Articles

Learning to use your new hearing instruments optimally and enjoyably will depend on many factors: your age and physical health, severity of hearing loss, how long you have had a hearing loss, and your level of motivation to improve your hearing. Learning to hear again requires patience and practice, and establishing reasonable hearing expectations. It will take a while for your auditory system to adjust to hearing through your hearing instruments, and their physical presence.

Getting Used to Hearing Instruments:

1. Begin with easier hearing situations: Start your "training to hear" program in familiar surroundings, such as around your home. After you have familiarized yourself with the operation of your instruments, put them on and start conversing with one or two people only. Unless it cannot be avoided, for the first few weeks, don't attempt to wear your instruments in noisy places like the supermarket or the airport or a noisy restaurant.

2. After the "breaking-in" period, it is important that you increase your wearing time until you are using your instruments all day. Soon wearing them will become routine. Using your instruments regularly under varying conditions will teach you how to fully exploit your hearing potential and enjoy optimum benefits from your instruments.

3. (If applicable to your model) Learn to Control the Volume: Don't set the volume control too high. This can result in distortion rather than in improved understanding. Don't try to understand soft voices over a great distance. Remember, people who hear well can't do that either. As you gain more "wearing experience," you can adjust the volume control when you need increased loudness.

4. Learn to observe yourself: Adapting to your hearing instrument. Ideally, your hearing instruments should become "part of your body," similar to glasses. To achieve this, make sure your ear mold or In-the-Ear instrument is a comfortable fit. Should you experience any discomfort or "pressure points" please call us right away. Make allowances for the effects of fatigue. Wearing hearing instruments and hearing a greater range of sounds may tire you at first. Take a break if you get tired or nervous. Be happy with a little progress each day.

Learn to be an effective listener. With your new hearing instrument(s) it is now easier to hear well and communicate effectively in both quiet and noisy situations. It is still necessary, however, for you to be an effective listener. Even people with good hearing often have to concentrate on what they want to hear and ignore or suppress the things they don't. Try to identify any sounds you don't recognize when you first start wearing your hearing instrument. Practice concentrating on the sounds and voices you want to hear, ignoring those that are less important. When there are a number of different sounds occurring around you, practice shifting your attention from one to the other.

Adjust your own voice. At first, you may not recognize the sound of your own voice. This is because you are now hearing yourself more correctly with the help of your hearing instruments. Furthermore, you now have the opportunity to adjust the volume of your voice and the way you pronounce words. It is good practice to read aloud to yourself in this phase of your training period.

5. Learning to hear again in difficult situations: Living with noise. The world is a noisy place. People with normal hearing are unable to suppress interfering noises by concentrating on the sounds they wish to hear. If, however, you have had hearing impairment for some time, you may have lost this ability. Your mission is to live with both unpleasant and pleasant sounds. Practice concentrating on what you want to hear. If you have multi-program instruments, practice choosing the best program for the situation.

6. Active Participation in Group Conversations: Even people who hear well can have problems understanding speech if several people are speaking at once. So it is understandable if you feel overwhelmed trying to hear in large groups. It will help if you move closer to the person you want to hear and watch his/her lips. Do not listen to the group but focus on a single speaker at a time. Experienced wearers of hearing instruments manage astonishing results in this type of situation.

7. Listening to the radio or television: Electronically produced speech may be difficult to understand. By focusing on the general meaning the speaker is trying to convey, instead of trying to decipher each word, your ability to use your hearing instruments should improve.

8. Using the telephone with a hearing instrument: There are a number of options, which can be discussed with us to determine which procedure works best for you. Your local telephone company can give you information about their free telephones for people with hearing loss.

Please include us as often as necessary to help you work through the first most difficult months on your journey to better hearing. Call us anytime. That's why we are here!
Care & Maintenance for your New Instrument(s)

Daily care and attention will prolong the life of your hearing investment.

Wipe daily with a soft, lint free cloth. Be sure to clean the receiver and vent openings with the proper cleaning tool; see your hearing professional for the proper tool and use.

Turn off when not in use overnight. Be sure to leave the battery door open to allow any accumulated moisture to dry. It is best to store the instruments in the jewelry box your dispenser provided at delivery. Also keep the battery compartment clean and dry.

