Hearing loss, tinnitus, and dizziness can be debilitating symptoms. Sometimes these symptoms come on suddenly without warning. At other times, they creep up slowly, eventually affecting a person’s overall quality of life. Our extensively-trained audiologists and physicians are pleased to offer a full range of services for hearing loss and related ear problems at Penn Medicine Becker ENT & Allergy. Penn Medicine Becker ENT & Allergy offers full Otology and Ear Surgery services at several convenient New Jersey locations.
Our audiology team works in partnership with our New Jersey and Philadelphia ENT specialists to provide individualized treatment plans and ensure that all of our patients’ ear-related issues are properly addressed.
Hearing loss, recurrent and chronic ear infections, ear wax buildup, dizziness, eardrum perforations, ear fullness, Eustachian tube dysfunction, and tinnitus (ringing in the ears) are just some of the ear conditions treated by physicians at Penn Medicine Becker ENT & Allergy.
Hearing Healthcare Services
Hearing Aids Service
Modern technology provided with specialized treatment plans
Help is available. Discover treatments and other resources to manage tinnitus
Hearing Loss Prevention
Prevention of some forms of hearing loss and tinnitus for all ages
Prevention and treatment of hearing loss and speech & language delays in children
Ear Infections & Swimmer’s Ear
Treatment for acute and chronic swimmer’s ear infections in children and adults
About Hearing Loss
In order for us to hear, our ears have to have properly working outer, middle, and inner ears, as well as an intact auditory neural pathway to the part of the brain that hears and helps us to attach meaning to sound – the auditory cortex. This complex system often experiences problems that may lead to hearing loss.
Hearing loss is, simply put, a decreased sensitivity to sounds. Speech may sound muffled or difficult to understand, and you may find yourself asking others to speak more clearly or repeat what they are saying. You might find yourself turning up the TV or radio volume or withdrawing from conversations and avoiding social situations.
Hearing loss is a widespread condition that affects approximately 35 million Americans. It is commonly associated with aging – 1 out of 3 people experience some degree of natural hearing loss by age 65 – but can occur in people of all ages. Hearing loss is often exacerbated by environmental factors such as noise exposure. It is also sometimes a side effect of certain medications or illnesses.
Types of Hearing Loss
Hearing loss is characterized according to which part of the auditory system is affected. There are three main types: Conductive, Sensorineural, and Mixed.
Conductive hearing loss
Conductive hearing loss occurs when a sound reaches the inner ear at a reduced volume. Causes include ear infections, fluid in the middle ear from colds and allergies, impacted earwax, foreign object in the ear, a perforated eardrum, benign tumor, or an abnormality or defect in the middle or outer ear. Medication or surgery can often successfully be used to treat the underlying condition and restore hearing.
Sensorineural hearing loss
Sensorineural hearing loss occurs when the nerves to the inner ear or brain are damaged. Speech will sound faint or muffled, regardless of the volume or clarity of the person speaking. Causes include exposure to loud noise, head trauma, viruses or diseases, genetics, aging, inner ear abnormalities, tumors, and Meniere’s disease. This type of hearing loss – the most common – is rarely treatable with medication or surgery, but patients can usually benefit from hearing aids.
Mixed hearing loss
Mixed hearing loss is a combination of both types, and occurs when there is damage to the inner, middle, and outer ear.
Most hearing loss occurs gradually. Sudden hearing loss is considered a medical emergency. A person experiencing sudden hearing loss must be seen as quickly as possible by an ENT physician. The best possibility of improvement occurs after an immediate diagnosis and initiation of treatment. If no visible obstruction or infection is visible, a hearing test will determine the type and amount of hearing loss. The ENT physician may wish to prescribe medication and/ or imaging of the inner ears.
Symptoms of Hearing Loss
Hearing loss often occurs in a gradual manner, often meaning that the person with hearing loss is unaware of the problem. In many cases, hearing loss is first detected by a family member who is having to speak louder or repeat themselves on a regular basis. Some signs of hearing loss include:
- Turning the TV or radio volume louder than other family members prefer.
- Difficulty understanding speech in crowded settings such as restaurants and meetings.
- More difficulty hearing children and women than men.
- Complaints of ringing in the ears.
- Repeatedly asking for people to repeat what they say.
- Excessive sensitivity to loud sounds.
It is a good idea to seek out help from an audiologist as soon as possible if you notice symptoms of hearing loss. Early treatment is often much more successful than waiting until the problem gets worse. More advanced hearing loss can be difficult to treat with solutions like hearing aids or medication.
The audiometric test, or hearing test, is an important tool in ear health. We offer comprehensive hearing tests for children 2.5 years old and up, as well as adults and seniors.
A hearing test is quick, generally taking fifteen to twenty minutes. It is followed by an interpretation of the results and customized recommendations for the treatment and/or prevention of hearing loss. A complete report is provided to you and your physician.
Who Should Get Their Hearing Tested?
Regular hearing testing is recommended for people of all ages for a variety of reasons.
For children, hearing is a crucial component of the learning process. An undiagnosed hearing impairment can cause difficulty in acquiring learning, language, and social skills. In adults, hearing loss often comes on so gradually that people are unaware of the problem until it has progressed beyond a point where it is easily treatable.
People with hearing disabilities, those with a medical history of an illness that can lead to poor ENT health, and people over 55 years old should have their hearing checked routinely. Additionally, people who spend time in noisy environments (such as construction workers, musicians, or hunters) should take measures to prevent noise-related hearing loss and get their hearing tested regularly.
Take Our Online Hearing Evaluation
While we do recommend scheduling a hearing test with a member of our audiology team if you notice symptoms of hearing loss in yourself or a loved one, it can be helpful to perform a few simple tests at home before making an appointment.
Listed below are 7 questions related to hearing.
If you, your child, or loved one answer “Yes” to one or more of these questions, hearing loss may be present and you may want to consider a full evaluation with an audiologist.
- Do you have noises in your ears or head (ringing, buzzing, humming, etc)?
- Do you feel as though people are whispering or mumbling?
- Do you hear well in quiet rooms but have difficulty understanding speech when background noise is present?
- Is your television turned up louder than it used to be or louder than is comfortable for others?
- Do you have trouble understanding on the telephone? Do you have a “good ear” for the telephone?
- Do you have any pain, pressure, or drainage in or from either ear?
- Do you ask people to repeat themselves when speaking to you?
Audiological Evaluations at Penn Medicine Becker ENT & Allergy
An audiological evaluation at Penn Medicine Becker ENT & Allergy Center is straightforward and painless. Our Audiologists will begin your evaluation by asking some questions about your hearing loss. These may include:
- When did you start to notice your hearing loss?
- Which ear is worse?
- Are there other symptoms, like ringing, dizziness, or drainage from the ear?
