- How much will hearing aids really help my hearing?
- What kinds of hearing aids are there? Aren't they pretty bulky and unsightly?
- If I need a hearing aid, do I have
to get one for each ear?
- What can I expect if I schedule an appointment with Dr. Crosby?
- If I visit your clinic, do I get a free hearing test?
- What exactly is a "hearing health professional"?
- What should I do if I think I have a hearing problem?
- Are there different kinds of hearing loss?
- What is an Audiologist?
- What Types of Tests and Treatments do Audiologists Perform?
- How Do I Know if I Have Hearing Loss?
- What Causes Hearing Loss?
- How is Hearing Loss Diagnosed?
- What Are The Different Degrees of Hearing Loss?
- What are the Different
Types of Hearing Loss?
- What are the Signs of Hearing loss in Children?
- What Style of Hearing Aid Do I Need?
- What are Assistive Listening Devices (ALDs)?
- What is Tinnitus?
- What Causes Tinnitus?
- How is Tinnitus Treated?
- Audiologist versus Hearing Aid Dispenser
How much will hearing aids really help my hearing?
Hearing aids are intended to compensate for sensorineural hearing loss. They do so by amplifying sounds selectively at those frequencies where your hair cells have failed to vibrate or do so poorly— because the hair cells have either died or are damaged. Because of this underlying physiological failure, hearing aids cannot return your hearing to completely normal, but they can significantly help most people. You will need a period of time to get used to them, just as you would for contact lenses or a new pair of shoes. But thereafter you’ll likely find you’re enjoying social functions, movies, television, and music ever so much more . . . because you can hear again.
What kinds of hearing aids are there? Aren't they pretty bulky and unsightly?
There are five main types of hearing aids these days, and the advent of microtechnology has made them much smaller yet more reliable than ever before. (1) Behind-the-Ear (BTE) hearing aids are tucked behind the outer ear (pinna) and almost invisibly connected to an earmold placed in your ear canal. This earmold is custom-made to replicate exactly the shape of your ear canal where it is located. BTE’s offer the most power and usually the most options of all the units. (2) In-the-Ear (ITE) hearing aids are placed in the outer ear and partly in the ear canal. They are comfortable, relatively inexpensive and easy to operate, although they are larger than other types of units. (3) In-the-Canal (ITC) hearing aids are smaller than ITE’s but require some dexterity in manipulating the volume wheel. (4) Completely in-the-Canal (CIC) units are the smallest hearing aids made and are inserted deep into the ear canal. They have a small, thin string attached to them to enable removal. Because they are so small and inaccessible, they have no manual controls. (5) Open ear products are an improvement over some of the other units, because they are lightweight, easily inserted and removed, and nearly invisible. They are similar to BTE’s but have no earmold. Instead, the signal processor behind the ear transmits sound by means of a transparent tube directly into the ear. Other sounds enter or leave the ear naturally. These units virtually eliminate feedback and distortion, two problems sometimes encountered with the other types of hearing aids. However, they do not currently generate the power to help persons with extensive hearing loss. Rarely, some patients can be helped with a cochlear implant, which is surgically inserted deep within the inner ear, but these units are beyond the scope of this discussion.
All five types of hearing aids use digital technology, although for profound hearing loss, some aids still employ analog features. The type of hearing aid you may be fitted for will depend upon the nature and degree of your hearing loss, but in most cases it will be virtually unnoticeable.
If I need a hearing aid, do I have to get one for each ear?
If you have a hearing loss in only one ear, you’ll only need a hearing aid for that ear. But most people have bilateral hearing loss—i.e., loss in both ears—and can benefit more from wearing a hearing aid in each ear. A single hearing aid for bilateral hearing loss will, in fact, improve your hearing, but it will be like having a monocle for poor eyesight—you could do much better with two. Not only will you discriminate speech and music better, but you will also be far better able to distinguish the direction from which the sound is coming—an important consideration if someone is honking his automobile horn or shouting a warning at you.
What can I expect if I schedule an appointment with Dr. Crosby?
