Archive for the ‘Audiologist’ category

What Should You Expect from Your Hearing Evaluation?

January 12th, 2012

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com

More than 32 million Americans have significant hearing loss, yet only a fraction of that number have ever had their hearing tested by a Board Certified Audiologist. Everyone over 25 should have a baseline audiogram! Consider this fact- 17% of all those involved in motor vehicle accidents will have resultant permanent sensorineural hearing loss. However, if you’ve never had a valid hearing evaluation, you’d be hard pressed to show that your hearing was normal prior to such an accident.

A thorough hearing test is the first step in determining if you do, in fact, have hearing loss. The hearing test results also allow your audiologist to recommend the best treatment options if you do in fact have hearing loss. A hearing test is a quick, painless and non-invasive test, and should always be performed by a licensed, Board Certified audiologist. Ask to see the credentials of those who will be doing your testing! As with most health care  professionals, credentialed individuals have the greatest amount of educational training in diagnosis and treatment of hearing impairment, and will offer you or your loved ones solutions that reflect their knowledge base.

Hearing Test Audiogram

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The test begins with a thorough case history, which reviews specific health information that may provide insight into hearing loss causes and will assist in determining which tests should be performed. Following the case history, the audiologist will examine your ear canals and eardrums with a special light called an otoscope. Your middle ear function will also be assessed by a test called tympanometry, which offers insight regarding the status of the area behind your eardrum. This area cannot be easily seen, and so the tympangram offers valuable information to the examiner. The test involves a pressure change, and may replicate the feeling you experience while going up in an elevator, but is not painful in any way.

Next, the levels of hearing in each of your ears should be measured in a sound-treated test booth. Some hearing aid technicians don’t use this type of equipment~ but be wary of any hearing test that is not conducted in such a booth, as reliability may be seriously compromised. During this test, a series of tones of different pitches, as well as speech signals, are presented to each ear through headphones. You will be asked to respond to the signals by either pushing a button, raising your hand or in the case of speech signals, repeating what you heard. You will be asked to respond to the lowest level that you can hear which determines your hearing thresholds. Thresholds for each pitch and ear are plotted on a graph called an audiogram. These thresholds indicate the level at which you are just barely able to detect sound. The speech testing yields a word recognition score, which is important in determining in part how well you will perform with hearing aids, which listening situations will be most challenging, etc.

Further tests may be conducted during the hearing test. Your ability to understand words or sentences at different volume levels or in the presence of noise may be assessed to determine how clearly you hear speech in various conditions. Following the tests, the hearing professional will discuss the results with you and may provide further recommendations, including treatment options, like hearing aids.

If you suspect you have hearing loss it is important to have your hearing tested as soon as possible. The use-it or lose-it principle does apply to our hearing; the sooner you treat hearing loss, the better the outcome of treatment. Most people wait an average of seven years from the time they suspect they have hearing loss until they purchase hearing devices. During that time period, the auditory system is at extreme risk for auditory deprivation, or lack of stimulation due to insufficient volume. This can make a difficult situation worse than it really needs to be. So why wait? Have a Board Certified Audiologist evaluate your hearing as soon as you (or others!) suspect there might be a hearing loss.

What’s the Best Hearing Aid?

December 8th, 2011

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com

“What’s the best hearing aid?” As an Audiologist, I’ve heard that question so many times. To successfully answer that question, perhaps the very first thing I need to do is modify it slightly ~ “What’s the best hearing aid for you?” An important concept to keep in mind when exploring today’s vast array of options for hearing devices is that what’s right for you may not be right for someone else, and vice reverse. The decision regarding which type of hearing instrument technology will sound and perform the very best will be largely dependent on you, your lifestyle, budget, and listening needs. These parameters tend to be highly variable from person to person, so let’s take a closer look.

Not all hearing losses can be correctly fit with the same style or type of device. This is very evident when fitting those with precipitous loss in the high frequencies.  High frequency deficits are the most common configuration of hearing loss, and respond best to open fit technology. This type of device leaves your ear canal open, ensuring that the sound of your own voice is normal and pleasant. Conversely, fitting those with high frequency loss with conventional “in the ear” devices can have catastrophic results in terms of patient satisfaction. Have hearing instruments that you or your loved one are not using? It may be resultant from the units being the wrong style for the loss! High quality open fit technology has been available for a relatively short period of time, and many of those whose instruments were purchased more than 5 years ago may not have had access to those devices.

What about some of the new “fancy stuff”, like Blue Tooth technology? Is that for you? Many of my patients are not familiar with Blue Tooth, but it can open up a world of ancillary devices and couplings for your hearing devices. For example, if you use Blue Tooth enabled hearing aids, you can wear a “streamer” around your neck, and answer your cell phone hands free through your hearing aids! With the new cell phone use restrictions now in place in Montgomery, that can be a really handy feature. It’s also possible to listen to your TV or IPod directly through your hearing instruments with this technology, or use a special microphone to make conversations with your significant other in a noisy car or restaurant much easier. Other technologies to consider are remote controls, assistive listening devices like amplified phones or doorbell alerts, or FM devices to help with performance in a classroom or job environment. However, if you don’t want or need such technologies, don’t pay for them!

AGX Hearing Lifestyle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What kind of lifestyle do you have? If you are still working, it’s likely that you are in highly variable listening environments, or your profession demands auditory accuracy (and most jobs do!). Those who lead very active lifestyles need to consider today’s high end technology, with plenty of noise reduction capability. On the other hand, if you’re retired, living alone, and seldom go to restaurants or parties,  simpler, more basic noise reduction features will suffice – and cost less! If you are the type of person who “wants the best of everything” then there are plenty of high end technologies to wow you (and your friends and family). Don’t overbuy, but do be honest with your Audiologist about your listening needs. If you aren’t you may be disappointed with your hearing devices.

