What is Hearing loss. A common problem

You know what hearing is, but what is hearing loss? Hearing loss, or hearing impairment (say: im-pare-ment), happens when there is a problem with one or more parts of the ear or ears. Someone who has hearing loss or impairment may be able to hear some sounds or nothing at all. Impairment means something is not working correctly or as well as it should. People also may use the words deaf, deafness, or hard of hearing when they're talking about hearing loss.
About 3 in 1,000 babies are born with hearing impairment, making it the most common birth defect. A hearing problem can also develop later in life. To understand how and why hearing loss happens, it helps to know how the ear works.

How Hearing Works

The ear is made up of three different sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.
When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.
The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. There are two types of hair cells: the outer and inner cells. The sound vibrations make the tiny hairs move. The outer hair cells take the sound information, amplify it (make it louder), and tune it. The inner hair cells send the sound information to your hearing nerve, which then sends it to your brain, allowing you to hear.
There are more than 500 million people experiencing diminished hearing worldwide. And unfortunately the number is rising. An estimated 60% of these go undetected, and 40% of all cases go untreated – don't be one of the statistics that suffer in silence.

What Problems Can Affect The Inner Ear?

There are many conditions that cause the delicate inner portion of the ear to function abnormally. They include:

• Otosclerosis
• Presbycusis
• Fistula
• Head injury
• Meniere's syndrome
• Noise
• Infections
• Sudden deafness
• Neural problems

Otosclerosis
Otosclerosis (the hereditary disease in which bone deposits collect around the small bone in the middle ear known as the stirrup) can also affect the cochlea (the coiled tube in the inner ear), and cause hearing loss in some people.
Presbycusis
The natural aging process also causes sensorineural hearing loss, in which the damage lies in the inner ear, the hearing nerve, or both. Beginning shortly after birth, we begin to lose hair cells and nerve endings within the cochlea (the region that hears very high frequencies). As this loss pattern progresses over a lifetime, sensorineural hearing loss develops.
There also are other age-related causes of hearing loss, including stiffening of portions of the cochlea and loss of nerve endings in the acoustic nerve.
Fistula
A fistula (opening) is an abnormal connection between the inner ear and middle ear. The inner ear is filled with fluid, and the middle ear is filled with air. If a fluid leak occurs from the inner ear, hearing loss and dizziness commonly result. This kind of hearing loss often is cured by surgically repairing the fistula. Such leaks are usually caused by trauma. The trauma may be direct, such as a blow to the ear or a head injury in a car accident. However, it may also be the result of air pressure changes in an airplane trip, a forceful sneeze, or lifting a heavy object.
Head injury
Direct head trauma, particularly trauma severe enough to cause unconsciousness, can cause inner ear concussions and hearing loss.
Meniere's syndrome
Meniere's syndrome is a condition characterized by fluctuating hearing loss (usually more prominent in the lower frequencies where we hear speech), dizziness, fluctuating ear pressure, and tinnitus (a noise sensation heard in one or both ears). It is due to a swelling and fluid overload of the middle compartment of the inner ear (a condition known as endolymphatic hydrops).
There are many treatable causes of Meniere's syndrome. When all tests have revealed none of the known causes, the condition is classified as Meniere's disease.
Noise
Noise is an important cause of hearing loss. An estimated 7 to 10 million people in American industry have noise-induced hearing loss, virtually all of which was preventable. In addition to industrial noise, recreational noise can damage hearing. Such noise is encountered commonly from gunfire, power tools, snow blowers, motorcycles, loud music (especially with earphones) and other causes.
In some cases, the playing of musical instruments can damage hearing. This has been reported not only with loud, electrical rock and roll instruments, but also with classical music performance such as violin playing and flute playing. One can minimize such problems by using ear protection whenever practical, such as during selected practice sessions.
Infections
Infections involving the inner ear and hearing nerve can also produce deafness. Middle ear infections can spread to the inner ear, causing loss of hearing and, usually, dizziness. Infections may also involve the hair cells or acoustic nerve, causing hearing loss and even sudden total deafness.
For more information about middle ear infections, go to Middle Ear Infection.
Sudden deafness
Sudden deafness may be caused by a variety of problems. Treatment is controversial, but there is some evidence to suggest that aggressive treatment may improve the chances for hearing recovery even after a sudden profound loss. Once the condition has been present for more than two or three weeks, even the most aggressive treatments generally do not work.
Neural problems
Neural (nerve-related) problems may also produce hearing loss. Among the more common are:

• Acoustic neuroma, a common tumor of the acoustic nerve
• Multiple sclerosis
• Autoimmune sensorineural hearing loss, in which the body attacks its own ear
• Ototoxicity, which is hearing loss caused by a substance that gets into the body; most often the substance is a medication, particularly certain antibiotics, but other toxins (such as lead) may also cause hearing loss

Need To Know: What is an acoustic neuroma? An acoustic neuroma is a common tumor of the acoustic nerve, the nerve responsible for hearing. It generally starts in the internal auditory canal, the bony channel through which the nerve courses as it goes from the ear to the brain. Acoustic neuromas grow, compressing the brainstem and other structures, including the facial nerve. Ordinarily, these tumors can be cured with surgery. They are managed best by neurotologists, inner ear subspecialists with particular interest and expertise in treatment of this specific tumor. Neurotologists often work in collaboration with a neurosurgeon. In the majority of cases, it is possible to remove acoustic neuromas without serious injury and without facial paralysis. In some tumors diagnosed early, it is even possible to preserve hearing (despite the fact that the tumor has its roots in the acoustic nerve).

What Other Conditions Can Cause Hearing Loss?

A number of other problems can cause hearing loss, particularly sensorineural hearing loss. Many of them are very common conditions that are not always associated with hearing loss. They include:

Common Childhood Infections

Mumps is the most common cause of one-sided total deafness in the United States. Frequently, the child and family are not aware of the hearing loss until years later. Other childhood infections, such as scarlet fever, may also affect hearing, particularly by destroying the eardrum and damaging the middle ear bones.

Special Infections

Many infections can result in hearing loss, including:

• Syphilis. It can be acquired at birth or through sexual contact, and a person may have it a long time before hearing symptoms occur (sometimes for 30 or more years). Caught early, this form of hearing loss can be cured. However, if it is not recognized and treated, the hearing loss may progress and even become total.
• Lyme disease. This increasingly common infection is spread through the bite of a tick. Lyme disease often causes a rash and joint pain, but these may be minor enough to escape notice. A diagnosis of Lyme disease can be made with blood tests. It is treated with antibiotics.
• Numerous other infections including herpes, cytomegalo virus (CMV), measles, mononucleosis, chickenpox, pneumonia, flu, and fungal diseases may cause hearing problems as well.

Problems With Blood Flow

Insufficient blood flow in the inner ear or related areas of the brain can contribute to hearing loss. This can happen as a result of cardiovascular disease, untreated high blood pressure, and other similar conditions. It also may be present in people whose blood tends to sludge and clot excessively (hypercoagulability), or who have too many blood cells (polycythemia).

Meningitis

Hearing loss is one of the most common consequences of meningitis, especially bacterial or fungal meningitis. Meningitis is an infection of the membranes covering the brain and spinal cord. Anyone who has had meningitis should have a hearing test upon recovery.
For more information about meningitis, go to Meningitis.

AIDS

AIDS is associated with ear infections and nerve damage. Conductive and sensorineural hearing loss both occur in people with AIDS. AIDS is also associated with tumors in the head and neck that can cause hearing loss.
For more information about AIDS, go to AIDS: What is it?.

Tuberculosis

Tuberculosis and other similar illnesses have been associated with hearing loss. The problem may be due to the disease itself or to the medications used to treat the disease (such as streptomycin). Despite the availability of vaccines for tuberculosis, it is becoming increasingly common, especially among people with AIDS and those who come in contact with them.

Arthritis

Arthritis (inflammation of joints) and vasculitis (inflammation of blood vessels) commonly are associated with hearing loss. These include conditions such as rheumatoid arthritis, lupus erythematosus, and others. The hearing problem is probably related to abnormalities in blood vessels from these diseases.

Allergies

It is well recognized that allergic problems in children cause fluid to collect in the eustachian tubes and middle ear. However, in some cases allergies may also cause inner ear problems such as Meniere's syndrome. Allergy treatments usually resolve the problem.

High Blood Pressure

Some conditions associated with high blood pressure (such as hypolipoproteinemia, which is extremely high cholesterol and triglyceride levels in the blood) are also associated with hearing loss. In general, it appears that people with high blood pressure have a higher incidence of hearing loss. They may also be more prone to noise induced hearing loss than others.
For more information about high blood pressure, go to High Blood Pressure.

Thyroid Problems

Hypothyroidism (underactive thyroid) is commonly linked with hearing loss. About half of people with low thyroid function have hearing losses. Moreover, about 3% of people with Meniere's syndrome have hypothyroidism; and in some, control of the thyroid disease eliminates the symptoms of Meniere's syndrome.
For more information about hypothyroidism, go to Hypothyroidism.

Kidney Disease

Many of the things that damage the kidney also damage the cochlea in the inner ear. Parts of the kidney and cochlea are quite similar and can be damaged by the same drugs, for example. Hearing loss is not uncommon in people with kidney disease.

