Ear and Hearing
Ear and Hearing
What is an Audiologist?
What do Audiologists do?
Why should I see an Audiologist?
What are Otoacoustic Emissions?
How do I know if my child has a hearing loss?
What are the high risk conditions associated with hearing loss in babies?
What is a cochlear implant?
How long have cochlear implants been used?
Who qualifies for a cochlear implant?
How is a cochlear implant different from a hearing aid?
What are the components of the cochlear implant?
How does the cochlear implant work?
Do I need a hearing aid?
When do I need hearing aids?
Do I need one aid or two?
Will my hearing get worse if I don't get two hearing aids now?
What should I look for when purchasing a hearing aid?
How much do hearing aids cost?
How has hearing aid technology improved?
What is a BAHA system?
Is the BAHA system like a hearing aid?
How does the BAHA system work?
What is a noise induced hearing loss?
When should I wear hearing protection?
How loud is too loud?
What are the laws for occupational noise exposure?
What type of hearing protection devices are best?
Are there noise prevention devices for people with hearing loss?
What is Electronystagmography?
What is an Auditory Brainstem Response (ABR) test?
What is Electrocochleography (EcoG)?
What is an Epley maneuver?
What is a tympanogram?
What does the hearing test mean?
What is tinnitus?
What causes tinnitus?
Is there a treatment for tinnitus?
What can I do to avoid or lessen the effects of tinnitus?
Will hearing aids help lessen the tinnitus?
Why are younger children predisposed to otitis media?
When are ventilation tubes needed?
How are tubes inserted?
What can happen if otitis media is not treated properly?
Is ear drainage after tube placement normal?
Is it harmful to have an eardrum perforation?
How are eardrum perforations treated?
Audiologists
What
is an Audiologist?
An Audiologist is a professional who evaluates and treats people
with hearing loss and balance disorders. Audiologists have
extensive training (at least a Masters level degree) to evaluate
infants to adults to determine the best intervention, whether it
be medical or amplification.
Audiologists perform comprehensive audiological evaluations for people of all ages, counseling, evaluating for and fitting of hearing aids and other assistive listening devices, cochlear implant rehabilitation, hearing conservation, balance testing, brainstem testing, and newborn hearing screenings.
Why should I see an Audiologist?
Audiologists have a Masters or Doctoral degree from accredited universities with special training in the prevention, identification, assessment, and non-medical treatment of hearing and balance disorders.
Hearing in Children
What
are Otoacoustic Emissions?
Otoacoustic Emissions (OAEs) are sounds generated within the cochlea of nearly all normal hearing ears by active biomechanical processes within the outer hair cells. OAEs are present in all normal ears, therefore it can be assumed that the absence is a sign of irregular cochlear function which could result in a hearing loss. Otoacoustics are used to screen infants and difficult to test patients to determine if a hearing loss is present.
How do I know if my child has a hearing loss?
Each child develops at his/her own pace. Below are some guidelines to your baby's hearing and speech development. Birth to 3 months: startles at sudden noise, recognizes your voice, and quiets when spoken to. 3 months to 6 months: turns towards interesting sounds and appears to listen, awakes easily to sounds. 6 months to 12 months: turns head towards soft sounds, understands no and bye-bye, begins to imitate speech sounds. 12 months + :says first words i.e. da-da, bye-bye, and ma-ma.
What are the high risk conditions associated with hearing loss in babies?
Cochlear Implants
What is a cochlear implant?
Cochlear implants are surgically implanted devices to provide sound information by directly stimulating the cochlea's remaining healthy nerve fibers. People who use cochlear implants received little to no benefit from hearing aids and without their implants are profoundly hearing impaired. With their implants these individuals can detect sound at conversational levels.
How long have cochlear implants been used?
French researchers stimulated the auditory nerve in the late 1950's . Since then, implants have been in development around the world. They have evolved from a single electrode to a multichannel electrode.
Who qualifies for a cochlear implant?
Adults: a severe to profound sensorineural hearing loss (>70dB),
unable to understand speech through the use of hearing aids, 18
years or older, deafened after learning oral speech and language,
desire and are motivated to be part of the hearing world.
Children: profound sensorineural hearing loss in both ears
(>90dB), age 2 to 17 years, little or no useful benefit from
hearing aids, high motivation and appropriate expectations (both
family and child), placement in an educational program that
emphasizes auditory skills.
