As a physician, your role starts by asking hearing-related questions as part of the case history interview and by screening your patients' hearing. As you may know, hearing plays an important role in both the emotional and physical well being of your patients. You can be an important source of information for your patients who are hearing impaired. The more you know about hearing loss and its effects on your patients' lives, the better you will be able to assist them in making informed decisions that will allow them to live their lives more fully despite the hearing impairment.
Audiologists help doctors help their patients hear better
The field of audiology is the assessment and treatment of hearing disorders. Audiologists are hearing healthcare professionals who identify, assess, and manage disorders of the auditory system. They select, fit, program, and dispense hearing aids and assistive listening devices to help patients who are hearing impaired, hear clearer and better. Essentially, an audiologist provides rehabilitation to improve the quality of a patient's life through better hearing.
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Definition of diagnostic testing services available at the Bordenick Audiology Group.
Auditory Brainstem Response (ABR)
ABR is an electrophysiologic test which determines the sensitivity of the ear to sound, in ongoing or spontaneous brain wave activity. It can be used to estimate the sensitivity of the ear to sound in newborns, in older children who did not perform well on a regular hearing test, and in adults who are unable to accurately complete a regular hearing test. For adults, the most common reason an ABR is recommended is to help eliminate the possibility of a disorder along the hearing nerve or in the brain itself. Response to a sound stimulus is imperative in determining the extent of hearing loss and the recommended (needed) amplification. To perform an ABR, electrodes are pasted and taped to the scalp and earlobes and soft foam tips are inserted down into the ear canals. Sounds are delivered through the ear tips at a comfortable-to-fairly-loud level. These sounds cause nerve responses that are picked up by the electrodes and passed on to sophisticated equipment that records the responses. An audiologist can then measure the responses to determine if they are normal or abnormal. The results are provided to the physician, so he or she can determine the need for further medical evaluation.Cerumen (Earwax) Removal
It is recommended that you refer your patients for cerumen management if they experience a progressive hearing loss over several weeks, their ears feel full, plugged, or achy, or if they hear constant or occasional ringing noises.
When a patient is referred to the Bordenick Audiology Group for earwax removal, a certified audiologist performs a thorough video otoscopic evaluation of the ear canal. If there are no contraindications such as recent otalgia, ear drainage, family history of diabetes, medical history of acquired immune deficiency syndrome, mastoid or extensive middle ear surgery, or the use of anti-coagulant medications, cerumen is extracted utilizing instrumentation or suction, depending on the extent of wax buildup.
Remember the ol' adage: "Never put anything smaller than an elbow into your ear."
Electronystagmography (ENG)
An ENG is generally performed on patients who have episodes of dizziness or balance problems. It is an electronic measuring instrument that charts a patient's eye movements during a vestibular evaluation.Evaluation of Vestibular Problems
Most people at one time or another in their lives have experienced some type of "dizziness" associated with lightheadedness, an imbalance disorder, or true spinning sensation commonly known as vertigo. In fact dizziness is a common complaint physicians hear from their elderly patients. There is a close relationship between the hearing and balance systems because they share the same space called "the inner ear." The inner ear is comprised of two parts, the cochlea that houses the sensory organs responsible for our hearing and the semicircular canals that contain the structure, which help us maintain our balance. We call the semicircular canals and the nerve that innervates from the brain the "vestibular system." This system works in conjunction with other important systems such as visual and sensory to maintain balance as well.Symptoms of peripheral vestibular dysfunction include:
• Severe nausea and vomiting
• Mild imbalance
• Hearing loss
• Feeling fullness in the earsCauses of dizziness disorders include:
• Viral or bacterial infections of the inner ear
• Meniere's disease
• Tumors of the vestibular nerve
• Benign paroxysmal positional vertigo (BPPV). BPPV is a common type of dizziness associated with brief episodes of vertigo when the head is moving up or down, or rolling over in bed. Typically, the episode lasts 10-60 seconds then goes away. BPPV affects more men than women. Sometimes BPPV resolves itself.Treatments of dizziness disorders include:
