A quick self test to see if you should have a hearing evaluation by an audiologist.
1. Do you find it difficult to follow a conversation in a noisy restaurant or crowded room?
2. Do you sometimes feel that people are mumbling or not speaking clearly?
3. Do you have difficulty following the dialog in a theater or ask someone what was said frequently?
4. Do you sometimes find it difficult to understand a speaker at a public meeting or a religious service?
5. Do you find yourself asking people to speak up or repeat themselves?
6. Do you find men’s voices easier to understand than women’s or children’s?
7. Do you experience difficulty understanding soft or whispered speech?
8. Do you have difficulty understanding speech on the telephone?
9. Do you have ringing or noises in your ears/head?
10. Do you hear better with one ear than the other?
11. Have you had any significant noise exposure in your work, recreation or military service?
12. Have any of your relatives (by birth) had a hearing loss?
13. Have you experienced a change in your hearing?
If you answered yes to any of these questions, it would be a good idea to have your hearing tested. If you answered yes to more than 2 of these questions you should have a hearing evaluation. If you have had a sudden change in hearing or one ear is different than the other, you should be tested immediately.
If your hearing is a concern some insurance companies require you to have a referral from your physician in order to see a Doctor of Audiology for evaluation. Medicare always requires a referral.
The hearing evaluation has many pieces that evaluate each part of the hearing mechanism. Exactly how the hearing examination is done depends upon the ability of the patient to respond. If the patient has any physical challenges, the examination is adapted to accommodate.
Standard Comprehensive Hearing Evaluation
- History: Before your evaluation begins the Doctor of Audiology will go over the medical and other history forms you filled out prior to your appointment. They will then discuss any areas that need further clarification or more information. It is important to disclose all your current and past health issues and medications/ over the counter medications/recreational drugs/herbals, noise exposure and family history of disease/illness. Each of these items may interact with your hearing, tinnitus or dizziness related issues in complex ways that require the doctor’s knowledge in order to help you.
- Otoscopic examination: the Audiologist will examine your ear, ear canal and ear drum (tympanic membrane), and visible middle ear with an instrument that looks like a flashlight with a small cone and a magnifying lens on it called an otoscope.
- Abnormal examination could reveal wax blocking the ear canal, growths, an hole in the ear drum, an abnormal ear drum, middle ear infection or fluid, middle ear tumor or growth, middle ear blood, damage to the ear canal, or foreign objects in the ear canal.
- Tympanometry: A device will be placed in the opening of your ear canal. This device will change the air pressure in your ear canal which makes the ear drum move back and forth. A tone will be played from the device during the test. The device records the result as a graph. You should not speak, move or swallow.
- Abnormal test results can reveal ear drum damage, middle ear fluid such as an ear infection, middle ear bone damage, growths in the middle ear, or bones that are too loose or too stiff.
- Acoustic Reflexes: The same device as in Tympanometry will remain in your ear with loud brief tones played at different pitches and levels. The Audiologist is looking for your eardrum movement in response to the sound. This is the reflex. You must not speak, move or swallow. An additional device will be placed in the opposite ear to play the same tones for additional reflex information.
- Abnormal test results can reveal possible tumor of the VIII or VII cranial nerve or brainstem, middle ear abnormality or other hearing abnormality but must be evaluated in addition with other tests from your hearing evaluation.
- Distortion Product and Transient Evoked Otoacoustic Emissions: A small sponge tip earphone will be placed in your ear canal. The computer will play specific sounds through this earphone in order to try to elicit a response from your cochlea of the inner ear. If the pathway to the cochlea is normal and the cochlea’s outer hair cells are healthy the sounds will be recorded consistently by the computer in response to the sounds. The test only takes a few minutes and requires that you sit quietly.
