief to be “bionic” again. However the next day much to my surprise I heard the distinctive “ding, ding” sounds that the hearing aid was running out of power again. “No!!” Although the replacement battery was a fit, it was a lesser strength one intended for watches & other small medical devices. I needed a longer life battery.

So back to the chemist I went again only to be informed that they were out of stock of hearing aid specific batteries, so I bought up a few regular ones to get me through the long weekend.

Anyway, today my trial was up. It was time to return the device and decide whether to order a custom hearing aid or not. “You don’t know what you’ve got until it’s gone” is the phrase that comes to mind at this point. The answer to my decision was a clear yes.

I had though one obstacle in my way… money. Living in the post GFC world that we do, my credit card is fairly maxed out. So I wasn’t sure that I could currently afford the Phonak Nano Ambra I was hoping to purchase (approx. AUD$4,500 fitted).

My audiologist, Michelle Nicholls, at the Neurosensory Unit in Brisbane mentioned that Phonak is owned by Sonova Group which also owns Unitron. According to Michelle, Unitron will be launching a comparative hearing aid on April 30 2012. Unitron’s Quantum micro CIC can be fitted with either 20, 12 or 6 channels, so it should offer a good alternative to the Phonak Nano Ambra for my moderate hearing loss.

As I have already registered with Australian Hearing (a Department of Human Services) for a partial subsidy to help pay for a hearing aid, the new Unitron Quantum micro CIC (20 channels) might only set me back around AUD$3,200 (including fitting & government subsidy). So potentially there’s a good saving to be made. Bearing this in mind I thought it best to wait until the end of the month before deciding on whether the Phonak Nano Ambra or the Unitron Quantum micro CIC would be better suited to my needs.

Not wanting to waste an audiology appointment, Michelle took a putty imprint of my left ear canal in preparation for ordering a custom fitted hearing aid. That way once I have all the facts, I can just ring up to confirm & pay, then wait for the device to be custom made then delivered to my audiologist for fitting.

Just in case you’re wondering how they make a custom fit hearing aid, here’s how. After the putty imprint of the ear canal is taken, the mould is scanned in house by a 3D scanner, the image is then sent online to the manufacturer. The scanned image is then adjusted and outputted in plastic by a 3D printer. Once it’s cleaned up, a technician fits the plastic shell with the technology. That’s the general idea. I’m sure it’s a more specific process than that. It’s amazing technology.

I’m so glad to be living in “THE FUTURE”. Yes indeed… we do have the technology. 

HAVE YOU HAD A SIMILAR EXPERIENCE? SHARE YOUR COMMENTS BELOW.

Connect with others who have hearing loss
Phonak has started a new online community initiative called Hearing Like Me
It supports those touched by hearing loss through the exchange of experiences. Check it out here: 

Read about the Siemens 3D Scanner which Digitizes Ear Impressions for Customized Hearing Aids

Australian Hearing is a Department of Human Services which provides a choice of hearing aids - from fully subsidised devices through to mid-range, high-range and premium devices. They offer hearing devices made by manufacturers such as Siemens, Bernafon, Phonak, Oticon, GN Resound, Widex and others. Eligibility applies (see below link).
Find out if you’re eligible for Australian Hearing here:

NEWS RELEASE - Unitron Announces Tiniest Quantum Ever 
Quantum 20/12/16 Features

Sunday, 8 April 2012

Echolocation vs. the Quietest Place on Earth


I read a news article this week about an ‘anechoic chamber’* at Orfield Laboratories in North America. The Guinness World Records have declared it “the quietest place on Earth”, for its ability to absorb 99.9% of sound.

The chamber is surrounded by 1m thick fiberglass acoustic wedges, has double walls of insulated steel and 30cm thick concrete (see picture above). According to Steven Orfield, the longest anybody has been able to sit in the darkened chamber was 45mins.

In the dark, it’s so quiet that the occupant becomes the sound, hearing only their body (i.e. heart beating, lungs breathing). Apparently this is a very disorientating experience, so much so that the occupant must be seated.

Mr Orfield said, “How you orient yourself is through sounds you hear when you walk. In the anechoic chamber, you don't have any cues. You take away the perceptual cues that allow you to balance and manoeuvre. If you're in there for half an hour, you have to be in a chair.” As a unilateral, hard of hearing person, I found this statement to be very interesting.

NASA has a similar chamber which they can put a water tank in to ascertain how long it takes before an astronaut starts to hallucinate, or whether they could even work in such an environment. The chamber absorbs electromagnetic energy to simulate the open space environment. Space is like a giant anechoic chamber.

This got me thinking about the connection between our hearing and our orientation in the environment around us. Our inner ear consists of a cochlea (which picks up sound), the labyrinth (semi-circular canals that perceives rotational movements), and the otolithic organs (which transduce linear accelerations). It’s interesting that the cochlea contributes to orientation in so much that that the brain uses sound to support other orientation inputs (Vestibular system, Somatosensory system of proprioception & kinesthesia, Vision). I suppose that’s the reason the inner ear is connected the way that it is.

