Hearing Specialist






Hearing Care


Your audiologist will have some questions for you when you have your first visit. It is important for the audiologist to know about your health and how you are hearing.

The audiologist may ask any of the following questions:

  • What brought you here today?
  • Have you noticed problems with your hearing?
  • Did you hearing loss happen all of a sudden? Or, has it gotten worse over time?
  • Do you have ringing in your ears?
  • Have you had a lot of ear infections?
  • Do you ever feel dizzy?
  • Have other people in your family had hearing loss?
  • Do you have to ask people to repeat what they said a lot?
  • Do you hear people speaking but can't understand what they are saying?
  • Have you worked in places that are very loud and noisy?
For children, the questions will be about the following topics:
  • Health history
  • Ability to understand and respond to familiar sounds
  • Response to loud, unexpected sounds, called a startle response
  • Hearing history, or any hearing tests they have had before
  • Speech and language development
  • Motor and thinking skills
Tests to diagnose hearing loss may include:
  • Physical exam. Your doctor will look in your ear for possible causes of your hearing loss, such as earwax or inflammation from an infection. Your doctor will also look for any structural causes of your hearing problems.
  • General screening tests. Your doctor may ask you to cover one ear at a time to see how well you hear words spoken at various volumes and how you respond to other sounds.
  • Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both.

Audiometer tests. During these more-thorough tests conducted by an audiologist, you wear earphones and hear sounds directed to one ear at a time. The audiologist presents a range of sounds of various tones and asks you to indicate each time you hear the sound.

Pure tone Audiometry
Pure-tone audiometry is a behavioral test used to measure hearing sensitivity. This measure involves the peripheral and central auditory systems. Pure-tone thresholds (PTTs) indicate the softest sound audible to an individual at least 50% of the time. Hearing sensitivity is plotted on an audiogram, which is a graph displaying intensity as a function of frequency.

  • Measures hearing sensitivity
    • – Air conduction à measures sensitivity of entire pathway of auditory system, including outer, middle, and inner-ear.
    • – Bone conduction à “by-passes” outer and middle-ear to measure sensitivity of inner ear directly.
  • Determines type and severity of hearing loss
    • Results are used to generate the audiogram

Speech Audiometry
Speech audiometry has become a fundamental tool in hearing-loss assessment. In conjunction with pure-tone audiometry, it can aid in determining the degree and type of hearing loss. Speech audiometry also provides information regarding discomfort or tolerance to speech stimuli and information on word recognition abilities.

In addition, information gained by speech audiometry can help determine proper gain and maximum output of hearing aids and other amplifying devices for patients with significant hearing losses and help assess how well they hear in noise. Speech audiometry also facilitates audiological rehabilitation management.

Importance of Audiometry 1. Subjective evaluation to diagnose hearing loss
2. Evaluates the entire auditory system
3. Provides information on the most appropriate “next step”
a. Further diagnostic testing
b. Medical intervention
4. Selection of hearing aids

Impedance Audiometry
The primary purpose of impedance audiometry is to determine the status of the tympanic membrane and middle ear via tympanometry. The secondary purpose of this test is to evaluate acoustic reflex pathways, which include cranial nerves (CN) VII and VIII and the auditory brainstem.

Tympanometry
Objective of tympanometry is to measure of the middle-ear system. It is not a hearing test, It provides Graphic representation of ear compliance in relation to the pressurization of the ear canal, Objectively it demonstrate the mechanical-acoustic characteristics of the outer and middle ear and it also measures the ease in which energy flows through the system.

Working

  • A probe is inserted in the ear canal that contains a loudspeaker, a microphone, and a pump.
  • A tone (226Hz) is delivered into the ear while the pressure is changed within the sealed canal.
  • Measurement taken at the probe - plots the flexibility of the TM and the ossicles.
  • Plot is displayed in a graph called the tympanogram


EcochG(Electrocochleongraphy)-
The electrocochleography test is an objective measure of the electrical potentials generated in the inner ear as a result of sound stimulation. This test is most often used to determine if the inner ear (cochlea) has an excessive amount of fluid pressure. Excessive fluid pressure in the cochlea can cause symptoms such as hearing loss, aural fullness, dizziness, and/or tinnitus. These symptoms are sometimes indicative of certain ear pathologies such as Meniere’s disease or endolymphatic hydrops.