- Air conduction and bone conduction audiometry: You will be seated in a sound treated room which is designed for testing hearing so that outside sound does not interfere with the test. You will have either a small sponge tip earphone or a headphone placed on each ear for air conducted hearing testing. By “Air Conduction” we mean the sound you are being tested with is being conducted from the earphone to your ear through the air, ear canal, ear drum, middle ear bones, and cochlea then on to the VIII nerve and up the levels of the auditory cortex. By “Bone Conduction” we mean the sound you are being tested with is being sent to the cochlea by vibrating the skull with a small round bone vibrator typically placed on the behind the ear on the skin of the mastoid bone. It is held in place with a head band similar to a headphone. This bypasses the ear canal, eardrum and the middle ear bones so that the cochlea of the inner ear is tested directly.
- You will be tested with different frequency tones from 250-8000 Hz (low to high pitch) and possibly higher depending on your chief hearing issues.
- The test sound (usually the tone played in several beeps) will start out easy for you to hear but then become more difficult to hear until you can no longer hear the test sound. You will be re-tested multiple times at each frequency until it is established where you can just detect the tone.
- You will also be tested with words to establish the softest level you can understand them and to determine how well you can understand speech when it is at a level that is comfortably loud for your hearing.
- Diagnosis: Your hearing evaluation results and diagnosis will be explained to you in detail. Be sure to ask any questions you may have. There are no “silly” questions. To assist you in this process and to help in remembering your results, we find it valuable to bring a “significant other” to your examination.
- The Audiogram: The quietest sound you can detect for each frequency (pitch) is plotted on a graph called an Audiogram
- The better your hearing the higher up the graph your results would be plotted.
- Zero dB does not mean that there is no sound. This level is merely the softest sound a person with normal hearing ability can perceive 50% of the time. Leaves rustling are about 20 dB in loudness on the decibel scale. A normal conversation usually occurs at about 45 dB-55 dB on the decibel scale. A gas lawn mower is at about 90 dB.
- You may have better hearing in some frequencies than in others others.
- Even a mild hearing loss in just a few frequencies can cause significant hearing difficulty.
The type of hearing impairment will be determined:
1. Sensorineural: Damage occurs to the part of the ear called the inner ear (cochlea) or the hearing nerve (auditory nerve – part of the VIII cranial nerve). With the special testing at Hearing and Balance Institute of the Rockies, Inc. we can determine if the loss is Sensory (cochlea), Neural (auditory nerve) or both.
2. Conductive: Damage occurs to the middle part of the ear affecting the middle ear bones called ossicles (malleus/hammer, incus/anvil, stapes/stirrup), the ear drum (tympanic membrane) or the pathway/ear canal from the part of the ear you can see (the pinna) to the ear drum.
3. Mixed: Damage to the hearing is a mix of both sensorineural and conductive types of hearing loss.
Advanced Audiometric Evaluations
Specialized diagnostic testing may be recommended or necessary for complete evaluation of your hearing. Both Auditory Brainstem Response (ABR) and Electrocochleography (ECochG) testing provide diagnostic information to assist in determining the cause of hearing loss, tinnitus, ear fullness, dizziness, and other conditions. They are also necessary when measuring the hearing capability of a person who cannot respond behaviorally, or to verify results that are inconsistent from behavioral testing.
Auditory Brainstem Response (ABR)
Auditory Brainstem Response (ABR) or Auditory Steady State Responses (ASSR) are widely used objective tests to assess auditory nerve function and hearing sensitivity. A test sound is given to the ear using earphones and the responses from auditory neural activity are recorded using electrodes attached to the skin of the head with a salt based electrode gel or paste and hypoallergenic tape. Patient participation is not required during the test (other than to sit quietly). The entire test procedure takes approximately 45 minutes.
ECochG measures the electrical potentials generated in the inner ear in response to stimulation by sound. Electrodes are placed on the forehead, ears and eardrums. A series of loud clicks are delivered to the ears through a soft sponge earphone inserted in the ear canal. Patient participation is not required during the test. The entire process takes approximately 45 minutes.