Ask the Audiologist

‘Hear’ is a subject near and dear to my heart…ears!!

Yup, I am an audiologist with 17 years experience. I have my Bachelor’s degree in Human Communication Disorders, and my Master’s degree in Audiology. I am currently working on my Doctoral degree in Audiology. In my years of practice, I have worked in a hospital setting with newborns, children, and adults. I have also worked in a private practice setting with ENTs (Ear, Nose and Throat physicians) and currently work in the manufacturing sector for a major hearing aid company.

Naturally, I can handle questions about the purchase and use of hearing aids and hearing aid technology. I can also answer questions about hearing loss, hearing loss prevention, and what to expect when undergoing a hearing test (for infants, children, and adults). I can also address such issues as earwax buildup, methods of cleaning wax out of ears, ear infections in children, and similar problems.

In addition, I am familiar with such alternative technologies as cochlear implants, middle-ear implants, and bone-anchored hearing aids.

As I am not a medical doctor, I cannot (and will not attempt) to answer questions about surgical or drug treatments. Regarding cause of hearing loss, often there may be one or more causes and only a medical physician can specify the cause in most cases. I can give some insight based on my experience, but my comments are in no way intended to replace proper medical advice. If you have a medical condition of any type, you are advised to seek the counsel of a qualified physician; and if I feel your question warrants a physician’s advice, I will say so.

So…if you have any questions, I will do my best to answer them as quickly as possible.

I’m not sure I completely understand what an audiologist does. Will you explain your vocation in greater detail, please? Thank you!

Ok - in all seriousness - I am in my mid thirties and I will be the first to admit I may be getting some hearing loss. My wife has to call me sometimes three times before I hear anything, and if there is background music forget it I can’t hear anything, or if I do it’s garbled as hell. I have had some sort of discharge from my left ear I have been neglecting. I clean it out sometimes two, three times a day. What gives? If it helps my father has double hearing aids - the kind you can barely see - and he is 68. But he has needed them for at least 15 years.

I have no problem when I am in front of someone, I hear them just fine. But if someone calls my name from another room, forget it… Could it just be a build up in wax? If so how do I get rid of it?

This was a question about “perfect pitch”, which I suspect is a musical and not a scientific term. Anyway, there used to be a sound based game at Chicago’s Museum of Science & Industry. A machine played a random tone for a couple of seconds – then you the player got to hit a button and use a dial, to generate another tone and to modulate it – the goal being to match the original tone. After you match the tone as best you can, you hit the button again and it would tell you how close you came – reading out the original tone and your match in terms hertz. As a kid, I could do this extremely well, apparently – lights flashed and some whistle like thing sounded and it even dispensed this novelty-coin thing as a “prize”. I was able to consistently match the tone within 5 hertz, and usually within 1 or two hertz.

Is this what thay would call perfect pitch? How unusual is this?

BTW, I had a kind of cheat. I would hum to match the tone, and I could actually hear a fluttering sound when I was dead on, which I later figured was some kind of phase cancellation. Anyway, I would sustain my hum after the machine stopped, and then match my tone to my hum. Worked every time.

I am aware the repeated exposure to loud noises will cause tinnitus. I work in an evironment that can be noisy at times and do wear hearing protection when required. Most of my work though is in the interior of Boeing 737’s, with all the sound proofing built into airplanes, the noise level is rather low. Plus we have mandatory hearing tests and training once a year, my hearing based on these these tests is great. The past couple of nights right at bed time I have notice a ringing in my right ear. It’s just annoying enough to make getting to sleep difficult. It has stopped by the time I get up for my midnight bathroom break. The only thing I have been doing lately that I can figure that is causing the problem is a lot of moving of stuff in a dusty garage. This has caused some stuffiness in my nose and I have felt like I have a cold coming on. Can stuffed up sinuses be the cause of the tinnitus?

I’m looking forward to the answers to some of the questions already posed. Like Plilosphr, I have a lot of difficulty hearing over background noise. I’ve had several people, w/ hearing aids, reccomend that I get one, but they’re quite expensive and I’m hesitant to spend the money w/o knowing how much help it will do me. Frankly I think there’s a lot of hype and scam in the hearing aid industry.

MissMossie: What an audiologist does….

Great question! The short and simple answer is to compare what I do to what an opthamologist does. Just as they measure your eye problems and write a prescription for glasses, so do I measure your hearing loss and write a prescription for a hearing aid. But as the opthamologist must know so much more about eyes (anatomy, underlying causes of problems, when to refer to physician, etc.) so must I know the same, but for ears and hearing.