Finally, as self-serving as this might sound, perhaps the only honest and comprehensive answer to the question above is “a hearing device recommended and provided by an exceptionally skilled and dedicated Audiologist.” Sometimes that’s not the answer folks are looking for. I have patients tell me “it’s all about price” or request a specific brand because a friend or relative was successful with a particular device. Hearing aids are a big investment with the potential for providing a big improvement in the quality of your life. People with hearing impairment need a competent and caring Board Certified Audiologist who will go the extra mile to provide them with solutions custom-tailored to their own unique hearing loss and listening situations. As critical as the various aspects of technology may be to the hearing aid industry, it is ultimately the professional who is the decisive factor in guiding patients to satisfaction and benefit with hearing devices.

Note: Doctors Hearing Clinic was recently named Best of 2011 Hearing Healthcare Professionals by The Hearing Review, and was Dr. Borton and her staff were the only clinic in Central Alabama to receive this award. This recognition was provided to only 165 hearing healthcare clinics across the United States.

Make the Most of Your Hearing – (re) Train Your Brain!

November 23rd, 2011

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com

We hear in our ears, but we process and understand sound in our brain. Hearing aids can help a person detect that are no longer in their range of audibility, but they don’t necessarily provide good listening skills. There is a fundamental difference between hearing and listening, and hearing devices alone do not assure good listening. We all know people who have normal hearing but are poor listeners (ok, ok, don’t reference your spouse’s selective hearing!). Hearing requires a functional auditory system that allows sound to be heard, listening requires specific effort and skill, and that can become more difficult when a hearing loss is present.

As technically advanced as modern hearing aids might be, these devices alone cannot ensure listening skills needed for communication. Listening integrates a number of skills including attending, understanding, and remembering. Unfortunately, many of these cognitive skills deteriorate as we age. This may show up as a worsening of short-term memory, or increasing difficulty understanding rapid speech. Modern hearing aids have certainly improved the quality of sound in noisy environments, but they do not eliminate background sounds. People with sensorineural hearing loss have disproportionately difficult time understanding speech in noise. In addition, research shows that a loss of hearing produces physical changes in the auditory pathways of the brain. We now know that when hearing loss deprives parts of the brain of auditory stimulation, neural pathways actually degrade. The old adage of “use it or lose it” is very true with regard to hearing loss- waiting to get hearing aids when you know you have hearing loss is problematic because your brain may not be receiving the kind of stimulation it needs to maintain speech understanding.

Bettie Borton, Au.D. Doctor of Audiology AudiologistWhen people lose confidence in their ability to communicate in noisy social situations, they simply drop out and avoid those environments. While this may save them effort and embarrassment, it ultimately costs them important personal and social contact. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. The need for additional therapy beyond that provided by devices alone is becoming increasingly evident, and is underscored by the fact that individuals with similar hearing loss frequently report a wide range in satisfaction and benefit from their hearing aids.

The good news is a Board Certified Audiologist can optimize your hearing aid hearing experience using a number of methods, strategies and techniques. The hearing healthcare professionals at Doctors Hearing Clinic specialize in developing individualized treatment plans for those struggling with hearing impairment, and can offer the very latest in technologies, as well as the time required to successfully implement them! Have realistic expectations for hearing aids – they’re wonderful devices, but not new ears. Join a self help group to share methods and techniques that are successful for you and others (Montgomery has a Hearing Loss Support Group that meets the second Thursday of each month at the First Methodist Church, 4 PM, free of charge!). And consider new computer software to “train your brain” to listen more effectively!

The great news is that with the help of a skilled Audiologist who routinely offers programs in aural rehabilitation, you or your loved ones can keep listening skills from deteriorating and improve ability to function in noisy situations. When a person injures an arm or leg, everyone recognizes the importance of physical therapy to strengthen adjacent muscles and instruction to optimize function. Similarly, it is likely that hearing devices alone will not produce optimal communication skills unless accompanied by counseling and training.

There are many exercises you can try on your own. Here are three examples:

• Use closed- captioned TV, or record programs using a DVR or TIVO. Watch the show live. Then replay it with closed captioning or by slowing it down.

• Listen to, while reading, audio books.

• Buy two copies of the newspaper. Have your spouse or colleague read the newspaper aloud while you are listening only, and then go ahead and read it yourself. Try this in quiet at first, and then proceed to noisier listening environments.

• Try self-help computer assisted training programs

One such auditory training therapy program designed to help the brain listen, Listening and Communication Enhancement (LACE) uses a computer or DVD. LACE is designed to enhance listening and communication skills, improve confidence levels, and provide communication strategies. The program consists of a variety of interactive and adaptive training tasks for listening to speech in noise, rapid speech, and auditory memory. Besides the immediate feedback given for each task, LACE provides you with a graph depicting daily improvement from the start of the training.

LACE training is conducted in the privacy of your own home at a pace comfortable to you; Doctors Hearing Clinic also offers a computer lab where you can take all or part of the training in their office. Research on thousands of people with hearing loss demonstrates that you can expect on average a 40% improvement of speech comprehension in noisy situations, if you complete the training program.

So if you or someone you love uses hearing devices, take the important step of seeking help from a Board Certified Audiologist to help you develop a comprehensive strategy for hearing and communication skills – train your brain for listening!

References: Robert W. Sweetow, Ph.D., Professor of Otolaryngology, University of California, San Francisco and the Better Hearing Institute

You bought new hearing technology, but, you still have difficulty hearing in noise. What’s going on??

November 3rd, 2011

By: Amit Gosalia, Au.D., FAAA
Board Certified Doctor of Audiology

Audiology Clinic, Inc.
505 NE 87th Ave., #150
Vancouver, WA 98664

(360) 892-9367
Follow Audiology Clinic | Facebook | Twitter
www.audiologyclinic.com 

Dr. Gosalia, I just bought a pair of $8500 hearing aids from XYZ in Portland. I was told that I would hear normally in all environments, including restaurants and ball-games. I am less than pleased because I still can’t hear or understand in noise. Did I waste my money?”

Amit Gosalia, Au.D. - Doctor of Audiology, Vancouver, WAThis was a case I dealt with a few months ago. This patient went to a business to purchase hearing aids, and this franchise/chain location set some lofty expectations for the patient. As hearing instrument technology improves, so do patient expectations. Terms such as noise reduction, noise management & directional hearing (along with many other proprietary terms) give the perception that the end-user will not hear background noise, and only hear the person in front of them. Unfortunately and fortunately, this is not true. Below I’ve touched the surface of noise, noise reduction and directivity.

