The auditory system consists of several main parts that help carry sounds/signals to the brain. Although hearing seems like a simple feat, the transduction of a signal through the auditory system up to the brain is quite complex.
The Outer Ear
Beginning with the outer portion of the ear, the pinna helps pick up sounds and funnel them into the ear canal, anatomically known as the external auditory canal. The pinna helps individuals localize where sounds are coming from. Sound then travels down the ear canal where it eventually reaches the eardrum, or the tympanic membrane. The tympanic membrane is a thin membrane of skin that vibrates with sound stimulation.
The Middle Ear
Once sound vibrates the tympanic membrane, sound is transferred across three bones (ossicles) in the air filled middle ear space. These ossicles are the tiniest bones in the body known as the malleus, the incus, and the stapes. The stapes bone is shaped like a stirrup and has a round footplate. These three bones work together as a lever system to mechanically transduce sound through the middle ear to the inner ear. As sound reaches the stapes, the footplate pushes on what is referred to as the oval window. This window is the beginning of the inner ear system.
The Inner Ear
After sound reaches the oval window, the stimulation causes fluid in the inner ear system to move. The inner ear is a fluid filled space and therefore sound is hydromechanically transduced. Within the inner ear is an important hearing organ called the cochlea. The cochlea is a snail-shaped organ which has many tiny receptor hair cells embedded in a basilar membrane which respond to certain frequencies of sound. This is known as tonotopic organization in which the base of the membrane in the cochlea responds to higher pitches and the apex responds to lower pitches. As the hair cells are stimulated by the fluid moving in the cochlea, neurons attached to the hair cells receive the signal then send the auditory signal along the auditory nerve and up to the auditory cortex in the temporal lobe of the brain. Although we perceive and interpret sound within milliseconds, the pathway that sound travels to get to the brain is very complex, as detailed above.
There is much more detail related to the process of hearing and understanding, but the above is a basic overview of how individuals hear and interpret a signal. For a more in depth explanation, watch the links below.
As our name suggests, Jacksonville Hearing and Balance Institute helps patients with hearing and balance/dizziness issues. But how are hearing loss and dizziness related? If you have scheduled an appointment because of your dizziness, why would you need to have your hearing evaluated?
The answer to the above questions lies within the anatomy of our inner ear. The hearing and balance organs are both housed in the inner ear. The cochlea is necessary for hearing and the semicircular canals are part of our balance system.
There are multiple disorders that can cause disruptions in our hearing and balance. The type and configuration of hearing loss can help our providers better diagnose your dizziness. Meniere’s disease is one example of a disorder that is defined by the dizziness you are experiencing and the type of hearing loss that you may have. A patient with Meniere’s disease can experience dizziness for 30 minutes to multiple hours and have fluctuations in their hearing accompanied by a roaring tinnitus. Semi-circular Canal Dehiscence is another disorder that can be accompanied with hearing loss. A patient with SCCD may have a slight conductive component present on the audiogram even though they may not perceive a hearing deficit.
Jacksonville Hearing and Balance provides a comprehensive evaluation to help diagnose and treat your hearing loss and/or dizziness. For questions or to schedule an evaluation, you can reach us at (904)351-1904.
The question regarding whether to purchase one or two hearing aids is an important topic to address with your audiologist during a hearing aid consultation. Hearing aids are an investment in your hearing health that can contribute to improved communication with family and friends and lead to better quality of life. Hearing aids are also a financial investment and it makes sense that many people want to weigh the benefits versus the cost.
In some cases one hearing aid truly is the best option. For example, a person may have a hearing loss in only one ear and normal hearing in the other ear. Another example is a person who has very little useful hearing in one ear; in this case a hearing aid may not provide any benefit at all and a cochlear implant may be the better option. In most other cases if both ears have a hearing loss then two hearing aids are better than one.
Binaural hearing is the term used to refer to hearing with two ears (whether with two normal hearing ears or with two hearing aids). Bimodal hearing applies to people who wear a hearing aid on one side and a cochlear implant on the other ear. Studies have shown that binaural/ bimodal hearing have many benefits and leads to improved communication ability.
Detecting Location of Sound
The ability to detect where sounds are coming from is called “localization” and is a function of the brain that is dependent upon sound being heard well by both ears. The brain uses timing and loudness cues to determine which ear received the sound first and at which ear the sound was louder in order to determine where the sound is located. The brain is unable to detect the location of sound accurately with only one (amplified) ear.
