how does the ear work?
The ear is made up of three main sections: The outer ear, the middle ear and the inner ear.
The Outer Ear
Sounds are received by our outer ear, which includes the pinna (auricle or outer ear) and the ear canal (external auditory meatus). The pinna captures sounds in the environment and increases the loudness of those pitches that make it easier to understand speech. The ear canal tunnels the sound to the tympanic membrane (eardrum) and helps to protect the structures of the middle ear.
The Middle Ear
The sound waves hit the tympanic membrane (eardrum) and cause it to vibrate. These eardrum vibrations then cause movements of the three tiny bones in the middle ear called the malleus (hammer), incus (anvil) and stapes (stirrup). Movement of these three tiny bones helps to deliver the sound vibrations to the inner ear. Delivering the sound from a relatively large eardrum to a smaller oval window (entrance way to the inner ear) also results in an amplification of the sound.
The Inner Ear
The inner ear is made up of the cochlea, which resembles the spiral feature of a seashell, and the auditory nerve. The cochlea is filled with a fluid. The fluid in the cochlea is set in motion by the movement of the stapes footplate, which sits in the oval window, as sound moves from the middle ear into the inner ear. This fluid vibration stimulates hair cells located in the cochlea. The stimulation of these hair cells causes them to generate an electrical impulse that travels along the auditory nerve from the cochlea to the brain. The translations of these messages or impulses into “speech” is a very complex process that occurs at the cortex level of the brain.
What are the different types of hearing loss?
Conductive, Sensorineural, Mixed and Central are the main types of hearing loss.
Conductive Hearing Loss: This type of hearing loss occurs when sounds are blocked or impeded as they pass through the ear canal or the middle ear. The sound vibrations are not allowed to efficiently pass through the outer and/or middle ear structures on their way to the inner ear. Common causes of these losses can be the build up of wax in the ear canal, foreign object in ear canal, perforated eardrum, otosclerosis, fluid in the middle ear or damage to the middle ear bones.
Sensorineural Hearing Loss: This type of hearing loss occurs when sound does not pass through the inner ear correctly. It is possible that your hearing healthcare provider will call your loss either a sensory or a neural loss. A sensory loss occurs when there is damage to the cochlea. A neural loss occurs when there is damage to the nerves that send the sound to the brain. Some examples of these types of damage might be when the tiny hair cells in the inner ear (cochlea) break down or the electrical impulses that travel along the acoustic nerve cannot deliver the messages to the brain properly. This can be caused by exposure to prolonged loud noise, certain medications, disease processes that can limit the blood / nutrient supply to the cochlea, acoustic nerve tumors, and various other anomalies, but is often caused by the natural aging process.
Mixed Hearing Loss: This type of loss occurs when both a conductive and sensorineural hearing losses are present at the same time.
Central Hearing Loss: This type of hearing loss occurs when the signal makes its way through the outer, middle and outer ear systems successfully, but the brain is unable to process the information.
How common is hearing loss?
Hearing loss affects at least 28.6 million Americans. Almost 6 million of these are children. Some people are born with hearing loss. In fact, it is estimated that between 1-6 children in 1000 are born with hearing loss. Others develop problems hearing later in life. There is a wide variety of causes. Hearing loss can run in families. Exposure to loud sounds, taking certain medications, some illnesses and the aging process are also causes.
What are some symptoms of hearing loss?
The list of symptoms can vary from person to person. If you have any of the symptoms listed below you should contact your local Audiologist or Hearing Aid Specialist for an evaluation. Here are a few symptoms that may be a sign of needing your hearing tested:
•You often want the TV volume turned up louder than others
•You regularly ask people to repeat themselves
•You find yourself watching the speaker’s lips to follow a conversation
•You have a problem hearing conversation while in a group of people
•You have difficulty understanding people on the phone
•You have difficulty hearing in a movie theater or any other entertainment venue
•You find it difficult to hear conversation in an automobile
•You choose to not attend social functions, meetings, or church services as much as you used to
•You keep to yourself in a social environment because it is easier and more comfortable not having to struggle to hear what is going on around you.
How does my hearing loss effect communication?
If you experience difficulty hearing soft speech then this is a loss of sensitivity or audibility. Sounds are not loud enough for you and this deficiency requires you to turn up the television or ask others to speak louder.