The long answer is quite complicated. The profession of audiology is a one that is stimulating and challenging. It is a terrific blend of science, technology, and psychology. The science part includes the life sciences, physics, and electronics. The technology part includes using diagnostic computers for testing the sense of hearing and balance as well as hearing aid techonology. Sometimes the tests are behavioural, other times the tests are electrophysiological (use of electrodes or probe mics). Some tests are quick, others are quite involved and somewhat invasive. The psychology part includes such things as counselling patients and their families about their hearing loss and how to cope. Additionally, and especially when dealing with children, we need to be able to work with other professionals; as in some cases, there are genetic or emotional issues (e.g. is the child’s delayed speech development due to being unable to hear language, or due to some other problem?) that need to be addressed.

Audiolology is a profession that is multi-faceted as one can work in a variety of settings, but most audiologists will specialize in one of the following areas:

[li]Educational Audiologist: school board wth children[/li][li]Diagnostic Audiologist: medical setting providing diagnostic testing and prescriptions/folllow-up for hearing aids[/li][li]Intra-Operative Monitoring: specialty of audiology in medical setting[/li][li]Industrial Audiologist: hearing conservation and occupational health and safety role[/li][li]Expert witness: testitify in legal proceedings[/li][li]University professor: teach in an undergraduate or doctoral program[/li][li]Rehabilitative Audiologist: work with client and their familes to navigate through the eduational and resource options for dealing with hearing loss or deafness.[/li][li]Research Audiologist: work with engineers and scientists to learn more about human anatomy and physiology and/or hearing aid technology[/li][/ul]

I’m currently none of the above, but I’ve had experience in most of the above fields. My current job with a hearing aid manufacturer blends many of them, since I provide peer training and consultation for all the different audiologists who work with our hearing aids and the software that programs and drives them. Since I’m an accredited and licensed audiologist, I can also “get my hands on” their patients if they have a particular problem when trying to fit one of my company’s hearing aids. As a result, my experience in “most of the above” is a perfect fit for my job, since having experience in the above varied roles, I can deal with the different kinds of audiologists in the above roles, and their patients.

One needs good people skills and a genuine interest in helping others. One must also be prepared to continually learn and push his or her limits to stay on the cutting-edge of the technologiess and test methodologies that are emerging. The job brings a great deal of personal and professional satisfaction and allows one to move around into a different area if burn-out occurs, which is generally quite rare.

Are you seeing many teenagers or college students with hearing loss? I know this sounds old fogey of me, but as a teacher, I’m astonished by how poor some of my students’ hearing is, and it’s not them ignoring me. The occasions it has come up has been where my students think they’re whispering about something they don’t want me to hear, and I can hear them plainly from ten or more feet away. They’re always shocked when I call them on it, and I suspect that they are honestly speaking as quietly as they can and still hear each other.

My hearing isn’t the best out there. I know I’ve taken some damage from loud concerts and the like. I have a little bit of tinnitus and if there’s background noise, sometimes I have to get someone to repeat what they said so I can understand them. Even with that, apparently, my hearing is better than my teenage students. Is this something you’ve run into?


To A.R. Cane:

Thanks for the question. You are right, there is a lot of hype in the hearing aid industry. Keep in mind that the industry is separate from the individual selling the product. The industry supplies the product to the seller. More on this, and hype and scam, a little later, but there are a couple of things I want to tell you up front:

First, check with your local laws, as most states and provinces require a minimum of a 30-day trial for a hearing aid. Once the aid has been fitted, you will be able to wear the aid in your own daily situations to determine if it will be helpful or not. There will likely be some necessary follow-up visits to get the hearing aid ‘fine-tuned’, based on your observations and experiences. No hearing aid will be perfect and restore hearing to 100%, but most people find them to be very useful and are quite satisfied.

If you do not believe you are getting that satisfaction that you feel is worth the money you are paying, it is within your right to return the hearing aid and you should get at least most of your money back (within that 30-day trial period). Most sellers (hearing aid dispensers or audiologists) will likely charge a fee for their professional time and service, as well as the cost of an earmold ( if one was ordered). The terms and conditions should be printed on the bill of sale, so be sure to read the fine-print. In some states or provinces, the person selling the hearing aid is required to notify you of your rights. If you do not feel the person you are dealing with is being honest and you are not comfortable with the way your questions are handled, take your business elsewhere.

