Hearing (Audiology)

Overview

Audiology services are provided for children and adults of all ages. All newborns born at Phelps have their hearing screened prior to discharge. Complete audiological assessments are conducted on infants through the geriatric population. Objective tests provide measurements of auditory function and brain wave activity that do not require voluntary responses from patients. A variety of hearing aids are customized to the type and severity of the hearing loss. Aural rehabilitation workshops assist the newly fit hearing aid users to adjust to louder, clearer sound and set realistic goals for hearing aid use.

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Diagnostics

• Universal Newborn Hearing Screening
• Hearing Assessment, including pure tone testing, speech audiometry, and analysis of middle ear function for infants, children, and adults
• Site of Lesion testing

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Rehabilitation

• Hearing Aid Evaluations
• Hearing Aid Dispensing
• Hearing Aid Orientation and Adjustment
• Assistive Listening Devices

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How Hearing Works

The Outer Ear
The outer ear is the external part of the ear that we see and the ear canal. The eardrum is located at the end of the ear canal and seals off the middle ear. The sound waves are directed to the eardrum which starts to vibrate.

The Middle Ear
The middle ear is the portion behind the eardrum which is filled with air. The eustachian tube connects the middle ear to the throat and keeps the air pressure in the middle ear space equal to the outside air pressure. We can sometimes feel the eustachian tube working when our ears “pop”. There are three bones in the middle ear space – the malleus, incus and stapes. The bones are connected and create a lever that conducts the sound energy from the eardrum to the inner ear.

The Inner Ear
The inner ear consists of the cochlea. It is the snail shaped portion filled with fluid and the nerve endings of the auditory nerve. The balance organ is attached to the cochlea. The stapes pushes against the cochlea at the oval window and creates a wave of fluid in the inner ear. This wave activates the hair cells which send impulses to the brain via the auditory nerve.

All these structures have to work efficiently for good hearing. Even the slightest problem along the way can compromise hearing.

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Your Child’s Hearing

You should trust your intuition if you suspect your child has trouble hearing. The range of hearing that is considered normal for young children is keener than for adults. This is because they need to hear the subtleties of sound to learn speech and language.

Children with a hearing loss often learn to compensate for a lack of audible signals by being more sensitive to other information in their environment: vibrations in the floor, changes in light as a door opens or closes, and air movement. Because of this, their responses can seem normal, making hearing loss difficult to detect.

A child is never too young to have his hearing tested. Testing a baby’s hearing through newborn hearing screening programs is the best way to detect hearing impairment as early as possible. All babies born at Phelps Hospital are screened for hearing impairment prior to discharge. Research shows that hearing impaired children can develop speech and language in the same manner as children with normal hearing if they are fitted with hearing aids prior to 6 months of age.

Pediatric Hearing Evaluation

Children present a special set of challenges when trying to assess their hearing. The audiologist must use techniques which are both engaging and obtain the most information in the shortest amount of time. These are the tests used based on age and/or development.

Birth to 3 months

AABR/OAE. These are typically screening tests that are used to determine if a child should have a complete diagnostic test. They are completely objective as they do not require active participation of the baby. These tests are mandated by New York State and are typically completed when an infant is born, prior to their discharge from the hospital.

Tympanometry. This is a very quick test which does not require a response from the child. It assesses the function of the middle ear where the eardrum and bones are. This test will show if your child has fluid behind the eardrum (which is the source of infection).

In order to fully understand what a hearing loss is, it is necessary to understand the function of the hearing system. The complete hearing system is responsible for our sense of hearing. It picks up sound waves and turns them into nerve impulses which can be interpreted by the brain. The hearing system consists of three main sections: the outer ear, the middle ear and the inner ear.