Cancer

Cancers that involve the ear and the brain can cause hearing loss. However, cancers elsewhere may also be related, particularly because many of the treatments for cancer produce hearing loss. Chemotherapy agents can affect the ear. Radiation may also cause hearing loss if the ear is included in the radiation field. Individuals who receive chemotherapy or radiation therapy should have an audiogram (hearing test) before treatment is begun, and usually during and after treatment.

Diabetes

Diabetes is one of the most common diseases in the United States. Although estimates vary from study to study, it appears that about 40 percent of people with diabetes have hearing loss. It usually occurs in both ears and is most severe in the high frequencies. However, Meniere's syndrome may also be caused by diabetes, and sudden deafness can occur.
For more information about diabetes, go to Diabetes In Adults.

Glaucoma

The relationship has been controversial, but it is probable that there is a significantly increased incidence of hearing loss in people with glaucoma, a condition in which there is high pressure within the eye. This is especially true for people with a type of glaucoma called narrow-angle glaucoma.
For more information about glaucoma, go to Glaucoma.

Sickle Cell Disease

About seven percent to nine percent of black Americans carry the sickle cell trait. About 1 in 400 has sickle cell disease, and 20 percent to 25 percent of people with sickle cell disease have sensorineural hearing loss. Sudden deafness has also been reported in connection with this condition, although in some cases hearing will return.

Fainting Disorders

A person who has hearing loss (often severe) along with fainting may have a condition called Jervell and Lange-Nielson syndrome. This hereditary condition accounts for approximately 1% of all cases of hereditary deafness. If hearing loss and fainting occur together, a person's heart should be checked immediately. The fainting can be due to heart arrhythmias (irregular heartbeats) that may cause sudden death.

Tinnitus And Dizziness

Tinnitus (ear noises) and dizziness commonly occur in association with hearing loss. In some cases, both of these symptoms can be effectively treated.
For more information about tinnitus, go to Tinnitus.

Hereditary Diseases And Syndromes

There are many hereditary diseases and syndromes that can lead to hearing loss. The syndromes involve defects in virtually any part of the body. Hearing loss is often hereditary.

• When it runs in families from generation to generation, the hearing loss usually follows a hereditary pattern called "autosomal dominant."
• However, the absence of a family history does not mean that hearing loss is not genetic. "Autosomal recessive" inheritance is common. It means that neither parent has hearing loss, but both carry a gene that causes it. On the average, the hearing loss will be present in one child out of four.

Support and practical information for new or potential hearing aid users, for friends and family, for kids with hearing problems and for their parents.
For modern life With a new, nearly invisible wireless hearing system, connecting lifestyle devices has never been easier.
If your question is not covered in this section,please contact ,

                                                                                                        Khalil 
                +923009009675
                                                                                                      

Hearing Loss, hearing aid, tinnitus, peshawar , pakistan

If you suffer from hearing loss or deafness and don’t know where to find the help and information you need to successfully live as a hearing-impaired person, then welcome to the Center for Hearing Loss Help. It is one of the Internet’s best sources of information on hearing impairment issues and sudden hearing loss.
At the Center for Hearing Loss Help, you will find a wealth of information on the causes of hearing loss and deafness. You will also discover ways to alleviate common ear problems such as Meniere’s disease, tinnitus (ringing in ears), inner ear imbalance, dizziness and hyperacusis. In addition, you will find help in choosing hearing aids and other assistive devices for hearing impaired people.
Check out our amplified phones, loop amplifiers and Music Links. Discover our numerous books on the causes of hearing loss and ways to successfully cope with it. Our goal is to provide you with the knowledge, support, and counsel you need in order to live an exciting and fulfilling life in spite of your hearing loss.
Articles
Many people get the help they need by simply reading our many free, in-depth articles that explain hearing loss and typical ear conditions such as tinnitus (ringing in ears), presbycusis, dizziness, loss of balance, Meniere’s disease and hyperacusis. Even more importantly, they learn how to deal with these issues and other ear problems that face hard of hearing people.
I write my articles in a simple but informative style—giving you the practical advice and information you need to successfully deal with your hearing loss or other ear problems. You’ll learn how to cope with sudden hearing loss, how proactive hearing protection procedures can limit your hearing impairment, and how to find the assistive listening devices that will best fit your needs.
In addition to our outstanding in-depth articles, in the Info & FAQ section, we have numerous shorter articles on specific topics concerning hearing loss, the hearing impaired condition and how hard of hearing people can successfully cope with hearing loss. These shorter articles will also give you practical information about hearing aids and assistive technolog the sort of information that is invaluable to people with hearing loss.
For more detail plz cont:            +923009009675     

Hearing Clinic Hearing Aids Peshawar Pakistan 00923009009675

Hearing Loss—Decibels or Percent?

© December 2000 by Neil Bauman, Ph.D. (Revised February 2003)
Question: From time to time, I see people writing, "I have 78% hearing loss in my right ear and 95% in the left." What does this percent mean? I thought sound was measured in decibels (dB), not percent? If this is the case what percent is 115 dB?—R. D.
Answer: Excellent questions. You have good reason to be confused because you cannot equate decibels to percentages no matter what anyone tells you.

Decibels vs. Percent

Sound intensities are indeed measured in decibels (dB). There are two reasons why you can never equate decibels to percentages. First, the decibel scale is open-ended like that of the Richter scale used for measuring earthquake intensities. To calculate a percent you need to know the maximum value possible. In both of these scales there is no limiting maximum value. Therefore, you cannot calculate a percentage. Any attempt to do so is just a bunch of meaningless gibberish!
Second, the decibel scale is logarithmic, while the percent scale is linear. Numbers that appear to be similar have vastly differing meanings. They are as different as trying to compare apples to elephants!
When people (ignorantly) talk about having a 50 percent hearing loss they likely mean that they have a 50 dB loss. Where did the idea come from that we can measure hearing loss in percentages? Here is how Brad Ingrao, an outstanding audiologist, explained it.
To measure sound intensity (the way audiologists measure it) you need to do a mathematical calculation that is so strange that 20 + 20 = 26 dB (SPL).
"To make a scale that makes sense to most people (including us knucklehead audiologists), a different equation is used to convert sound intensity using the Sound Pressure Level (SPL) scale to the Hearing Level (HL) scale that goes from 0 dB HL (normal threshold) to 120 dB HL (pain).
If we forget about hearing losses greater than 100 dB (like most people tend to do), we get 0 dB to 100 dB as the usable (dynamic) range of hearing for the average 'normal' ear.
Since doctors and audiologists tend to under-estimate their patient's ability to understand such things (or they don't understand it themselves), the erroneous concept of dB = % evolved."
There you have it folks. It seems health care professionals think we are too stupid to understand much, so they let us believe error rather than teach us the truth.
We can put a stop to this nonsense right now. Let's understand how this decibel scale works and why using a percentage value to describe our hearing losses is so very wrong.
First we need to understand that a decibel is not a given intensity (loudness) of sound, but rather, it is a ratio of how many times louder (or softer) a sound is than a given reference sound level.
This means that 0 dB is not the absence of sound, but is an arbitrary zero. We define it as the faintest sound that a young sensitive human ear can hear. Furthermore, because the decibel scale is logarithmic, every 10 dB increase in sound intensity is actually a ten-fold increase. Therefore, a sound intensity of 20 dB is not twice as loud as a sound intensity of 10 dB, but is 10 times as loud, and a sound intensity of 30 dB is 100 times as loud as a sound intensity of 10 dB. Similarly, a sound intensity of 50 dB would be 100,000 times as loud (10 x 10 x 10 x 10 x 10). This is how the decibel scale works. It is totally unlike the linear percent scale.
Now lets see the fallacy of trying to compare this "funny" decibel scale to the percent scale. To illustrate this, let's assume (remember this assumption we're making here is totally wrong) that 0 dB is equal to 0 percent hearing loss and that 100 dB equals a 100 percent loss. This would then mean that 50 percent would equal a 50 dB hearing loss, right? Wrong! Not by a long shot! A 50 percent hearing loss would equal, believe it or not, only a 3 dB loss! Looking at it the other way, a 50 decibel loss is not just half as loud, like it would be in a percentage scale, but would only be one thousandth of one percent as loud!
Here is another example. I have a 70 dB loss. This is not equal to a 70 percent loss by any means. In actual fact it means that the softest sound I can hear needs to be 10,000,000 times louder than the softest sound a person with normal hearing can hear. One out of ten million is definitely not a 70 per cent loss but would be a loss of 99.9999999%! Quite a difference, isn't it? Now you can see why we must never use percentages when talking about our hearing losses. They just do not equate. They are absolutely meaningless!

Percent Used to Describe Discrimination

Although we cannot use percentages to describe our hearing losses, we correctly use percentages to describe our ability to discriminate sounds. To determine our ability to discriminate between words, our audiologist sets the volume at our most comfortable listening level. She then has us listen to a list of words and we repeat back what we think we heard. The number we get right, converted to a percentage, becomes our discrimination score. Therefore, if I understood 80 out of 100 words in my right ear, my discrimination is 80% for that ear. I may have an entirely different result for my other ear. Consequently, we can correctly describe our ability to understand what we hear as a percentage. A person could correctly say that his discrimination is 78% in his right ear and 95% in his left ear. But this has nothing to do with the severity of our hearing losses as such.

