On Wednesday, June 3, we visited The Village at Unity, an excellent senior living facility in Greece. Over thirty residents joined us for our presentation “Balance, your ears and hearing”. Balance problems and dizziness are very common complaints to physicians among seniors. Our focus was educating the residents about the ears as our primary organ of balance, as well as problems that affect balance and produce vertigo or other types of dizziness.
We had a great time interacting with the residents, answering questions and providing information about problems that can affect a person’s wellbeing, safety and risk of falls. One area of discussion that surprised many was the relationship of good hearing to balance and safety. We use our hearing to help stay balanced. Improving hearing can improve our sense of balance in our environment by providing cues about objects or people around us. Hearing can decrease our fall risk!
Another topic of interest was our comprehensive vestibular evaluation, designed to confirm or rule out ear-related causes of dizziness or imbalance. Positional vertigo is another very common (and very treatable) disorder many suffer with needlessly. Along the way we touched on the topics of hearing loss, hearing aids and tinnitus.
We look forward to another opportunity to interact with the residents regarding other topic relating to the ears and hearing. We enjoyed it thoroughly. As always, we hope to help keep you on a Clear Path to good hearing and ear health!
It has been said that the inner ear is a balance organ first, a hearing organ second. The snail-shaped inner ear is divided into the cochlea at one end and the utricle, saccule, and semicircular canals at the other. The cochlea contains the hearing organs. The other structures house the organs of balance and are filled with fluid shared by the cochlea. For the majority of audiology patients we concern ourselves mostly with the cochlea and hearing deficits. However, we also have many patients with ear-related balance or vertigo disorders. Should we manage patients differently when they present with problems of both hearing AND balance?
Two of the most common health conditions among the elderly are hearing loss and dizziness/imbalance. There are also many younger patients who have lost hearing and also have poor balance systems. Both sections of the inner ear may have been affected at the same time, as with labyrinthitis or Meniere’s disease, or they may be unrelated. It may seem odd to suggest a patient might improve his or her balance by wearing hearing aids, however, a recent study has found just that.
A study published in the Laryngoscope journal has found that patients with poor equilibrium improved their balance-related posture adjustments while wearing hearing aids. It appears we use sound as a guide to the world around us and our movement, much like we use sight and sense of touch. We can better gauge where our bodies are in space when we can hear the environment around us. Amplified hearing may also promote greater confidence, alertness and a sense of connection to ones surroundings. Risk of falls and injury are diminished when balance improves.
Do not underestimate the power of good hearing! Find out if we can help you with hearing AND imbalance. We want to keep you on a Clear Path to good hearing and ear health!
In the world of hearing healthcare, as in all professions, there are standards we all must maintain. Practices that are licensed to dispense hearing instruments have strict laws and codes of ethics designed to ensure patients are dealt with in a professional and fair manner. These guidelines involve the handling of protected health information (the HIPAA law), scope of practice, diagnostic testing, reporting of test data, selection, fitting and pricing of hearing aids and follow-up care. We have made these responsibilities a source of pride in our office. Other reputable practices adhere to these guidelines as well. It is a grave disappointment any time a dispensing office engages in behavior that discredits the rest of us and disserves the community.
A longstanding regional hearing center that has long been respected and considered a pillar of the community has recently been engaged in practices that undermine much of what the audiology community has been building over many years. Patients are being offered “discounted” hearing aids, for which all services are billed separately (out of pocket from the patient) at every appointment, such as office visits, hearing aid reprogramming and hearing aid cleaning. These are services that would be included in the cost of the instruments. Fees are being charged for repairs of hearing aids that are under warranty. For a typical hearing aid lifespan with regular follow-up care, these fees will outpace any savings at the outset. Additionally, certain major hearing aid manufacturers have considered their inclusion on their website to be deceptive, as this particular practice has never purchased any of their products. The ethical questions that have been raised are deeply disturbing and disappointing, coming from what had been a highly-respected audiology practice for 35-plus years. Reputations in this field are fragile, whether a founder or a family member in the practice is responsible. There are enough disreputable hearing aid centers in the area; participating in unethical behavior does not help the cause of those of us who strive to uphold our proud profession.
At Clear Choice Hearing and Balance we will always practice within the full scope of audiology and hearing instrument dispensing, and we will fight to maintain the standards that have elevated audiology to its current place within the healthcare continuum. The patients’ needs are our highest priority, and our place within the greater medical community continues to allow us to grow. Choose wisely when considering hearing healthcare options.
On Wednesday March 11 we presented an in-service on benign positional vertigo to the volunteer staff at St. Joseph’s Neighborhood Center in the South Wedge section of Rochester. Over a dozen physicians, nurses, interns and staff attended this interactive vertigo workshop. We explained the purpose of the inner ear balance center, the basic function of the organs of balance, the nature of positional vertigo (also known as BPPV) and treatment strategies.
