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This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

Hearing Issues & Answers

Hearing, Hearing Loss and Hearing Aids: Issues and AnswersDr. Douglas L. Beck , Audiologist, Editor-In-Chief, Healthy Hearing Website

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.

HOW DO I KNOW IF I HAVE HEARING LOSS?

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.

AUDIOLOGIST:
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 listeningsituations.

PHYSICIANS:

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.

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 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)

TYPES OF HEARING LOSS:

The external and the middle ear conduct and transform 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.

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 increase in the loudness of speech 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, also thought of as the “clarity” of speech may be affected. Certainly both loudness and clarity may be affected too.

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 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.

BTEs: 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.

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 or hearing aid dispenser makes the ear impression in the 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, and then a waxy material is placed in the ear canal. 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!

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 normal hearing 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. Hearing aids should not to be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable, however, hearing aids cannot eliminate background noise.

THREE LEVELS OF HEARING AID TECHNOLOGY:

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.

DIGITAL HEARING AIDS:

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.

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 and learned to adjust the volume control. There are adjustments that the audiologist can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.

GETTING — USED TO HEARING AIDS:

People learn 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. I usually recommend you wear the hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aid. 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. Start off 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 to Learning to Use a Hearing Aid:
# Use the aid at first in your own home environment.

# Wear the aid only as long as you are comfortable with it.

# Accustom yourself to the use of the aid by listening to just one other person – husband or wife, neighbor or friend.

# Do not strain to catch every word.

# Do not be discouraged by the interference of background noises.

# Practice locating the source of the sound by listening only.

# Increase your tolerance for loud sounds.

# Practice learning to discriminate different speech sounds.

# Listen to something read aloud.

# Gradually extend the number of persons with whom you talk, still within your own home environment.

# Gradually increase the number of situations in which you use your hearing aid.

# Take part in an organized course of aural rehabilitation, see your audiologist to learn about these courses.

HEARING and VISION and COMMUNICATION:

To maximally communicate, you need to use hearing from both ears (binaural hearing) and you need to use your eyes and ears together. You will not communicate well using your hearing aids alone. To facilitate optimal communication, you will need to pay attention to the speaker’s gestures and facial expressions! To maximize communication remember to watch the person speaking, reduce the distance between the speaker and the listener, reduce or eliminate background noises from the listening environment and use good lighting. If someone is speaking to you from across the room, while the TV is on, while doing the dishes, it will be very difficult to adequately communicate, despite fantastic hearing aids!

BINAURAL HEARING: DO I NEED TWO HEARING AIDS?

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.

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. Do call your audiologist to schedule an appointment time to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.

BACKGROUND NOISE:

Virtually all patients wearing hearing aids complain about background noise at one time or another. There is no way to completely eliminate background noise.

Remember, when you had normal hearing there were still times when background noise was a problem. It is no different now, even with properly fit hearing aids! The good news is there are circuits and features that help to reduce (or minimize) background noise and other unwanted sounds. In fact, there are research findings that demonstrate digital hearing aids with particular circuit and microphone options can effectively reduce background noises. Please speak with your audiologist about this.

Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter, however, not only was the background noise made quieter, but so too, was the signal (the speech sound).

Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.

The best and most efficient way to eliminate or reduce background noise is through the use of FM technology. Please speak with your audiologist about this.

MAINTENANCE:

More than 75 percent of all hearing aid repairs are due to moisture and earwax accumulating in the hearing aid. The vast majority of these repairs are 100 percent preventable. It is extremely important to clean the entire hearing aid every time it is removed from your ear by wiping and brushing it. To better protect your investment, use a DRY-AID kit every night! Electronic dry-aid kits are the best. They include a germicidal light that kills most bacteria and other germs. They also have desiccants to absorb moisture and fans to circulate air around the internal components of the hearing aid. Get in the habit of cleaning the hearing aid after each use and keeping the hearing aid in the dry-aid kit at night. The hearing aid is electronic and moisture is the enemy! Preventive maintenance is the key to trouble free, long life from a hearing aid. A well maintained hearing aid can easily last 5 to 7 years, maybe longer.

For more information on hearing aids please visit the following:

Siemens_Hearing_Instruments
Oticon
Sonic_Innovations
GN_ReSound
Starkey
Phonak
Beltone

HEARNG AID BATTERIES:

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!

For More Information on Hearing Aid Batteries CLICK HERE.

WHAT ARE ASSISTIVE LITSENING DEVICES (ALDs)?

You may have certain communication needs that cannot be solved by the use of hearing aids alone. These situations may involve the use of the telephone, radio, television, and the inability to hear the door chime, telephone bell, and alarm clock. Special devices have been developed to solve these problems. Like hearing aids, assistive listening devices make sounds louder. Typically, a hearing aid makes all sounds in the environment louder. Assistive listening devices can increase the loudness of a desired sound (a radio or television, a public speaker, an actor, someone talking in a noisy place) without increasing the loudness of the background noises. This is because the microphone of the assistive listening device is placed close to the speaker, while the microphone of the hearing aid is always close to the listener.

ARE ALDs ONLY FOR PEOPLE USING HEARING AIDS?

No. People with all degrees and types of hearing loss — even people with normal hearing can benefit from assistive listening devices. Some assistive listening devices are used with hearing aids; some are used without hearing aids.

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, but not all, 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 aids 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. You should be able to get hearing-aid-compatible phones from your telephone company or almost any retail store that sells telephones. Not all hearing aids have a “T” switch. Make sure your hearing aids have a T switch 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.

WHAT IS TINNITUS?

Tinnitus is the term for the perception of sound when no external sound is present. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus can be intermittent or constant, with single or multiple tones. Its’ perceived volume can range from very soft to extremely loud.

HOW MANY PEOPLE HAVE TINNITUS?

50 million Americans experience tinnitus to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, they cannot function on a “normal,” day-to-day basis.

WHAT CA– USES TINNITUS?

The exact cause (or causes) of tinnitus is not known in every case. There are, however, several likely factors which may cause tinnitus or make existing tinnitus worse: 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 and many others. Of these factors, exposure to loud noises and hearing loss are the most probable causes of tinnitus. I strongly recommend that an audiologist and a physician should evaluate all presentations of tinnitus.

TINNITUS MANAGEMENT and TREATMENT?

There are many options for people who experience tinnitus. Some wear hearing aids to help cover up their tinnitus, some wear tinnitus maskers. Additionally, there are combined tinnitus maskers and hearing aids  all in one unit! Some patients require counseling to help them develop strategies to manage their tinnitus. If you’ve been told “learn to live with it,” there are many additional options to explore. Your audiologist is an excellent resource for issues and answers related to tinnitus. Additionally, I recommend that all people with tinnitus visit the American Tinnitus Association website for more information, ideas and strategies concerning tinnitus. http://www.ata.org/

MIDDLE EAR IMPLANTS:

Middle ear implants are surgically implanted devices. The FDA has approved specific middle ear implants and the FDA is still reviewing others. The middle ear implant is a useful hearing instrument and is quite different from traditional hearing aids. Generally speaking, hearing aids reproduce sounds and make them louder than the original sound. When a hearing aid is placed in the ear canal, the loud sound is perceived by the hearing impaired ear. Middle ear implants work by vibrating the middle ear bones, rather than by producing audible sound.

Therefore, middle ear implants are less likely to produce feedback, and they do not occlude, or “plug up” the ear canal. Additionally, for most people wearing middle ear implants, their hair tends to cover up the external device.

In summary, the reported benefits of middle ear implants are elimination of the occlusion effect, elimination/reduction of feedback, reduction in distortion, improved clarity, as well as some cosmetic advantages.

Middle ear implants are an excellent alternative for people with moderate to severe sensorineural hearing loss, after they have tried traditional hearing aids for a few months and after they have determined that traditional hearing aids are not able to provide the desired benefit.

If you are considering a middle ear implant, speak with your audiologist. Your audiologist can direct you to an otolaryngologist, otologist or neurotologist with experience and expertise in implanting these devices.

Not all patients are surgical candidates, and each candidate does not receive the same benefit. Nonetheless, middle ear implants are an option, and are worthy of further consideration for appropriate patients. Again, the best source for initial information on this topic is your audiologist.

For more information on middle ear implants, CLICK HERE.

COCHLEAR IMPLANTS:

Generally speaking, cochlear implants are for patients with severe-to-profound, sensorineural hearing loss. There are approximately 500,000 patients in the USA with severe-to-profound hearing loss. Cochlear implants are only recommended after the patient has tried the most powerful and most appropriately fit hearing aids, and has not shown sufficient benefit from hearing aids. Cochlear implants are devices that are “permanently” surgically implanted into the inner ear.

Cochlear implantation is a surgical procedure performed by otolaryngology surgeons. Cochlear implants have been FDA approved for almost two decades and the advances and improvements in the technology have been amazing. The Food and Drug Association (FDA) and the American Medical Association (AMA) recognize cochlear implants as safe and effective treatment for severe-to-profound sensorineural hearing loss. Most insurance programs pay (at least partly) for cochlear implantation. Your audiologist, your otolaryngology surgeon and their appropriate office staff are experienced at managing insurance issues.

Appropriately identified adults as well as profoundly deaf children (starting at age 12 months) can be implanted. Research demonstrates that the earlier a deaf child is implanted, the better the long term result will be with respect to speech and language development. Following surgery, rehabilitation is necessary, as the child must learn to associate the sound signals with normal sounds. Regarding deaf adults, research suggests that adults who receive cochlear implants are less lonely, have less social anxiety, are more independent, have increased social and interpersonal skills, and of course, they hear better with the cochlear implant!