Let’s start with noise. Noise is any disrupting event (in this case, sound) that impedes one’s ability to sense (in this case, hear) a signal (in this case, speech). For the purpose of this post, we’ll concentrate on hearing speech within a noisy environment. A general term and formula that is used in hearing healthcare is Speech-to-Noise Ratio (SNR) which tells us how loud speech is in relation to noise. For example, average speech is 45-55 decibels (dB) hearing speech in a basketball stadium where the crowd is cheering over 90 dB is difficult because the speech is 35-45 dB lower than the noise. This is considered a very low SNR; now compare this to speaking at a normal volume in a quiet library, the SNR will be high making speech much easier to understand. When someone has a hearing loss things change. Without amplification important parts of speech are not heard well, making understanding the person next to you difficult, if not impossible. The natural ability of any person to hear through noise decreases as hearing loss increases. This is a fact that has been well established in research on the human auditory system. Thus, a hearing aid can help make missing pieces of speech more easily heard but it cannot repair one’s ability to hear through noise and find valuable pieces of speech. For this reason, modern hearing aids focus on managing noise and amplifying clean speech.

Hearing instruments can come with or without venting. Vents are holes that are drilled through either the hearing instrument or the earmold for the purpose of letting air and sound travel in and out of the ear canal. The larger the vent, the closer you get to a more natural, open ear. Newer technology has allowed us to keep the ear open with small hearing instruments that rest behind the ear and even some custom molded devices (please see other postings for detailed descriptions of hearing technology). As cute as they may be, if your hearing is not within or near normal limits in the lower frequencies, an open ear device may not be for you.

One advantage of an open ear hearing aid is to allow low frequency sound to escape the ear canal, keeping the user’s voice more natural. When the user complains of hearing their own voice in their head or sounding as if they are speaking in a barrel, it’s usually a phenomenon called occlusion (or ampclusion). Keeping an ear canal open minimizes this effect but also introduces two detrimental issues. First, low frequency environmental sounds will bypass the hearing aid and travel into the ear naturally through the vent. These sounds that bypass the hearing aid are often heard naturally because most hearing losses are minimal in the low-frequencies and greater in the high-frequencies. This also means that the hearing aid is not able to process the sound before it’s heard, so technologies such as noise reduction do not affect low-frequency sounds in the open ear hearing aid.

Secondly, directional microphones will prove less beneficial in the open-ear fitting.2 What this means is that the more open the ear canal, the harder it becomes to hear what’s in front of you. So, theoretically, if our goal is to have the instruments focus more front-facing, the ear canal should not be very open. Note that normal low frequency hearing will be affected by closing the ear canal, and opening the canal with moderate to profound low frequency hearing will result in less hearing in those frequencies.1,2

So, what does this tell us about hearing in noise with amplification? You will hear background noise in noisy environments. You will most likely hear the kids screaming four tables away. You may still have difficulties hearing the person across the table from you. The good news is that with proper hearing aid selection and the correct technology that meets your lifestyle and budget, you’ll hear much better. Only a well trained hearing care professional can make these choices and help you to establish reasonable expectations for better hearing.

“Ms. XX, although the level of technology you purchased is consistent with an Active Lifestyle (in our clinic approx $7500 – $1000 less than the chain!!), you should know that hearing aids only supplement your hearing in those difficult environments. In fact, with normal hearing, I have difficulty hearing at basketball games and certain restaurants as well. Although we can not restore normal hearing, we can help you hear much better in more environments. You will still have some difficulty hearing and understanding in certain environments, but, with some realistic expectations, expert advice, and some auditory retraining, you will find greater success.”

 

1 What is the Effect of Venting on Directivity? Audiology Online 10/2009; Todd A. Ricketts, Ph.D., CCC-A, FAAA

2 Efficacy of an Open-Fitting Hearing Aid; Hearing Review February 2005; Francis Kuk, Phd, et al

Consumer Protection Laws & Regulations for Hearing Aid Purchases

October 12th, 2011

By Crystal L. Chalmers, Au.D.
Doctor of Audiology

North State Audiological Services
15 Jan Court
Chico, CA 95928

(888) 844-7024
Follow North State Audiological Services | Facebook | Twitter | Youtube
www.nsaudiology.com

Here in California – as in many states – purchasers of hearing aids are afforded protections under state laws and regulations administered by the Department of Consumer Affairs (DCA) through the Speech-Language and Audiology and Hearing Aid Dispenser Board (SLPAHADB).

The SLPAHADB was formed on January 1, 2010 by combining the Speech Language Pathology and Audiology Board with the Hearing Aid Dispensers Board.  Previous laws and regulations remain virtually unchanged except that audiologists are no longer required to hold dual licensure for practicing audiology and dispensing hearing aids.

Audiologist & Ear Doctor, Dr. Crystal Chalmers, Chico, CaliforniaThis board’s mission is ensuring the competency and fair practices of hearing aid dispensers.  It does so by providing licensure through testing, ethical guidelines, boundaries for advertising practices, and acts as a vehicle for consumer complaints, ultimately providing enforcement and disciplinary functions.

While political discussion in the media about government intrusion in our lives is a hotbed topic, consumer protection laws are generally an accepted interaction between the citizenry and government.  Who wants to buy poisonous food, cars that don’t run, or housing that collapses in the slightest breeze, to name just a few examples?

Why should it be any different with hearing aids?   Purchasers have a right to expect fair and honest treatment as well as professional expertise from those they seek help.  It could be argued that hearing aid purchasers – many of whom are our senior citizens – should receive an added degree of protection as many of our laws are designed to protect us as we age beyond our more active years, and thereby tend to rely on the care and guidance of those who are younger.

