Archive for the ‘Hearing Care’ category

Hearing Loss And Hearing Aid Myths Debunked – Fiction vs. Fact

January 18th, 2012

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

A recently completed study by Johns Hopkins University – published on November 14, 2011 in the Archives of Internal Medicine – now confirms that 1 in 5 Americans have hearing loss in at least one ear.  This is well over 50 million people and far exceeds previous hearing care industry estimates of approximately 25 million.

The Johns Hopkins study is unique in that the data used statistically corresponded with the entire US population by including both men and women of all races, aged 12 and older, living in cities throughout the country.

Using the World Health Organization’s definition of hearing loss – not being able to hear sounds of 25 decibels or less in the speech frequencies – the Johns Hopkins researchers found that over 30 million Americans have hearing loss in both ears and that over 20% of the population – in excess of 50 million people – have hearing loss in at least one ear.

Despite there being so many of us with hearing difficulties, too many people are still unaware of how or where to obtain professional help as the misconceptions about hearing loss and hearing aids are commonplace in our society.   The fact that you are reading this article is an excellent first step towards empowering yourself (or a family member) and taking control of your hearing health.

Audiologist & Ear Doctor, Dr. Crystal Chalmers, Chico, CaliforniaCommon Hearing Loss and Hearing Aid Myths

Myth: Buying hearing aids online, by mail, or at a big box store saves time, money, and gets the same results as professionally fit devices.

Fact: The proper diagnosis and selection of hearing technology as a solution for hearing difficulties is not the same thing as purchasing common consumer goods.  Rather, it should be a process built upon a relationship of respect and trust between the patient and a highly trained, competent, and ethical professional whose services and products provide long-term value.

Myth: Anyone licensed to sell hearing aids is qualified to test a person’s hearing.

Fact: By law in the state of California, only audiologists are licensed to perform diagnostic hearing evaluations.  The “free” tests that hearing aid dispensers frequently advertise are not comprehensive exams and are merely designed to determine if a person could be helped by a hearing aid.

Myth: Hearing loss affects only “elderly” people and is merely a sign of aging.

Fact: Hearing loss can affect people of all ages.  As mentioned in the Johns Hopkins study, 20% of the US population aged 12 years and older have hearing difficulties severe enough to impact communication.

Myth: Hearing aids don’t really do anything but amplify sound.  Besides they’re unsightly and uncomfortable.

Fact: While the hearing aids from 20 years ago left a lot to be desired from both technology and cosmetic standpoints, today’s hearing devices are exceptional technological performers and are so small as to be very discreet.  However, the most important consideration for you, the consumer, is not what the product is, but rather how it is fit to your hearing lifestyle, and to what extent you are provided with expert follow-up in the fitting of that device.   That is what makes my patients so successful in being able to enjoy better hearing.

Would you like to learn more about solutions to hearing difficulties and  hearing aid technology?  Here are two great places to start:

#1.) My Internet website at www.nsaudiology.com. This educational website offers a world of information, including highly informative videos, a free guide to better hearing, online specials, current “News & Events”, and the “Ask Dr. Chalmers” section where I have posted previously published original articles such as the one you are reading now.

#2.) Attend my upcoming Free Educational Luncheon Seminar which will be held Wednesday, January 25, 2012, starting at 11:30 AM at the Chico Women’s Club.  I’ll be providing an in-depth discussion covering everything from how your hearing works, to what are the different types of hearing care professionals, to insights about technology solutions for hearing difficulties.  A delicious catered lunch will be served.  There is no cost or obligation to attend, but due to limited seating, reservations are required.  Simply call my office today at 1 (888) 893-1352 …. Because hearing is 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 230 to be members in this elite association. AudigyCertified™ is a trade-mark of Audigy Group, LLC.

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

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.

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

It Doesn’t Really Matter If I Wear My Hearing Aids, RIGHT?