How is a cochlear implant different from a hearing aid?
A hearing aid amplifies sounds. A cochlear implant provides useful sound information by directly stimulating the surviving auditory nerve fibers in the cochlea by bypassing the damaged parts of the ear.
What are the components of the cochlear implant?
The internal components are surgically implanted completely under the skin and consist of an electrode array inserted into the cochlea and a receiver attached to the electrode array. The external components include a speech processor (a little larger than a pager), a headset with microphone, a transmitting coil, and cables which attach all external components together.
How does the cochlear implant work?
Sounds are picked up by the microphone and via a thin cable, the sound is sent to the speech processor. The speech processor amplifies, filters, and digitizes sound into coded signals. These coded signals are then sent to the transmitting coil via the cables and the transmitting coil send the signal across the skin to the implanted receiver. The receiver stimulates the electrode array and the nerve fibers are stimulated. The electrical impulses are delivered to the brain and interpreted as sound.
Hearing Aids
How
common is hearing loss?
More than 24 million Americans have some type of hearing problem. Hearing difficulties are often unrecognized by the person involved. Children and teenagers seldom complain about the symptoms of hearing loss, and adults may lose their hearing so gradually, they do not realize it is happening.
The first step in determining the need of a hearing aid is a comprehensive evaluation by an Audiologist. The Audiologist will ask you a series of questions, look in your ears with an otoscope and complete a comprehensive evaluation of your hearing. With all these results in hand, it will be determined if your hearing loss warrants a medical evaluation or a hearing aid.
There are different causes of hearing loss. Some can be treated with medication or surgery. Others can be helped through hearing aids. A complete hearing test should be performed by a certified audiologist to determine the nature and degree of hearing loss. The audiologist will determine if hearing aids can be of benefit. You should have your hearing evaluated if:
1) The TV volume has to be increased beyond the comfort level of others in the household;
2) You have difficulty understanding voices over the telephone;
3) It is hard to understand words when background noise is present;
4) Friends and family appear to be mumbling.
Hearing aids can improve speech understanding in various listening situations and, thus, improve one's quality of life. Although older hearing aids were not liked, new digital and programmable technology permits many patients to wear them comfortably.
If your hearing loss is in both ears, two hearing aids are better than one. A hearing aid in each ear results in: better speech understanding in noisy places, better sound localization, better sound quality, improved distance hearing, improved sound identification, less exertion to hear, and a feeling of balance.
Will my hearing get worse if I don't get two hearing aids now?
Research shows that when only one ear is aided, the unaided ear's ability to understand speech and tolerate sound deteriorates. This is also true if the hearing loss is in only one ear.
What should I look for when purchasing a hearing aid?
First of all, you should make sure you see a licensed Audiologist or dispenser with a reputable history in your area. Once you have chosen whom you wish to work with, the following questions should be addressed.
How much do hearing aids cost?
That can vary from office to office. There are many hearing aids available for a couple of hundred dollars. Those hearing aids are typically not customized to an individual's ear or hearing loss, therefore should be avoided. Most professional offices offer hearing aids from $700 up to a few thousand dollars per aid. The more technologically advanced the hearing aid (i.e. computer programmable and completely in the canal), the higher the cost. One thing to keep in mind is not every hearing aid is suited for every individual. Even the most expensive aid may not be the right hearing aid for you.
How
has hearing aid technology improved?
Most people put off getting hearing aids for several years. We have all
heard the stories of how Aunt Bea's hearing aids just sit in her drawer or how
Uncle Ed still can't hear with his hearing aids. Unfortunately, these stories
are told all the time, so why should one rush out and order hearing aids? Recent
advances in hearing aid technology have made them easier to use and provide
better hearing. The newer technology allows for: automatic volume control,
elimination of feedback, smaller size and improved speech understanding in
noise. The latest digital technology incorporates a mini computer so adjustments
can be made for a change in hearing loss or to tailor your hearing aids to match
your lifestyle or hearing needs. Newer hearing aids are advancing us towards
restoring hearing and allowing one to be involved in the extra activities once
avoided because of poor hearing.
The BAHA system is an implantable prosthetic device specifically designed for patients age five and older with mixed or conductive hearing loss as well as those with Single Sided Deafness.
Is the BAHA system like a hearing aid?