While all the laws and regulations are too lengthy to list here, these are several of the most important.  For the full listings, visit the SLPAHADB website at www.speechandhearing.ca.gov

  • 30 Day Warranty  – The “Song-Beverly Consumer Warranty Act” provides a 30 day warranty on all new and used hearing aids.  If the hearing aid is not specifically fit for the buyer’s particular needs, the device may be returned to the dispenser within 30 days of the of the date of the actual receipt by the buyer or completion of fitting by the seller, whichever occurs later.  If the buyer returns the device the seller must either adjust or replace the device or promptly refund the total amount paid.

It should be noted that while many dispensers advertise things like “30 day risk-free guarantee” they are merely staying within the state mandated minimum trial period of 30 days.  My professional opinion is that for many purchasers, 30 days is too short as it does not allow enough time for the brain to get used to hearing again.  In my practice, I offer a 75 day trial period in order to make certain my patients have all the time they need to be successful.

  • Mail Order & Internet Sales  – California law provides that mail order/Internet hearing aids may only be purchased through a dispenser licensed in California.  The law also states that that when hearing aids are purchased by mail order/Internet, there must be no fitting, selection, or adaptation of the instrument and that the seller must not give any advice with respect to the taking of an ear impression(s). Anyone contemplating this avenue should be aware of potential risks as to work effectively, hearing aids must fit correctly.  If a sale doesn’t involve personal contact between the dispenser and buyer, it is difficult to assume that proper fitting and follow-up care could occur.
  • In-Home Contracts & Cancellation Rights – If you sign a hearing aid purchase contract in your home, federal and state laws allow you to cancel it for any reason by midnight of the third business day after you signed the contract.
  • Advertising Guidelines –  Did you know that in California, hearing aid dispensers are not licensed to perform diagnostic hearing evaluations (only audiologists are licensed to do so) and are therefore not allowed to charge a fee for “testing”?  That is why they advertise “free” tests, BUT they must state that the “test” is “to determine if you could be helped by a hearing aid.”

No one selling hearing aids in California can refer to themselves as a “specialist” without including the title “hearing aid dispenser”, nor can anyone refer to certification by putting a bunch of letters after their name.  For example, this listing: “John Doe, NB-HIS” is unlawful.  The correct listing should be:  “John Doe, Hearing Aid Dispenser, Lic. No. XXXX, NB-HIS, Certified by the National Board of Certification in Hearing Instrument Sciences”

Have you ever received one of those “rebate coupons” that resemble checks as part of a direct mail solicitation?  It is a violation to send those to anyone living in California.

And finally, no California licensed hearing aid dispenser can use the terms “doctor” or “physician” or “clinic” or “audiologist” or any derivation thereof, except as authorized by law.

These are just a few of the consumer protections for purchasing hearing aids.   I urge you to be good consumers by getting the facts and educating yourself about where you stand and whom it is that you are considering doing business with.  You’ve worked hard all your life and deserve to be treated fairly, professionally, and with what is in your best interest  …. Because hearing is a wonderful gift!

About the writer:  Crystal Chalmers, Au.D., is an AudigyCertified™ Doctor of Audiology, the owner of North State Audiological Services in Chico, and a member of AudigyGroup, the nation’s largest member-owned association of independent hearing care professionals.

Since 2006, AudigyGroup has interviewed over 5,000 of the 18,000 audiologists in the United States, yet has selected only 200 to be members in this elite association. AudigyCertified™ is a trade-mark of AudigyGroup, LLC.

To learn more about Dr. Chalmers, her practice, and AudigyGroup visit online at www.nsaudiology.com

Sound Advice

October 6th, 2011

By: Dr. Amin Musani
Doctor of Audiology
The Hearing Clinic
119 W. Main Street
Denison, TX 75021
(903) 462-4022
www.thehearingclinic.org

I watched as the next IDPA shooter stepped up to the firing line. You could tell he had done this before. He carefully but purposefully loaded a magazine into his handgun and chambered a round. On cue, he drew and shot a perfect score in amazing time. His handgun seemed like an extension of his arm. The bullets landed exactly where he willed them to on the cardboard target. After safely holstering he stepped back, turned around and flashed a smile, which told you he was pleased with his results and all that training and endless hours of practice had finally paid off. As he made it back to the observer area I walked over and congratulated him for a job well done. Curious as to what type of handgun he was using I asked him, “What kind is it?” He replied, “It’s 2:30pm.”

It never ceases to amaze me the high number of shooters that I come in contact with that do not wear any type of hearing protection while shooting. Granted, some things in our lives we cannot control. However, noise induced hearing loss (NIHL) and Acoustic Trauma are phenomenon that we most certainly do have control over and yet many shooters ignore the very basic principle of wearing hearing protection.

When is firearm noise is too much? When do we cross that line between loud and damagingly loud? Table 1 [1] displays some of the decibel (dB) levels of various sounds found in our daily lives. A decibel is a unit of measurement and for our purposes here it is measured on a logarithmic scale and there is a 10-fold increase in noise energy for each 10 dB increase. Said another way, an increase of 10 dB doubles the loudness level.

Sounds over 140dB can cause pain, and prolonged exposure to noise over 85-90dB can result in permanent hearing loss. Gunfire may be categorized as an impulse noise, which has the characteristic of an explosive burst. Impulse noise of sufficient intensity and pressure is often a cause of acoustic trauma. Generally, studies have shown that such impulse sounds may result in the shifting, skewing, bending, swelling, bursting, tearing, fusing &/or severe mechanical damage to the inner ear cells, structures, and auditory pathways. That is, short-duration sounds of sufficient intensity (e.g., a gunshot or explosion) may result in an immediate, severe, and permanent hearing loss, which is termed acoustic trauma. The degree of hearing impairment seen after acoustic trauma varies and may range from a mild to profound hearing loss.

Figure 1 (Pickles & Heumen; 2001) compares electron microscopy of normal, healthy outer hair cells (specialized hearing cells in our inner ear) to damaged ones. Once such damage occurs, it is permanent. There is no method of regenerating these cells or “curing the damage.” Bear in mind that this is only one site where such damage can occur from noise exposure along our auditory pathway.

