Audiology & Hearing Aids
Our mission is to help all of our patients achieve healthy hearing. Our team of ENT doctors and audiologist work together to cover the whole spectrum of hearing disorders. If we identify a hearing loss, we will work with you to determine the best care for your ears.
How the Ear Works
The pinna and ear canal (outer ear) funnel sound to the eardrum. The incoming sound waves create vibrations on the eardrum that amplifies and transfers the sound to the tiny bones (malleus, incus, and stapes) in the middle ear space. The Eustachian tube is also part of the middle ear and its primary function is to equalize the pressures. These vibrations are then transferred to the fluid-filled cochlea (part of the inner ear). Inside the cochlea, there are tiny hair cells that create nerve impulses based on the movement of the fluid, which are then sent to the brain to be interpreted. The vestibular system is also in the inner ear and plays an important part in balance and coordination.
Comprehensive Hearing Tests
How to Interpret Your Audiogram
The audiogram is a representation of your hearing. The graph shows your hearing thresholds (the quietest levels you can hear). Across the top is pitch (frequency) with the lowest pitch on the left moving to the highest pitch on the right. Pitch is measured in Hertz (Hz). You can think about it like keys on a piano moving from base (low) to treble (high). Down the side of the chart is volume with very quiet sounds at the top and increasing to very loud at the bottom. Volume is measured in decibels (dB). Anything better than 20 dB HL is considered normal and anything greater is considered hearing loss of some degree.
There are many different symbols on the audiogram. Everything in red is associated with the right ear and everything in blue is associated with the left ear. The red circles and blue X’s are the symbols for air conduction (AC). Air conduction is measured with headphones so the sound passes through the outer, middle, and inner ear. The red and blue brackets are the symbols for bone conduction (BC). Bone conduction is measured with a BC device that sits behind your ear and directly stimulates the inner ear.
Word recognition is measured during your hearing test. The speech recognition threshold (SRT) is the quietest level you can understand speech. The word recognition score is the percentage of words you can correctly understand in a quiet environment.
Types and Degrees of Hearing Loss
Degrees of Hearing Loss
Degree of hearing loss typically is used to describe the severity of hearing loss. It is based on the level required for you to hear a sound. The louder the sound, the worse the degree of hearing loss. It can range from normal to profound. Below is a table of the different degrees of hearing loss.
Types of Hearing Loss
There are three types of hearing loss. The first type of sensorineural hearing loss. This is the result of damage to the inner ear or hearing nerve. Generally, this type of hearing loss is permanent and cannot be corrected by means of surgery or medication. Some common causes of sensorineural hearing loss include aging, family history (genetics), noise exposure, and medications that damage the ear. Hearing aids or other forms of amplification may help you hear better if you have this type of hearing loss. Audiograms with sensorineural hearing loss have AC symbols (X and O) and BC symbols (brackets) superimposed and hearing levels are poorer than 20 dB HL.
The second type of hearing loss is conductive hearing loss.This occurs when there is problem in your outer or middle ear preventing sound from travelling to your inner ear. This type of hearing loss can often be corrected with medication or surgery. Some common causes of conductive hearing loss include fluid in your middle ear, a hole in your eardrum, earwax, an infection in your outer or middle ear, and Eustachian tube dysfunction. The audiogram will indicate a conductive hearing loss when the BC symbols (brackets) are in the normal range and the AC symbols (O’s and X’s) show some degree of hearing loss.
The last type of hearing loss is mixed hearing loss. This occurs when there is a conductive hearing loss in addition to an underlying sensorineural hearing loss. The conductive component may be correctable with surgery or medication, however the remaining sensorineural hearing loss is permanent. On the audiogram, a mixed hearing loss is present when both the AC and BC symbols show some degree of hearing loss but there is a gap (difference) between the two symbols.
Why do you need a Hearing Test?
