The Monterey Hearing and Balance Center Custom and Digital Hearing Aids

How do we hear?

Hearing is a complex process involving the three major parts of the ear: the outer, the middle and the inner ear. The outer ear collects surrounding sound waves and funnels them through the ear canal down to the eardrum, the beginning of the middle ear. The sound waves cause the eardrum to vibrate. Three tiny bones attached to the eardrum convert the vibration into pressure waves and move them down to the inner ear. There the cochlea, a fluid-filled, bony maze full of minute hair cells, turns the pressure waves into electro-chemical impulses which then travel to the brain where they are interpreted as the sounds you recognize.

What causes hearing loss?

A number of conditions can cause a disruption in the hearing process and lead to hearing loss. The two most common types of hearing loss are conductive and sensorineural. 

• Conductive hearing losses occur when the outer or middle ear is unable to properly conduct sound and pressure waves to the inner ear. These losses are common in children with ear infections and in anyone with blockage caused by earwax, bacterial infection, allergies, trauma to the ear, congenital malformations or calcium growths. Such hearing losses are usually temporary and can often be successfully treated by medical or surgical procedures.

• Sensorineural hearing losses are a result of nerve damage to the hair cells, or nerve fibers, in the inner ear. Causes can be genetic or congenital, or they can stem from an illness, disease, chemicals or medications. The most common causes, however, are attributed to aging and prolonged exposure to noise. Such hearing losses are usually permanent and typically treated with hearing aids or, in severe cases, cochlear implants.

How do I know if I have a hearing loss?

The best way to find out if you have a hearing loss is to be tested by an audiologist. In fact, it makes sense to have your hearing checked on a regular basis just as you do your vision, particularly if you are over 40 years old. To see if you have any warning signs of hearing loss, take our website test.

What happens if I don't get my hearing loss treated?

If a medical condition is causing the damage, not only is your hearing affected, your overall health could get worse if left unattended. When your auditory system is damaged, the brain is no longer stimulated by sound impulses. If too much time elapses before treating the hearing loss, the brain forgets how to recognize certain sounds. When this happens, therapy is necessary to retrain the brain to hear these sounds.

What is an audiologist?

Audiologists are healthcare professionals who have earned a master’s and/or doctoral degree (AuD) in audiology, the science of hearing. Audiologists are trained in the prevention, diagnosis and non-medical treatment of hearing disorders. They are clinically, academically and professionally trained to determine which hearing losses need medical attention and which can be corrected with hearing aids or other assistive listening tools. Many dispense hearing aids, which requires state licensing. Some are affiliated with professional organizations that provide continuing education programs, codes of ethics and standards of care.

What is a hearing aid specialist?

Hearing Aid Specialists are trained and licensed to perform basic hearing tests and dispense hearing aids to individuals who specifically seek hearing aids, not diagnostic services.

Why go to an audiologist for a hearing aid?

Audiologists are the most qualified professionals to test, select and verify the performance of hearing aids.

• They have earned a master’s or doctoral degree in audiology and have completed a full-time internship program.
  
• They conduct a complete hearing assessment – patient history, physical examination and audiometric evaluations – to determine if a hearing aid or a referral to a medical specialist is appropriate.
  
• They have extensive testing tools to help pinpoint the cause of hearing loss, and they have state-of-the-art equipment to customize hearing aids properly.
  
• They provide patient education and training to help ensure the greatest success in hearing treatment and continuity of service for the life of the hearing aid.

What qualifications should I look for in an audiologist?

All audiologists have earned either a masters or doctorate in audiology. All have completed clinical training and, if they dispense hearing aids, should be licensed to do so. Other factors to consider include:

• Experience – how long have they been serving patients?
  
• Expertise – what level of training and education have they achieved? Do they participate in continuing education programs on a regular basis?
  
• Diagnostic services – does their scope of services include a broad range of tests for hearing loss and hearing-related disorders or are their services restricted to amplification testing for dispensing hearing aids?
  
• References – are they known in the community? Do they come well recommended?
  
• Professional affiliations – do they belong to professional organizations that provide continuing education, a code of ethics, standards of practice and information on the latest testing and treatment techniques?   

What happens when I visit an audiologist's office for a hearing exam?

A typical first visit to an audiologist’s office takes about an hour. It focuses on three areas that help determine the nature of your hearing loss and the best treatment. 

• Your personal history is taken to learn what may have influenced your hearing loss – certain illnesses, your parents’ hearing, occupational background, exposure to noise. 
  
