Hearing Loss
Q: What causes hearing loss?
A: There are two categories of hearing loss. Sensorineural heearing loss is the result of damage to the inner ear or auditory nerve and is usually permanent. Conductive hearing loss occurs when sound waves are unable to reach the inner ear. It’s typically resolved by surgery or medical treatment.
In general, hearing loss is caused by damage to the inner ear from aging or loud noises, ear infections, abnormal bone growths or tumors, earwax buildup or a ruptured eardrum.
Q: What is the first sign of hearing loss?
A: Early signs of hearing loss include difficulty understanding conversations in crowded places or over the phone, struggling to hear consonant sounds, feeling tired after conversations and ringing in your ears, also known as tinnitus.
Q: What are the signs of hearing loss in children?
A: Hearing loss in children can occur at any time in life from acquired factors such as ear infections, head trauma, certain medications and genetic factors. You may suspect your child has a hearing loss if you observe any of the following:
- Failed newborn hearing screening
- Delays in speech and language acquisition, including baby babbling
- Frequent ear infections
- Not startled by loud sounds
- Not turning to the location of sounds after six months of age
- Difficulty following verbal directions
- Daydreaming in many situations
- Concerns by school teachers or failed school hearing screening
- Loud volume on the TV or radio
- Complaints from the child that they cannot hear
A pediatric audiologist is trained to test children of all ages. Any symptoms of hearing loss in children should be addressed promptly to prevent delays or negative impacts on speech, language and academic development.
Q: What are the different degrees of hearing loss?
A: The results of your hearing test are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. The top of the graph is very quiet, and the bottom is very loud. Frequency, or pitch, from low to high, is plotted from left to right. Hearing level (HL) is measured in decibels (dB) and is described in general categories. The general hearing loss categories used by most hearing professionals are as follows:
- Normal hearing (0-25 dB HL)
- Mild hearing loss (26-40 dB HL)
- Moderate hearing loss (41-70 dB HL)
- Severe hearing loss (71-90 dB HL)
- Profound hearing loss (greater than 91 dB HL)
Q: Can hearing loss be restored?
A: Though hearing loss can only be fully restored in limited cases, hearing aids and other treatments can allow you to hear the sounds of your world again. If you have conductive hearing loss, which occurs when sound waves are blocked from reaching the inner ear, it may be resolved with surgery or medical treatment.
Sensorineural hearing loss, which permanently damages the hair cells in the ear that detect sound, cannot be resolved. However, hearing aids can help you reconnect with sounds again.
Q: How is hearing loss diagnosed?
A: If you exhibit symptoms of hearing loss, you should see an audiologist to have a formal hearing evaluation. This hearing test, or audiologic evaluation, is diagnostic and allows the audiologist to determine the type and degree of your hearing loss. There will also be a hearing test that evaluates your sensitivity, acuity and accuracy to speech understanding. Your audiologist may also test your speech understanding at different volume levels and in different conditions—such as noise—to help the professional recommend the best hearing aids for your particular needs.
The hearing evaluation will also include a thorough case history and a visual inspection of the ear canal and eardrum. Additional tests of middle ear function may also be performed depending on your symptoms. The results of the evaluation can be useful to a physician if the audiologist believes your hearing loss may benefit from medical intervention.
Results of the hearing evaluation are plotted on a graph called an audiogram. The audiogram provides a visual representation of your hearing test results across various pitches or frequencies, especially those necessary for understanding speech. The audiogram and results from your speech understanding tests are used to create a prescription for programming hearing aids, if necessary.
Q: How can hearing loss be prevented?
A: There are a variety of steps you can take to prevent hearing loss. You can avoid noise-induced hearing loss by wearing earplugs or other hearing protection in loud environments. Also, consider turning down the volume on your television or music. Other types of hearing loss can be prevented by avoiding putting cotton swabs in your ears, managing your blood pressure, keeping diabetes under control and avoiding ototoxic drugs when possible.
Tinnitus
Q: What is tinnitus?
A: Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, buzzing or clicking. Tinnitus is not actually a disease, but a symptom of an underlying condition of the ear, the auditory nerve or another influencing factor. Tinnitus can be intermittent or constant, with single or multiple tones. The perceived volume can range from very soft to extremely loud and may be recurrent or constant.
Q: What causes tinnitus?
A: Many, and often, an exact cause is never found. Common causes of tinnitus include:
- Hearing loss: Because the hair cells in the ear that pass sound to the brain can leak electrical impulses to the brain when they are broken
- Ear infections or ear canal blockage: Which changes the pressure within the ear
- Head or neck injuries: Which can impact the inner ear, hearing nerves or brain function related to hearing
Other factors include Meniere’s disease, problems with the Eustachian tubes, tumors in the head and neck, temporomandibular joint (TMJ) disorders and certain medications.