There are several reasons why we recommend you receive a hearing test before seeing one of our ENTs and below are some common reasons:
Hearing loss/difficulty hearing: The hearing test will determine the type and degree of hearing loss you have. The doctor needs this information for appropriate treatment.
Tinnitus: There are several causes of tinnitus but many of these are connected to hearing. It is important to know if there is any underlying hearing concern before assessing tinnitus.
Clogged ears/fullness/ear pressure: This symptom can be related to many different ear conditions. The information from the hearing test will help the doctor determine the cause of the pressure/fullness.
Dizziness/vertigo/imbalance: The inner ear is composed of the cochlea (hearing) and vestibular system (balance). Since these systems are so closely related, it is common for balance concerns to occur with hearing loss. An audiogram can help determine the underlying condition causing the balance concern.
Your Hearing Journey
At Pacific ENT, we offer a wide range of amplification options to best serve you.
Your journey to amplification starts with the hearing aid consultation, which is about an hour long. During this appointment we will discuss your hearing history and your personal needs regarding amplification. Your appointment will also include a listening experience with hearing aids so you can get firsthand experience with how the devices sound. We recommend that you bring a communication partner, like a spouse or family member, to your appointment. Many people find it beneficial to bring someone with them to offer additional support and insight.
During the consultation, the audiologist will help you select the appropriate hearing aids for your needs. Pacific ENT works with a variety of manufacturers including:
If you decided you want to pursue hearing aids, the second step is the hearing aid fitting appointment. During this appointment, you are fit with your personal devices. Your hearing aids are programmed specifically to your hearing loss by the audiologist. We believe in providing the best care so we perform Real Ear Measurements to ensure that your hearing aids are programmed appropriately. The hearing aids also come with a 45-day adjustment period so we can make changes if your aren’t 100% happy with your devices.
Pacific ENT provides all the necessary follow up care after your fitting to ensure you are successful with your hearing aids. We strive to ensure the best care and outcomes for our patients.
Even if you did not purchase your hearing aids from Pacific ENT, we are more than happy to help you. We offer office visits for reprogramming, troubleshooting, cleaning, and repairs.
Hearing Aid Styles
IIC hearing aids are the smallest and most discreet hearing aid style. These hearing aids are practically invisible because they sit deep inside your ear canal. Based on the placement of the hearing aids, you can still benefit from the natural shape of your ear which can help with localization. Since these devices are so small, you will have to change the batteries frequently and do not have a lot of the features that larger hearing aids have.
CIC hearing aids are the second smallest custom hearing aid style. This style is less likely to pick up wind noise or feedback. They use smaller batteries which means they need to be changed more frequently. They are more susceptible to damage from earwax and moisture. This style can cause occlusion which causes a feeling of your ears being plugged up.
In-The-Canal (ITC)/Half Shell (HS)
ITC hearing aids are the second largest custom hearing aid style. They can include controls, like volume control, or a button for program changes which smaller styles do not have. They have larger batteries which means longer battery life. There is also a rechargeable option. Depending on the manufacturer, they can directly connect to a cell phone. This style is susceptible to damage from ear wax or moisture. This style can cause occlusion which causes a feeling of your ears being plugged up.
In-The-Ear (ITE)/Full Shell (FS)
ITE hearing aids are the largest custom hearing aid style. Since they are larger, they will have more features and user controls. They will also be easier to handle, if dexterity is a concern. They have larger batteries which means longer battery life. There is also a rechargeable option. Depending on the manufacturer, they can directly connect to a cell phone. These are less discreet than other custom styles. This style is more susceptible to wind noise. This style can cause occlusion which causes a feeling of your ears being plugged up.
Receiver-In-Canal (RIC)/Receiver-In-The-Ear (RITE)
With RIC hearing aids, the speaker sits inside of your ear canal and the microphones and processor sits behind your ear. This is an advantage because if the speaker is damaged it can be replaced in the office. The larger size allows for more durability and more features, but is less discreet than custom styles. Most will have the ability to connect directly to a cell phone and have a rechargeable option. The audiologist can do an “open” fit which allows for a more natural sound.
