Audiology Info

When a hearing loss is suspected, the audiologist may be the first person you encounter, and likely, the first person to diagnose you or your child with hearing loss. Following a comprehensive evaluation, the audiologist will recommend the most appropriate management approach, including hearing aids and/ or other assistive listening devices. For children, medical clearance is required, by law, prior to any hearing aid fitting. Depending on the type of hearing aid selected, the audiologist may need to take an impression of the ear, using a silicone based material. For children, the audiologist will provide well fitting earmolds as your child grows. Additionally, the audiologist will provide the appropriate follow up evaluations to note progress and monitor any changes in hearing.

Newborn/Infant Hearing Screening

In this office, we use an otoacoustic emissions (OAE) test to evaluate newborn and infant’s hearing. As the baby rests quietly, a small probe tip (like an earplug) is placed into the ear canal and two tones are simultaneously presented. Once the cochlea (organ of hearing) processes the sound, an electrical stimulus is sent to the brainstem. In addition, there is a second and separate sound that does not travel up the nerve but comes back out into the infant’s ear canal. This “byproduct” is the otoacoustic emission. The emission is then recorded with the microphone probe and represented pictorially on a computer screen. The audiologist can determine which sounds yielded a response/emission and the strength of those responses. If there is an emission present for those sounds that are critical to speech comprehension, then the infant has “passed” the hearing screen. This test can take as little as 5 to 8 minutes if the infant is in a quiet, peaceful, resting state. If an infant fails the hearing screen, it is unknown if there truly is a hearing loss, how much hearing loss is present, or whether or not the hearing loss is permanent or correctable. However, if hearing loss is suspected, your child will be referred for an additional physiological test (know as auditory brainstem response testing) to determine the type and severity of their loss.

Comprehensive Hearing Evaluation

A hearing test is performed with the patient in a sound treated room, while the audiologists uses a piece of equipment called an audiometer to deliver sounds through either headphones, insert earphones (soft sponge material), speakers, or a bone oscillator (a headband with a vibrating piece placed on the bone behind the ear). The patient is instructed to respond by either raising their hand or pressing a button on a responder. For younger children, more age appropriate strategies are utilized (explained below). This test measures the softest sound detectable (intensity) across a range of frequencies (pitch). This testing determines the type and degree of hearing loss. During the evaluation, speech testing is also performed, in which the patient is asked to repeat a list of words to determine their speech reception thresholds (softest decibel level a person can correctly repeat back spondee words) and speech discrimination abilities.

Visual Reinforcement Audiometry

Visual reinforcement audiology (VRA) testing evaluates the hearing of infants from six months to two years. Sounds of varying intensity and speech are presented to one of two speakers as the child sits on a parent’s lap. If a sound is heard by the child, then he or she turns toward the appropriate speaker and is rewarded by a visual stimulus, such as an animated toy conditioned play audiometry or a flashing light.

Conditioned Play Audiometry

This test is appropriate for children from two to five years of age. The child is instructed to listen for a sound and to respond when a sound is heard by doing varying tasks, such as placing a block in a bucket or placing a peg in a pegboard. Headphones may be worn by the child for this type of testing. Once the child is conditioned, threshold of hearing can be determined by decreasing signal intensity to the softest point that the child still performs the task. Speech thresholds (described above) are typically obtained by having the child identify pictures, objects or body parts.

Middle Ear Analysis

Using a procedure called tympanometry, the audiologist obtains an objective measurement of middle ear mobility of the eardrum, the volume of the external ear canal, and pressure within the middle ear system. The data obtained provides middle ear analysis information related to several pathological conditions of the middle ear, most commonly acute otitis media (ear infections). This allows for a more collaborative diagnosis and assures the most accurate treatment or management strategies.

How do I know if I need hearing aids?

For the majority of people hearing loss is gradual and you may be the last to notice that you are experiencing communication difficulties. Individuals with hearing loss frequently report that they can hear, but cannot understand what a person is saying or that they are experiencing increased difficulty in background noise. The best way to find out if it is the right time for you to consider hearing aids, is to schedule an appointment with your audiologist. The audiologist can then guide you in deciding if now is the right time for you to pursue amplification.

What type of hearing aids do I need? Will you be able to see them?

The style of hearing aids is determined by your hearing loss, personal communication needs, and cosmetic expectations. Recently, consumer reports put out a statement recommending that you purchase a hearing aid with digital technology, a feedback cancelling system, and directional microphones. To find out which device is best for you, schedule an appointment with your audiologist.

How much do hearing aids cost?

The cost of hearing aids ranges depending on the level of device sophistication, which is determined by the level of hearing loss and communication needs. Contact your audiologist for more detailed pricing information.

Why can’t I just get one hearing aid?

When you are experiencing an equal amount of hearing loss in both ears it can be expected that a recommendation for two hearing aids will be made. Just as it is important to receive information from both eyes, the same holds true for the ears. For example, if you were experiencing a loss of vision in both eyes you would not think of only improving your vision in one eye.

Are hearing aids covered by my insurance?

Unfortunately Medicare does not currently provide coverage for hearing aids. If you have a private insurance company hearing aid coverage varies and a simple call to your provider can provide information specific to your insurance plan.