- Do you have any congenital conditions?
- Are you exposed to loud noises in the workplace?
- Do you take any medications?
- Is there a family history of hearing loss?
After performing a thorough interview, our audiologists will examine your ears to rule out any simple anatomic reasons for your symptoms. Then, a series of hearing assessments will be performed.
The first part of the hearing test consists of objective testing or “automatic” tests; in other words, no answers are needed from the patient. The computers will get answers from each ear. The two tests done in this manner are middle ear testing and otoacoustic emissions. For middle ear testing, the patient feels a slight air pressure change then hears some louder tones, checking the eardrum and acoustic reflexes. During otoacoustic emissions the patient hears quiet tones; the inner ear sends a tone back that the computer records. This same test is used to check newborn babies’ hearing in the nursery.
The patient’s cooperation is needed for the actual hearing test. The patient sits in a spacious soundproof listening room. Many people report that once the earphones are in place, they can hear their breathing and heartbeat. If a person has tinnitus it may seem louder during the test in the listening room due to the lack of environmental sounds to mask.
This test is divided into two parts: speech testing and pure tones. For the pure tones, the patient pushes a button or verbally indicates that they hear a pulsed tone, each time it is heard. During speech testing, the patient will repeat back both very softly spoken words and words at a comfortable listening level. The audiologist will work with the patient to make the test as “user-friendly” as possible, giving people multiple opportunities to hear the tones and words.
Once testing is complete, the audiologists will review the results with you and offer their recommendations in detail.
Treatment for Hearing Loss
Nearly all hearing loss can be managed or treated to some degree. While inner ear hearing loss cannot be “fixed,” there are options for patients who would like to improve their hearing. The cause of the hearing impairment and the needs of the individual will help to determine the proper course of management. Regardless of the type of hearing loss you are experiencing, treatment options are available. Some options at Penn Medicine Becker ENT & Allergy include:
- Hearing Aids
- Medications for conditions such as ear infections
- Manual removal of impacted earwax
- Surgical correction for traumatic injury or congenital factors
- Cochlear implants for severe hearing loss that direct sound to the auditory nerve
When hearing loss has occurred in the inner ear, the treatment will usually be hearing instruments such as hearing aids. A hearing aid (also called a hearing instrument or hearing device) is a miniature digital personal amplification system that can be worn in or over the ears. Hearing aids amplify only in the regions of hearing loss, as assigned by the audiologist, giving increased ease of listening both in quiet and background noise.
These devices can be set for the wearer’s individual listening environments and lifestyle. Many devices can utilize ancillary products, allowing Bluetooth (wireless) connection to cell phone, TV, or computer. Many people are surprised to learn that their hearing aids can automatically adjust for volume in the surrounding area, lowering volume for loud voices and increasing amplification for quieter voices, as well as suppressing background noise in the immediate vicinity to increase speech understanding. Some hearing devices can “zoom” to pick up a voice in the passenger seat or back seat of a car.
Hearing aids are smaller and more sophisticated than ever, such as Oticon Hearing Aids, with a variety of features and options suitable for any lifestyle. A contemporary hearing aid has two microphones to pick up sound (the difference in sound level to the microphones is an important cue to the device), digital circuitry to amplify and modify the signal, and a receiver to turn the electrical signal back into sound to deliver to the ear.
Candidates for Hearing Aids
Hearing loss can be objectively measured. This can be done as part of a brief evaluation by an audiologist. An audiologist uses specialized equipment to determine if you have hearing loss, the amount of hearing loss you have in each ear, and what part of the hearing system is not fully functioning. This knowledge can help direct treatment with an appropriate hearing aid or listening device.
Many patients have hearing loss in both ears. In these situations, optimal results are usually obtained with 2 hearing aids. Every patient is different. Our audiologists work as a team to determine the best possible hearing instruments for each patient’s listening needs, budget, and abilities.
Choosing the Right Hearing Aids
After determining the type and degree of your hearing loss, our audiologists will work with you to choose hearing devices that fit you for comfort, style, budget, and sound quality. You will be able to test a pair of hearing aids in a variety of listening situations to hear what they sound like. It may be beneficial to bring a loved one with you to the appointment for hearing a familiar voice.
Hearing aids come in a variety of styles. Some are custom-created and sit completely in the ear canal; others sit over the ear and have a tiny tube that extends into the ear canal. During the hearing education evaluation, we discuss the benefits of the different styles in association with the patient’s hearing needs (type and amount of hearing loss can influence these factors), lifestyle, and preferences to determine the most appropriate style and size.
Purchasing Hearing Aids
At Penn Medicine Becker ENT & Allergy, we specialize in providing a full range of hearing instruments and listening devices. We will gladly guide you in choosing the right device for your needs and budget while helping you to fully understand your purchasing options.
Hearing aids are not covered by Medicare and certain health insurance companies, while other insurers do give a hearing aid benefit. It is important to check your individual plan to find out if you are covered.
If your hearing aids will not be covered by insurance, you have other options. Financing is an option for some patients and there are some non-profit organizations which provide financial assistance for hearing aids. Our office helps patients get in touch with these organizations when financial assistance is needed.
Using and Caring for Hearing Aids
As with any new assistive device, hearing aids may take a few days or weeks to get used to. Here are some tips on acclimating to new hearing aids:
- We recommend that you begin by wearing your hearing instruments in quiet surroundings, gradually building up to noisier environments.
- Get used to your hearing instrument by listening to a single person with whom you regularly converse. We recommend that you let your friends and family know that you are using new hearing instruments so that they will be patient with you as you get used to the new devices.
- As you move into noisier environments, try to separate background noise from the sounds you are focusing on.
- As you move into larger settings, practice locating the source of a sound.
- Pay attention to any difficulties adjusting to hearing instrument usage, and bring these to our attention at your follow-up visit with our Audiology department. As with any new device, hearing instrument settings may require some fine-tuning. We are committed to helping you learn to use your hearing instruments in a manner that provides a positive impact on your everyday living.
Proper maintenance and care will extend the life of your hearing aid. Some simple steps you can take are as follows:
- Keep hearing aids away from heat and moisture.
- Clean hearing aids as instructed.
- Use hair care products and dry your hair before putting on the hearing aids.
- Open hearing aid battery doors to avoid draining the batteries when you are done wearing the devices for the day.
- Replace dead or dying batteries immediately.
- Wear the hearing instruments as full-time as possible.
- Call for an appointment to return every four to six months for maintenance and cleaning of the hearing aids.
Other Assistive Listening Devices
While hearing aids have undergone impressive technological improvements in recent years, they don’t work ideally in every situation, particularly those in which there is excessive background noise. That’s because the microphone is usually integrated into the unit, rather than in the vicinity of the speaker; turning up the volume will result in amplification of all sounds, including background noises.
