Audiology at FYZICAL

Our audiologists are the industry experts at identifying, diagnosing, treating and managing disorders of the auditory and balance system. We are proud to be able to offer the following services:

Hearing Loss

  • Determine a patient’s type and degree of hearing loss through a full panel of state-of-the-art hearing tests
  • Provide individualized recommendations for treatment

Hearing Aid

  • Dispense a wide range of hearing aids from the top manufacturers
  • Fit each hearing aid for comfort and functionality
  • Program every hearing aid to ensure it provides the best possible treatment based on the details of a patient’s specific type of hearing loss

Dizziness and Balance

  • Diagnose the cause of unexplained episodes of dizziness or balance issues
  • Provide treatment for the diagnosed disorders

Hearing Loss Prevention

  • Provide counseling and education on how to prevent further hearing loss
  • Offer custom-made earmolds for additional hearing protection

Tinnitus

  • Deliver rehabilitation services to help patients cope with symptoms

Read more about our Audiology at FYZICAL:

Hearing Test

The first thing our audiologist will do when a patient walks into their office is to take a case history. This involves reviewing a patient’s medical and hearing history.  Next, a physical exam will be completed, using a lighted otoscope to look into the ear.

Finally, a variety of tests will be performed. These tests are used to confirm whether the patient is experiencing any hearing loss, and if so, the cause and degree of the hearing loss.

A pure-tone test measures the faintest tones a patient can hear. The patient will sit in a sound booth and wear specially-designed headphones. Every time they hear a tone they will raise their hand or push a button. At the end of the rest, the results are recorded on an audiogram. This is a visual representation of how well a patient can hear, specifically the loudness (decibels) of each pitch (hertz) that was correctly identified.

Speech testing is used to measure how well a patient can hear spoken words. The patient’s speech reception threshold (SRT) and speech detection threshold (SDT) are determined; these results are also recorded on the audiogram. A series of words is read aloud; in one version of the test the patient just indicates if they heard the words, while another version of this test requires the patient to repeat the words back to the tester.

Middle ear tests are a series of tests used to measure how well the middle ear is functioning. These tests are especially important for preschool aged children as they are most likely to be affected by middle ear problems. Tympanometry is used to check for fluid trapped within the middle ear; the test forces air into the ear canal and the degree to which the eardrum can move back and forth is measured. Acoustic reflex measures determine the location of hearing problems. Loud tones are presented to the ear and the level at which the tiny muscle within the ear reacts is measured. Static acoustic impedance measures the volume of air within the middle ear.  This test is used to determine if there is a perforated eardrum or a problem with ventilation.

An auditory brainstem response (ABR) provides the audiologist with information on a patient’s inner ear and the neuronal pathway that connects the ear to the brain. Electrodes are placed on the patient’s head to record brain activity in response to sounds. This test typically lasts two hours; the patient must lie still for the duration of the test. This is a subjective test, which makes it good for measuring hearing loss in children.  Because of this test’s subjective nature, it is part of most newborn hearing screenings.

Otoacoustic emissions (OAEs) are barely audible sounds given off by hairs that line the cochlea. A small probe is placed into the ear canal and sounds are played. Any OAEs emitted by these hairs are recorded by the probe. Since this test is objective, it is also used as part of most newborn hearing screenings.

Hearing Loss

Hearing loss can vary by type and degree. The type of hearing loss is determined by which part of the auditory system is damaged. There are three types: conductive, sensorineural and mixed. The degree can range from mild to profound.

Conductive hearing loss is marked by an inability of sound to be properly transmitted from the outer or middle ear. Impacted earwax, a perforated eardrum or a malformation to the outer ear can all prevent sound waves from being properly captured by the outer ear and funneled down the ear canal. Fluid within the middle ear, an ear infection and poor Eustachian tube function can all prevent the vibration of the sound wave from traveling from the eardrum through the bones in the middle ear. This type of hearing loss is usually only temporary and can be treated through medical or surgical means.

