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What is an Audiologist?
Audiologists are the primary health-care professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children.
Audiologists:
- Prescribe and fit hearing aids
- Assist in cochlear implant programs
- Perform ear or hearing-related surgical monitoring
- Design and implement hearing conservation programs and newborn hearing screening programs
- Provide hearing rehabilitation training such as:
- auditory training
- speech reading
- listening skills improvement
- While most audiologists earn a doctor of audiology (AuD) degree, there are other doctoral degrees that audiologists can obtain, i.e., PhD, ScD, etc., from accredited universities with special training in the prevention, identification, assessment, and treatment of hearing disorders.
- Audiologists must be licensed in most states.
- Audiologists treat all ages and types of hearing loss: adults, teens, children, and infants.
- Audiologists work in a variety of settings, such as:
- Hospitals, Clinics, Private Practice, ENT offices, Universities, K-12 schools, government, military, and VA hospitals.
- Almost all types of hearing loss are treatable by an audiologist.
- Most hearing loss that is caused by nerve damage can be treated by an audiologist with hearing aids, assistive listening devices, and hearing rehabilitation.
What to expect from a complete hearing exam?
The Beginning of Your Visit when you go to the audiologist or fitter’s office for your hearing test, you will first have a discussion with the test administrator about your medical history as well as your history of hearing loss in general. You may be asked questions about noise exposure, medications you are taking, any ear surgeries you may have had, any diseases of the ear that you have or had, and hereditary factors. It may be helpful to bring notes with you to make sure that you cover everything comprehensively before the hearing test begins.
Upon completion of this discussion, you will be put through a series of seven different hearing tests to gauge different aspects of hearing loss. Different audiologists and fitters may do the following hearing tests in a slightly different order, but the sequence below outlines what is most common. It is extremely important that you have all of these tests done to create the most complete picture of your hearing and all of these hearing tests can be performed in a single office visit.
The First Step – Tympanometry
The first step in your hearing test is tympanometry. Tympanometry tests the movement of the eardrum. During this painless test, you need to do nothing but relax and let the readings be taken. The hearing test administrator will begin by placing the tip of a handheld tool into your ear. This tool will change the air pressure inside your ear and will also produce a clear tone. It will then measure how your eardrum responds to the pressure change and to the sound. This test will help to set a baseline for the rest of the hearing tests by letting the administrator know if any specific medical issues, such as an ear infection or a blockage of your Eustachian tube, should to be taken into consideration.
The Next Step – Hearing Tests that Require Headphones
Next, you will be placed in a soundproof room and given headphones through which the administrator will speak to you or play sounds. You will then be given a series of hearing tests through these headphones, including a pure-tone test, a speech reception threshold test (SRT), a most comfortable listening level test (MCL), an uncomfortable loudness level test (UCL), and a word recognition test, also commonly known as a speech discrimination test.
First, you will be given a pure-tone hearing test, which can help to determine the type, degree, and configuration of your hearing loss. Pure-tone thresholds (PTTs) determine the softest level at which you can hear the tone at least 50 percent of the time. For this hearing test, you will be asked to indicate each time you hear a tone in the headphones by either raising your hand or pressing a button.
The SRT test will be administered next. During this hearing test, you will be asked to repeat several two-syllable words while the intensity is decreased in order to find the lowest level at which you are able to repeat half of the words. Then, the MCL test will be performed to determine the loudness at which you prefer to hear by having you identify the level at which it is easy and comfortable to hear sounds. The UCL test (also called the upper level of comfortable loudness) will then do the opposite and will find the loudest level that you would ever wish to listen to – with anything louder being painful. During this portion of the hearing test, the volume in the headphones will slowly be raised, and you will be asked to indicate when the voice you hear has reached this upper level. These three hearing tests can give great insight into your level of hearing loss.
You will then be given the word recognition/speech discrimination test, in which you will listen to a set of single syllable, phonetically balanced words at a comfortable hearing level. You will then be asked to repeat these words back to the administrator one at a time. The results of this portion of the hearing test are critical to helping you establish a realistic expectation of what a hearing aid can do for you.
The Last Step – Bone Conduction
Finally, you will remove the headphones for the last of the hearing tests – the bone conduction test. A small oscillator (which looks like a small disc) will be placed on the bone behind your ear, and it will painlessly stimulate the bones of your skull, which, in turn, stimulate your inner ear. You will again be asked to indicate when you hear a tone as the sound level is raised and lowered to find a level at which you can hear the sound at least half the time. This hearing test is used to find out whether or not you’re hearing loss is affected by issues relating to your inner ear.
The Results of Your Hearing Test
Once your hearing tests are complete, the results should be available immediately, and the administrator should discuss them with you and put them into the context of your everyday life. The hearing tests will be able to determine if your hearing loss is conductive (relating to the outer and/or middle ear), sensory neural (relating to the inner ear hair cells and nerves), or a combination of the two. The hearing test results will also tell you whether your hearing loss is mild, moderate, severe or profound. And your speech discrimination results will give you a practical look at what level of speech understanding you will be able to achieve with a hearing aid, because even with the best hearing aid you cannot achieve a level of understanding that is better than your discrimination score.
If the administrator is also a hearing aid dispenser, he or she may then make recommendations as to what type of hearing aid would work best for you, and may even suggest two or three different models. Remember – you are under no obligation to purchase your hearing aid from the administrator of your hearing test. Because of HIPAA regulations, you are entitled to a copy of the results of your hearing tests without making a purchase. Remind the administrator of this if any issues arise, and make sure that your copy of your results also includes the date of the exam and the administrator’s name.