Many people also experience difficulty hearing in select situations such as on the telephone or while watching TV. There are many assistive listening devices available to help make listening with a hearing aid easier and more enjoyable for these situations. Our experienced staff of hearing professionals will educate you about these various options, and help you find the device(s) that best suits your needs and your budget. Many patients use both hearing aids and assistive listening devices.
Telephone Assistive Listening Devices (ALDs)
These devices are helpful in a variety of situations. They can be used to help you hear the TV, phone, a lecture, conversation in an environment with a busy background, and many other situations where the listener would have trouble perceiving what is being said, especially while using hearing aids. They are helpful in meetings, churches, restaurants, movie theaters, retail stores, airports, and other places where distracting background noise drowns out speech.
ALDs work by broadcasting signals to a handheld FM receiver, which the user can tune into and listen at a volume level comfortable for that person. They enable the user to differentiate the sounds they need to hear from distracting background noise. The devices include a microphone to capture sound, a transmitter to send the signal over an FM frequency, and a receiver to broadcast the signal to the hearing aid.
Most assistive listening devices nowadays rely on wireless technology and are Bluetooth compatible for use with a cell phone, TV, computer, and other connected devices.
Custom Ear Molds
When you choose a hearing aid to fit your lifestyle and hearing needs, you’ll want to ensure you receive optimum performance and comfort. Custom earmolds are the perfect solution: created from a silicone impression of your ear canal or outer ear, they are shaped to fit comfortably and easily, whether designed to be worn in the ear canal or the concha (bowl) of the outer ear.
Custom earmolds aren’t designed solely for hearing aids; they are also invaluable in helping patients achieve a comfortable, secure fit for earplugs, Bluetooth headsets, and other in-ear devices. After taking an impression of your ears – a process that is quick and comfortable – we’ll have a laboratory design the mold for whichever product you desire.
Custom Ear Plugs
If earplugs are a regular part of your life, you’ll want to consider custom earplugs. Designed from an impression of your ear canal, custom earplugs allow for unparalleled comfort and safety. They won’t fall out or hurt, as standard earplugs might, and you can rest assured they’ll block the right amount of noise, giving you better hearing protection and a more enjoyable listening experience.
Custom earplugs are available for a variety of situations. Musician’s earplugs offer high fidelity and sharp clarity, reducing sound levels so that music and speech are clear and natural while offering protection from the long-term effects of noise exposure. Swimmer’s earplugs prevent moisture from entering the ear canals, protecting against dangerous infections and abnormal bone growth. Earplugs for hunting and shooting feature acoustic filters and electronics designed to protect your ears from loud gunshots while allowing normal sounds to filter through. These are perfect for people in law enforcement.
Balance, Vertigo and Dizziness
People who experience lightheadedness feel as if they are going to faint. This may be accompanied by nausea or vomiting. The feeling often dissipates when you lie down. Occasional episodes of lightheadedness are common and are rarely indicative of a serious problem. They happen when a sudden drop in blood pressure and blood flow to the head occurs, as when you get up too quickly from sitting or lying down.
Vertigo is another form of dizziness characterized by the sensation that your surroundings are moving, despite the lack of any actual movement. You feel unsteady, as though your body is spinning or tilting, which makes standing or walking difficult. You may experience nausea and vomiting.
When a person experiences vertigo, dizziness, or a spinning sensation, it can be very frightening. An episode of vertigo can cause serious injuries. Often the person has no idea why vertigo is occurring. There are many causes of dizziness and vertigo. Some of these causes are circulatory or heart-related issues, medications, gait problems, and inner ear disturbances.
In order for the balance system to work properly, the inner ears, the eyes, and the muscles and nerves of the body have to all be working together and coordinating signals properly. A problem in any of these areas can cause vertigo and imbalance.
Vestibular disorders are found in 35% of U.S. adults age 40 and older, approximately 69 million Americans. These problems can result in decreased mobility and confidence, serious injury, and even death. Often balance testing is the first step in helping to pinpoint the source of dizziness and vertigo.
Dizziness & Vertigo Evaluations and Treatment
Dizziness and vertigo can be frightening but rarely indicate a serious problem. Many of us experience a “rush of blood to the head” and the accompanying sensation of lightheadedness on occasion or feel that our environment is moving around us.
A number of factors can cause these episodes, ranging from colds and allergies to anxiety, medications, inner ear disorders, and migraine headaches. Many of the causes of dizziness are benign. Still, since the experience can be unpleasant, and with the potential for a more serious underlying condition, we recommend you come in for testing if you experience any unexplained episodes of dizziness.
We’ll perform a detailed evaluation to help determine if your inner ears are responsible for your vertigo, lightheadedness, or imbalance. We offer solutions to help improve and, in many cases, eliminate symptoms.
Treatment options include physical and occupational therapy, vestibular rehabilitation, lifestyle changes, medications, and surgery. We will assess and interpret the findings from our evaluation and get you started in the right direction.
Ear infections occur when fluid becomes trapped in the middle ear. They are most common in children, who are more susceptible to colds and infections than adults, and whose Eustachian tubes are still developing. For all the pain and misery they bring, ear infections are usually easy to treat.
What Causes Ear Infections?
The buildup of fluid in the middle ear is most often caused by colds and sinus infections, but can also be the result of allergies, cigarette smoke and other airborne irritants, infected or enlarged adenoids, and teething, which results in an overabundance of mucus and saliva.
Ear infections occur most frequently in the winter months and are more likely to affect people living in cold climates, or those who have recently gotten over another illness when the body is less resistant to infection. Children who attend daycare, rely on pacifiers, weren’t breastfed, and are exposed to tobacco smoke are more prone to developing ear infections.
Ear Infection Symptoms
Pain in the ear is the main symptom of an ear infection. Patients may also experience a feeling of fullness in the ear, hearing loss, malaise, vomiting, and diarrhea. Younger children may have a fever and have increased irritability and trouble sleeping.
Treating & Preventing Ear Infections
A health care provider will diagnose an ear infection by examining the ears with an otoscope to check for signs of an infection. These include redness and dullness, fluid behind the eardrum, pus or fluid in the middle ear, and a perforated eardrum.
Ear infections usually clear up on their own after a few days and are easily treated with simple home remedies. Try eardrops and over-the-counter medications for pain, and hold a warm, moist washcloth against the ear. Patients should get plenty of rest and drink lots of fluids. The telemedicine doctor will prescribe antibiotics if bacteria are causing the infection.
Preventive measures include practicing good hygiene (frequently washing hands with hot water and soap), avoiding exposure to irritants like tobacco smoke, and making sure your child’s immunizations are current.