Sensorineural is the most common type of hearing loss. This type of hearing loss is due to damage within the inner ear or to the auditory nerve, which connects the ear to the brain. Typically, once a sound wave vibration passes through the middle ear it hits the cochlea, within the inner ear. This hit causes the fluid inside the cochlea to move which activates the tiny hairs within. The hairs will then release an electrical signal which is sent via the auditory nerve to the brain; the brain then processes this signal as sound. Exposure to loud noises, aging, illness and certain drugs can all cause damage to the inner ear. This type of damage is usually permanent and cannot be corrected through medical or surgical means. Fortunately, almost 90% of individuals with this type of hearing loss can receive benefit from the use of a hearing aid.

Mixed hearing loss is a combination of both. The individual will have damage to the outer or middle ear and the inner ear or auditory nerve. To treat this type of hearing loss the conductive hearing loss is addressed first and then the sensorineural.

The degree of an individual’s hearing loss can range as well—from mild, moderate, severe to profound. Since hearing loss usually develops slowly, mild hearing loss is often easily overlooked. Noisy environments are typically the only location those with mild hearing loss will notice they are missing words. Moderate hearing loss begins to make one-on-one conversations harder. Severe hearing loss makes it nearly impossible to follow a conversation without the use of a hearing aid. Those that suffer from profound hearing loss are typically unable to utilize a hearing aid; they may rely on sign language to communicate.

Hearing Aids

There are many decisions that go into picking the right hearing aid. Fortunately, these decisions do not have to be made alone as a Fyzical audiologist will be on hand every step of the way.

The first decision that needs to be made is on the hearing aid style. There are six main styles of hearing aids. Typically, the smaller the model the fewer features it can contain and the smaller the battery that fits inside it is; smaller batteries have a shorter lifespan.

Completely-in-the-canal (CIC) fits entirely in the ear canal, making this model practically invisible. This is the smallest model, which means it also takes the smallest battery and has no room for any additional features. This style works for those with mild to moderate hearing loss.

In-the-canal (ITC) fits partially within the ear canal and partially outside of it. It is only slightly more visible than the CIC but can contain a few additional features and a slightly larger battery. This model also works for those with mild to moderate hearing loss.

In-the-ear (ITE) sits in the outer portion of the ear and comes in two styles, full shell or half shell. This style is even larger than the ITC which means it is more visible but can contain more features and a larger battery. This style works for those with mild to severe hearing loss.

Behind-the-Ear (BTE) is the most common type of hearing aid. It has two parts, one that sits within the ear canal and one that sits behind the ear. A tube connects both parts. This is the largest model which means it can fit the most features and can take the largest battery. This style works for all types of hearing loss.

Receiver-in-canal (RIC) style is very similar to the BTE. It contains two parts, one located behind the ear and one within the ear. The only difference is that the RIC is less visible as the parts are connected with a wire instead of a tube.  This style works for those with mild to severe hearing loss.

Open fit is the final style. Two pieces are connected with a thin wire, one piece sits behind the ear and one sits within. The difference between this style and RIC is that the piece within the ear canal is much smaller. This allows low-frequencies to enter the ear and be processed naturally, while high-frequencies still go through the hearing aid for amplification.  This style is ideal for those with mild to moderate hearing loss.

The next step is deciding which additional features you want or need. This is a constantly expanding list as hearing aid technology continues to evolve. A few of these options are:

  • Wireless connectivity – this enables the user to wirelessly connect to Bluetooth®enabled devices, such as televisions and cellphones. This eliminates most of the interference from background noise
  • Synchronization – this is useful for those that require a hearing aid in each ear. It enables the user to make changes to one hearing aid and have those changes automatically made to the other.
  • Remote controls – this enables the user to change the settings of the hearing aid without having to fiddle with small buttons or remove the piece from the ear.
Hearing Aid Fittings

While selecting the correct hearing aid is certainly half the battle, the hearing aid fitting is the most important step towards better hearing.

The hearing aid arrives to Fyzical’s office from the manufacturer un-programmed. The audiologist takes all the information gathered from the hearing tests and uses a digital computer program to adjust the hearing aid to fit the patient’s specific hearing needs. The individual’s preference is also taken into consideration when programming the device.