Percentage and Hearing Disability

If your hearing loss resulted from an accident on the job, there is a formula that is used to calculate the percent disability pension for which you may be eligible. Don't get mixed up. This is not your hearing loss expressed as a percentage. Rather, this formula calculates how much your degree of hearing loss supposedly impacts your ability to remain employed at full wages.
For example, plunking your hearing loss levels into the formula may yield a result of 75%. This means that with your particular hearing loss, you may be entitled to a 75% disability pension. Again, this is not your average hearing loss expressed as a percentage. If you are interested in how they calculate a percentage disability for any given hearing loss, see my article you can read it at "How Much Are You Worth as a Hard of Hearing Person?".

Classifying Our Hearing Losses

Hearing health care professionals classify hearing into several categories such as normal, slight, mild, moderate, moderately severe, severe, profound and deaf. Not all of them use all of these categories, nor do they all use the same hearing loss ranges in each one. In the past, most used this simple scale.

Simple Hearing Classification Hearing Threshold
 

Normal hearing	down to 20 dB
Mild hearing loss	21 to 40 dB
Moderate hearing loss	41 to 60 dB
Severe hearing loss	61 to 90 dB
Profound hearing loss	below 90 dB

Today, research has shown that even hearing losses of only a few decibels can cause significant hearing problems. As a result, many hearing health care professionals have fine-tuned this scale to better reflect this reality. (Note that these ranges are arbitrary and may vary slightly among authorities.)

Today's Hearing Classification Hearing Threshold
 

Normal hearing	-10 to 15 dB
Slight hearing loss	16 to 25 dB
Mild hearing loss	26 to 40 dB
Moderate hearing loss	41 to 55 dB
Moderately severe loss	56 to 70 dB
Severe hearing loss	71 to 90 dB
Profound hearing loss	91 to 120 dB
Deaf	below 120 dB

Describing Our Hearing Losses

Unless you have a "flat" curve on your audiogram, how can you accurately describe your hearing loss? Your hearing loss could be different at every frequency so one word could be meaningless.
The best way is to be specific. If I have the typical "ski slope" hearing loss, I could describe it as, "I have a 30 dB loss at 500 Hz, dropping to 100 dB at 4,000 Hz." A more general way, but still accurate, would be to describe it as, "I have a mild loss in the low frequencies, dropping to profound in the higher frequencies.
The next best way to describe our hearing losses is to average the 4 frequencies that carry most of the speech information to arrive at a single figure. Use the following four frequencies—500 Hz, 1,000 Hz, 2,000 Hz and 3,000 Hz—and average the hearing loss at these frequencies to come up with one figure. However this method falls down if we only have a bit of hearing left in the very low frequencies. Incidentally, it is not right to take the average of our best and worst figures. That could give a very wrong impression of our hearing losses.
If you want a very simple way to describe your hearing loss, the most accurate (and simple) is to say you have either a mild, moderate, severe, or profound hearing loss. Your audiologist can tell you which category your hearing is generally in. (Remember, you could be mild in the low frequencies and profound in the highs—but to oversimplify, you can reasonably accurately reflect your practical hearing loss by using one of these categories.) It is much more meaningful, and far more accurate than trying to use a meaningless percentage.

Hearing Clinic Cochlear Implants

Cochlear Implants

What Is a Cochlear Implant and How Does it Work?

Cochlear implants are implantible devices designed with the goal of providing sound detection and speech recognition for people who receive little or no benefit from hearing aids. There are several manufacturers of cochlear implants such as Advanced Bionics Corporation, Cochlear Americas, and Med-El. The cochlear implant-regardless of the manufacturer-is comprised of both internal and external components.

The internal portion, which is implanted surgically, has a receiver and tiny electrodes. The receiver is imbedded under the skin behind the ear and the electrodes are surgically inserted into the cochlea.

         

The external portion, shown in the picture below includes a speech processor that is connected to a headpiece by a cord. The headpiece has a transmitting coil that sends the signal from the speech processor to the internal part of the cochlear implant. It magnetically attaches to the surface of the head behind the ear at the spot where the internal portion of the implant is located.

Platinum Series	Auria Processor
Sprint Processor	Esprit Processor
There are additional speech processors and configuration options available other than those shown above

The internal and external portions work together to change sound into electrical signals that are sent to the hearing nerve. First, the microphone picks up the sound energy, and transmits the signal through the cord to the speech processor. The speech processor filters, analyzes and converts the sound energy into a digital code that is then sent back through the cord to the headpiece where it is transmitted across the skin, via radio frequencies, to the internal receiver. Then, the internal receiver delivers the signal to the electrodes that have been placed inside the cochlea. The electrodes bypass the damaged parts of the cochlea and send a tiny electrical charge directly to the auditory nerve. Finally, the auditory nerve carries these electrical signals to the brain where they are interpreted as sound. This process occurs so rapidly that the listener will hear speech and other sounds without any noticeable delay

Hearing Clinic Hearing Aids Peshawar Pakistan 00923009009675

What I Wish Audiologists Understood

© February 2002 by Neil Bauman, Ph.D.
Question: A lot of people are not completely happy with their audiologists. Obviously, audiologists are missing the boat somewhere. I am an audiologist just starting my own audiological practice. What is it that hard of hearing people really want from their audiologist? I want to meet their real needs and have satisfied clients.—M
Answer: Excellent question!. Excellent attitude too! I wish you every success! Here is what I wish audiologists would understand—and practice.
I wish audiologists understood hard of hearing people! From what I have observed, audiologists seem to think their "job" is to fit/sell hearing aids as the solution to the hearing loss problems of the hard of hearing people that come to them. I wish audiologists understood that their real job is to us help hard of hearing people cope with our hearing losses.
One way they can begin to do that is by fitting us with appropriate hearing aids. The trouble is, they stop there. They think their job is now done. The truth is, at this point, their job has barely begun.
With a little training, anyone can learn to dispense hearing aids. They don’t need a Doctor of Audiology for that! Learning about hard of hearing people and the many effective coping skills they need to live successful lives—now that is worthy of an audiological degree!
There are three main coping strategies we hard of hearing people need to learn—amplification, speechreading and coping skills.

Amplification

Amplification includes hearing aids and other assistive listening devices (which audiologists know little about and push even less). Many times hearing aids are what we need, but very often we need more than that. We need attachments to our hearing aids—things like microphones that plug into DAI (direct audio input) boots. We need hearing aids with t-coils so we can effectively use the phone and listen using loop systems. Few audiologists seem to know t-coils exist. If they really understood our problems and truly cared about us, they would never sell us hearing aids that are not equipped with good pre-amplified t-coils. I wish audiologists realized just how vitally important such things can be to our hearing health.
I wish audiologists would teach us how to become friends with our hearing aids. We need training and coaching and support as we start life with these strange uncomfortable things stuck in our ears. We need to learn to cope with sound all over again. We need their help to do this. I wish audiologists would not sell us hearing aids and then dump us out on the street. That is one reason why so many hearing aids languish on bed tables and in dresser drawers instead of doing their job of helping us hear. Many of us never learn how to cope with hearing aids.

Speechreading

Speechreading (the old term is lipreading) is very important to us. Unfortunately, in my experience, most audiologists downplay the value of speechreading. I've actually had audiologists pooh-pooh speechreading to my face. Obviously, they don’t have a clue just how necessary speechreading is to people like me. People who lose their hearing need help, training and encouragement in learning speechreading—not derision and scorn. Speechreading is every bit as important as being fitted with hearing aids! I wish audiologists could realize this.

Coping Skills

There are numerous coping skills we hard of people need to learn. I wish audiologists would realize this and teach us what we need to know—even though we don’t know we need to know it. We need to learn how to talk to hard of hearing people—whether we wear hearing aids or not. We also need to know the rules so we can teach our families and friends how to communicate effectively with us (My book, "Talking With Hard of Hearing People—Here's How to do it Right," gives many tips on how to do this.) We need to learn about the various alerting devices available so we can be alerted even when we are not wearing hearing aids (like at night). We need to learn how to re-arrange the furniture in our homes so we can hear/understand better. We need to learn how light affects our ability to "hear." We need to learn how to cope in noisy restaurants—e.g. how to pick the best place (hearing-wise) in any given restaurant by taking into consideration the available light, sources of noise, etc. We need to learn to use our eyes in place of our ears for warning signals. (For example, watching for flashing lights instead of listening for sirens. By the time we can hear a siren, it is already to late.) This list goes on and on and on. There are just so many things we need to learn. I wish audiologists would teach me these things I need to know.
We also need audiologists to warn us about things like noise and how it can damage our ears—especially now that we already have hearing losses. We need to know how to preserve the little precious hearing we still have. Furthermore, we need to know about the many drugs that can damage our ears. We need to be warned that we are now even more at risk from the effects of ototoxic drugs than the general population. We need to know how noise and certain drugs can team up to smash our remaining hearing.
Hard of hearing people feel alone and cut off. I wish audiologists realized just how cut off we can be and put us in touch with support groups (like SHHH and ALDA) so we do not feel so alone any more. Because we so often shrink inside, we need help in learning how to be assertive in asking that our needs be met.
If we have not been through the grieving process, we need help grieving for our hearing losses. We need someone to guide us though the process and not make us feel stupid or foolish for grieving. I wish my audiologist understood how important it is to help my hearing spouse grieve for the loss of the easy communication they once enjoyed. We need to know that failure to grieve leads to both physical and emotional problems down the road.
Hearing loss affects our whole family. Therefore, all of us need joint help and counseling. I wish my audiologist would teach all of us the coping strategies we need to live successful lives together.
I wish audiologists would realize that hearing aids are just a small part of the solution, not the total solution. I wish audiologists understood just how vitally important speechreading and coping skills are to us. I want audiologists to be aware that if I had to make a choice between hearing aids or speechreading and coping skills, I'd dump my hearing aids in a heartbeat—not the other way around. (If we all did that, they’d be out of a job.) That’s how important these things are to me. These are the things I wish audiologists would understand.

