How does the human ear work?
The human ear is divided into three main parts: the outer ear, which collects sound and directs it down to the ear drum; the middle ear, which converts the vibrations of sound in the air to sound in the fluid-filled inner ear; and the inner ear, where sound is converted to a neurological signal and sent to the brain. The shape of the outer ear and the separation between ears allows us to detect the locations of sounds that we hear. The middle ear contains three small bones that connect the eardrum to the inner ear and help reduce the loss of sound as it travels from the air to the fluid-filled inner ear. The inner ear contains thousands of tiny hair cells that pick up sound vibrations in the fluid and convert them to a neurological signal, which is then sent up the auditory nerve to the brain.
What is hearing loss?
Hearing loss is an inability to perceive sounds within the normal range of hearing. Hearing loss is diagnosed to be one of three types: conductive; sensorineural; or mixed. The type of hearing loss helps determine the best method of treatment. Conductive hearing loss occurs when something prevents sound from reaching the inner ear. For example, an ear canal may become plugged with earwax, or the middle ear may become infected and fill with fluid. This type of hearing loss can usually be treated with medication or surgery, although some chronic conductive hearing losses may require hearing aids or other amplification devices. Sensorineural hearing loss occurs in the inner ear and interrupts the conversion of sound to a neurological signal and/or the transmission of that signal to the brain. This is typically due to the hair cells becoming damaged and dying off, which can happen from other medical conditions (ex: Meniere’s disease, blood clots, genetic conditions), environmental factors (ex: noise exposure, certain medications, head trauma), or as part of the natural aging process (though genetics may still play a role). This type of hearing loss usually cannot be treated with medication or surgery and may require hearing aids or other amplification devices, depending on the severity of the hearing loss and the impact that it has on the patient’s daily life. Mixed hearing loss occurs when a person has both conductive hearing loss and sensorineural hearing loss. Mixed hearing loss may be cause by various medical conditions or multiple conditions occurring at the same time. Depending on the cause of a mixed hearing loss, it may be treated with medication, surgery, hearing aids, or any combination of those options.
Who should get a hearing exam?
Anyone who feels that he or she is having difficulty hearing or understanding others should get a hearing exam. Oftentimes, family and friends will notice that you are asking them to repeat themselves, or that you turn the volume on the TV too loud. These can be early warning signs of a hearing loss. If you or your loved one exhibits any of the following symptoms, a hearing test is recommended:
- Asking people to repeat themselves
- Withdrawing from conversations or social situations
- Misunderstanding or responding inappropriately to questions
- Setting the television or radio volume louder than normal
- Feeling as though other people are mumbling
- Speaking at a louder volume than normal
- Ringing in the ears (tinnitus)
- Seeming forgetful or inattentive
- Poor speech or language abilities (especially in children). A diagnosis of speech or language disorder from a speech-language pathologist should usually be accompanied by a hearing exam.
If you decide to come to Link for an evaluation, it will help to take note of when and where you have difficulties; as part of our patient-centric approach, we take that information into account to develop individualized treatment plans for each patient. It may also be helpful to bring a friend or family member – someone with whom you regularly communicate – to provide feedback.
What does a hearing exam involve for adults?
A hearing exam is a noninvasive procedure that consists of several behavioral and physiological tests. Depending on your case history, your exam may include some or all of the following tests:
- Otoscopic Exam: the audiologist will look in your ears to ensure that the ear canals are clear of earwax, debris, or foreign objects. We observe anatomical markers, check that the eardrum is intact, and look for any visible abnormalities such as infection.
- Tympanometry: the audiologist uses a device (a tympanometer) that changes the air pressure in your ear canal while measuring the sound that bounces back from the eardrum. This helps us detect infections, perforations, ossicular disarticulations, and other conditions of the outer and middle ear that may not be visible during the otoscopic exam. For the patient, this test feels as though you are traveling in an elevator for a few seconds.
- Middle Ear Reflexes: the audiologist uses the tympanometer to play some loud sounds for a few seconds and stimulate the middle ear reflex. Observing this reflex helps to identify neurological problems that could cause or contribute to hearing problems.