Cochlear implants are utilized in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the nonfunctional inner ear and converts sound into electrical impulses that directly stimulate the cochlear nerve. The implant consists of an external portion comprised of a microphone, sound processor, and external coil and an internal portion that must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and stimulating electrode array, which is inserted into the cochlea or inner ear. The electrical signals are manipulated and controlled by the audiologist to maximize speech perception. The brain interprets these electrical impulses as sound. Again, not all patients are surgical candidates, and not all cochlear implant recipients receive the same benefit.

It is important to remember that the vast majority of the patients who receive cochlear implants are actually “deaf” prior to implantation, and they have not been successful with traditional hearing aids. Your audiologist is a very knowledgeable resource in regards to cochlear implants and will be happy to discuss them with you.

For more information on cochlear implants please visit the following:
Advanced Bionics
MED EL and
Cochlear.

RECOMMENDTAIONS and WARNINGS:

Please review this information with your spouse or loved ones and please feel free to discuss all of these issues with your audiologist and/or your physician.

Federal regulation prohibits any hearing aid sale unless the buyer has first received a medical evaluation from a licensed physician. However, if you are at least 18 years old, you can sign a form (waiver) that says you are fully aware of your rights but choose not to have the medical evaluation. Then, you can purchase hearing aids without seeing a physician. For people under 18 years of age, waiver of the medical evaluation is not permitted. These rules and regulations may vary state-by-state and you certainly need to check with your state rules, regulations and laws. I do not recommend using waivers.

I believe your best health interest is served by seeing a licensed audiologist for a complete audiometric evaluation and seeing an otolaryngologist for the medical and/or surgical diagnosis and treatment of all ear and hearing disorders and diseases.

The opinions throughout this article are those of the author. Other audiologists and otolaryngologists may have different opinions and recommendations. Additionally, each patient and each hearing problem is unique. “Self-diagnosis” and treatment is unwise, is not recommended and may indeed lead to a worsening situation.

Some state associations, national associations and indeed many state and federal rules and regulations vary from location-to-location and they change over time. Therefore, it is very important for you to check with your local licensed health care professionals to verify and confirm the information in this pamphlet, and to best determine how it applies to you and your situation, if at all.

This article may be downloaded and photocopied in its entirety (only) for personal and educational purposes.

If you have questions, or would like to contact the author, you can contact Dr. Beck at email address: audsx2@aol.com.

ACKNOWLEDGEMENT:

Dr. Beck wishes to thank: Aimee LaCalle Au.D., at HearLab Inc. in San Antonio, Texas, and Barbara Beck, Au.D Candidate, from Audiology Online in San Antonio, Texas for their kind, thoughtful and helpful review of this manuscript.

Dizziness

Dizziness is a symptom not a disease. It may be defined as a sensation of unsteadiness, imbalance, or disorientation in relation to an individual’s surroundings. The symptom of dizziness may vary widely from person to person and be caused by many difference diseases. It varies from a mild unsteadiness to a severe whirling sensation known as vertigo. As there is little representation of the balance system in the conscious mind, it is not unusual for it to be difficult for the patient to describe his symptom of dizziness to the physician. In addition, because the symptom of dizziness varies so widely from patient to patient and may be caused by many different diseases, the physician commonly requires testing to be able to provide the patient with some knowledge about the cause of his dizziness. Dizziness may or may not be accompanied by a hearing impairment

FUNCTION OF THE NORMAL EAR

The ear is divided into three parts: external ear, middle ear, and inner ear.

The external ear structures gather sound and direct it toward the eardrum. The middle ear chamber consists of an eardrum and three small ear bones. These structures transmit sound vibrations to the inner ear fluid.

The inner ear chamber (labyrinth) is encased in bone and filled with fluid (endolymph and perilymph). This fluid bathes the delicate nerve endings of the hearing and the balance mechanism.

Fluid waves in the hearing chamber (cochlea) stimulate the hearing nerve endings which generate an electrical impulse. These impulses are transmitted to the brain for interpretation as sound. Movement of fluid in the balance chambers (vestibule and three semicircular canals) also stimulates nerve endings, resulting in electrical impulses to the brain, where they are interpreted as motion.

MAINTENANCE OF BALANCE

The human balance system is made up of four parts. The brain acts as a central computer receiving information in the form of nerve impulses (messages) from its three input terminals: the eyes, the inner ear, and the muscles and joints of the body. There is a constant stream of impulses arriving at the brain from these input terminals. All three systems work independently and yet work together to keep the body in balance.

The eyes receive visual clues from light receptors that give the brain information as to the position of the body relative to its surroundings. The receptors in the muscles and joints are called proprioceptors. The most important ones are in the head and neck (head position relative to the rest of the body) and the ankles and joints (body sway relative to the ground).

The inner ear balance mechanism has two main parts: the three semicircular canals and the vestibule. Together they are called the vestibular labyrinth and are filled with fluid. When the head moves, fluid within the labyrinth moves and stimulates nerve endings that send impulses along the balance nerve to the brain. Those impulses are sent to the brain in equal amounts from both the right and left inner ear. Nerve impulses may be started by the semicircular canals when turning suddenly, or the impulses may come from the vestibule, which responds to changes of position, such as lying down, turning over or getting out of bed.

When one inner ear is not functioning correctly the brain receives nerve impulses that are no longer equal, causing it to perceive this information as distorted or off balance. The brain sends messages to the eyes, causing them to move back and forth, making the surroundings appear to spin. It is this eye movement (called nystagmus) that creates a sensation of things spinning.

Remember to think of the brain as a computer with three input terminals feeding it constant up-to-date information from the eye, inner ear and muscles and joints (proprioceptors). The brain itself is divided into several different parts. The most primitive area is known as the brainstem, and it is here that processing of the input from the three sensory terminals occurs. The brainstem is affected by two other parts of the brain, the cerebral cortex and the cerebellum.

The cerebral cortex is where past information and memories are stored. The cerebellum, on the other hand, provides automatic (involuntary) information from activities which have been repeated often.

The brainstem receives all these nerve impulses: sensory from the eyes, inner ear, muscles and joints; regulatory from the cerebellum; and voluntary from the cerebral cortex. The information is then processed and fed back to the muscles of the body to help maintain a sense of balance.

Because the cortex, cerebellum and brainstem can eventually become used to (ignore) abnormal or unequal impulses from the inner ear, exercise may be helpful. Exercise often helps the brain to habituate to (get used to) the dizziness problem so that is does not respond in an abnormal way, does not result in the individual feeling dizzy. An example of habituation is seen with the ice skaters who twirl around, stop suddenly, and do not apparently have any balance disturbance.

TYPES OF DIZZINESS

Sensations of unsteadiness, imbalance or disorientation in relationship to one’s surroundings may result from disturbances in the ear, neck, muscles and joints, the eyes, the nervous system connections of these structures, or a combination of any of the above.

Ear Dizziness

Ear dizziness, one of the most common types of dizziness, results from disturbances in the blood circulation or fluid pressure in the inner ear chambers, from direct pressure on the balance nerve, or physiologic changes involving the balance nerve. Inflammation or infection of the inner ear or balance nerve is also a major cause of ear dizziness.

The inner ear mechanism is about the size of a pea, and is extremely sensitive. There are two inner ear chambers: One for hearing (cochlea), and one for balance (vestibule and semicircular canals). These chambers contain a fluid which bathes the delicate nerve endings. These nerve endings are stimulated when there is movement of the fluid. Nerve impulses are then transmitted to the brain by the hearing and balance nerves. The nerves pass through a small bony canal (internal auditory canal), accompanied by the facial nerve.

Any disturbance in pressure, consistency or circulation of the inner ear fluids may result in acute, chronic, or recurrent dizziness, with or without hearing loss and head noise. Likewise, any disturbance in the blood circulation to this area or infection of the region may result in similar symptoms. Dizziness may also be produced by over stimulation of the inner ear fluids, such as one encounters when he spins very fast and then stops suddenly.

Central Dizziness

Central dizziness is usually an unsteadiness brought about by failure of the brain to correctly coordinate or interpret the nerve impulses which it receives. An example of this is the “swimming feeling” or unsteadiness that may accompany emotional stress, tension states, and excessive alcohol intake. Circulatory inefficiency, tumors, or injuries may produce this type of unsteadiness, with or without hearing impairment. A feeling of pressure or fullness in the head is common. Occasionally true vertigo (spinning) may be caused by central problems.

Neck Dizziness

Neck Dizziness (cervical vertigo) results from abnormal or uncoordinated nerve impulses being sent to the brain from the neck muscles.

The neck muscles are constantly sending nerve impulses to the balance centers of the brain to help maintain equilibrium. Spasm (tenseness) of the muscles may result in an abnormal nerve discharge, leading to unsteadiness or dizziness. This spasm may result from injury, arthritis of the spine, or from pressure on nerves in the neck.

Muscle-Joint Dizziness

Muscle-joint dizziness is relatively uncommon. Any disturbance of sensation arising from the muscles and joints in the limbs (such as occurs in the muscular dystrophies and other abnormalities) produces this type of unsteadiness. Such an example is the unsteadiness experienced when one tries to walk on a leg that has “gone to sleep.”