The complete Ecochg testing takes up to 40 minutes to 1 hr. A patient undergoing an Ecochg test will have several surface electrodes placed on their head. A tiny microphone and an earphone will then be inserted into the canal of the test ear.

Procedure
The patient will be instructed to relax while they listen to a clicking sound. It is very important that the patient be relaxed for this test, since any tension or muscle movement can slow down the averaging process. No response from the patient is required for this test. While the patient is listening to the clicking, the audiologist will measure the Ecochg response with a computer that uses signal filtering and averaging to isolate neural activity from the cochlea.

After this test is complete, the patient will schedule a follow up appointment to return in two weeks. At the follow up visit, the referring physician will discuss the Ecochg results and other audiological test results with the patient.

Hearing Screening of infants/children
There are 2 main types of hearing screening methods for newborns. These may be used alone or together:

Oto Acoustic Emissions:
OAE measures whether parts of the ear respond properly to sound. During the test, a plastic probe containing both a transmitter and a microphone is inserted into the infant's ear. The transmitter sends sounds down into the inner ear, and the microphone picks up the vibrations the hair cells make in response. In normal-hearing persons, the ear “echoes” sounds, and this “echo” can be detected by the OAE machine. Since the probe of the OAE machine which is very soft and comes in different sizes, is placed just inside the ear canal of the infant it does not cause any discomfort in the child.

AABR Screening
ABR activity is a direct measurement of the neural response to sound that is generated along the auditory system from the level of the cochlea and through the VIII nerve and pontine-level of the brainstem and that correlates with behavioral hearing measures in the mid- to high-frequency region. The ABR is recorded using surface electrodes that are attached to the infant's head. Click stimuli are presented through insert or muff-style earphones that are worn on both ears. ABR measurements are sensitive to neural auditory disorders (i.e., auditory neuropathy).

ABR
What is an Auditory Brainstem Response?
The Auditory Brainstem Response (ABR) is an objective test that can be used to estimate hearing sensitivity and to identify neurological abnormalities of the auditory nerve and the auditory pathway up through the brainstem.

What can I, as the patient, expect at my appointment?
After the audiologist places electrodes on your ear lobes and forehead, ear phones are placed in your ear to deliver the click stimulus. You do not need to respond to the click but you will sit in a reclined position and are instructed to lay as relaxed as possible with your eyes closed throughout the test.

What does the ABR measure?
As the clicks are delivered through the earphones, the electrodes measure the electrical activity from the auditory pathway. These electrical responses are analyzed by the computer and produce a waveform. The different peaks on the resulting waveform provide information on the time it takes various structures of the auditory pathway to respond following the stimulus.

Auditory Steady State Response (ASSR)
Auditory Steady State Response (ASSR) is an objective test used for evaluation of hearing ability in children too young for traditional audiometric testing. Most children are referred for ASSR after a newborn hearing screen in the hospital indicates the possibility of hearing loss. Early intervention strategies, such as hearing devices or cochlear implantation, are necessary for development of speech and language skills in a child with hearing impairment. The results obtained from ASSR testing can be used to estimate the behavioral pure-tone audiogram. This information is essential in the management of children with hearing loss. The person being tested must be very quiet and still in order to obtain reliable ASSR results. Often, testing is performed under sedation or in natural sleep if the person is under 6 months of age. Results are obtained by measuring brain activity while the person listens to tones of varying frequency (pitch) and intensity (loudness). The brain activity is recorded using electrodes taped on the forehead and behind each ear. The use of electrodes eliminates the need for active participation of the patient (i.e., pushing a response button every time a tone is activated). The results are detected objectively using statistical formulas that determine the presence or absence of a true response. Similar to traditional audiometric testing, threshold is determined as the lowest level at each frequency at which a response is present. ASSR provides an accurate, frequency-specific estimate of the behavioral pure-tone audiogram.