October 28th, 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

WRONG! According to ScienceDaily (Sep. 20, 2011), mild hearing loss has now been linked to brain atrophy in older adults. Anecdotally, over the course of my 30+ years in private practice as a Board Certified Audiologist, I’ve observed this to be true. But now, more and more research is indicating strong correlation between failure to obtain or use hearing devices and increased problems with understanding speech and cognition.

Bettie Borton, Au.D. Doctor of Audiology AudiologistWe have all heard (or perhaps experienced) the complaint that despite the fact that speech is audible, it’s not understandable. “I hear but I can’t understand” is probably the most commonly voiced concern in my office. So, if someone has hearing loss, if your hearing aids make sounds louder, why doesn’t that solve all hearing related issues? Well, like lots of things in life, it’s just not that simple.

A person’s audiogram (or those little blue X’s and red O’s on the graph of your responses to the “beeps”) tells us a lot, but it does not yield the whole story. Hearing thresholds (or the point at which someone is just barely able to detect sound across the frequency range) are certainly important, but don’t give much information regarding how well someone will understand when speech sounds are made sufficiently loud. Word recognition testing, with and without noise, provides additional information regarding this capability, and as a by-product, an indirect measure of the distortional component inherent to sensorineural hearing loss.

We now have mounting evidence that those who have hearing loss, but fail to get and/or use hearing devices run the risk of depriving their auditory system of sufficient loudness, which in turn results in degradation of the mechanisms responsible for understanding speech. A new study by researchers from the Perelman School of Medicine at the University of Pennsylvania shows that declines in hearing ability may accelerate gray mater atrophy in auditory areas of the brain and increase the listening effort necessary for older adults to successfully comprehend speech. When any one of our senses (smell, taste, sight, hearing, or touch) is changed in some way, the brain reorganizes and adjusts. In the case of those with hearing loss, researchers found that the gray matter density of brain in areas specific to hearing was lower in people with decreased hearing ability, suggesting a link between hearing ability and brain volume.

So, use it or lose it may be the prevailing philosophy. Take heart (and USE those instruments that you have!) According to this study,  early intervention for hearing loss with the consistent use of amplification can slow the progression of speech comprehension difficulty. “As hearing ability declines with age, interventions such as hearing aids should be considered not only to improve hearing but to preserve the brain,” said lead author Jonathan Peelle, PhD, research associate in the Department of Neurology. “People hear differently, and those with even moderate hearing loss may have to work harder to understand complex sentences.”

In two recent research studies, researchers measured the relationship of hearing acuity to the brain, first measuring the brain’s response to increasingly complex sentences and then measuring cortical brain volume in auditory cortex.  Results indicate that older adults (60-77 years of age) with normal hearing for their age were evaluated to determine whether normal variations in hearing ability impacted the structure or function of the network of areas in the brain supporting speech comprehension.

The studies found that people with hearing loss showed less brain activity on functional MRI scans when listening to complex sentences. Poorer hearers also had less gray matter in the auditory cortex, suggesting that areas of the brain related to auditory processing may show accelerated atrophy when hearing ability declines.

In general, research suggests that hearing sensitivity has important consequences for neural processes supporting both speech perception and cognition. Although most the research has been conducted in older adults, the findings also have implications for younger adults, including those concerned about listening to music at loud volumes. “Your hearing ability directly affects how the brain processes sounds, including speech,” says Dr. Peelle. “Preserving your hearing doesn’t only protect your ears, but also helps your brain perform at its best.”

Physicians should monitor hearing in patients as they age, and everyone should have a baseline audiogram performed by a Board Certified Audiologist, looking specifically at speech recognition abilities even in the presence of normal hearing. Patients should talk to their physician or audiologist if they are experiencing any difficulty hearing or understanding speech. If your physician has not referred you for hearing evaluation, take action!

The research cited above in this article appears in the latest edition of The Journal of Neuroscience and was funded by the National Institutes of Health.

 

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.

Stop Transactional Hearing Care!