Visual Dizziness

Eye Muscle imbalance or errors of refraction may produce unsteadiness. An example of this is the unsteadiness which may result when one attempts to walk while wearing glasses belonging to another individual.

Another example of visual dizziness is that occasionally produced if one is seated in a car looking out the side window at passing objects. The eyes respond by sending a rapid series of impulses to the brain indicating that the body is rotating. On the other hand, the ears and the muscle-joint systems send impulses to the brain indicating that the body is not rotating, only moving foreword. The brain, receiving these confused impulses (from the eyes indicating rotation, from the ears and muscle-joint systems indicating forward motion) sends out equally confusing orders to various muscles and glands that may result in sweating, nausea and vomiting. When one sits in the front seat looking forward, the eyes, ears, and muscle- joint systems work more uniformly and one is less likely to develop car sickness.

A visual disturbance may be caused by dizziness from other sources. Intermittent inability to focus the eyes, difficulty reading or intermittent blurring of vision, although at times the result of anxiety or tension may result from small reflex movements of the eye called nystagmus. This nystagmus is common during severe dizziness.

WARNING

Persons subject to dizziness should exercise caution when swimming. Buoyancy of the water results in an essentially weightless condition, and visual orientation is greatly impaired if one’s head is under water. As a result, orientation depends almost entirely on the inner ear balance canals. An attack of dizziness at this time could be very dangerous. Similarly, individuals who have lost both inner ear balance canals should avoid underwater swimming.

EAR DIZZINESS: SYMPTOMS

Any disturbance affecting the function of the inner ear or its central connections may result in dizziness, hearing loss or tinnitus (head noise). These symptoms may occur singly or in combination, depending upon which functions of the inner ear are disturbed.

Ear dizziness may appear as a whirling or spinning sensation (vertigo), unsteadiness, or giddiness and lightheadedness. It may be constant, but is more often intermittent, and is frequently aggravated by head motion or sudden positional changes, nausea and vomiting may occur, but one does not lose consciousness as a result of inner ear dizziness.

DIAGNOSING THE CA– USE OF DIZZINESS

Dizziness may be caused by any disturbance in the inner ear, the balance nerve or its central connections. This can be due to a disturbance in circulation, fluid pressure or metabolism, infections, neuritis, drugs, injury, or growths.

At times an extensive evaluation is required to determine the cause of dizziness. The tests necessary are determined at the time of examination and may include detailed hearing and balance tests, x-rays, and blood tests. A general physical examination and neurological tests may be advised.

The object of this evaluation is to be certain that there is no serious or life-threatening disease, and to pinpoint the location of the problem. This lays the groundwork for effective medical or surgical treatment.

CIRCULATION CHANGES

Any interference with the circulation to the delicate inner ear structures or their central connections may result in dizziness and, at times, hearing loss and tinnitus. These circulatory changes may be the result of blood vessel spasm, partial or total occlusion (blockage), or rupture with hemorrhage.

Atypical Migraine or Basilar Migraine

Inner ear dizziness due to blood vessel spasm is usually sudden in onset and intermittent in character. It may occur as an isolated event in the patient’s life or repeatedly in association with other symptoms. If it is recurrent it usually is associated with migraine headache-type symptoms. Predisposing causes include fatigue and emotional stress. Certain drugs such as caffeine (coffee) and nicotine (cigarettes) tend to produce blood vessel spasm or constriction and should be avoided. Blood vessel spasm has been noted to occasionally begin after head injury. Although there may have been no direct injury to the inner ear by the trauma, the spasm may begin to damage the ear.

Occlusion

As one gets older, blood vessel walls tend to thicken due to an aging process known as arteriosclerosis. This thickening results in partial occlusion, with a gradual decrease of blood flow to the inner ear structures. The balance mechanism usually adjusts to this, but at times persistent unsteadiness develops. This may be aggravated by sudden position changes such as that encountered when one gets up quickly or turns suddenly.

Complete occlusion of an inner ear blood vessel (thrombosis) results in acute dizziness often associated with nausea and vomiting. Symptoms may persist for several days, followed by a gradual decrease of dizziness over a period of weeks or months as the central nervous system and uninvolved ear compensates for the loss of the involved ear.

Hemorrhage

Occasionally one of the small blood vessels of the balance mechanism ruptures. This may occur spontaneously, for no apparent reason, or it may be the result of high blood pressure or head injury. Symptoms are the same as those of occlusion.

Treatment

Treatment of dizziness due to changes in circulation consists of anti-dizziness medications to suppress the symptoms. They also stimulate the circulation and enhance the effectiveness of the brain centers in controlling the symptoms. An individual with this type of dizziness should avoid drugs that constrict the blood vessels, such as caffeine (coffee) and nicotine (tobacco). Emotional stress, anxiety and excessive fatigue should be avoided as much as possible. Often, increased exercise will aid in the suppression of dizziness in many patients by stimulating the remaining function to be more effective.

BENIGN POSITIONAL VERTIGO

Postural or Positional Dizziness

Postural or positional dizziness is a common form of balance disturbance due to circulatory changes or to loose calcium deposits in the inner ear. It is characterized by sudden, brief episodes of imbalance when moving or changing head position. Commonly it is noticed when lying down or arising or when turning over in bed. This type of dizziness is rarely progressive and usually responds to treatment, but it may recur. Treatment usually consists of exercises designed to provoke the dizziness until it fatigues. This type of exercise may be recommended by your physician to cause the positional dizziness to run its course more quickly. Occasionally, postural dizziness may be permanent and surgery may be required.

IMBALANCE RELATED TO AGING

Some individuals develop imbalance as a result of the aging process. In many cases this is due to circulatory changes in the very small blood vessels supplying the inner ear and balance nerve mechanism. Fortunately, these disturbances, although they may persist, rarely become worse.

Postural or positional vertigo (see above) is the most common balance disturbance of aging. This may develop in younger individuals as a result of head injuries or circulatory disturbances. Dizziness on change of head position is a distressing symptom, which is often helped by vestibular exercises.

Temporary unsteadiness upon arising from bed in the morning is not uncommon in older individuals. At times this feeling of imbalance may persist for an hour or two. Arising from bed slowly usually minimized the disturbance. Unsteadiness when walking, particularly on stepping up or down, or walking on uneven surfaces, develops in some individuals as they progress in age. Using a cane and learning to use the eyes to help the balance is often helpful.

INFECTION

Symptoms

Imbalance due to ear infection is usually insidious and mild in onset. Such imbalance may occur with or without hearing impairment. As the infection gets closer to the vital balance mechanism in the inner ear, the dizziness becomes more constant and severe in nature, and is often associated with nausea and vomiting.

Treatment

Control of an ear infection is imperative in this type of dizziness in order to prevent spread of the infection directly into the balance center of the inner ear. Should this develop, serious complications including total loss of hearing in the involved ear may result. If the infection cannot be eliminated by medical treatment, surgery is indicated to remove the infection.

NEURITIS

Neuritis is a physiological change which occurs in the nerve after injury by trauma, a virus, autoimmune disease, or vascular compression. When this occurs, the balance function is impaired, resulting in a severe, and at times prolonged, episode of dizziness, often followed by some unsteadiness or motion for weeks to years. Fortunately, this balance disturbance usually subsides in time and usually does not recur in the majority of cases. It may be, however, very chronic at a moderate to mild level. Medical treatment is helpful in eliminating symptoms until the central nervous system can compensate for the injured nerve. This usually consists of dizziness- suppressing drugs. On occasion, the central nervous system cannot compensate and surgery may be necessary

METABOLIC DISTURBANCES

Occasionally metabolic disturbances produce dizziness with or without associated hearing loss by interfering with the function of the inner ear or the central nervous system. Occasionally hearing loss may occur without the presence of dizziness.

A change of thyroid function or abnormalities in the blood sugar are the most common metabolic disturbances resulting in dizziness. Rarely, fat metabolism abnormalities may also cause problems resulting in hearing loss and/or dizziness. Thyroid dysfunction is diagnosed by blood tests and treatment consists of taking a thyroid hormone. Abnormalities in the blood sugar are diagnosed, again by blood studies, and treatment usually consists of diet control and/or drug therapy. Fat metabolism problems and diagnosed by studies of the fatty acids and cholesterol in the blood. Treatment of these may consist of diet control with or without drug therapy.

ALLERGIES

Rarely, allergies may cause dizziness and/or vertigo. Allergies are usually diagnosed by obtaining a careful history and occasionally performing a series of skin tests with inhalants and food, and/or blood tests. Treatment usually consists of elimination of the offending agents when possible, or, if this is not possible, by allergy shots to stimulate immunity.

INJURY

Injury to the head occasionally results in dizziness of long-standing origin. If the trauma is severe, it is usually due to the combined damage to the inner ear, balance nerve, and central nervous system. Lesser injury may damage any one, or a combination of these components. The unsteadiness is at times prolonged, and may or may not be associated with hearing loss and head noise as well as other symptoms.

Trauma and Inner Ear Concussion

In head trauma the inner ear structures may be damaged by the severe sudden shaking that occurs. The pressure in the inner ear often begins to rise or calcium crystals may be dislodged. There may also be bleeding into the inner ear. This is called inner ear concussion. Although present over a period of months, the dizzy symptoms will often subside, but at times a mild persistent dizziness occurs. In other patients a post-traumatic endolymphatic hydrops (Meniere’s disease) begin to develop some months to years after the injury. In these cases continual medicine may be required, or surgery may be necessary.

