Are Football Games Too Loud?

Football: Loud, proud and…noisy!

The beginning of fall signals the start of some very important things: cooler weather, pumpkin beverages and, of course, football season. Whether you are a fan of the NFL or the NCAA, you know how exciting it can be to root for your team in a stadium filled with fans cheering their hearts out. You might have also noticed how LOUD that same situation can be.

It is not unusual for pro and collegiate football stadiums to reach noise levels well over 100 dB, sometimes even into the 120s or 130s (for reference, a power saw produces sound levels of approximately 110 dB). In fact, teams often consider it a point of pride to have the loudest stadium in the league. While this can make for an energizing atmosphere for players and spectators alike, it can also be very dangerous for the hearing of anyone in that environment, especially for an extended period of time. How harmful a sound is can be determined by analyzing two factors: intensity of the sound and duration spent listening.

Check out an earlier JHBI blog post ( to learn the specifics of noise induced hearing loss and review professional guidelines on maximum exposure times allowed in various levels of sound. It’s easy to see how loud football games, which may average 80-90 dB of noise but have frequent peaks into the 100+ dB range, can quickly cause permanent hearing damage. So, what can you do to protect your ears and cheer on your team at the same time?

The easiest solution to prevent noise damage is to wear ear plugs or muffs consistently when in a loud environment. Many hearing healthcare professionals have started initiatives to provide hearing protection to fans at sporting events and as a result, it is becoming more common to see people of all ages and hearing levels protecting their ears. Even the tiniest of fans need to be kept safe from noise exposure!

So the next time you are packing for your tailgate, be sure to include hearing protection for everyone attending the game. To learn more about custom earplugs, check out an earlier blog ( or speak to your audiologist.

Are Online Hearing Tests Reliable?

Internet Hearing Evaluations: Beware!

Although a hearing test performed in the comfort of your own home may seem like a viable alternative to making an appointment to see an audiologist, online hearing tests are not approved by the U.S. Food and Drug Administration (the federal agency that is responsible for ensuring medial devices and equipment are approved for use). Results obtained from an online hearing test are unlikely to be accurate or reliable. A face-to-face examination with an audiologist is the best practice for diagnosing and assessing your hearing healthcare needs. Listed below are components of an examination that require in-person assessment to ensure accurate diagnosis.

Medical history:

At your appointment, the audiologist will ask many questions about your past and recent medical history, with special attention given to your hearing difficulties. Physical conditions and medications can affect your hearing and should be documented in your chart. Documentation of any balance problems, noise exposure and tinnitus are also important in your overall care. Most online hearing tests will not assess any medical conditions that may be contributing to your hearing loss.

Otoscopic examination:

An otoscope is a lighted, magnifying device used to assess your ears to determine if obstruction, such as earwax, is present in the ear canal. Drainage or possible infections can also be inspected during otoscopy. This critical part of the evaluation is not possible during an online hearing test.

Equipment required for hearing tests:

The American National Standards Institute (ANSI) has published guidelines that outline the amount of acceptable level of ambient room noise that is allowed for an accurate hearing test. When having a hearing test performed by an audiologist, a sound booth is used to ensure ANSI standards are met. Hearing tests performed at home are subjected to background noise beyond control, such as noise from traffic, computer monitors and air conditioners. This background noise may skew results obtained during at home testing and elevate your hearing levels.

There are also standards for the headphones used for hearing tests. At home testing will show various results when different types of headphones are used. In office, headphones are calibrated specifically to the audiometer used for testing.

When testing is completed at home, only one part of your auditory system is checked. Further testing is required (through use of additional head pieces and tests) to determine the type of hearing loss you may have. A visit with an audiologist is necessary to accurately diagnosis the type and degree of your hearing loss.

If you are in need of an accurate hearing evaluation, please contact The Hearing Center at Jacksonville Hearing and Balance Institute to schedule an appointment with one of our Board Certified Audiologists!