Swimmer’s Ear, or otitis externa, occurs when water that contains bacteria enters the ear. The moist environment of the ear canal enables the bacteria to flourish, causing inflammation and infection.
The first sign of Swimmer’s Ear is minor pain, accompanied by pus-like drainage from the ear that may be yellow or green and a red, swollen ear canal. You may experience hearing loss and itchiness. As the condition worsens, the pain will increase and symptoms will become more pronounced. Eventually, you might experience complete blockage of the ear canal, swollen lymph nodes, and fever.
Seek medical care at the first sign of an infection. Severe pain or fever warrants an immediate call to your doctor or a trip to the ER.
Causes of Swimmer’s Ear
Swimmer’s Ear is usually caused by excess water entering the ear canal, hence the name. It can also occur when dirt, sand, or other debris gets trapped in the ear canal. Scratching the ear canal or cleaning it with a foreign object can also lead to infection, as can allergies, bony growths in the ear canal, bubble baths, soap, shampoo, excessive perspiration, and skin conditions such as eczema and psoriasis.
Swimmer’s Ear Treatment & Prevention
Treatment for Swimmer’s Ear involves eliminating the infection by controlling the bacteria in the ear. You will be prescribed ear drops containing antibiotics, steroids, or other antifungal medications. Over-the-counter drugs can help relieve pain.
Be sure to avoid water-related activities when treating Swimmer’s Ear. It’s a good idea to refrain from wearing earplugs or headphones, too.
In order to avoid contracting Swimmer’s Ear in the future, make sure to dry your ears thoroughly after contact with water, whether you’ve been swimming or bathing. Wear specially designed swimmer’s earplugs to prevent water from entering the ear canals, and avoid swimming when signs warning of high bacterial counts are posted.
As a preventive measure, you can mix together a solution containing equal parts of white vinegar and rubbing alcohol and place drops of this solution in your ears before and after swimming or bathing. This will dissuade bacteria and fungi from growing, and encourage drying in the ear canal.
Pediatric Hearing Loss
Some children are born with hearing loss, while others develop hearing impairment later in their development.
Early clues that babies may be hearing-impaired can include the absence of the Moro (startle) response to loud sound in the first several months of life (be aware that this response extinguishes in all babies, normal-hearing or hearing-impaired, after the third to fifth month) if there is significant hearing loss. They may also notice the cessation of cooing and babbling after the first six months for babies who are deaf (profoundly hearing-impaired).
For toddlers with hearing loss, there may be a delay of speech, few words understood or spoken, or poor pronunciation (articulation). Older children may complain of ringing in the ears (tinnitus), which often accompanies inner ear hearing loss.
None of these symptoms are conclusive indicators of hearing loss, but they should alert parents to the need for testing with an audiologist. The earlier hearing loss is found and treated, the better it is for the child and the child’s family.
Causes of Hearing Loss in Children
Two very common and easily treated causes of hearing loss in children are the presence of earwax that occludes the canal, and middle ear fluid, which may or may not be infected. Earwax can often be removed safely from a child’s ear canal by the child’s pediatrician or ENT specialist and ear infections are typically easy to treat with home remedies or antibiotics.
The causes of more complex hearing loss include birth issues such as jaundice (hyper-bilirubinemia) or the momentary loss of oxygen flow for the baby (hypoxia), family hearing loss (inherited), genetic causes, loss from a severe illness or high fever, head trauma, intense noise trauma (such as airbag deployment near the ear), and certain medications.
Some children are born with a malformation of the outer, middle, or inner ear. If these children have other affected systems of the body, the child may be diagnosed with the syndrome and he may need to be followed by more than one medical specialist. Hearing loss in a child may be an indicator of other medical needs and issues and should be attended to in partnership with the child’s physician.
Hearing Tests for Children
Parents who notice indicators of hearing loss in their child should consult with an audiologist to diagnose any hearing issues, if present. Although non-reactions to loud sounds in the home can indicate the need for a hearing evaluation, parents should understand that this does not constitute a full assessment of a child’s hearing, as softer speech may not be heard.
Newborn Hearing Tests
The first hearing screening a child receives is typically in the nursery at the hospital, ideally 24 – 48 hours after birth. A hand-held computer sends closely matched tones into the baby’s ear and reads if a set of inner ear nerve cells react to the signal.
If the baby is crying, the test cannot be performed until the baby settles. This early hearing screening test, called Otoacoustic Emissions (OAE), is designed to rule out moderate to severe hearing loss. However, the baby could still have a milder hearing loss. If the infant did not pass the hearing screening, the baby will be scheduled for follow up testing, usually a repetition of the test. It is very important to perform follow-up testing.
If the baby does not pass the second test, the child must be scheduled for Auditory Brainstem Response testing (ABR) with an audiologist. This is a lengthier test, typically about one hour if the baby stays asleep.
Because of these tests, some parents find out within one to two months of the baby’s birth if the baby is hearing impaired. They will probably not yet have any behavioral clues of a child’s hearing loss at that age.
Hearing Tests for Toddlers and Children
For toddlers and older children, a hearing test is performed in a sound-treated booth. The toddler sits on a parent’s lap facing a pair of speakers and the testing audiologist. When the audiologist’s voice or sound stimuli are presented to the child through the speakers the toddler will turn to the sound. Animated toys reinforce the response. Some toddlers will respond to commands such as, “Clap hands,” or “Where is Mommy?” This does not give ear-specific information. The results will be interpreted for you by the audiologist.
Older children can drop a block or press a button when they hear the speech stimuli or sound through insert earphones. They can point to pictures or repeat back words. Their testing and results will be much like that of an adult. The audiologist will explain the results and recommendations.
Treating Hearing Loss in Children
If a child’s hearing loss is caused by excess ear wax, it should be relatively easy to treat. Other types of hearing loss will require a more in-depth treatment plan.
Parents will need to explore ways to help their children overcome any obstacles that may be created by early hearing loss. A team approach with the parents, audiologist, Ear, Nose, and Throat physician, school counselor or social worker, speech-language pathologist, and teacher(s) helps each family decide the best educational options for the child.
Inner Ear Hearing Loss Treatment
If it is found that a child has inner ear (sensorineural) hearing loss in one or both ears, the audiologist will advise parents of their hearing and educational options.
Inner ear loss is not able to be changed by medical management. The best way to help most children with inner ear hearing loss is through the use of digital hearing aids. The earlier that amplification is fitted for children with inner ear hearing loss, the more likely they will not fall behind academically, in college, or in the workforce.
Cochlear Implants for Deafness
Children who are born deaf (meaning no usable hearing, not those with mild to severe hearing loss) may receive no benefit from hearing aids. In cases where the parents wish for the deaf child to be a member of the Deaf community, hearing aids are not a viable option. American Sign Language would be taught to children of the Deaf community.