Trauma and Chronic Vestibular Neuritis

In more severe trauma, the balance and hearing nerve may be sheared. This occurs when the skull suddenly stops and the brain continues to move for a fraction of a second. The nerve is damaged at the entrance to the temporal (ear) bone. Symptoms are usually unresponsive to medical treatment and require surgery.

Trauma and Brain Damage

Again in severe trauma the base of the brain and/or the cerebellum may be injured. These structures are slow to heal and there is often a residual dizziness that is severely resistant to any treatment. Fortunately, the symptoms are usually relatively mild and do not preclude some type of work. However, occasionally they may be quite incapacitating. Medication is not often beneficial, but rehabilitation therapy can be quite helpful.

A perilymphatic fistula is a leak of inner ear fluid into the middle ear. Relatively minor closed head injuries may cause a fistula, the fistula occurs at either the oval window (window where the stapes bone fits) or the round window membrane (an opening from the cochlea to the middle ear). Fistulas change the pressure in the inner ear and lead to a variety of symptoms, some of which can be incapacitating. Persistent daily low grade dizziness is often associated with fistulas, but the patient may also experience severe episodes of vertigo similar to those seen in Meniere’s disease. Surgery is usually required to close a fistula and stop the symptoms. If the fistula is large, or has been present for some time, there may be permanent damage to the inner ear and symptoms may persist even after closure of the fistula. In these cases a vestibular nerve section is necessary to stop the persistent dizziness.

TUMORS

A noncancerous tumor occasionally develops on the balance nerve between the ear and the brain. When this occurs, unsteadiness, hearing loss and head noise may develop. Extensive hearing tests, balance tests, and x-rays are necessary to diagnose such tumors.

If the diagnosis of a tumor is established, surgical removal is imperative. Continued growth of the tumor would lead to complications by producing pressure on vital adjacent nerves and the brain. An operation has been developed which allows the removal of these tumors at an early stage. Best results can be obtained if the tumor is diagnosed early and removed while the only symptoms are hearing loss, dizziness, and tinnitus (head noise).

Dandy’s Syndrome

A total loss of inner ear balance function in both ears is rare. It results in a condition called Dandy’s syndrome. This may result from infections, injuries or tumor removal. There may be serious dizziness at the time the individual first loses the balance mechanism. Other portions of the balance mechanism (eyes, muscles and joints) help the individual to compensate for the loss of inner ear function. Most do quite well except in the dark or when swimming. Many notice oscillopsia, a tendency for objects to appear to move up and down while in motion.

There is no treatment for Dandy’s syndrome. Most patients compensate well and lead normal lives. One should avoid movement in total darkness and avoid underwater swimming.

VASCULAR COMPRESSION SYNDROME

The vestibular (balance) nerve is located in a very complex part of the skull called the posterior fossa. A number of blood vessels are in close proximity to the nerve. If a blood vessel happens to compress or pulsate against the vestibular nerve, dizziness may result.

The diagnosis of this syndrome is difficult. A careful history and the results of specialized auditory and balance tests provide the physician with the suspicion of a vascular compression syndrome. The treatment is microvascular vestibular nerve decompression.

LABYRINTHINE DYSFUNCTION

Labyrinthine dysfunction describes one of the non-specific conditions where the inner ear is not functioning properly. Although the cause is often unknown, viral illnesses, medication, and trauma are known at times to cause this condition. In order to reach this diagnosis definitively, hearing and balance testing must be done.

Symptoms may be highly variable. They can range from occasional unsteadiness to episodic vertigo or constant unsteadiness. Hearing loss is occasionally present.

Initially, treatment is medical and a wide variety of medications may be used. Occasionally, vertigo exercises are helpful. When vertigo cannot be controlled with medication or exercises, surgery is sometimes indicated.

ENDOLYMPHATIC HYDROPS

Endolymphatic hydrops is a term which describes increased fluid pressure in the inner ear. In this respect it is similar but not related to glaucoma of the eye fluids. A special clinical form of endolymphatic hydrops is called Meniere’s disease, described elsewhere in this book. All patients with Meniere’s disease have endolymphatic hydrops, but not all patients with hydrops have Meniere’s disease.

There may be many causes of endolymphatic hydrops. It occurs widely in people of European decent and rarely in oriental or black people. It may be caused or aggravated by excessive salt intake or certain mediations. The symptoms are highly variable. The patient may have one symptom or a combination. Often there is a combination of hearing changes, disequilibrium, motion intolerance, or short dizzy episodes. There may be tinnitus and/or a pressure feeling in the head or ears. The patient does not have the well defined attacks of Meniere’s disease (fluctuating hearing loss, tinnitus and episodes of spinning lasting minutes to hours). Often the division between the two diagnoses may be blurred and difficult to separate, even for the patient. Endolymphatic hydrops may progress to Meniere’s disease in some patients.

The treatment of endolymphatic hydrops is similar to that for Meniere’s disease. Medications are first used. Diuretics (water pills) are almost always used. Their purpose is to decrease the fluid pressure in the inner ear. In addition to diuretics, other medications may be indicated, depending on the cause of symptoms in each patient’s case. If these fail, surgery is sometimes indicated. (See Surgery for vertigo elsewhere in this document).

MENIERE’S DISEASE

Meniere’s disease is a common cause of repeated attacks of dizziness, and is thought to be due (in most cases) to increased pressure of the inner ear fluids due to impaired metabolism of the inner ear. Fluids in the inner ear chamber are constantly being produced and absorbed by the circulatory system. Any disturbance of this delicate relationship results in overproduction of underabsorption of the fluid. This leads to an increase in the fluid pressure (hydrops) that may, in turn, produce dizziness which may or may not be associated with fluctuating hearing loss and tinnitus.

A thorough evaluation is necessary to determine the cause of Meniere’s disease, if possible. Circulatory, metabolic, toxic and allergic factors may play a part in any individual. Emotional stress, while making the disease worse, does not cause it.

Symptoms

Meniere’s disease is usually characterized by attacks consisting of vertigo (spinning) that varies in duration from a few minutes to several hours. Hearing loss and head noise, usually accompanying the attacks, may occur suddenly. Violent spinning, whirling, and falling associated with nausea and vomiting are common symptoms. Sensations of pressure and fullness in the ear or head are usually present during the attacks. The individual may be very tired for several hours after the overt spinning stops.

Attacks of dizziness may recur at irregular intervals and the individual may be free of symptoms for years at a time, only to have them recur again. In between major attacks, the individual may have minor episodes occurring more frequently and consisting of unsteadiness lasting for a few seconds to minutes.

Occasionally hearing impairment, head noise, and ear pressure occur without dizziness. This type of Meniere’s disease is called cochlear hydrops. Similarly episodic dizziness and ear pressure may occur without hearing loss or tinnitus, and this is called vestibular hydrops.

Treatment of Meniere’s Disease

Treatment of cochlear and vestibular hydrops is the same as for classic Meniere’s disease. The treatment of Meniere’s disease may be medical or surgical, depending upon the patient’s stage of the disease, life circumstances, and the condition of the ears. The purpose of the treatment is to prevent the hearing loss, and stop the vertigo (spinning).

It is aimed at improving the inner ear circulation and controlling the fluid pressure changes of the inner ear chambers. At times it is necessary to cut the balance nerve or remove the inner ear structures.

Medical treatment of Meniere’s disease varies with the individual patient according to suspected cause and magnitude and frequency of symptoms. It is effective in decreasing the frequency and severity of attacks in 80% of patients. Treatment may consist of medication to decrease the inner ear fluid pressure or prevent inner ear allergic reactions. Various drugs are used as anti-dizziness medication. Vasoconstricting substances have an opposite effect and, therefore, should be avoided. Such substances are caffeine (coffee) and nicotine (cigarettes).

Diuretics (“water pills”) may be prescribed to decrease the inner ear fluid pressure.

Meniere’s disease may be caused or aggravated by metabolic or allergic disorders. Special diets or drug therapy are indicated at times to control these problems.

On rare occasions we may use gentamycin injections which selectively destroy balance function. This treatment is reserved for patients with Meniere’s disease in their only hearing ear or with Meniere’s disease in both ears.

DIZZINESS: SURGICAL TREATMENT

Surgery is indicated when medical treatment fails to control the vertigo. The type of operation selected depends on the degree of hearing impairment in the affected ear, the life circumstances of the individual, and the status of the individual’s disease. In some operations the hearing may be occasionally improved following surgery, and in others it may become worse. In most cases it remains the same. Head noise may or may not be relieved, and in some cases may become even more marked. In most cases it is not relieved.

Surgery is most successful in relieving acute attacks of dizziness in the majority of patients. Some unsteadiness may persist over a period of several months until the opposite ear and the central nervous system are able to compensate and stabilize the balance system.

Surgical Procedures Include:

GEndolymphatic Shunt

This operation drains excess endolymph from the inner ear. It is usually performed under general anesthesia and requires hospitalization for one to two days.

An incision is made behind the ear. A mastoid operation is performed and a tube is inserted into the endolymphatic sac of the inner ear to control the abnormal fluid pressure.

A shunt operation usually is advised when hearing is relatively good in the involved ear. Further loss of hearing may occur in 25% of cases due to progression of the disease. Total loss of hearing in the operated ear following surgery is uncommon, but does occur in about 3% of operations.

GTranslabyrinthine labyrinthectomy and section of the vestibular (balance) nerve.