Feeling like you hear pretty well but people “mumble” too much, is often related to high frequency hearing loss. This type of loss makes hearing consonants such as “t”, “sh”, “f”, “p”, “s”, and “th” more difficult than vowel sounds. As an example, the words “cap” and “cat” are hard to distinguish from each other during conversation. This sometimes results in inappropriate answers to questions or hearing but not understanding others.
If you have difficulty understanding speech in a noisy environment then this difficulty is often due to a speech processing problem or a poor signal-to-noise ratio in the communicative environment. An example is when you can't understand speech clearly in a crowded room or noisy environment and this causes you to regularly ask other person to repeat themselves or “giving up” on a conversation.
Who can help me with my hearing loss?
•Audiologists
•Hearing Aid Specialists
•Otolaryngologists (ENTs) or Otologists (ear doctors)
• Seek advice from your primary care physician
What will happen when I see an audiologist or hearing aid specialist?
There is nothing to fear since this procedure is painless. The professional will obtain an ear and hearing medical history from you and will discuss your specific communicative complaints.
You will have your ears examined (otoscopy) by the hearing healthcare professional. Next the professional will perform the audiometric testing (hearing test). The results of the test are graphed out onto an audiogram. An audiogram is a graphical representation showing how well you heard the various pitches (frequencies) in each ear. You should also expect that your hearing healthcare professional will perform procedures to determine how well you understand speech (possibly in quiet and in noise and at various levels). Most comfortable and uncomfortable levels should be measured to help determine the appropriateness of various hearing aid technologies. Most professionals also test the mobility of your eardrums (tympanometry) and check the pressure in your middle ears. After the completion of the testing, the professional will take time to discuss the results with you and if you have hearing loss, how it can effect your ability to communicate. If appropriate, the professional will also discuss the various amplification options currently available, their advantages and disadvantages, and other rehabilitative strategies.
If you and your hearing healthcare professional agree that a trial period with amplification is appropriate then an exact impression of your ear may be made. This will depend on the type of amplification that is appropriate for you. This impression helps the hearing aid manufacturer provide a custom fitted In-The-Ear instrument or an earmold for a Behind-The-Ear instrument. To make the impression, a small piece of cotton or foam will be inserted into your ear, followed by a putty type material (it will fill the ear canal and the outer portion of your ear). When the material firms up it is gently removed and sent to the manufacturer with a copy of your audiogram to create a custom instrument just for you.
How are my hearing thresholds assessed?
1. You listen to a series of pure tones (simple sounds) using headphones or with tiny soft insert earphones in each ear. The tones or frequencies presented are in a range commonly used to hear everyday environmental and speech sounds (250Hz through 8000Hz)
2. You will raise your hand or press a response button when you hear the specific sound.
3. The sound volumes are decreased in intensity to find your hearing threshold.
4. The thresholds are then recorded on the audiogram form used to map out frequency and intensity.
5. The above steps are repeated using a bone vibrator instead of headphones. The bone vibrator is like a headband, placed behind your ear or on your forehead.
What is speech testing?
This is a simple procedure to measure how clearly you understand speech. You listen to and then repeat a series of two syllable words at decreasing intensity levels. This procedure results in determining your speech reception threshold. You will repeat a similar procedure with single syllable words presented at a higher intensity level in quiet. Some healthcare professionals will also conduct an evaluation designed to measure your ability to distinguish speech with noise also present.
How can I contribute to a successful hearing aid fitting?
•Tell your hearing healthcare professional everything about your lifestyle and about everything that seems to keep you from hearing as well as you would like. The more information you provide, the better the solutions your professional can provide. Your loss needs to be discussed in detail so that the proper recommendations can be made.
•Discuss openly your expectations. Make sure that your hearing healthcare professional is able to explain which of your expectations are realistic and which are going to be more difficult to achieve. You will need to communicate any questions that come up during the fitting and trial period.
•Wear your hearing aid. When adjusting to a new hearing aid it is important to wear the instrument to give your ears and brain time to get used to the sound.
•Keeping a diary and sharing your everyday experiences could assist your professional when he/she is trying to make the proper adjustments. The more feedback you provide your hearing healthcare professional, the better they can fine tune your instruments. The adjusting of a hearing aid after the fitting can be the most important part of the process, making the instrument as helpful and comfortable as possible.
•Be Patient! The average patient takes a few weeks to fully appreciate the benefits their hearing aids can provide.
Why should I try hearing aids?
•New hearing aid technologies provide benefits like never before.
•Your hearing loss is more noticeable than hearing aids will ever be.