Sadly, there can be scams. I’ll illustrate with a comparison.

Hearing aids are sold like new cars. For example, Ford makes cars in Detroit. Ford gets an order from Joe Smith’s Ford dealership in, oh, say, Denver. Joe Smith is, like all car dealers, an independent business that has a contract with Ford to sell new Ford cars exclusively. Ford fills Smith’s order correctly and ships the cars from Detroit to Denver. Smith then makes all kinds of outrageous claims about his new shipment of Fords (say, “they get 100 mpg”), and consumers buy the cars. When the cars do not live up to Smith’s claims, who is at fault? Smith, of course, but some consumers will undoubtedly blame Ford.

This is the situation hearing aid manufacturers find themselves in. Once the hearing aid leaves our factory, we have no control over how it is marketed or hyped to consumers by sellers, but we do face some of the consumers’ misdirected ire. We know that no hearing aid can cure deafness or restore hearing to 100%, but we hear of some outrageous claims coming from sellers. In fact, any claims we manufacturers make about our aids must be backed up by lab research results and will be verified by the FDA (and similar authorities in other countries) before we can make our claims public. Sellers are not necessarily subject to these restrictions. We do what we can to stop sellers making outrageous claims, but we are not always successful. Towards this end, hearing aid manufacturers are starting to advertise and market to consumers (like car manufacturers do), so that consumers are informed when they visit a seller.

You’ll notice I’m using the term “seller” instead of “audiologist.” This is because in some states and provinces, audiologists are not allowed to advertise. But sellers can. Sometimes, an audiologist and seller will team up to open a clinic where the audiologist tests and prescribes and the seller fills the prescription. This is fine, but it allows the audiologist to tacitly advertise by piggybacking on the seller’s advertisement: “We have welcomed audiologist Sue Jones to our clinic,” for example.

You may well ask why we manufacturers continue to sell to shady and/or questionable sellers. In addition to the fact that we often do not know which sellers are shady or questionable, the answer is that we are not a governing body (for example, the state licensing board or professional college of audiology) nor can we police individual businesses in their communities, which may or may not have different consumer protection laws and regulations. It is the responsibility of the consumer to report these activities to the authorities in their jurisdiction, just as it would be the responsibility of Joe Smith’s Ford customers to report his false advertising to the authorities in Denver, Colorado, so they can investigate and take any necessary steps to resolve the problem. Sadly, most consumers will not take this step, so change doesn’t happen.

I’ll address the other questions that have arisen (from Philosphr, Boyo Jim, and racer72) in another post—I can combine answers to some of their individual questions, so I’ll try to be efficient in my response. And I’ve gotta remind myself that not every question requires a long essay-type answer!

Added on preview: Least Original User Name Ever, if I had a dollar for every time I ever got that, I could retire comfortably.

Could you evaluate Starkey Laboratories, Inc. ? Are their products good? Would you work for them? Invest in the company? Thanks!

Philosphr’s question on a discharge, and on background noise…

For the discharge from the left ear, you should consult your family physician. It most likely is something that can be remedied, but only your physician can say for sure what it is; and what, if any, remedy is possible.

As far as not being able to hear with background noise or from a distance, there is a chance that there may be some hearing loss. Overall, most public places are more noisy in general. Some of the background music in certain restaurants is almost overwhelming when trying to carry on a conversation. But, it is true that a person with a hearing loss will experience more difficulty in background noise than a person without a hearing loss. Why?

The answer is based on a couple of things. First, an ear that is functioning normally not only brings in sounds from the environment, it also naturally suppresses some of the background noise. When hearing is abnormal due to some degree of hearing loss, the ability of the ear to naturally suppress the background noise is compromised. The ‘noise suppression’ ability is no longer there, so the ear is essentially ‘less efficient’ in background noise. This can be incredibly frustrating.

Second, hearing loss basically acts like a filter. Speech is made up of many frequencies- some are high pitched frequencies (like /s/, /sh/, /t/, /th/, /f/) which are responsible for the ‘clarity’ of speech; some are low pitched frequencies (like /m/, /n/, /ng/,/zh/, /o/) which are responsible for loudness. If you are missing any of the frequencies (partially or completely) you are essentially listenting to ‘filtered speech’. Most often, it is the high frequencies that deteriorate over time (due to a pesky phenomenon known as aging) or with hazardous noise exposure. Persons with these types of hearing losses often report they cannot hear well in background noise.