Hearing clinic peshawar pakistan 00923009009675

Recruitment from Hearing Loss Explained

© June 2001 by Neil Bauman, Ph.D.
Question: Some people can't wear hearing aids because of severe recruitment. Recruitment seems to be such a weird word for this problem. The word means "to enlist." The dictionary doesn't describe anything to do with hearing loss and hearing aids. So what really is recruitment and how did it get this strange name?—C. H.
Answer: Good questions. No wonder you are confused! Even many of the hearing health care professionals don't understand this condition that goes by the strange name of recruitment. There is a lot of misunderstanding about recruitment. Actually, recruitment really is a good word to describe this phenomenon—once we understand what goes on in our inner ears.

What is Recruitment?

Very simply, recruitment is when we perceive sounds as getting too loud too fast.
Before we look at how recruitment got its name, there are two things we need to know about recruitment.
First, recruitment is always a by-product of a sensorineural hearing loss. If you do not have a sensorineural hearing loss, you cannot have recruitment.
Second, there are two other phenomena that often get confused with recruitment. These are hyperacusis (super-sensitivity to normal sounds) and phonophobia (fear of normal sounds resulting in super-sensitivity to them). Both hyperacusis and phonophobia can occur whether you have normal hearing or are hard of hearing. In fact, if you have a sensorineural hearing loss, you could suffer from all three conditions at once!

How Recruitment Got Its Name

Now let's look at how recruitment "works" and how it got its name. Perhaps the easiest way to understand recruitment is to make an analogy between the keys on a piano and the hair cells in a cochlea.
The piano keyboard contains a number of white keys while our inner ears contain thousands of "hair cells." Think of each hair cell as being analogous to a white key on the piano.
The piano keyboard is divided into several octaves. Each octave contains 8 white keys. Similarly, the hair cells in our inner ears are thought to be divided into a number of "critical bands" with each critical band having a given number of hair cells. Each critical band is thus analogous to an octave on the piano.
Just as every key on the piano belongs to one octave or another, so also, each hair cell belongs to a critical band.
When you play a chord on the piano—you press two or more keys together but they send one sound signal to your brain. Similarly—but yet different—when any hair cell in a given critical band is stimulated, that entire critical band sends a signal to our brains which we "hear" as one unit of sound at the frequency that critical band is sensitive to. This is the situation when a person has normal hearing.
However, when we have a sensorineural hearing loss, some of the hair cells die or cease to function. When this happens, each "critical band" no longer has a full complement of hair cells. This would be analogous to a piano with some of the white keys yanked out. The result would be that some octaves wouldn't have 8 keys any more.
Our brains don't like this condition at all. They require each critical band to have a full complement of hair cells. Therefore, just as our government, when it runs short of military personnel, puts on a recruitment drive, so too, our brains do the same thing. However, since all the hair cells are already in service, there are no spares to recruit.
What our brains do is rather ingenious. They simply recruit some hair cells from adjacent critical bands. (Here is that word recruit or recruitment.) These hair cells now have to do double duty or worse. They are still members of their original critical band and now are also members of one or more additional critical bands.
If only relatively few hair cells die, then adjacent hair cells may just do double duty. However, if many/most hair cells have died, then in order to have a full complement of hair cells in each critical band, any given hair cell may be recruited into several different critical bands.

The Result of Recruitment

The result of this recruitment causes us two basic problems.
First, the sounds reaching our brains appear to be much louder that normal. This is because the recruited hair cells still function in their original critical bands and also in the adjacent one(s) they have been recruited into.
Remember that when any hair cell in a critical band is stimulated, the whole critical band sends a signal to our brains. So the original critical band sends one unit of sound to our brains, and at the same time, since the same hair cell is now recruited to an adjacent critical band, it stimulates that critical band also. Thus, another unit of sound is sent to our brains. Hence, we perceive the sound as twice as loud as normal.
If our hearing loss is severe, a given hair cell may be recruited into several critical bands at the same time. Thus our ears could be sending, for example, eight units of sound to our brains and we now perceive that sound as eight times louder than normal. You can readily see how sounds can get painfully loud very fast! This is when we complain of our recruitment.
In fact, if you have severe recruitment, when a sound becomes loud enough for you to hear, it is already too loud for you to stand.
The second result of recruitment is "fuzzy" hearing. Since each critical band sends one signal at the frequency of that critical band, when hair cells get recruited into adjacent bands, they stimulate each critical band they are a member of to send their signals also. Consequently, instead of hearing just one frequency for a given syllable of sound, for example, perhaps our brains now receive eight signals at the same time—each one at a different frequency.
The result is that we now often cannot distinguish similar sounding words from each other. They all sound about the same to us. We are not sure if the person said the word "run" or was it "dumb," or "thumb," or "done," or "sun," or? In other words, we have problems with discrimination as well as with volume. If our recruitment is bad, our discrimination scores likely will go way down.
When this happens, basically all we hear is either silence or loud noise with little intelligence in it. Speech, when it is loud enough for us to even hear it, becomes just so much meaningless noise.
This is why many people with severe recruitment cannot successfully wear hearing aids. Their hearing aids make all sounds too loud—so that they hurt. Also, hearing aids cannot correct the results of our poor discrimination. We still "hear" meaningless gibberish.
However, people with lesser recruitment problems will find much help from properly adjusted hearing aids. Most modern hearing aids have some sort of "compression" circuits in them. When the compression is adjusted properly for our ears, these hearing aids can do a remarkable job of compensating for our recruitment problems.

Hearing clinic peshawar pakistan 00923009009675

Drugs and Tinnitus: Put Yourself in the Driver’s Seat

© April 2009 by Neil Bauman, Ph.D.

Introduction

When “Jonathan” took a course of Erythromycin prescribed by his doctor, the last thing on his mind was that this drug would cause him to lose hearing in one ear, give him hyperacusis and balance problems, and result in “horrific bilateral tinnitus.”
No one warned “Eunice” that taking the anti-depressant drug Amitriptyline would result in “screaming tinnitus”, a condition much worse than her original depression.
Without warning, drugs that were prescribed for Jonathan and Eunice to treat other health issues resulted in loud, intrusive tinnitus, making their lives almost unbearable. (These stories are true, although I’ve changed their names.)

Ototoxic Drugs—What Are They?

Ototoxic (OH-toe-TOKS-ik) drugs are those medications that can cause ototoxic (ear damaging) side effects to your ears. Such drugs can cause hearing loss, hyperacusis (normal sounds now too loud), tinnitus and other phantom sounds, and a whole host of balance problems. This does not happen to everyone who takes drugs by any means, but it does happen to a significant number of unfortunate people.
Note this well. Even though a drug’s description lists tinnitus as a side effect, it does not mean that you will develop tinnitus if you take it. Some people do. Many don’t. The problem is that you don’t know into which class you will fall. Therefore, you should learn about the side effects of any drug before you begin taking it. Be particularly cautious until you know that any given drug won’t adversely affect your ears.

Which Drugs Can Cause Tinnitus?

There are more than 450 prescription and over-the-counter drugs from Acebutolol to Zuclopenthixol that can either trigger tinnitus, make existing tinnitus worse or cause another (new) tinnitus sound to appear.
Most of the drug classes have tinnitus-causing drugs sprinkled throughout. For example, antibiotics, painkillers, anti-anxiety and anti-depression drugs, anti-malarial medications, anti-cancer drugs and blood-pressure controlling medicines, to name a few, can all trigger tinnitus.

Is Drug-Induced Tinnitus Temporary or Permanent?

Tinnitus arising from taking ototoxic drugs may, or may not, be permanent. The good news is that tinnitus resulting from taking such drugs is often temporary and goes away in a few days to a few weeks after you stop taking the drug. For example, ototoxic anti-inflammatories such as Aspirin, Ibuprofen and Naproxen generally cause temporary tinnitus (but there are no guarantees).
The bad news is that the resulting tinnitus may be permanent. For example, if you are taking an aminoglycoside antibiotic, you are lucky if the tinnitus stops within a couple of weeks after you finish the drug therapy. For a good number of people, this kind of tinnitus never goes away.

Some Drugs Produce Distinctive Tinnitus Sounds

Drug-induced tinnitus usually first appears as a continuous high-pitched sound and occurs in both ears. However, certain ototoxic drugs produce distinctive tinnitus sounds. For example, tinnitus caused by Acetylsalicylic acid (Aspirin) and Quinine (and related drugs) is generally a high-pitched or hissing sound, and may sound like a continuous musical note. In contrast, tinnitus caused by Erythromycin can produce what sounds like “blowing,” while loop diuretics (such as Furosemide) may produce a middle-frequency sound.