The operation is performed under general anesthesia and requires hospitalization for approximately five to seven days. Through an incision behind the ear, a mastoidectomy is performed, the inner ear balance chambers are removed, and the balance nerve is cut. In order to fill in the cavity where bone was removed, a superficial incision made on the abdomen and a small amount of fat is obtained and placed in the mastoid.

In cases selected for labyrinthectomy and section of the vestibular nerve, hearing is severely impaired. The operation results in total loss of hearing in the operated ear, and frequently, a temporary increase in dizziness. Fortunately, the attacks of dizziness are eliminated in nearly every instance. Persistent unsteadiness, however, may continue for a period of weeks or months until the central nervous system stabilizes the balance system. When necessary, this operation can be performed if other surgery is not successful.

Middle fossa section of the vestibular (balance) nerve

This procedure is performed under general anesthesia, and usually requires five to seven days of hospitalization. Through an incision above the ear, the balance nerve is cut before it enters the inner ear chamber.

Middle fossa section of the vestibular nerve may be advised when hearing is good in the involved ear. Up to 5% of patients may develop a severe hearing impairment in the operated ear. Fortunately, the attacks of dizziness are eliminated in nearly every instance. Persistent unsteadiness, however, may continue for a period of weeks or months until the central nervous system stabilizes the balance system. Temporary paralysis of half the body has occurred following a middle fossa nerve section, due to brain swelling. This complication is, however, extremely rare.

Retrosigmoid section of the vestibular (balance) nerve

This operation is performed in the hospital under general anesthesia and requires hospitalization for about five to seven days. Through an incision well behind the ear, the balance nerve is cut before it enters the inner ear. In order to fill in the cavity where bone was removed, a superficial incision is made on the abdomen and a small amount of fat is obtained and placed in the space where the bone was removed.

This procedure allows examination of the anatomy between the inner ear and the brain, particularly the vessels. This operation may be advised when the hearing is good in the involved ear, and the patient is somewhat older. Up to 15% of patients may develop a severe hearing impairment in the operated ear after surgery. Fortunately, the attacks of dizziness are eliminated in nearly every instance (90% – 95%). Persistent unsteadiness may continue for several weeks to months until the central nervous system has stabilized the balance system. Temporary paralysis of half the body has occurred following a surgery due to brain swelling. Fortunately, this complication is extremely rare.

RISKS AND COMPLICATIONS OF SURGERY FOR DIZZINESS

Hearing Loss

Further hearing impairment in the operated ear may occur following any of the procedures, and is the expected result following some. This has been commented on for each procedure.

Tinnitus

Tinnitus (head noise) usually remains the same as before surgery. If the hearing is worse following surgery, tinnitus may likewise be more noticeable.

Taste Disturbance and Mouth Dryness

Taste disturbance and mouth dryness are not uncommon for a few weeks following surgery. In 5% if the patients this disturbance is prolonged.

Weakness of the Face

The facial nerve travels through the ear bone in close association with the hearing and balance nerves, the inner ear and mastoid (refer to the diagram). Temporary weakness of one side of the face is an uncommon postoperative complication of ear surgery. It may occur as the result of an abnormality or swelling of the nerve. Permanent paralysis of the face is extremely rare. Should it occur, however, eye complications could develop requiring treatment by an eye specialist.

Spinal Fluid Leak

All of the operations described above can result in a leak of cerebrospinal fluid (fluid surrounding the brain). Further surgery may be necessary to stop it.

Infection

Infection is a rare occurrence following surgery for dizziness. Should it develop, however, it could lead to meningitis (an infection of the fluid surrounding the brain) and may require prolonged hospital treatment. Fortunately, this complication is very rare.

Hematoma

A hematoma (collection of blood under the skin incision) develops in a small percentage of cases, prolonging hospitalization and healing. Reoperation to remove the clot may be necessary if this complication occurs.

DIZZINESS: NONSURGICAL TREATMENT

Vestibular Rehabilitation

Current retrospective studies indicate that 85% of patients with chronic vestibular dysfunction gain at least partial relief of their symptoms after undergoing vestibular rehabilitation.

Typically, a physical therapist evaluation of patients with vestibular or balance disorders take approximately 60-90 minutes. The evaluation begins with a history of the patient’s symptoms. This includes how long the patient has been symptomatic, how long the symptoms last, general activity level and medications that the patient is currently taking. Range of motion, strength, coordination, balance and various sensory systems are also assessed. Patients are asked to perform; transitional movements such as rolling, supine to sit and sit to stand. This is to determine whether these motions produce or increase symptoms. One of the most difficult things for patients with vestibular disorders to do is walk and move the head. Different combinations of head and neck movements are performed during gait to provoke symptoms. Balance is also tested on a firm surface and again on a compressible surface with eyes open and closed. Time tests of balance are performed with eyes open and closed, while standing on one foot and with feet aligned as if on a tightrope.

Following the evaluation, a treatment plan is developed. The treatment consists of habitual exercises, balance retraining exercise, and usually a general conditioning program. The goal of habituation exercises is to decrease the patient’s symptoms of motion provoked dizziness or lightheadedness. The exercises are chosen to address the patient’s particular problems that were discovered during the evaluation. These exercises use repetitive movements or positional stimuli to physiologically fatigue the response of the vestibular system. This, in turn, increases the patient’s tolerance for these movements. Controlled provocation of symptoms with the home program “desensitizes” the patient’s response to movements that previously stimulated dizziness. Patients that have non-reproducible or spontaneous symptoms (ones that appear unexpectedly and independently of whether the patient is moving); do not respond as well to these exercises as a means to control their symptoms. Balance retraining exercises are also given when appropriate and consist of activities directed towards improving the patient’s balance. Exercises are chosen according to the problem areas discovered in the evaluation and often involve interaction among the three sensory inputs involved in balance: vision, somatosensory cues and vestibular inputs. Thus the patient may be asked to perform exercises with eyes closed or standing on a compressible surface. A general conditioning program usually consists of a walking program or another fitness program that the patient is interested in. The length and intensity of the general conditioning program depends upon the patient’s previous activity level and how easily their symptoms are provoked. The patient must consistently perform all the exercises as described in their treatment program to achieve the goals of improving their balance and decreasing their dizziness. Typically the exercises are performed twice a day. Patients are advised not to avoid positions that provoke symptoms unless they are unsafe.

Usually the patient is given a home exercise program to perform, and asked to return to the office in two to four weeks for a follow-up visit to monitor their progress and modify their home program as necessary. If the patient lives very far way, this can sometimes be done over the phone. Occasionally, if the patient’s problems are significant enough, he or she may be asked to come into to office for balance/vestibular training that can be supervised by the physical therapist.

SUMMARY

There are many causes of dizziness. This dizziness may or may not be associated with hearing loss. In most instances the distressing symptoms of dizziness can be greatly benefited or eliminated by medical or surgical management.

Hearing Problems in Children

Five thousand children are born profoundly deaf each year in the United States alone. Another 10 to 15 percent of newborns have a partial hearing handicap.

FUNCTION OF THE NORMAL EAR

The ear is divided into three parts: an external ear, a middle ear and an inner ear. Each part performs an important function in the process of hearing.

The external ear consists of an auricle and ear canal. These structures gather sound and direct it toward the eardrum. The middle ear chamber lies between the external an inner ear. This chamber is connected to the back of the throat by the eustachian tube, which serves as a pressure equalizing valve. The middle ear consists of the eardrum and three small ear bones (ossicles): malleus (hammer), incus (anvil) and stapes (stirrup). These structures transmit sound vibrations to the inner ear. In so doing, they act as a transformer, converting sound vibrations in the external ear canal into fluid waves in the inner ear.

The inner ear chamber contains the microscopic hearing nerve endings bathed in fluid. Fluid waves stimulate the delicate nerve endings which in turn transmit sound energy to the brain, where it is interpreted.

TYPES OF HEARING IMPAIRMENT

The outer and middle ears conduct and transform sound; the inner ear receives it. When there is some difficulty in the outer or middle ear, a conductive hearing impairment occurs. When there is trouble in the inner ear, a sensorineural or hair cell impairment is the result. Difficulty in both the middle and inner ear results in a mixed hearing impairment.

CONDUCTIVE IMPAIRMENT

A conductive type of hearing impairment occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear. Conductive losses reduce the loudness of sound that is heard.

A conductive impairment may occur from blockage of the outer ear canal, from a perforation (hole) in the eardrum, from middle ear infection or fluid
due to blockage of the eustachian tube, or from a congenital defect or disease of any of the three middle ear bones. This type of impairment is usually correctable through surgery.

The child with a conductive hearing loss will never go deaf. He will always be able to hear, either through ear surgery or by use of properly fitted hearing aid.

SENSORINEURAL IMPAIRMENT

A sensorineural hearing loss is used to describe hearing impairments which result from disturbances or defects in the inner ear and transmission of electrical signals from the hair cells. These impairments may be congenital (i.e. present at birth), hereditary, developmental, or a combination of these. In addition, these impairments may result from infections, injuries, ototoxic drug therapy, or lack of oxygen.

Hearing loss may be divided further due to the cause of the hearing handicap.

A. Congenital hearing loss

1. Genetic – In the genetic type there is an actual defect in your child’s genes which results in an abnormal development of the ear.

2. Non-genetic – This is a hearing loss which is due to some problem which occurred during the fetal development or the immediate birth period.