- Otoacoustic Emissions (OAEs): the audiologist uses a device to play some sounds in your ear. If the inner ear is functioning correctly, it generates an echo, which is then measured by the device. Observing these echoes helps to identify problems in the inner ear that can cause or contribute to hearing problems.
- Puretone Audiometry: the audiologist presents sounds to find the softest sounds that you can hear at different pitches. These scores, called puretone thresholds, are compiled into a graph to illustrate which environmental and speech sounds you are able or unable to hear.
- Speech audiometry: the audiologist plays some recorded words through a pair of calibrated headphones and asks you to repeat them. This allows us to observe how well you are able to detect and recognize speech.
- Most Comfortable Loudness (MCL)/Uncomfortable Loudness (UCL): the audiologist will play some sounds to find the loudness that is most comfortable for you and the loudest sounds that you can tolerate. These scores give us the dynamic range of your hearing abilities and help ensure that any hearing aids or other amplification devices remain comfortable and audible.
What does a hearing exam involve for children?
As with adults, a hearing exam is a non-invasive procedure that consists of several behavioral and physiological tests. These tests are the same as for adults with some modifications depending on the developmental age of the child. Otoscopic Exam: the audiologist will look in your ears to ensure that the ear canals are clear of earwax, debris, or foreign objects. We observe anatomical markers, check that the eardrum is intact, and look for any visible abnormalities such as infection. Tympanometry: the audiologist uses a device (a tympanometer) that changes the air pressure in your ear canal while measuring the sound that bounces back from the eardrum. This helps us detect infections, perforations, ossicular disarticulations, and other conditions of the outer and middle ear that may not be visible during the otoscopic exam. For the patient, this test feels as though you are traveling in an elevator for a few seconds. Middle Ear Reflexes: the audiologist uses the tympanometer to play some loud sounds for a few seconds and stimulate the middle ear reflex. Observing this reflex helps to identify neurological problems that could cause or contribute to hearing problems. Otoacoustic Emissions (OAEs): the audiologist uses a device to play some sounds in your ear. If the inner ear is functioning correctly, it generates an echo, which is then measured by the device. Observing these echoes helps to identify problems in the inner ear that can cause or contribute to hearing problems. Speech audiometry: the audiologist plays some recorded words through a pair of calibrated headphones and asks you to repeat them. This allows us to observe how well you are able to detect and recognize speech. Puretone Audiometry: the audiologist presents sounds to find the softest sounds that you can hear at different pitches. These scores, called puretone thresholds, are compiled into a graph to illustrate which environmental and speech sounds you are able or unable to hear. Some Modifications may include: Behavioral Observation Audiometry: some children may not be able to respond directly to the sounds that are presented. In this case, we vary the timing of our presentations and observe changes in the child’s behavior that occur with the sounds (ex: eye shift, head turn, facial expressions). Visual Reinforcement Audiometry: some children may respond to sounds by looking toward the source of the sound (usually starting at around 6 months of age). We use remote-controlled toys that move and light up when the child looks toward the source of the sound to reinforce this behavior. Conditioned Play Audiometry: some children are able to respond to sounds in the form of a game (usually starting at around 1-2 years of age). We teach the child to take turns in a game whenever a sound is heard. Picture-Pointing Audiometry: some children may not be able to repeat the words we give them, but can point the words out on a picture board. We ask the child to point to the pictures (ex: “where is the snowman?”) or to point to other objects (ex: “where is your nose?”). If you have any other questions or concerns about scheduling a hearing examination, please feel free to call us at 360-551-4800. If an audiologist is not available to answer your questions, we will call you back as soon as possible.
How long does it take to complete a hearing exam?
It typically takes about a half an hour to complete the exam portion of a hearing evaluation. We allow for extra time for counseling before the exam and to go over the results after the exam. Please account for up to an hour and a half for your appointment to ensure that we can address all of your questions and concerns. If you have any other questions or concerns about scheduling a hearing examination, please feel free to call us at 360-551-4800. If an audiologist is not available to answer your questions, we will call you back as soon as possible.