No. The BAHA system combines a sound processor (worn externally) with a small titanium fixture implanted behind the ear. The BAHA system does not have in-the-ear components that can often contribute to and aggravate inner ear infections and/or block sound.
How does the BAHA system work?
The BAHA System is the only implanted treatment for hearing loss that works through direct bone conduction. It uses bone tissue to transfer sound to a functioning cochlea. It does not rely on amplification to improve sound tone or quality.
Hearing Protection
What
is a noise induced hearing loss?
Typically individuals who are exposed to excessive noise demonstrate a high frequency hearing loss affecting the hearing nerve.
When should I wear hearing protection?
If a situation is in question, you should probably wear ear protection. Shooting a rifle one can have affects on your hearing down the road. People who work in noisy environments, i.e. factories, railroads, construction, etc. as well as those who expose themselves to loud noises at home, i.e. lawn mowers, drills, saws, chainsaws, etc., should always wear ear protection.
How
loud is too loud?
Exposure to sounds over 85dB are dangerous to the auditory system.
These sounds may be generated by: lawnmowers, shop tools, truck
traffic, rock concerts, automobile horns, jet engines, and
gunfire.
What
are the laws for occupational noise exposure?
OSHA has determined it is in the best interest of the employer
and employee to enforce the use of hearing protection device in
situations of 85dB of noise or greater over an 8 hour period.
Louder sounds can do damage in a much shorter period of time.
What
type of hearing protection devices are best?
There are several over the counter hearing protection devices
available at local pharmacies and sporting goods stores. Most
available have a Noise Reduction Rating (NRR) of 15 to 30 dB
listed on the package. This rating is valid only if the ear plugs
are properly inserted and continuously worn. Earmuffs which fit
over the entire outer ear create a seal around the ear keeping
the harmful effects of noise out. Earplugs and earmuffs may be
used in conjunction with each other in instances of extreme noise
(>105dB) and typically provide 10-15dB additional protection.
Are there
noise prevention devices for people with hearing loss?
Electronic ear protection is available for those hunters with a
hearing loss or those wanting to hear the sounds of the
environment. The hearing protection device resembles a behind the
ear or in the ear hearing aid and will amplify the sounds around
although as soon as a shot is fired or loud noise is present, the
circuit will shut down acting as a ear plug. Typically this
electronic ear protection is available through hearing healthcare
professionals and is custom made to the ear.
Audiological Tests
What
is Electronystagmography?
An ENG evaluates the balance function of the inner ear. It is a
test pertinent to the recording of involuntary eye movements,
nystagmus, and helps to determine the origin of the problem.
What
is an Auditory Brainstem Response (ABR) test?
An ABR is a test which measures the speed of electrical impulses
along the acoustic nerve from the inner ear to the brainstem.
What is Electrocochleography (EcoG)?
EcoG is a measure of the electrical potentials within the auditory system. As the auditory system is stimulated by an acoustic signal, it causes a change in the electrical potentials of the sensorineural mechanism that can be monitored through electrodes placed on the head and in the ears. This test is used to identify cochlear/endolymphatic hydrops for patients with dizziness.
An Epley maneuver, also known as canalith repositioning, is a therapeutic procedure which relieves symptoms for patients who have periods of brief spinning dizziness associated with position changes. These patients are identified as having benign paroxysmal positional vertigo (on the ENG) before this procedure is performed.
A tympanogram is a measurement of ear canal volume, middle ear pressure and compliance. A tympanogram will detect fluid, a perforation in the eardrum, function of a pressure equalization tube, ossicular disarticulation, as well as a healthy middle ear.
What does the hearing test mean?
The audiogram is a graphic representation of the ability to hear tones. The hearing is tested from 250 Hz to 8000 Hz (low frequency to high frequency tones). The left ear's responses are noted with an "X" and the right ear's responses are noted with a "O". There are varying degrees of hearing loss. Normal range is from 0-25dB, mild hearing loss range is 25-40 dB, moderate hearing loss range 40-60dB, moderate-severe hearing loss range 60-75dB, severe hearing loss range 75-90dB, and above 90dB is the profound hearing loss range. The ability to understand a list of 25 words is measured at a comfortable listening level and then the % of words correct is recorded. This test is the speech discrimination score. The speech recognition threshold score is the softest level at which words can be repeated 50% of the time.