Understanding in Noise
When sound reaches the ears, the signal travels to the inner ear and is then transferred to the hearing never. It then travels up the brainstem to the hearing centers of the brain. The brain analyzes and combines the sound heard from both ears to help “tease out” the speech signal from the unwanted background noise. If the brain only receives sound from one amplified ear it has much more difficulty separating speech from noise.
When sounds are received by both ears the signal travels through multiple pathways in the brainstem. This double input of information to the brain creates a boost in the volume of the speech signal making it easier to hear. This boost or summation of volume does not occur with one ear.
Studies have shown that when the brain listens with two ears, less effort is needed to hear and understand speech which helps to reduce fatigue.
For more information about the benefits of listening with two ears or about bimodal benefit for cochlear implant users call Jacksonville Hearing and Balance Institute at 904-399-0350 to set up a hearing aid consultation.
The Link Between Hearing Loss and Cognitive Decline
Recently, the Hearing Center at Jacksonville Hearing and Balance Institute partnered with Phonak (a major hearing aid company) to give a presentation to the community regarding the connection between hearing loss and cognitive decline in older adults. Unfortunately, it filled up too quickly for us to accommodate everyone who wanted to attend. Just in case you missed it, here are some of the highlights from the presentation:
The study in question was conducted by Frank Lin, Ph.D. and his colleagues at Johns Hopkins University using information gathered from older adults over a period of decades. The researchers found that those individuals with untreated hearing loss (whether it was mild, moderate, severe, or profound) were significantly more likely to experience cognitive impairments than their normal hearing peers.
But just how are hearing loss and cognitive impairment connected? As Dr. Lin reports, “Your inner ear has to take in a complex sound and convert it into a signal that goes into the brain. When we say that people have hearing loss, it means the inner ear is no longer as good at encoding those signals with accuracy and fidelity. So the brain gets a very garbled message — you can hear what’s being said but you can’t quite make it out. It takes a little more effort to hear what that person said. As a result, the brain has to re-dedicate sources to help with hearing and sound processing. That comes at the loss of something else.” Dr. Lin also notes that, “As we develop hearing loss, we withdraw socially. You’re less likely to go out and you may be less likely to be engaged in conversation.”
While more research needs to be completed regarding the link between hearing loss, social isolation, and cognitive decline, these early results certainly emphasize the importance of hearing heath on one’s overall health. Unfortunately, up to two-thirds of adults with hearing loss remain untreated. Here at JHBI, we hope that by increasing awareness about this topic, we can identify hearing impairments and possible intervention strategies earlier rather than later.
Lin, F. R., et al. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine(4), 173, 293-293. doi:10.1001/jamainternmed.2013.1868
Boosting Your Hearing Aid Performance with Wireless Technology
Even with the best hearing aids, it can still be difficult to enjoy your favorite song or your favorite TV show, or hear a speaker clearly in a business meeting or at a restaurant. It may even still be difficult to hear someone talking to you on the phone. Over the past 10+ years, hearing aid manufacturers have developed wireless accessories to accompany hearing aids. These devices can be used in even the most complex listening environments. Today, some hearing aids will even connect directly to iPhones. Below is a list of outlined accessories and their uses as well as more information regarding direct connectivity options.
Several hearing aid manufacturers now offer direct-to-iPhone hearing aid options. Starkey, Oticon, Resound, and Widex hearing aids can be connected via bluetooth straight to your cell phone and most apple devices! Each manufacturer has their own free, downloadable, and user-friendly app which can control your hearing aids, including volume control, program changes, and some even allow you to control the directionality of your microphones in different listening situations. Phone calls are streamed directly to your hearing aids; your music, a video, a movie, anything streaming on your phone…that’s right! It goes straight to your hearing aids! They have now become wireless headphones!
Cell Phone Accessories:
With the technology of bluetooth, connecting your world to your hearing aids has become easier than ever. Several manufacturers offer wireless accessories that either clip to your lapel or hang around your neck. These intermediary devices allow your cell phone to talk directly to your hearing aids. As long as you are wearing your clip-on or your neck loop, your phone calls can stream directly to your hearing aids, as well as any other audio streaming from your cell phone. All it takes is a simple pairing procedure which your audiologist can help with!
