Audiology Frequently Asked Questions

Answers from a Monterey Audiologist with 25+ Years of Experience

At Central Coast Audiology, Inc., our Salinas audiologist receives many of the same questions day to day. The answers provided here are intended to give you some insight on hearing loss issues. For more information, you can call our offices at (831) 216-1281 and speak with our team. We are always happy to address your concerns.

Am I a candidate for hearing instruments and what are the signs of hearing loss?

Almost anyone who is experiencing difficulty with communication due to hearing loss is a candidate for hearing instruments. There are some hearing losses that can be medically treated without a need for amplification, however, that is usually the exception and not the rule. The good news is there are usually warning signs that there is a possible hearing loss.

Signs of hearing loss:

• Do you feel that people mumble and do not speak clearly?
• Do you understand some people better than others?
• Do you frequently ask people to speak up or repeat themselves?
• Do you have difficulty understanding on the phone?
• Do you find it difficult to follow a conversation in a crowded room or with background noise?
• Do you turn the volume of the television or radio up louder than is comfortable for others?
• Do you find it difficult to hear in public places, such as an auditorium or church?
• Do family and friends comment on your inability to hear?
• Do you ever concentrate to listen so hard that you become fatigued?
• Do you have ringing in your ears?

If you answered yes to any of the above questions, you may have a hearing loss and you should have your hearing evaluated by an audiologist. It is recommended that everyone have their hearing tested annually, whether they suspect a hearing loss or not.

Can a hearing loss effect my mental well-being?

Yes. We all know that if you have a hearing loss, it is difficult to understand speech. What is not sufficiently appreciated is that a patient's emotional and mental state may also be affected by the erratic and disrupted communication patterns caused by hearing loss. A patient with hearing loss is four times as likely to manifest psychological disturbances as a person with normal hearing. There is also evidence that hearing loss can exacerbate the behavioral picture of patients with Alzheimer's and other cognitive disorders, affecting memory, alertness, and general ability to cope, beyond the expected limiting factors of the disorder without the presence of hearing loss. Thus, while hearing loss is invisible, the effects are not.

What causes ringing/noises in the ears, and why do I have it?

Ringing (tinnitus is the technical term) in the absence of stimulating sound from outside the ear can be caused by many things, such as fatigue or taking a dose of aspirin. It is believed that the ringing is due to spontaneous activity in the cochlea. The most common cause of tinnitus is hearing loss, and in particular sensorineural hearing loss. This is probably because the majority of patients with sensorineural hearing loss have some damage in the cochlea that is causing the hearing loss. It is these damaged sections that are presumed to be producing the spontaneous activity that leads a patient to hear sounds in their ear.

How do I hear?

Sound is vibration that travels through a medium, typically the air. When these vibrations reach the outer ear, this is the beginning of hearing. The ear has four main parts that sound must travel through for you to hear: the outer ear, the middle ear, the inner ear, and beyond the inner ear that includes the VIIIth nerve and the brain.

Outer ear

The outer ear consists of the external ear (pinna or auricle), the ear canal (external auditory meatus) and the ear drum (tympanic membrane). The outer ear directs sound into the ear canal and carries it to the eardrum. When these sound vibrations reach the eardrum, the eardrum begins to vibrate.

Middle ear

The middle ear contains the three smallest bones in the body; the malleus, incus and stapes. These bones conduct sound through the air filled middle ear and transfer the sound to the inner ear. These bones are known as the "ossicles" and are connected to form the "ossicular chain." The last bone in the chain is pushed in and out of the oval window of the cochlea. The eustachian tube, which equalizes pressure between the ear and the environment, is also found in the middle ear.

Inner ear

The inner ear, the end organ of hearing, contains both the cochlea and the vestibular system that works to keep the body balanced (your equilibrium). The snail-shaped cochlea contains what are called "hair cells" that are not really hairs, but microscopic cells that connect to approximately 24,000 nerve fibers which are essential for hearing. The rocking of the stapes in the oval window moves fluid within the cochlea causing a "shearing" action or movement of the hair cells. This shearing action causes the hair cells to send an electrical impulse to the auditory nerve (VIIIth nerve).

Beyond the inner ear (central auditory pathway)

The "shearing motion," stimulating the hair cells, causes impulses to be sent beyond the cochlea, to the auditory (VIIIth) nerve. The auditory nerve carries the information to the brain, via the brainstem, for decoding. There are auditory centers in the brain which interpret the stimulus enabling the understanding of what is being heard. If these parts of the brain are badly damaged or are not stimulated for a long period of time, a patient may not be able to hear speech even at high levels despite the fact that the auditory nerve has transmitted it to the brain.

What are the types of hearing loss and some causes?

