·How do I know if I have a hearing loss?
Self-screening is a good starting point. Do you have trouble hearing conversations in a noisy environment such as a restaurant or at a cocktail party? During normal conversations at home or on the telephone, do you hear many or most words but miss key terms or phrases? Do people seem to be mumbling much of the time? Do you have trouble distinguishing some words from other, similar-sounding ones? Do you find it easier to understand men’s voices than those of women or children? Do you often ask people to repeat something they’ve just said? Do you have trouble hearing everything that’s said in a movie or on a TV show? Do you have difficulty understanding what you’ve just heard? If you experience any of these difficulties, you may well have a hearing problem—one that can probably be helped.
·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 apparatus. 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 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.
·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.
·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 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 postfitting 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 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 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.
·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.