Tinnitus Evaluation
Tinnitus refers to an auditory perception not produced by an external sound. It is commonly described as a "hissing, roaring, or ringing" and can range from high pitch to low pitch, consist of multiple tones, or sound like noise (having no tonal quality at all). It most often is constant, but can also be perceived as pulsed, or intermittent, and may begin suddenly, or may come on gradually. It can be sensed in one ear, both ears, or in the head. Tinnitus may cause or be associated with a wide range of problems including sleep difficulties, fatigue, stress, trouble relaxing, difficulty concentrating, depression, and irritability. As a result it can affect one's quality of life including social interactions and work.

Audiologists are qualified to evaluate, diagnose, develop management strategies, and provide treatment and rehabilitation for tinnitus patients. In evaluating and managing tinnitus, it is helpful and worthwhile for audiologists to work with a multidisciplinary team approach.

Prior to recommending or beginning any treatment for tinnitus, it is essential that a differential diagnosis be attempted. It is important to consider the entire person, not merely the audiogram and/or the characteristics of the tinnitus. There are many factors that can cause and affect tinnitus and its perception that will influence the management plan and outcome of any treatment.

The basic tinnitus evaluation (beyond the audiologic examination) should consist of the following measures:

Comprehensive case history including, but not limited to, questions regarding time of onset, course of progression, description, location, perceived cause, extent to which the patient is bothered, exacerbating factors (such as food, stress, lack of sleep, etc.), history of noise exposure, medications, familial history of hearing loss or tinnitus, effect on sleep, and effect on personal/social/occupational relationships.

  • Loudness discomfort levels
  • Minimal masking level
  • Subjective questionnaires; There are several valid and reliable surveys designed to measure the disability and handicap associated with tinnitus.
  • Professionals that specialize in the assessment and treatment of tinnitus also may find additional audiologic procedures useful for diagnosis and counseling.


Tinnitus Patient Management Procedures
Similar to the evaluation process, the treatment of patients with tinnitus is most likely to succeed when a multidisciplinary approach is employed. While it is true that at this time there is no cure for most cases of tinnitus, it is not true that "there is nothing that can be done about it". A number of treatment approaches that can be performed by audiologists have been described with various degrees of reported success.

They are listed below along with a brief description:
1. Counseling
A trained professional counselor can be very helpful whenever the tinnitus becomes problematic. Counseling should be considered both as a primary approach, when appropriate, and as an adjunctive approach, to all treatment strategies. Counseling consists of gathering data through careful listening, making adjustments in one's strategies based on that knowledge, and conveying information. Thus, it serves both a diagnostic and therapeutic function.

2. Cognitive Behavioral Therapy
One type of counseling that may be successful in helping people cope with tinnitus is cognitive behavioral modification therapy. This approach can help persons identify the way they react to their tinnitus and learn new responses, thereby minimizing the negative thoughts and behavior patterns that are associated with tinnitus.

3. Habituation & Tinnitus Retraining Therapy
Tinnitus Retraining Therapy is a method developed to facilitate habituation to tinnitus. It combines sound enrichment therapy with directive counseling. Sound is employed to reduce the contrast between silence or ambient noise and the perception of the tinnitus. It may be in the form of environmental sounds, amplification, or broadband sound generating devices. A reduction of the perception of the tinnitus (but not complete obliteration of it) is considered essential to the process of habituation. Counseling and education serve to demystify tinnitus, providing the patient with an intellectual and emotional framework in which habituation can occur.

4. Hearing Aids & Tinnitus Instruments
For individuals with hearing loss, environmental sounds may be inadequate in themselves to afford relief. However, amplifying them with the assistance of hearing aids may provide enough background stimuli to give tinnitus relief, while simultaneously enhancing the individual's listening and communication abilities. If hearing aids alone are inadequate, tinnitus instruments may be of help. Tinnitus instruments are devices that provide amplification, and add the option of an independently controlled broadband sound generator.

5. Maskers & Home Masking Devices
Maskers are used to cover-up the tinnitus perception with a competitive signal that either partially or completely competes with or conceals the tinnitus. This can be achieved by a number of methods, ranging from environmental masking to ear-level worn sound generators. Also, there are commercially available recordings of a wide range of sounds that can provide complete or partial masking. In addition to their masking effect, these sounds may assist in relaxation.

6. Self-help and Support/Education Groups
Some people find help, stay informed on the latest information, and share treatment experiences by talking to others with similar problems. These groups should be facilitated, or at least attended, by an audiologist or a psychologist (to prevent misinformation from being conveyed) and may include lectures from a variety of related disciplines.

