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.
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.
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.
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.
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.
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.
People whose work and play put them at risk for ear damage commonly complain about difficulty hearing and ringing/buzzing in the ears. Construction workers, machinists, contractors and musicians find themselves immersed in loud sounds as a matter of common practice. Add off-the-job hobbies, such as shooting, power tools or practicing music, and you have a recipe for significant 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 noises, particularly in quiet environments. While these are certainly signs one has done damage to the ears, it is important to note we now have excellent technology to effectively and discretely improve these symptoms.
For most hearing loss 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 very 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 the additional symptom of tinnitus, the goal is to increase the amount of sound we receive. Silence will only allow tinnitus to become more dominant, as it is more a brain phenomenon triggered by ear damage. Many modern hearing instruments can be custom programmed with tinnitus therapy noise that 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) over time. Tinnitus can be come no more noticeable than a watch on your wrist or the rim of your glasses as you look through them.
The latest innovation is technology that pairs many modern hearing instruments with smart phones. Various iPhone or Android phones can utilize an app specific to the amplification and tinnitus of the patient. We can now control the sound into our ears much like we control virtually everything else in these days of text messages and social media, by tapping a screen on our phone. This is an unprecedented level of control by the wearer, and 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.
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.
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.
You love your grandchildren — their smiles, the way they look like their parents did when they were young, and their exuberance — but sometimes, they are very hard to hear. Children have a way of swallowing their words, or slurring them together, and typically have softer and higher pitched voices. That is, when they are not shrieking with delight or terror. Their way of speaking makes it hard to understand them under any conditions, but with hearing loss it can be even tougher, especially with age related hearing loss, which tends to impact the higher frequencies most.
Hearing loss is no reason to miss out on the fun and important relationships you desire with your grandchildren. Teaching them the best way to speak with you will take patience and repetition, but it is worth it. Share these tips with them in an age appropriate way each time you see them. Soon it will become second nature.
1. Tell them about your hearing loss. The first step is letting them know that it is hard for you to hear them. You can show them your hearing aids and explain that your ears don’t work as well as theirs do. For younger children that might be enough of an explanation, but older children will be interested in the scientific aspects. Visit websites like KidsHealth or Dangerous Decibels with them to explore how hearing works and the causes of hearing loss.
2. Ask them to get your attention first. Explain that it is much easier for you to hear them if they get your attention first. That way you can concentrate on what they are saying and have a better chance of understanding the topic of the conversation. Knowing the context can help a lot when you need to figure out harder-to-hear words.
3. Make sure they are facing you. Explain how you use their lips to help you hear. Tell them, “If I can’t see you, I can’t hear you.” My family and I sometimes play lipreading games to help them understand how I use lipreading to hear. They can be a lot of fun
4. Keep background noise low and the lights bright. Ask them to turn down the music while you talk or to move away from the air conditioning unit to minimize competing sounds. Well-lit spaces also make it easier to lipread.
5. Teach them to take turns speaking. Children can be excited to speak and don’t know to wait their turn, but it is probably difficult for you to hear more than one speaker at a time. Remind them to take turns speaking. This is good manners in any event, and will make it much easier for you to follow the conversation.
6. Ask them to speak at a normal volume and pace. Explain that normal speech is easier to lipread, while shouting or excessively slow speech is harder for you to understand. Clarity of the sounds is the key, so ask them to speak each word as clearly as they can rather than slurring them together. Sometimes asking them to pretend they are speaking to an audience or are onstage can help them understand what you mean.
7. If you miss something, ask for clarification. Rather than just saying “What?” or tuning out, ask them to rephrase or spell a difficult word (depending on their age). Or ask them to point to the object in question. Repeat the part of the sentence you heard and ask them to fill in the missing pieces. Say what you think you heard — sometimes the mishearings can be very funny if you let them be.
8. Get down to their level. Sit on the floor with them, or ask them to join you on your lap. Interact with their toys along with them. The more engaged you are with them in activities, the more willing they will be to make the extra effort to communicate.
9. Maintain a good energy level. Communication takes work, especially when you have hearing loss. Make sure you are well rested before a visit. Eat healthy foods, try to exercise regularly and be sure to get enough sleep. Don’t be afraid to take breaks if your energy is lagging.
10. Keep your sense of humor. It can be frustrating, but remember the goal is to connect with your grandchildren, so why not laugh at the misunderstandings rather than being upset by them. Children are used to making mistakes and learning new words, and they will not judge you for your errors. If you are at ease with your hearing loss, they will be too.
Hearing loss can make communication difficult, but by following these tips and maintaining a healthy attitude, it does not have to stand in the way of meaningful and lasting relationships with your grandchildren. Don’t let a single moment with them go to waste.