September 21st, 2011

By: Dr. Helen Hallenbeck
Board Certfied Audiologist
Vibrant Hearing
601 South Orange Street
Missoula, MT 59801
(406) 549-1951 
www.myvibrantsound.com

A gentleman called yesterday and wondered if one of our audiologists would please make an impression of his ear. He found a hearing aid and wanted to “whittle on it” to make it fit his ear better. My first reaction (after “YUCK!”) was Why in the world would anyone want to wear a hearing aid that was customized for another person’s ear and hearing loss?!?!

Helen Hallenbeck, Audiologist Missoula, MTWas it a fundamental lack of understanding of the complexities of hearing loss and the insidious impact that loss has on relationships, communication patterns and lifestyle? Was it financial limitations? It takes an average of 7 years from the moment a person realizes they have a hearing loss until that person decides to get help. Throughout that period of emerging awareness, the person with a hearing loss is bombarded with mixed marketing messages. “Our Amazing Hearing Aids get rid of ALL unwanted background noise!” “Our Amazing Hearing Aids are INVISIBLE!” Our Amazing Hearing Aids will let you hear ONLY what you want to hear!”. In addition to the inexcusable exaggeration of the capabilities of any hearing technology, the hearing aid companies lure people in with FREE! everything.

Is it any wonder, when a person is finally ready to make the deeply personal and incredibly important  investment, that they fundamentally misunderstand what it is they are investing in and who it is they are investing with? The gentleman’s request for an ear impression so he could make his own hearing aid should not come as a surprise. The  hearing industry has painted themselves into a corner with salesmanship and bottom-dollar marketing. As a result the industry has devalued it’s very existence.

The truth is, hearing loss is complicated, frustrating and has a profound negative impact on the lives of the people that are affected. It is time the industry began to address the PERSON with the hearing loss. Today’s hearing technology is truly amazing and an appropriate solution can be found to fit within virtually any budget. But unless that technology has been chosen specifically for the individual, with all of his needs, desires, concerns, question and fears having been accounted for and carefully considered, then the technology has been wasted.

Let us each  work to make rigorous diagnostics, counseling, education, prevention and rehabilitation the expectation of the consumer.  Let’s stop the transactional process of hearing care that so dominates this industry and start humanizing what is truly a disability.

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.

Hearing Loss Contributes to Lost Income & Impacts Employers

May 25th, 2011
By: Jennifer Bentley, Au.D.
Doctor of Audiology

The Hearing Assessment Center
9101 Franklin Square Drive
Baltimore, MD 21237

(410) 583-7021
Follow The Hearing Assessment Center | Facebook | Twitter | Youtube
www.hearingassessment.com
 

When the topic of hearing loss comes up in a conversation, most people don’t think twice about it—dismissing it as a problem faced by “old” people, and more of an inconvenience than a real health issue.

The fact is, hearing loss is a serious condition affecting nearly 30 million Americans. Studies report that one out of six baby boomers (ages 42-60) and one out of 14 in the Gen X population (age 30-41) are affected by hearing loss. Given these age breakdowns, it is fair to assume that most of these individuals are still active in the workforce.

Jennifer Bentley, Au.D. - Doctor of Audiology Baltimore, MarylandFor this large portion of the work force, hearing loss is more than “inconvenient.” If left untreated, even a mild hearing loss can jeopardize safety and cost them (and their employers) dearly.

In terms of safety, consider this: a person with untreated hearing loss, regardless of age, is given instructions to take medicine at specific times and in certain dosages. If those instructions are not crystal clear, the results can be life-threatening. Add in other outside factors such as the noise from the hospital emergency room, or a crying toddler, and the difficulty of hearing proper instructions increases.

The “danger” in these scenarios doesn’t even factor in the ability to hear sirens, smoke alarms, baby cries, car horns, and other alerting signals. The more significant the hearing loss, the greater the risk is to oneself or others, and that’s more than an inconvenience.

In addition to safety, job security and income for an employee with untreated hearing loss may be at risk. Consider a scenario where a boss gives a series of instructions and deadlines to a staff person. Even a mild hearing loss could impair the employee’s ability to hear the details correctly. This puts the project at risk and may even jeopardize that person’s job.

