Frequently Asked Questions
Hearing loss occurs to most people as they age. Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. In the year 2001, there are some 28 million people in the USA with hearing loss. Hearing loss is the single most common birth "defect" in America. Hearing loss in adults, particularly in seniors, is common.
You may have hearing loss if...
- You hear people speaking but you have to strain to understand their words.
- You frequently ask people to repeat what they said.
- You don't laugh at jokes because you miss too much of the story or the punch line.
- You frequently complain that people mumble.
- You need to ask others about the details of a meeting you just attended.
- You play the TV or radio louder than your friends, spouse and relatives.
- You cannot hear the doorbell or the telephone.
- You find that looking at people when they speak to you makes it easier to understand.
If you have any of these symptoms, you should see an audiologist to get an "audiometric evaluation." An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed audiologist. An AE is not just pressing the button when you hear a "beep." Rather, an audiometric evaluation allows the audiologist to determine the type and degree of your hearing loss, and it tells the audiologist how well or how poorly you understand speech. After all, speech is the single most important sound, and the ability to understand speech is extremely important. The AE also includes a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. The results of the AE are useful to the physician should the audiologist conclude that your hearing problem may be treated with medical or surgical alternatives.
Written hearing tests, "dial a hearing test" and other online hearing tests are not particularly accurate and are certainly not diagnostic tests, but may be utilized as screening tools. These screenings are usually free and can be scored within a few seconds. Written hearing screenings may point the patient (or consumer) in a particular direction and may help validate that a hearing problem may indeed exist.
Therefore, we have designed a written hearing screening to provide you with some general guidelines about your hearing ability. It is free and it may offer you insight regarding the likelihood that a hearing loss is present. If you would like to take the written hearing screening, Click here.
Basically, if you have two ears with hearing loss that could benefit from hearing aids, you need two hearing aids. It is important to realize there are no "normal" animals born with only one ear. Simply stated, you have two ears because you need two ears. If we try to amplify sound in only one ear, you cannot expect to do very well. Even the best hearing aid will sound "flat" or "dull" when worn in only one ear.
Assuming you have two ears that hear about the same, you can do a little experiment at home to better understand how important binaural hearing is:
First, gently close just one ear, by simply pressing the little fleshy part in the front of your ear canal (the tragus) into your ear canal -- a little. Do not apply pressure, do not hurt yourself. Just close the ear canal to eliminate sound from entering the ear. The idea is to close that ear for about ten minutes while you watch TV or listen to the radio, or speak with your spouse. Then, after a full ten minutes, remove your finger. What an amazing difference!
There are many advantages associated with binaural (two ear) listening and importantly, there are problems associated with wearing only one hearing aid -- if you are indeed a candidate for binaural amplification.
Localization (knowing where the sound came from) is only possible with two ears, and just about impossible with one ear. Localization is not just a sound quality issue; it may also be a safety issue. Think about how important it is to know where warning and safety sounds (sirens, screams, babies crying, etc) are coming from. Using both ears together also impacts how well you hear in noise because binaural hearing permits you to selectively attend to the desired signal, while "squelching" or paying less attention to undesired sounds such as background noise.
Binaural hearing allows a quality of "spaciousness" or "high fidelity" to sounds, which cannot occur with monaural (one ear) listening. Understanding speech clearly, particularly in challenging and noisy situations, is easier while using both ears. Additionally, using two hearing aids allows people to speak with you from either side of your head - not just your "good" side!
People cannot hear well using only one ear. There are studies in the research literature that show that children with one normal ear and one "deaf" ear are ten times more likely to repeat a grade as compared to children with two normally hearing ears. Additionally, we know that if you have two ears with hearing impairment, and you wear only one hearing aid, the unaided ear is likely to lose word recognition ability more quickly than the ear wearing the hearing aid.
There are many styles of hearing aids. The degree of the hearing loss, power and options requirements, manual dexterity abilities, cost factors, and cosmetic concerns are some of the factors that will determine the style the patient will use. The most common styles are listed below:
- ITE: In-The-Ear units are probably the most comfortable, the least expensive and the easiest to operate. They are also the largest of the custom made styles.
- ITC: In-The-Canal units are a little more expensive than ITEs. They require good dexterity to control the volume wheels and other controls on the faceplate, and they are smaller than ITEs.