CURRENT NEWS: Jason Day, golfer, suffers from BPPV at U.S. Open

Jason Day and BPPV

The 2015 U.S. open was recently played at Chambers Bay. During the second round of play, Jason Day, the 8th ranked golfer in the world, was overcome with symptoms of vertigo and collapsed on the 9th hole. His diagnosis: BPPV. This is not the first time Day has experienced these symptoms. Day stated “Last year, I (withdrew) after I had vertigo and this one was worse.” He reported feeling nauseous all day on Friday, and experienced symptoms again during Round Three on Saturday. Day was treated by local physicians, Dr. Robert Stoecker and Dr. Charles Souliere, and was able to finish the tournament, tying for 9th place. Every possible effort was taken to not provoke his symptoms, such as carrying his head as still as possible and bending at his knees to pick up his ball.

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo. It is defined as the sudden sensation that you are spinning or that the inside of your head is spinning. Signs and symptoms of BPPV can include: dizziness, vertigo, a loss of balance/unsteadiness, nausea, or vomiting. Nystagmus, which is abnormal rhythmic eye movement, can also accompany symptoms of BPPV. Symptoms are usually brief, most of the time lasting less than one minute in duration.  It can be triggered by positional changes with your head. Examples of movement include nodding your head, laying back or rolling over in bed.

If you or someone you know is experiencing any of the above mentioned symptoms, contact our office to make an appointment for an evaluation.

  • Click the link below to see Dr. J. Douglas Green, neurotologist at Jacksonville Hearing and Balance Institute, give an interview on BPPV with JAX Channel 4 News.

Should I Update My Hearing Aids?

How do I know if I should update my hearing aids?

Hearing aid technology advances every day and as a result, new products and programming options are constantly becoming available. Many hearing aid wearers will wonder how they know if they need a change in programming or an update in technology to a newer product. Let’s take a look at some reasons you might consider making a follow-up appointment with your audiologist.

1. A change in hearing

If you have noticed a change in how you hear without the hearing aids on, it is important to return to your audiologist for follow-up care. It is possible that something as simple as ear wax could be causing you difficulties or you may have had a permanent shift in hearing that would require reprogramming. In severe cases where a significant change in hearing is noted, it is possible that a more powerful hearing aid might be required.  Your audiologist can guide you on options for modifying your current hearing aids or purchasing new ones to meet your needs.

2. Lifestyle changes

You may find that when your lifestyle changes, your communication demands change as well. For example, if you start a new job that requires conference calls or meetings in large rooms, you may need additional programming to your hearing aids to help with multi-talker settings or echo reduction. Most hearing aids are also compatible with wireless devices, which are accessories designed to help in specific difficult listening situations. Your audiologist may recommend using one or more of these accessories to meet your needs.

3. General maintenance

The lifespan of hearing aids can range anywhere from a few years to over ten years, with the average user getting about five years per device. Remember that regular maintenance and cleaning is important to extending the life of your devices, and can help to reduce wear and tear. For that reason alone, it is important to return to your audiologist every six months to a year to have your aids inspected and cleaned. If your hearing aids are more than a few years old and you have found they are becoming unreliable, you might consider discussing new technology or a significant repair.

Regular follow-up with your audiologist is an excellent idea for keeping you and your hearing aids performing as best as possible. If you have noticed that your hearing aids are not performing as well as they once did, or you are struggling more to hear than you have before, make an appointment with your JHBI audiologist today to see what help is available.

Famous Folks with Hearing Loss

Hearing Loss: You Are Not Alone

Hearing loss is the third most common physical impairment reported by Americans, following only arthritis and heart disease. In fact, approximately 48 million Americans, or 20% of the population, suffer from some degree of hearing loss.  Because hearing loss is essentially an “invisible disorder,” meaning someone cannot see that you have problems hearing just by looking at you, many individuals are not aware of how prevalent it is. Fortunately, over the past few years, there has been an increase of outspoken celebrities willing to give a face to hearing loss. These people prove that hearing loss can affect anyone, regardless of age, race, socio-economic status or gender. Let’s take a look at some of the famous faces of hearing loss who are creating awareness for an impairment which touches millions of Americans every year.