How Soon Will the Tinnitus Occur After Taking a Drug?

Tinnitus may show up very quickly after you begin taking an ototoxic medication, or it may take several days for it to become obvious to you. For example, tinnitus from loop diuretics (Furosemide) may start just minutes after you begin receiving it intravenously. In contrast, tinnitus may not show up until 2 or 3 days after taking an aminoglycoside antibiotic. Strangely enough, with certain drugs such as the Benzodiazepines (a class of tranquilizers), tinnitus may only start after you have stopped taking the drug.

Tinnitus, Hearing Loss and Drugs

Hearing loss and tinnitus often go together. I have seen it reported that about 70% of the people with hearing loss also have tinnitus. Therefore, if you preserve your hearing, you can help yourself avoid unnecessary tinnitus. To this end, you should be aware that there are around 300 drugs associated with hearing loss. Taking such drugs may result in both hearing loss and tinnitus.
Tinnitus often precedes, or accompanies, the hearing loss. In fact, tinnitus is the number one indicator that you may be doing damage to your ears from an ototoxic drug. It also may be the only warning you’ll ever get, so don’t ignore it!

It’s All About Choices—What You Can Do about Tinnitus

Knowledge is power. When you are aware of the many drugs that can damage your ears and the many risk factors that can make you even more susceptible to ototoxic side effects, you are in a position to help yourself protect your precious ears.
If your ears start to ring after you begin taking a new drug or an increased dose of an existing drug, you should immediately report this to your doctor. Together you should then decide what to do—whether to reduce the dose to a level below where it causes tinnitus, or stop taking the medication and try another.
You need to decide for yourself about the trade offs to taking any given medication. For example, “Joan” takes Celecoxib for her arthritis. When she takes it, her tinnitus gets louder, but her arthritis pain improves. She chooses the increased tinnitus (which doesn’t really bother her) over the arthritis pain (which she definitely doesn’t like). That is her choice, and she is content to live with it.
“Harold,” on the other hand, began taking Amitriptyline and soon noticed he had severe tinnitus. His tinnitus was driving him “buggy” so he contacted me for help. I suggested the Amitriptyline might be causing his tinnitus. With his doctor’s permission, he stopped taking the drug. Twelve days later, he joyfully reported that his tinnitus went away. That was his choice and he is glad he made it.
Just because a drug isn’t listed as causing tinnitus, doesn’t mean it can’t. For example, when her doctor doubled her dose of Irbesartan, “Sarah” found her existing tinnitus became noticeably louder. When she complained to her doctor, he reduced her dose and her tinnitus returned to its previous level, yet Irbesartan still is not listed as causing tinnitus.
When it comes to your ears, don’t let ototoxic drugs flip your world upside down! Remain in the driver’s seat and take control by reading, asking questions and making the best choices you can.

(First published in slightly revised form in the April, 2009 edition of
Tinnitus Today, the magazine of the American Tinnitus Association)

The information in this article was extracted from the second edition of the book Ototoxic Drugs Exposed by the same author. To learn more about drugs that can cause tinnitus and other ear problem, or to learn the specific ototoxic side effects of the 743 ototoxic drugs, 30 herbs and 148 chemicals mentioned in this book, get your own copy of Ototoxic Drugs Exposed.

Tinnitus Treatment: Is It for Real?

Hearing Clinic Tinnitus

Tinnitus—What's That?



Question: I've begun hearing an annoying buzzing or ringing sound in my ears. What's going on?—T. S.

Answer: The fancy name for the sounds you are hearing is tinnitus. Some people pronounce it "TIN-ih-tus" and others "tih-NYE-tus." Either way is correct. Both are in the dictionary.
The Phantom Strikes Again

Tinnitus is the word we use to describe hearing certain phantom sounds. Tinnitus is not a disease. Rather it is generally a symptom of something wrong in your auditory system. The dictionary defines tinnitus as the sensation of noise, often ringing or roaring, in your ears that comes from inside your head in the absence of any external sound.

Since there is normally no external sound corresponding to the sounds you are "hearing," tinnitus is truly a phantom sound. Your brain actually detects signals in your auditory system or in its own auditory circuits, and you perceive and "hear" them as real. Make no mistake about it; to you the phantom tinnitus sounds are just as real as any external sounds.

One person wrote his ear specialist, "Doctor, please confirm that this noise is not all in my head, and that I am not going mad."

The ear specialist wrote back, "With pleasure! You are not going mad! And yes, it is all in your head, but then, so are your ears!"
What Does Tinnitus Sound Like?

There are a variety of tinnitus sounds. Many people say their ears are ringing or buzzing (mine are ringing right now as I write this-as they have for decades). These are just two of the common tinnitus sounds. Your tinnitus may be a ringing, roaring, beating, clicking, banging, buzzing, hissing, humming, chirping, clanging, sizzling, whooshing, rumbling, whistling or dreadful shrieking noise. To some people, tinnitus sounds like rushing water, breaking glass, owls hooting or chain saws running.

About half the people with tinnitus only hear one tinnitus sound at a time. However, about one quarter of tinnitus sufferers hear two tinnitus sounds at the same time. For example, Ruby heard the roar of Niagara Falls in one ear and what sounded like a broken washing machine in her other ear after taking anti-cancer drugs. To me tinnitus is usually a high-pitched ringing or whine in my ears (much like a high-speed turbine running), and less often a soft shhh sound or a low rumbling noise. Pam hears what sounds like birds chirping and occasionally an owl hooting. When Una shakes her head she hears the pure tone "F ". The rest of the time she hears what sounds like a piece of sheet metal being hammered or a constant high-pitched tone.

About 16% of the people with tinnitus hear three or more tinnitus sounds at the same time. One poor lady, Mrs. P___, used to hear what sounded like a cow bell, a door bell, a tune, a noise like rushing water and a roaring like traffic in a tunnel—all at once.

Because of the variety of tinnitus sounds, sometimes people confuse it with another class of phantom sounds (auditory hallucinations) called Musical Ear syndrome. Tinnitus is always a simple sound. In contrast, Musical Ear syndrome sounds are more complex sounds such as voices, singing or music. (Read the eerie yet fascinating account of Musical Ear syndrome.)

Tinnitus comes in a variety of sounds, volumes and patterns. You may perceive its volume as ranging from subtle to shattering!

Your tinnitus may be constant. It may come and go. In one survey, 72% experienced their tinnitus all the time, 18% heard their tinnitus frequently and only 10% had occasional tinnitus.

About half the people with tinnitus hear their tinnitus in both ears at the same time. About 10% hear it in their left ear, and another 10% hear it in their right ear. For the remainder, they just hear their tinnitus inside their head somewhere.

At times tinnitus can be just plain weird. Occasionally other people may hear your tinnitus (objective tinnitus) as a clicking sound, just like you do. This kind of tinnitus occurs when a muscle in your ear contracts making this clicking sound.

A few people have a type of tinnitus that pulses with every heartbeat (pulsatile tinnitus). This kind of tinnitus results from a (big) artery too close to your middle ear.

Perhaps the weirdest kind of tinnitus is where people can change their tinnitus by doing ordinary, everyday things such as moving their eyes (gaze evoked tinnitus), moving their jaw (temporomandibular joint—TMJ), turning their head, applying pressure to parts of their bodies or even just by bending over which increases their blood pressure—and for them, their tinnitus.

Anita once told me, "When I move my eyes side to side or up and down the pitch of my tinnitus varies with my eye movement." Neat, huh?—until it begins to really bother you. She added, "It also varies with the muscular movement of my jaw, like when eating. Opening and closing my mouth can make the pitch of my tinnitus vary too."
How Common Is Tinnitus?

Tinnitus is relatively common. At least 17 out of every 100 people around the world have some degree of tinnitus. Here in the United States, the American Tinnitus Association estimates that about 50 million Americans have tinnitus to some degree while about 12 million have tinnitus severely enough that they seek medical advice. About 2 million of these have tinnitus so bad that they cannot function normally.
What Causes Tinnitus?

Tinnitus is a symptom, not a disease. Among the more common things that cause or trigger tinnitus are exposing your ears to loud sounds, taking various drugs, eating certain foods, hearing loss, allergies, stress and various ear conditions.
1. Loud Noise

Loud noise is the most common cause of preventable tinnitus. A study of 1,687 people with tinnitus revealed that noise exposure accounted for one out of four cases of tinnitus. Tinnitus from noise exposure and hearing loss generally go together. The American Tinnitus Association reports that up to 90% of all people with tinnitus have some level of noise-induced hearing loss. If you are around loud sounds for a while, perhaps you've noticed that your ears rang for a while after. This is tinnitus.

You may find that tinnitus occurs immediately after you have been exposed to a loud noise. Most often, you get mild, temporary tinnitus, but it may be permanent. The length of time your tinnitus lasts and its severity generally increases each time you expose your ears to loud noise. Finally, one day, if you continue to work, play or live around loud sounds, you may end up with permanent (and distressing) tinnitus, not to mention hearing loss.

This does not have to happen. You can protect yourself from noise-induced tinnitus. The choice is yours. All you need to do is avoid loud sounds or protect your ears from excessive noise by wearing ear protectors.
2. Prescription Drugs

The second most common cause of preventable tinnitus is from taking various prescription or non-prescription drugs. There are hundreds of these drugs in common use. My book "Ototoxic Drugs Exposed" lists 447 drugs (and 29 chemicals) that are known to cause tinnitus. Such drugs can either cause tinnitus in the first place, make your existing tinnitus louder or cause a new tinnitus sound.