What is the difference between a Newborn Screening and a Diagnostic Test?
A Newborn Screening test only reveals whether or not your child has difficulty hearing. It does not tell us what caused the hearing difficulty, the severity of the problem, or what the best options for treatment are. The Diagnostic Test is a longer, more detailed test that will help answer those questions.
What does an ABR involve?
A diagnostic auditory brainstem response (ABR) is a test that looks at neural responses to sound to determine whether lesions or other abnormalities exist in the ear, along the auditory nerve, or in the brainstem. Some wires are taped to the patient’s scalp and ears and connected to a computer. The computer then records neural responses to sound. For a diagnostic ABR, we look at the timing of the neural response, how it differs between ears, and how long it takes the response to move up the brainstem. This can tell us whether and where a problem exists within the lower central auditory pathway. Diagnostic ABRs are usually indicated for one or two reasons: (1) to mitigate the need for high-cost and high-stress imaging like MRIs; or (2) when the patient cannot have an MRI or CT scan because of a medical condition or implant. No preparation is really required for an ABR. You can sleep through the entire procedure. However, we may need to perform a standard hearing test before your ABR to ensure that the ABR produces valid results. Anticipate a 1-2 hour appointment to complete the diagnostic ABR.
What are hearing aids?
Hearing aids are assistive devices that amplify specific sounds by a set amount (called gain) to make it easier for the user to hear and understand speech. The gain of the hearing aid varies depending on the volume of the speech or other environmental sounds around the user, ensuring that sounds are audible and comfortable for the user. Modern digital hearing aids also come with a variety of features including digital noise reduction, directional microphones, wireless features, remote controls, and more. As part of your hearing aid selection, we review your typical listening environments and personal needs to find the hearing aid with the right features for you.
When are hearing aids recommended?
Hearing aids are recommended whenever a hearing loss is severe enough to cause you difficulty in your daily life. This is different for every person. It is recommended, however, that you seek out hearing aids as soon as you start to notice difficulties communicating; hearing loss, if left untreated, can lead to myriad social and psychological conditions. Additionally, the longer the hearing loss goes untreated, the more difficult it becomes to adjust to amplified sound when you do decide to try hearing aids. If you’re curious whether your hearing difficulty may warrant hearing aids, we have some interactive questionnaires available to help you assess your hearing capabilities.
What hearing aids are sold at Link Audiology?
As an independent audiology clinic, we are not tied to any specific hearing aid manufacturer. We work with all major manufacturers. Each of these manufacturers offers a variety of styles (in-the-ear, behind-the-ear, mini-behind-the-ear, etc.) and features to meet your needs.
What if I have a hearing aid from another place?
We can usually make adjustments or repairs to your hearing aid; however, we are unable to program private-label hearing aids. This is not because of any policy at Link Audiology but because manufacturers of private-label hearing aids will not distribute their programming software to outside clinicians. Unfortunately, we cannot program hearing aids that were purchased at Costco, Miracle Ear, Beltone, or Avada. Some manufacturers will, for a fee, re-purpose hearing aids so that we can program them; however, we cannot guarantee that the manufacturer who made your private-label hearing aids will offer this service.
What do hearing aids cost at Link Audiology?
Our hearing aids and services range in price. The cost will ultimately depend on the features required to meet your listening and lifestyle needs and the services that you want included with your purchase. Many health insurance policies do not cover hearing aids, but we will check with your insurance to see whether they cover part or all of the cost for hearing aids. If your insurance policy covers hearing aids, we will attempt to bill your insurance company. We also offer a payment plan for those who are unable to afford the full cost up front.
What warranties and guarantees are offered with hearing aids at Link Audiology?
We strive to make all of our patients happy and offer an extended money back guarantee to back this up. Per Washington State law, hearing aids must come with a 30-day money back guarantee; at Link, all of our hearing aids come with a 60-day money-back guarantee. If you are unhappy with your hearing aids, for whatever reason, they may be exchanged or returned up to 60 days after you receive them. Typical manufacturer warranties will cover repairs and loss or damage for the first three years. Extended warranties are available with all of our hearing aids for a small fee.