- MC: Mini-Canals are the size between ITC and CIC. A mini canal is a good choice when you desire the smallest possible hearing aid while still having manual control over the volume wheel and possibly other controls.
- CIC: Completely-In-the-Canal units are the tiniest hearing aids made. They usually require a "removal string" due to their small size and the fact that they fit so deeply into the canal. CICs can be difficult to remove without the pull string. CICs do not usually have manual controls attached to them because they are too small.
- BTE: Behind-The-Ear hearing aids are the largest hearing aids and they are very reliable. BTEs have the most circuit options and they can typically have much more power than any of the custom made in the ear units. BTEs are the units that "sit" on the back of your ear. They are connected to the ear canal via custom-made plastic tubing. The tubing is part of the earmold. The earmold is custom made from an ear impression to perfectly replicate the size and shape of your ear.
Tinnitus is an abnormal perception of a sound which is reported by patients that is unrelated to an external source of stimulation. Tinnitus is a very common disorder. It may be intermittent, constant or fluctuant, mild or severe, and may vary from a low roaring sensation to a high pitched type of sound. It may or may not be associated with a hearing loss. It is also classified further into subjective tinnitus (a noise perceived by the patient alone) or objective (a noise perceived by the patient as well as by another listener). Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. The location of tinnitus may be in the ear(s) and/or in the head.
The term DIGITAL is used so often today, it can be confusing. When the term "digital" is used while referring to hearing aids, it generally means the hearing aid is 100% digital. In other words, the hearing aid is indeed a "complete computer". 100% digital hearing aids have been commercially available since 1996 and are wonders of modern technology. 100% digital hearing aids can process sound using incredibly fast speeds such as 100 to 200 million calculations per second. Interestingly, most 100% digital hearing aids have analog components, such as the microphone and the receiver. 100% digital hearing aids transform analog information into a digital signal and process the sound to maximize the speech information you want to hear, while minimizing the amplification of sounds you do not want to hear.
Digital technology is tremendous and it allows the audiologist maximal control over the sound quality and loudness of the hearing aid. Importantly, digital technology allows the audiologist to tailor or customize the sound of your hearing aids to what you need and want to hear. In summary, if you want the best technology-- get 100% digital hearing aids.
Hearing aid prices vary, depending on many factors. In general, hearing aid costs usually increase with more complex and sophisticated circuitry and smaller size.
Hearing aids vary in price according to style, electronic features, and local market conditions.
Most hearing aid companies will provide a free hearing test. This can take place in the comfort of your home or at a hearing aid center with a friend or family member present and at a time and date of your choosing.
Site and Types of Lesions Producing TinnitusExternal Auditory Canal Lesions
Obstruction of the external auditory canal by wax or other foreign bodies may cause a sensation of fullness in the ear with decreased hearing and when this is present, the patient may experience tinnitus. Usually, this is resolved once the obstruction in the ear canal is removed.Vascular Lesions
The heart's pumping and blood circulation normally are only occasionally heard by the patient in the silence of a sound-proofed room. However, if the sounds are heard constantly, they signal a pathologic condition and acquire the properties of real tinnitus. In these instances, the patient perceives a pulsating noise in synchrony with his or her heart rate. When this is present, it needs to be evaluated thoroughly. Vascular noises usually are caused by turbulences within blood vessels. Narrowing of blood vessels as well as vascular tumors may cause type of tinnitus. In addition, other vascular malformations may result in this type of sound. Since most of the vascular lesions associated with pulsating tinnitus can be cured by surgical therapy and since some of the underlying vascular disorders are potentially dangerous, all cases of pulsating tinnitus must undergo a thorough medical work-up before treatment is considered.Muscular Lesions