Tinnitus
What is tinnitus?
Tinnitus is the name for noise in the head. It is commonly described as ringing, crickets, and buzzing which may be constant or intermittent. Nearly 36 million American suffer from tinnitus and more than 7 million people can not lead normal lives due to these head noises.
The most common causes of tinnitus are age-related hearing loss and loud noise exposure. Tinnitus my be a symptom of a serious middle ear infection, a hole in the eardrum, fluid in the middle ear, or stiffening in the ossicles (middle ear bones). It may also be a symptom of a more serious head or neck aneurysm or tumor. Tinnitus may also be caused by allergies, high or low blood pressure, depression, diabetes, and damage to the auditory nerve.
Is there a treatment for tinnitus?
There usually is no specific treatment for noises in the ear or head. Most causes of tinnitus can not be readily identified therefore treatment is difficult. However, examination by your ENT physician and audiologist is important to check for treatable and serious causes tinnitus.
What can I do to avoid or lessen the effects of tinnitus?
Make every effort to: avoid exposure to loud sounds; have blood pressure checked, if high seek medical attention; decrease intake of salt; avoid caffeine and nicotine; rest and avoid overexertion; reduce stress; and try your best to ignore the noises.
Will hearing aids help lessen the tinnitus?
Hearing aids may help reduce the head noise and occasionally they will go away. Often times a person with a hearing impairment will be hearing speech and environmental sounds much better with the hearing aids so the tinnitus takes a back seat and is less noticeable, although it may still be there.
What is swimmer’s ear and how is it treated?
Inflammation or infection of the ear canal is external otitis (swimmer’s ear). Swimming pool chemicals as well as lakes, rivers and oceans can irritate the canal lining causing swelling, itching, pain and the overgrowth of bacteria in the ear canal. Cotton tip applicators (e.g. Q-tips) and frequent cleaning of the ear can destroy the normal protection mechanism of the ear canal. Treatment consists of avoiding the cause of the irritation and then usually ear drops are prescribed, which may have an antibiotic, anti-inflammatory, adjusted to a pH that will deter further germ growth. For more severe swelling the doctor may place a small cotton "wick" in the ear to keep the canal open and allow the drops to penetrate better.
Why are younger children predisposed to otitis media?
The Eustachian tube which allows ventilation of the middle ear from the nose does not function as well in childhood until the skull matures allowing easier clearance of fluid and better ventilation of the ear in later childhood.
When are ventilation tubes needed?
Children or adults with eustachian tube problems are more prone to ear infections, persistent fluid behind the ear drum and hearing loss. Fixing the eustachian tube itself is difficult because of its location at the skull base and proximity to the carotid artery. Therefore a way to bypass this dysfunction and allow proper ventilation of the middle ear, releasing the fluid and improving the hearing is by placing a small tube into the ear drum.
Tubes can be inserted by your ENT physician in most adults and older children in the office with local anesthesia. Younger children will require a brief general anesthetic while a small incision is made in the ear drum, the fluid is then removed and a tube is place within the incision. Results are often immediate with improved hearing and less ear discomfort shortly after surgery.
What can happen if otitis media is not treated properly?
If ear infections are not treated and followed until completely resolved the persistent fluid will often cause hearing loss which can delay speech development in young children. Also, if the fluid remains infected and appropriate antibiotic therapy is not initiated, the infection can advance to injure the bones for hearing, the balance center, the nerves for hearing, taste and facial movement, and most seriously can infect the brain.
Is ear drainage after tube placement normal?
Immediately after the tubes are placed thick or even bloody drainage is fairly common for a few days. Using the prescribed drops after surgery will help, and if not, you should contact the office. Later on (weeks or months) drainage may recur especially if the patient has a cold, stuffy nose, or ear infection. The drainage is a sign that the tubes are working. Drops should be restarted, and you should contact the office or your primary care doctor.
Is it harmful to have an eardrum perforation?
An eardrum perforation alone may not be harmful if there are no signs of infection, drainage, or hearing loss. Most eardrum perforations heal without any surgery.
How are eardrum perforations treated?
If a perforated eardrum does not spontaneously heal or shows signs of infection or damage to hearing. An ENT surgeon will often surgically explore the ear, and try to find the underlying cause of the perforation, and repair the eardrum with a thin layer of tissue taken from the patient.