Hearing. More than your ears.

You hear with more than your ears. We tend to think of the ears as the hearing organ of the body. This is reasonable. Our ears take in sound. The visible part of the ear acts as a funnel to direct sound waves inward. These waves cause vibrations in the middle ear and cause a fluid wave to travel through the inner ear. As we have explained in earlier articles, the inner ear transforms the mechanical sound waves into electrical signals that then travel to the brain. The nervous system and brain have an enormous impact on hearing. Those impulses that travel toward the brain’s hearing centers make several stops along the way. The brainstem is at the top of the spinal cord and helps us organize the sounds we hear by loudness, duration and pitch. Parts of the thalamus then help connect hearing with other senses and brain functions. By the time the signals reach the auditory cortex of the brain, it has been largely decoded. The cortex of the brain can then apply recognition, memory and responses to the sounds, especially after years of experience. When a person does not hear well, it is natural to suspect a problem with the ears themselves. However, with the myriad of structures involved in listening, it is important to remember the roles the brain plays. Any condition that can affect nerves and brain can disrupt the chain of events we rely on for hearing. This is why diagnosis of hearing must take into account more than ear damage. The problem can be with the outer ear, middle ear, inner ear, or any part of the nervous system PAST the ear. A quick screening of hearing levels for a few tones is simply not enough. A thorough diagnostic evaluation is necessary to determine the BEST way to overcome hearing problems. Call to found out how to get started. As always, we want to keep you on a CLEAR PATH to good hearing and ear health.


Operating Full Scope

Professionals in every field are limited by their training, experience, education or professional license. The scope of practice for lawyers, for example, is vast. However, it is unlikely the same attorney will aid in estate planning and also prosecute criminal cases. A radiologist with a medical degree cannot perform heart surgery or prescribe dermatology medications without the proper certification. We live in an age of specialization.

This is true in hearing health care, as well. There is a well-defined clinical scope defining our field. This includes diagnosis and treatment of disorders of hearing, tinnitus, balance/vertigo, hearing aid dispensing, ear wax removal (some states) and hearing conservation. Audiologists may choose to work with adults, children, infants or various ages.

Clear Choice Hearing and Balance has made an effort to create an audiology/hearing aid dispensing practice that is as full-scope as possible. We offer a medical model of service delivery, however, with the patient’s input being the center of our focus. With a diagnostic battery that includes evoked potentials, otoacoustic emissions, high-resolution camera otoscopy, multi-frequency tympanometry, acoustic reflexes, play audiometry, visual referencing audiometry, behavioral observation audiometry, conventional audiometry, auditory processing evaluation, videonystagmography, evoked potential testing, balance testing and tinnitus assessment, there is very little we cannot do to aid in the diagnosis of disorders of hearing and balance. Our patients range in age from infants to centenarians.

As far as treatment is concerned, we are able to fit instruments of virtually any brand of hearing instrument for any type and degree of loss. Many have tinnitus therapy programs available. We have a background in tinnitus therapy, hearing conservation and vestibular/balance therapy, as well. Additionally, there is a network of medical professionals we often refer patients to, depending on the diagnosis.

If you are seeking help for problems of hearing, tinnitus and balance/vertigo, choose your professionals wisely. As always, we wish to keep you on a clear path to good hearing and ear health.


A typical day at Clear Choice

We wanted to share a glimpse into the diversity of patients we might see on a typical day. We will follow one of our providers as the morning unfolds.

First patient is a 65 year-old male with a known hearing loss. He has been referred to us by a friend who is our patient. We test his hearing, and he decides to upgrade his ten year-old hearing aids.

A 40 year-old woman has been referred by her primary physician for a “plugged” ear sensation. She is found to be occluded with copious but shallow ear wax. We clear the ear under magnification by way of suction. Her hearing is found to be normal, and the plugging is resolved.

An 86 year-old woman is seen for a routine check-up. Her hearing aids are not working properly. After cleaning and basic maintenance, the aids are functional and working appropriately.

A 55 year-old male is seen for bothersome tinnitus. During the examination he is found to have significant noise-induced hearing loss. We fit him with open-fit hearing instruments and provide counseling on tinnitus therapy strategies. We will track his progress over time.

A 58 year old woman is seen for severe dizziness triggered by motion. Testing reveals one-sided hearing loss and positional vertigo. The vertigo is treated at our office, and we refer her to an ear, nose and throat physician, due to asymmetric conductive hearing loss.

A 21 year old musician is seen to have impressions made for custom high fidelity hearing protection. He has requested baseline hearing testing and is found to be normal.

A 91 year old woman is brought by her son for severe hearing loss and difficulty hearing her family. The son acts as translator and driver. We evaluate her ears and fit her with appropriate hearing aids.