If parents want their deaf children to have the opportunity to hear, they may opt for one or two cochlear implants. These are surgically implanted devices that send electrical signals to the auditory system, bypassing the inner ears that are not sending the signals.
One month after the surgery the child is fitted for an external processor. The family and child learn how to use the cochlear implant. The child would receive speech therapy and auditory-verbal therapy to enhance understanding of the incoming signal. Frequent reprogramming, or “mapping,” helps the child have access to more sound.
Preventing Pediatric Hearing Loss
Some causes of hearing loss in children cannot be prevented. However, all children need to be aware of the dangers of acquired hearing loss and the permanent onset of ringing in the ears (tinnitus) from loud music, sports arenas, firearms, and power tools.
Even one excessively loud concert can permanently alter hearing or bring on ringing. The damaging sound from the event may not cause pain or discomfort, so there is no way of judging that it is harming the inner ears. Earplugs and other protective devices should always be used in excessively noisy situations for both children and adults.
Even everyday, seemingly harmless activities such as using earbuds can cause damage long-term. Children should take breaks from listening to music with earbuds and parents should consider purchasing special inexpensive volume-limiting earphones to help preserve hearing in children.
Why Choose Our Audiologists
At Penn Medicine Becker ENT & Allergy, our experienced audiologists work with board-certified ENT physicians to provide quality care for patients all across New Jersey. Each one of our audiologists are highly trained in audiology, with many of our experts holding a doctorate in the specialty. They work with each patient to find solutions that work for the individual and improve their quality of life.
- Karen McQuaide, Au.D. is a specialty-trained audiologist with over 20 years of experience at academic and private audiology and balance disorder practices. She has served in leadership positions at New York University, Temple University, University of Florida, and Robert Wood Johnson University Hospital to name a few.
- Jill MacMillan, Au.D. is a highly trained licensed audiologist with approximately 20 years of experience who attended at East Carolina University, Florida State University and went on to receive her doctorate of Audiology degree at AT Still University in Mesa Arizona. She is a member of the American Speech Language and Hearing Association.
- Caren “CC” Sokolow, M.A. spent 20 years as an audiologist in the Philadelphia area practicing in physician office and academic medical center settings. She received her Bachelor of Arts degree from the University of Pittsburgh, and her Master of Arts degree in Audiology from Temple University.
Locations We Serve
At the Penn Medicine Becker ENT & Allergy, we provide state-of-the-art evaluation and treatment for patients suffering from disorders of the hearing and balance system. We seek to combine knowledge, skill, training, experience, and compassion with advanced technology. We promise to personalize your care. We offer unparalleled care at convenient offices located across New Jersey:
Pick one of our 16 convenient locations
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Hearing Aids FAQs
The outer ear is made up of the pinna (the part that sticks out from the head) and the ear canal. The air-filled middle ear starts with the tympanic membrane (eardrum) that completely seals the ear canal from the middle and inner ear structures. The three tiniest bones in the human body, the ossicles, are called the malleus (“hammer”), the incus (“anvil”), and the stapes (“stirrup”).
The job of the middle ear system is to convert the sound collected by the outer ear into mechanical energy by vibrating, sending it into the inner ear at the oval window (the base of the stapes). The middle ear also has another important structure, the Eustachian (yoo-stay-shin) tube, which serves to aerate the middle ear on the other side of the tympanic membrane. This allows our ears to have the same air pressure on both sides of the tympanic membrane.
The inner ear is itself divided into three parts, by their jobs. The cochlea is the tiny, snail shell-shaped organ that changed the vibrations from the middle ear into electrical energy to travel up to the brain. In the inner ear is a fluid related to spinal fluid and many tiny structures that hold up hair cells to transmit nerve impulses to the hearing nerve. The other two parts, the vestibule, and the semicircular canals, are the vestibular system, which monitors head movements, eye movements, and posture, contributing to our ability to stay standing. When patients are dizzy we want to rule out that there is a problem in the vestibular system.
The rest of the ear is actually made up of the nerves that lead to the auditory cortex in the brain and the auditory cortex itself. The brain attaches meaning to the sound it heard, whether it is music, words, environmental sounds, or an alarm. This is called auditory processing.
Hearing loss can have many causes, which are rooted in the anatomy and physiology of the cochlea. Hearing loss can be a result of blockage in the ear canal – ear wax, foreign bodies, and ear canal infections can all cause hearing loss.
The middle ear space – behind the eardrum—may also contribute to hearing loss. Fluid in the middle ear (“Otitis media”), holes in the eardrum, or poorly functioning ear bones are some of these middle ear causes.
In many cases, hearing loss is a result of deterioration of nerves that bring hearing signals from the ear to the brain. This “sensorineural loss” is the most common source of hearing loss in adults and may be due to occupational and recreational noise exposure, or simple aging. The rise of portable listening devices such as the iPod has also been associated with hearing loss.
Syndromic, hereditary, and congenital abnormalities may also contribute to hearing loss.
An audiologist is a person who is trained to perform specialized tests of hearing and vestibular function to determine if hearing loss or a vestibular problem is present. Audiologists determine where in the system the problem is, provide rehabilitative approaches, and make appropriate recommendations.
Their scope of practice includes hearing aid dispensing, cochlear implant team, intraoperative monitoring for ear- and nervous system-related surgeries, hearing conservation design and implementation, newborn hearing screening, aural (hearing) rehabilitation, central auditory processing disorders, tinnitus management, and teaching audiology and speech-language pathology students.
Audiology professionals work with all ages, from infancy and childhood to adults and seniors. Job settings include private practice, working with ENT physicians, hospitals, universities, mobile vans for hearing conservation, military service, government settings, and schools. Most audiologists have doctoral degrees such as an Au.D, Sc.D, or Ph.D. There are only approximately 16,000 audiologists in the United States.
It is very common for people with gradually progressive hearing loss to think that nothing is wrong and that the difficulty lies in others “mumbling” or “not speaking clearly.” We often have no clue that we are struggling to hear because the brain gradually adjusts to each slight incremental change in the hearing, tricking us into believing we are just fine. Part of the answer, too, is that hearing loss, when not total, can seem “intermittent” or situational.
Since many types of hearing loss are preventable there are seniors who have minimal or no hearing loss. Still, the majority of seniors will have some hearing loss in later years.
There is no such thing as “a normal amount of hearing loss for your age.” Many adults have gradual inner ear hearing loss during their working years; it is not limited to seniors.
Gradual hearing loss does NOT mean that a person will necessarily lose all hearing. By the same token, wearing hearing aids will not prevent further hearing loss.
Any hearing loss that is present and interferes with communication is not normal for any age and needs to be treated.
We know even a mild hearing loss or hearing loss in one ear can greatly affect a patient’s ability to communicate, in children and adults. We want to know many different things about hearing loss to guide the patient to the proper treatment.
