Going to the audiologist and getting a hearing test for the first time may be nerve-racking, and perhaps you don’t know what to expect. Here are a few tips for those of you about to take your first trip to the audiologist.
What to tell your audiologist
There are many causes of hearing loss, whether it’s mild or profound. Make sure your audiologist ensures that your hearing loss isn’t just a temporary inconvenience, or indicative of something else.
– Your audiologist should perform an otoscopic examination. By looking in your ear canal with an otoscope (that hammer-like tool with a light on the end), an audiologist can determine if an obstruction, such as a foreign object or cerumen (ear wax), is contributing to your hearing loss.
– Were you one of those kids who always seemed to have an ear infection? If so, it makes sense that you’re experiencing symptoms of hearing loss. Those who are prone to ear infections often have excess fluid around their eardrums. By performing a test of your middle ear function (a tympanogram), your audiologist can discern whether or not there’s fluid around your eardrum and make sure that it’s vibrating at the right rate.
– Make sure your audiologist knows if your hearing loss is accompanied by problems with balance or vision. This could be symptomatic of a different condition and might require the doctor’s attention.
– Do you have that pesky, persistent ringing in your ears? It’s known as tinnitus, it has a variety of causes and it may lead to hearing loss.
What to Expect at the Audiologist
– An audiological evaluation is a multi-step process. After your audiologist has conducted both an otoscopic examination and a tympanogram, there are several other tests he or she might perform. When the test is finished, your audiologist will document the results on a chart called an audiogram, which will diagnose your hearing as normal, or show that you’re experiencing mild, moderate, severe or profound hearing loss.
– During a pure tone threshold test, you are placed in a room and asked to listen to beats of different frequencies. The purpose of this test is to indicate your threshold—the absolute lowest volume at which you can hear the various sounds. It’s important to remember that children and adults have different thresholds and therefore should have different results.
– To many of us, speech is arguably the most important sound. To determine your threshold for understanding speech, your audiologist might want to test your speech detection threshold. In order to do so, you are asked to repeat words back to your audiologist through a microphone at varying intensities and volumes.
– It’s important to know that the hearing test can take a long time. While sitting in a sound-proof booth struggling to hear a slew of sounds can be frustrating, if you stick it out, your results will be accurate.
– If you experience any painful symptoms during the hearing test, be sure to tell your audiologist. It might be tedious, but the test should not be painful or invasive.
HEARING LOSS TYPES
Conductive Hearing Loss
Conductive hearing loss is caused by any condition or disease that impedes the conveyance of sound in its mechanical form through the middle ear cavity to the inner ear. A conductive hearing loss can be the result of a blockage in the external ear canal or can be caused by any disorder that unfavorably effects the middle ear’s ability to transmit the mechanical energy to the stapes footplate. This results in reduction of one of the physical attributes of sound called intensity (loudness), so the energy reaching the inner ear is lower or less intense than that in the original stimulus. Therefore, more energy is needed for the individual with a conductive hearing loss to hear sound, but once it’s loud enough and the mechanical impediment is overcome, that ear works in a normal way. Generally, the cause of conductive hearing loss can be identified and treated resulting in a complete or partial improvement in hearing. Following the completion of medical treatment for cause of the conductive hearing loss, hearing aids are effective in correcting the remaining hearing loss.
The audiometric profile that indicates a conductive hearing loss is the presence of air-bone gaps (better hearing by bone conduction than by air conduction), excellent word recognition at a comfortable listening level, and evidence of a middle ear dysfunction on immittance. For situations where a blockage is noted in the external ear canal, hearing testing is deferred until the canal is cleared.
Sensorineural Hearing Loss
The second type of hearing loss is called sensorineural hearing loss. This word can be divided into its two components – sensory and neural – to allow us more clarity in specifying the type of hearing loss. The comprehensive audiometric assessment and supplemental tests can yield the information needed to differentiate between a sensory and a neural hearing loss, although they can co-exist in the same ear. Neural hearing loss is another name for retrocochlear hearing loss.
Sensorineural hearing loss results from inner ear or auditory nerve dysfunction. The sensory component may be from damage to the organ of Corti or an inability of the hair cells to stimulate the nerves of hearing or a metabolic problem in the fluids of the inner ear. The neural or retrocochlear component can be the result of severe damage to the organ of Corti that causes the nerves of hearing to degenerate or it can be an inability of the hearing nerves themselves to convey neurochemical information through the central auditory pathways.
The reason for sensorineural hearing loss sometimes cannot be determined, it does not typically respond favorably to medical treatment, and it is typically described as an irreversible, permanent condition. Like conductive hearing loss, sensorineural hearing loss reduces the intensity of sound, but it might also introduce an element of distortion into what is heard resulting in sounds being unclear even when they are loud enough. Once any medically treatable conditions have been ruled out, the treatment for sensorineural hearing loss is amplification through hearing aids.