Technology is available that could be used to assist the understanding ability of a person with hearing loss under difficult listening situations and alert a hard of hearing person in dangerous situations. Ask the audiologist about these items:

1.  Waking up: Bed shaker, pillow vibrator, alarm clock that uses a bright light
2.  Overcoming noise and distance: Personal FM system, FM built into or attached to hearing aids, parent wears microphone
3. Telephone listening: Amplified phone handset, TTY (often free from the telephone company)
4. Understanding TV: Closed captioned on TV, infrared TV system, hardwired or personal FM
5.  Understanding movie: Ask the theatre for an assistive listening device, they have them for use
6.  Fire safety: Lighted fire alarm, install loud smoke alarm near where your child sleeps
7.  Team sports: Helmets with built in FM amplification systems can be made available

PRE-NATAL

• 24 weeks gestation: auditory system is fully developed; fetus can hear mother’s voice en utero

0-3 MONTHS

• Startle response to sudden loud noises 
• Reflexive response to sound (e.g. eye widening, brow furrowing, cessation of movement) 
• Recognizes / prefers mother’s voice 
• Begins cooing

4-5 MONTHS

• Side to side auditory localization begins to emerge for close sounds

6 MONTHS

• Side to side auditory localization should be well developed, even for sounds that are far away 
• Begins babbling 
• Begins repeating sounds

9 MONTHS

• Auditory localization to sounds above and below the infant emerges 
• Responds to name

12 MONTHS

• Receptive vocabulary emerges; baby begins to understand simple language (nouns and verbs); understands about 50 words 
• Responds to simple commands (e.g. play pat-a-cake, wave bye-bye, where’s Mommy?) 
• Interested in environmental noises 
• Babbles in response to human voice

18 MONTHS

• Understands about 150-200 words 
• Understands simple sentences 
• Follows one step directions 
• Points to body parts on request 
• Points to objects and pictures when named 
• Begins to combine two word phrases 

2 YEARS

• Understands about 300 words 
• Follows two step directions 
• Able to identify five body parts 
• Listens to and understands simple stories 
• Understands and answers simple yes / no and “wh” questions 
• Begins to speak in short sentences

2½ YEARS

• Understands about 500 words 
• Understands nearly all sentence structures 
• Speaks in sentences

3 YEARS

• Understands about 900-1200 words 
• Follows three step directions 
• Recognizes several melodies 
• Enjoys hearing favorite books repeatedly 
• Remembers three details of a story 
• Understands conversational turn-taking 
• Understands most common adjectives 
• Is interested in and understands explanations of “why?” and “how?”

4 YEARS

• Understands about 2800-13,000 words 
• Remembers five details of story 
• Understands and responds correctly to complicated sentences

6 YEARS

• Understands about 20,000 words
• Remembers six details of a story

Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you are a parent and you suspect your child has hearing loss, trust your instincts and speak with your child’s doctor. Don’t wait!

Children

• Parent or caregiver concern
• History of ear infections 
• Frequent upper respiratory infections 
• Allergies, snoring, and/or mouthbreathing 
• Delayed or disordered speech-language development 
• Speech mis-articulations 
• Developmental delay 
• Balance problems 
• Vision problems 
• Poor listening attention 
• Frequent request for repetition (e.g. “what?” or “huh?”) 
• Misinterpretation of what has been said 
• “Selective” hearing 
• Trouble hearing in noise 
• Difficulty following multi-step directions 
• Trouble with listening comprehension 
• Problems organizing thoughts for language expression (oral or written) 
• Loudness sensitivity 
• Difficulty learning to read 
• Trouble with reading comprehension 
• Concerns regarding attention skills 
• Concerns regarding learning skills 
• Concerns regarding social communication skills 

Adults

• Trouble hearing a doorbell or a telephone ringing 
• Complaints that speech sounds “muffled”; it is loud enough, just not as clear as desired 
• Frequently asking for repetition of what has been said 
• Complaints that people are mumbling when they speak 
• Preferring the volume of electronic devices louder than friends or family members 
• Great difficulty hearing in a crowded room or in background noise 
• Difficulty hearing in a large room (i.e. auditorium) or at your place of worship
• Needing to look at someone when they are talking in order to understand 
• Missing parts of conversations 
• Responding inappropriately to questions or comments 
• Tinnitus (ringing, buzzing, crickets, static noises in the ears) 
• Balance problems 

Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential. If you are a parent and you suspect your child has hearing loss, trust your instincts and speak with your child’s doctor. Don’t wait!

Children 

• Parent or caregiver concern 
• Family history for hearing loss 
• Maternal TORCH infections during pregnancy (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes) 
• Craniofacial anomalies 
• Mondini malformation (congenital cochlear malformation) 
• Low birthweight (less than 3oz.) 
• Low Apgar scores at birth 
• Mechanical ventilation for more than 5 days 
• Meconium aspiration 
• Persistent pulmonary hypertension (PPHN) 
• Bronchopulmonary Dysplasia (BPD) 
• Sepsis / Meningitis 
• Use of ototoxic medications 
• Hyperbilirubinemia (severe jaundice, especially if requiring blood transfusion) 
• Interventricular hemorrhage 
• Hydrocephalus 
• Syndromes or congenital anomalies 
• Chromosomal abnormalities 
• Interventricular hemorrhage 
• Infectious diseases (measles, mumps) 
• Ear infections 
• Complaints of tinnitus 
• Head injury 

Adults

• Family history for hearing loss 
• Aging 
• Use of ototoxic medication (medicine that is toxic to the ears) 
• Complaints of tinnitus (ringing, buzzing, crickets, static sounds in the ear) 
• Menieure’s Disease (episodes of fluctuating hearing loss with roaring tinnitus and dizziness) 
• Viral disease (causing sudden hearing loss) 
• Perilymph fistua 
• Head trauma 
• Excessive noise exposure