  1. Halle Berry: Oscar winning actress Halle Berry, who regularly speaks as an advocate for women of domestic violence, shared her story of hearing loss related to abuse she suffered at the hands of a previous significant other. Berry reportedly suffers a permanent unilateral hearing loss in her left ear following repeated blows to the head.
  2. Rush Limbaugh: Entertainer and radio talk show host Rush Limbaugh is one of the most well-recognized cochlear implant users in the world. In 2001 Limbaugh announced that he was deaf in both ears from auto-immune inner ear disorder. Today, he is a successful bilateral cochlear implant user.
  3. Bill Clinton: Former United States President Bill Clinton suffers from the most common form of hearing loss: high frequency hearing loss. Clinton, like so many others, reportedly ignored his hearing loss until significant communication difficulties finally spurred him to take action. Clinton wears bilateral in-the-canal hearing aids.
  4. Jodie Foster: Actress, director and producer Jodie Foster admitted to Chicago Tribune that she notoriously neglects her health issues, including “this hearing loss thing” and her occasional vertigo attacks. Foster has been spotted sporting a hearing aid so hopefully she is on the path to taking control of her hearing loss.
  5. Pete Townshend: Song writer and guitarist of The Who Pete Townshend has both hearing loss and tinnitus (ear ringing) as the result of years of noise exposure at rock concerts and practice sessions. Long-term exposure to loud sounds or brief exposure to extremely loud sounds can cause permanent hearing loss, as is the case with Townshend and many other famous musicians.


The above list is just a small sample of the list of celebrities with hearing loss. They, and many others, go to show that hearing loss does not have to get in the way of doing amazing things. If you think you may have a hearing problem, make an appointment at The Hearing Center for a consultation to talk about getting help now.

Tinnitus Management

What is Tinnitus?

Tinnitus, more commonly known as “ringing in the ears”, is the presence of sound in the ears or head where no external sound source is present. It can also be described as a buzzing, hissing, or roaring noise depending on the patient’s perception.  According to the American Tinnitus Association, 50 million people in the United States suffer from some degree of tinnitus. Of those 50 million, 16 million people experience symptoms severe enough to seek medical attention. Tinnitus may or may not accompany hearing loss, but should always be classified as a symptom, not as a disease by itself. It can be intermittent or constant, with symptoms ranging in severity amongst patients.

The reference link below provides in depth information on the different types of tinnitus (subjective vs. objective tinnitus) and possible causes of tinnitus.

 Treatment Options

In most cases, there is no medical or surgical treatment which will eliminate tinnitus. While there is no cure for tinnitus, listed below are common treatment options to help with the management of tinnitus.

  • Hearing aids: When a patient presents with both tinnitus and hearing loss, one of the most successful management strategies is the use of a hearing aid. Patients receive benefit from amplification for their hearing loss, which frequently is also very effective in “masking out” their perceived tinnitus. Many newer hearing aid models have built-in tinnitus maskers, which use sounds such as white noise and music for masking purposes.
  • Tinnitus maskers:  For patients with normal hearing who suffer from tinnitus, the use of a tinnitus masker may be effective. A tinnitus masker looks much like a traditional behind-the-ear style hearing aid. This device does not offer any amplification, just a tinnitus masking noise, which is used to distract the wearer from his/her perceived tinnitus.
  • Sound generators: For many, the presence of an external sound source can be useful to mask out the tinnitus. Commonly used devices can include running fans, radios at low volumes or soft background music. There are many types of tabletop sound generators, and also pillows with built-in speakers for those who have trouble sleeping because of their tinnitus. Most generators enable users to choose from a variety of sound options, such as rainfall, ocean waves and nature sounds, to best mask out their tinnitus.
  • Neuromonics Tinnitus Treatment:  There are currently three different treatment options offered by Neuromonics:


    • Oasis:  The Oasis is a medical device that is FDA approved for the long-term, significant relief of tinnitus. Designed as a lightweight, hand-held device, the Oasis is customized to the patient’s unique tinnitus profile. The protocol is clinically administered by an audiologist or physician. The device uses relaxing music that is embedded with a neural stimulus, which stimulates the auditory pathway to promote neural change. Over time, new connections are able to train the brain to filter out tinnitus disturbance, providing long-term relief. The Oasis works with Neuromonics Tinnitus Treatment (NTT) and uses a two step process for long-term relief.

Step 1: Relieving the Symptoms (~2 months)

The device is worn for at least 2 hours a day during daily activities. This enables users to begin to feel in control of their tinnitus

Step 2: Breaking the Cycle (~ 4months)

The device is initially worn for at least 2 hours a day. As training continues, treatment times are reduced as tinnitus disturbance decreases.