Mixed Hearing Loss
A mixed hearing loss can be thought of as a sensorineural hearing loss with a conductive component overlaying all or part of the audiometric range tested. So, in addition to some irreversible hearing loss caused by an inner ear or auditory nerve disorder, there is also a dysfunction of the middle ear mechanism that makes the hearing worse than the sensorineural loss alone. The conductive component may be amenable to medical treatment and reversal of the associated hearing loss, but the sensorineural component will most likely be permanent. Hearing aids can be beneficial for persons with a mixed hearing loss, but caution must be exercised by the hearing care professional and patient if the conductive component is due to an active ear infection.
Types of tinnitus
Tinnitus varies considerably in intensity and type. Some people describe tinnitus as high-frequency whistling sounds while others perceive tinnitus as a buzzing noise or a sound similar to butter sizzling in a frying pan.
Tinnitus can vary a lot between individuals, therefore you can find many different types of tinnitus. The most important difference can be found in the extent to which tinnitus is considered a problem by the people it affects. Some people learn to live with the condition quite quickly, and in these cases tinnitus is often perceived as just a buzzing noise in the back of the head. To others, the condition is intolerable and so disturbing that they have to quit their jobs or give up studying.For many tinnitus sufferers the problem is most noticeable at night. As the din of daily activities subsides, tinnitus becomes more prominent.
Upsetting noise and upsetting silence
One of the biggest problems mentioned by sufferers is their irritation with the incessant sound in their ears and heads often intensified by varying degrees of hearing loss. This combination often makes it difficult to conduct an ordinary conversation.Many tinnitus sufferers do not like quiet, as this only amplifies their tinnitus. Others find excessive noise uncomfortable. Again, tinnitus can be perceived in many different ways.To some tinnitus sufferers, certain high-frequency sounds can be very painful. This condition is also known as hyperacusis.
Common problems among tinnitus patients:
⦁ Sleeping problems
⦁ Persistence
⦁ Hearing problems
⦁ Despair, frustration, depression
⦁ Annoyance, irritation
⦁ Hyperacusis
What is tinnitus?
Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year. This amounts to nearly 25 million Americans.
What causes tinnitus?
Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:
Noise-induced hearing loss
Ear and sinus infections
Diseases of the heart or blood vessels
Ménière’s disease
Brain tumors
Hormonal changes in women
Thyroid abnormalities
Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.
People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.
Service members exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound. In fact, tinnitus is one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.
Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.
Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.
Why do I have this noise in my ears?
Although we hear tinnitus in our ears, its source is really in the networks of brain cells (what scientists call neural circuits) that make sense of the sounds our ears hear. A way to think about tinnitus is that it often begins in the ear, but it continues in the brain.
Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.
Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.
What should I do if I have tinnitus?
The first thing is to see your primary care doctor, who will check if anything, such as ear wax, is blocking the ear canal. Your doctor will ask you about your current health, medical conditions, and medications to find out if an underlying condition is causing your tinnitus.
If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.
What if the sounds in my ear do not go away?
Some people find their tinnitus doesn’t go away or it gets worse. In some cases it may become so severe that you find it difficult to hear, concentrate, or even sleep. Your doctor will work with you to help find ways to reduce the severity of the noise and its impact on your life.
Top Causes of Severe Hearing Loss
Some instances of tinnitus are caused by infections or blockages in the ear, and the tinnitus can disappear once the underlying cause is treated. Frequently, however, tinnitus continues after the underlying condition is treated. In such a case, other therapies.both conventional and alternative. may bring significant relief by either decreasing or covering up the unwanted sound.
What Causes Tinnitus?
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. Carpenters, pilots, rock musicians, street-repair workers, and landscapers are among those whose jobs put them at risk, as are people who work with chain saws, guns, or other loud devices or who repeatedly listen to loud music. A single exposure to a sudden extremely loud noise can also cause tinnitus.
A variety of other conditions and illnesses can lead to tinnitus, including:
⦁ Blockages of the ear due to a buildup of wax, an ⦁ ear infection, or rarely, a ⦁ benign tumor of the nerve that allows us to hear (auditory nerve)
⦁ Certain drugs — most notably ⦁ aspirin, several types of ⦁ antibiotics, anti-inflammatories, sedatives, and ⦁ antidepressants, as well as ⦁ quinine ⦁ medications; tinnitus is cited as a potential side effect for about 200 prescription and nonprescription drugs.
⦁ The natural aging process, which can cause deterioration of the cochlea or other parts of the ear
Meniere’s disease, which affects the inner part of the ear
⦁ Otosclerosis, a disease that results in stiffening of the small bones in the middle ear
⦁ Other medical conditions such as ⦁ high blood pressure, ⦁ cardiovascular disease, circulatory problems, ⦁ anemia, ⦁ allergies, an underactive ⦁ thyroid gland, and ⦁ diabetes
⦁ Neck or jaw problems, such as ⦁ temporomandibular joint (⦁ TMJ) syndrome
⦁ Injuries to the head and neck