Do not store the hearing instruments with the battery installed for an extended length of time. Remove the battery and store your hearing instruments in a cool dry place.

Remove hearing instruments before using hair spray.

Do not expose your hearing instruments to excessive moisture, humidity, or steam.

Do not wear your hearing instruments while bathing, showering, or swimming.

Keep away from heat sources such as stoves, heat registers, hair dryers, or open flame.

Do not drop your hearing instruments or allow the instrument to be subjected to rugged handling.

Keep away from pets; dogs in particular are aroused by feedback sounds sometimes produced by hearing instruments when not being worn.

Keep fresh batteries in your hearing instruments and be aware that your hearing aid will stop functioning when the battery dies. This is of particular importance as you drive in traffic or are in other situations where you may rely on warning sounds for safety.

Keep in touch Keep in touch Keep in touch. We encourage you to maintain regular contact with us. A regularly scheduled check of your instruments will ensure long lasting reliability of your new hearing instrument(s). Yearly testing of your hearing is also crucial to assure that the products you purchased are delivering the performance needed to match any changing hearing conditions.
Trouble Shooting:

Use this guide to help solve some of the common problems patients may experience. If you have a problem not defined or one that persists, call us right away.

1. No Sound
a. Battery may be dead or in backwards.
b. Check to see instrument is on.
c. Sound outlet may be plugged with wax.

2. Weak Sound
a. Weak battery.
b. Sound outlet may be plugged with wax.
c. Your hearing condition may have changed.
d. Microphone inlet plugged with wax.

3. Crackling/Frying Sound
a. Weak battery.
b. Wax problem.

4. Whistling Sound
a. Volume control is too high or excessive wax buildup in your ear.
b. Object, such as coat collar, hat, or scarf may be covering the microphone inlet.

Audiological Evaluation

Summary: The basic audiological evaluation is conducted to determine the presence of a hearing loss, the type and degree of hearing loss, and the recommended treatment options.

Procedures/Time
The audiological evaluation consists of a battery of tests to assess hearing levels and speech understanding.

* Otoscopy: to assess the outer ear canal and determine to presence of occluding wax
* Pure tone air/bone conduction audiometry to assess hearing levels and determine degree and type of hearing loss (15 min)
* Speech audiometry to assess speech understanding and determine prognosis with amplification (15 min)
* Acoustic Immittance: Tympanometry and Acoustic Reflex Thresholds to assess middle ear function and integrity of ascending pathways of auditory nerve (15 min; only as indicated)
* Distortion product Otoacoustic emissions to assess function and integrity of outer hair cells (15 min; only as indicated)
* Review of results: The results are discussed with patient as to the degree and type of hearing loss and how HL impacts communication (15 min)
* Recommendations: Recommendations are given based on test results. This may involve routine monitoring of hearing levels, communications strategies, amplification, or medical referral. Questions are answered. (30 - 45 min)

What caused my hearing loss?
There are several different causes of hearing loss: Excessive wax, fluid in the middle ear, presbycusis (aging), trauma, noise exposure, ototoxic medication, genetics, sudden hearing loss, viral infection. There may be more than one contributing factor.

Will my hearing get worse?
There is a chance that hearing will gradually decline over time. If there is a history of progressive hearing loss, this could occur more rapidly. It is important to preserve hearing by wearing ear protection when exposed to very loud sounds (lawn mowers, equipment, concerts, etc).

Are there any medical options to correct my hearing?
This depends on the type of hearing loss that is present. For conductive type hearing losses, medical intervention often can improve hearing levels (removing wax or draining middle ear fluid). There is no medical treatment to restore sensorineural hearing loss. The most common treatment for this type of loss is the use of hearing aids.

