AUDIOLOGY
Audiologists are autonomous professionals who diagnose and treat disorders of the auditory, balance and other neural systems. Audiologists provide audiological rehabilitation to children and adults across the entire age span. We select, fit and dispense hearing instruments and related devices and participate in hearing conservation activities including sound measurements, fitting hearing protective devices and providing consultation on the effects of noise on hearing. Audiologists provide direct assessment of the balance system and provide rehabilitation/remediation of the balance difficulty, where appropriate. We provide fall risk assessment and assist extended care facilities in developing fall prevention programs. Audiologists are involved in auditory and related research pertinent to the prevention, identification, and management of hearing loss, tinnitus and balance system dysfunction. Audiologists are licensed by the Ohio Board of Speech-Language Pathology & Audiology.
THE HEARING MECHANISM
The hearing mechanism is astounding. When working properly, it enables humans to hear the minor drone of mosquito and to understand the nuances of the highly specialized code of speech and language. The hearing mechanism consists of four important areas. The first part includes the pinna or outer ear which functions as a sound gathering device and the ear canal. The canal funnels sound waves to the beginning of the second part of the system, the middle ear. The tympanic membrane or eardrum responds to sound waves and sets the ossicular chain into motion. The three bones of the ossicular chain-the malleus, incus and stapes-serve to move sound into the third part of the system, the inner ear is where hearing begins. Thousands of small, specialized sensory cells called hair cells await stimulation in the inner ear. When stimulated, the hair cells fire in patterns similar to the patterns of the sound waves transmitted across the bridge of the three bones of the middle ear. In effect, these patterns develop a code which is transmitted to the, the auditory centers of the brain via Auditory Nerve and the pathways of the brainstem. When the coded message reaches the fourth area of the hearing mechanism, the auditory centers of the brain, the message is decoded, recognized and classified against the sound, speech and language information stored in the brain. The process is amazing when you consider the time it takes to recognize a single word in a conversation or the features of a simple melody of your favorite song.
Any of the four sections, or a combination of sections, of the hearing mechanism may contribute to hearing loss or tinnitus. Sometimes the problem is as simple as impacted cerumen or earwax. Children may experience speech or language delays or learning difficulties due to fluid in the middle ear space. Otitis media (middle ear fluid) is one of the most common illnesses from birth to three years; as many as 25% of all children from kindergarten to the fifth grade are affected. Other problems may involve damage or deterioration of the complex function of the inner ear or central pathways to the auditory centers of the brain. Sensorineural hearing loss from noise exposure is a common (and preventable) example of inner ear damage resulting in sensorineural hearing loss. Heredity and the normal process of aging often play a part in hearing loss. After the age of 55, one in four persons develop hearing loss serious enough to cause communication difficulties. The auditory centers of the brain can be the source of hearing and processing difficulties. For a variety of reasons, the brain can develop problems deciphering the complex code sent by the inner ear and central pathways. Central Auditory Processing Disorders can cause subtle educational and listening difficulties in both children and adults and is a common contributor to learning difficulties noted in children failing to thrive in school.
FROM ASSESSMENT TO TREATMENT
The good news is that almost every person with a hearing loss can be helped. The first step to consider when hearing or listening difficulties are suspected is to have a comprehensive hearing examination by an Audiologist. Based on a comprehensive history, results of the hearing examination, middle studies and other tests of inner ear or central auditory function, the Audiologist will explain the results and develop a plan to address your hearing problem. The plan may include referral to medical or surgical specialists. Since most sensorineural hearing losses do not respond to medical treatment, hearing rehabilitation including hearing instruments may be the best answer for those with moderate to severe hearing loss. For those with marginal hearing deficits, listening or learning difficulties, specific intervention may include counseling, listening skills evaluation and redirection or educational intervention. For those with significant tinnitus, a variety of treatment paths may be considered including hearing instruments or masking devices, medication, biofeedback techniques and tinnitus habituation training. There is a solution for everyone. The following includes descriptions of some of the diagnostic studies and treatment options commonly used by Audiologists in the diagnosis and treatment of hearing and balance disorders:
DIAGNOSTIC STUDIES
HEARING EXAMINATION
A comprehensive evaluation delineating a patient's hearing status from the outer ear to the auditory centers of the brain. The examination begins with a complete history of the symptoms, genetic, medical, and other significant factors contributing to the problem. Specific diagnostic tests include pure tone audiometry to determine the extent and specific frequency areas of hearing function, middle ear studies, speech reception and recognition studies and otoacoustic emissions studies of the inner ear. more about the Hearing Aid Process
MIDDLE EAR STUDIES
An extensive assessment of the integrity of the middle ear system. Middle ear studies permit direct analysis of the functional integrity of the primary mechanical portion of the hearing system. Studies can determine the presence or absence of fluid in the middle ear space, tympanic membrane perforation and provide diagnostic information about the ossicular chain, Eustachian tube ventilation function and the stapedius muscle reflex.
OTOACOUSTIC EMISSIONS
A non-invasive test procedure completed to assess the status of the cochlea at the hair cell level-where hearing actually takes place. This brief test procedure not only issues information about the hair cells of the inner ear but can also be used to objectively screen hearing levels in newborns and young children.