There is evidence to suggest that once deterioration of certain specialized hearing cells (spiral ganglion cells) has begun, there is a corresponding deterioration within the central nervous system at areas higher up in the auditory system (Kim et al., 1997; Morest et al., 1998). Thus, once damage has occurred at lower levels it is not isolated there but rather may progress upwards through the auditory pathway. This is very characteristic of impulse noise such as gunfire that causes acoustic trauma. The inner ear, then, is not the only structure at risk from such exposure.

Figure 1. Normal, healthy outer hair cells (L) vs. damaged outer hair cells (R).

Virtually all of the structures of the ear and hearing system can be damaged from gunfire noise (NIH Consensus Statement; 1990). Generally, for sound levels below 140 dB, different types of sounds produce the same hearing loss. This does not appear to be the case at levels above 140 dB, where impulse noise creates more damage than would be predicted. This may imply that impulse noise above a certain critical level results in acoustic trauma from which the ear cannot recover (NIH Consensus Statement; 1990).

Exposure to noise between 90 and 140 dBA (dBA denotes a decibel measure made with a filter that adjusts for human auditory sensitivity) damages the inner ear metabolically rather than mechanically and causes injury depending on the level and duration of exposure. Noise-induced hearing loss, in contrast to acoustic trauma, develops slowly over years, and is caused by any regular and consistent exposure exceeding a daily average of 85-90 dBA (Clark & Bohne; 1999). Acoustic trauma may occur from just one unprotected exposure to gunfire noise.

For sounds between 75 – 90 dBA, the ear has a natural protective mechanism to reduce its sensitivity to low frequency impact sounds through what is termed the middle ear reflex. Generally speaking, muscles in our middle ear contract and stiffen three tiny bones (the smallest bones in the human body called ossicles; see Figure 2) that relay sound to the inner ear. However, a delay of 300 to 500 milliseconds is required to set this protection fully in operation. Most naturally occurring impact sounds can easily be dealt with by the middle ear, but many man-made sounds, such as explosions from guns, as well as certain industrial noises, occur so quickly that our middle ear protective mechanism cannot respond quickly enough. The hearing loss caused by such sounds is permanent acoustic trauma (Truax; 1999).

Peak sound levels from rifles and shotguns can range from 132 dB SPL (sound pressure level is another unit of measurement) for small-caliber rifles to more than 172 dB SPL for high-powered firearms. Americans collectively own more than 230 million guns, and more than half of men in the American industrial workforce occasionally use guns. The National Rifle Association estimates that 60 to 65 million Americans collectively own more than 230 million guns. Because guns are so prevalent in our culture, shooting firearms is the most important source of excessive noise outside the workplace. The severity of injury produced by impulsive noise exposure and the prevalence of shooting by Americans makes gun noise America’s most serious non-occupational noise hazard. The acoustic energy in a single report from a high-powered rifle or shotgun is equivalent to almost 40 hours of continuous exposure at 90 dBA. In other words, 1 bullet equals 1 week of hazardous occupational noise exposure. An avid target shooter can be exposed to an entire year’s worth of hazardous occupational noise in just a few minutes (Clark & Bohne, 1999; NRA, 1999).

What about firearms themselves? Is a .22LR any better on your ears than a .45ACP? Table 2 [2] compares the dB levels of various cartridges.

Recall that sounds over 85-90 dB can lead to permanent hearing damage without hearing protection. As can be seen from Table 2, even firing a .22LR (134 dB) has the potential of causing permanent, irreversible, inner ear damage.

There are various kind of hearing loss. Conductive hearing loss refers to physical damage, infection or fluid build up in the middle ear cavity (Figure 2). If the gunblast is of sufficient intensity a conductive loss may be seen and accompanied by such symptoms as eardrum rupture or middle ear bone damage.

Conductive losses are typically open to medical treatment from a physician who specializes in diseases of the ear (Otologist or Otolaryngologist). Sensorineural hearing loss refers to damage within the inner ear. This is usually, incorrectly, referred to as “nerve type deafness” which really only occurs in about 1% of the American population (Mueller and Hall, 1998). Sensorineural hearing loss is the most common type of hearing loss in America, and noise induced hearing loss or acoustic trauma from firearms is typically sensorineural. It is permanent, irreversible and with proper hearing protection, can be avoided or minimized.

Probably the most common excuse I have heard from shooters is that “my ears have toughened up from shooting and I don’t have to wear hearing protection.” Well, I’m sorry to say that this is not possible. What is more likely is that you have sustained sensorineural hearing loss and some sounds just don’t seem as loud any longer (along with speech). However, it is still critical to wear hearing protection as the hearing you do have left can still be harmed from unprotected firearm exposure. As researchers and educators have noted, “Ears don’t get tough, they get deaf.” (Mueller & Hall, 1998).

Typically, noise induced hearing loss and acoustic trauma affect the high frequencies first. Our ears respond to sounds across a wide range of frequencies, from about 20 to 20 000 Hertz (Hz). Speech frequencies are roughly located between 250-8000 Hz. Low frequencies are used to “hear people” while the highs are what we use to understand what they say. To put it another way, the power of speech (vowels) is located in the low frequency range while the clarity of speech (consonants such as s, k, th, sh, f, th) is located in the highs. High frequency consonants are necessary to maximize speech intelligibility. Noise damage from firearms affects these high frequencies first due to, some believe, anatomical reasons (Mueller & Hall, 1999). Figure 3 [4] depicts an audiogram (record of one’s hearing) of a sensorineural hearing loss typical of shooters.

As such, many people complain that “I hear people, but sometimes I don’t understand what they said.” Women’s and children’s voices, typically in the high frequency range, are usually the most difficult to understand when one has such a high frequency hearing loss. Add to all this that our hearing gets worse just from the normal aging process and you quickly realize just how important hearing protection really is.

Other factors also determine how susceptible one is to firearm noise exposure. For examples, blue-eyed individuals may be more susceptible than people with greater melanin content in their eyes. Some studies have shown that males are more susceptible to noise induced hearing loss (NIHL) than females. Newborns and older individuals also seem to be more likely to develop hearing loss from NIHL. Finally, some studies have also shown that smoking increases one’s chances of acquiring hearing loss from noise. This may be due to the carbon monoxide in the smoke (Henderson, Subromaniam, & Boettcher; 1993).