A 46 year-old male is seen for tinnitus. He is concerned the noise in his ears is a sign of a deeper medical issue. He has a history of industrial noise exposure. Testing reveals an early high frequency loss of hearing in both ears consistent with tinnitus. We discover no “red flags” pointing to tumors or major ear abnormalities.

This morning’s patients have come here from the city, the suburbs, rural villages and senior living facilities. We have the privilege of serving a wide variety of people with a variety of problems. It is our mission and our passion. As always, we wish to keep you on a CLEAR PATH to good hearing and ear health.


ABR – not as scary as it looks

A great challenge of audiology has always been to examine organs and structures we cannot see. When we look through an otoscope or camera into the ear canal, we can see as far as the eardrum. The most important parts of the ear for most disorders, however, are in the inner ear and even the nerve network carrying the hearing and balance signals towards the brain. Even imaging studies, such as MRI and CT, cannot show us the behavior of the nerve SIGNAL.

Luckily, we now have access to a form of EEG that allows us to examine the nerves in action. Since the hearing and balance nerves always receive signals from the inner ear, we know if we can observe the firing of impulses, we can tell if the brain is receiving the signal and if the signal is accurate.

The Auditory Brainstem Response, or ABR, is performed by placing electrodes on the forehead and behind the ears, as well as earphones inserted in both sides. Electrical activity that results from sounds presented to the ears is measured, and predictable patterns arise. Experience tells us how long it should take for each wave to appear on the computer screen. This all provides information about the nerve network of the hearing system.

The uses and variations for ABR testing include: infant hearing screenings, estimating hearing levels in adults that cannot respond to normal hearing test procedures, finding weaknesses in the balance organs, and aiding in diagnosis of conditions such as acoustic neuroma, Meniere’s disease and auditory neuropathy. We can now incorporate these techniques into test batteries for infants, children and adults.

We always strive to remain on the cutting edge of diagnosis and treatment. Our goal is to keep you on a clear path to good hearing and ear health.


What does “laurel” vs “yanni” tell us about hearing loss?

Much has been made about the recent viral audio/video debate about a single word. Some people hear only “Laurel”, and some only “Yanni.” Some hear either, depending on what they are told they will hear, and some hear both on successive trials. What has caused this discrepancy between two seemingly unrelated words, and how does hearing loss enter into the perception of the word?

It turns out the original word was a recording of “laurel.” A well-recorded version of this word played through high quality speakers or headphones should be unmistakable. The reason for the differing perceptions has to do with the frequencies that make up the “l” and “ee” sounds. The “l” as in laurel has mostly low frequencies. The “ee” sound some hear at the beginning and end of the word contains low AND high frequencies, due to a more closed mouth and throat.

A manipulated version of the word “laurel” with added high frequencies has complicated the matter for many ears and caused the viral phenomenon. Some listeners appear to place high priority on high frequency sounds and hear “Yanni”, and others emphasize low frequencies and hear the original word. Expectations of a particular word prior to listening may also have an effect.

In any case we see how a subtle change in perception can cause us to substitute an incorrect word when listening. This is what happens to individuals with hearing loss. Common mistakes on word testing of hearing impaired patients include “bake” for “date”, “use” for “youth” and “rib” for “lid.” Mishearing just a portion of a sound can cause a cascading effect of miscommunication, well beyond mistaking your Aunt Laurel for your Uncle Yanni.

Awareness is always the first step towards improvement. As always we want to keep you on a clear path to good hearing and ear health.


Your medications may be damaging your ears

There are several risk factors for hearing loss when an audiologist reviews a patient’s history. Well known factors include exposure to loud noises, family history of hearing loss, ear surgery, infections and diseases. A lesser known aspect of a patient’s history is medications.

There are over 200 known medications that may damage your ears and affect their functions. Some affect hearing, some affect balance, and some both.

Common offenders include chemotherapy drugs containing platinum, such as cisplatin or carboplatin, certain diuretics/water pills, such as furosemide (Lasix), certain classes of antibiotics (including many ending in –mycin), quinine, salicylates such as high-dose aspirin and medications for ED.

The inner ear has hearing and balance organs in close proximity. A change in blood chemistry may affect either or both. Some medications, such as aspirin, have a temporary effect. Others may be permanent and last long after the drug is out of the bloodstream.

If someone you know has been put on a regimen including one of these medications, be aware of possible ear effects. Often there may be substitutes with less risk to the ears. Allow your physician to help you decide if the benefits of the drug may be worth the risk to the ears.

If you believe a medication has harmed your hearing or balance, contact your physician immediately and have your ears evaluated. As always, we wish to keep you on a CLEAR PATH to good hearing and ear health.



Hearing loss and tinnitus: there’s an app for that!