We were very pleased with the response to this presentation, as the attendees were engaged and interactive. Many questions were asked, and one physician was additionally able to provide a patient perspective, as he has experienced several bouts of vertigo and formerly saw patients in emergency care. We also provided insight into our in-office VNG test battery. The principles of history taking and compounding or alternative conditions were reviewed, as was good follow-up care.
Dizziness is among the most common complaints to primary care providers, behind headache and back pain. Positional vertigo is among the most common ear related causes of dizziness. It can be treated safely and effectively without medications or surgery, given a correct diagnosis. Our in-office test battery can rule out many other common causes of imbalance or dizziness.
We are thankful for St. Joseph’s Neighborhood Center, a tremendous resource and asset to the South Wedge area and the region’s uninsured or underinsured. The comprehensive health and social services they provide are funded exclusively by charitable donations, and the majority of practitioners provide services on a volunteer basis. See http://www.sjncenter.org/ for more information. As always, we wish to help keep you on a clear path to good hearing and ear health.
There has been increased awareness of noise damage to hearing lately. People are increasingly cognizant of the punishment loud noises or music can inflict on our ears. Temporary damage can become permanent damage over time. OSHA has established guidelines about workplace noise “dosages”, and shooters and musicians are lately hearing more about hearing protection devices. What do earplugs do, and which kinds of earplugs are best to use?
The main function of earplugs is to block sound from entering the ear canal. The less energy vibrating the eardrum, the less loudness will be heard. Hearing damage comes from the intensity AND the duration of the exposure. Intense, brief sounds may be as damaging as less intense sounds of longer duration. Solid or foam plugs are generally economical and will block or absorb much of the energy in sound. For this reason they are useful for highly damaging noises, such as power tools or jet engines. Unfortunately, when sound quality is important, these plugs fall short. Low frequencies pass through, however, high-frequency sounds are banned, and clarity is poor. Also, disposable plugs need to be replaced often.
For musicians and others in need of good sound clarity as well as attenuation, we recommend hi-fi musicians’ custom plugs. These devices have a hollow channel to let sound through the plug. The hole is then plugged with a special filter, which provides a “flat attenuation”. This means the sounds heard are relatively natural sounding although softer. Ears are protected, and sound quality does not suffer. This is good news for demanding listeners such as performing musicians. There are three different strengths of filters: 9dB, 15dB and 25dB. 15dB is standard for most musical applications. 9dB may be appropriate for unamplified combo work or chamber music, and 25dB should be reserved for very loud groups, such as heavy metal bands or large drumlines.
There are other strategies, such as limiting exposure time, using acoustic modifications in the room and turning down the volume. There are other devices to protect hearing, such as earmuff-style protectors. These can even be worn on top of plugs for even greater protection. This works well for shooters. Greater awareness has increased our options.
We always say the best earplugs in the world are…..the ones that actually get worn. As always, let us keep you on a CLEAR PATH to good hearing and ear health.
Very often patients will ask us why they cannot hear well in noisy places, such as restaurants. Some of these people have normal or near-normal hearing. The situation is puzzling to them, since they don’t present with significant decrease in hearing, yet they are noticing a breakdown when in challenging environments. In quiet they hear fine. In noise they become frustrated. Why does this happen? Is it normal? What are the patterns we notice from those who ask about hearing in noise? What can be done?
What we have noticed is very few people under 40 report this phenomenon. As patients reach their 40s and 50s they tend to notice difficulty in hearing, particularly in background noise. This may be true even when hearing levels are normal. Neuroscience has provided us with evidence of a brain region that acts as a filter for background noise when we are listening to a specific signal, such as speech. Background noise tends to be “static”, or relatively constant. Speech, on the other hand, is more dynamic, and has peaks and valleys we extract meaning from. If a particular region of the brain’s cortex loses function, the ability to listen accurately in the din of a restaurant suffers greatly.
This filtering region appears to gradually lose effectiveness over time, particularly with hearing loss. Additionally, degradations in the hearing nerve’s ability to send well-coordinated signals to the brain affect the quality of the signals we hear. Research has found loud noises can affect the synchrony of auditory nerve firing, even before they damage hearing levels. The ear becomes easily “overloaded”. This is partly why it is better to talk slowly and clearly to a hearing impaired person than to shout loudly. Often we will notice a large family gathered at a restaurant, and the grandparents appear to miss most of the conversations. They are feeling the effects of these issues, as well as possible hearing loss, where the high-frequency “clarity” sounds in speech are not heard.
In an upcoming blog we’ll explore some strategies that can help with hearing more effectively in the presence of background noise. Stay tuned, and let us keep you on a clear path.