B. Acquired hearing loss – This is a hearing impairment which occurs sometime after birth and is not transmitted to future children.

CONGENITAL FACTORS

Several viral infections, including CMV and German measles contracted by the mother during the first three months of pregnancy may interfere with inner ear development in the fetus. Occasionally, other viral diseases are at fault. The viruses of measles and mumps may cause a sensorineural hearing loss after birth, but this happens infrequently. Immunizations are now available for both of these diseases.

PROBLEMS AT BIRTH

A very difficult and complicated labor or premature birth may also result in an inner ear hearing impairment on occasion. This may be due to lack of oxygen. These are many syndromes which can also result in a hearing impairment at birth. One can have a hearing loss at birth without any hereditary relationship.

Jaundice occurring at or shortly after birth is capable of damaging the inner ear. This is most often due to Rh incompatibility between the mother’s and the child’s blood. Fortunately, this is not a common occurrence.

HEREDITARY IMPAIRMENT

The development and function of the ear is dependent upon hundreds or even thousands of genes interacting with each other and with the inter-and extrauterine environment. A major cause of late-onset hearing loss is genetic. There are several patterns of inheritance. In autosomal dominant disorders, one parent expresses the trait, which he transmits to 50 percent of his children. In autosomal recessive inheritance, the parents of the children are clinically normal, but carry the recessive gene to 25 percent of their children. X-link inheritance traits are transmitted from a carrier mother to 50 percent of her sons.

Most cases of hereditary childhood deafness are sensorineural rather than conductive in nature. Most examples of hereditary hearing loss are recessive. Recessive deafness characteristically is associated with retention of hearing of low frequency sounds since most of these cases are associated with abnormalities primarily affecting the first turn or the cochlea (i.e. the Scheibe inner ear abnormality). In dominant inherited deafness, the audiogram generally is flat. However, there are other dominant types of mid-frequency sensorineural hearing loss. In X-link recessive deafness, some retention of hearing is usually seen in all frequencies.

Hereditary sensorineural hearing loss may be present at birth, or may develop later in life. This may be due to inner ear malformations or to other associated syndromes which have an associated inner ear hearing loss. One may see a genetic sensorineural hearing loss with or without associated abnormalities.

INFECTIONS

The most common type of acquired sensorineural loss is meningitis. Frequently this may affect both ears, but can involve one ear. Other types of infections would include viral diseases, such as mumps, rubella and otitis media.

HEARING IMPAIRMENT IN ONE EAR

A hearing impairment that is confined to one ear deprives a person of the ability to distinguish the direction of sound. He will also have difficulty hearing from the involved side in a noisy background. These are minor problems to a young child. When this hearing impairment in one ear is conductive, surgery will usually be able to restore the hearing, giving a better balance of hearing. This is usually done in a child who is in his teens. When the impairment is sensorineural, it is often possible when the child grows older to restore some of this balance of hearing through the use of a special hearing aid (i.e. CROS hearing aid).

TREATMENT

There is no known medical or surgical treatment that will restore normal hearing in patients with sesorineural hearing impairments. We, therefore, rely on rehabilitation through the use of a hearing aid and special training. Fortunately, many children with this type of hearing impairment will not show progression of the impairment as they get older.

THE HARD-OF-HEARING CHILD

If your child’s hearing impairment is in the range of 35-70 dB HL, he or she should do well with a properly fitted hearing aid. He or she will probably be able to attend school with normal hearing children. He or she will need preschool speech therapy and auditory training in order that communication abilities will be at the optimal level when regular school starts.

HEARING AID EVALUATION

Evaluation of the hearing in a young child may require several visits with the audiologist. It is important to determine an accurate measurement of both the type and the degree of hearing impairment in order to select the proper hearing aid. An aid that is too powerful for a young child may be uncomfortable and cause the child to reject it. On the other hand, if the aid is not strong enough, a child may receive little or no benefit from it and therefore object to wearing it.

SPEECH READING (LIP READING)

Speech reading is very important whatever the type of degree of impairment. This skill enables a person with impaired hearing to understand conversation by attentively observing the speaker. All of us, whether we have a hearing loss or not, employ the sense of sight as well as the sense of hearing in ordinary conversation. We find it easier to comprehend if we can watch the speaker’s facial expressions, lip movements and gestures. Just as the visually handicapped learns to use his sense of hearing to compensate for his impaired sight, the person with defective hearing must learn to use his eyes to assist him in hearing. A study of the fundamentals of lip reading or of speech reading, as it is called, will make communication less of an effort and therefore more pleasant for both the speaker and the listener.

Speech reading has its limitations. For example, when the distance between the speaker is great or when there is inadequate lighting or defective vision, one may not always be able to see the speaker’s lips clearly enough to speech read adequately. Some persons do not open their mouths very far when they speak and, consequently, their lip movements are very limited. Others have beards, hold their hands over their mouths, or smoke as they talk, making speech reading difficult if not impossible.

It is important to tell other family members and friends to get the child’s attention before speaking. The child with a hearing impairment must recognize characteristics of the English language. Many sounds and many words look the same on the lips. The hearing impaired child will find it impossible to see certain words on the lips and therefore needs to continuously fill in the “gaps” of words and sentences. Two thirds of all sounds in the English language are not visible on the lips. Because of the difficulties presented by sounds, the speech reader is encourage to follow the contact or thought of what is being said rather than to try to lip-read each word.

The child, who is learning to speech read, learning to use a hearing aid, or both, should have help from a professional person trained to teach these skills. There are many books on the subject of speech reading. Help is also available at various universities.

Cued speech is a phonemically-based hand supplement to speech reading (speech is made up of sounds called phonemes). The 26 letters in our English language, either singly or in combinations, produce 43 phonemes. Spelling does not illustrate the pronunciation differences whereas cued speech can show the child how something is pronounced while it is being spoken. It is comprised of eight hand shapes used to represent groups of consonant sounds and four positions about the face to represent groups of vowel sounds. Combinations of these hand shapes and placements are used to illustrate exact pronunciations in words in connected speech. Although cueing helps recognize pronunciation, the child will still need speech lessons with a speech therapist. Some deaf educators find some limitations with cued speech, but in certain specific instances this has been used with some success.

PROFOUND SENSORINEURAL HEARING IMPAIRMENT

For those children who are not able to achieve any benefit with a hearing aid and an oral educational program, they will require training in manual forms of communication such as finger spelling or American Sign Language. The type of school depends upon the child’s hearing level, progress, and communication skills. If your child’s level is greater than 70 dB, he or she will not, in all likelihood, be able to attend classes with normal hearing children, at least in the beginning. It will be difficult for him or her, but with the help of a hearing aid, training in speech reading, and attention to speech correction, he or she may be able to progress through schools for the hearing handicapped to normal schools, to college, and to take his or her place in society with normal hearing people.

For those children who are not able to achieve understanding for speech, special schools are available to train them in the manual form of communication. The type of school a child attends depends upon his progress in communication.

REHABILITATIVE MEASURES

There are two very important factors to be determined upon examining the child with a suspected hearing impairment. First, determination should be made regarding the presence of a hearing loss and the type (i.e., conductive or sensorineural). Secondly, once a hearing loss is found to be present, it should be determined if this loss is progressive or stable. Therefore, your child may require periodic audiograms to be sure that the hearing loss is going to remain stable.

A complete otologic/audiologic examination by a competent ear specialist and audiologist are necessary to determine what type of hearing impairment is present, its probable cause, and its treatment. At times it may be necessary to obtain special x-rays of the inner ear, a balance test or other laboratory tests to make this decision.

A well-rounded program of rehabilitation for children with hearing loss may include speech reading, auditory training, speech therapy and instruction in the use of a hearing aid. One may also consider other adjuvants to assist with their communication skills such as cued speech or other manual techniques. All aspects of the program do not necessarily apply to each child with an impairment, but each individual may be helped through some of these methods.

THE COCHLEAR IMPLANT

The cochlear implant is an electronic device that is implanted into the inner ear of a severe to profoundly hearing impaired child. This device is only utilized in the child who cannot benefit with a hearing aid. It is a device which is used to bypass the disease or nonfunctional hair cells and converts the sounds we hear to electrical impulses which directly stimulate the cochlear nerve. The implant consists of an external portion comprised of a microphone, sound processor, and external coil and an internal portion that must be surgically implanted. The surgical procedure involves the placement of an internal coil beneath the skin behind the ear and a stimulating electrode which is inserted into the cochlea or inner ear.

To determine suitability for this device in the severe to profoundly hearing impaired child, a careful examination is required. The evaluation is performed to determine whether or not the child can receive adequate information from a powerful hearing aid, or whether or not the procedure can be performed and give the expected improvement.

Currently there are several multiple channel devices which are utilized. This is related to the number of stimulating electrodes within the cochlea.

What is Central Auditory Processing Disorder (CAPD)

Auditory Processing (also called Central Auditory Processing) refers to the means by which we make sense of what we hear. “Auditory Processing Disorders” refers to the abnormal interaction of hearing, neural transmission and the brain’s ability to make sense of sound. People with auditory processing disorders may indeed have normal hearing, but they have difficulty understanding auditory information. This may be apparent by difficulty understanding speech in the presence of noise, problems following multi-step directions, and difficulty with phonics or reading comprehension, among other things. Parents, educators, physicians, speech-language pathologists and others realize the role that auditory processing plays in a child’s ability to learn, leading to an increase in referrals to audiologists with expertise in this area. Proper diagnosis can be made only after the completion of a battery of audiometric tests, administered by an audiologist. Individualized remediation programs are available to help strengthen auditory processing skills in diagnosed children and adults.