A tinnitus app

People whose work and play put them at risk for ear damage often complain about difficulty hearing and ringing in the ears. Construction workers, machinists, contractors, musicians and others find themselves immersed in loud sounds as a matter of common practice. Add hobbies, such as shooting, power tools or practicing music, and you have a recipe for ear damage at an early age. Hearing loss is not a sign of aging, it’s more indicative of “wear and tear” of the ears.

Along with difficulty hearing soft speech and speech in background noise, many noise-damaged patients complain of incessant ringing or buzzing. These are signs one has done damage to the ears. It is important to note we now have technology to improve these symptoms effectively and discretely.

For most patients, the days of big, squawking hearing aids filling your ears or the big “shrimp” behind the ears are over. Most modern hearing instruments are small and hide behind the top of the ear. Only a barely-visible wire enters the canal with amplified sound. The instruments are tuned to the frequencies of loss. High frequencies are added when the loss is in the highs. The same goes for a low or middle frequency losses.

For tinnitus, the goal is to increase the amount of sound we receive. Silence will only allow tinnitus to become more dominant. This is more a brain phenomenon triggered by ear damage. Many modern hearing instruments can be custom programmed with tinnitus therapy noise. This can help promote long term habituation to tinnitus. Habituation is a powerful brain phenomenon that allows us to ignore familiar stimulation, like clothes on our skin or unappetizing odors. Tinnitus can be come no more noticeable than a watch on your wrist or the rim of your glasses as you look through them.

Welcome to the future

The latest innovation is technology that pairs many hearing instruments with smart phones. iPhone or Android phones can utilize a tinnitus app specific to the amplification and tinnitus of the patient. We can now control sound into our ears much like we control virtually everything else. We tap a screen on our phone. This is an unprecedented level of control by the wearer. Many people are experiencing improved quality of life though this technology.

Don’t miss out on the sounds of life. Be careful with noise exposure and utilize all the technology that is now available. We want to keep you on a clear path to good hearing and ear health.


Article on musicians and hearing loss

Audiologist Ron D’Angelo wrote an article that was published in the January, 2017 edition of the Journal of the International Trumpet Guild. The article concerns the intelligent use of hearing conservation strategies and products for musicians and music teachers. A professional trumpet player when he is not seeing patients at our Greece and Brighton offices, Ron has experience on both sides of the stage. He has seen the results of hearing damage from loud musical situations.

Musicians frequently visit our office for consultations on hearing loss, tinnitus, poor loudness tolerance and hearing conservation products.  These include custom high-fidelity musicians’ ear plugs and custom ear impressions for in-ear monitors for use onstage or in the studio. Other strategies include environmental changes, positioning, spacing and rest time for ears. We want you to enjoy your music responsibly for as long as possible.

Naturally, this type of advice goes for anyone whose occupation or hobbies may be……loud. There are excellent strategies and products to extend careers and save ears for many whose vocations or avocations put them at risk for permanent hearing damage. A consultation and diagnostic evaluation of your ears is a great first step. Only then can we guide you confidently in the right direction. As always, we hope to keep you on a clear path to good hearing and ear health.


New Brighton Location

Clear Choice Hearing and Balance is excited to announce our Brighton office has moved to a new location. A stone’s throw from our current space, the new suite allows us to better serve you in an opulent, spacious environment. The office provides us with two concurrent audio test booths, improved facilities for vestibular assessment and rehabilitation, as well as hearing instrument fittings.

The address is listed below. We are in a dedicated medical building with improved access for patients. The Westfall Surgery Center is adjacent to Clinton Crossings at the end of Senator Keating Boulevard.

We still have the convenience of a known medically-rich location to serve our patients from the south and east sides. We will continue to provide state-of-the-art assessment and rehabilitation of disorders of hearing, tinnitus and vestibular function. Our phone number has not changed.


Westfall Surgery Center                                                                                                                                                

Suite 210

1065 Senator Keating Boulevard Rochester, NY 14618

585 342-4327


Public presentation October 7

On Friday October 7th we will be participating in the Day of Hearing at Nazareth College, sponsored by Rochester chapter of the Hearing Loss Association of America (HLAA). Local audiologists will be speaking on various topic related to the ears and hearing. Ron D’Angelo, AuD will be presenting on the topic, “A new spin…vertigo, imbalance and hearing loss” from 10:15-11:00 AM.

This presentation will reflect our focus on various disorders of hearing, imbalance and dizziness and our work with area physicians and other professionals. The talk will be informative and interactive; questions and anecdotes are welcome. Mechanisms of balance will be reviewed, as well as disorders that produce imbalance, dizziness and even changes in hearing.

The workshops are free and open to the public. The York Wellness and Rehabilitation Institute will be the venue. We hope to see some of you there. As always we wish to keep you on a Clear Path to good hearing and ear health.