Hearing Professional Center

WHAT IS AN AUDIOLOGIST?

An audiologist is an individual who has a masters or doctoral degree in audiology. Audiology is the science of hearing. In most states an audiologist must be licensed to practice.

In the past, the master's degree has been the accepted "clinical" degree for audiologist. The profession is undergoing a transition to a doctorate level degree as the entry-level requirement to practice audiology. A master's program in audiology is a thing of the past. The Au.D. (Doctor of Audiology), is the first professional degree in Audiology and is earned exclusively by regionally accredited universities and colleges. Other doctoral degrees that are earned and utilized by audiologists are the Ph.D. (research), the Sc.D. (Science), and the Ed.D (Education).

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, and otolaryngology (ENT) offices. 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.

EAR IMPRESSIONS?

All custom made hearing aids and earmolds are made from a "cast" of the ear. The cast is referred to as an ear impression. The audiologist makes the ear impression in their office. It takes about 10 to 15 minutes. The audiologist places a special cotton or foam dam in the ear canal to protect the eardrum then fills the ear canal with a waxy material. When the material hardens (about 5 to 10 minutes later) the wax cast, along with the dam are removed from the ear canal. Often, the ear canal will be "oily" after the impression is removed. This is normal. The oil comes from the wax material and prevents the wax material from sticking to the skin.

Tell the audiologist before the ear impression is obtained if you are allergic to plastic or dyes!

HOW DO I KNOW IF I HAVE HEARING LOSS?

Hearing loss occurs to most people, 70% 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 were 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 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 for an "audiometric evaluation." An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed audiologist. The AE includes a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. An AE is not just pressing the button when you hear a "beep". The evaluation allows the audiologist to determine the type and degree of your hearing loss, and 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. "Written hearing tests, "dial a hearing test" and other online hearing tests 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.

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.

REALISTIC EXPECTATIONS AND GETTING USED TO HEARING AIDS

REALISTIC EXPECTATIONS:

Hearing aids work very well when fit and adjusted appropriately. They amplify sound! You might find that you like one hearing aid better than the other. The left and right hearing aids will probably not fit exactly the same and they probably won't sound exactly the same. Nonetheless, hearing aids should be comfortable with respect to the physical fit and sound quality. Hearing aids do not restore the hearing to normal and are not as good as normal hearing. You will be aware of the hearing aids in your ears. Until you get used to it, your voice will sound "funny" when you wear hearing aids. Many of today's hearing aids have features that make noisy environments more tolerable; however, hearing aids do not eliminate background noise.

YOUR OWN VOICE:

When you wear hearing aids for the first time, you will probably notice your voice sounds funny! You will hear your voice amplified through the hearing aid. You may describe this sensation as feeling "plugged up" or hearing your voice echoing. This is normal and will usually go away in a few days after you have given yourself a chance to get accustomed to your new hearing aids.There are adjustments that the audiologist can do to relieve these symptoms should they persist beyond the first few days of wearing your new aids.

GETTING USED TO HEARING AIDS:

People adjust at different rates. Some people need a day or two to learn about and adjust to their hearing aids, most need a few weeks and some may need a few months. There is no perfect way to learn about hearing aids. We usually recommend you wear the hearing aids for as long as you are comfortable for the first week. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aids. Eventually you will wear the hearing aids most of your waking hours. It is recommended that you interact with those people you are most familiar with during your first few days. Begin by listening with your hearing aids in a favorable listening environment and work towards more difficult listening situations. Let your friends and family know that you are using your new hearing aids.

Helpful Steps in adjusting to Hearing Aids:
1. Use the aids at first in your own home environment.
2. Wear the aids only as long as you are comfortable with them.
3. Accustom yourself to the use of the aids by listening to just one other person - husband or wife, neighbor or friend.
4. Do not strain to catch every word.
5. Do not be discouraged by the interference of background noises.
6. Practice locating the source of the sound by listening only.
7. Increase your tolerance for loud sounds.
8. Practice learning to discriminate different speech sounds.
9. Listen to something read aloud.
10. Gradually extend the number of persons with whom you talk, still within your own home environment.
11. Gradually increase the number of situations in which you use your hearing aids.
12. Take part in an organized course of aural rehabilitation, see your audiologist to learn about these courses.

PHYSICAL FIT:

One concern with all new hearing aids is the physical fit. Hearing aids need to be comfortable, not too tight and not too loose, they should fit just right. Do not wear the hearing aids if they cause any discomfort or irritations. Call your audiologist to schedule an appointment to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.

WHAT IS TINNITUS

Tinnitus is the perception of sound reported by a patient 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 rare. The location of tinnitus may be in the ear(s) and/or in the head.

TYPES AND DEGREE OF HEARING LOSS

DEGREE OF HEARING LOSS

Results of the audiometric evaluation are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. Frequency, from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) and is described in general categories. Hearing loss is not measured in percentages. The general hearing loss categories used by most hearing professionals are as follows:

_____Normal hearing (0 to 20 dB HL)
_____Mild hearing loss (21 to 40 dB HL)
_____Moderate hearing loss (41 to 70 dB HL)
_____Severe hearing loss (71 to 90 dB HL)
_____Profound hearing loss (greater than 91 dB HL)

TYPES OF HEARING LOSS:

The external and the middle ear conduct and transmit sound; the inner ear receives it. When there is a problem in the external or middle ear, a conductive hearing impairment occurs. When the problem is in the inner ear, a sensorineural or hair cell loss is the result. Difficulty in both the middle and inner ear results in a mixed hearing impairment (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain than the ear, and will be discussed only briefly.