Some patients may experience a clicking noise radiating from their ear and this can be heard by another person. This can result in a repetitive type of clicking sound and is due to contractions of a muscle within the middle ear. These are involuntary spasms of one of the two muscles attached to the middle ear bones. There are two muscles in the middle ear: the stapedius attached to the stapes bone (stirrup) and the tensor tympani, attached to the malleus (hammer). These muscles normally contract briefly in response to very loud noise. Spasms of the eustachian tube muscles normally are restricted to one side, resulting in click-like sounds. These contractions do not usually open the eustachian tube, but involve the tensor tympani muscle. Since this muscle attaches to the malleus, it thus directionally pulls at the tympanic membrane. Sometimes one can see the movement of the malleus with the clicking sound when this occurs. On occasion, one or both of these muscles may begin to contact rhythmically for no apparent reason for brief periods of time. Because the muscles are attached to one of the middle ear bones, these contractions may result in repetitive sounds in the ear. This clicking sound, although annoying, is harmless and usually subsides without treatment. Should this muscle spasm continue, medical treatment with muscle relaxants or surgery (cutting the spastic muscle may be necessary).Opening Movements of the Eustachian Tube
Opening the eustachian tube occurs by coordinating action of the two palatal muscles (levator and tensor palatini). The normal action that opens the eustachian tube and causes this are swallowing and yawning. Some patients are bothered by the clicking sound in the ear which accompanies the action of swallowing and some patients can produce these sounds voluntarily and elicit this type of noise.Central Lesions
The hearing nerve has approximately 30 thousand fibers within it. Most of these fibers demonstrate spontaneous activity and certain sound frequencies are associated with certain fibers. It is possible that the alterations in this spontaneous activity may generate tinnitus. It has also been demonstrated that the auditory nerve is covered by myelin, and it is in this area that the nerve is more sensitive to vascular compression by blood vessels in the posterior fossa. It is therefore possible that the tinnitus may be secondary to a vascular compression of the auditory nerve. All the fibers of the auditory nerve end in the cochlear nucleus and each fiber may come in contact with as many as 75 to 100 cells of the nucleus. There is also another pathway which is referred to the efferent pathway which is an inhibitory pathway and may be related to the awareness of tinnitus. Specifically, tinnitus may be perceived because of the inability of the efferent system to suppress the tinnitus.
It has been suggested that even though tinnitus may have originated in the cochlea, retrograde changes may occur within the auditory pathway and the tinnitus then becomes a central phenomenon.Middle Ear Lesions
Any dysfunction of the structure(s) of the middle ear (i.e. tympanic membrane, ossicular chain problems) can result in tinnitus. Acute and long-standing inflammation of the middle ear sometimes will result in tinnitus. Often when the middle ear abnormalities are corrected by surgery, the tinnitus disappears. Sometimes in otosclerosis there is an additional component of tinnitus present, probably of cochlear origin, which is usually not improved by surgery.Cochlear Lesions
The cochlea is probably the most common site in the origin of tinnitus. The inner and outer hair cells are connected to the central auditory pathway by two systems. Afferent fibers carry information from the inner ear to the central nervous system. Efferent fibers from the brain go to the inner ear. It is felt that abnormalities of the hair cells, efferent or afferent fiber pathways may give rise to tinnitus.A Summary of the Causes of Tinnitus
Tinnitus may originate from various lesions and from different sites. The auditory system involves highly complicated inner ear structures, many afferent and efferent nerve pathways and a great amount of nuclei that form a complex meshwork. To pinpoint tinnitus to a certain structure becomes questionable. This is demonstrated by patients who have had intractable tinnitus after having surgery on their ear or incurring severe diseases of the ear. In an attempt to relieve the tinnitus, cutting the auditory nerve has been done and yet the tinnitus was persistent, indicating the site of lesion causing the tinnitus must have shifted into the central nervous system.
Tinnitus could be explained by abnormal neural activity in the auditory nerve fibers, which may occur if there is a partial breakdown of the myelin covering of individual fibers. A defect in the hair cell would trigger the discharge of connected nerve fibers. For chronic cochlear disorders, there may also be increased spontaneous activity in the hair cells and neurons resulting in tinnitus. In the auditory nerve there are two different kinds of afferent fibers: Inner hair cell fibers with large diameters and outer hair cells fibers with small diameters. Thus, loss of signals from the cochlea might trigger tinnitus as a manifestation of a functional imbalance between the two sets of fibers. In addition, other abnormal changes of the cochlear fluids may result in tinnitus.
There is not one type, one site or one origin of tinnitus, but a multitude of types, sites, and origins. It is also unlikely that one hypothesis on the cause of tinnitus could explain all the features.
All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery it is a medical emergency and the individual needs to see a physician immediately.