Tinnitus usually appears first as a continuous high-pitched sound. Often tinnitus precedes or accompanies hearing loss from ototoxic drugs. In fact, tinnitus is the number one indicator that you may be doing damage to your ears. It also may be the only warning you'll ever get. Pay attention to it! If your ears start to ring after you begin taking any drug, you should immediately report this to your doctor. You and your doctor should then decide what to do-whether to reduce the dose, change the medication or stop taking that medication altogether.
3. Certain Foods

Specific foods such as red wine, grain-based spirits, cheese and chocolate can trigger or increase tinnitus in some people. Penny finds that wine, vinegar and certain spices affect the loudness of her tinnitus. She also finds that any foods containing mold will make her tinnitus louder.

Other things to beware of include caffeine, monosodium glutamate (MSG), nicotine, alcohol, marijuana and some spices. For example, Sue finds that eating hot spices such as chili peppers, hot salsa and hot paprika make her tinnitus louder.

Some people find that just eating foods high in sugar makes their tinnitus louder.
4. Hearing Loss

Very often, hearing loss and tinnitus go hand in hand. Tinnitus does not cause hearing loss. Rather, it is the other way around. Hearing loss often results in tinnitus. The good news is that wearing hearing aids to correct the hearing loss often results in the tinnitus going away or fading into the background while you are wearing your hearing aids. Unfortunately, your tinnitus can come back at night when you remove your hearing aids to sleep.
5. Allergies

Allergies can also trigger tinnitus. Penny writes, "Allergies play a big part in the level of my tinnitus. I couldn't walk into a library without having my tinnitus go off the charts—all because of dust." She adds, "Many people have allergic reactions to things and don't even know it's allergy-related. They don't connect what they ate with the level of their tinnitus, or what they smelled, or what plants they're surrounded by, or if there's mold out in their yard."
6. Stress

Uncontrolled anxiety, stress and tension often make your tinnitus worse. Recent studies show that stress can also cause annoying tinnitus. Learning how to deal with the stress in you life can eliminate or greatly reduce tinnitus from this cause.
7. Ear Conditions

Certain ear conditions may also trigger tinnitus. For example, many people, including children, experience tinnitus along with a middle ear infection (otitis media) or a sinus infection. Generally, the tinnitus will lessen and gradually fade away once the infection clears up.

Other conditions that can trigger tinnitus include calcium build-up on the small bones in your middle ears (otosclerosis), pressure problems in the Eustachian tubes connecting your middle ears to your throat, an increase of fluid in your inner ears (Meniere's disease) or any other condition that disturbs the fluid pressure in your inner ears. In addition, tinnitus may be caused by tumors on your auditory nerves (acoustic neuroma), changes in the hair cells of your inner ears, poor nerve function due to pressure on them from surrounding tissues, operations on or around your ears, and even such simple things as wax (cerumen) build-up, foreign bodies or swelling in your ear canals. The truth is that almost anything that can go wrong with your ears or in your auditory system can trigger tinnitus.
The Effects of Tinnitus

The impact tinnitus has on a person's life can vary enormously. Obviously there is a major difference between mild or short lasting tinnitus and loud, severe, constant tinnitus day in and day out. Some people learn to completely ignore their tinnitus. The fancy term for this is "habituation." For many others, tinnitus is only a mild irritation. However, for some, tinnitus is totally debilitating and disrupts their entire life. People with severe tinnitus often have problems sleeping. They may be irritable and cannot concentrate on anything other than their tinnitus. As a result, they are constantly under stress, perform poorly, and lose their joy of living. The great musician, Beethoven, once lamented, "My ears whistle and buzz continually day and night. I can say I am living a wretched life."
What Can You Do About Tinnitus?

You do not have to let tinnitus drive you "buggy." There are a number of ways you can help yourself control your tinnitus. I've touched on five of these in this article-protect your ears from loud sounds, avoid tinnitus-producing medications, avoid certain foods, get your allergies under control and reduce your stress. There are many others. Unfortunately, they require more space than an article of this nature permits. If you would like to learn more about tinnitus and the many things you can do to help bring it under control, see my book "When Your Ears Ring—Cope with Your Tinnitus—Here's How." Take charge of your tinnitus. You don't have to let these phantom sounds control you.

Hearing Clinic Hearing Aids Peshawar Pakistan 00923009009675

Demystifying Hearing Testing—
The Eight Steps Necessary for a Complete Audiological Evaluation and What It All Means

Question: I need to get my hearing tested, but I hate taking tests. What is a hearing test like? What all will a hearing test tell me?—H. T.
Answer: You are not alone in your dislike of taking tests. There are a number of people that don’t like getting their hearing tested. To them, it is a test. They hated taking tests during their school days, and they hate them now. To them, taking a test implies a strong chance of failing the test. If this has been your attitude towards hearing testing, you’re in for a surprise. Here’s the good news. You can’t “fail” a hearing test.
I actually look forward to getting my hearing tested. You see, I’m curious to know whether anything about my hearing has changed since the last time.
Actually, “testing” is a misnomer. It is really a hearing evaluation to see how well, or how poorly, you hear and understand speech. Furthermore, it is not just one “test” or evaluation. The testing process consists of a whole series of evaluations.
In case you are not aware of it, you don’t just want a “hearing test.” You really want a complete audiological evaluation, which is only done by audiologists. This process should consist of 8 or more separate tests or evaluations, depending on your particular situation. Each of these 8 evaluations are necessary, so if your audiologist skips any of them (and some do), ask that he fully complete each one of them.
Note: hearing testing is done under carefully-controlled clinical conditions. These tests are not meant to reflect real-world listening situations. Rather, they are designed to make it possible to give consistent results no matter who tests your hearing; to document and compare changes in your hearing from one year to another; and to compare your hearing loss to hearing losses of other people. This means that the results of these tests only reflect how well you will hear under ideal listening situations. In real-world situations, your hearing will typically be worse.
The 8 steps in the complete audiological evaluation are normally completed in the following logical sequence as each step typically builds on what has been learned in the previous steps.

1.     Hearing History

Typically, your audiologist first gathers (and evaluates) information about your hearing history. She will ask you a number of questions regarding your ears and hearing loss that may include questions such as:

• What brought you here today?
   
• How long have you noticed difficulty with your hearing?
   
• Has your difficulty with hearing had a gradual or sudden onset?
   
• Is there a family history of hearing loss?
   
• Do you know what caused your hearing loss?
   
• Does your hearing problem affect both ears or just one ear?
   
• Have you exposed your ears to loud noise?
   
• Do your ears ring?
   
• Do you experience dizziness or vertigo?
   
• Do you have a history of ear infections?
   
• Have you noticed any pain, or discharge from your ears?
   
• Do you have greater difficulty hearing women’s, men’s or children’s voices?
   
• Are there situations where it is particularly difficult for you to follow conversations?

Note: Good audiologists will also ask you what medications you are on. Then they will check to see if any of your medications have ototoxic side effects that could be causing your hearing problems. This is a very important step so don’t let your audiologist overlook it. A number of audiologists use the book “Ototoxic Drugs Exposed” for this purpose.
Also, during this step feel free to volunteer any other information that you think may be relevant to your hearing loss so your audiologist understands as much as possible of your hearing situation.

2.     Physical Inspection—Ear Canal & Ear Drum

Following your hearing history, your audiologist will use an otoscope (basically a combined flashlight and magnifying glass) to physically inspect your ears for ear wax (cerumen) or foreign objects that might be blocking your ear canals. Anything partially or completely blocking your ear canals can adversely affect your hearing, and consequently corrupt any testing results.
Your audiologist will also inspect your ear canals and ear drums for problems (holes in your ear drum, signs of infection in your ear canal or middle ear, etc.). If he sees any serious problems, he will refer you to an ear specialist (medical doctor) for treatment. Remember, audiologists assess hearing. They do not treat ears medically.
However, some audiologists are trained to remove any excess ear wax they find, and then continue on with the evaluation process. Others will send you to a medical doctor for this procedure. If this is the case, you will have to come back later for your hearing tests.
Instead of using an otoscope, some audiologists now use a tiny TV camera that they insert into your ear canals to inspect your ears. This way both you and your audiologist can see what your ear canals and ear drums look like. This is cool to watch.