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Hearing Aid

The most common misperception about hearing aids is that they provide normal hearing to wearer- but this is NOT SO….

Hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aid technology is constantly evolving and becoming increasingly advanced. Modern hearing aids are small high-tech computers, which are constantly being refined and developed to provide a better reproduction of natural human hearing. This progress allows for increasing numbers of sophisticated features to be built into the hearing aids and provide improved sound reproduction. The ability to adapt the hearing aids to individual demands with respect to your daily environment and type of hearing loss is constantly improving.

Among the various hearing needs concerns, we know one of the age-old concerns is to be able to hear and understand speech in noisy situations such as at meetings, crowded restaurants. Today’s hearing aids possess more powerful noise reduction ability and enable more precise frequency increments’ adjustment so as to enhance speech clarity to help you hear better.

A complete range of hearing aids, coming in different styles with varying degrees of power ensures that every individual can find the most suitable hearing aid to address their hearing need. In general, the higher the extent of hearing loss, the larger and more powerful the hearing aid required.

Hearing aids can be divided into five categories:

  • Behind-the-ear hearing aids
  • In-the-ear hearing aids
  • In-the-canal hearing aids
  • Invisible-in-the-canal hearing aids
  • Receiver-in-the-canal aids

Behind-the-ear hearing aids (BTE aids): BTE hearing aids consist of a case which hangs behind the pinna. The case is attached to an earmold or dome tip by a traditional tube, slim tube, or wire. TEs are generally capable of providing more output and may therefore be indicated for more severe degrees of hearing loss. However, BTEs are very versatile and can be used for nearly any kind of hearing loss. BTEs come in a variety of sizes, ranging from a small, "mini BTE," to larger, ultra-power devices. Size typically depends on the output level needed, the location of the receiver, and the presence or absence of a telecoil.
In-the-ear hearing aids: In the ear aids (ITE) devices fit in the outer ear space (called the concha). Being larger, these are easier to insert and can hold extra features.They are sometimes visible when standing face to face with someone. ITE hearing aids are custom made to fit each individual's ear. They can be used in mild to some severe hearing losses.

In-the-canal hearing aids: ITC aids are generally not visible unless the viewer looks directly into the wearer's ear. These aids are intended for mild to moderately severe losses. Completely-in-the-canal(CIC) hearing aids fit tightly deep in the ear and is barely visible.

Invisible-in-the-canal(IICs): Invisible in canal hearing aids (IIC) style of hearing aids fits inside the ear canal completely, leaving little to no trace of an installed hearing aid visible. This is because it fits deeper in the canal than other types, so that it is out of view even when looking directly into the ear bowl (concha). A comfortable fit is achieved because the shell of the aid is custom-made to the individual ear canal after taking a mould.

  • Receiver-in-the-canal (RIC): Receiver-in-canal (RIC) hearing aids sit behind the ear and deliver sound directly into the ear. This is because the receiver is located outside of the hearing aid itself and instead inside ear canal. The hearing aid and receiver are connected by a discreet ‘receiver wire’ which houses an electrical cable.These aids provide more natural and crisper sound quality given the receiver is located inside the ear canal.
  • Can often be more discreet and invisible than custom invisible-in-canal (IIC)and completely-in-canal (CIC) hearing aids.

Contra Lateral Routing of Signal (CROS) hearing aids For individuals with one good hearing ear and one profoundly impaired ear, picking up sound from the poor ear can be difficult. This group of patients with single-sided hearing loss will always face difficulty with the speakers are not position on the side of the good ear. CROS hearing aids are designed for these patients. CROS aid consists of two parts:

1. The CROS aid has a microphone that picks up sounds and voices from the non-hearing ear and wirelessly transmits them to the hearing aid on the other ear.
2. The hearing aid receives signals from the non-hearing ear and plays it to the good ear.

Our team of experienced and qualified audiologists first undertakes diagnostic hearing evaluation then hearing conservation strategies are discussed & subsequently if required Hearing aid trial/fitting is suggested. As per requirement, we dispense a wide variety of hearing aids including the most advanced technology currently available.

You will first need to have your ear & hearing examination done. Additional testing in the sound proof room may be done in the clinic. The hearing test will provide a starting point for determining hearing aid candidacy.