______Conductive hearing loss occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstructions in the ear canal, perforations (hole) in the eardrum membrane, or disease of any of the three middle ear bones, to name a few.

A person with a conductive hearing loss may notice that their ears may seem to be full or plugged. This person may speak softly because they hear their own voice quite loudly. Crunchy foods, such as celery or carrots, sound very loud and this person may have to stop chewing to hear what is being said. All conductive hearing losses should be evaluated by an audiologist and a physician to explore medical and surgical options.

______Sensorineural hearing loss is the most common type of hearing loss. More than 90 percent of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. Sensorineural hearing loss is also called "cochlear loss," an "inner ear loss" and is also commonly called "nerve loss." Years ago, many professionals said there was nothing that could be done for sensorineural hearing loss - that is totally incorrect today. There are many excellent options for the patient with sensorineural hearing loss.

A person with a sensorineural hearing loss may report that they can hear people talking, but they can't understand what they are saying. An overall increase in the loudness may only add to their confusion. This person will usually hear better in quiet places and may have difficulty understanding what is said over the telephone.

______Central hearing impairment occurs when auditory centers of the brain are affected by injury, disease, tumor, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although understanding of speech may be affected. Certainly both loudness and clarity may be affected too.

WHAT ARE ASSISTIVE LISTENING DEVICES (ALDs)?

Assistive Listening Devices (ALDs) are devices created to be used to improve a person’s ability to hear and/or communicate in very specific situations. Some ALDs are used in conjunction with hearing aids and some are not. The goal of ALDs is to emphasize what you want to hear. There are various types of technologies used for ALDs, which include FM systems, infrared systems, induction loop systems, personal microphones, phone amplifiers, and paging systems. Alerting devices are also available to alert someone who is hearing impaired when a sound is made. These devices use flashing lights, strobe lights or vibration. Examples of alerters include doorbell signalers, telephone ring signalers, fire/smoke alarms, carbon monoxide alarms, signalers for baby cries, vibrating clock alarms, etc. Visual devices that translate spoken speech into text are also available, such as text phones, closed-captioning, and computer speech recognition software. Both people with normal hearing ability and individuals with varying degrees of hearing loss can benefit from the use of ALDs. Discuss your hearing needs with your audiologist to find out which ALD is appropriate for you.

For more information on the types of ALDs we have available, go to Services and click on Assistive Listening Devices.

WHAT TYPES OF ALDs EXIST?

There are many assistive listening devices available today, from sophisticated systems used in theaters and auditoriums to small personal systems.

Various kinds of assistive listening devices are listed below:

Personal Listening Systems: There are several types of personal listening systems available. All are designed to carry sound from the speaker (or other source) directly to the listener and to minimize or eliminate environmental noises. Some of these systems, such as auditory trainers, are designed for classroom or small group use. Others, such as personal FM systems and personal amplifiers, are especially helpful for one-to-one conversations in places such as automobiles, meeting rooms, and restaurants.

TV Listening Systems: These are designed for listening to TV, radio, or stereos without interference from surrounding noise or the need to use very high volume. Models are available for use with or without hearing aids. TV listening systems allow the family to set the volume of the TV, while the user adjusts only the volume of his or her own listening system.

Direct Audio Input Hearing Aids: These are hearing aids with direct audio input connections (usually wires) which can be connected to the TV, stereo, tape, and/or radio as well as to microphones, auditory trainers, personal FM systems and other assistive devices.

Telephone Amplifying Devices: Most standard telephone receivers are useful with hearing aids. These phones are called " hearing aid compatible." The option on the hearing aid is called the T-Coil. The T-coil is automatically activated on some hearing aids and manually activated on others. Basically, the telephone and the hearing aid's T-coil communicate with each other electromagnetically, allowing the hearing aid to be used at a comfortable volume without feedback and with minimal background noise. Hearing-aid-compatible phones are readily available in almost all retail stores that sell telephones. Not all hearing aids have a T-coil. Make sure your hearing aids have a T-coil before purchasing a new hearing aid compatible phone! There are literally dozens of T-coil and telephone coupling systems. Speak with your audiologist to get the most appropriate system for your needs.

Cell Phones: Most hearing aids can be used with most cell phones. Importantly, digital hearing aids and digital phones may create constant noise or distortion. There may be significant problems for some hearing aids when used with particular cell phones! The best person to address this problem is your audiologist - speak with your audiologist BEFORE you buy a cell phone or hearing aids!!!!

Regarding "hands free" systems, there are many to choose from and hearing impaired users usually benefit maximally by using binaural hands free systems.

For more information on the types of ALDs we sell, go to Services and click on Assistive Listening Devices.

HEARING AID STYLES

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 and they are smaller than ITEs.

MC: Mini-Canals are a size between ITC and CIC. A mini canal is a good choice when you desire the smallest possible hearing aid yet your ear canal is too small to accommodate the entire instrument.

CIC: Completely-In-the-Canal units are the tiniest hearing aids made. They usually require a "removal line" due to their small size and the fact that they fit so deeply into the canal. CICs can be difficult to remove without the line.

BTE: Behind-The-Ear hearing aids are the largest and most reliable hearing aids available. Wax and moisture are less problematic. BTEs are the units that "sit" on the back of your ear. The sound is directed into the ear canal using various coupling devices. Some are over the counter, others are custom made: all are dependant on your needs, hearing loss and environment.