First, a thorough hearing history will be taken. Next, a physical examination of your ears will be done, and you will take a complete hearing test—including tympanometry to evaluate the status of your middle ear and audiometric reflex testing to determine more definitvely what type of hearing loss you have. Audiometric evaluation of your hearing in each ear will generate an audiogram, a graphic depiction of your hearing performance over a wide range of frequencies. If you have a hearing loss that cannot be corrected except by medication or surgery, or if your symptoms and test results indicate other, more serious problems, Dr. Crosby will refer you to a physician in the proper specialty for dealing with your particular problem. If you have a hearing loss that can best be helped by hearing aids, she will make a comprehensive assessment of how your particular hearing loss, lifestyle issues, physical limitations (if any), financial considerations, and cosmetic concerns will affect the choice of hearing aid best suited for your needs. Thereafter, once you choose a hearing aid, you will have a 60-day trial period in which to wear the instrument and come to the clinic for FREE servicing and adjustment. If you are not satisfied with your hearing aids, you may return them within the trial period and obtain a refund for all but the testing and fitting charges. Once you have purchased your hearing aids, Dr. Crosby is available for post fitting tests to assess your hearing gains and discuss any needs for additional therapy, including “brain training” to improve speech discrimination and assistive listening devices such as TV ears and special telephones.
If I visit your clinic, do I get a free hearing test?
If you visit your family doctor, do you have to pay for any testing he or she does? Some hearing health specialists advertise that they’re offering a “free hearing test”—but this test usually does not begin to match the extensive evaluation an audiologist can offer a patient (see below), using high-tech equipment and a soundproof testing room. Just as there’s a huge difference between reading an eye chart and getting a full medical eye exam, there’s a huge difference between the usual “free hearing test” and a thorough audiologic examination, which may cost in the range of $125.
But here’s the good news: If you have Medicare coverage, most or all of the cost of an extensive audiologic evaluation may be paid by Medicare. If you have opted out of Medicare and have a so-called “Advantage” plan (HMO or PPO), check with your plan administrator to determine if your test costs will be covered.
What exactly is a "hearing health professional"?
A hearing health professional is someone trained and certified by a medical association and/or a state licensing board to evaluate your hearing and to offer some—but not necessarily all—of the treatment options designed to improve your hearing. An otologist or otorhinolaryngologist is a medical doctor specializing in ear or ear/nose/throat medicine, respectively, who can determine the extent of your hearing loss and offer treatment for those conditions that require medication or surgery (conductive hearing loss) or sensorineural therapy.
An audiologist is someone specifically trained to evaluate the nature and extent of your hearing loss. Audiologists typically have a postgraduate degree beyond the college level and have passed rigorous certification tests by their professional organization and state licensing board. Some have doctorate-level degrees in clinical audiology. Audiologists can treat sensorineural problems by fitting hearing aids customized to amplify sounds at the frequencies where your hearing loss is greatest. They can also treat other hearing problems such as tinnitus (ringing or buzzing in the ears) and cerumen (wax) buildup, and they may offer other services such as “brain training” to improve auditory discrimination, audiometric reflex testing; tympanometry, and noise protection to prevent further damage to the cilia in your inner ear.
A licensed hearing aid specialist is someone trained to do hearing evaluations and to fit or custom-fit hearing aids. There is no postgraduate degree requirement for this position (though many specialists may have a graduate or postgraduate degree), but there are certification and licensing tests to be met, and there are professional associations concerned with maintaining high standards of performance and service. Some hearing aid specialists are employed by, or have exclusive arrangements with, specific hearing aid manufacturers to fit customers with only that brand of hearing aid. Others may work independently and will be able to offer customers a choice of hearing aids from several manufacturers. Most hearing aid specialists do not go beyond fitting and servicing hearing aids, offering assistive listening devices, and selling batteries and noise protection equipment.
What should I do if I think I have a hearing problem?
You can call your doctor or make an appointment to see him or her and obtain a referral to a qualified hearing health professional who can make a determination as to (1) what type of hearing loss you have, if any, (2) how severe it is, and (3) what treatment options are available.
Are there different kinds of hearing loss?