A survey conducted by the Better Hearing Institute indicates, “Working Americans who ignore their hearing problems are collectively losing at least $100 billion a year in earnings.” The survey showed that, “Even people with mild hearing loss, who may miss a consonant here or a word there, may lose income if they can’t completely grasp the latest news at the water cooler or a phone message from the boss.”

The report goes on to estimate that the average worker with untreated hearing loss loses from $1,000 per year (those with mild hearing loss) to $12,000 a year with profound hearing loss.

Given the fact that most hearing loss is noise-induced (contrary to years of thinking it was related to age), it is not likely that the number of people suffering from hearing loss will decline in our noisy society. As a matter of fact, there is an epidemic of hearing loss in young people.

Reports indicate that children as young as 7 are being diagnosed in unprecedented numbers with noise-induced hearing loss. The impact of this epidemic, of course, is yet to even be a reality for employers.

Being Proactive Can Make A Difference

It is easy to be proactive in addressing hearing loss in the workplace. The best place for individuals and businesses alike to begin is with a hearing-loss awareness program. The goal of an awareness program is to commit to the prevention and the proactive treatment of hearing loss for those who are affected.

In terms of prevention, hearing conservation programs are recommended for noisy businesses. When around high levels of occupational noise, the employee’s hearing sensitivity should be monitored on an annual basis. In low-noise environments, such as an office building, employers should include hearing-loss awareness education as part of their worksite wellness programs.

In terms of proactive treatment, encourage employees to get their hearing tested and treated if a loss does exist. Offering to help pay or share the cost of hearing aids (or other assistive listening devices) could speak volumes about an employer’s commitment to staff and hearing health. Such minor “investments” on the part of the business can be huge in terms of employee loyalty and enhancing morale.

Additionally, businesses can take steps to make it easier for employees with hearing loss to hear more efficiently.

For instance, offer phone amplifiers, install loop systems in meeting rooms, and encourage greater sensitivity and awareness among all staff members—offering tips or training to help them communicate more effectively with their co-workers who have hearing loss.

May is Better Hearing Month!

May 4th, 2011

By: Peter J. Marincovich, Ph.D., CCC-A
Audiology Associates
1111 Sonoma Ave., Suite 308
Santa Rosa, CA 95405
(707) 827-1630
www.audiologyassociates-sr.com

May is Better Hearing month—but despite the fact that more than 34 million Americans report some type of hearing problem, relatively few are screened annually. With about 1 in 10 Americans reporting some type of hearing difficulty, hearing loss is the third most common health problem in the United States. Although hearing problems are commonly associated with the aging process, hearing loss affects all age groups. More than half of hearing impaired persons in the United States are under age 65, including 6 million people between the ages of 18 and 44—and more than 14 million are school-age children. Here are some things to be aware of concerning hearing.

Better Hearing & Speech MonthSound voids. Do you hear “ool” but not sure if someone said “pool,” “tool” or “cool”? Do you find yourself saying “I hear OK, but I have trouble understanding,” or “Soft sounds are too soft but loud sounds are too loud.” Hearing clearly when there’s background noise can be especially difficult for someone with hearing loss and trying to explain your hearing situation can often be difficult.

It’s common for people to be unaware of their hearing loss due to the gradual nature of its progression. As hearing slowly declines, an individual develops compensation strategies without even realizing it. Often it’s others, who are trying to communicate with the hearing-impaired individual, who are more aware of the situation. Hearing problems often go unrecognized, sometimes taking years before sufferers seek professional help.

Causes. There are many causes of hearing loss. Sometimes it’s readily apparent, such as wax build-up in the external ear canal, a condition that’s easily treated but unfortunately goes unrecognized in many individuals. Other causes can include hereditary factors, trauma, ear disease and certain medications. The cause of hearing loss is sometimes presumed. For instance, noise-induced hearing loss attributed to the use of stereo systems or portable music players is a growing phenomenon. Avoiding loud noise may help prevent premature hearing loss and the perception of sound voids.