It’s important for your audiologist to know if your hearing loss is present in one ear or both, mild or severe, middle ear or inner ear, sudden or gradual, with an illness or head trauma, and many other questions.
Does the patient also have vertigo or tinnitus? Does the patient have a family history of hearing loss? Do other family members need to get tested? Do the results show that other types of physicians should be involved in the patient’s care? Is the patient a surgical candidate or hearing aid candidate?
Studies have shown that hearing loss isolates people from their friends, loved ones, and community. This isolation can be manifested in withdrawal, depression, anxiety, and worsening of physical medical conditions. Furthermore, studies out of Johns Hopkins and the University of Pennsylvania show that untreated hearing loss can put a person at a greater risk of dementia and brain atrophy.
People with uncorrected hearing loss in the workforce also tend to earn a lower salary than their counterparts who have sought help.
Earwax (cerumen) is a common culprit of hearing difficulties in the outer ear. Many people are concerned about their ear wax and have lots of questions about why and how it accumulates—and how to prevent wax buildup. Earwax buildup may frequently occur in some individuals because of ear canal shape and some health factors.
The best way to safely clean ears is with a washcloth on the outside of the ear. The use of Q-tips may push the wax back into the canal and closer to the eardrum. In some instances, people have perforated their eardrums with Q-tip use.
The three ways that a healthcare professional can remove wax from the ears are: manually with a wax loop, by gently pressurized water, or with suction.
A wax loop is a hand tool that scoops out earwax. This is ideal if the wax is loose or soft and not adhering to the canal walls or is not too far down in the ear canal. For wax that has been in the ear canal for a while (and thus is usually dense, dark, often adhering to the canal walls), the best methods are to suction out with a mini specialized vacuum or to gently loosen it and wash it away with irrigation.
Often wax removal needs to wait after discovery to allow for softening and loosening by the patient (for more comfortable removal) with an over-the-counter product such as Debrox or equal parts hydrogen peroxide and water. This is possible after the canal has been deemed medically ready; in other words, the tympanic membrane (eardrum) has no hole in it.
Always check with your healthcare provider before using one of these products in case any change in hearing is due to eardrum perforation. People with infections and open eardrums should not use these products.
Ear candling describes the practice of placing a hollow candle in the ear canal, lighting it, and allowing the candle to burn within five to ten centimeters from the person’s ear. The manufacturer claims that it removes impurities and earwax from the patient’s ears with suction created by the candle. In fact, no suction occurs with the candles.
The residue left behind has been found to be remnants of the candle and not earwax or toxins from the body. Ear candling is not therapeutic and places the user at risk for burns of the face, ears, and eardrums. It does not remove ear wax. The manufacturer also claims that ear candling originated with the Hopi tribe, but the tribe has stated that this is not true and has asked the manufacturer to stop making that claim.
When someone has Eustachian tube dysfunction he/she may feel sensations such as ear pain, pressure, fullness, clogged ears, hearing his/her own voice in the ear very loudly, and have difficulty monitoring voice volume. Common causes are barotrauma (air travel or scuba diving) and sinus involvement.
A traditional treatment approach is for the patient to utilize nasal sprays to help to alleviate the discomfort and reduce swelling. Some patients have surgery to open the eardrum to relieve the pressure.
Many people have been treated with a newer approach that is neither invasive nor painful. It is called middle ear insufflation. It works with the body to help the Eustachian tubes open with gentle air. It can be done from age five and older, in the office or home. Most patients that have middle ear insufflation see an improvement or full relief following the treatment. Children who use the home version of this device tend to have fewer episodes of otitis media.
Hearing Aids FAQs
95 percent of all hearing losses can be successfully treated. If a hearing aid has been suggested to you, then you will probably see a significant increase in your quality of life by using one. Sadly, only one-fourth of those who could benefit from hearing instruments actually purchase one.
Some patients ignore their loss because they believe hearing instruments can’t help their specific type of loss. Others incorrectly believe they are too old to benefit from amplification. No person is ever too old to benefit from the improved communication that hearing instruments can provide.
Most people with inner ear hearing loss benefit from hearing aids, when fitted properly. Some patients may have an “unaidable” ear, in which there is too much hearing loss, the person’s ability to tolerate amplified sound is severely diminished, or there is an extremely poor understanding of speech. Even if a person was told some time ago that he “can’t be helped” or “nothing can be done,” it is important to get a new opinion because so much in amplification science has changed! We are able to help more people than ever before with new devices.
For people with aidable hearing loss in both ears, we know that the best listening happens with both ears giving the auditory cortex the same information. They will hear and understand better in quiet and in background noise; they won’t have a “useless side” in a restaurant or family gathering (the people on the unaided side get ignored); and they can better localize the direction of the sound source, which is critical in communication and for safety purposes.
We also know that a small percentage of monaurally aided patients will lose understanding of speech in the unaided ear, and we cannot predict who will experience that unfortunate situation. It is important to discuss this with the audiologist to determine the best outcome for each individual.
Custom-fit hearing aids need to go to a lab to be made, so they may take approximately two weeks to arrive at our audiology office. Aids that do not have custom-fit parts arrive quickly and the appointment for the fitting can be arranged sooner, based on the audiologist’s and patient’s availability.
Nearly all people who need hearing aids have cosmetic concerns. Others worry about what other people will think of them if it is known that they have hearing loss. Still, others are worried about the maintenance and upkeep of hearing aids. While not addressing all of these concerns, new hearing aids are a huge improvement on previous devices.
Digital hearing aids are nothing like their old analog counterparts. Older hearing aids were bigger and the sound quality was much poorer. In addition, there was relatively little adjustment for sound quality. There were few ways to avoid amplifying in areas where the wearer did not need amplification. There were no adjustments for hearing better in background noise.
Old aids used to whistle while sitting in the person’s ears, and the wearer was unable to prevent it or even hear it when it was happening. Despite these disadvantages, there were, in fact, many satisfied hearing aid wearers, even with older hearing aids. We all tended to hear about the unsatisfied patient, not the satisfied ones!
With new digital technology, we can shape the sound specifically for a person’s hearing loss, giving sound only where it is needed. This is done through a computer and a patient-worn interface at the time of the appointment, allowing the computer to send changes to the aids. We can adjust the type and method of noise management in the aids.
We can also digitally suppress feedback, the whistling that used to be common. There are even many aids which have Bluetooth capability, allowing a user to have the sound of the cell phone or television directly in the aids, for infinitely more clarity and ease of use.
Despite the amazing flexibility that the digital platform provides for hearing intervention, hearing aids still require acclimation. Remember that the hearing-impaired individual most likely gradually lost hearing over many years. Suddenly we are asking that person to listen to a lot of sounds that they have not had to process for a while. We certainly can shape it to make it comfortable but the new wearer still will hear things that have been inaudible for a very long time.