After completion of the tinnitus program, your audiologist will work with you to set up a maintenance cycle. Many patients find they no longer need the device after the program, though some users continue to use the device 2-4 hours per week to help maintain perceived benefits.


    • Haven: The Haven is a customizable device for on demand tinnitus relief that is clinically administered by an audiologist or physician. The Haven combines a high frequency signal with relaxing music for tinnitus relief while wearing the device.


    • Sanctuary: The Sanctuary is a semi-customizable device used by patients for tinnitus relief when they need it. While the Sanctuary also uses relaxing music combined with a neural stimulus, the device comes with three pre-programmed profiles for the users to choose between for optimal tinnitus relief.  Unlike the Oasis, the Sanctuary is not a long-term treatment program. This device can be beneficially to those patients who find their tinnitus to be bothersome in certain situations, rather than a constant problem.


  • Tinnitus Retraining Therapy (TRT)
    • There are two components to TRT: sound therapy and direct counseling & education on effective coping techniques. The thought is that with proper counseling, education and understanding the brain is able to get used to a sound pattern in order to distract one’s attention away from the tinnitus and reduce anxiety. With intervention, it is thought that the negative reaction to tinnitus can be conditioned and altered.  Counseling techniques should be taught by an audiologist or professional who received specialized training in tinnitus management.
      • For sound therapy, a patient would wear an ear-level tinnitus masker that presents soft sounds to the ear that is barely audible.
      • During counseling, adaptation techniques are taught, which allows the brain to de-emphasize the importance of the tinnitus.

If you or someone you know is affected by tinnitus, schedule an appointment with your Audiologist to discuss appropriate management options.


Hearing Aid Feedback

Why do my hearing aids whistle?

Many hearing aid users wonder about that high pitched whistle sound that sometimes comes from one or both of their hearing aids. What is it and why does it happen? That high pitched sound is referred to as feedback and it can occur with any sound system that involves a microphone and a speaker, just like a hearing aid.

How does feedback occur?

In order to understand feedback, we will first look at how a hearing aid works. All hearing aids have at least one microphone which picks up sound waves from the environment and converts them to an analog signal. The analog signal is converted to a digital signal, which can be amplified and manipulated by the hearing aid to fit the user’s needs. After processing, the signal is converted back to an analog signal and sent to the receiver (speaker). The receiver converts the analog signal back to an acoustic signal and delivers it to the ear as sound. The sound travels down the ear canal and is absorbed by the ear drum.

Sometimes, excess amplified sound leaks from the receiver and gets picked up again by the microphone of the hearing aid. The microphone will re-amplify the already processed sound and the signal gets stuck in an endless loop of being delivered by the receiver and picked up again by the microphone. This creates that loud, high- pitched squeal we refer to as feedback.

How can I reduce feedback?

Feedback is possible with any sound system, and you have likely heard it occur at some point with a speaking microphone or a band setting up to play. While occasional feedback is normal, excessive feedback is not. Let’s look at some ways that feedback can be reduced.

  1. A good fit- A well fit hearing aid will minimize how much sound can leak out of the ear canal and get picked up again by the microphones. This is especially important for custom “in-the-ear” hearing aids. Behind-the-ear products have the advantage of more distance between the microphones and the receiver, which helps to reduce feedback. Keep in mind that it is normal for your hearing aids to whistle while you work to get them in your ears properly because a good seal has not yet been formed.
  2. Turn down the volume – When your hearing aids are turned up all the way, the output from the receivers is greater than it is at lower volumes. This increases the risk of the microphones picking up the excess sound. If you consistently need to turn your hearing aids up to their maximum level and this is causing excessive feedback, it may be time to speak to your audiologist regarding a more powerful hearing aid or a different fit.
  3. Clean your ears- Wax build-up in your ears can cause significant feedback because the sound is reflected by the wax instead of absorbed by the ear drum. Typically, hearing aid users will describe a situation where feedback was not present and then came on suddenly, in all situations and in only one ear. Consider having a doctor look in your ears for wax if you think this might be your problem.
  4. Clean your hearing aid – To the same point, wax build up in your hearing aid can also cause significant feedback if it blocks the sound from escaping from the receiver. Check to see if the receiver is clogged with wax and then refer to the proper way to clean that wax depending on your style of hearing aid.
  5. Feedback manager- Most hearing aids have feedback managers available in them, and many are very successful at reducing excessive squeal. Your audiologist can activate this feature on your hearing aids if it is available.