Yes. Broadly speaking, there are three different kinds of hearing loss, which affect three different parts of your hearing. Conductive hearing loss affects the ear canal and/or the mechanical parts of your hearing organ—your ear drum and the three small bones, or ossicles (hammer, anvil and stapes), which transmit sound to your inner ear. It can be caused by mechanical blockage, disease, breakdown of the ossicles, or puncture of the eardrum. Such hearing loss is not necessarily permanent and can often be treated by medication or surgery. Sensorineural hearing loss affects the cochlea, a fluid-filled coil in your inner ear resembling a seashell, which contains hair cells (cilia) that convert the mechanically conveyed sound from the ossicles to electrical impulses that are passed along the auditory nerve to your brain. Usually the cilia are damaged or die from disease, frequent exposure to high levels of noise, trauma, or simply as a result of aging.This hearing loss, by far the most common type, is permanent and cannot be corrected by medical or surgical means. But sensorineural hearing problems can be greatly helped by the proper fitting of hearing aids and the use of assistive listening devices. CNS (central nervous system) hearing loss results from damage to the auditory nerve or to the temporal lobe in the brain by disease, trauma, or certain types of brain tumor. These problems must be referred to an otologist or a neurologist for evaluation and treatment. Finally, some hearing losses may result from a combination of the factors identified above.
What is an Audiologist?
Audiologists are healthcare professionals who evaluate, diagnose, treat, and manage hearing loss and hearing conditions like tinnitus and balance disorders. An audiologist holds a minimum of a Master's degree in Audiology. Professionals seeking education in Audiology who do not currently hold a Master’s degree must now pursue a Doctoral degree in Audiology (Au.D). Audiologists must be licensed in the state where they practice, and are regulated by the Division of Consumer Affairs.
An audiologist may be awarded the Certificate of Clinical Competence in Audiology by the American Speech-Language-Hearing Association (ASHA), otherwise known as the CCC-A. With additional training and expertise, the audiologist may receive the honor of Fellow, which is bestowed by the American Academy of Audiology (AAA).
What Types of Tests and Treatments do Audiologists Perform?
Common services and treatments provided by an audiologist include:
- Diagnostic hearing tests and evaluations
- Audiologic evaluations
- Hearing aid fitting and consultation
- Hearing aid repairs and maintenance
- Pediatric hearing loss detection and treatment
- Hearing conservation and protection programs
- Earmold and earplug fitting and consultation
- Musicians earplugs and monitors
- Tinnitus treatment programs
- Dizziness and balance testing and treatment
- Ear or hearing-related surgical monitoring in hospital settings
- Hearing rehabilitation and auditory training
- Assisting in cochlear implant programs
- Insurance billing for medically necessary diagnostic testing and hearing aids, when patients have policies that cover these benefits
How Do I Know if I Have Hearing Loss?
If you think you or a loved one may have hearing loss, you are not alone. Oftentimes people notice signs of hearing loss but do not take the steps to get it treated right away. Typically, it takes people an average of seven years to seek treatment. 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.
- You miss environmental sounds such as birds or leaves blowing.
- You find yourself avoiding certain restaurants because they are too noisy, or certain people, because you cannot understand them.
- You hear a ringing sound in your ears, especially when it is quiet.
What Causes Hearing Loss?
Hearing loss can be due to several factors such as the aging process, exposure to loud noise, medications, infections, head or ear trauma, congenital (birth) or genetic factors, diseases, as well as a number of other causes. Recent data shows that about 20 percent of adults in the United States (48 million) report some degree of hearing loss. Hearing loss often occurs gradually throughout a lifetime.
How is Hearing Loss Diagnosed?
If you have any symptoms of hearing loss, you should see an audiologist to have a formal hearing evaluation. This hearing test, or audiologic evaluation, is diagnostic in nature and allows the audiologist to determine the type, nature and degree of your hearing loss. Your sensitivity, acuity and accuracy to speech understanding will be assessed as well. Your audiologist may also test for speech understanding at different volume levels and in different conditions, such as noise, to provide an indication as to how successful of a candidate you will be for hearing aids.
The hearing evaluation will also include a thorough case history and a visual inspection of the ear canal and eardrum. Additional tests of middle ear function may also be performed. The results of the evaluation can be useful to a physician, if the audiologist believes your hearing loss may benefit from medical intervention.