•Conversations will be less stressful by not having to ask others to repeat themselves as much.
•Television volumes set at levels comfortable to others.
•Conversation on the phone made easier
•Enjoy the theater, church services, shopping, and being with family and friends with the confidence of being able to hear and communicate in many different situations.
•Hear the pleasant sounds of nature: water falls, birds and leaves rustling in the park or even the pleasant sound of a cat purring.
What are some possible signs that my child has hearing loss?
Your child responds inconsistently to loud sounds.
Your child doesn't seem to be developing speech or language as well as others his/her age.
Your child has the tendency to withdraw in social situations.
Your child tends to daydream more than other children his/her age.
Your child suffers from frequent ear infections.
*If you suspect your child has a hearing loss, you should have his/her hearing checked by your Pediatrician, General Practitioner, an Otolaryngologist (ENT) or an Audiologist. These specialized professionals are there to remove suspicion and replace them with specific diagnostic information. Do not rely on at home tests to determine whether your child has hearing loss. Most children with hearing loss will respond to some sounds.
What are some reasons for pediatric hearing loss?
There are many reasons that an infant or child may have hearing loss. Some children are born with hearing loss, others develop hearing loss later in life. 50% of babies born with hearing loss do not have any high risk indicators, so it is important to recognize that sometimes it is not easy to identify the cause of the loss. Some high risk indicators include family history of hearing loss, syndromes that includes hearing loss (Ushers Syndrome, Down Syndrome, Waardenburg Syndrome), and infections during pregnancy (toxoplasmosis, cytomegalovirus, herpes). Life saving devices used with extremely ill infants and the illness themselves can also sometimes result in hearing loss. Some children, even healthy children, develop hearing loss a few months or years after birth. This can occur due to family history of hearing loss, illnesses, excessive noise, or the process of a disorder. The best way to keep track of your child's hearing is to monitor his/her speech and language development. If it seems to be slow or behind children his/her age express your concern to your pediatrician and ask for a hearing test.
How can I help my child cope with hearing loss and hearing aids?
As parents, you can make your child’s adjustment to hearing loss, hearing instruments, and his/her personal development easier with your awareness and acceptance. As a family, giving a little extra attention to your child will help him/her adjust to the loss. Just as every child is unique, children with hearing loss need individualized care. Patience, understanding, and listening carefully to your child will encourage him/her to communicate with you. Reorganizing your home’s physical environment to lower noise levels and ease face-to-face communication will also help. Together, you and your child will be able to grow and adjust with confidence.
Encourage interaction and share experiences so that you can evaluate how well your child is adjusting. You must support, be attentive, and interact with your child so that you can effectively communicate with his/her medical professionals and teachers how well your child's treatment plan is working. Become your child's best advocate. Do not excuse your him/her from the normal household routines. S/he will obtain the same benefits from these responsibilities as a child with typical hearing development.
Your healthcare professional can offer help with suggestions on how to improve communication with your child. The earlier the hearing loss is diagnosed the more time available for your child to develop the skills necessary to communicate successfully. Children's ability to adapt far exceeds our expectations; they will be better able to adjust more quickly with total family support.
How do I help my child adjust to wearing hearing aids?
Patience is the key to adjustment; it takes a great deal of patience for anyone to adjust to hearing instrument(s). If age appropriate, explain to your child the importance of wearing their hearing instruments at all times while awake and of communicating to you their experiences. Reassure him/her that you are there to help them through this adjustment period. Observe your child in every situation possible. Use a diary to record vital information so your child's hearing healthcare professional can better evaluate and make adjustments to the instruments as needed for your child's comfort. The information kept in the diary will not only benefit your child but will also help your healthcare providers understand how well your child is progressing with his hearing instrument(s). A hearing healthcare provider will be able to go over the daily routine maintenance of your child’s hearing instruments and instruct you and your child on the importance of proper disposal of batteries.
Your professional will instruct you and your child on the importance of keeping the instruments dry. Your child should never go swimming or bathe while wearing the instruments. It is important for your child to understand the need to handle their hearing instruments gently. With continued care, your child’s instrument(s) will provide him/her with an extended period of reliable amplification. There are several items on the market that will assist the child from accidentally losing their instruments. You should consult their hearing healthcare professional. It is important that your child understands that their instruments need continuous care and should be treated with respect.