I’ve also noticed that some shooters will wear their hearing protection, but only while shooting. When observing from just a few yards away, they do not wear their hearing protection. This is simply not good hearing conservation practice and is against competition rule #7 of your IDPA manual. In fact, if one was to comply with this rule, anyone within 50 yards of the firing line must wear not only hearing protection, but eye protection also. Some handguns at IDPA produce a very discernible boom that can still damage your ears (see Table 2), even if you are not shooting and are only a few feet to yards away. Of course, this will vary with the type of firearm, cartridge, and distance from the shooter, but Table 2 clearly shows that even a report from a .22 can damage your ears. Though not relevant to IDPA purposes, the use of muzzle brakes and ports dramatically increases the level of noise exposure from firearms.

In the consideration of sounds that can damage hearing, one point is clear: it is the acoustic energy of the sound reaching the ear, not its source, which is important. That is, it does not matter if the hazardous sound is generated by a machine in the workplace, by a loudspeaker at a rock concert, by a lawnmower or a firearm during an IDPA event. Significant amounts of acoustic energy reaching the ear may create damage–at work, at school, at home, or during leisure activities. Although there has been a tendency to concentrate on the more significant occupational and transportation noise, the same rules apply to all potential noise hazards, including and especially firearms (Clark and Bohne; 1999).

Sound advice dictates that when at the gun range, by all possible means, take appropriate measures to practice safe gun handling. Wearing hearing protection (along with eye protection) falls into this category, whether you are the shooter or an observer. Think of it this way: hearing aids could cost you anywhere from $600 to $8000 per pair! Protect your hearing and you could spend that on more important things…like firearms, ammunition, training & IDPA.

References
  • American Academy of Audiology. http://www.audiology.org/consumer/guides/aural.php
  • Clark, W.W. & B.A. Bohne (1999). Effects of noise on hearing. Medical Student Journal of American Medical Association. May 5th, Vol. 281: 17.
  • E.A.R., Inc. (2001). http://www.earinc.com/howhearingworks.html
  • Henderson, D., Subromaniam, M., & Boettcher, F. (1993). Individual susceptibility to noise-induced hearing loss. Ear and Hearing, 14(3): 152-156.
  • Kim, J., Morest, D.K., and Bohne, B.A. (1997). Degeneration of axons in the brain stem of the chinchilla after auditory overstimulation Hear Res, 103:169-191.
  • Kramer, W. Gunfire and Hearing Protection. Ball State University, Muncie, Indiana.
  • Mestel, R. (2000). Los Angeles Times. Original print date February 28, 2000. http://www.audiology.org/consumer/guides/aural.php
  • Morest, D.K., Kim, J., Potashner, S.J., and Bohne, B.A. (1998). Long-term degeneration in the cochlear nerve and cochlear nucleus of the adult chinchilla following acoustic overstimulation. Micro Res Tech 41:205-216.
  • Mueller, H.G. & Hall, J.W. (1998). Audiologists’ Desk Reference. Vol. I Singular Publishing: San Diego
  • Mueller, H.G. & Hall, J.W. (1998). Audiologists’ Desk Reference. Vol. II. Singular Publishing: San Diego.
  • National Rifle Association (1999). Fact Card. http://www.nraila.org/research/99fctcrd.htm.
  • NIH: National Institute of Health Consensus Statement Noise and Hearing Loss. Online 1990 Jan 22-24;8(1): 1-24. http://text.nlm.nih.gov/nih/cdc/www/76txt.html
  • Pickles, J., & Heumen, W. (2001). Hearing Unit. Vision Touch and Hearing Research Centre, University of Queensland. http://www.vthrc.uq.edu.au/hearing/hearing_home.html
  • Truax, B. (1999). Handbook of Acoustic Ecology (2nd Edition). Cambridge Street Publishing.

Dr. Amin Musani is a Clinical Audiologist practicing in Denison, TX. Any comments or questions may be directed to DrAminMusani@cableone.net or The Hearing Clinic 119 W. Main St. Denison, Texas, USA 75021, Phone: (903) 463-9900, FAX: (903) 463-9911.

[1] Mueller and Hall (1998).

[2] William Kramer, Ph.D.

[3] Mestel, 2000.

[4] E.A.R. Inc.

Musically Trained Ears & Learning to Hear with Hearing Loss

July 21st, 2011

By: Suzanne Yoder, Au.D.
Doctor of Audiology
HearWell Center
2400 Ardmore Blvd., Suite 401
Pittsburgh, PA 15221
(412) 271-3002
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www.hearwellcenter.com

Professional and highly skilled musicians have taught researchers in audiology and hearing science that the ear can be trained with practice. The studies have uncovered that musical training creates more activity in the brain of the listener to help sort wanted sounds from unwanted sounds. Research further demonstrated that musicians have a listening skill that is helpful not only in musical applications but in other real world listening situations such as hearing in noise. Noisy environments are challenging for every listener. Normal hearing individuals will understand between 60-70 % of speech in the presence high noise levels. Good listeners will employ a number of skills in order to understand speech in noise including filling in the blank when a word is not heard, watching for visual input (lipreading and gestures), standing closer and leaning in towards the speaker. With these skills a good listener, even in noise, will be able to follow conversations fairly well.

Noise is naturally disruptive to understanding speech and more so in individuals with hearing loss. Most hearing disorders are a result of permanent damage to the delicate structures of the inner ear including the cochlear hair cells. The more severe the loss, the more damage there is to these hair cells leading to increasingly distorted and muted sound signals to brain and a loss of specificity for speech. Therefore, individuals with hearing loss who wish to communicate verbally must learn additional coping and listening skills to offset this specificity loss.

Hearing aids and assistive listening devices are very important for treating hearing loss but they are not the only treatment necessary for learning to hear again. Since most people delay getting hearing aids for years the consequence is an under-stimulated auditory system. People with long standing, untreated hearing loss become accustomed to not hearing and consequently, not listening. This is not a surprise since it is hard work to listen when you can’t hear and people with untreated hearing loss often withdraw from communication limiting their opportunities for practice. Wearing hearing aids does not mean the brain will instantly remember how to hear and listen. Hearing aids will return audibility for sound but it takes time to adapt to new sounds and it takes time to learn to listen again. Audiologists are trained to help people in both areas with counseling and follow up being the most important aspects of the hearing aid selection and fitting process. New hearing aid users need to be closely monitored on their progress with hearing devices as well as counseled on auditory training programs when needed.