3.     Tympanometry & Acoustic Reflexes

After your audiologist inspects your ear canals, the next step in the complete audiological evaluation process goes by the name of Impedance Audiometry or Acoustic Immittance Testing. Impedance Audiometry consists of two parts. The purpose of this test is to evaluate how well your outer and middle ears are working.
The first part, called tympanometry (tim-pan-AHM-ih-tree), is a quick and easy test that takes longer to explain than to carry out. This test measures how easily your ear drums vibrate, and at what pressure these vibrations are the easiest.
Here’s how it all works. Your middle ears are normally filled with air at a pressure equal to the surrounding atmosphere. Your ear drums vibrate best when the air pressure inside your middle ears is the same as the outside atmospheric pressure.
To test whether this is the case, or not, a special probe, much like an ear plug, is placed snugly in your ear canal. A tympanometer connected to this probe then automatically varies the air pressure in your ear canal while producing a clear tone. It measures and records how your ear drums respond to the pressure changes in the presence of sound.
The result is shown on a tympanogram. A tympanogram is a graph of the relationship of the air pressure in your ear canal to the impedance of your middle ear. (The easiest way to understand impedance is to think of impedance as resistance to movement.) Impedance is lowest when the outside air pressure is equal to the air pressure in your middle ear.
Your audiologist will classify the results of your tympanometry as either Type A, B or C.
Type A is the result you want (Fig . 1). It indicates your middle ear mechanism is working normally. The graph looks like a mountain peak—not too high or too low—and centered in the middle of the graph (Fig. 1, solid line).
There are two variations in Type A. Type AD has a taller than normal peak (Fig . 1, dashed line). This indicates one (or more) of the bones in your middle ears are dislocated or damaged, or there may be a loss of elastic fibers in your ear drums. Type AS (Fig. 1, dotted line) has a shorter peak than normal. This often indicates a “stiff” system such as might occur if you have otosclerosis.¹
Type B (Fig. 2) shows a more or less flat graph resulting from little or no variation in impedance. This indicates a conductive hearing loss at all frequencies. Typically, this is the result of middle ear infections where your middle ear fills with fluid thus preventing your ear drum from vibrating freely. A Type B tympanogram may also result from a hole in your ear drum, or from ear wax blocking your ear canal.
Type C tympanograms (Fig. 3) show a peak similar to Type A tympanograms, but the peak is shifted off center. If the peak is shifted to the left (indicating negative air pressure in the middle ear), your ear drum is sucked in (Fig. 3, solid line). If the peak is shifted to the right (indicating positive pressure in the middle ear), your ear drum is bulged out (Fig. 3, dashed line). In either case, the result is a conductive hearing loss at both low and high frequencies. Type C tympanograms generally indicate that your Eustachian tubes are blocked, or otherwise are not working properly.²
The second part of the Impedance Audiometry test is measuring your Acoustic Reflex (AR). Your Acoustic Reflex is how well the tiny muscles in your middle ears contract in response to loud sounds. This testing is automatically done at the same time as the tympanometry testing so you might not even be aware it was done.
What is an Acoustic Reflex? Glad you asked. The Acoustic Reflex is an automatic mechanism God designed to help protect your inner ears from damage from loud sounds. Here’s how it works. There are tiny muscles (called the stapedius muscles) that are attached to the third bones (stapes or stirrup) in your middle ears. These muscles automatically contract when your middle ears are exposed to sounds over about 80 dB. When these muscles contract, they pull your stirrup bones (stapes) away from your oval windows so they won’t transmit this sound as loudly to your inner ears.³
At the same time, tiny muscles that are attached to your ear drums (called the tensor tympani) also contract in response to louder sounds. This stretches your ear drums slightly, thus reducing their mobility. This also reduces the volume of sounds transmitted through the bones of your middle ears, again helping prevent inner ear damage.
During this portion of the test, the impedance audiometer sends a louder tone into your ear canals. If these two muscles automatically contract at the presence of this sound, it shows your ears received the sound and attempted to protect themselves from it. This means your Acoustic Reflex mechanism is working properly.
If there is no Acoustic Reflex, it could indicate you have a conductive loss in your middle ears, you have a severe sensorineural hearing loss or your have a lesion(s) on your auditory nerve.

4.     Pure Tone Testing

Now that the preliminaries are out of the way, we come to what everyone thinks of when they think of hearing testing—what is called pure tone testing. The primary purpose of pure-tone testing is to determine the type (conductive, sensorineural, mixed), degree (mild, moderate, severe, etc.), and configuration (shape of loss, etc.) of your hearing loss. (Learn more about the shape of hearing losses in the article "Kinds of Hearing Losses.")
Pure-tone audiometry is done in a soundproof booth to ensure that background noise does not affect the test results. As a result, you will only hear those sounds that your audiologist introduces into the room, either though earphones (air conduction response), bone conduction oscillator (bone conduction response) or though speakers located in the room (sound field response).⁴
During a complete audiological evaluation, your audiologist will test your hearing first using air conduction testing, then using bone conduction testing. (Sound field testing [4c] is usually reserved for later when you are fitted with hearing aids.)

4a.    Air Conduction Testing

The purpose of the pure-tone air-conduction hearing test is to document the softest tones you can hear at least 50% of the time at selected test frequencies. During this test, you wear headphones and listen for these tones—first in one ear, then in the other ear. Each time you hear a tone, you typically press a button to indicate this.
Your audiologist will use a specially-calibrated device called an audiometer (ah-dee-AHM-it-ter) to measure your hearing loss. The audiometer produces a series of tones ranging from very low to very high pitches (frequency). At each pitch (frequency) of sound, you will hear a series of tones (beeps) of varying intensities (loudness). Your audiologist will lower the volume of this tone until you no longer respond consistently. Then she will do the same with a different frequency. She does this for the standard test frequencies between 250 Hz and 8,000 Hz. because these are the frequencies you use for speech.
The frequency or pitch of the sound is referred to in Hertz (Hz). The intensity or loudness of the sound is measured in decibels (dB). The softest level at which you can hear each tone is called your pure-tone threshold. Your audiologist will record your responses on a chart called an audiogram that graphically portrays your hearing loss, i.e. the softest sounds you can hear at each frequency tested.⁵
By convention, the air conduction results are displayed on your audiogram using blue Xs for your left ear and red Os for your right ear.
If you have tinnitus and you have trouble distinguishing the faint test tones from your tinnitus, ask your audiologist to use warble tones instead of pure tones. The warble tones are most distinctive and thus are easy to separate from your tinnitus. This is what I do. If the audiometer can’t produce warble tones, ask your audiologist to use the “double-beep” option—the tones are all repeated twice separated by a short pause (beep-beep). These “beep-beep” tones are not as easy to distinguish as warble tones, but are much easier to distinguish than the standard single tones.
Since your hearing loss likely varies by frequency, the standard way to express your degree of hearing loss is to calculate your Pure Tone Average (PTA)—the average of your hearing loss at 500, 1000 and 2000 Hz.—and use this figure to describe your hearing loss.
For example, if your hearing loss was 35 dB, 45 dB and 55 dB at 500, 1,000 and 2,000 Hz respectively, then your PTA would be 45 dB.
The proper way to express the results of your pure tone average (PTA) are as follows:

	Normal	0 – 25 dB
	Mild hearing loss	26 - 40 dB
	Moderate hearing loss	41 - 55 dB
	Moderately Severe hearing loss	56 - 70 dB
	Severe hearing loss	71 - 90 dB
	Profound hearing loss	>90 dB

      Thus, from the above example, you would describe your hearing loss either as a 45 dB loss, or as a moderate hearing loss.
Note: Never say you have a 45% hearing loss. This is totally meaningless. You cannot express decibels (dB) as percentages because decibels are not linear units of measurement. Stick to decibels, or use the mild, moderate, severe format.

4b.    Bone Conduction Testing

For bone conduction testing, you repeat the same procedure used for air conduction testing, but this time, instead of wearing earphones, you wear a special bone conduction oscillator (vibrator) placed on the mastoid process—the bony bump behind your ear. Bone conduction testing assesses how well you hear when the sound signal is transmitted through the bones of your skull to you cochlea. Since it bypasses your outer and middle ears, bone conduction testing can determine how well your inner ears work independent of any problems that might occur in your outer and middle ears. Bone conduction results are always better than, or equal to, your air conduction results.
Again, by convention, bone conduction results are displayed on your audiogram using angle brackets (<>)—blue “greater than” angle brackets (>) for your left ear and red “less than” angle brackets (<) for your right ear.
If your bone conduction results are normal and your air conduction results show a hearing loss, then you have a conductive loss. This means your middle ears are not working properly.
However, if both your bone conduction and air conduction results show the same degree of loss (within 10 dB), then you have a sensorineural hearing loss. This means your middle ears are working properly. Therefore, your hearing loss is in your inner ears or auditory nerves.
If both your air and bone conduction results show a hearing loss, and there is more than a 10 dB difference between the air conduction and bone conduction results (what they call the air-bone gap), then you have both a conductive loss (in your middle ears) and a sensorineural loss (in your inner ears). Appropriately, they call this a mixed loss.
At this point, I should briefly mention a bit about masking techniques. Masking is where your audiologist puts noise in the ear not being tested to prevent it from hearing sounds meant for the other ear. Masking is typically used if one of your ears hears much better than the other one. In this case, your better ear will hear (via bone conduction) the sounds being presented to your worse ear. As a result, you will likely respond when you shouldn’t. By masking your better ear, it can’t hear the test tones from the ear being tested, thus the test results are not corrupted.
In case you are interested, when you are wearing headphones it takes 40 dB of sound to vibrate your skull. (The corresponding figure is 60 dB when using insert earphones, and 0 dB for bone conduction.)⁶ This means that if you have normal hearing, when wearing headphones, the ear opposite to your test ear will typically hear any sounds though your skull (bone conduction) that are presented at a level greater than 40 dB).