AUDITORY BRAINSTEM RESPONSE STUDIES
Computer-based procedure which evaluates the physiologic capacity of the inner ear, central auditory pathways through the VIII Nerve and brainstem pathways to the auditory centers in the brain. Beyond neurodiagnostic information of the central auditory pathways, the procedure is used to establish objective hearing levels in patients from newborns to adults.
CENTRAL AUDITORY PROCESSING EVALUATION
Central auditory processing dysfunction is a complex issue. It requires clinical assessment from several vantage points. In our offices, we view the assessment as a team approach including Audiologists and Speech-Language Pathologists. Initial testing includes comprehensive hearing examination including a panel of comprehensive tests designed to clarify specific areas of difficulty in hearing, listening and auditory learning. Our Speech-Language Pathologists continue the assessment with a functional language assessment. The team meets and reviews findings and develops strategies for intervention at home, in school and in structured, family-centered therapy sessions in our offices. This assessment-therapy paradigm is frequently used in the educational workup of students failing to perform to their academic potential, with individuals suspected of ADD/ADHD or following head trauma or other Central Nervous System insult.
TINNITUS EVALUATION
Ringing, roaring, high or low pitched sounds are common terms used to describe the internal noise of tinnitus. It is usually constant, can be in one or both ears and is commonly associated with hearing loss though the presence of tinnitus does not necessarily mean that hearing sensitivity has or will change. Other etiologic or contributing factors to the onset of tinnitus include middle ear fluid, inner ear disorders, excessive noise exposure, certain medications, diabetes or hypoglycemia, high or low blood pressure, allergies to food or inhalants, trauma to the head, jaw or neck, temporomandibular dysfunction (TMD) and a host of other systemic/metabolic disorders.
Estimates of tinnitus sufferers in the US range from 40 to 50 million persons. Tinnitus can prevent or disrupt sleep, cause fatigue, irritability or depression. Although there is no cure for tinnitus, the situation can often be remedied or improved with a variety of approaches. The first step is a comprehensive hearing examination including otoacoustic emissions tests and auditory brainstem response studies. Tinnitus matching procedures are used to identify important characteristics of the tinnitus. Following the evaluation, rehabilitation planning and treatment options are considered.
Tinnitus treatment may include hearing instruments, tinnitus masking devices, retraining/habituation therapy, counseling, biofeedback or relaxation training. Our team also includes a consulting psychologist for additional evaluation or clinical intervention.
DIZZINESS/BALANCE ASSESSMENT
One in 25 persons will experience true vertigo (spinning, false movement sensation) after the age of 45. Except for low back pain, dizziness is the most common complaint patients offer their primary care provider. Our dizziness assessment protocol includes a series of questionnaires and easily tolerated tests to evaluate the physiologic status of both inner ear (labyrinthine) and brainstem/cerebellar segments of the balance system. Results of the tests enable objective evaluation of normal and abnormal function and provide information about factors contributing to the patient's complaint of dizziness. The testing protocol takes about an hour. It includes an extensive balance history, inventory of medications and perceptual assessment of the impact of the balance problems. The results are interpreted and sent to the referring health care practitioner usually within 24 hours. Specific recommendations may include vestibular rehabilitation planning, specific balance exercises to be completed in our office.
Fall precautions may be issued with specific recommendations to improve safety in each patient's individual residence or community. more on Dizziness Evaluations
COCHLEAR IMPLANTS
HEARING INSTRUMENTS: THE PROCESS
Modern hearing instrument technology and digital signal processing circuitry provide opportunities to improve the lives of many hearing impaired individuals not previously amenable to successful instrument fitting and rehabilitation. These advances demand extensive training in critical hearing assessment techniques as well as a firm understanding of the effects and specific application of scientifically sophisticated circuitry. It is our philosophy that the key element in the fitting and managing advanced hearing technology is not the instrument or circuit but the Audiologist managing the process of hearing rehabilitation. From the clinical assessment of your hearing loss to the follow-up care provided after your hearing instrument fitting, you will be seen by professional Audiologists with advanced training and doctoral degrees.
Audiologists are the hearing care professionals uniquely educated and qualified to provide the best diagnostic hearing assessment and hearing instrument fitting and follow-up care services for your specific hearing needs.
SUGGESTIONS TO IMPROVE COMMUNICATION
1. Stay on the topic of conversation. If you go "off the topic", get back on track by asking the talker to restate the topic.
2. Nose reading-lots of information is available by focusing on the talker's nose so as to lipread and see facial expressions too-even those without much hearing loss can benefit from this!
3. Try to have all conversations in the same room so that you can see the talker's face.
4. Concentrate on what is being said, not what you will say next-there is always plenty of time to formulate a response.
If you wear hearing aids, add the following:
1. Wear your hearing aids from morning until night, everyday beginning right after you get up.
2. Remind telephone callers to speak directly into the phone. Put the telephone near the hearing aid microphone-towards the top of your ear.
3. Clean your hearing aids daily. Best to do it at night before bedtime. Spray the tissue with the earmold spray and wipe each earmold. Use the pick to remove debris from the two holes in the earmold tip.