Auditory Brainstem Response Recording (ABR). This test is generally used when a child is referred from the screening tests. It is an objective test which does not require the baby to respond. The test essentially measures the brain’s response to sounds presented to the ears through insert headphones. Because the responses that are measured are so small, muscle movement can contaminate the response. In the past a child older than 2 or 3 months would have been sedated for the test to be successful. New instrumentation which is used at Phelps Hospital allows us to obtain excellent results without sedation. The child needs to be quiet but can nurse or play quietly for the duration of the test. ABR can be used for any aged patient.

Four months to 2 years

Visual Reinforcement Audiometry. The child sits with a parent in the testing booth. Sounds are presented through speakers or headphones. The child is taught to turn toward the sound where a video screen will light up. When the audiologist presents the sound, the child responds by looking at the screen. The test uses both pure tones and speech.

Two+ years

Conditioned Play Audiometry. A child can be taught by the audiologist to place a block in the box or a ring on the tower when he hears a sound through the headphones.

Speech Audiometry. A child may be asked to point to body parts or point to pictures in a book. Children with more language will be asked to repeat simple words. The results indicate how softly words that are spoken can be perceived by the child.

The Early Intervention Program (EIP) is a public program funded by New York State and Westchester County for children under the age of three who are either suspected of having or are at risk for developmental delays or disabilities. The Speech & Hearing Center is approved as a provider of EIP services and is under contract with Westchester County to deliver services for audiological assessment. Potentially eligible children can be referred to the program by calling (914) 813-5094.

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Adult Hearing Loss

Adult onset hearing loss is defined as a gradual hearing loss that occurs with age. It is a common but not insignificant part of the aging process. According to the National Institutes of Health, an estimated one-third of Americans between the ages of 65 and 75 have some degree of hearing loss. The estimate goes up to one half for those 75 and older.

Signs Commonly Associated with Hearing Loss

• Asking people to repeat
• Ringing, buzzing, humming in your ears
• Believing people are mumbling
• Turning the volume up on the TV or radio
• Staying home to avoid frustration in social situations, sometimes resulting in feelings of isolation

An audiologist will evaluate your hearing to determine if a hearing loss is present. You may be referred to a doctor to address any medical issues that may be contributing to your hearing problems.

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Adult Hearing Evaluation

A compete hearing evaluation tests different parts of the hearing mechanism. Some tests require a voluntary response while others record ear and brain activity automatically.

The most familiar portion of the evaluation is the Pure Tone Test. The audiologist will present tones which require a response by raising a hand or pushing a button. The tones that are tested are the ones where the speech sounds occur. The result of this test will determine the degree of hearing loss and the pitch range of the loss. Pure tones are also presented via bone conduction to determine if there is a conductive component to the hearing loss. A conductive hearing loss reflects a problem in the middle ear which can often be medically treated.

Speech Discrimination is tested by having you repeat single syllable words either in quiet or in the presence of background noise. This test results in a percentage score. It attempts to quantify your ability to understand speech if given ample volume to hear all the speech sounds. This is a quick test of speech understanding and gives a snapshot of the function of the pathways in the brain that process speech.

Impedance and Acoustic Reflexes test the eardrum and bones of the middle ear to determine if they move efficiently so that there is adequate stimulation of the cochlea and the auditory nerve. This is another test of sound conduction and can further identify conductive hearing loss.

Otoacoustic Emissions (OAE) are present in ears which have a healthy middle ear and not more that a slight hearing loss. OAEs have been found to be sensitive to changes in the hair cells of the cochlea and predictive of hearing loss from noise exposure or ototoxicity.

Information obtained from the complete audiological evaluation is used to determine the degree of hearing loss and possible impact on communication.

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Hearing Quiz

Take this Quick Hearing Check to see if you need to have a hearing test.

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The Process for Hearing Aid Purchase

Once a hearing evaluation has been completed and the patient has decided to explore the option of purchasing hearing aids, an appointment is scheduled for a hearing aid evaluation.