Will a hearing aid help me?
For most people, a hearing aid will help them hear environmental sounds and voices better. It is important to remember that wearing a hearing aid(s) will not allow you to hear as well as you did when your hearing was normal. It should be recognized that certain types and degrees of hearing loss may cause problems with the processing of sounds, which can lead to poor understanding of speech even with hearing aids.
Tinnitus Retraining Therapy (TRT)

Summary: Tinnitus is a common phenomenon that affects about 17% of the general population. It often is described as "ringing in the ears" and can vary from person to person. Some people hear roaring, buzzing, or high-pitched tones. For some people tinnitus can be ignored, but for others it can have a negative impact on their daily life (concentrating, working, sleeping, etc). Although there is no cure for tinnitus, sound therapies and other treatments can provide tinnitus relief.

Tinnitus Retraining Therapy (TRT) is a process that attempts to retrain the brain to ignore (habituate to) the tinnitus through the use of directive counseling and sound generators that emit a low level broadband sound.

Procedures/Time:

Part 1: Audiological evaluation

* Pure tone and speech audiometry to assess hearing and provide a basis for tinnitus measures (30 min)
* Acoustic Immittance: Tympanometry and Acoustic Reflex Thresholds to assess middle ear function and integrity of ascending pathways of auditory nerve (15 min)
* Distortion product Otoacoustic emissions to assess function and integrity of outer hair cells (15 min)
* Electronystagmography (ENG) (only as indicated) see ENG section
* Auditory Brainstem Response (ABR) (only as indicated) Need to refer

Part 2: Tinnitus/Hyperacusis evaluation

* Threshold of white noise to serve as a comparison for minimum masking levels (5 min)
* Pitch match to obtain an estimate of the perceived signal in each ear (10 min)
* Loudness match to determine perceived loudness of the tinnitus in each ear (10 min)
* Minimum Masking Levels to determine how well the brain can detect the tinnitus signal in the presence of competing noise (15 min)
* Loudness Discomfort Levels to determine patient's tolerance level for sound (20 min)

Analysis/recommendations

* This involves review of results and determination of category of patient and treatment options based on the hearing loss, tinnitus, and/or hyperacusis. (15 min)
* Results and recommendations are discussed with patient (45 min)

Counseling session

This TRT session involves demystifying tinnitus and neutralizing the patient's negative associations, which are crucial to the successful management of tinnitus. The patient is educated about the anatomy and physiology of the auditory system and how it relates to their tinnitus. The patient's concerns are addressed and questions are answered. The TRT treatment plan is reviewed and impressions are taken for sound generators if appropriate. (1-2 hours)

Fitting of sound generators

Sound generators are fit to patient's ears and orientation of use, care and maintenance is discussed. Expectations for improvement are reviewed along with how use of sound therapy will help manage the tinnitus. (1 hr)

Follow-up

* After patient has been fitted with devices, a follow-up protocol is discussed. Potential problems are addressed and use and setting of devices are reviewed. Further counseling takes place as needed.
* 3-4 weeks (30 min)
* 6-12 weeks (30 min)
* 6 months (1-2 hrs) Repeat basic audiological evaluation and tinnitus/hyperacusis evaluation, compare to previous results, follow-up and counseling
* 12 months (repeat above until patient is discharged)

How do you treat tinnitus?
Our treatment is called Tinnitus Retraining Therapy, but other names such as habituation-oriented therapy, tinnitus treatment based on a neuropsychological model, and "Dr. Jastreboff's treatment" are used as well. It involves an extensive audiological evaluation, several counseling sessions, the use of external sound, and frequently the use of sound devices. It does not involve any surgery or drugs.

What does retraining therapy mean?
We try to retrain the subconscious parts of the brain to ignore the sound of your tinnitus and to achieve the stage in which you are not aware of and/or annoyed by your tinnitus.

Are there any side effects of the treatment?
There are no side effects.

What kind of audiological tests are performed? Will it hurt my ears? What if I don't have tinnitus when I am tested?
The tests include an audiogram and several specific tests which allow us to evaluate whether you have tinnitus and/or hyperacusis, and to what degree. The tests begin with low levels of sound and gradually get louder; therefore, none of the tests will be painful. If your tinnitus is not present on the day of the testing, it will NOT influence the possibility of success with the treatment.

I recently had audiological tests done. Do they have to be repeated?
We prefer to have the tests performed in our Center. There are very specific measurements we perform which are not routinely provided in other clinics.