Conductive hearing loss

Conductive hearing loss is caused by a problem in the outer or middle ear, including eustachian tube malfunction or a defect in the ossicular chain. In most cases, conductive hearing loss affects the lower frequencies or pitches and makes it difficult to hear vowel sounds. Since vowels contain the "power of speech" the patient perceives speech and other sounds as being much "quieter" than normal. Conductive hearing loss can often be medically treated.

Disorders of the outer ear that can cause conductive hearing loss include:

• Blockage of the external ear canal: Blockage of the external ear canal by either accumulated ear wax (cerumen) or a foreign body can produce a conductive hearing loss. If the obstruction is complete, it will prevent sound energy from reaching the eardrum.
• Bone growths in the external ear canal: Growths of the bony external ear canal can occur as osteomas, which are protrusions of bone extending from the walls of the external ear canal into the canal itself and are hard to the touch. If these growths are large enough, they can block the ear canal.
• Otitis externa: Otitis externa, also known as swimmer's ear, can be a bacterial or fungal infection of the external ear canal skin, and can cause conductive hearing loss. If there is swelling of the ear canal it can obstruct the pathway of the canal to the eardrum.

Sensorineural hearing loss

Sensorineural hearing loss is the most common type of hearing loss and is caused by damage to the inner ear and/or the auditory nerve. Noise exposure, diseases, certain medications and aging can destroy parts of the inner ear and cause permanent hearing loss. Once damaged, the inner ear cannot be repaired.

With sensorineural hearing loss, the entire cochlea is seldom damaged. The undamaged parts of the cochlea transmit sound to the auditory nerve and on to the brain. Sensorineural hearing loss is also characterized by a lower tolerance to loud sounds (called recruitment). Sensorineural hearing decreases the ability to differentiate consonant sounds (thus the fine distinctions in words such as hat versus cat). Most sensorineural hearing losses can be treated effectively with hearing instruments.

Disorders of the inner ear that can cause sensorineural hearing loss:

• Hereditary hearing loss: This is defined as those cases in which the cause is present in the genetic makeup of the individual. Hereditary hearing loss may be associated with other signs and/or symptoms such as renal involvement, degenerative diseases of the nervous system, albinism and metabolic disorders or as part of a syndrome.
• Congenital hearing loss: This means merely that the hearing loss was present at birth and can include both hereditary as well as acquired causes. The acquired cases have causes that acted while the fetus was developing in the womb, but not contained in the genetic makeup. Some congenital sensory hearing losses may be due to birth injury often associated with anoxia, drug ingestion by the mother and significant degrees of prematurity.
• Presbycusis: This is the sensory loss that is due to degenerative changes associated with the aging process. Presbycusis is the most common cause of sensory hearing loss in the adult population, usually starting around age 25.
• Noise-induced hearing loss: This is the second most common cause of acquired sensorineural hearing loss. The adverse effects of noise on the ear cause damage to tiny "hair cells" in the inner ear. When the hair cells become damaged from exposure to a single noise exposure such as gunfire or to prolonged exposure to loud noises such as music, machines, motors and other noise producing equipment, they are unable to be stimulated properly by an incoming sound signal. Once these hair cells have become damaged there is no way to repair them.
• Ototoxic drugs: There are several drugs that damage the structures of the cochlea and/or semicircular canals and are known to be ototoxic (poisonous to the ear). The more common drugs that are particularly toxic to the ear are certain antibiotics, salicylates (drugs containing aspirin), and quinine. The damage caused by these drugs often depends on the dose administered and length of time used.
• Virus-induced hearing loss: This is caused by specific viruses invading the body. The viruses of measles and mumps are well known causes of sensorineural hearing loss. The group of viruses that cause respiratory infections may also be carried by blood to the cochlea causing a viral reaction and can produce a sudden hearing loss.
• Sudden hearing loss: As its label implies, this is an abrupt loss of hearing. Sudden hearing loss of known causes may be due to drugs, trauma, infection, or disease. There are, however, many instances when no cause can be found. There are two theories as to what happens in these cases: Viral Labyrnthitis, which produces damage to the inner ear structures and Vascular Occlusion which is the abrupt interference of blood supply to the cochlea.

Mixed hearing loss

When a patient has both a conductive hearing loss and a sensorineural hearing loss, it is called a mixed hearing loss. For example, if a child who has a permanent sensorineural hearing loss gets otitis media, the effects of the two types of hearing loss combine to create a greater loss.

What if I have a hearing loss and do not receive treatment for it?

If you have a hearing loss that is caused by a medically treatable problem, the problem could worsen over time without treatment. If the hearing loss is due to a condition such as a lesion or tumor in the auditory system, this could be potentially life threatening. Whether the condition is medically treatable such as most conductive losses, or due to damage such as noise exposure or age, the result in the brain is the same, it does not get stimulated. This is called auditory deprivation. The brain is not getting stimulated by sound or is getting distorted versions of the sound due to the damage in the auditory system.