BTE hearing aids are fit with a custom earmold with tubing. They are larger so they are good option if dexterity is a concern. They are a good option for someone who needs powerful hearing aids. The larger size allows for more durability and more features but is the least discreet option for hearing aids. Also, the tubing will need to be changed often for the hearing aids to function properly.
Hearing Aid Brands
Additional Hearing Aid Options
More and more manufacturers are offering rechargeable batteries. Most manufacturers use lithium ion batteries which can hold a charge up to 30 hours. The battery is built into the hearing aid and comes with a charger that you use at night. Many individuals find rechargeable batteries more convenient because you do not need to change them weekly. Rechargeable batteries are also a good option for someone with dexterity concerns.
Most hearing aids can directly connect to a smartphone. With this feature, your phone calls can stream directly to your hearing aids. This feature also allows you to use an app to change volume or programs.
This is an option that is available in many hearing aid models. Once activated, it can pick up an electromagnetic wireless signal produced by a phone or an induction loop system. This is a helpful feature because it is a direct transmission and can improve the sound quality when there is a lot of background noise. Smaller hearing aid models may not have a telecoil because it takes up too much space.
Hearing Aid Accessories
There are several additional accessories you can get for your hearing aids. One option is a remote microphone. Your communication partner wears the microphone and his/her voice will stream into your hearing aids. Another popular option is a TV connector. You plug the TV connector into your TV and then the signal will stream directly to your hearing aids.
Tinnitus refers to “ringing in the ears” when no other sound is present. Tinnitus can also sound like hissing, roaring, pulsing, whooshing, chirping, whistling, or clicking.
What causes tinnitus? Is it a common problem?
Around 10% to 15% of Americans suffer from tinnitus and around 16 million people seek medical attention for it. The prevalence of tinnitus is higher in older adults.
Tinnitus is a symptom, not a disease. Common conditions that can cause tinnitus include: hearing loss, loud noise exposure, migraine headaches, head injury, medicines, anemia, hypertension, stress, cerumen, certain types of tumors, caffeine, alcohol, tobacco, and Meniere’s Disease.
How is tinnitus treated?
The most effective treatment for tinnitus is treating the underlying condition, but for most patients the cause is unknown. In these cases, tinnitus can be managed with other methods.
Common methods for managing tinnitus include:
- Improving your general wellness by:
- Reducing caffeine, alcohol, and tobacco
- Social activity
- Stress reduction
- Get adequate rest and avoid fatigue
- Hearing aids increase auditory stimuli and may divert attention from the perception of tinnitus
- Sound therapies stimulate the brain and can help desensitize the body to the tinnitus
Recommended Tinnitus Apps:
- ReSound Tinnitus Relief
- Oticon Tinnitus Sound
- Widex ZEN Tinnitus
- White Noise Lite
- Tinnitus Therapy Lite
- Relax Melodies: Sleep Sounds
- Sleep Bug: White Noise Soundscapes & Music Box
Implantable Hearing Solutions
Cochlear implants are an alternative for individuals who no longer benefit from hearing aids. It involves directly stimulating the hearing nerve with electricity from a surgically implanted electrode.
If the ENT physician and/or audiologist determines that you would be a potential candidate for a cochlear implant, a cochlear implant evaluation will be recommended.
During the evaluation, the audiologist will test your speech understanding with appropriately fit hearing aids in background noise. Based on the results from the hearing test and evaluation, the audiologist will discuss with you if you are a candidate. Most insurances will cover a cochlear implant if the individual meets certain requirements.
The next steps include follow up appointments with the surgeon and the audiologist. During your pre-op appointment, the doctor will review the surgery with you and order necessary tests. The audiologist will help you select the correct processor and device options for your needs. Your primary care physician will perform tests to determine your surgical risk. You will also be required to receive vaccinations to reduce the chances of developing a serious infection called meningitis.