Hearing aid success varies widely and not all listeners are created equal. The most successful hearing aid wearers are those that educate themselves about the adaptive process behind using hearing devices and take on the task of improving their listening skills by doing auditory training exercises. With all that we’ve learned in research with musicians, it is apparent that the ear can and should be trained to help compensate for loss of hearing sensitivity. Thanks to musicians and the researchers in the field we have the tools and resources to make this possible.

You Heard Right. Patients are Happy with Hearing Aids!

July 13th, 2011

By: Drs. Neil and Shannon Aiello
Doctors of Audiology
Columbia Basin Hearing Center
1149 N. Edison Street, Suite D
Kennewick, WA 99336
(509) 736-4005
Follow CBHBC | Facebook | Twitter | Youtube
www.columbiabasinhearing.com

Why don’t people use hearing aids? If asked, many people are hesitant based on the fact that they have a friend, who has an aunt, whose husband spent a great amount of money on hearing aids that he ended up hating. There are indeed many “hearing aid horror stories” circulating the popular bridge clubs and local fishing holes. “They were uncomfortable, they made everything louder, they whistled, and of course, they costs so darn much.” There was a time that these were valid complaints from hearing aid users. However, we are happy to report that those times are over.

In 2011, it was reported that 74% of hearing aid users are satisfied with their hearing aids, a 55% increase from 2000. Furthermore, satisfaction with hearing aids that are less than one year old has increased to 81%. And believe it or not, 82% of hearing aid users would recommend hearing aids to a friend. The patient population of hearing aid users has not changed much in the past ten years. So what has changed to account for this increase in satisfaction? (MarkeTrak VIII, 2010)

There has been much advancement in the past ten years resulting in greater patient experience and satisfaction with their hearing aids. The hearing aid technology itself has exponentially advanced. Equally important, the Audiologists providing hearing care have also grown in their knowledge and patient care.

Neil and Shannon Aiello, Columbia Basin Hearing and Balance, Kennewick, WATechnologically, hearing aids are much more advanced than those of even five years ago. As with every other modern technology, be it cell phones or computers, new hearing aid technologies are also rapidly emerging. These advancements have focused on increasing audibility of a speaker in a difficult listening situation, such as background noise. Hearing aids are now automatically processing when “noise” or unwanted sound is present and reducing it. Likewise it is also processing when “speech” or a desired listening signal is present and increasing it. Most of the hearing aids dispensed today have some amount of automatic adjustments making it so patients don’t have to adjust the hearing aids themselves. With new hearing aids performing countless adjustments per millisecond, it’s no wonder patients are hearing better in difficult environments.

Another emerging technology in hearing aids is Bluetooth. In its simplest form, Bluetooth technology allows patients to directly receive audio input through their hearing aids. For example, if a person is using a cellphone with Bluetooth compatible hearing aids, the signal from the phone is routed through the hearing aid rather than through the phone allowing the patient to “hear” the phone directly through the hearing aids. This technology is also available for the television, landline phones, or iPods. It can even help hear a spouse in a difficult environment, such as a restaurant or the car, by using a small lapel microphone. These advancements have added another level of satisfaction for hearing aid users and their families.

There has also been much advancement in the styles of hearing aids offered today. Gone are the days of the Grandma Monster Behind-the-ear or In-the-ear hearing aids. New digital hearing aids, even the behind the ear style, have become more streamlined and cosmetically appealing. In fact, there are now some hearing aids that fit completely down the ear canal and are 100% invisible. Now even the most cosmetically concerned patients can experience the benefits of better hearing without the embarrassment of others knowing they have a hearing aid.

More important than the technological advancements in the hearing aids or design of the hearing aids, patients are more satisfied with the care they are receiving from their Audiologists. Many Audiologists have now obtained their Doctor of Audiology, or Au.D., which has their increased the education and training. In addition to that, some Audiologists have obtained certification, such as AudigyCertification, in addition to the entry level requirements as a commitment to premier patient care. This certification assures patients that they are receiving expert advice by the highest trained and credentialed Doctors of Audiology. It also helps patients know that they will be recommended appropriate technology based on their unique needs and listening environments, and not be recommended technology that is the latest hearing fad or on a special one day sale. Additionally, by instituting patient-centered care, the Audiologist, patient and significant family members work closely with one another. The patient is routinely seen for aural rehabilitation, which involves retraining the brain to hear again, through the trial period and beyond to make sure that they are experiencing better quality of life through better hearing.

If you or your loved one has been hesitant to try hearing aids because of Aunt Betty’s hearing aid horror story, there has never been a better time to experience the benefits of advanced hearing technology and patient-centered care. Insure the best hearing possible  by calling an AudigyCertified Doctor of Audiology today.

Medicare and Hearing Health Care

July 6th, 2011

By Crystal L. Chalmers, Au.D.
Doctor of Audiology

North State Audiological Services
15 Jan Court
Chico, CA 95928

(888) 844-7024
Follow North State Audiological Services | Facebook | Twitter | Youtube
www.nsaudiology.com

Two questions my staff and I get on a regular basis are: #1.)“Does Medicare pay for hearing tests?  Also: #2.) “If the tests show that I need hearing aids, will Medicare pay for the devices?”

The answer to question #1 is that Medicare does not cover routine hearing exams.  When I say “routine” I am referring to regular hearing testing done at the request of the patient for the purpose of determining the extent of hearing difficulties, much the same as any other health care check up.

Diagnostic audiological services are paid for, by Medicare, when a physician orders testing to obtain information to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.

Audiologist & Ear Doctor, Dr. Crystal Chalmers, Chico, CaliforniaHowever, services are excluded when the diagnostic information required to determine the appropriate medical or surgical treatment is already known to the physician or the diagnostic services are performed only to determine the need for hearing aids or hearing aid reprogramming.

