Adults

Audiology Services for Adults

We offer the most complete set of audiology services for adults on the Kitsap and Olympic peninsulas so we can meet all of your hearing healthcare needs. We can do your routine hearing test, offer hearing aids and other solutions, even program your cochlear implant. We also have all-inclusive hearing aid care plans available. Whatever your hearing needs, call Link Audiology and we will take care of it for you.

Hearing Test

Who should get a hearing exam?
If you are having difficulty hearing or understanding others you should get a hearing exam. Family and friends will usually 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 has 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 come to Link for a hearing test, it will help to take note of when and where you have problems. 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 speak – to provide feedback.

What does a hearing exam involve for adults?
A hearing exam is a noninvasive procedure that includes several behavioral and physiological tests. Depending on your case history, your exam may include some or all of the following tests:

Otoscopic Exam: we 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: we use 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, holes in the eardrum (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 like you are traveling in an elevator for a few seconds.

Middle Ear Reflexes: we use the tympanometer to play some loud sounds for a few seconds and stimulate the middle ear reflex. Checking this reflex helps to identify neurological problems that could cause or contribute to hearing problems.

Otoacoustic Emissions (OAEs): we use a device to play some sounds in your ear. There are cells in your ear that pick up sound and send it to the brain. Those cells also send back an echo, which we measure to see if they’re working properly. We use these echoes to identify problems in the inner ear that can cause or contribute to hearing problems.

Puretone Audiometry: we play sounds to find the softest sounds that you can hear at different pitches. These scores, called puretone thresholds, are graphed to illustrate which sounds you are able or unable to hear.

Speech Audiometry: we play some recorded words and ask 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): we play some sounds to find the loudness that is most comfortable for you and the loudest sounds that you can tolerate. These scores help ensure that any hearing aids or other amplification devices remain comfortable and audible.

How long does it take to complete a routine hearing exam?
It takes about a half an hour to complete the exam. 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 for your appointment to ensure that we can address all of your questions and concerns.

What does it cost to get a hearing test? That depends on what tests you need. We charge for our hearing tests as part of the medical model used at our practice. That allows us to charge less for our hearing aids and to use transparent unbundled pricing.

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.

Hearing Aids/ALDs/Access

ALDs are devices 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.

Implantable Devices

Are you currently using hearing aids and find that they don’t provide enough benefit? We offer cochlear implant evaluations and services, and can get you connected with a surgeon if you are a candidate.

Diagnostic ABR

A diagnostic Auditory Brainstem Response (ABR) is a test that looks for lesions or other abnormalities along the auditory nerve or in the brainstem by observing the brain’s response to sounds. 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 if 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 required for an ABR. You can sleep through the entire test. 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.

Central Auditory Processing

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 scenario, 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 in the brain and what specific processes are deficient. It then provides recommendations for 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.

Tinnitus

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. 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.

Aural Rehabilitation

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.