The person who patiently and consistently uses hearing aids over a period of time will be rewarded for their efforts with an ease of communication and access to a palette of music and sounds that they have been missing.
There is no dependency, as in addiction. Once the person acclimates to the new sound over a period of weeks, there is a wonderful enhancement to communication that they will notice. They will definitely notice the difference when they take the aids off for the night, but no actual permanent hearing change will happen in the head or ears. This is just the brain noticing the stark contrast between aided and unaided hearing.
Hearing aids should never hurt the wearer’s ears, either with the physical fit or by causing a greater loss of hearing. If the aids are not completely comfortable, then that needs to be communicated to the audiologist. Hearing levels should be monitored and verification of the fitting will ensure that the sound is not too intense for the person’s hearing.
Aids should be worn in almost all listening situations. They should be removed at night and placed in a dehumidifier to remove moisture from the day. If a wearer is taking a nap, it is fine to leave the aids in the ears if desired.
Hearing aids should not be worn in excessively noisy situations, when listening to music, or where water is involved (shower, hot tub, swimming, etc). Ears with hearing loss need to be protected from intense noise such as loud music, power tool use, and impact noise such as firearms of any type. Aids should not be worn to bed. If a hearing-impaired person fears not hearing alarm clocks or a fire alarm, there are special alerting devices. The audiologist can suggest the best options.
You may wear hearing aids through the security checkpoint at this time. Of course, you may be asked to remove them by the TSA agent, or regulations could change in the future which require air passengers to remove the hearing aids from their ears.
Almost all hearing aids are vented in some way in the ear canal to keep ears comfortable during the pressure changes that occur during the flight, so it is not necessary to remove hearing aids for flying if you do not wish to do so.
If you are someone who finds that the pressure changes in the cabin are bothersome to your ears, you may wish to try a pair of Ear Planes, which are available at drugstores and pharmacy areas of larger stores. These are designed to slowly change the air pressure in the wearer’s ear canals to help reduce the discomfort some people feel in their ears when flying. If you are using Ear Planes, you cannot wear hearing aids at the same time. Be certain to bring your case with you to store the aids to avoid having to roll up the aids in a tissue, an easy way to break, unintentionally launder or lose the devices.
All hearing aids use batteries, but there are different sizes. It is important to purchase the correct battery size for your aids. Just like a cell phone or watch, the wrong size will not allow the hearing aids to operate. The audiologist will tell you the correct size and may offer suggestions about where to buy batteries.
A few hearing aid manufacturers have begun offering models that use rechargeable batteries, but most of these cannot yet power the instruments for the wearer’s full day. This technology may be utilized by more hearing aid models in the future but is not yet widely available.
Battery manufacturers have begun offering mercury-free batteries and these have just started to be available in many areas. Although the manufacturers say that batteries can be thrown out in the trash, recycling is environmentally-friendly and easy to do. Many audiologists will collect spent batteries to recycle for you if you are a patient at their facility.
Batteries, no matter what chemicals comprise them, are dangerous if swallowed. Never keep batteries where a child or pet can get to them. They should never be handled near medications. Hearing aid batteries are small and pill-shaped. They should not be placed on any horizontal surface (like a counter or bureau top) other than in the case itself so that they will not be accidentally ingested with food or pills. If a pet or person is thought to have swallowed a battery, immediate emergency medical services are needed. Do NOT attempt to make the pet or person vomit to retrieve the battery. Again, emergency medical services are needed immediately to properly and safely remove the battery from the person or pet.
Batteries should not be kept in the refrigerator or a hot car. They should be stored at room temperature away from children and pets.
Each year, many hearing aids are brought back to the audiologist, damaged by a pet who chewed it. No matter how carefully the aids are cleaned, the scent of earwax will not be removed. It is the perfect size and scent for a pet appetizer. This, of course, is dangerous for both the pet and the device!
Most hearing aids have a loss and damage policy for the first year or two, but these policies always charge a deductible. If the loss and damage policy has been used, the wearer may wish to purchase new loss and damage insurance on that aid. The pet does not have loss and damage insurance on it, so for all concerned, please keep hearing aids and batteries away from pets.
Hearing aids should be wiped with a clean, lint-free cloth after each day’s use. The battery doors should be opened to prevent battery drain during the night. Moisture and wax are two common enemies of hearing aids. Wax traps at the end of the earmold or aid keep wax out of the electronics. If wax has collected in the wax trap, it is easy to change.
A wonderful place to store the hearing aids at night is a hearing aid dehumidifier. It removes the moisture that might have developed in the aids during the day. This device is good to use in any weather, not just humid days since the wearer’s body transfers moisture to the devices in the cold or heat.
Hearing aids can go anywhere a person can go, with the exception of water and noise. Never store hearing aids in extreme heat or extreme cold. It is best not to wear aids in very dusty or dirty environments.
We are always told that we should not take valuables to a hospital. There is no one who can monitor their whereabouts. The difficulty with this thinking is that patients need to communicate in the hospital with the staff, nurses, and physicians. Without their hearing aids, this can be a very difficult to impossible proposition.
If a family member is able to bring the aids each day and remember to take them home again, that is ideal. If that option is not available, ask if the hospital can loan a personal listener to the patient. Many hospitals have a loan program for these devices, which look like a Walkman with over-the-ear earphones for listening. These can be used to better hear the TV (and keep the volume down) as well as understanding essential communication with the healthcare professionals. They can be removed when the patient is resting or sleeping. These devices are returned at the end of the patient’s stay.
In long-term rehabilitation, it is more common for a patient to wear his or her hearing aids to this type of facility. For example, a container labeled with the patient’s name may be kept on the medicine cart and given to the patient each morning, returned to the cart at night with the aids inside.
Each facility has different policies; it is essential to discuss the hearing aid policy with the facility’s patient care coordinator. Specifically ask where the devices will be stored, who will handle them, who has access, and how a loss or damage claim would be handled if such a need arose.
Hearing aids can be paired with many devices to enhance the listening experience. These include Bluetooth devices that interface with cell phones, television, MP3 players, computers, etc., sending the sound directly into the wearer’s hearing aids. The listener hears as if the voices were speaking right in their ears, like wearing earphones, significantly increasing the signal to noise ratio and boosting intelligibility.
The listener can walk away from the device, in some cases up to thirty feet, and still be connected to the sound streaming from that device. The listener can choose to listen alternately to the streaming device and activating the microphones to hear someone speaking to them in the room. Phone calls are heard in both ears if desired.