4c.    Sound Field Testing

Sound field testing is simply testing while listening to loudspeakers in the sound booth, as opposed to listening through headphones/earphones or bone-conduction oscillators.
Sound field testing is usually reserved for testing how well you hear with your hearing aids on, since you can’t very well wear headphones and hearing aids at the same time or you risk getting feedback. Besides, it would be very uncomfortable.
During sound field testing, you sit in the soundproof booth facing the front and listen to sounds from two loudspeakers—one on each side of the booth set at 45 degrees to your ears.
The main purpose of sound field testing is to compare how well you hear with your hearing aids on as compared to how well you hear with your “bare ears.” Obviously, the results should be much better with your hearing aids on, or you are not getting any benefit from wearing them.
Normally, sound field testing is only done after your audiologist fits you with new hearing aids or significantly alters the settings on your existing hearing aids. This confirms whether your hearing aids are really helping you, or whether they need more “tweaking” to properly fit your hearing loss.

5.     Speech Recognition Threshold (SRT)

So far, all the testing has been to determine the degree and type of your hearing loss. The following tests now look at how well you respond to speech.
The first speech test done is typically the Speech Recognition Threshold (SRT) test. It is sometimes called by its older name, Speech Reception Threshold.
The purpose of the Speech Recognition Threshold (SRT) test is to determine the softest level at which you just begin to recognize speech 50% of the time.
Audiologists determine your SRT by asking you to repeat a list of easy-to-distinguish, familiar spondee words. (Spondee words are just two-syllable words that have equal stress on both syllables. You’ll notice that when you repeat a spondee word, you speak each syllable at the same volume and take the same length of time saying each syllable.) Spondee words were chosen for this test because they are easy to understand at faint hearing levels. Some of the commonly-used spondee words in this test include airplane, baseball, cupcake, hotdog, railroad, cowboy, ice-cream, outside, playground and sidewalk.
Some people are concerned that because they have had their hearing tested so often they have memorized the SRT word list, and thus they will not get a reliable test. (You can read more about this in the article “Help, I’ve Memorized the Word List!”) This is not a problem. In fact, you should be familiar with all the spondee words in the list before testing commences because this familiarization results in an SRT that is 4 to 5 dB better than that obtained if you didn’t know them. Remember, the purpose of this test is not to test your hearing acuity, but to determine at which level you begin to recognize speech.
When you take the Speech Recognition Threshold test, your audiologist will tell you, “Say the word ‘baseball.’ Say the word ‘cowboy.’ Say the word ‘hotdog.’” etc. As she does this, she varies the volume to find the softest sound level at which you can just hear and correctly repeat 50% of these words. This level is your SRT score expressed in decibels (dB). You will have a separate SRT test for each ear.
The Speech Recognition Threshold test serves several purposes. First, it is a measure of the reliability of your pure-tone air-conduction test. In fact, your SRT should be within 5 dB of your Pure Tone Average (PTA). Second, the SRT suggests the level of loudness at which words should be presented for the Word Discrimination (WD) testing that will follow. Third, your SRT determines how much power (gain) you will need in a hearing aid that is right for your degree of hearing loss.
Here’s some interesting facts about SRT values and what they mean to you. If your SRT is 5 dB (normal), you can understand speech perfectly at 21 feet and still catch some words at over 100 feet. If you have a mild hearing loss—for example a SRT of 30 dB—you could only hear perfectly at 1 foot but could still hear some words at 18 feet. If your SRT is 60 dB (a moderately severe hearing loss), you would need the speaker to be only 1 inch from your ear in order to hear perfectly and within 1 foot to still hear some of the words correctly. You can readily see that if you have an SRT of 70 or more you won’t hear much at all without hearing aids or other amplification.⁷
Closely related to the SRT is the Speech Awareness Threshold (SAT), sometimes called the Speech Detection Threshold (SDT). Your SAT score is the lowest level at which you can identify, but not understand, sound as speech. Normally, SAT testing is only done if SRT testing cannot be done for some reason.

6.     Most Comfortable Listening Level (MCL)

After determining your SRT, your audiologist will typically determine your Most Comfortable (listening) Level by talking to you and making the volume louder and louder until you indicate that it is “just right.” This is the volume at which you likely best hear speech. Therefore, this is the volume at which you’d normally want your hearing aids set. Typically, your MCL is about 40 dB louder than your SRT level if you have normal hearing. If you have a hearing loss it may be different. For example, my MCL is only 20 dB above my SRT level.

7.     Uncomfortable Loudness Level (UCL) or Threshold of Discomfort (TD)/Recruitment Testing

Typically after your audiologist finishes the MCL testing, he will test you for how loud a sound you can stand. This is your Uncomfortable Loudness Level (UCL) or Threshold of Discomfort (TD). It is sometimes called the Upper Level of Comfortable Loudness. No matter what you call it, it is the loudest level of sound that you would ever want to hear. Anything louder would be painful.
To do this test, your audiologist keeps talking to you and slowly raises the volume. You indicate when his voice is almost, but not quite, painful.
The UCL is very important for properly adjusting your hearing aids. Your hearing aids should be set so that no sounds ever exceed your UCL, and in fact, should stay 5 dB or so below this level.
Unfortunately, most audiologists consider the UCL test a test of recruitment (abnormal increase in loudness perception) at the same time. (You can learn more about recruitment by reading my article on “Recruitment.”) To a certain extent, UCL testing is a test of recruitment. However, it is not good enough because it does not identify the specific frequencies that cause your recruitment. As one audiologist told me recently, “We are so used to not seeing the frequency-specific UCL scores” that we don’t test for them. This needs to change.
It is my personal belief that many hearing aids end up in dresser drawers simply because they are not set to properly control recruitment—and this can only be done if you know which specific frequencies are causing recruitment. That is why frequency-specific recruitment testing is so important.
For example, in my 55 years of having my ears tested, frequency-specific recruitment testing has only been done once—and that was because I finally insisted it be done. It is no accident that my current hearing aids are the only ones I have worn in 51 years of wearing hearing aids that do not cause me pain because of recruitment. I no longer have to yank my hearing aids out just because my mother-in-law sets a glass on the table—and blows the top of my head off (figuratively, of course)—because recruitment levels were not set properly for how I perceive sound.
The proper way to test for recruitment is frequency by frequency for each ear in turn. To do this your audiologist uses the pure tone testing format and earphones. However this time, instead of seeing how soft a sound you can hear, he determines how loud a sound you can stand before your eyes blink, and you wince or jump as your recruitment kicks in.
These scores can be plotted on your audiogram just like the pure tones were, but using different symbols.
Your audiologist should then use these results to set your hearing aids so no sounds will ever equal or exceed these recruiting values at these frequencies. When this is done properly, the difference is like night and day. It is that wonderful!

8.     Word Recognition (WR) or Speech Discrimination (SD) Testing

The final speech test is Word Recognition (WR) testing, formerly called Speech Discrimination (SD) testing. The purpose of Word Recognition testing is to determine how well you hear and understand speech in a perfectly-quiet environment when the volume is set at your Most Comfortable Level (MCL).
To do this, your audiologist says a series of 25 or 50 single-syllable phonetically-balanced (PB) words. (Phonetically-balanced just means that the percent of time any given sound appears on the list is equal to its occurrence in the English language. The words in this test cover the whole spectrum of sounds made in English.) They are single syllable words such as chew, what, knees, etc.
For this test, your audiologist will say, “Say the word ‘come.’ Say the word ‘high.’ Say the word ‘chew.’ Say the word ‘knees,’” and so on. You repeat back what you think you hear.
Each ear is tested separately. During this test, your audiologist keeps her voice (or a recording on tape or CD) at the same loudness throughout. If you have normal hearing, the volume is typically set to 40 dB above your SRT (although it may range from 25 - 50 dB above your SRT level, depending on how you perceive sound). If you have a significant hearing loss, it is set to your MCL.
This is the only test where the results are recorded in percentages. The rest of the hearing tests are all expressed in decibels.
Your Word Recognition score is an important indicator of how much difficulty you will have communicating, and how well you may do if you wear a hearing aid. If your word recognition is poor, speech will sound garbled to you.
For example, a Word Recognition score of 100% indicates that you heard and repeated every word correctly. If your score was 0%, it means that you cannot understand speech no matter how loud it is—speech will be just so much gibberish to you. Scores over 90% are good and are considered to be normal. Scores below 90% indicate a problem with word recognition. If your score is under 50%, your word recognition is poor. This indicates that you will have significant trouble following a conversation, even when it is loud enough for you to hear. Thus, hearing aids will only be of very limited benefit in helping you understand speech. If your word recognition falls below 40%, you may be eligible for a cochlear implant.
Incidentally, people with conductive hearing losses frequently show excellent speech discrimination scores when the volume is set at their Most Comfortable Level. On the other hand, people with sensorineural hearing losses typically have poorer discrimination scores. People with problems in the auditory parts of their brains tend to have even poorer Word Recognition scores although they may have normal auditory pure-tone thresholds.
In addition to determining how well you recognize speech, Word Recognition testing has another use. Your audiologist uses it to verify that your hearing aids are really helping you. She does this by testing you first without your hearing aids to get the baseline Word Recognition score. Then, later she tests you with your hearing aids on. If your hearing aids are really helping you understand speech better, your Word Recognition scores should be significantly higher than they were without them on. If the scores are lower, your audiologist needs to “tweak” your hearing aids, or try different ones, to bring your Word Recognition scores up.