Is the counseling a form of psychotherapy or biofeedback?
No, the counseling will provide you with information about the causes and factors involved in your tinnitus/hyperacusis, explain to you how the retraining therapy works, and teach you how to control your tinnitus. The counseling session is a fundamental part of the treatment process.

What is the role of external sound?
External sound from radios, TVs, stereos, etc. is used at a low level in order to bring changes in your subconscious hearing system, and not to cover (mask) your tinnitus. It reduces the contrast between your tinnitus and complete silence, and slightly distracts you from the sound of your tinnitus.

What are the devices and what do they look like?
The devices used in retraining therapy are called "noise generators" or "sound generators." Presently, we are recommending two styles. One is a pair of small instruments that are worn behind both ears. They look similar to the behind-the-ear hearing aids and can be worn with glasses. The other style is worn in the ear, but not blocking the ear canal as in the case for many hearing aids. They do not interfere with your work or talking on the telephone.

Can I just buy the devices?
The devices are used to help speed up the process of retraining, but what is important is how they are used. The manner in which the devices are used depends on each patient's individual needs. If you just buy and wear the devices, you most probably will not achieve improvement, and in some cases you may even cause more damage. We will teach you how to use them effectively.

Do I need to have the devices?
Not everybody needs the devices. After the medical and audiological evaluation, we will give you our recommendations and you can choose your treatment.

I am using hearing aids; how can I use other devices?
Depending on the type of hearing aids, it is possible that we can work with your hearing aids and you will not need any other devices.

I was using maskers without effect. What is the difference between masking and these devices?
Although in some cases masking can provide tinnitus relief, this approach is aimed at making tinnitus inaudible. When the device is removed, however, the tinnitus returns. In addition, the level of sound required to mask the tinnitus may be uncomfortable. We use the devices to generate noise, not to cover the sound of tinnitus. The goal of retraining therapy is to retrain the brain so that it eventually does not pick up the tinnitus sound, and in order to do this, the tinnitus sound cannot be covered. Generating sound that mixes with your tinnitus will help you feel more comfortable and remove the emotional response to tinnitus. At this point, tinnitus no longer bothers you, even when it is perceived.

My mother is deaf and she has tinnitus. Can she benefit from Tinnitus Retraining Therapy?
This therapy uses sound as a part of the protocol. So if your mother is completely deaf and does not have a cochlear implant she would not be able to benefit from this therapy. However, the use of electrical stimulation of the ear (through cochlear implant or external stimulation) combined with Tinnitus Retraining Therapy may help. If she can hear sound, even if she cannot recognize speech, we may be able to help her.

I am taking some medication. Will I be able to continue?
Our medical evaluation will provide the answer to this question. In general, if you are taking medication for any other reason than tinnitus, you will be able to continue taking the medication.

How long does the treatment take?
The treatment takes 12-24 months. If you carefully follow the protocol, you should see an improvement within half a year.

Will I be cured?
You will no longer be bothered or annoyed by your tinnitus. However, if you concentrate and want to hear your tinnitus, you will. This is why we refer to Tinnitus Retraining Therapy as a treatment, and not a cure.

What is the guarantee that I get better?
There is no guarantee, but from our experience over 80% of our patients have reported significant improvement.

How frequently do I need to return to the Center?
There are several follow-up visits: After 3 weeks - ½ - 1 ½ hour, at 12 weeks - ½ - 1 ½ hour, 6 months - 1 ½ - 2 ½ hours, and then every 6 months up to the end of the treatment. For patients who live far away, the 3-week and 12 week follow up visits may be replaced by over-the-phone consultations.

Is this treatment covered by insurance?
In general, no. Some insurers cover part of the evaluation and sometimes the devices. Medicare does not cover it. You will find a list of the procedures that are frequently performed and their insurance codes. You may call or write your insurance company and check with them as to your coverage and possible reimbursement. You will be responsible for payment of typically non-covered services at the time they are rendered.

I am using retraining therapy for my tinnitus. I need to have some dental work done which involves high speed drilling. Can I have it done and what can I expect?
You should contact the center and the person who is working with you. High-speed dental drills produce loud sound which is transmitted not only by the air, but also by bone conduction. This sound may increase tinnitus (in most cases temporarily). In general, it would be better to avoid loud drilling if possible. There is a new, and still controversial, quiet technology called air abrasive microdentistry, which you might like to explore and seek more information about from dental professionals.