A real-ear measurement is often taken and this information is added into the programming. A microphone is placed in the ear to measure how much sound is able to reach the eardrum. Since everyone’s ears are a different shape and size, the same level of amplification can sound different. The audiologist is able to take this real-ear measurement and adjust the hearing aid accordingly.

Environmental simulation is a good way for the patient to test out the programming of the hearing aid before leaving the office.  Real-world sounds are played over a surround sound speaker system and the patient is able to see how their hearing aid performs. If any adjustments are needed they can be done right there.

Once all the programming and adjustments have been made, the audiologist will review hearing aid maintenance. The hearing aid needs to be cleaned daily with a dry cloth to remove any dirt or grime. The earmold can be cleaned separately with a mild soap solution, making sure it is completely dry before reattaching. A hearing aid drying container can be used to prevent moisture from accumulating in the device. The hearing aid should be placed in this drying container overnight. To ensure the hearing aid is working as it should, a listening check should be performed every other day. A listening tube is used to make sure the sound coming from the device is not weak or scratchy.

Additional pure-tone and speech testing are normally performed during the pre-evaluation. Pure-tone air conduction testing involves playing tones through specially designed earphones. Every time the patient hears a sound they are instructed to raise their hand or push a button. Pure-tone bone conduction requires a small bone conductor to be placed behind the ear. Instead of emitting a sound the bone conductor sends out a small vibration. The results from both versions of the pure-tone test are compared.

To test for a patient’s speech reception threshold (SRT) a series of words is read aloud; the patient indicates which words they heard and understood. The word discrimination (WD) score is determined by asking the patient to repeat back the list of words. The number of correct words is recorded. The most comfortable level of loudness (MCL) is determined by playing speech at various levels, with the patient indicating which is most comfortable to listen to. A patient’s uncomfortable level of loudness (UCL) is tested similarly; the patient indicates which level is uncomfortable but not painfully loud.

Once all these tests have been performed, the patient and audiologist work together to determine the best hearing aid for their level of hearing loss. The hearing aid is fitted and programmed according to the results of these previous tests. After the patient has worn the hearing aids for a few weeks they return for a post-hearing aid fitting. The tests completed in the pre-evaluation process are repeated; this time the patient is wearing the hearing aid. Any adjustments can then be made to the programming of the hearing aid. The patient is encouraged to return every four to six weeks to repeat these tests; this ensures the hearing aid is working as well as possible.

Hearing Aid Evaluation

A hearing aid evaluation is completed in order to determine which hearing aid will work best for a patient’s specific type and degree of hearing loss. Typically, this type of evaluation contains two parts, pre-evaluation and post-hearing aid fitting. A pre-evaluation confirms if the patient is a good candidate for a hearing aid and determines their comfortable and uncomfortable listening levels. A post-hearing aid fitting is used to fine tune the hearing aid in order to get the best results.

Additional pure-tone and speech testing are normally performed during the pre-evaluation. Pure-tone air conduction testing involves playing tones through specially designed earphones. Every time the patient hears a sound they are instructed to raise their hand or push a button. Pure-tone bone conduction requires a small bone conductor to be placed behind the ear. Instead of emitting a sound the bone conductor sends out a small vibration. The results from both versions of the pure-tone test are compared.

To test for a patient’s speech reception threshold (SRT) a series of words is read aloud; the patient indicates which words they heard and understood. The word discrimination (WD) score is determined by asking the patient to repeat back the list of words. The number of correct words is recorded. The most comfortable level of loudness (MCL) is determined by playing speech at various levels, with the patient indicating which is most comfortable to listen to. A patient’s uncomfortable level of loudness (UCL) is tested similarly; the patient indicates which level is uncomfortable but not painfully loud.

Once all these tests have been performed, the patient and audiologist work together to determine the best hearing aid for their level of hearing loss. The hearing aid is fitted and programmed according to the results of these previous tests. After the patient has worn the hearing aids for a few weeks they return for a post-hearing aid fitting. The tests completed in the pre-evaluation process are repeated; this time the patient is wearing the hearing aid. Any adjustments can then be made to the programming of the hearing aid. The patient is encouraged to return every four to six weeks to repeat these tests; this ensures the hearing aid is working as well as possible.

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