Hearing Aid Trial (HAT)/ Selection:
This appointment allows you the opportunity to sit down with the consultant and discuss the different kinds of hearing aids available today. A family member is welcome during the hearing aid selection process for the required discussion & a decision will be made as to which hearing aid (or aids) is most appropriate based on your hearing loss and individual requirement/specific listening demands.

Impression(s) of the ear(s) will be taken at this time, if needed.

Hearing Aid Fitting:
A few days after the selection, you will return for the hearing aid fitting. This appointment is also scheduled for 25-30 minutes. At this time, you will be instructed regarding the proper care, use, and maintenance of the hearing instrument(s). Realistic expectations and initial experiences will be discussed.

Hearing Aid Follow up:
After your hearing aid fitting, future follow-up appointments will be scheduled. There will be Two (2) follow-ups (complementary) scheduled within one week & then within one month of adaptation. Thereafter, Once in a year/ routine follow-ups ( on chargeable basis) as per required for future/further improvement.

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Ear Molds

An ear mold is a piece of acrylic plastic or other soft material moulded to precisely fit in the ear and to deliver the sound from a BTE hearing aid. When an individual suffering from hearing loss chooses a behind the ear hearing aid design, customized earmolds are frequently needed to ensure proper fit and performance.

At ‘Priority’ our audiologist makes an impression of the empty parts of your outer ear and ear canal using a quick drying (usually) silicone impression material. The impression is sent to a lab, which then creates an ear mold which will fit into your ear.

The styles of earmolds can vary and the style you choose depends on the type of hearing loss you suffer from and the design of the hearing aid you have. Ear molds are usually clear or frosted, but many hearing aid users now select brightly colored or decorative ear molds. Some designs are meant to make the ear molds less visible, and some are meant to make them more

Types of Earmolds
1. Dome-style Molds Dome-style and soft earmolds are often combined with behind-the-ear (BTE) hearing devices and are placed in the ear canal. A BTE aid, which is worn behind the user’s ear, transmits audio to the earmold by way of a flexible and thin tube.

2. Canal Earmolds
Canal earmolds are similar to earmolds with dome-fashioned designs. These molds are made from the ear canal impressions and are designed to look inconspicuous. They also offer a customized fit and good audio retention for the wearer. The patient needs to have a fairly long ear canal for the mold to fit precisely inside. No part of the mold extends inside the concha bowl. Instead, the piece is completely fitted within the ear canal.

3. Full-shell Earmolds
Full-shell earmolds are designed to supply optimum hearing aid retention. They are sculpted to look natural and are really popular among hearing aid patients. They prevent annoying feedback and are recommended for moderate to severe loss of hearing.

4. Skeleton Earmolds
Skeleton earmolds are designed with cosmetic enhancement in mind. The molds, which feature a back ring, supply maximum comfort. A rim of material is used to hold the mold within the concha and create an effective seal. In addition, skeleton earmolds are made for people suffering from mild to severe hearing loss.

6. Half-shell Earmolds
Earmolds that are called half-shell molds are sculpted like full-shell molds; however, the material that is used in half-shell earmolds is cut and designed to cover the concha bowl’s bottom half. Patients who choose this mold need to have adequate ear retention. Moreover, individuals suffering from mild hearing loss often opt for these kinds of molds.

Non-hearing aid users may use earmolds, too. Custom earmolds are a great way to protect your hearing from loud sounds at work or at play. Musicians, stock car racers and even some professional football teams use earmolds with an acoustical chamber which blocks most noise while still allowing the wearer to understand speech.

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Swimming Ear Plugs

Custom swimming ear plugs are the very best ear plugs for swimming because of their superior fit, remarkable durability and lifespan, and excellent ability to seal water out of the ear canals. Each pair of custom molded swimming ear plugs is made from impressions taken of your ears to fit you and you alone. Using your impressions, custom earmold lab technicians will craft a set of custom swim plugs that will fit your ears perfectly and provide you with the very best comfort and water blocking capabilities you can get from an ear plug for swimming. These custom-made earplugs do not have filters and completely seal the ear canal from water. This way, you reduce the risk of inflammation and enjoy activities in and on the water with no worries.