Frequently Asked Questions - Ear & Hearing


Audiologists

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.

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

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.

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.

  • Family member with permanent hearing loss since childhood. 
  • Serious infection present at birth (i.e. herpes, syphilis, German measles) 
  • Difficult birth or delivery which affected baby's breathing 
  • Cranio-facial abnormalities (i.e. cleft palate, malformed ears) 
  • Baby requiring NICU for 2 or more days following birth 
  • Disorder or infection of the brain (i.e. meningitis) 
  • Blood exchange or transfusion
Hearing Aids

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.

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.

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.

  • Are several types or brands available?
  • Is there a trial period?
  • Is my money refundable if I decided not to keep my hearing aids?
  • Is there a contract with clearly addressed prices and return policies?
  • Is in office servicing available or will my hearing aid have to return to the manufacturer for repairs?
  • Is there a warranty including loss and damage included in the purchase price of the hearing aid?

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.

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.

Hearing Protection

Typically individuals who are exposed to excessive noise demonstrate a high frequency hearing loss affecting the hearing nerve.

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.

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.

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.

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.

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

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.

An ABR is a test which measures the speed of electrical impulses along the acoustic nerve from the inner ear to the brainstem.

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.

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

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.

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.

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.

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.

Swimmer's Ear

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.

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.

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.

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.

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.

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.

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.

Cochlear Implants

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.

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.

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.

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.

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.

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.

BAHA System

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.

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.

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.

The Surgery Center of Charleston The South Carolina Sinus Institute