Q: Does tinnitus cause hearing loss?
A: Tinnitus may interfere with your hearing, but it does not cause hearing loss.
Q: Can people with tinnitus have hearing loss?
A: Because tinnitus is a symptom of a variety of inner ear disorders, many people with tinnitus also experience hearing loss.
Q: How is tinnitus treated?
A: Depending on the severity and underlying condition causing the tinnitus, there are several treatments available to improve the perception of unwanted noise. The most common treatments for tinnitus include:
- Hearing aids with tinnitus-masking features
- Tinnitus retraining therapy
- Sound therapy
- Avoidance measures
- Avoidance of certain medications
- Behavioral therapy
Hearing Tests
Q: When should you get your hearing checked?
A: You should visit an audiologist for an exam if you’re struggling to hear, someone else has noticed a change in your hearing, you’re experiencing ear drainage or pain or hearing loss runs in your family. Additionally, people aged 65 or older or those who work in loud environments should have a hearing test.
Q: How often should you get your hearing checked?
A: According to the American Speech-Language-Hearing Association (ASHA), healthy adults under 40 who are not experiencing any hearing loss should have their hearing tested every three to five years. People who are 65 or older, have already been diagnosed with hearing loss or are regularly exposed to loud noise, should receive a hearing test annually.
Hearing Aids
Q: What level of hearing loss requires a hearing aid?
A: Hearing aids are beneficial even for people with mild hearing loss. Treating hearing loss while it is still mild will allow you to remain engaged with your surroundings and connected with loved ones.
Q: Is it better to get hearing aids early?
A: Yes. There are a variety of benefits to treating hearing loss early, including:
- Improved communication with friends and colleagues
- Hearing aids contribute to a better quality of life, improved mental well-being, and increased social involvement
- Increased connection to the world around you
Q: What are the different types of hearing aids?
A: Hearing aids fall into two categories: in-the-ear models and behind-the-ear models.
- In-the-ear hearing aids are worn in the ear canal. Styles include Invisible-in-the-canal (IIC) and completely-in-the-canal (CIC) models: which are the smallest options available
- In-the-canal (ITC) models: which sit in the lower part of the outer ear bowl and are slightly larger than their IIC and CIC counterparts
- Low-profile hearing aids: which include both half-shell and full-shell designs that sit in the outer ear bowl
- Behind-the-ear hearing aids sit behind or on top of the outer ear with tubing connected to the ear canal. Styles include: Receiver-in-the-ear (RITE) or receiver-in-canal (RIC): which have the speaker resting in the ear canal and the microphone and processor resting behind the ear
- Behind-the-ear with earmold, which can offer more features, controls and battery power
Q: Which hearing aid is best for my kind of hearing loss?
A: Your audiologist will help you choose the hearing aids that will work best for you. Factors they will consider include your degree of hearing loss, the shape of your outer ear and ear canal and any additional features you may benefit from.
Q: Is it okay to just wear one hearing aid?
A: If you’ve been diagnosed with hearing loss in only one ear and normal hearing in the other, you only need one hearing aid.
But if you have hearing loss in both ears, using two hearing aids will help you hear in noisy environments and determine the direction of sounds. Even if you have less hearing loss in one ear than the other, using two hearing aids will be beneficial.
Q: What is it like to hear through a hearing aid?
A: Hearing aids can reconnect you to sounds you’ve been missing and help you better understand speech, but they don’t restore the ear’s natural functions. You may find the new sounds a bit overwhelming at first, since your brain needs time to re-acclimate to processing information from your ears. Sounds may also seem unusually loud, but you’ll become used to them with time.
You’ll have several follow-up visits with your audiologist to ensure that your device is working for you. During these visits, your provider will help you with any questions or concerns about adjusting to your hearing aids.
Q: What are the side effects of a hearing aid?
A: Like most significant lifestyle changes, hearing aids may take some getting used to. Along with many benefits, there may be some uncomfortable side effects initially, but your audiologist will help you find solutions to any issues that arise.
Side effects may include:
- Headaches: This is a result of your ears getting used to new sounds and usually disappears within a few months.
- Irritated or itchy ears: Your ears may feel uncomfortable if your hearing aids do not fit properly. An audiologist can help adjust your device to reduce this feeling. If your ears itch, you remove your hearing aids to clean them and prevent wax buildup.
- Feedback issues: If you hear a whistling or buzzing sound, it may be because your hearing aids are misdirecting sound. Though this does not occur as often with the digital processors offered by modern hearing aids, your audiologist can help if you’re experiencing this issue.
Q: What are assistive listening devices (ALDs)?