Keep in mind that in certain situations, all hearing aids will give off feedback. For example, if you take your hearing aid out of your ear and cup your hand around it, it should squeak. In fact, if you do not hear it squeak in this situation, it is possible that your hearing aid is not working correctly. As mentioned previously, it is also normal for hearing aids to feedback while being put in and adjusted to sit properly. Even after the hearing aids are in correctly, feedback can still be induced by covering your ears with your hands or putting something like a headphone over the hearing aids.

If feedback is a concern or you feel your hearing aids squeak excessively, talk to your audiologist about some ways to troubleshoot this problem without sacrificing your listening experience.

How to Interpret an Audiogram

Reading the Graph

An audiogram is a graphical representation of pure tone audiometry test results. It charts the softest sounds (threshold) that a patient can hear at each frequency tested. The frequency of the tone is displayed across the x-axis (horizontal), while the loudness of sound is displayed along the y-axis (vertical). Frequency is measured in Hertz (Hz) and intensity is measured in Decibels (dB).

There are different symbols used to differentiate between the thresholds based on the transducer used. Below is a chart of the commonly used symbols on an audiogram. Air conduction testing is performed using earphones, inserts, or speakers. Sound is sent through the middle ear to the inner ear. For bone conduction testing, a bone vibrator is placed behind the ear to deliver sounds directly to the inner ear, bypassing the middle ear.


Degree of hearing loss

Once thresholds have been plotted on an audiogram, the degree of hearing can be determined. For adults, normal hearing is considered to be thresholds 25 dB or less.

Intensity (in dB)

Degree of hearing loss

0-25 dB

Hearing is within normal limits

25-35 dB

Mild hearing loss

40-65 dB

Moderate hearing loss

70-90 dB

Severe hearing loss


Profound hearing loss

Types of hearing loss

The type of hearing loss is determined based on the difference between the air conduction and bone conduction thresholds.

Sensorineural hearing loss reveals a problem with the inner ear organ or auditory nerve pathway. If air conduction and bone conduction thresholds are within 15 dB of one another, the hearing loss is considered sensorineural.

Conductive hearing loss reveals a problem in the middle ear system. If air conduction thresholds show a hearing loss, but bone conduction thresholds are within normal limits, the hearing loss is considered conductive.

Mixed hearing loss reveals a problem with both the middle ear system and the inner ear organ.  A hearing loss evident through bone conduction testing and a greater degree of hearing loss through air conduction testing with a difference of 15 dB or more between thresholds would be considered mixed.

If you would like to have your hearing tested, or if you have any questions about your specific audiogram, please make an appointment with your JHBI healthcare provider.

Hyperacusis: Sensitivity to Sound

Hyperacusis: What is it?

Hyperacusis is defined as an unusual intolerance to ordinary environmental sounds. Individuals with hyperacusis usually have inappropriate responses to sounds that are not bothersome to a typical person.  This differs from loudness recruitment, in which a person with hearing loss cannot tolerate moderate to loud sounds. With loudness recruitment, loud sounds are too loud. With hyperacusis, all sounds are usually too loud. Many people with hyperacusis have normal hearing sensitivity. The disorder can occur in one or both ears, and is commonly accompanied by tinnitus.

Potential Causes of Hyperacusis

Studies show that in a majority of hyperacusis cases, there may not be an underlying medical condition. However, some conditions that have been linked to hyperacusis include:

Peripheral Central
Bell’s Palsy Migraines
Ramsay-Hunt Syndrome Depression
Stapedectomy Post-traumatic   stress disorder
Perilymph fistula Head injury
Meniere’s Disease Lyme Disease
Williams syndrome

One major cause of hyperacusis is exposure to very high levels of noise, either as a single intense exposure or a long-term exposure. Use of hearing protection devices is crucial in prevention of noise induced hearing loss and hyperacusis.

What Can Be Done?