Oral storytelling is one of the most ancient art-forms. Stories have been passed on by word of mouth to entertain, educate and inform from generation to generation, long before recorded history.
Although these oral traditions have changed, the desire to TELL and HEAR stories remained constant. This is why hearing loss can have such a significant impact on everyday life.
The sudden change in hearing ability after receiving new hearing aids or cochlear implants impacts most aspects of your life, but listening exercises can vastly improve one’s auditory skills.
Those who are unable to participate in conversations can experience feelings of loneliness, isolation, and frustration. Thankfully, there are ways to rehabilitate from the loss of hearing, through technology and auditory training.
Audiobook exercises can be conducted at home or as part of an Auditory Rehab program. A Rehab Specialist, such as a rehab audiologist, an auditory verbal therapist or speech pathologist, can guide and coach you on the strategy, as well as recommend sessions where family or significant others can join in and learn effective communication techniques. Therapy-based services can help you successfully put the pieces of the communication puzzle together.
Today, a new era of oral storytelling or audio books is booming with mobile technologies such as smartphones, tablets, and multimedia entertainment systems in cars and podcasts over the internet.
Audiobooks, especially, are easily accessible and an enjoyable way to practice listening that can be completed independently at your own pace. They are particularly useful for patients who might have difficulty finding a suitable conversational partner. Auditory training at home with audio books and the corresponding texts is an enjoyable rehabilitation option that spans the scope of a beginner to experienced cochlear implant user.
Your first book should be a book you are already familiar with and have even read a few times. This serves as a way to get the “feel” of the audiobook experience which focuses on listening not vision. You’ll find that it’s quite different from reading paper books, so ease yourself into this and don’t rush. Non-fiction books are a good beginning as the storyline is familiar and predictable.
Select audiobooks that have a clear narrator, a relatively slow pace and without accents foreign to you. Consider books with few characters to follow. Sound effects and background music should be limited as not to obscure the spoken words of the book.
Select audiobooks that have a clear narrator, a relatively slow pace and without accents foreign to you.
It is important to listen in a quiet room or connect your sound source directly to your cochlear implant processors or hearing aids with a Telecoil, Bluetooth or a direct audio input cable.
There are three listening levels based on your auditory experience and skills.
As a beginner, try listening to an unabridged audiobook while reading the book simultaneously. This helps you to make the connection between the words you hear and words. By listening and looking at the words at the same time, a connection can be made and comprehension soars.
If this level is a challenge: Ask a friend to read a written passage out loud to you while you follow along reading the words. Run your fingers along the words as they are spoken. This is easier than a recorded audiobook because you are familiar with the friend’s voice and speaking style. A friend can respond to your requests to slow down, repeat or make changes based on your abilities.
When you become more familiar with the practice of listening to audiobooks, listen to an unabridged audiobook and have the hardcopy book to look at as needed, or to review what was said and heard. Listen to the audiobook for short periods of time as it can be fatiguing.
If this is a challenge try reading the book first. This will help with understanding the topic or plot so you know the storyline as you listen to the audiobook.
Remove the visual and focus on listening ALONE to the audiobook without the written text. Over time this will build your confidence and improve the ability to follow and take part in natural conversation situations.
When it comes to audiobook sources there is your local library and countless companies. Begin with a familiar story such a fable or classic tale and make you book choice based on the narration. Ask a librarian or friend with typical hearing for help choosing a narrator. Resources for free audiobook listening samples are available NoveList Plus, iTunes, and Audible. Consider if the source offers options to listen to multiple speeds and the ability to quickly rewind or fast forward.
A popular option for hearing aid and cochlear implant users is the “Great Listen Guarantee” in which you can exchange one audiobook for another, no questions asked offered by Audible. This allows you can try the audiobook and decide if the sound quality and narrator fit your listening level and needs.
“Oh the Places You’ll Go” by Dr. Seuss, read by John Lithgow
This is a children’s book that has been read at high school and college graduations! It’s a book well-loved for beginners.
“Because of Winn-Dixie” by Kate DiCamillo, read by Cherry Jones
This is a heart-warming story for young adults about a girl who learns how to get over her fear and loneliness thanks to a dog named Winn-Dixie and is perfect for intermediate listeners.
“The Picture of Dorian Gray” by Oscar Wilde, read by various.
The dramatic reading of this book has a different person reading the different parts, which makes it an excellent audiobook to practice listening and understanding different voices and accents.
Audiobooks are an excellent tool for auditory training and listening practice.
Soon you will be on your way to improved speech understanding for following conversations with much to talk about with all the audiobooks you’ve enjoyed!