I am using retraining therapy for my hyperacusis. I have to have some dental work done which involves high speed drilling. Can I have it done, and what can I expect?
You should avoid exposure to any loud sounds. High speed drilling could potentially worsen your condition.

I was advised to have an MRI done. Can I expect any problems with my tinnitus and hyperacusis?
If you need to have an MRI done, we advise you to use an open field MRI. In addition, your ears should be protected. Unfortunately we have to make you aware that some of our patients have reported that their tinnitus/hyperacusis started or became unbearable after MRI exposure.

Can cosmetic facial surgery affect my tinnitus and/or hyperacusis?
There is no reason to suspect that this procedure will have any effect. I would try to postpone the surgery if it involves drilling or is in very close proximity to the ear.
Central Auditory Processing (CAP) Evaluation

Summary: Central auditory processing disorder (CAPD) affects the ability of a person to process information that is heard. People with CAPD have normal hearing, but sound/speech is distorted or "lost" in the brain.
Procedures / Time:

Part 1: Audiological evaluation

* Pure tone and speech audiometry to assess hearing and provide a basis for auditory processing measures (30 min)
* Acoustic Immittance: Tympanometry and Acoustic Reflex Thresholds to assess middle ear function and integrity of ascending pathways of auditory nerve (15 min)
* Distortion product Otoacoustic emissions to assess function and integrity of outer hair cells (as indicated; 15 min)
* Auditory Brainstem Response (ABR) (as indicated; refer for testing)

Part 2: Central Auditory Processing evaluation

* Word Recognition Score (WRS) in Noise Test (10 min)
* Staggered Spondaic Word (SSW) Test (15 min)
* Phonemic Synthesis Test (10 min)
* Other Tests (as indicated)

List of Terms and Explanations

FOUR CATEGORIES:
1. Decoding: People with decoding problems may have difficulty with reading accuracy receptive language, phonics, articulation, and are easily confused.
2. Tolerance-Fading Memory: Those with tolerance fading memory may have difficulty with reading comprehension, auditory figure-ground (see below), auditory memory (see below), expressive language, and are easily distractible.
3. Integration: Integration problems include difficulties with reading, spelling, and phonics.
4. Organization: Those with organization problems have difficulty with organizing and sequencing information.

OTHER TERMS:
Type A: This term is only used with the Staggered Spondaic Word (SSW) test. It implies that the person missed more in the left competing condition than the other conditions. People who are Type A have severe reading and spelling problems.

Reversals: This term is also used with the Staggered Spondaic Word (SSW) test. It implies that the person reversed the order of the two test items. People who have a high number of reversals often have sequencing or organizational difficulties.

Auditory Figure-Ground Problems: When a person has "Auditory Figure-Ground Problems," this simply means that he/she has difficulty hearing and understanding speech when there is background noise present (pencil sharpener, talking, loud heating cooling vents, etc.).

Auditory Memory Problems: When a person has "Auditory Memory Problems," this means that the person has difficulty understanding verbal instructions, directions, lists or study materials.

Auditory Discrimination Problems: When a person has an "Auditory Discrimination Problem," he/she may have difficulty hearing the difference between similar words such as COAT/BOAT or sounds such as CH/SH.

Auditory Attention Problems: When a person has "Auditory Attention Problems," he/she cannot stay focused for listening. Other factors can affect attention, but a person with CAPD cannot maintain attention.

Auditory Cohesion Problems: "Auditory Cohesion Problems" affect the person's ability to comprehend. For example, persons with this problem may have difficulties with comprehending verbal math problems, understanding riddles, or drawing inferences from conversations.

Sound Blending/Phonemic Synthesis: Sound blending is the ability to blend individual sounds together into a meaningful word.
Links

Want to know more about hearing loss? Check out these websites:

International Hearing Society

American Academy of Audiology

American Speech and Hearing Association

North Carolina Association of Hearing Care Professionals

Better Hearing Institute

Siemens

Apply for credit online at this website:

Care Credit/Sound Choice