Cochlear Implants

Cochlear Implants

Generally speaking, cochlear implants are for patients with severe-to-profound, sensorineural hearing loss. There are approximately 500,000 patients in the USA with severe-to-profound hearing loss. Cochlear implants are only recommended after the patient has tried the most powerful and most appropriately fit hearing aids, and has not shown sufficient benefit from hearing aids. Cochlear implants are devices that are “permanently” surgically implanted into the inner ear.

Cochlear implantation is a surgical procedure performed by otolaryngology surgeons. Cochlear implants have been FDA approved for almost two decades and the advances and improvements in the technology have been amazing. The Food and Drug Association (FDA) and the American Medical Association (AMA) recognize cochlear implants as safe and effective treatment for severe-to-profound sensorineural hearing loss. Most insurance programs pay (at least partly) for cochlear implantation. Your audiologist, your otolaryngology surgeon and their appropriate office staff are experienced at managing insurance issues.

Appropriately identified adults as well as profoundly deaf children (starting at age 12 months) can be implanted. Research demonstrates that the earlier a deaf child is implanted, the better the long term result will be with respect to speech and language development. Following surgery, rehabilitation is necessary, as the child must learn to associate the sound signals with normal sounds. Regarding deaf adults, research suggests that adults who receive cochlear implants are less lonely, have less social anxiety, are more independent, have increased social and interpersonal skills, and of course, they hear better with the cochlear implant!

Cochlear implants are utilized in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the nonfunctional inner ear and converts sound into electrical impulses that directly stimulate the cochlear nerve. The implant consists of an external portion comprised of a microphone, sound processor, and external coil and an internal portion that must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and stimulating electrode array, which is inserted into the cochlea or inner ear. The electrical signals are manipulated and controlled by the audiologist to maximize speech perception. The brain interprets these electrical impulses as sound. Again, not all patients are surgical candidates, and not all cochlear implant recipients receive the same benefit.

It is important to remember that the vast majority of the patients who receive cochlear implants are actually “deaf” prior to implantation, and they have not been successful with traditional hearing aids. Your audiologist is a very knowledgeable resource in regards to cochlear implants and will be happy to discuss them with you.

Types of ALDs

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, but not all, 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. You should be able to get hearing-aid-compatible phones from your telephone company or almost any retail store that sells telephones. Not all hearing aids have a “T” switch. Make sure your hearing aids have a T switch 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.

Candidates for ALDs

Are ALDs Only for People Using Hearing Aids?

No. People with all degrees and types of hearing loss — even people with normal hearing can benefit from assistive listening devices. Some assistive listening devices are used with hearing aids; some are used without hearing aids.

Assistive Listening Devices (ALDs)

Assistive listening devices are used to maximize hearing using instruments which may or may not be used in conjunction with a hearing aid. These instruments fall into several categories:

1. Telephone Amplifiers.
2. Infrared Listening Systems for Television and Theater.
3. FM Listening Systems for lectures, conversation in noisy places, or at business meetings.
4. Devices to Warn of Fire.
5. Signalling Devices Such as Doorbells and Telephone Ringers.
6. Terminals to Communicate over Telephones.

Types of Hearing Aids

There are many types of hearing aids today and the type of hearing aid is dependent upon both the style chosen and technology chosen.

Styles of Hearing Aids

Hearing aids are available in many different sizes and styles thanks to advancements in digital technology, miniaturization of the digital electronic part and fresh focus on design among the hearing aid manufacturers. Many of today’s hearing aids are considered sleek, compact and innovative – offering solutions to a wide range of hearing aid wearers.

When selecting style the following is considered:

  • The degree of the hearing loss (power requirements)
  • Manual dexterity abilities
  • Patient budget

In-the-Ear Styles

Completely-In-the-Canal (CIC) – The smallest custom hearing aids made,  CICs sit deeply and entirely inside the ear canal. They usually require a “removal string” due to their small size and the fact that they fit so deeply into the canal. They fit a mild to moderate hearing loss and offer high cosmetic appeal.

In-The-Canal (ITC) hearing aids sit in the lower portion of the outer ear’s bowl and are slightly larger than a CIC hearing aid. Because of their slightly larger size, they often have a longer battery life than CICs and come available with more options depending upon the size of ear. They fit mild to moderate hearing losses.

Half-Shell – The half shell model fills half of the bowl of the outer ear and like ITC hearing aids, they allow more options and longer battery life due to the larger size. This size is ideal for persons seeking a smaller hearing aid that may have potential dexterity concerns.

Full Shell or In-The-Ear (ITE) – The largest of the custom hearing aids made, full shell hearing aids fill up the entire bowl of the outer ear. This size allows the maximum number of controls and features and is able to fit mild to severe hearing losses.

Behind-the-Ear (BTE) Styles

Mini-BTE with slim tubes – This type of BTE is often referred to as an  “open fit” hearing aid. The small miniature hearing aid sits behind the ear and transmits sound into the ear canal via a thin plastic tube. The tubing connects to a soft tip that sits in the ear canal but doesn’t occlude it. The result is a natural, open feeling as air and sound enter the ear naturally around the tip, while amplified sound enters through the tip. This style of BTE is recommended for mild to moderate high frequency losses and offers cosmetic appeal to the small size of the hearing aid.

Receiver-in-the-Ear (RITE) – RITE hearing aids, also known as Receiver-in-canal (RIC) models, are similar to the mini BTE however instead the speaker of the hearing aid sits inside the ear canal versus the main body of the hearing aid behind the ear. Although it looks like a mini BTE when worn on the ear, the RITE style fits a higher degree of hearing loss (mild to severe), while still providing the “open” fitting.

BTE with custom earmold – BTEs with custom earmolds fit the widest range of hearing loss, from mild to profound. They are slightly longer in shape and are contoured to sit nicely behind the ear for a sleek, compact look.  This style of hearing aid typically offers a wide array of features and options, as well as more control and power than custom models.  BTEs are connected to the ear canal via custom-made plastic tubing and earmold. The earmold color and style, as well as the wearer’s hairstyle will determine how this style looks on each person.

 

Hearing Aid Technology

A wide range of technology and a whole host of features are available in each hearing aid style. The cost of hearing aids generally depends on the technology and the number of features the instrument has, and not necessarily on the style selected.

Today’s digital hearing aids are typically offered in various levels such as basic or entry-level to advanced or premium-level. WIthin each level, different technology and features are available.

Basic digital hearing aids generally require the wearer to make some manual adjustments in certain listening environments such as turning a volume control up or down, or pushing a button to change listening programs. In contrast, a premium or more advanced hearing aid responds automatically to changes in the listener’s environment, making changes based on the signals being detected by the hearing aid. The hearing aid wearer is not required to make any manual changes.

As the level of the technology increases in hearing aids, so do the availability of advanced features. Examples of some of the advanced features found in today’s digital hearing aids are shown below.

  • Directional Microphones – Applies preference to sounds in front of the wearer and reduced sound from behind the wearer. This technology has been proven in studies to improve speech understanding in background noise.
  • Noise Reduction -Determines if signal contains unwanted background noise and reduced level of background niose if present. Background noise is less annoying and hearing aid wearer’s listening comfort is improved in noisy situations.
  • Feedback Management – Reduces or eliminates whistling that can often occur with hearing aid use. Hearing aid wearer’s comfort is improved from annoying whistling.
  • Wind Noise Reduction – Reduces the noise created from wind blowing across the hearing aid’s microphone(s). Designed to improve comfort for persons who spend a lot of time outdoors.
  • Data Logging/Learning – The ability of the hearing aid to track and learn the hearing aid wearer’s preferences in various listening environments. This information can assist the hearing professional in making future programming adjustments and allows the hearing aid to adapt to the wearer’s preferences.
  • Telecoil/Auto-telecoil – This feature picks up a signal from a compatible telephone and hearing aid wearers can listen to the telephone without whistling. Some hearing aids this requires a push of a button to activate, other manufactuers offer an auto-telecoil where the hearing aid switches automatically when a telephone signal is detected.
  • Bluetooth Interface – Establishes a wireless connection between hearing aids and Bluetooth compatible devices. Designed to improve wearer convenience and use with devices such as cell phones, Mp3 players, computers, etc.

Type & Degree of 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 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)

Types of Hearing Loss

The external and the middle ear conduct and transform 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.

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 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 increase in the loudness of speech 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, also thought of as the “clarity” of speech may be affected. Certainly both loudness and clarity may be affected too.

A Discussion on Tinnitus

What is Tinnitus

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.

Tinnitus is a symptom much like a headache, pain, temperature, hearing loss or vertigo. With tinnitus, the reported distress is usually subjective and difficult to record and appreciate by others.

The quality of the tinnitus refers to the description by the patient of the tinnitus: It may be a ringing, buzzing, cricket, ocean, etc., type of sound. The quality may be multiple sounds or a singular sound.

Tinnitus may be produced in one or more locations, called its site of lesion. The cause of tinnitus may be singular or multiple. A peripheral (i.e., auditory nerve or cochlea) site of lesion includes dysfunction established within the auditory system that extends up to but not involving the brainstem. A central site of lesion refers to involvement of the central auditory pathways, beginning at the brainstem and involving other portions of the central nervous system.