If you are cleared for the procedure, the surgery will be scheduled. The surgery is usually an outpatient procedure performed under general anesthesia and lasts about 2-3 hours. During the surgery, the surgeon inserts the electrode into the inner ear. After the surgery, you will follow up with Dr. Goldsztein before your activation.
The activation of the cochlear implant will occur about 3 to 4 weeks after your surgery. At the activation, the audiologist will create your programming and review how to use and take care of your cochlear implant. This is the first time you will hear sounds with your processor. Speech will sound different at first, and many individuals describe sounds being robotic or cartoonish. With time, speech will start to sound more natural as your brain adapts to hearing with the cochlear implant. After the activation, there are several follow up appointments with the audiologist to continue working on your programming as you continue to adjust to the cochlear implant.
Rehabilitation is a key component of being successful with a cochlear implant. The audiologist will give you daily listening activities and rehabilitation resources to help you hear better with your cochlear implant.Images courtesy of Cochlear Americas, ©2020.
Bone Conduction Devices
Bone conduction devices are intended for individuals who have a conductive, mixed hearing loss, or single-sided deafness. The device converts sound into vibrations which travel through your skull and directly stimulates your inner ear.
At Pacific ENT, we will help you decide if you are a candidate for a bone conduction device. If you meet the requirements, the audiologist will help you select a manufacturer that best fits your needs as there are many alternatives. You will also meet with one of our surgeons who will discuss the surgery process with you.
The surgery for a bone conduction device is a safe and relatively simple process. This is usually an outpatient procedure where the surgeon places the implant and abutment for the processor behind your ear.
Depending on which type of device you choose, you will be fit with your processor after healing, usually one to three months after your surgery. At your fitting appointment, the audiologist will program the processor and show you how to use your new device.
Images courtesy of Cochlear Americas, ©2020
We work with the following manufacturers:
Hearing Protection and Custom Earplugs
How Loud is Too Loud?
We live in a noisy world and exposure to loud sounds has the potential to damage our hearing. Noise- induced loss of hearing can occur immediately from an extremely loud sound, such as a gunshot or explosion, or can occur from noise exposure over an extended period, such as loud music or heavy equipment.
Noise levels are measured in decibels, or dBA. The higher the number, the louder the sound. Generally, sounds below 70 dBA are safe for listening, and sounds above 85 dBA can be potentially damaging, though it depends upon the length of exposure. For a sound that is 85 dBA, the safe listening time is 8 hours. The rule of thumb is for every 3 dBA increase in noise over 85 dBA, the safe listening time is cut in half. For example, for a sound that is 88 dBA, the safe listening time is 4 hours.
Ways to Prevent Noise-Induced Hearing Loss
- Wear hearing protection when you are around loud noises. There are several different types of hearing protection. Earplugs or safety earmuffs can easily be purchased at the store, but you need to ensure proper insertion for proper protection. When looking at purchasing hearing protection, you want to make sure it has a high Noise Reduction Rating (NRR). You can also purchase custom earplugs from an audiologist, and they will ensure proper fit and function.
- Turn down your music. It is recommended that the device volume setting does not exceed 50%.
- Do not listen to loud sounds for extended periods of time. Time is an important factor in how damaging a sound can be. Try to limit the time you are around loud sounds. Take breaks from the noise. Walk or move away from the loud sound, if possible.
- Use quieter products. Be aware of noise ratings for appliances, tools, hair dryers, children’s toys, and sporting equipment.
Musician Earplugs: Musician earplugs are filtered earplugs that decrease the decibels that reach the ear across all frequencies which improves sound quality. These are great for musicians, concerts, medical professionals, industrial workers, and sports fans. You can choose from 10 dB, 17 dB, or 26 dB attenuation.