So, we have a hearing loss that is basically filtering out critical speech sounds, but then when there is background noise, the noise itself will mask some of the critical speech frequencies, making them even harder to hear. This is why a person may not have trouble hearing in quiet as some of those critical speech frequencies are not masked. Also, if someone is speaking to you directly (at a usual distance of about 2-3 ft.) their voice is directed to you and the volume is favourable. Each step backward the speaker takes will roughly reduce the loudness by half. With this nifty law of physics, speaking to a person (especially one with a hearing loss) from any great distance or from another room is an exercise in frustration for both parties. Just don’t do it. (Yes, this is much easier said than done!)

As adults, with a lifetime of language exposure, a mimimal hearing loss can be classified as an annoyance, but once the hearing begins to deteriorate further, the frustration level can increase. Given the redundancy of the English language, it is possible for the brain to ‘fill in the blanks’ so the person thinks he or she is ‘hearing everything’. As the hearing loss progresses, this ability to ‘fill in the blanks’ is no longer possible as too much information is missing.

Ideally, a person should pursue hearing aids earlier rather than later. Research supports that not aiding an ear will not necessarily lead to further loss, but may contribute to a degredation in the discrimination ability (ability to recoginize or discriminate what is being heard). The ears are designed to be used, and with a hearing loss, there is a compromise to the input, and over time, the brain will adjust to the lack of input, generally in a negative way. In some case, aiding the ear can reverse this, in some cases, not.

Hope that answers your question–I could get more detailed, but then I’d be writing something akin to a master’s thesis. Did I answer your question?

GKW, with all due respect, I’d rather not get into the pros and cons of specific manufacturers. I’m sure you could find information–including investment information and advice–on Starkey easily enough from other sources though.

Okay, now to address racer72’s questions about tinnitus:

I wonder if the stuff you are moving is at all heavy. There is a great deal of blood supply to the inner ear, and sometimes exertion can cause strain on the blood vessels and there can be a resulting tinnitus that will vary among persons- a pure ringing or even a pulsing tonal sound. You are correct as well that a sinus problem may be related to tinnitus. If it persists, you would be wise to consult your family physician. In many instances, the exact cause for tinnitus cannot be determined which can leave not only the patient frustrated, but the medical professionals as well.

For what it’s worth (and so you can feel good about your regular use of hearing protection at your job), I’ll add that sometimes following exposure to loud noise (loud music, industrial noise, or gunfire) there may be a ringing in the ears and the ringing will generally go away in about 10-12 hours. What is happpening is that the hair cells in the inner ear are affected by the loud noise–they actually swell up, and it is during this ‘swelling up’ that a ringing noise will be heard. Over the course of 10-12 hours, the swelling will go down (as the hair cells recover), and the ringing noise will go away. If this keeps happening over time, the inner hair cells will lose their ability to ‘recover’ and the damage will be permanent, and it may be accompanied by a permanent ringing (or tinnitus). This is how hearing is damaged over time with repeated noise exposure.

I hope in your case, once the garage work is completed, and the sinus issue is resolved, the tinnitus will go away.

Honestly, this is a little outside my experience. From what I recall of childhood music lessons, “perfect pitch” is the ability to identify a note–say if the pianist played a certain note, the person with perfect pitch could respond “That’s an F-sharp,” or similar. But this is really outside my experience, and I can’t help with this question.

This I do know a little about, since it has to do with the physics of sound. It doesn’t sound like phase cancellation to me, but instead, I think you’ve described a “beat.” This is not the “it’s got a great beat, man” sense, but rather a term used by hearing scientists (known in the field as “acousticians”) to describe the phenomenon of “Periodic variations that result from the superposition of two simple harmonic quantities of different frequencies. They involve the periodic increase and decrease of amplitude at the beat frequency (frequency 1 minus frequency 2).” This is what I think you are hearing when you would hum the tone and could match it to the tone generated by the game at the museum.

By the way, your question is the first to send me to a reference book. The quoted material above is adapted from Yost and Nielsen’s Fundamentals of Hearing: An Introduction, 2nd Edition, (New York: Holt, Rinehart and Winston, 1977). Thanks for sending me down memory lane!