CAUTION: Batteries are dangerous if swallowed! Keep batteries out of the reach of children. Never put batteries in your mouth for any reason — they are easily swallowed. Always check medication before taking — batteries have been mistaken for tablets. In the event a battery has been swallowed, seek immediate medical attention. Call the National Battery Hotline at 202-625-3333 for more information.
Are hearing aids really better now?
The human ear is a complex human system. It has the responsibility of capturing, processing, and delivering millions of sounds. There is no “miracle” in hearing aids, but with modern advancements in hearing aid technology, hearing healthcare professionals are able to optimize your hearing abilities like never before. Digital hearing instruments process sound more effectively than previous generations of hearing aids. Programmable hearing instruments give professionals more flexibility to adjust the sound of your hearing aids to better match your hearing loss and communication needs. Many instruments offer options such as telecoils that allow you to couple your hearing aid to your telephone, or directional microphones which make conversation in a noisy restaurant easier. Ask your hearing healthcare professional which instruments and options are best for you.
How do I care for my hearing aids?
Proper regular maintenance will help ensure a dependable working condition and a longer life span of your hearing instruments.
•To prolong battery life, open battery doors or turn off your instruments when not in use.
•Store instruments in a cool, dry place away from direct sunlight or heat.
•Moisture from normal use may enter the device and cause corrosion of internal components. Use a hearing aid dehumidifier, often known as a “dry aid kit,” to reduce moisture build up.
•It is recommended that you clean your instruments often. You should wipe your hearing aids with a dry cloth before insertion and after removal. This will help remove the earwax at night when it is moist and then again after any remaining particles have dried overnight. Your hearing healthcare professional will instruct you on the proper cleaning procedure.
•Use the brush or tool provided to remove wax or debris from the device. Hold the instrument upside down or sideways when brushing the tip of the canal; this will allow the debris to fall out instead of going back into the device.
•Never get the instrument wet. Remove from ears before showering or swimming.
•Should instruments accidentally be exposed to water, immediately remove the battery and lay on a towel to allow them to dry naturally. Do NOT try to accelerate the process using a microwave or hair dryer. The heat may cause more damage than water. Use a hearing aid dehumidifier, often known as a “dry aid kit,” to reduce moisture.
•Keep instruments away from children and pets, as they can be harmful if accidentally swallowed.
•After showering, dry ears thoroughly before inserting your hearing instruments.
•If you have a dog, be careful where you store your hearing aids. You should store them in a place that is high enough that the dog can not get to them and destroy them.
Do I need to regularly follow-up with my hearing healthcare professional?
Yes, even the best hearing aids require repairs and adjustments occasionally. Also consider that as we live our lives, our senses continually change; a regularly scheduled visit to your hearing healthcare professional is therefore important. Your hearing healthcare professional can keep you up-to-date on the latest advancements, features, and options and will also monitor your hearing health. You have a responsibility to your family and yourself to have your hearing and your instruments checked regularly to provide you with optimum benefit.
If you move, you should locate a professional in your new area who can help you with your hearing instruments. Magnatone’s Hearing Healthcare Professional Locator will allow you to search for a new professional.
Why do my ears ring?
The perception of a sound inside of one’s ear or head is called tinnitus. Tinnitus occurs when a person perceives the presence of a sound when there is no actual external source of the sound. Patients describe their tinnitus in a multitude of ways. They report their tinnitus to be constant or intermittent; to be in one ear, both ears, or in the middle of their head; to be present only in certain quiet environments or present all of the time; to always sound the same or to vary in pitch and intensity; to have various tonal qualities (“ringing”, “buzzing”, “steam”, “whistling”, “hissing”, etc.); and to differ in the level of annoyance it causes them.
The etiology (source or cause) of tinnitus is not always clearly known or understood. Not all, but a majority of tinnitus is related to a sensori-neural hearing loss. A common explanation of tinnitus is that for individuals with a sensori-neural hearing loss, the hair cells in the cochlea (inner ear) are damaged. These damaged hair cells do not respond to sound as well as healthy hair cells do, thus resulting in hearing loss. These same damaged hair cells occasionally “fire” on their own, without any sound stimulating them, and send a signal to the brain that a sound is present even though no such sound is present, thus resulting in tinnitus. Tinnitus can also be caused by some common medications.
If you notice tinnitus you should talk to your doctor. It is also a good idea to request a complete audiometric evaluation (hearing test). While there is no easy “cure” for tinnitus, there have been many therapies developed through the years to help patients cope with or mask their tinnitus. Helpful non-medical strategies include the use of a hearing aid or tinnitus masker to cover-up the sound, the regulation of diet and caffeine intake, the controlling of everyday stress, the use of environmental ambient sounds at night to mask the tinnitus (such as leaving a radio turned on or playing a tape of a waterfall), biofeedback, etc.
