Perforation of the eardrum

A persistent feeling of fullness in the ear

Tinnitus of recent or sudden onset, especially in just one ear

An unexplained difference in speech perception between ears

A rapid deterioration in speech perception

Physicians and Hearing

Otologists, otolaryngologists, and otorhinolaryngologists are physicians with special training in the treatment of disorders involving the ear, nose, and throat. All three are more commonly known as ear, nose, and throat specialists, ENT physicians, or simply ENTs. An otologist is the most specialized, concentrating exclusively on disorders of the ear. An ENT is knowledgeable about the medical treatment of hearing loss. She should also be familiar with nonmedical treatments; in fact, many ENTs are affiliated with audiologists, and in some cases, audiologists are members of their practices. If you see an ENT first, he will likely refer you to an audiologist for an evaluation of your hearing and nonmedical treatment of your hearing loss.

You may feel more comfortable seeing your family physician first, and that’s perfectly reasonable. However, your physician may not fully appreciate the significance of your hearing loss, because the typical medical examination involves conversation in a quiet room about fairly predictable topics. Your physician may also be unfamiliar with nonmedical treatment options and might not be in the habit of referring patients to audiologists. If your hearing loss is not among the 5 to 10 percent that can be medically treated, it may be dismissed as a natural consequence of aging. You may be advised to learn to live with it. If your hearing loss isn’t medically treatable, ask your family physician for a referral to an audiologist. Alternatively, remember that you can seek the advice of an audiologist on your own (check with your insurance plan first).

AUDIOLOGISTS

The audiology profession emerged at the end of World War II, when tens of thousands of men and women returned from military service with permanent hearing losses. Today, every audiologist earns a graduate degree in audiology from an accredited university program. New professionals entering clinical practice are required to earn a doctoral degree; most of them hold the Doctor of Audiology (AuD) degree. There are also many audiologists with excellent qualifications and exceptional experience who continue to work with master’s degrees (usually MA, MS, or MEd). In

addition to rigorous coursework, all audiology students are required to complete a variety of clinical experiences and an intensive clinical internship. Your audiologist should be a member of the American Academy of Audiology (AAA) and/or the American Speech-Language-Hearing Association (ASHA). Both require members to abide by a strict code of ethics, ensuring that the services you receive are provided in an ethical manner. Both organizations also have continuing education requirements. A license to practice audiology is required in all states. This is different from a license to dispense hearing aids, which is discussed later.

Choose your audiologist with care. The first step is to check credentials. These usually appear on the audiologist’s business card, letterhead, or website, but you can also call her office and ask. The audiologist’s name should be followed by her graduate degree (for example, MA, MS, MEd, AuD, or PhD) and certification from the American Board of Audiology (ABA) and/or ASHA (CCC-A). Her state license number may also be included.

Graduate Degrees in Audiology

The audiologist you see has one (or more) of these degrees:

Master’s (four years undergraduate + two years graduate + 9–12 month internship)

AuD (doctoral level: four years undergraduate + three years graduate + one-year internship). The AuD is a professional degree similar to those held by dentists (DDS), optometrists (OD), podiatrists (DPM), and veterinarians (DVM). A clinical PhD is similar to an AuD.

PhD (doctoral level: four years undergraduate + four or more years graduate). This degree is usually held by audiologists who wish to teach and conduct research.

Beyond credentials, you should look for someone with whom you’d want to have a long-term relationship—someone you can trust, in whom you have confidence, and with whom you feel comfortable communicating. This should be someone who takes the time to learn about your hearing problems and how they make you feel. If you think that you might try hearing aids at some point, it’s best to start with an audiologist who’s licensed to dispense them. In this case, there are more questions to ask, and these are included in Chapter 7.

Audiologists most often work in hospitals, medical centers, and private practices. There are several ways to locate an audiologist in your area:

Contact AAA or ASHA for a referral (see the Resources section at the end of the book for contact information).

If you see an ENT physician, ask her for a recommendation.