There are easy ways to tell if a particular sound is potentially harmful. Do you have difficulty talking or hearing others talk over the sound? Does the sound make your ears “ring” (tinnitus), “hurt” or seem “muffled” after exposure? If you answered “yes” to any of these questions, the noise may be damaging your hearing. Most people don’t realize how loud everyday sounds actually are. Nearly 30 million Americans are exposed to dangerous noise levels each day, and 10 million Americans suffer from irreversible hearing damage due to noise.

The diagnostic hearing tests. The purpose of a complete evaluation is to determine the true nature of any hearing loss. The diagnostic process may include a variety of tests, depending on the assessment of your needs: audiometric tests to measure hearing at different pitches; speech evaluation to measure how well you hear and recognize ordinary conversation at different volumes; immittance tests of the middle ear; and complete medical evaluations.

Tinnitus is a medical condition characterized by persistent ringing in one or both ears, which can only be heard by the affected individual. These sounds can come and go; however, most suffers experience symptoms 24 hours a day, 7 days a week. The American Tinnitus Association estimates more than 50 million Americans suffer from tinnitus. It’s also the number one complaint from United States veterans. In some cases, tinnitus retraining therapy (TRT) and tinnitus retraining instruments (TRI) may provide individual solutions.

The balance system, due to its close proximity to the hearing mechanism, is also part of a comprehensive hearing evaluation. Fear of falling is a major health concern of individuals in their latter years. Nearly 300,000 hip fractures result from balance-related falls every year. The natural aging process may affect any one or all of the senses, as well as the central nervous system’s ability to interpret and react quickly to them. It’s very common to hear from someone who has fallen that they saw the curb or step, but just were not able to react fast enough or to keep their balance. With proper diagnosis and therapeutic exercise called balance retraining, many older adults are able to return to a more active lifestyle.

The Communication Needs Assessment in addition to the diagnostic hearing evaluation and after medical evaluation, if an individual still suffers from difficulty communicating; a complete communication needs evaluation is now the gold standard of hearing care. The fist step is identifying the individual’s need: What are the listening situations where the individual would like to hear well? The second step is identifying the individual’s lifestyle. For example, not just if they have trouble hearing in restaurants, but how often they do, or would they like to, go to restaurants.

May is Better Hearing & Speech MonthTechnology alone doesn’t help people hear better. Instead, it’s how well the practitioner works with the individual and applies the technology. If an individual doesn’t see well through a pair of glasses, it’s not due to the “glass,” per se. It has to do with either the measurement of the individual’s vision, the prescription or fit, or some combination. Hearing Aids are similar in application. What helps someone hear better is the correct amount of sound at the appropriate pitches for that individual’s hearing loss, environment and communication needs. Individuals with similar hearing loss may require completely different amplification strategies based on all of the factors mentioned here.

The all-important aftercare completes a comprehensive communication needs assessment for an exceptional sound experience. This includes assessment of need for assistive listening devices for telephone, Bluetooth, TV, loops or music systems. In addition to assistive solutions, aftercare will include lip reading and listening skills counseling.

It’s important that a hearing-impaired individual take an active role in listening and participate in the recommended auditory retraining and rehabilitation program to ensure he or she hears and understands as much as possible. The auditory system may not have heard certain voices and sounds for many years, and the reintroduction of new sounds and voices needs to be presented gradually. In other words, just as the hearing loss may have occurred gradually, the reintroduction of new sound needs to occur gradually. Through this process, each individual will adapt and develop necessary listening skills.

A hearing screening can quickly and accurately evaluate an individual’s hearing, determine the degree of hearing loss and put them on the path toward treatment. After treatment, it’s important to monitor the hearing loss to ensure the technology is meeting an individuals needs.

 

Peter J. Marincovich, Ph.D, CCC-A, is clinical director and owner of Audiology Associates, a full-service audiology practice since 1984, with offices in Santa Rosa, Mendocino, Novato and Mill Valley.