There have been many studies done on auditory deprivation to determine the long term effects on the brain. These studies suggest that if the brain is not stimulated, the potential to "forget" how to hear is great and is closely related to the length of time that brain goes without stimulation. The longer the patient goes without treatment (including amplification if that is warranted) the more likely it is the brain will forget how to hear and understand speech even after treatment is implemented. These findings suggest that it is important to seek appropriate treatment in a timely manner for hearing loss if the brain is to maintain its ability to understand speech.

What is the progression of hearing loss and the implications?

The progression of hearing loss in most cases is an obvious one from a small amount of hearing loss to greater and greater loss. The implications vary depending on the degree of hearing loss.

Borderline normal hearing

• May have problems in difficult listening situations such as in groups or in noise.
• May need visual cues (to watch the speaker's face and especially lips) to understand some conversations and certain speakers.
• May need to sit close to the speaker to understand the conversation.

If the problem is affecting the patient's ability to function normally in everyday life, they should probably consider amplification if the hearing loss is not medically treatable.

Moderate hearing loss

• Having problems in difficult listening situations such as in groups or in noise.
• Having difficulty understanding conversations on the telephone.
• Having difficulty understanding one-on-one conversations.
• Need visual cues (to watch the speaker's face and especially lips) to understand some conversations and some speakers.
• Need to sit close to the speaker to understand the conversation.
• People have to speak up for person to understand what is said.
• Quality of the patient's speech may be affected.

As the patient's quality of life is impacted, Hearing amplification should be considered if the hearing loss is not medically treatable.

Severe hearing loss

• Impossible to function in difficult listening situations such as in groups or in noise.
• Impossible to understand conversations on the telephone.
• Having difficulty understanding one-on-one conversations.
• People have to speak up for person to understand even part of what is said.
• Needs to sit close to the speaker to understand even part of the conversation.
• Need visual cues (to watch the speaker's face and especially lips) to understand even part of any conversation and any speaker.
• Quality of the patient's speech may be affected.
• May have difficulty identifying loud environmental sounds (sirens, telephone ring, car horn, etc.) making safety a concern.

Severe hearing loss affects the patient's ability to function normally in everyday life and they should consider amplification. If the hearing loss is medically treatable, it is most likely a mixed hearing loss, and may require amplification post medical treatment.

Profound hearing loss

• Impossible to function in difficult listening situations such as in groups or in noise.
• Impossible to understand conversation on the telephone.
• Impossible to understand one-on-one conversations.
• People have to speak up for person to understand even part of what is said.
• Need to sit close to the speaker to understand even part of the conversation, if any at all.
• Need visual cues (to watch the speaker's face and especially lips) to understand even part of any conversation and any speaker.
• Quality of the patient's speech is affected.
• Have difficulty identifying loud environmental sounds (sirens, telephone ring, car horn, etc.) making safety a concern.

When the problem is affecting the patient's ability to function normally in everyday life they must consider amplification. If the hearing loss is medically treatable, it must be a mixed hearing loss, and may require amplification post medical treatment to detect.

How do I know if I have a hearing loss?

Hearing loss occurs to most people as they age. Hearing loss can be due to aging, exposure to loud noise, medications, infections, head or ear trauma, congenital or hereditary factors, disease processes and many other causes. The vast majority of hearing problems do not require medical or surgical intervention. Some 90 to 95 percent of all cases of hearing loss can be corrected with hearing aids.

You may have hearing loss if:

• You hear people speaking but you have to strain to understand their words.
• You frequently ask people to repeat what they said.
• You don't laugh at jokes because you miss too much of the story or the punch line.
• You frequently complain that people mumble.
• You need to ask others about the details of a meeting you just attended.
• You play the TV or radio louder than your friends, spouse and relatives.
• You cannot hear the doorbell or the telephone.
• You find that when people look directly at you while they speak to you, it makes it easier to understand.

If you have any of these symptoms, you should see an audiologist to get an "audiometric evaluation." An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed audiologist.

What is an audiometric evaluation?

An audiometric evaluation allows the audiologist to determine the type and degree of your hearing loss, and it tells the audiologist how well or how poorly you understand speech. Your ability to hear and understand speech in quiet and in noisy situations are important indicators of auditory health, and they can be accurately tested by your audiologist. The AE also includes a thorough case history (interview) as well as visual inspection of the ear canal and eardrum. The results of the AE are also useful to the ear, nose and throat doctor, in the event the audiologist concludes your hearing problem may be treated with medical or surgical alternatives.

Written hearing tests, "dial a hearing test," and other online hearing tests are not 100% accurate, and are certainly not diagnostic, but they may be utilized as screening tools. These screenings can be scored within a few seconds. Written hearing screenings may point the patient in a particular direction and may help validate that a hearing problem exists.