• The audiologist will examine your ears to see if your hearing loss is due to damage or blockage in the outer ear. 
  
• You’ll receive a series of hearing tests to establish the level at which you hear certain tones and pitches and recognize specific words.

It is at this point that your audiologist will either refer you to a physician or surgeon for medical treatment or discuss options for enhancing your hearing with listening aids.

What is the best hearing aid?

No single hearing aid is best. An audiologist will help determine what is best for you after diagnosing your hearing loss and discussing your own personal needs. Considerations would include your occupation, lifestyle, budget, personal taste, any physical limitations you have and the nature of your hearing loss.

Hearing aids have made significant advances in recent years, both technologically and stylistically: 

Technologically, there are three types of hearing aids – analog, digitally programmable and 100% digital. 

• The analog circuits are the most basic, the least expensive and have fewer capabilities for hearing in specific surroundings. They essentially provide amplification, with volume controlled manually.
• The digitally programmable hearing aids have an automatic volume control, programmed by the audiologist, and may include more than one microphone to accommodate various listening situations.
• 100% digital hearing aids are the most sophisticated and feature advanced circuitry and unique signal processing capabilities. They contain tiny computers with dual microphones and multi-channel signal processors (up to 15 channels) that automatically adjust directional noise and sound frequency so that speech can be distinguished from background noise.

Digital technology gives audiologists maximum control over sound quality and amplification. What’s more, it enables them to customize your hearing devices so that you hear what you want to hear and minimize what you don’t want to hear, such as background noise. 

There are four major styles of hearing aids – behind the ear, in the ear, in the canal and completely in the canal – to house whatever technology is chosen. Style selection is based on both physical and hearing-related factors as well as personal preference.

• With Behind the Ear (BTE) models, the electronics are housed in a case that fits behind the ear. Tubing and an ear mold route the sound to the ear canal. In general, BTE hearing instruments can provide the maximum amount of amplification. 

• In the Ear (ITE) fit within the outer ear and extend into the ear canal. They are the least expensive and easiest to operate.
  
• In the Canal (ITC) are smaller than ITEs and fit further into the ear canal. They are an option for mild to moderate hearing losses.
  
• Completely in the Canal (CIC) fit even further in the ear canal, closer to the eardrum. The least visible, they are restricted to persons with ear canals large enough to accommodate them. They are also the most expensive.

What can I expect from my hearing aids?

Hearing aids work very well when they are properly fitted and programmed. Initially, you’ll be aware that you have hearing aids in your ears, and your voice may sound strange. However, your listening skills should improve as you become accustomed to amplification. While hearing aids will not restore your hearing capabilities to pre-existing levels, you should expect the following results:

• You’ll hear sounds you haven’t heard in a long time – paper rustling, birds singing, your car signal device clicking.
• Your hearing in quiet and moderate backgrounds will have improved (one-on-one and small group conversations, TV). So, too, when using the telephone or cell phone.
• When it is noisy, your hearing will not be as good as it is in quiet surroundings.
• Soft speech will be more audible.

How much do hearing aids cost?

Depending on the technology and style, hearing aids can range from $1,500 to $3,000 per hearing aid. The most expensive are not necessarily the best solution for everyone. The choice should be determined by the nature of your hearing loss, your budget, style preference, occupation, lifestyle and personal preference.

How long do hearing aids last?

If you take good care of your hearing aids, they should last about six years. During this time, your hearing may change, typically necessitating a programming adjustment by your hearing aid dispenser or audiologist.

How do I care for my hearing aids?

To extend the lifetime of your hearing aids, follow these general guidelines:

• Clean your hearing aids regularly as instructed by your audiologist and hearing aid manufacturer.
• Keep them dry.
• Avoid getting them near excessive heat.
• Remove spent batteries immediately.
• Avoid applying hair spray while wearing hearing aids.
• Do not use alcohol or cleaning fluid for cleaning.

Where do I go for more information about hearing aids?

You can contact us at The Monterey Hearing & Balance Center or visit our Resources section.

What should I know about hearing aid batteries?

Batteries typically last 7 to 14 days depending on the number of hours used per day. You will hear a chirping noise right before they stop working. All hearing aid batteries are air-activated. To extend their life, the battery door should be opened when not in use. 

Caution: Batteries are toxic if swallowed, requiring immediate medical attention. Keep them away from children and pets. Also, never put your batteries in the refrigerator or freezer, as moisture will corrode them.