• Screening for hearing loss
• Repositioning therapy
• SurgeryHearing Evaluation
The audiologist first examines a patient's ear canals for excessive earwax (cerumen) build-up or other debris. To perform a hearing test, the patient is seated n a sound-proof booth. To begin with, soft tones are presented and the patient is asked to signal whether the tone is heard or not by either pressing a button or raising his or her hand. Next, two-syllable and one-syllable words are presented and the person is asked to repeat the words. These tests are charted and the audiologist can determine whether a hearing loss exists and, if so, its degree and type. The degree of hearing loss is determined based on the loudness level required for a patient to hear the tones. If there is hearing loss, it is described and measured in decibels (dB) as:• Mild 21-40 dB
• Moderate 41-60 dB
• Severe 61-80 dB
• Profound 80+ dBOtoacoustic Emissions (OAE) test
The OAE test determines the function of hair cells (cilia) in the cochlea by turning sound energy into nerve energy. The OAE test takes approximately five minutes per ear and can be recorded on people at virtually any age, from newborn to well above age 80. The audiologist inserts a soft-tipped probe into the patient's ear and generates various tones of sound waves. The response to this acoustic stimulus determines the integrity of the hair cells. If the test results are normal, then hair cells are functioning normally and hearing sensitivity is essentially normal.Site of Lesion Testing
The site of lesion test determines whether the patient has sensorineural or conductive hearing loss. The site of lesion for about 95 percent of all hearing losses is the cochlea, resulting in sensorineural hearing loss, or what is called "nerve deafness." Only 5 percent of hearing losses are conductive, resulting from structural or mechanical damage to the outer ear and/or middle ear.Symptoms of Hearing Loss
• Asking people to repeat sentences
• Difficulty understanding children or soft voices
• Turning up the volume on the TV or radio
• Strained personal relationships
• Denying a hearing loss exists
• Social withdrawal
• Fatigue and stressTypes of Hearing Loss
There are essentially two types of hearing loss: Conductive and Sensorineural. An obstruction or infection in the ear canal causes a conductive hearing loss. Other causes include a perforation or scarring of the eardrum or middle ear, and Eustachian tube dysfunction. Otosclerosis, fixation of the middle ear bones, is another potential cause of conductive hearing loss. Most conductive hearing loss requires medical treatment. Sensorineural, also known as nerve deafness, is the result of damage to the nerve fibers in the inner ear. Noise exposure, ototoxic medication, diabetes, stroke, and other circulatory diseases cause sensorineural hearing loss. The natural aging process also commonly causes it. Hearing aids are usually the best solution to a sensorineural hearing loss.Tinnitus Evaluation
It is estimated that 50 million people are effected by tinnitus, often referred to as "ringing in the ears." Approximately 12 million of these people suffer severely. What you can do as their physician is refer them to an audiologist for a comprehensive hearing evaluation. Tinnitus can be present in the outer ear, middle ear, inner ear, and the brain. A medical history, phsyical examination, and a series of specialized tests can help determine precisely where the tinnitus is originating. While there is no cure for tinnitus, there are several treatment options that offer varying degrees of relief from the constant ringing.Those options are:
• Hearing aids
• Counseling
• Relaxation techniques
• Biofeedback
• Medication
• Masking devices
• Tinnitus retraining therapy
• Temporomandibular joint (TMJ) treatment
• In some cases, psychiatric help.What causes tinnitus?
Several factors are known to cause or worsen tinnitus. They include noise exposure, cerumen (wax) build-up in the ear canal, certain medications, ear or sinus infections, jaw misalignment, cardiovascular disease, certain types of tumors, otosclerosis, underactive thyroid, and head and neck trauma.Tympanometry
Tympanometry measures how well the eardrum is vibrating, the pressure in the space behind the eardrum, and how the tiny ossicular bones-the malleus (hammer), incus (anvil), and stapes (stirrup), are functioning. The procedure involves subjecting the eardrum to air pressure changes in order to determine if impedance and compliance in its ability to transmit sound waves to the brain. An abnormal finding on this particular test may indicate a conductive hearing loss requiring a referral for further medical evaluation. An example of a hearing problem with abnormal tympanometry would also be a patient with fluid in the ear, otherwise known as otitis media. A tympanogram provides a visual chart of the measurements and effectiveness of the eardrum.
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