Armed with the results of your hearing tests, you can then move forward toward making the purchase of a quality hearing aid that meets your needs. Take your time, ask a lot of questions, and shop around for the best product at the best price. The hearing test administrator may be the person you return to when making your purchase, and he or she may not. The most important thing is to make sure that when you finally buy your hearing aid, the dispenser is taking the results of your hearing tests into consideration and is helping you to make a purchase that will help improve your hearing for years to come.
What is Digital Hearing Aid Technology?
Digital Hearing Aids
What does it mean if hearing aids are digital? This is a common question among consumers and is a question that comes up on all electronic devices, not just hearing aids.
Digital signal processing means incoming signals are converted into a series of binary numbers and are then processed using mathematical equations. The mathematical equations used in digital signal processing are called algorithms. Each hearing aid manufacturer utilizes unique algorithms to manipulate the signal, allowing a precise replication of the original signal with minimal distortion resulting in excellent sound quality.
Digital processing algorithms in hearing aids enable very complex manipulation of signals. A few examples are as follows:
- Separate sound into different frequency regions and amplify each region selectively, depending on the wearer’s hearing loss.
- Enable different amounts of amplification for soft, moderate, and loud sounds, so sounds are audible, but loud sounds are not uncomfortable or over amplified.
- Separate background noise from a desirable signal such as speech and reduce the background noise – improving overall listening comfort.
- Detect and eliminate whistling from occurring to improve listening comfort.
- Allow wireless communication between right and left hearing aids to allow hearing aids to work together and process sound in sync.
- And many, many more!
What is an earmold impression?
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 10-15 minutes.
How do I know if I have Hearing Loss?
Of course, the most obvious symptom is inability to hear. However, hearing loss sneaks up on people. Often family members and friends are aware of hearing problems before the hearing-impaired person. Many people in the early stages of hearing loss of this sort will find themselves:
- Asking people to repeat themselves more frequently
- Offering inappropriate answers because they have misheard a conversation or question
- Going out less and socializing less
- There are many other symptoms that may be related to hearing loss:
- Increased levels of frustration and irritability are common.
- Sometimes difficulty understanding speech is more of a problem than an inability to hear speech.
- Feelings of ear fullness or pressure, ear noises (ringing, buzzing, crickets, seashells, steam, and others), and dizziness.
Hearing loss is not always slowly progressive and stable from day to day. It may be sudden, rapidly progressive, or even fluctuating (good times and bad times).
What is the realistic expectations of a Hearing Aid?
Hearing aids work very well when fit and adjusted appropriately. They amplify sound! You might find that you like one hearing aid better then the other. The left and right hearing aids will probably not fit exactly the same and the probably won’t sound exactly the same.
What is Tinnitus?
Tinnitus is the medical term for “hearing” noises in your ears when there is no outside source of the sounds. The noises you hear can be soft or loud. They may sound like ringing, blowing, roaring, buzzing, hissing, humming, whistling, or sizzling. You may even think you are hearing air escaping, water running, the inside of a seashell, or musical notes.
Symptoms:
Subjective tinnitus is frequently associated with hearing loss. About 90% of patients have sensorineural hearing loss; 5% suffer from conductive hearing loss; 5% have normal hearing.
The causes of subjective tinnitus include:
- impacted ear wax
- ear infections
- hardening of the structures of the inner ear
- hearing loss related to age or excessive noise
- ototoxic medications, including aspirin, quinine, some diuretics, heavy metals, alcohol, and certain antibiotics
- meniere’s syndrome
- head trauma
- systemic diseases, including syphilis, hypertension, anemia, or hypothyroidism
- tumors of the ear
What is a balance test (ENG)?
An Electronystagmogram (ENG) is the most common audiological test ordered for individuals complaining of dizziness or vertigo. This test records and measures voluntary and involuntary eye movements (the vestibular ocular reflex), specifically nystagmus. Nystagmus is an involuntary back and forth jerking movement of the eyes that occurs when the entire balance system is stimulated. When the vestibular and ocular systems are functioning normally, nystagmus is only rarely seen. For the purpose of testing, nystagmus can be elicited through certain movements or stimulation of the vestibular system (the balance organs of the inner ear). This helps to determine the cause or origin of your dizziness. An ENG evaluates the oculomotor system and the vestibular system. The test takes approximately an hour and a half to complete.
The ENG is Comprised of a Series of Subtests or Tasks. There are Three Main Parts:
- Oculomotor Analysis — patients perform various visual tasks that require eye movement
- Positional Testing — patients are placed in various body positions to determine if dizziness develops and to see if nystagmus occurs
- Caloric Stimulation — small amounts of both warm and cool water are introduced into each ear canal to independently stimulate the inner ear vestibular system
Throughout each part of the test, patterns of normal and abnormal eye movements are analyzed. The main purpose is to look for the presence of nystagmus in both the absence and presence of vestibular stimulation, as well as look for symmetry of responses. Analysis allows for determining if the disorder is central, peripheral or systemic.
- Central problems are caused by disturbances in the brain or central nervous system
- Peripheral problems arise from disturbances in the labyrinth (inner ear balance organ)
- Systemic problems are the result of disturbances in the organs and peripheral nerves (nerves outside of the brain or spinal column)
Diagnosis allows your physician to prescribe appropriate treatment options.