Results of the hearing evaluation are plotted on a graph called an audiogram. The audiogram provides a visual view of your hearing test results across various pitches or frequencies, especially the ones necessary for understanding speech.
The audiogram and results from your speech understanding tests are used to create a prescription by which hearing aids are programmed, if necessary.
What are the Different Degrees of Hearing Loss?
After you undergo a hearing evaluation, the results are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. The top of the graph is very quiet and the bottom of the graph is very loud. Frequency, or pitch, from low to high, is plotted from left to right. Hearing level (HL) is measured in decibels (dB) and is described in general categories, not by percentages. The general hearing loss categories used by most hearing professionals are as follows:
- Normal hearing (0 to 25 dB HL)
- Mild hearing loss (26 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)
What are the Different Types of Hearing Loss?
There are four types of hearing loss:
1. Sensorineural hearing loss: When the problem is in the inner ear, a sensorineural hearing loss is the result. This commonly occurs from damage to the small hair cells, or nerve fibers, in the organ of hearing. Sensorineural hearing loss is the most common type of hearing loss and accounts for more than 90 percent of hearing loss in all hearing aid wearers. The most common causes of this hearing loss are age-related changes and noise exposure. Loss may also result from disturbance of inner ear circulation, increased inner ear fluid pressure, or from disturbances of nerve transmission. There are many excellent options for the patient with sensorineural hearing loss.
2. Conductive hearing loss: When there is a problem in the external or middle ear, a conductive hearing impairment occurs. 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, obstruction of the ear canal, perforation (hole) in the eardrum membrane, or disease of any of the three middle ear bones. All conductive hearing losses should be evaluated by a physician to explore medical and surgical options.
3. Mixed hearing loss - When there are problems in the middle and inner ear, a mixed hearing impairment is the result (i.e. conductive and a sensorineural impairment).
4. Auditory neuropathy spectrum disorder (ANSD): The least common hearing impairment is ANSD. This type of loss requires more in-depth diagnostic testing, including a hearing evaluation with pure tones, otoacoustic emissions (OAEs) and auditory brainstem response (ABR) testing. In this type of hearing loss, the nerve fibers in the organ of hearing typically appear to be functioning well, but a breakdown of the information occurs along the pathway to the brain. A person may still have normal hearing to sounds, but the sound is not encoded properly at the brain. This type of hearing disorder is diagnosed more often in children, due in part to newborn hearing screenings that use automated ABR equipment and routine speech screenings by pediatricians and school systems, but can be present in adults as well.
What are the Signs of Hearing loss in Children?
Hearing loss in children can occur at any time in life from other acquired factors such as ear infections, head trauma, certain medications, and genetic factors. You may suspect your child has a hearing loss if you observe any of the following:
- Failed newborn hearing screening
- Delays in speech and language acquisition, including baby babbling
- Frequent ear infections
- Not startling to loud sounds
- Not turning to the location of sounds after six months of age
- Difficulty following verbal directions
- Daydreaming in many situations
- Concerns by school teachers or failed school hearing screening
- Loud volume on the TV or radio
- Complaints from the child that they cannot hear
A pediatric audiologist is trained to test children of all ages. Any symptom of hearing loss in children should be addressed promptly so that speech, language and academic development are not delayed or impacted.
What Style of Hearing Aid Do I Need?
There are many types of hearing aids today, and the style or device is dependent upon the user's individual needs. There are in-the-ear styles as well as behind-the-ear styles. Also, hearing aid technology has advanced, with many new and improved options from which to choose.
Hearing aids are available in many different sizes and styles, thanks to advancements in digital technology and miniaturization of the internal components. Many of today's hearing aids are considered sleek, compact, and innovative - offering solutions to a wide range of hearing aid users. When selecting a style of hearing aid, the following should be considered:
- The type/degree of the hearing loss
- Power requirements
- Manual dexterity and visual abilities
- Cosmetics and aesthetics
- Skin sensitivities
- Anatomical and medical considerations
What are Assistive Listening Devices (ALDs)?