Can I use my hearing aid with my smart phone?
Most hearing aids now have smart phone capabilities. Some require a remote control to link to your smart phone, while other link directly to your smart phone.
What are cochlear implants?
Cochlear implants are medical devices that stimulate the auditory nerve using electrical impulses. This allows the user to hear sounds without acoustic amplification. If you have severe to profound hearing loss (i.e. thresholds at 70 dB HL or worse on your audiogram) and you do not feel that hearing aids are helping you, then you might be a candidate for a cochlear implant. You’ll need to have a lengthy evaluation to make sure that you are a candidate for a cochlear implant. The evaluation includes review of your most recent hearing test, measurement of your hearing aids’ output, and repeating words heard through your hearing aids. Beyond your test results, other candidacy factors include motivation and personal support structure.
What is an ALD?
ALDs are devices, other than hearing aids, that can help you hear better in specific situations by either amplifying sounds or transmitting sounds directly to your hearing aids. For example, some ALDs wirelessly transmit your TV’s audio signal to amplified headphones that can help you hear the TV better. Other ALDs can wirelessly transmit a person’s voice across a room to your hearing aids. By decreasing the distance between you and the speaker, the intelligibility of the speech signal is enhanced. Personal TV Amplifiers These headphones can be worn to amplify the sound from the TV or radio. The sound is sent wirelessly to the headphones via a transmitter, so someone else can listen through the standard speakers as well. Amplified Telephones The telephone is amplified either by a built-in amplifier or by one that attaches to your telephone. Many amplified telephones have lights that flash when the phone rings, larger buttons for the visually-impaired, and other customizable features. Captioned Telephones Some telephones can connect to the internet and provide live captioning of your telephone conversation. These can come with lights, touch screens, and other customizable features like amplified phones. Personal Amplifiers A microphone, wired to an amplified headset, can be carried in your pocket, placed on a table, or pointed toward a speaker to help you understand. Remote Microphones These microphones can be held or worn by someone else. As they speak into the remote microphone, the sound is transmitted wireless to a headset or to your hearing aids. FM Systems These systems are typically used in group or classroom settings. The presenter wears a microphone and transmitter. The transmitter sends the signal out to anyone nearby with a receiver. The receiver is typically a small device that attaches to the bottom of your hearing aid. Loop Systems These systems transmit sound over an electromagnetic signal that can be picked up by any device with a T-coil. Many hearing aids have T-coils built into them, allowing you to listen to audio over a loop system. Other We can find an ALD or other device to suit almost any need – there are doorbells that make your lights flash, alarm clocks that vibrate your pillow, and more. Please ask us if you would like any additional information.
What is tinnitus and who is affected by it?
Tinnitus is a sound that you hear that no one else can hear. It is one of the leading complaints related to the ears and the #1 complaint of returning veterans. The type of sound can vary from person to person – some hear ringing, others hearing buzzing, or wind noise, or static. In most cases (97% or more), the tinnitus is subjective, meaning it cannot be measured by putting a microphone in the ear. Scientific studies have shown that subjective tinnitus is generated in the brain and not in the ear. It typically occurs with a hearing loss, as the brain is trying to adjust for the decreased ability to perceive sound. Because it cannot hear the sounds that it used to, the brain seeks out the missing sounds. Unable to identify the source of the sound, many people react to it on an emotional level with symptoms including heightened anxiety, depression, and even thoughts of suicide. But there are options for treatment that have been shown to be very effective when properly administered.
What does a tinnitus exam involve?
A tinnitus exam is similar to a standard audiometric exam. In addition to the tests described in the hearing test section, you will be asked to complete a survey about your tinnitus and respond to sounds to try and match the pitch and loudness of your tinnitus. We will avoid loud sounds in this exam, as those sounds may exacerbate your tinnitus. The goal of the evaluation is to determine what your tinnitus sounds like, how it is impacting you, and the best treatment to address the problem.
How long does a tinnitus evaluation take?
Because the tinnitus evaluation requires more tests and counseling than the typical hearing test, we schedule 2 hours for each tinnitus evaluation. Though we may finish the exam in less time, please plan on spending the full 2 hours.