A: People with all types and degrees of hearing loss can benefit from an assistive listening device (ALD). Since the microphone of a typical hearing aid is worn on or behind your ear, its ability to enhance the talker-to-background-noise ratio can be limited. However, ALDs are designed to increase the loudness of a desired sound, such as a radio, television or a public speaker, without increasing the background noise. This is because the assistive listening device’s microphone is placed close to the talker or device being used, while the hearing aid’s microphone is always close to the listener.
ALDs include alarm clocks, TV listening systems, telephone amplifying devices and auditorium-type assistive listening systems. Many newer devices are small, wireless and compatible with a person’s digital hearing aids. Alarms and other home ALDs may be small devices that are placed discreetly on tables, next to the TV or on the wall.
OTC Hearing Aids
Q: What is an over-the-counter (OTC) hearing aid?
A: OTC hearing aids are medical devices meant to treat mild to moderate hearing loss in those 18 or older. Like prescription hearing aids, they are regulated by the FDA, but each has its own safety and efficacy guidelines. OTC hearing aids are different from personal sound amplification products (PSAPs), which the FDA does not regulate.
Q: What is the difference between a hearing aid and an OTC hearing aid?
A: Unlike prescription hearing aids, OTC hearing aids are only meant for adults with mild or moderate hearing loss. They do not require an exam or fitting from an audiologist or other licensed professional.
Q: What kinds of hearing loss is an OTC hearing aid designed for?
A: OTC hearing aids are designed for adults experiencing mild or moderate hearing loss. They are not intended for use by those under 18 or by adults with severe hearing loss.
Q: Can I get a hearing aid without an audiologist?
A: Prescription hearing aids, which are customized for your needs and appropriate for all levels of hearing loss, are only available after receiving a hearing exam from an audiologist or other licensed professional. The FDA has approved over-the-counter hearing aids for certain cases of mild to moderate hearing loss and are available without a hearing exam.
Audiologist
Q: What is an audiologist?
A: Audiologists are healthcare professionals who evaluate, diagnose and treat hearing loss and other auditory conditions like tinnitus and balance disorders. Audiologists also provide valuable insights and products to help you prevent hearing loss, such as protective custom earplugs. Audiologists are trained to work with all ages, from newborns to older adults; however, some specialize in certain age groups or conditions. An audiologist holds an advanced degree in audiology. Currently, audiologists must hold a doctoral degree and be licensed by the state in which they practice. Additionally, audiologists must be licensed in the state where they practice and are regulated by the Division of Consumer Affairs.
In addition to their education and state licensure, an audiologist may be awarded the Certificate of Clinical Competence in Audiology by the American Speech-Language-Hearing Association (ASHA), otherwise known as the CCC-A.
Q: What types of tests and treatments do audiologists perform?
A: Common services and treatments provided by an audiologist include:
- Diagnostic hearing tests
- Audiologic evaluations
- Hearing aid fittings and consultations
- Hearing aid repairs and maintenance
- Aural rehabilitation
- Pediatric hearing loss detection and treatment
- Hearing loss prevention and protection programs
- Earmold and earplug fitting and consultation
- Custom musicians earplugs and monitors
- Tinnitus management programs
- Dizziness and balance testing and treatment
- Hearing rehabilitation and auditory training
- Cochlear implant candidacy evaluations and implant programming
Q: Is an audiologist a doctor?
A: Audiologists are healthcare professionals who have earned at least a master’s degree and most hold a doctorate of audiology degree; however, they are not physicians.
Q: What can an audiologist diagnose?
A: Audiologists work with patients of all ages. They diagnose:
- Hearing loss: This can be caused by damage to the inner ear, a ruptured eardrum, earwax buildup, ear infections or abnormal bone growth.
- Auditory processing disorders: These disorders cause the brain to struggle to understand and process sounds, as well as to differentiate speech from non-speech.
- Tinnitus: This condition is marked by a ringing or whooshing sound in the ears.
- Balance disorders: These conditions make you feel dizzy or unsteady on your feet. You may also feel vertigo or the sensation that the room is spinning around you.
Q: What is the difference between an ear doctor and an audiologist?
A: An ENT or otolaryngologist is a doctor who treats issues related to the ears, nose and throat. They focus on diseases, tumors, nerve issues and other abnormalities in these areas of the body.
An audiologist is a hearing healthcare professional who specializes in hearing and balance disorders. They specialize in the technology used to manage conditions like hearing loss.
Q: What is the difference between an audiologist and a hearing instrument specialist (HIS)?
A: A hearing instrument specialist is licensed to perform audiometric testing to sell and fit hearing aids. To obtain a license, a HIS generally has to complete a hearing aid certification program, complete in-field training hours, and pass an exam. Hearing instrument specialists can fit and repair hearing aids; however, they cannot diagnose a hearing loss.