Tinnitus is, therefore, a symptom of neurotologic disease. It may occur with a hearing loss, vertigo or pressure symptoms in the ear or it may occur alone.

Tinnitus must always be thought of as a symptom and not a disease, just as pain in the arm or leg is a symptom and not a disease. Because the function of the auditory (hearing) nerve is to carry sound, when it is irritated from any cause it produces head noise. This phenomenon is similar to the sensation nerves elsewhere. If one pinches the skin, it hurts because the nerves stimulated carry pain sensation.

A complete cochleovestibular evaluation is necessary in all patients with severe disabling tinnitus. The test battery is used to attempt to establish the site of lesion and to rule out any significant pathology which may require further treatment. There are many causes just related to the ear which would result in tinnitus. Such things as simple ear wax in the ear canal to other middle ear abnormalities may result in tinnitus. Otosclerosis (fixation of the stapes bone in the middle ear) can cause tinnitus as well as fluid in the middle ear. There are many other ear abnormalities which may cause tinnitus. A more common example would be Meniere’s disease. Sudden trauma to the inner ear such as exposure to excessively loud sounds may result in tinnitus. Tumors on the hearing nerve or other problems in the brainstem or central nervous system may also cause tinnitus. In addition, other vascular abnormalities in the skull or base of the skull may result in tinnitus.

HOW MANY PEOPLE HAVE TINNITUS?

50 million Americans experience tinnitus to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, they cannot function on a “normal,” day-to-day basis.

What Causes Tinnitus

Tinnitus is the term for the perception of sound when no external sound is present. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus is not a disease but a symptom of another underlying condition – of the ear, the 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. 50 million Americans experience tinnitus to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, that their day to day functioning is affected.

The exact cause (or causes) of tinnitus is not known in every case. There are, however, several likely factors which may cause tinnitus or make existing tinnitus worse: 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 and many others. Of these factors, exposure to loud noises and hearing loss are the most common causes of tinnitus. Treating a hearing loss, either by medical management, if indicated, or with hearing aids, may offer relief of tinnitus. Other new and effective tinnitus treatments are also available. If you have tinnitus, a comprehensive hearing evaluation by an audiologist, and a medical evaluation by an otologist is recommended.

Treatment and Management

Generally, most patients will not need any medical treatment for their tinnitus. For patients who are greatly bothered by tinnitus, they may use some masking techniques such as listening to a fan or radio which would mask some of their tinnitus. In addition, other sound source generators can be obtained and be adjusted to sound-like environmental sounds and this is also effective in masking tinnitus. This generally is more advantageous if one is attempting to go to sleep. A tinnitus masker is utilized in some patients. It is a small electronic instrument built into a hearing aid case. It generates a noise which prevents the wearer from hearing his own head noise. It is based on the principle that most individuals with tinnitus can better tolerate outside noise than they can their own inner head noise.Biofeedback training is effective in reducing the tinnitus in some patients. It consists of exercises in which the patient learns to control the various parts of the body and relax the muscles. When a patient is able to accomplish this type of relaxation, tinnitus generally subsides. Most patients have expressed that the biofeedback offers them better coping skills.

Other measures to control tinnitus include making every attempt to avoid anxiety, as this will increase your tinnitus. You should attempt to obtain adequate rest and avoid overfatigue because generally patients who are tired seem to notice their tinnitus more. The use of nerve stimulants is to be avoided. Therefore, excessive amounts of caffeine and smoking should be avoided. Tinnitus will not cause you to go deaf and statistically, 50 percent of patients may express that their tinnitus with time decreases or is hardly perceptible.

There are other medications which 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 may work for one patient may not work for another. Some of these medications have been proven, however, to decrease the intensity of the tinnitus and make it much less noticeable to the patient. There is, however, no drug anywhere which will remove tinnitus completely and forever. There are some drugs which will also cause tinnitus. If you have tinnitus and are on medication, you should discuss the symptom of tinnitus with your physician. In many instances, once the drug is discontinued the tinnitus will no longer be present.

Visit the American Tinnitus Association website for more information, ideas and strategies at  www.ata.org

Realistic Expectations for Hearing Aid Users

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 are do not restore normal hearing 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. Hearing aids should not to be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable, however, hearing aids cannot 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 and learned to adjust the volume control. There are adjustments that the audiologist can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.

GETTING — USED TO HEARING AIDS:

People learn 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. I usually recommend you wear the hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aid. 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. Start off 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 to Learning to Use a Hearing Aid:

  • Use the aid at first in your own home environment.
  • Wear the aid only as long as you are comfortable with it.
  • Accustom yourself to the use of the aid by listening to just one other person – husband or wife, neighbor or friend.
  • Do not strain to catch every word.
  • Do not be discouraged by the interference of background noises.
  • Practice locating the source of the sound by listening only.
  • Increase your tolerance for loud sounds.
  • Practice learning to discriminate different speech sounds.
  • Listen to something read aloud.
  • Gradually extend the number of persons with whom you talk, still within your own home environment.
  • Gradually increase the number of situations in which you use your hearing aid.
  • 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. Do call your audiologist to schedule an appointment time to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.

How do I know if I have a Hearing Loss?

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. Recent data suggests there are over 34 million Americans with some degree of hearing loss.

Hearing loss often occurs gradually throughout a lifetime. People with hearing loss compensate often without knowing they have hearing loss.

Common signs of hearing loss include:

  • 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.

If you have any of these symptoms, you should see a hearing professional to have an “audiometric evaluation.” An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed hearing professional.  An AE is not just pressing the button when you hear a “beep.” Rather, an audiometric evaluation allows the hearing professional to determine the type and degree of your hearing loss, and tells the professional how well or how poorly you understand speech. Speech understanding testing provides the professional how successful amplification may be for your hearing loss.

The AE should also include a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. Further tests of the middle ear function may also be performed.  The results of the AE are useful to the physician should the hearing professional conclude that your hearing loss may be treated with medical or surgical alternatives.

Result of the AE are plotted on a graph referred to as an audiogram. The audiogram provides a visual of your hearing test results across various frequencies.

Hearing Aid Battery Information

Hearing Aid Batteries

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!

Taking an Impression of the Ear

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 the 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, and then a waxy material is placed in the ear canal. 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!

Digital Hearing Aids

The term digital is used for most of today’s current technology, from televisions to cell phones.  Hearing aids today are also digital, meaning incoming sound is converted into a series of numbers, which is then processed using mathematical equations. Digital processing enables very complex manipulation of sound, for example, to separate speech from noise.

The digital technology within hearing aids also allows to separate sound into different frequency regions and amplify each region selectively, depending on the hearing aid  wearer’s hearing loss. The processing within hearing aids also enables different amounts of amplification for soft, moderate, and loud sounds, so sounds are audible, but loud sounds are not uncomfortable or over amplified. And, digital processing enables a natural sound quaity with minimal distortion, resulting in excellent sound quality.

Digital hearing aids are programmable, meaning the hearing aid settings can be precisely fine tuned and special features can be adjusted for each wearer by a hearing aid professional, using special hearing aid software on a computer. Hearing aids are programmed and customized for both the hearing loss and the preferences of the person who wears them.

Advanced Technology

In addition to basic digital hearing aid technology, many hearing aid manufacturers offer several levels of advanced features made possible with digital processing technology. Digital hearing aids continue to advance and have become much more automatic and are equipped with sophisticated features for people who regularly encounter dynamic listening situations. Examples of of some of these advanced features, what they do and how they benefit the hearing aid wearer are:

  • Directional Microphones – Applies preference to sounds in front of the wearer and reduced sound from behind the wearer. This technology has been proven in studies to improve speech understanding in background noise.
  • Noise Reduction -Determines if signal contains unwanted background noise and reduced level of background niose if present. Background noise is less annoying and hearing aid wearer’s listening comfort is improved in noisy situations.
  • Feedback Management – Reduces or eliminates whistling that can often occur with hearing aid use. Hearing aid wearer’s comfort is improved from annoying whistling.
  • Wind Noise Reduction – Reduces the noise created from wind blowing across the hearing aid’s microphone(s). Designed to improve comfort for persons who spend a lot of time outdoors.
  • Data Logging/Learning – The ability of the hearing aid to track and learn the hearing aid wearer’s preferences in various listening environments. This information can assist the hearing professional in making future programming adjustments and allows the hearing aid to adapt to the wearer’s preferences.
  • Bluetooth Interface – Establishes a wireless connection between hearing aids and Bluetooth compatible devices. Designed to improve wearer convenience and use with devices such as cell phones, Mp3 players, computers, etc.

Background Noise

Virtually all patients wearing hearing aids complain about background noise at one time or another. There is no way to completely eliminate background noise. Background noise exists and is importatnt to hear in order for the hearing aid user to be involved in their environment. There is no way to completely eliminate background noise, however, technology exists today to reduce distracting noise and allow you to focus better on the person you want to hear.

Remember, when you had normal hearing there were still times when background noise was a problem. It is no different now, even with properly fit hearing aids! The good news is there are circuits and features that help to reduce (or minimize) background noise and other unwanted sounds. In fact, there are research findings that demonstrate digital hearing aids with particular circuit and microphone options can effectively reduce background noises.

Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter, however, not only was the background noise made quieter, but so too, was the signal (the speech sound).

Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.

The best and most efficient way to eliminate or reduce background noise is through the use of FM technology.

What is an Audiologist?

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.