What treatments are available for tinnitus?
We work with several types of tinnitus treatment: (1) sound replacement therapy; (2) tinnitus masking; and (3) Neuromonics therapy. The therapy that we use will depend upon the severity of your tinnitus, whether it is accompanied by hearing loss, your responses to the questionnaire, and your personal preferences. Sound replacement therapy aims to reduce your perception of the tinnitus by amplifying the sounds that you are missing. This is usually accomplished by some combination of hearing aids and counseling. Sound replacement therapy is best for people who have hearing loss and who notice their tinnitus but are only mildly bothered by it. Tinnitus masking aims to reduce your perception of the tinnitus by providing soothing background noises. You may already find that your tinnitus is less noticeable in the presence of background noise. Tinnitus masking utilizes that same principle to provide relief when you need it most. Since tinnitus is usually accompanied by hearing loss, we offer several hearing aids with tinnitus maskers built in. Neuromonics is a manufacturer of a breakthrough tinnitus therapy that aims to reduce your perception of tinnitus by breaking the emotional connection to it and acclimating you to the sound. The user carries a small device that looks like an mp3 player, which contains music that is specifically programmed to help with your tinnitus. It works in stages, first by training your brain to stop the stress response to the tinnitus, then by training your brain to ignore the tinnitus. During your regular follow up appointments, we monitor your progress by how often you use the device and how your responses to the questionnaire change over time. If you would like to learn more about Neuromonics, please visit their website at www.neuromonics.com, call and schedule an appointment, or stop by for a brochure.
What is aural rehabilitation and who may benefit from it?
Aural rehabilitation is a program that helps you better use the sound that you hear. This is an important component when treating hearing loss, especially for those that have gone untreated for a long time. After having hearing loss for a while, the brain forgets how to correctly use the sounds that were lost. When those sounds are restored through amplification, you may have difficulty adjusting because the brain doesn’t know what to do with those sounds anymore. There are a variety of aural rehabilitation techniques, including computer programs (LACE, Fast ForWord), games, group sessions, and more. We select from these various techniques and adjust them for each patient, to create an individualized aural rehabilitation program that suits each patient’s needs.
What are Auditory Processing Disorders (APD) and whom do they affect?
Some people have difficulty understanding speech, even though their ears are working normally. When this occurs, it may be because the brain is unable to process the sounds correctly. So a person with APD might respond to the statement “Tell me something about a cat” by saying something inappropriate, like “It’s what you do on a stage.” In that particular instance, the person confused the sequence of letters in the word cat and heard the word act instead. APD may affect anyone, but it is most prominent in children as they are learning to listen to speech. Adults may also be affected by APD that went undiagnosed in their childhood or developed with traumatic brain injury. Since there are different models for diagnosis, and APD symptoms tend to overlap with those of other conditions like ADD/ADHD, it is difficult to tell exactly who may be affected by APD. Dr. Grolley and Dr. Souza both learned to diagnose and treat APD by Dr. Jeananne Ferre, one of the co-developers of the Ferre-Bellis model.
What is the Ferre-Bellis model?
The Ferre-Bellis model aims to not only diagnose APD, but to determine where the problem exists within the brain and what specific processes are deficient, and then prescribe a rehabilitation program based on that information. This is important because the brain doesn’t just hear a word and produce a response; it dissects sound, identifies the individual components, puts it back together, attaches meaning to the sound, cross-references it to other parts of the brain for linguistic and emotional content, generates an appropriate response, then sends that information to the motor cortex to verbalize the response. And all of this happens in just a few milliseconds! When you understand this process, it becomes evident that there are a lot of places where the process can break down. It is for this reason that the Ferre-Bellis model breaks APD into 5 different types (3 primary and 2 secondary) and prescribes a rehabilitation program based on the APD type.
How do I contact Link Audiolgy?
Phone: 360-551-4800
Fax: 360-551-4801
Email: connect@linkaudiology.com
Address: 9573 Ridgetop Boulevard Suite #103 Silverdale, WA 98370