With a TV Link, you will have the audio from the TV streaming directly into your hearing aids. All you have to do is hook up the accessory to your TV. Enjoy the comfort of listening to your favorite show at the volume you prefer while your loved ones can still enjoy the show at their preferred volume. Most TV Links require an intermediary device, however, which connects to the hearing aids and the TV Link then connects to the intermediary device.
Many manufacturers make accessory options in the form of a remote microphone. Remote microphones significantly improve the signal-to-noise ratio in noisy environments. Although most hearing aids at all technology levels reduce background noise levels in noisy environments to some degree, a remote microphone brings the speaker’s voice directly to the hearing aid users’ ears. The speaker wears the remote microphone and the listener wears an intermediary device which streams the signal to the listener’s hearing aids. This makes for exceptional speech understanding in noise and better understanding over longer distances. Some remote microphones can transmit to the users’ hearing aids from up to 80 feet away!
If you would like to learn more about these devices for your hearing aids and learn what your options are, schedule a hearing aid consult with an audiologist today! They should be able to answer any questions you might have! Just call: 904-399-0350
One of the most important steps in the cochlear implant process is rehabilitation. Research studies demonstrate that patients adjust more quickly and achieve greater overall success when they actively participate in a rehabilitation program. Rehabilitation with a cochlear implant can be done at home with computer based programs and listening exercises with family members or in a more formal setting with an auditory verbal therapist.
After a cochlear implant is activated it is important to complete listening exercises to help teach the brain how to listen with a cochlear implant. Immediately following activation, speech often sounds strange and unclear; this is because sound is being delivered to the brain through electrical stimulation (versus acoustic stimulation). The brain must adjust to this new way of receiving sound input. This process of “brain acclimatization” can be greatly impacted by the amount of effort put into the rehabilitation stage. Imagine never completing physical therapy after a knee or hip replacement; it would be very difficulty to walk effectively and progress may be much slower. Fortunately there are many resources available for patients to help them with their “listening therapy’. Each cochlear implant company offers an abundance of support and activities intended to help the brain acclimate to listening with a cochlear implant.
Cochlear’s Communication Corner offers specially designed activities for every age group from young children to older adults. Each group offers activities that range in difficulty to allow you to tailor you rehabilitation process to your specific needs. They also offer a Music program to help you enjoy the sounds of music again. In addition Cochlear has a telephone program called “Telephone with Confidence”. This program allows you to practice listening on the telephone through guided activities.
Advanced Bionics’ The Listening Room provides numerous listening activities for people of all ages. Activates vary in difficulty and are labeled as beginner, intermediate or advanced to allow you to work through hearing skills at your own pace. The activities can be completed with a listening partner or done independently. Lessons are designed to improve speech understanding as well as increase music appreciation.
MED EL’s BRIDGE program contains listening exercises for various age groups. The activities for adults focus on sentence recognition. The recorded activities can be done independently and allow the listener to vary how the sentences are presented to mimic more ‘real world’ scenarios. There are also activities that can be completed with a partner. Suggestions are given on how to increase the difficulty of the task to ensure the listener continues to make progress once a particular skill is mastered.
Congratulations! You should consider your decision to purchase hearing aids to be a smart investment of both your time and money. As you continue to get used to your new devices, you will likely develop a strong bond with your hearing aids, and will want to be without them as infrequently as possible. It is important that you develop a basic hearing aid maintenance plan that you routinely follow to ensure peak performance of your devices. You should also be familiar with common causes of hearing aid damage so that you can avoid exposing your hearing aids to hazardous conditions (although even the most meticulous hearing aid wearer will need a repair at some point in time!)
Damage to Hearing Aids: What to Expect
Moisture and earwax are two of the most common causes of hearing aid damage. It is estimated that as many as 75% of the hearing aid repairs seen in our office are related to these two items.
Earwax: Although the degree to which a hearing aid is exposed to earwax is determined more by body chemistry than good cleaning practices, cleaning your hearing aid regularly with a lint free cloth or hearing aid cleaning wipe will limit the problems resulting from earwax. Cleaning your hearing aid with a solvent or household cleaner is not recommended and can result in damage to the hearing aid casing or components.
Moisture: Moisture problems related to the environment are difficult to avoid, and the use of a hearing aid drying system (discussed below) is the best solution for this. To avoid accidental moisture damage, avoid storing your hearing aids in your bathroom or kitchen where moisture levels are high. We recommend storing in the original case on your dresser or nightstand. In addition, posting a note on your shower door can help prevent accidentally wearing your hearing aid into the shower.