People with all types and degrees of hearing loss can benefit from an assistive listening device (ALD). Since the microphone of a typical hearing aid is worn on or behind your ear, its ability to enhance the talker-to-background-noise ratio is limited. However, ALDs are designed to increase the loudness of a desired voice, such as a radio, television, or a public speaker, without increasing the background noise. This is because the microphone of the assistive listening device is placed close to the talker or device of interest, while the microphone of the hearing aid is always close to the listener.
ALDs include alarm clocks, TV listening systems, telephone amplifying devices, and auditorium-type assistive listening systems. Many newer devices are small, wireless, and compatible with a person’s digital hearing aids. Alarms and other home ALDs may be small devices that are placed discreetly on tables, next to the TV, or on the wall.
What is Tinnitus?
Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus, often called head noise, is not a disease, but a symptom of another underlying condition of the ear, auditory nerve, or elsewhere. Tinnitus can be intermittent or constant, with single or multiple tones. Its perceived volume can range from very soft to extremely loud.
What Causes Tinnitus?
The exact cause of tinnitus is not known in every case. However, there are several likely factors which may cause tinnitus or make existing head noise worse. These include:
- Noise-induced hearing loss
- Wax build-up in the ear canal
- Certain medications
- Ear or sinus infections
- Age-related hearing loss
- Ear diseases and disorders
- Jaw misalignment
- Cardiovascular disease
- Certain types of tumors
- Thyroid disorders
- Head and neck trauma
How is Tinnitus Treated?
Generally, most patients will not need any medical treatment for tinnitus. There are several treatments and measures to help with the management of tinnitus including:
- Listening to a fan or radio
- Tinnitus-masking devices
- Biofeedback training
- Avoidance measures
- Avoidance of certain medications
- Hearing aids, if the listener also has a hearing loss
If these measures do not work, there are several medications that have been utilized to suppress tinnitus. Some patients benefit with these drugs and others do not. Each patient has an individual response to medication, and what works for one patient may not work for another.
Audiologist versus Hearing Aid Dispenser: What is the difference?
There are vast differences in the professional roles in diagnosing and treatment of hearing loss. It is still common today for someone to get screened, tested, or fitted with a hearing aid by someone and still not know what qualifications that person had. How do you know who you can trust? An important distinction to understand when treating your hearing loss is the difference between an Audiologist and a hearing aid dispenser. An Audiologist is a Doctor of Audiology who is extensively trained in the science of hearing; while a hearing aid dispenser applies for a license after meeting some basic requirements (see below).
Audiologist: An Audiologist is trained to diagnose, treat and monitor disorders of the hearing and balance system. They are trained in anatomy and physiology, amplification devices, cochlear implants, electrophysiology, acoustics, psychophysics and auditory rehabilitation. Doctors of Audiology complete, at a minimum, an undergraduate and doctoral level degree in audiology, as well as a supervised externship prior to state licensure and national certification. This usually requires 8 years of post-secondary education (4 years of college and 4 years of graduate school). The graduate school years focus on the medical, diagnostic and rehabilitative aspects of hearing loss, hearing aids and the vestibular system. Upon completion of training, Audiologists must also pass a national standardized examination in order to be eligible for state licensure. Continuing education requirements must be met in order for an Audiologist to maintain state licensure.
Hearing Aid Dispenser: A hearing aid dispenser is licensed to perform audiometric testing for the sole purpose of selling and fitting hearing aids. In order to obtain a license, hearing aid dispensers are required to pass an exam. Prior to taking the exam, certain requirements must be met, which vary from state to state. In many states, hearing aid dispensers are only required to have a high school diploma. In other states, hearing aid dispensers must complete two years of college or post-secondary education in any field prior to applying for licensure. Some states require completion of distance learning coursework prior to taking the exam.
In summary, the requirement for state licensure to dispense hearing aids is based on the minimum education necessary to protect the health, safety and welfare of the patient. The differences in education required for Audiologists versus hearing aid dispensers reflect the significantly larger range of professional practices that Audiologists are permitted to engage in.
Audiologists are highly trained degree professionals. Audiologists receive extensive training in assessment of hearing, diagnosis, fitting and adjustment of hearing aids that helps to ensure:
- An accurate diagnosis;
- An appropriate treatment plan of intervention;
- A positive outcome from the hearing aid.