What other assistive listening devices are available besides hearing aids?

There are a number of Assistive Listening Devices (ALDs) that amplify sounds for use in specific situations, such as watching TV or attending a movie, a play or presentation. There are also ALDs to replace standard equipment, such as alarm clocks, telephones and smoke detectors

What are cochlear implants?

Cochlear implants are for patients with severe to profound sensorineural hearing loss who would not benefit from hearing aids. A cochlear implant allows sound waves to bypass the nonfunctional inner ear and convert them into impulses that stimulate the cochlear nerve. This is done by surgically placing an internal receiver beneath the skin behind the ear and an electrode array into the cochlea. The electrical signals are then manipulated by an audiologist to maximize speech perception. The brain then interprets these electrical impulses as recognizable sounds.

What can I do to protect myself from hearing loss?

Repeated exposure to loud noises can have a cumulative, damaging effect on your hearing. At work, wear hearing protection if your job involves noise levels exceeding 90 decibels. You should also guard your hearing outside of work – at a rock concert, while hunting, when operating power equipment, even drying your hair. Earplugs that typically reduce noise levels by 15 to 20 decibels provide generally adequate protection, but in extremely loud situations, we recommend that you wear earmuffs over earplugs.

What is tinnitus?

Tinnitus (pronounced tin-it-tis) is a perceived sound in the ears, most often reported as a ringing though some people hear hissing, roaring, whistling, chirping or clicking. The noise can be constant or intermittent with a range from very soft to very loud. 

What causes tinnitus?

The exact causes of tinnitus can be difficult to identify. Some of the known factors that cause or exacerbate tinnitus conditions include: hearing loss and exposure to loud noise (the two most common causes), earwax, certain medications, ear and sinus infections, ear diseases and disorders, jaw misalignment, tumors, thyroid conditions, anemia, stress, hypertension and some physical traumas. It’s important that you receive tinnitus-specific testing. The more comprehensive your diagnosis, the more successful your treatment.

What kind of tests does an audiologist perform for tinnitus complaints?

Under construction

How is tinnitus commonly treated?

When medical attention isn’t able to eliminate tinnitus, alternative treatments may help manage it:

• Hearing aids are particularly successful when hearing loss is in the same frequency range as the tinnitus.
  
• Tinnitus Maskers resemble hearing aids and produce a band of noise to cover up the tinnitus.
  
• Biological feedback teaches a relaxation process to control the response to stress and how it influences your tinnitus.
  
• Cognitive/behavioral therapy alters negative thoughts about tinnitus rather than treating the tinnitus itself.
  
• Tinnitus Retraining Therapy helps you become less aware of the sounds of their tinnitus through counseling and the use of in-the-ear sound generators.
  
• Drugs can be prescribed when the underlying cause is attributable to anxiety, depression or sleep deprivation.

What causes dizziness?

There are three primary systems in the body that keep us in balance by feeding input to the brain – the eyes (visual system), inner ears (vestibular system) and muscles/joints (proprioceptive system). If a conflict or disturbance occurs in any of these systems, you can feel dizzy, unsteady on your feet, have a sense of vertigo or suffer from nausea. Dizziness has many causes. Finding the exact reason for the condition and providing effective treatment can be difficult. 

Many people experience dizziness due to a change in the vestibular system, the part of the inner ear dedicated to balance and body position. Sometimes the damage can be traced to a head trauma, ear infections, a virus, drugs, a stroke and, in rare instances, a slow-growing tumor. So while the cause may not be easily determined, it’s important to eliminate medical possibilities.

Who should I see for dizziness?

You’ll want to see your physician or a neurologist to identify any medical causes for your imbalance. The doctor may schedule you for an MRI as well as vestibular diagnostic testing by an audiologist or balance specialist. You may, of course, schedule your own vestibular testing with an audiologist who, in turn, will work with your doctor. 

What diagnostic tests are performed for dizziness and balance issues?.

There are a number of tests that are designed to identify the cause of dizziness and help treat balance complaints. They examine the three primary systems in the body responsible for balance – the eyes, inner ears and postural muscles/joints – and record information about how each system responds to various positions and stimuli.

What are the standard treatments for managing dizziness? 

Treatment for vestibular disorders varies according to the diagnosis. It may consist of drugs, diets, physical therapy or surgery. 

How can I get more information about dizziness?

You can contact us at The Monterey Hearing & Balance Center or visit www.vestibular.org.