If you live near a university, check to see if it has a graduate training program in speech and hearing (you can ask AAA, ASHA or the university); if so, audiology services might be available through a university clinic (this is distinct from the audiology services that are provided at the university’s hospital). Services at university clinics are very thorough and allow plenty of time for discussion and questions. However, because they’re provided by audiology interns (graduate students in audiology working under the supervision of fully qualified, licensed audiologists), they may take a little more time. University clinics are probably the best places to find comprehensive hearing rehabilitation services (see Chapter 10).

Audiology services are also available at most hospitals (including university hospitals); call your hospital’s information number to inquire.

Ask friends and acquaintances about their experiences with local audiologists (some of whom are probably in private practice).

If all else fails, check the yellow pages under “Audiologists.”

Other Hearing Aid Dispensers

Not all hearing aid dispensers are audiologists, who must have university degrees and a license to practice audiology. According to the U.S. Food and Drug Administration, the minimal requirements for a license to dispense hearing aids are (1) a high school diploma, and (2) at least 6 months of training under a licensed hearing aid dispenser. Typically, applicants must also pass both written and practical examinations.

Non-audiologist hearing aid dispensers who belong to the International Hearing Society (IHS) are known as Hearing Instrument Specialists. Hearing Instrument Specialists test hearing; select, fit, and dispense hearing aids; and provide on-going follow-up care and counseling. They must abide by the IHS Code of Ethics and maintain professional competency through continuing education.

Some (non-audiologist) hearing aid dispensers are certified by an independent certification board, the National Board for Certification in Hearing Instrument Sciences (NBC-HIS). To become board certified and use the NBC-HIS credential, applicants must have at least 2 years’ experience as a dispenser and pass a national competency examination. To maintain certification, certified members must meet continuing education requirements.

When discussing hearing aid dispensers, this book refers to audiologists, in part, because they dispense most of the hearing aids in this country.2 In some states, audiologists who dispense hearing aids are required to be licensed as audiologists and hearing aid dispensers. Always ask about a dispenser’s education, experience, certification, licensure, and other credentials.

THE GOALS OF A HEARING EVALUATION

The most basic goal is to determine if your hearing is normal. If it’s not normal, it’s important to determine where in the auditory system the problem lies and, whenever possible, its cause. If there’s any chance that the cause is a medical condition that could be treated, you will be referred to a physician. Other important goals include establishing the type, symmetry, configuration, and severity of your hearing loss (more about those terms later); assessing how much difficulty the hearing loss creates in your life; and determining the steps that should be taken to minimize it.

Each evaluation should be customized to fit the needs of the individual person. That means that it’s not always necessary to do all of the tests described here; it also means that your audiologist may include tests that are not described here. In any case, this overview will give you a good idea of what to expect. The order in which tests and procedures are done varies from one audiologist to another.

NONMEDICAL EXAMINATION OF YOUR EARS (OTOSCOPY)

The audiologist examines each ear canal and eardrum with a lighted instrument called an otoscope. He’s looking for things that could interfere with a complete and accurate hearing test (for example, a foreign body, earwax, or infection in the ear canal; or a hole in the eardrum). If something out of the ordinary is found, you will be referred to a physician—the hearing evaluation may or may not proceed that day. Some audiologists have equipment that allows you to watch a video image of your ear canal and eardrum during the examination. This is fun and much less stressful than looking at images of other body parts during medical examinations!

CASE HISTORY INFORMATION

Audiologists ask many questions; some will be about your general health and the medications you take regularly, so you should be prepared to supply that kind of information. You’ll also be asked questions about your hearing: When did you first notice a hearing problem? Did it start suddenly or develop gradually? Has it become worse over time? Do you hear better in one ear than the other? In what types of situations do you find it most difficult to hear? Is there a history of hearing loss in your family? Have you been exposed to loud noise? Do you hear ringing or other noises in your ears? Do you have balance problems? You may also be asked questions about your vision, your ability to manipulate small objects with your fingers, and the type of support available to you at home. There’s no need to worry about privacy; your audiologist is legally and ethically bound to keep all patient information confidential.

Because your audiologist is interested in knowing how your hearing loss affects you and your family on a daily basis, you may be asked to complete