Other: Other common reasons hearing aids become damaged include:
Pets (many pets love to chew hearing aids)
Hairspray or other hair products
Dropping the hearing aid
Incorrect battery insertion
Exposure to excessive heat (being left inside a car, etc)
Hearing Aid Care Products
Routine Care = Longer Hearing Aid Life and Better Hearing Aid Performance
There are many products designed to help you care for your hearing aids. Listed below are some of our most commonly recommended products:
Hearing Aid Dryers (Desiccant jars): Basic dry jars cost as little as $10.00. More sophisticated electric dryers are also available for purchase and contain UV lamps which have antimicrobial benefits.
Cleaning Wipes: Wipes designed specifically for use with hearing aids help control wax build-up.
Tubing Blowers: Tubing blowers are used to clean the tubing of behind-the-ear hearing aids. This also helps with moisture build-up which often occurs in hearing aid tubing, which may help reduce how often tubing needs to be changed.
Establishing a good maintenance plan is an essential part of your hearing aid journey and will help ensure that your hearing aid functions at peak performance for many years to come. If you are unsure of cleaning procedures for your hearing aid or are in need of a hearing aid repair, make an appointment with your audiologist to discuss the proper plan for you and your hearing aids!
This is a question that the audiologists and physicians hear every day at The Hearing Center and JHBI. Let’s take a look at what matters (and what doesn’t!) when it comes to making that decision.
The first step to deciding whether or not it’s time to try hearing aids will depend on your hearing loss. Hearing aids can be programmed to fit all different degrees and configurations of hearing loss, from mild to profound. However, you have to keep in mind that what your hearing loss looks like will greatly affect your outcome with amplification. For example, patients that have very little usable hearing left may be better suited to a cochlear implant. Patients with middle ear problems may want to try a bone-anchored hearing device. So how do you know what’s right for you? That’s an easy one to answer- you just have to ask an audiologist. Come in for a hearing aid consult. If hearing aids aren’t the correct choice for you, we promise to guide you to whatever is.
Most people with hearing loss know that they have trouble hearing. In fact, that is usually what drove them to get a hearing test in the first place. However, even with severe hearing loss, some people will deny any hearing difficulties. Hearing aids are a process that involve both commitment and work on the part of the new user, so that person has to be invested in a positive outcome. In other words, it is important that you feel like you have something to gain from wearing a hearing aid. If you are convinced that you are not having any difficulty hearing, it will be hard to justify using hearing aids. Keep in mind, though, that sometimes it is actually the people you are talking to that take the brunt of a hearing loss. Are they frequently repeating or speaking up so that you can be apart of the conversation? Look to those closest to you for honest opinions about how they are affected by your hearing difficulties. If they are expressing frustration, that might be a reason to consider trying hearing aids.
Hearing aids are for people with hearing loss, no matter their age. It does not matter at all how old you are- If you have a hearing problem, it is time to consider a hearing aid. Please do not wait until you reach a certain age to start considering a hearing aid.
It’s okay to be worried about what a hearing aid will look like. We are all human, and we want to present our most confident self to the world. For some people, it’s scary to think about what a hearing aid will look like. The good news is that we have come a long way from the large devices that used to be the industry standard. Most styles are nearly invisible these days. Depending on your ear canal size and hearing loss, your audiologist can guide you into the most discrete style possible.
For many people, the price of hearing aids can be very intimidating. At JHBI, we offer different levels of hearing aids at varying prices to meet the needs of everyone that comes through our door. We also have some financing options that may help. We encourage you to come in and see what we have to offer and talk about what your budget allows. Even if a hearing aid isn’t an option for you currently, we may be able to find some ways to help you hear better that are within reach.
A rapid decline in hearing that occurs all at once or over the course of several hours and should be treated as a medical emergency.
SSNHL most often occurs in one ear and may be accompanied by a feeling of fullness and ringing (tinnitus) in the affected ear as well as a room-spinning sensation (vertigo). Some individuals report hearing a loud “pop”. The hearing loss may be noticed first thing in the morning upon waking or when holding a telephone up to the affected ear. Other indications of a SSNHL include difficulty with understanding conversation in noisy environments and/or difficulty hearing sounds directed at the affected ear. In some cases voices may sound “fuzzy” or distorted.