A person’s first reaction to intolerance to sounds may be to wear ear plugs or other hearing protection devices to reduce the loudness of sounds. This strategy is usually not helpful, as the person may actually be worsening their poor intolerance to relatively normal sound levels. Wearing hearing protection may provide temporary relief to a bothersome sound, but when the device is removed, the individual may be even more sensitive to sounds than they were before.

Another approach that may be more successful in helping an individual deal with hyperacusis is called sound desensitization, which is administered by a professional. For this therapy, the individual with hyperacusis will listen to barely audible white or pink noise for a set amount of time each day. Over time, the individual will build a tolerance to the sounds, and find they are no longer sensitivity to every day sounds.

If you or a loved one is experiencing unusual intolerance to sounds, please visit an ear specialist for medical evaluation.

New Hearing Aids: What Should I Expect?

First time hearing aid users

Approximately 8.4 million people in America currently wear hearing aids. While some of those individuals may have been wearing hearing aids for decades, some are just starting their journey to better hearing. If you are considering hearing aids for the first time, or considering trying amplification again after a long time, you may wonder what the first few weeks of life will be like in your new ears. Understanding what to expect can help to ease some of the anxiety associated with a new fitting.

Be Patient

On average, patients wait over 10 years after their initial diagnosis to be fit with their first set of hearing aids. Most of these people will have gradual, progressive hearing loss which they have not noticed getting worse with time. This means that many first time hearing aid users have been living in a quieter world than usual for many years. They may not have heard the softer, every day sounds of life that are always present but not necessarily attended to by individuals with normal hearing. When these individuals first start using hearing aids, these sounds are suddenly audible again. New hearing aid users report being able to hear everything from the refrigerator running, to water boiling on the stove, to the turn signal in the car. All of these sounds are now novel and interesting for the brain because they have not been heard in so long. Put simply, that means that these sounds may be at the forefront of a new user’s attention more than he or she might want. Certainly no one wants to sit and listen to the air conditioner run, but it may feel like that is what you are doing during the first few weeks in hearing aids. Be patient. Your brain needs time to adjust to all the new stimulation it is receiving and decide what is and is not important to attend to. By wearing your hearing aids full-time, you will teach your brain to ignore the noises that you do not want to pay attention to, just like it used to do before your hearing loss.

You will hear many new sounds that you have not have heard in awhile with your hearing aids. Some of these sounds will be exciting, others may be bothersome. Consistent use of hearing aids allows your brain to readjust to new stimulation.

Don’t Change Your Routine

One thing that new hearing aid users are tempted to do is to avoid crowded areas or noisy situations when they first get their hearing aids. They may be afraid that these situations will be overwhelming or even painful. It is very important that you do not change how you live your life because of new hearing aids. You should feel comfortable wearing your devices all day, every day. In order to get to that point, you have to expose yourself to more difficult listening situations like background noise and crowds. In truth, these situations may be a little overwhelming at first (but never painful!), but with time, your brain will get better at filtering out noise and focusing on speech. Being in more difficult listening situations also allows you to provide feedback to your audiologist, who can make appropriate programming changes based on your lifestyle.

Go about your regular life in your hearing aids. You may feel overwhelmed with sound in more difficult listening situations, but this will improve with time and follow-up programming.

Have Realistic Expectations

Finally, it is very important to have realistic expectations about how hearing aids will work for you. Your hearing aids will not restore normal hearing and you should be skeptical of anyone that tells you otherwise. If there is a lot of background noise present, such as in a busy restaurant or a party, communication will be difficult just like it is for a normal hearing individual. You will also likely always need to use visual cues and context clues when communicating, just like you did before your hearing aids.  Your audiologist will spend time going over your hearing loss specifically and explaining why hearing aids may help in some situations, but not in others. Don’t be afraid to ask questions! Hearing aids are a financial expense and a time commitment, so it is only fair that you know their benefits and limitations.

While hearing aids hold the potential to provide a huge benefit to individuals with hearing loss, they cannot restore normal hearing. Some listening situations will always be difficult and the communication strategies you have developed will continue to serve you well, even with new hearing aids.   

Know that your experience with hearing aids will be uniquely your own. Family and friends can provide good insight into the hearing aid process but your hearing loss and fittings are different so your experience will be different as well. If you are considering amplification and would like to talk more about your options or what to expect, please make an appointment with your JHBI audiologist today to learn more!