This reminded me of a teenager I had heard about years ago named Ben Underwood**. Ben, who became blind weeks before his third birthday, had an amazing ability to use echolocation to ‘see’ his environment. Echolocation is the ability to detect the surrounding environment by sensing echoes bouncing off objects.
By clicking his tongue, Ben was able to hear the distinctive echoes around him. One of Ben’s observations was that “people sound just like the surface of water” (which would make sense considering the human body averages approx. 60% water). He became so good at using echolocation that he was able to ride a bike, rollerblade, play video games, try karate and even surf waves.

Even though a sighted person wouldn’t use the clicking technique employed by Ben, they would still rely on their hearing to navigate as demonstrated in the darkened anechoic chamber.

*Anechoic: Neither having nor producing echoes.
**Unfortunately Ben passed away in 2009 from a brain tumour just before his seventeenth birthday. He lived a remarkable life in a short time and still inspires others today.


HAVE YOU FOUND THAT YOUR ORIENTATION HAS DIMINISHED WITH YOUR HEARING LOSS? IF SO, SHARE YOUR EXPERIENCES BELOW.

Read more about The Quietest Place on Earth here:

Read more about Ben’s Echolocation here:



Wednesday, 4 April 2012

Becoming the Bionic Woman: Hearing Technology for Ménière's Disease



It’s been many years since I’ve watched an episode of The Bionic Woman. As a child I would be glued to the TV enthralled by the super human qualities of character Jaime Sommers, a tennis pro that nearly died in a skydiving accident only to be “re-built” with a bionic right ear, a strengthened right arm and enhanced performance legs. The catchphrase was, “We can rebuild her… we have the technology”.

As much as I would love to be able to crush a tennis ball with my right hand, or run up to 60 miles per hour (about 96km), I would quite happily settle for the bionic ear. Thanks to Meniere’s Disease I’m more like some character from the Beverly Hills Hillbillies with an ear trumpet, “What’s that sonny? Speak into the ear horn!!”

But luckily this isn’t 1976. We’re living in “THE FUTURE”, so what cost six million dollars in the seventies would surely be available and affordable now. Right? Well not quite.  Thirty six years on a top-of-the-line hearing aid will put you back about AUD$4,300 to $5,000 (for a single aid, not including fitting). It’s not the implanted variety that the Bionic Woman had, but its close.

Last week I went to my hearing specialist, at the Neurosensory Unit in Brisbane, for an audiogram specifically to fit me for a trial hearing aid.

My audiologist, Michelle Nicholls, took me through the usual audiogram (anyone with Meniere’s would be familiar with this test). After the test she asked me what type of outcome I was looking for; specifically if I wanted to hear a wide range of sounds or primarily just speech. Apparently older recipients of hearing aids prefer to hear speech without the addition of the ambient noise that surrounds us.

As a young-ish person with Menieres, of course I wanted to be able to hear speech better but I also wanted to be able to hear music better and all the richness of the sounds that surround us. I wanted to feel more a part of my surroundings as I had before I started to lose my hearing. Also I wanted to be better able to orientate myself with sound. ( If I ask somebody in another room where they are, they invariably say, “I’m here!”. “Here? Where exactly is here?” “I can’t tell anymore because I’m going deaf in one ear and can’t pinpoint where “here” is.”) But most of all I wanted to be able to hear the very low frequency pitch, like the low, guttural sounds of my cat purring (between 25 and 150 Hertz). Once I have that sound back I’ll be happy.

Based on my requirements and my moderate, unilateral hearing loss diagnosis, Michelle selected a hearing aid she believed would be suitable. She selected the Phonak  Audéo S IX SMART (a micro Behind-The-Ear model) for trialling with the expectation that if it worked well I could look at getting a Phonak Nano Ambra (a Custom In-The-Ear model) which essentially has the same features as the S IX SMART but is neatly concealed in the ear canal.

I tried the Phonak  Audéo S IX SMART on my left Meniere ear and Michelle took me through the Real Ear Test. She asked me questions, I provided her with feedback, then she would make some adjustments through her computer (see bottom right pic above) and we’d repeat the process. Once we were satisfied that I had the optimum level, I was released back into the wild with my “bionic” ear.

On my way out through the reception I was suddenly very aware of the sound around me. It felt like somewhere in the room there was a concealed microphone and speakers, like a subtle PA system. I heard the whir of the ducted air conditioner above, which I had not previously noticed. So this is what it’s like to be bionic.

In the busy café downstairs I approached the cashier to place my decaf coffee order. I felt so much more tuned into what was happening; people chatting behind me, music coming from the speakers above and most importantly the cashier asking me to place an order, which I did. I could feel myself smiling because of my bionic secret. I was mindful to compose myself so as not to appear weird but as I looked down I “heard” the cashier ask me if I wanted a receipt. I looked up and with a beaming smile I said, “Yes. Yes I would love a receipt.”  Knowing that my fascination for the rediscovered world of sound was spilling over, I came clean and said, “I’ve just been fitted with a hearing aid, so I’m feeling pretty pleased at the moment because I can hear things I haven’t heard for a while.” The cashier was inquisitive and tried to spot the device in my ear saying, ”It’s not very noticeable”. Yay! (See pictures above.)