Solid Earplugs: Solid earplugs provide maximum attenuation. They are a great option for high-noise occupational or recreational environments.
Surfer Plugs: Exposure to cold water or wind in the ear canal can cause the formation of multiple bony bumps in the ear canal called exostoses, often referred to as surfer’s ear. Surfer’s ear can make someone more susceptible to other ear conditions, such as outer ear infections (swimmer’s ear), wax build up, and hearing loss (if the growths occlude the ear canal). Surfer plugs are a great option for preventing surfer’s ear because the semipermeable vent allows for sound to pass through (so you can hear while wearing the ear plug), while preventing water from getting into the ear canal.
Swim Plugs: Swim plugs are made from a floatable material and are a great option for keeping water out of the ear. They are ideal for patients who have recurrent ear infections, eardrum perforations, pressure equalizing tubes, and patients on water restriction post-surgery.
Common Hearing Loss and Hearing Aid Questions
Is it true that using hearing aids will make my hearing worse?
If programmed properly, hearing aids should not cause hearing loss or damage. We use Real Ear Measurements which means we can measure the output of your hearing aid inside your ear canal to ensure your hearing aids are fit appropriately. Hearing aids also have maximum output limits that prevent sounds from being too loud.
It is normal for you to feel like the world is sharper and louder after you are first fit with hearing aids because it takes time for your brain to adapt. As you continue to wear them, things will start to sound more natural.
What is the difference between over-the-counter hearing devices and hearing aids fit by an audiologist? Why are they so expensive?
Many patients have seen commercials for low priced hearing devices on TV and are shocked to discover the true cost of hearing aids. Most OTC or direct-to-consumer hearing devices will not be programmed to your specific hearing loss. This means that they can amplify sounds you do not want to hear and potentially even cause damage to your ear.
The audiologist works closely with you to ensure your hearing aids are programmed appropriately and providing you with the most benefit. Audiologists are trained in adjusting and fine-tuning hearing aids to fit each patient’s lifestyle, listening challenges, and listening goals. Hearing aids are a medical device, and although they are expensive, they are an investment. If taken care of, a pair of hearing aids should last several years, and during that time, the audiologist can reprogram the hearing aids as your hearing changes.
Does Insurance cover hearing aids?
Some insurances have a hearing aid benefit, but it varies plan to plan. Our patient’s hearing is important to us, so we work with each patient to find the best hearing aid for their lifestyle, needs, and budget. In addition to insurance benefits, we also have financing available for those who would like to pursue that option.
Why use receiver-in-the ear (RIC) hearing aids if custom hearing aids can be invisible?
The main benefit of the RIC style hearing aid is that the speaker is separate from the body of the hearing aid. This makes hearing aid maintenance and repairs easier. Another benefit of having the speaker separate from the body is that if a person’s hearing were to decline, the speaker can be replaced with a more powerful speaker. However, there are many circumstances where a custom hearing aid is appropriate. The audiologist will help you determine the best style of hearing aid for your hearing goals.
Which is the best brand?
There are several hearing aid manufacturers; each has a unique fitting philosophy and approach to treating hearing loss. All the major hearing aid manufacturers have similar styles and advanced features, but patients usually prefer the sound quality of one manufacturer over another. Another important determinant of your success is the audiologist. The audiologist will work with you to determine what fitting philosophy and features will be the most beneficial and provide a recommendation they feel is best suited for you, your hearing loss, your lifestyle, and your budget.
Will it help my tinnitus?
There are many things that can cause tinnitus but hearing loss is one of them. In many cases, hearing aids alone can improve a person’s tinnitus by providing stimulation to the ear and brain. In addition to amplification, many of the hearing aid manufacturers specialize in tinnitus, and there are available tinnitus programs that can be added to the hearing aid. These tones lay at a level which is barely audible in hopes of distracting your brain from the tinnitus, because as we know, the more you focus on it, the more bothersome tinnitus can be.