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We have long been proud to present a collaborative approach to the care of patients’ ears and hearing. With every patient we seek answers and direction from not only the patient’s symptoms and history, but also from our diagnostic testing. This may push us to ask about other systems in the body. It is not uncommon that hearing disorders may flow from other conditions.
An audiologist recently summarized her work as “holistic”, due to collaborations with other professionals, as there may be underlying medical conditions accompanying hearing disorders. There was an implication that this was a unique approach. Every day we take extensive medical histories and collaborate with referring physicians, in order to find possible compounding factors or disorders that may relate to the ears. More referrals may be made. Tests may be ordered. This is not “holistic”; it is good comprehensive audiological care. It is “listening to your patients”. It is active participation.
The particular audiologist was correct in implying the ears do not act in a vacuum. They are connected to many areas of function within the body, such as the circulatory, nervous, musculoskeletal and balance systems and are sensitive to changes in body chemistry. A good hearing professional will always be sensitive to the interconnectivity within the body. Care for the person first; the ears will follow.
Maintaining a place for audiology within the greater medical community has always been our mission and passion. This is why we have forged relationships with primary care providers, ear surgeons, neurologists, physical therapists, chiropractors, acupuncturists and others. Additionally, the professionals at Clear Choice Hearing and Balance donate time and services to local senior assisted living communities, community health centers such as St. Joseph’s Neighborhood Center and school music programs. We strive to provide good stewardship and connectivity within our greater Rochester community.
Your symptoms are trying to tell you something
Frequently we will see patients with disruptive ear symptoms. These may be sudden hearing loss, plugged ear sensations, sudden-onset tinnitus, veering while walking or spinning dizziness sensations. Some of these people will wait weeks or even months to be examined. This may be due to either lack of concern, scheduling concerns or fear of the unknown. Experience has shown us it is rarely wise to wait to examine a problem that may be either very serious or easily treatable.
With sudden loss of hearing, often in one ear only, the cause could be located in the outer ear, the middle ear, or the inner ear. The implications vary greatly across these possibilities. An outer ear cause of sudden loss may be a foreign body in the canal, wax impaction or infection. Middle ear causes may involve congestion of the Eustachian tube, fluid behind the ear drum or damage to the three tiny bones that transmit sound. Inner ear causes include infection, autoimmune reactions, leaking of inner-ear fluid, or head trauma. Many of these kinds of hearing disruptions may present as “plugging” sensations.
Sudden-onset (or sudden-awareness) tinnitus, or ear ringing, is often a benign condition, however, it bears having the ears and hearing examined. This noise may be a ring, a hiss, a buzz, a chirp, a pulse or other type of sound. It may be a symptom of an underlying problem needing attention.
Sudden loss of balance and/or dizziness may signal conditions such as inner ear infection, growths along the hearing nerve or nervous system abnormalities. This is another condition that should be examined expeditiously. The hearing system needs to be evaluated as well, as the ears are our main balance organs. The state of hearing can give clues about the underlying cause. Also, common variants of vertigo can be solved in one or two visits without medication or surgery.
A good first step for all these conditions is a thorough examination of the ears, including middle ear testing and full-scale audiogram. A trained audiologist will be sensitive to “red flags” that require prompt medical treatment and guide toward the appropriate next step. Do not wait on sudden hearing loss. We want to keep you on a clear path to good hearing and ear health.
Why we ask so many questions.
You probably would not find it unusual for your primary physician to ask many questions regarding your health. We all know PCPs need to take a thorough history in order to fully diagnose and treat a problem or refer to an appropriate specialist. As audiology and hearing professionals, we often ask questions about seemingly unrelated health matters. This may include medications, trauma, systemic illnesses (such as diabetes), hypertension, infections, cancer and other factors. Why do we ask about conditions that may seem unrelated to ears?
To those of us charged with identifying, diagnosing and often treating problems of hearing and balance, the complexity of the hearing and balance system is well known. The act of listening involves the outer ear to collect sound, an eardrum and three middle ear bones to vibrate, an inner ear to convert mechanical vibrations into nerve impulses, nerve networks to organize and transmit the coded messages carried by these impulses, and the brain to interpret the sounds we detect. This system requires skin, bone, connective tissue, blood supply, specialized sense organs, nerves, neurotransmitters and well-organized brain regions.
Balance involves movement of fluid in the ear detected by specialized “hair cells”, a nerve network to transmit coded messages from the ear, central nervous system structures to interpret the messages, the muscular system to make appropriate adjustments in body position, the eyes to verify where we are or whether we are moving, stretch receptors in the skin to sense movement, our proprioceptive sense to determine where our joints are in space and even hearing to bring in information about our immediate environment.
With so many structures and tissues involved in the processes of hearing and balance, it is essential to collect information to allow us to rule out such a vast array of potential causes for disorders. It is another way we strive to be your clear choice for hearing and ear health.