One question often asked is "How long does the battery last?" Typically they last 7-14 days based on a 16 hour per day use cycle. Batteries are very inexpensive, costing less than a dollar each. Generally, the smaller the battery size, the shorter the battery life. The sizes of hearing aid batteries are listed below along with their standard number and color codes.
- Size 5 RED
- Size 10 (or 230) YELLOW
- Size 13 ORANGE
- Size 312 BROWN
- Size 675 BLUE
Today's hearing aid batteries are "zinc-air." Because the batteries are air-activated, a factory-sealed sticker keeps them "inactive" until you remove the sticker. Once the sticker is removed from the back of the battery, oxygen in the air contacts the zinc within the battery, and the battery is "turned-on". Placing the sticker back on the battery will not prolong its life. Since many of today's automatic hearing aids do no have "off" switches, removing the battery at night assures that the device is turned off. Zinc-air batteries have a "shelf life" of up to three years when stored in a cool, dry environment. Storing zinc-air hearing aids in the refrigerator has no beneficial effect on their shelf life, in fact, quite the opposite may happen. The cold air may actually form little water particles under the sticker. Water is made of oxygen and hydrogen. If the water vapor creeps under the sticker, the oxygen may contact the zinc, and the battery could be totally discharged by the time you peel off the sticker! Therefore, the best place to store batteries is in a cool dry place, like the back of your sock drawer, not the fridge!
An audiologist is a person who has a masters or doctoral degree in audiology. Audiology is the science of hearing. In addition, the audiologist must be licensed or registered by their state (in 47 states) to practice audiology.
In the field of audiology, the master's degree has been the accepted "clinical" degree for almost 50 years. However, the profession is undergoing a transition to a doctorate level degree as the entry-level requirement to practice audiology. In a few years, there will be very few colleges and universities offering a master's program in audiology. The Au.D. (Doctor of Audiology) is the clinical doctorate degree and is issued exclusively by regionally accredited universities and colleges. There are other doctoral degrees that have been earned and utilized by audiologists to date, such as the Ph.D. (still highly sought today by researchers and academicians), the Sc.D. and the Ed.D.
Audiologists work in a variety of settings including hospitals, schools, clinics, universities, rehabilitation facilities, cochlear implant centers, speech and hearing centers, private audiology practices, hearing aid dispensing offices, hearing aid manufacturing facilities, medical centers, as well as otolaryngology (ENT physician) offices. Although the vast majority of hearing problems do not require medical or surgical intervention, audiologists are clinically and academically trained to determine those that do need medical referral. As a licensed healthcare provider, the audiologist appropriately refers patients to physicians when the history, the physical presentation, or the results of the audiometric evaluation (AE) indicate the possibility of a medical or surgical problem. Many audiologists also dispense (sell and service) hearing aids and related assistive listening devices for the telephone, TV and special listening situations.
Otolaryngologists (also called ear-nose-and-throat, or ENT, doctors) are physicians who have advanced training in disorders of the ear, nose, throat and head and neck. Otologists or neurotologists are physicians who in addition to their ENT requirements continue their specialized training for an additional year or more in the diagnosis and treatment of disorders of the ear. Otolaryngologists, neurotologists and otologists are the physicians who typically treat disorders of the ear (or hearing mechanisms) requiring medical or surgical solutions.
HEARING AID SPECIALISTS:
The hearing aid specialist has training in the assessment of patients who specifically seek rehabilitation for hearing loss. The hearing aid specialist is licensed or registered to perform basic hearing tests and can sell and service hearing aids and related products.
There are essentially three levels of hearing aid technology. We refer to these as analog, digitally programmable, and digital.
ANALOG technology is the technology that has been around for many decades. Analog technology is basic technology and offers limited adjustment capability. It is the LEAST expensive.
DIGITALLY PROGRAMMABLE technology is the "middle grade" technology. Digitally programmable units are analog units digitally controlled by the computer in the office to adjust the sounds of the hearing aid.
DIGITAL technology is the most sophisticated hearing aid technology. Digital technology gives the audiologist maximum control over sound quality and sound processing characteristics. There are qualitative indications that digital instruments do outperform digitally programmable and analog hearing aids. Digitals are not perfect, but they are very good. Digital hearing aids have been widely available since 1996.