I have another tinnitus question. Eleven years ago, I hit a concrete abutment in the dark and went over the handlebars of my bike, landing on my face. I have had a high-pitched tone in my ears ever since. It’s not enough to drive me insane, or obscure other sounds, but it’s always there. Can anything be done for it, or will I have to live with it forever?

Are teenagers losinh hearing due to the widespread use of 'ear bud" earphones? They also tend to listen to very loud music-it seems that listening to very loud music, for a long time, is causing hearing losses. So, will there be a big market for hearing aids in 10-20 years?

Now for phouka’s question about teens and college students, and hearing loss. This should address ralph124c’s question as well. Hearing loss in young people is an issue that is near and dear to me, so I’ll take a deep breath and continue…

I should state first that I’ve seen people of all ages. Hearing loss isn’t limited to senior citizens. But I have noticed that I see young people more frequently than I used to. Certainly, it is safe to say that the incidence of noise-induced hearing loss is increasing among school- and college-aged people. And noise-induced hearing loss is 100% preventable, with education and changes in attitudes and behaviors.

The reason for the increase in such a hearing loss is simple: young people today listen to music that is too loud through technology that can deliver decibel levels of the sort that would mandate hearing protection in industrial or work situations. An IPod,as I understand it, can deliver sound levels of over 100 dB. For comparison’s sake, a jackhammer subjects its operator to about 100 dB. But the jackhammer operator must wear ear protection, under most OSHA rules. Our kids don’t, and they listen to that level on their IPods! And they do so through earbuds that pretty much shoot sound straight at their eardrums. Note that I don’t mean to pick on IPods specifically; my ire is directed at manufacturers of any personal stereo and/or earbuds that can put out that level, and beyond. And car audio manufacturers, and so on. And of course, young people do also go to concerts, nightclubs, and other loud places; and do participate in activities that have hazardous sound levels (for example, motorcycling, snowmobiling, etc.).

Of course, any pleas or entreaties from parents, teachers, and health professionals to turn it down are met with eye-rolling and “if it’s too loud, then you’re too old.” Because the kids are getting the message from a number of much cooler sources that loud = good. For example, a few years ago, Sony Playstation was advertised with the slogan “Play It Loud.” The film Spinal Tap is about a band that is proud to have amps that “go to 11.” A local school program in my city (Calgary) that provides free rock concerts to high schools during which students are advised of city programs and services for youth is called the “Loud Lunch” program. Ironically, this program also promotes healthy lifestyles–anti-smoking, for example–but as far as I can tell, it does not address hearing health care. There are numerous other examples, and undoubtedly, peer pressure plays a part too. But kids are surrounded by the message that loud = good. It is entirely possible, IMHO, that the reason your students whisper loudly is because they’ve taken this message to heart, and now they can’t hear each other at any softer level.

In one sense, young people cranking up the volume makes sure that I remain employed, because if today’s teens continue as they are, then tomorrow, they will be my patients (and hopefully, my company’s customers). But in another sense, I find it to be a very sad thing, since hearing loss for this reason is so easy to prevent. You can lessen your risks of cancer and heart disease through not smoking, and our children have learned this very well; but why can we not manage to teach them that they can lessen their risk of hearing loss if they only turn it down? We’ve made it “cool” not to smoke; how do we make it “cool” to listen at a reasonable level?

Note that I’m using “reasonable level” to describe that at which you can still hold a conversation without yelling.

As a teacher, phouka, you may be interested in the Dangerous Decibels program. It calls itself a “public health partnership for prevention of noise-induced hearing loss,” but most importantly for you, it has an outreach program designed for schools and a teacher’s guide. I don’t know if the outreach program extends as far as Texas, but there is plenty that is downloadable from their site, and you can begin to understand more on this topic.

Fishbicycle, my remarks for you are coming next. I’m unsure if I can supply an answer for you, but I will give it some serious thought and address your post somehow.

Thank you!

That’s what would be called “pitch memory”. Perfect pitch is sort of a “super” pitch memory: Wikipedia defines it as “the ability to identify or sing a musical note without the benefit of a known reference.”

In addition to simple pitch memory, what such a device as you describe measures is how accurately your ears can identify minute differences in pitch. This has more to do with “relative pitch” than “absolute pitch”.

You know when you go and sit in that box with the earphones and it goes ‘doo doo doo doo doo’? Why do they make it go ‘doo doo doo doo doo’ in a pattern? Cos even if you can’t hear it you can just press the clicky thing in time with your memory of the pattern. Always bugged me that.