It is estimated that the incidence of SSNHL is 20 cases per 100,000 persons a year. Both men and women are affected equally. SSNHL can occur across the lifespan however, there is a higher incidence for individuals in their 40s and 50s.
There are many possible causes of SSNHL however, cause is only identified in about 15 % of cases. Many times the reason remains unknown. Some causes of SSNHL include, viral infections, autoimmune disease, ototoxic (toxic to the inner ear) medications, trauma and compromise of blood circulation to the inner ear.
Treatment for SSNHL should be sought immediately. There is a high chance of recovery of hearing with prompt treatment. Unfortunately, many things can delay a person from seeking treatment. Symptoms of SSNHL are often thought to be related to allergies, a sinus infection or wax build up which can also result in a feeling of fullness in the ear and muffled hearing. In most cases the aforementioned will not be accompanied by tinnitus or vertigo and will likely affect both ears (unlike the typical presentation of SSNHL).
If a SSNHL is suspected it is very important to have an evaluation performed as soon as possible by a medical professional who specializes in disorders of the ear such as an otologist or otolaryngologist. Case history information, physical examination and results from a hearing evaluation completed by an audiologist will help confirm a SSNHL. Often times an MRI and blood work will be ordered to help determine the cause of the SSNHL. Treatment most commonly includes a course of corticosteroids given either in pill form and/or as an injection into the middle ear space.
In 30 to 60% of SSNHL cases spontaneous recovery of some or all of the hearing may occur within fourteen days of onset. In many cases however, the hearing does not recover on its own. The chance of partial to total recovery of hearing is high if treatment is received within ten days after onset, with the highest chance of recovery being when treatment is received within 72 hours of onset. In cases where treatment is delayed more than two to four weeks after onset, the chance of recovery is low and often times the hearing loss is irreversible.
If you experience a sudden change in hearing in one ear, which may or may not be accompanied by fullness, tinnitus and vertigo, please seek medical care immediately.
Exposure to loud noises is a common cause of hearing loss among the population. Noise induced hearing loss (NIHL) is characterized by a “gradual, progressive loss of high frequency hearing sensitivity that usually presents as a “notch” that occurs at or around 4000 Hz.” For more information on noise induced hearing loss, visit http://american-hearing.org/disorders/noise-induced-hearing-loss/ .
How can you protect your hearing?
There are many ways to prevent NIHL, such as:
Avoid or limit exposure to dangerously loud sounds
Decrease the volume of music systems
Move away from loud sound sources when possible
If you must be around loud sounds, use appropriate hearing protection
What kind of hearing protection devices are available?
At The Hearing Center, we offer a variety of hearing protection devices. Common devices include:
Swim plugs are designed to prevent moisture from entering the ear canal during swimming, showering and water sports
Shooter’s protection is designed to protect hunters/shooters from impulse noises up to 160 dB peak SPL. These devices can be made with special acoustic filters that allow for awareness of conversation and the ability to track animals.
Industrial noise protection- Some work places require workers to wear custom hearing protection due to exposure to dangerous sound levels. Employees who work in industrial factories, construction sites and around aircraft equipment are likely to be required to wear hearing protection. Specialized devices can be made that can connect to radios for those who work in jobs that require radio use.
Musician earpieces provide hearing protection for musicians who practice and perform in a variety of settings. Depending on the source and location of the sound, different levels of attenuators can be used in the earpieces to allow for optimal hearing protection.
Motorcyclist’s protection is designed to help eliminate wind noise under a helmet.
Custom sleep plugs can be used to promote interrupted sleep.
Custom fit ear tips for mp3 players or other headphones are designed to have standard earphones fit into a custom fit ear tip. These earplugs help block excessive environmental noise and allow the listener to turn down the music volume.
If you believe you have a noise induced hearing loss, or at risk of one, make an appointment with your JHBI audiologist to discuss a custom hearing protection option that is suitable for your needs!
The Hearing Center At JHBI Proudly Serves Patients In Jacksonville (Jax), Jacksonville Beach, Neptune Beach, Atlantic Beach, Mandarin, Ortega, Ponte Vedra Beach, Flagler Beach, Fernandina Beach, Amelia Island, St. Augustine, St. Augustine Beach, Orange Park, Macclenny, Middleburg, St. Johns, St. Marys, Waycross, Nocatee, Vilano Beach, Green Cove Springs, Middleburg, Jacksonville Beach.