Why should I wear two hearing aids?
For individuals with equal or fairly equal hearing loss, it is usually beneficial to use two hearing instruments. This is called binaural amplification. Simply put, our brain is designed to work with a two-ear system and therefore most hearing aid users report a more balanced sound when using two hearing aids. Not everyone notices binaural benefits, but most do. Binaural benefits include improved localization. Our brain uses input coming from both ears to localize sounds in our environment. It recognizes where a sound is coming from due to a slight difference in intensity and timing between the two ears. Our brain also uses input coming from both ears to better focus on a desired signal when the desired signal is in the presence of background noise. This advantage is called binaural squelch. Another advantage noticed by some binaural hearing aid users is an increase of overall volume when both ears are aided. That is, the addition of two ears does not double the sound but does increase the intensity of a sound a few decibels. This phenomenon is called binaural summation.
Why do hearing aids whistle?
The whistling that can occur with any amplifying device is called feedback. Feedback occurs when sound coming out of the hearing aid goes back into the hearing aid and re-amplifies again. This re-amplification results in the hearing aid becoming unstable and going into “oscillation”. This instability creates the whistling sound. This is the same occurrence as a microphone that squeals during a presentation or concert.
Hearing aids can feedback if they are not seated into the ear properly, if they are too loose, if they are turned up too loud, or if there is an internal hearing aid circuit problem. Most current digital hearing aids are more stable than previous models and therefore do not feedback as much. Also, some newer digital hearing aids have feedback control circuitry in them. The more sophisticated feedback suppression involves a changing of the phase of a sound (by inserting a reverse phase signal into the mix or by shifting the phase of the sound). There are also some feedback control circuits that notch or lower the gain of the hearing aid at the point on the frequency response curve where the feedback is being generated.
How much does a hearing aid cost?
Unfortunately there is no simple answer to questions about hearing aid costs. Some of the factors that help determine the cost of a hearing aid includes the level of technology used to design the instrument, the size of the instrument, any extra options ordered, warranties, location of the dispenser’s office, hearing aid manufacturer and model, etc. In general though, hearing aids are often separated into low-end (economical), mid-range, and high-end (premium) categories. Low-end instruments generally have a limited amount of current technology built into them and often cost less. High-end products often come with the best technologies currently available and cost the most. Mid-range hearing aids fall in between in both technological advancements included and price. It is wise to hear your hearing healthcare provider's recommendations and ask for the pros and cons of each.
What are some hearing aid options / advancements?
Most hearing aids currently manufactured are digital. Digital means that the sound is digitized (passes through an analog to digital converter) prior to the amplification process. This digitized sound can be processed by the amplifier more efficiently and effectively. A programmable hearing aid is one that can be attached with a cord to the dispenser’s computer for the purpose of changing the instrument’s sound processing. Programmable hearing aids have more features that the hearing healthcare professional can adjust to better fine-tune an instrument to match your specific needs. Noise reduction circuits are the algorithms, or a method of processing sound, designed into a hearing aid to help the hearing aid emphasize sounds sounds that with speech characteristics (speech is usually “choppy”) over more constant sounds (more likely to be ambient noise). Feedback suppressors or cancelers attempt to control the amount of whistling coming from a hearing aid. Controlling feedback allows a user to access more gain, use the telephone more easily, and have less embarrassing feedback moments. Directional microphones are used to help a hearing aid user hear sounds in front of them more so than sounds behind them. Compression / output limiting is used to make sure that a hearing aid does not make loud sounds uncomfortably loud. Wind noise reduction is a circuit that tries to lessen the detrimental effects of wind turbulence. Multi-memory hearing aids are designed with different sound processing programs for use in more than one listening situations. These programs are set by the hearing healthcare professional to allow the patient to push a button to “re-tune” their hearing aid to better perform in a specific environment (i.e., noise, traffic, or telephone). Multi-channel and multi-band are a reference to the frequency zones available for manipulation by the dispenser. The more channels or bands that a hearing aid has the more adjustable it is. A Telecoil is a small coil placed inside of a hearing aid that picks up the electro-magnetic energy coming from a telephone or assistive listening device. A telecoil allows a hearing aid user to communicate with a hearing aid adapted telephone without being bothered by feedback