Hearing Aid Evaluation. The patient and the audiologist begin the process by discussing the patient’s lifestyle, living arrangement and specific activities that are enjoyed (e.g. attending musical events). Any dexterity or vision issues will also be addressed. It is important for the audiologist to understand your lifestyle to know in what listening situations you will require the hearing instruments to perform. Specific features and styles of hearing instruments will be discussed depending on your needs. At the end of this session, you and your audiologist will determine which level of technology and style hearing aids are right for you. Your audiologist will inform you of the cost and services included in your purchase price as well as the refund amount if you should decide to return one or both hearing aids.

Hearing Aid Fitting and Counseling. Your audiologist will program your hearing aids and check the physical fit of the instruments. Realistic expectations and good communication strategies will be reviewed. You will practice inserting the hearing aids, changing the batteries and learn how to keep them clean. You will be seen in approximately one week after your initial fitting for a follow up visit. Your audiologist will encourage you to take notes regarding your reactions to different listening environments during the week. The expiration date of your 45 day trial period will be set.

Hearing Aid Fitting Verification. Real Ear measures are used to determine the level of amplification at the eardrum while using the hearing aids. This is an objective measure of the function of the hearing aids in relation to the hearing loss as determined by the original hearing test.

Hearing Aid Follow up. Remember to bring your notes! You will discuss the first week of hearing aid use, including any questions or problems that may have occurred. Adjustments to the sound of the hearing aids may be made at this time if the audiologist feels it is warranted. Any issues with physical fit or insertion will also be addressed. At this point, your progress will determine the frequency and number of follow up visits within the 45 day trial period.

New York State law allows for the return of hearing aids within 45 days of purchase if the patient is not satisfied with the fitting. The New York State Hearing Aid Dispensing Law states the percentage of charges that can be retained by the facility to cover the cost of the sessions spent by the audiologist for the hearing aid evaluation, fitting and follow up visits during the 45 day trial period.

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Adapting to Hearing Aids

Now that you have purchased hearing aids, you are ready to start the rehabilitative process. It is essential that you become educated in all the options which are appropriate for your situation. Including family members and significant others in the process is highly recommended. This will allow your communication partners to understand the hearing difficulties you are having and the techniques that are valuable in improving your listening.

There is a common misconception that hearing aids are the “cure-all” for hearing loss. In reality, hearing loss is a chronic condition which requires long term management. Hearing instruments are only part of that management.

At Phelps Hospital we offer two group hearing aid counseling sessions called Sound Advice. Anyone who purchases hearing instruments whether they are new to hearing aid use or upgrading to new technology is invited to attend, along with their hearing partners. New users and “old timers” can exchange ideas and tips for better communication and listening comfort.

There is no charge for this workshop. The workshop is designed to give hearing aid users support for the decision that they have made to take responsibility for their hearing loss. Topics discussed include the interpretation of an audiogram (hearing test), types of assistive listening devices (e.g. telephones, TV amplification), helpful communication strategies for difficult listening situations (e.g. noisy restaurants) and everyday barriers to communication.

Successful hearing aid use takes commitment and consistency. Unrealistic expectations often lead to disappointment and frustration. The majority of people with hearing loss have the same degree of loss in both ears. Hearing well from both ears provides better speech clarity, localization of sounds and a fuller sound with better fidelity. Giving the “hearing brain” a clear, full sound, helps to preserve the pathways needed to process and understand conversation. Research has shown that people who do not use those pathways (do not use amplification) lose the ability to understand, even when the sound is loud enough to overcome the hearing loss.

Adjustment to amplification and learning to hear well again can be challenging. There will be sounds in your environment which you may not have heard in a number of years. The brain will require time to integrate these “new” sounds back into your listening repertoire. You may need others to identify sounds you haven’t heard in a while! The fastest and easiest way to become comfortable with this new sound is to use your new hearing instruments during all waking hours. You and your audiologist will need to work closely so you can be comfortable using your hearing aids all day as you encounter different listening environments.

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Contact

Donald R. Reed Speech & Hearing Center
777 North Broadway
Suite 303
Sleepy Hollow, NY 10591
(914) 366-3010

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