If the need for testing and hearing technology does not come under the specific guidelines outlined above, then the patient is responsible for 100% of the professional fees.

As for question #2.), the same is true for hearing aids, which under Federal law are considered “cosmetic” items.  Whether or not you agree with this, the law has stood this way for decades and it would take an act of Congress to change the national coverage policy.

That said, as a consumer you should be aware of any audiologist or hearing aid dispenser who tells you “yes” they will bill Medicare for your non-referred hearing tests and/or hearing aids.  This practice is illegal and as a consultant and special witness for the FBI, I can tell you that the Federal Government is not taking these fraudulent acts lightly.  In fact, they are cracking down on this activity and have recently prosecuted cases here in California.

To find out more about Medicare coverage for hearing care services and technology, visit the official U.S. Government site at www.medicare.gov.

If you have more questions about hearing care such as diagnostic testing and hearing technology, you can visit my website, or call my office toll free at 1 (888) 893-1352 …. Because hearing is a wonderful gift!”

About the writer: Crystal Chalmers, Au.D., is an AudigyCertified™ Doctor of Audiology, the owner of North State Audiological Services in Chico, and a member of Audigy Group, the nation’s largest member-owned association of independent hearing care professionals.

Since 2006, Audigy Group has interviewed over 5,000 of the 18,000 audiologists in the United States, yet has selected only 190 to be members in this elite association. AudigyCertified™ is a trade-mark of AudigyGroup, LLC.

To learn more about Dr. Chalmers, her practice, and Audigy Group visit online at www.nsaudiology.com

The Hearing Aid Tax Credit – Not Moving at the Speed of Sound

June 16th, 2011

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
www.doctorshearingclinic.com

As a member of the American Academy of Audiology Board of Directors, the “big picture” with regard to hearing healthcare is one of my primary focus areas. With all the talk about the new healthcare plan currently being debated in the Senate, you may be wondering what is the status of the Hearing Aid Tax Credit Act? Unfortunately, it is not part of the current healthcare reform legislation and it has been moving through the House and the Senate at a snail’s pace.

Bettie Borton, Au.D. Doctor of Audiology AudiologistThere are some differences between the House of Representatives and the Senate bills: the House one (H.R. 1646) calls for provision of a tax credit towards the purchase of each hearing aid of up to $500 per device, available once every five years. It would be available to people age 55 and over, or those purchasing a hearing aid for a dependent. This bill excludes coverage for people earning over $200,000 a year. The Senate bill (S. 1019) would provide the same $500 credit but cover all age groups.

Although similar bills are introduced on the Hill every year, they never get very far. However, since August 2009, the bill has reached the threshold of 100 bipartisan co-sponsors (66 Democrats and 34 Republicans), so there is every reason to be optimistic that it will finally be passed. This hope is shared by leading healthcare and advocacy organizations, including Better Hearing Institute (BHI), the Hearing Loss Association of America, the American Academy of Audiology, the American Speech-Language Hearing Association and the AARP, among others.

Why should you care about the passage of the Hearing Tax Credit legislation? Well, for one thing, hearing loss is one of the most common conditions affecting older Americans. As Better Hearing Institute, points out that:

  • 3 in 10 people over age 60 have hearing loss
  • 1 in 6 baby boomers (ages 41-59) have a hearing problem
  • 1 in 14 Generation Xers (ages 29-40) already have hearing loss
  • At least 1.4 million children (18 or younger) have hearing problems; it is estimated that 3 in 1,000 infants are born with severe to profound hearing loss.  In fact, hearing loss is the most common of birth defects, occurring more frequently than, for example, Down Syndrome.

While sensorineural hearing loss can’t be “cured”, studies have conclusively shown that hearing technology, such as hearing aids, not only helps users hear better, but, at the same time, it vastly improves the overall quality of their lives by allowing them to participate in conversations and social activities, as well as reducing isolation, getting better compliance with medical concerns, and a host of other advantages.

By the same token, those who do not wear hearing aids are at an increased risk of loneliness, isolation and depression. For children, untreated hearing loss means that their language and social skills development will be delayed and / or diminished. Any way you look at it, hearing aids are necessary for quality of life, safety, and skill development for many Americans, young and old.

Unfortunately, for far too many people with hearing loss they remain out of reach.

Millions of people need hearing devices, but don’t get them, and a large part of the problem is the cost. There are currently an estimated 36 million Americans with some degree of hearing loss. Yet, according to BHI, only nine million actually wear hearing aids. Of those who do not, many cite the high cost of assistive technology for not getting treatment; in fact, two out of three adults with hearing loss say financial constraints are the main reason they do not use hearing aids.

The cost of hearing aids – ranging from $1,000 to 4,000 per hearing aid – is not covered by either Medicare or most private insurers, making it too expensive for many people. But a survey carried out by BHI demonstrates that 10 million of the 27 million Americans with untreated hearing loss would likely buy hearing aids if tax credits were available.

That’s why it is crucial that the Hearing Aid Tax Credit Act does not languish on the Hill much longer.

Make your voice heard! Congressmen do listen to their constituents, so it is critical that you write your representatives urging them to support this legislation.

For optimum effect, Doctors Hearing Clinic and BHI recommend that you personalize your letter, sharing the story of why the hearing aid tax credit is important to you and your family. For example, you may mention that your elderly parents are on fixed income and can’t afford the full price of hearing aids. Or, you are struggling financially and can’t pay for your child’s devices.

Alternatively, BHI offers online forms so you can type your message to your Congressperson directly, and Doctors Hearing Clinic provides copies of written directives to take further action.

Hearing Aid Tax CreditAdditionally, three states – New York, North Dakota and Montana – are currently debating hearing aid tax laws similar to the federal ones. Consider asking our state representatives to entertain such legislation. The more feedback and comments your representative receives, the better a chance of him or her sitting up and listening. For more information about this very important legislation, visit www.hearingaidtaxcredit.org, or call the professionals at Doctors Hearing Clinic. If we work together on this issue, we will all benefit.