Over the past week of trialling the Phonak Audéo S IX SMART I’ve had similar moments of awe but have remained more contained in my outward persona. I even went on a first date with a fellow who was none the wiser of the presence of hearing assistance, which was great because that’s not the sort of conversation I want to have on a first date. I’ll save that for the honeymoon ;-) (Just kidding folks.)

I haven’t been wearing the hearing aid all day. Obviously it can’t be worn in the shower or while sleeping in bed. When not in use I’ve kept the device next to my bed. In the morning I click the battery hatch door into place and put the device in my ear where it stays until about late afternoon. It’s been great for chatting with my flatmate, watching television and listening to music (without headsets as it would get in the way, although there is a Phonak accessory for that). It’s been particularly good for being out and about, shopping, in cafes, and hearing ambient noise to help orientate myself. I’ve even had a few “bionic” moments, hearing conversations normally out of range.

On the negative side, I tried to have a phone conversation using the Meniere ear and although there was some improvement I found it easier just to revert to my good ear. I also find that by mid-afternoon I’ve been taking the hearing aid off for a while as it begins to feel heavy (like wearing chandelier earrings for a few hours) even though it weighs next to nothing. Also if I brush my hair back behind my ear with my fingers there is a prominent microphone sound, like if you were to brush your hand over a regular microphone (“testing… one, two, three”). The same thing occurs when wearing sunglasses. That can be a little annoying however this wouldn’t be an issue with a Custom In-The-Ear model. And last but not least, I haven’t found it particularly effective in hearing the low frequencies of a cat purr (sigh!). That could be partly to do with the position of the microphone behind the ear, so an In-The-Ear model might be better for that.

Overall I feel it has been a beneficial experience. I’ve found that although my hearing is not back completely, there is enough of an improvement to make daily activities more tolerable and even enjoyable. Now all I have to do is find the funding for the Phonak Nano Ambra. Oh, well… at least it’s not $6million.

HAVE YOU BEEN FITTED WITH A HEARING AID BECAUSE OF MENIERE’S DISEASE? IF SO, SHARE YOUR EXPERIENCES BELOW.

WATCH Lindsay Wagner as The Bionic Woman

Bionic Woman Intro

Bionic Woman's Ear Problem

MORE ABOUT THE HEARING AIDS BELOW:

Phonak Audéo S IX SMART 
Features & Benefits
Acoustically Optimized Vent (AOV) - Minimum occlusion
DuoPhone - With the push of a button, the phone signal is heard in both ears
EchoBlock - Understand well in echoey environments
FlexControl - Easy interaction with the hearing system
FlexVolume - Controls that allow the wearer to easily make targeted adjustments
NoiseBlock - Premium comfort in background noise
QuickSync - Control both instruments with one touch
Real Ear Sound - Natural sound orientation
SoundFlow - Continuous and instant optimization to all environments
SoundRecover - Awareness of the sound environment and listening pleasure
SoundRelax - Eliminating annoying sounds
WhistleBlock - Feedback free hearing
WindBlock - Suppresses wind noise
ZoomControl - Ability to choose the hearing focus 
WaterResistant - Water, sweat, moisture and dust resistant! 
StereoZoom - In an extremely noisy situation where you want to communicate with just one person, StereoZoom can zoom in even closer and reduce noise even further. 
Auto ZoomControl - When you cannot easily face the speaker, e.g. in a car, auto ZoomControl can zoom to either side and backwards for effortless understanding.
UltraZoom Premium - In noisy situations with several people talking around you, UltraZoom automatically zooms to the voices coming from the front. Noise from the side and back is reduced.

Phonak Nano Ambra
Features & Benefits
Acoustically Optimized Vent (AOV) - Minimum occlusion
DuoPhone - With the push of a button, the phone signal is heard in both ears
EchoBlock - Understand well in echoey environments
FlexControl - Easy interaction with the hearing system
NoiseBlock - Premium comfort in background noise
QuickSync - Control both instruments with one touch
Real Ear Sound - Natural sound orientation
SoundFlow - Continuous and instant optimization to all environments
SoundRecover - Awareness of the sound environment and listening pleasure
SoundRelax - Eliminating annoying sounds
WhistleBlock - Feedback free hearing
WindBlock - Suppresses wind noise
ZoomControl - Ability to choose the hearing focus 
WaterResistant - Water, sweat, moisture and dust resistant! 
StereoZoom - In an extremely noisy situation where you want to communicate with just one person, StereoZoom can zoom in even closer and reduce noise even further. 
Auto ZoomControl - When you cannot easily face the speaker, e.g. in a car, auto ZoomControl can zoom to either side and backwards for effortless understanding.
UltraZoom Premium - In noisy situations with several people talking around you, UltraZoom automatically zooms to the voices coming from the front. Noise from the side and back is reduced.

Accessories and FM’s
Phonak have optional wireless accessories for TV, telephone, MP3 player, GPS and computers such as ComPilot, TVLink S, PilotOne and iCom – TVLink.