People can also use a mini microphone that streams to the aids, again enhancing intelligibility by decreasing the distance and increasing the signal to noise ratio. If the mini microphone is placed on a lectern or meeting table or clipped to the person who is speaking, the listener can sit almost anywhere in the room, up to approximately thirty feet away, and hear very clearly what the speaker is saying. This mini mic may also be extremely useful in a car or in a noisy restaurant.
Alerting devices are important for helping people who have difficulty hearing alarm clocks, smoke detectors, doorbells, infant monitors, etc. The electronics are remade for hearing impaired people with different types of signals, or they can be wired to a central device that alerts the individual with flashing strobe light or vibration. For people who have difficulty hearing on the telephone, there are amplified phones or phones that send a signal directly into the hearing aids through a special program.
People who have conditions such as dementia and Alzheimer’s may have trouble using hearing aids independently. Many seniors with disabilities may have limited access to help and may not feel able to manage hearing aids. Even if help is available, hearing aids are small, need some care, and require consistent placement after removal to avoid damaging and losing them. The audiologist can suggest alternative devices, such as simple amplifiers with insert or over-the-ear headsets.
Hearing aids can be donated to various organizations that are able to remake the devices for underserved communities in the United States or abroad. Your audiologist can supply you with a list of organizations accepting donations.
Approximately 30 million people in the United States suffer from tinnitus. About 10 percent of the population will report experiencing tinnitus all of the time, and approximately 1 percent state that it affects their quality of life. 44 percent of people with tinnitus have minimal hearing loss or have thresholds in the normal range of hearing sensitivity. 1 in 4 people state that their tinnitus is loud, while 1 in 5 describes the tinnitus as disabling.
One way to reduce the possibility of getting tinnitus is to keep a distance from noise or wear appropriate hearing protection. It is essential to wear hearing protection during all noisy activities such as when using heavy equipment and power tools, riding a motorcycle, or using a snowblower or leaf blower.
It is difficult for music lovers to know if their earbuds or speakers are playing at a dangerous level that may cause permanent inner ear hearing loss and tinnitus. In general, if others can hear the music of the earphone wearer, it is too loud. If you cannot carry on a conversation over the music through earphones or speakers, the volume could be potentially damaging.
Musicians and music lovers should wear musician plugs during practice, rehearsals, and concerts. The type of music does not change the risk of music-induced hearing loss. Musician plugs evenly attenuate the intensity level of all music and lyrics, keeping the ears safer while maintaining the wearer’s listening ability.
Hunters can wear specialized hearing protection for use while hunting. Concert-goers and musicians, as well as hunters, must wear hearing protection at every exposure to effectively prevent hearing loss and subsequent tinnitus.
The relationship between hearing loss and tinnitus can be a bit confusing. Someone with a severe hearing loss will not necessarily have severe tinnitus, or tinnitus at all. Many people with tinnitus have hearing sensitivity in the normal range.
Many people with hearing loss will report having no tinnitus, although the presence of hearing loss is correlated with tinnitus for 90% of those with tinnitus. In patients who have tinnitus and hearing loss, tinnitus often improves or resolves when the hearing loss is treated.
Pediatric Hearing Loss FAQs
Some parents may feel that a wait-and-see approach is best, or they may be advised to see if the baby develops speech on his own. Particularly with boys with delayed speech milestones, parents may be advised that boys are slower than girls and that they may safely wait before considering testing. This is not helpful advice. In reality, it is better to err on the side of caution and test a child as soon as hearing loss is suspected. No harm will come to a child if normal hearing is found but many difficulties can arise from the delay of diagnosing hearing loss in a child.
Children with hearing loss are capable young people who, with early and continuing guidance and assistance from their families, schools, and the medical community, can achieve and succeed at whatever they choose!
Children with hearing loss may be completely self-sufficient in the classroom or they may need assistance to achieve the best education. Hearing-impaired children should receive guidance from the Child-Study Team in the school with an IDEA or 504 Plan to guide professionals in creating a useful IEP (Individualized Education Plan).
A teacher may need to pre-teach concepts to the hearing-impaired child or follow up with each set of directions to make certain that the child understands them before moving on. The child may or may not require a teacher’s aide in the classroom. The classroom size may need to be modified. All classrooms for the hearing-impaired should have sound-absorptive material and should not be near noisy areas of the school.
In the classroom, children with hearing aids should sit close to the teacher for best hearing and visual cues. An FM system, which communicates between the hearing aids and a body-worn microphone on the teacher, provides improved signal to noise ratio for the best understanding of the teacher.
Optional accessories for hearing aids allow hearing-impaired children to use their hearing aids as their Bluetooth headset for cell, iPod, iPad, computer, etc. A miniature remote microphone is available for placing in front of or plugging directly into a TV for clear transmission.
Parents and teachers are essential for tracking their hearing-impaired student’s progress via questionnaires and continued discussion with the support team. Help from an audiologist is needed for providing the best amplification solution for the child’s listening environments and hearing needs. This includes real-ear verification measurements to help determine the best settings of the aids for that child.
Children with auditory processing disorders may have normal hearing on the hearing assessment, but they have difficulty making sense of speech at times, especially in difficult situations such as in background noise or if multiple commands are given simultaneously. Children with APD can learn to listen and understand better with appropriate auditory therapy with an audiologist or speech-language pathologist. They may benefit from hearing aids set very low or with an FM system to improve the signal to noise ratio in class.
Many children have one or more bouts of middle ear fluid, or otitis media, beginning at any age in childhood, including infancy. Some families will have a propensity for it, with one or both parents having had otitis media as a child. Other families will have just one child with frequent bouts of middle ear fluid. The fluid typically builds up in the middle ear space, behind the eardrum, after an upper respiratory infection and may or may not be painful. The child is not deaf during this period but may have hearing loss ranging from mild to moderate-severe. These children need to be seen by their physician and possibly by an ENT specialist for management of the fluid. Hearing should be tested before and after middle ear fluid management. Periodic checks with a simple eardrum test, called tympanometry, can be performed by an audiologist to monitor for the presence of middle ear fluid. Medical management of the fluid may be accomplished by a period of watchful waiting with the ENT physician, antibiotic administration if necessary, and/or removal of the fluid through the eardrum (myringotomy and pressure equalization tubes).
During the time that a child has middle ear fluid, his/her ability to hear and understand language is diminished to some degree. This can affect speech production or language learning. Children may not pay attention to parents or teachers. They may turn up the TV very loudly, or their own voice may be louder or quieter than usual. Children may have changes in behavior such as frequent crying, temper tantrums, or being quiet and withdrawn. Once the fluid has resolved the child’s hearing may return to normal, but testing should be used to determine this. For children with recurrent otitis media, hearing loss may develop permanently. Some of these children are candidates for hearing aids.
For children with hearing loss in one ear and not the other, or if they have a mild loss, that does not mean that there is no need to amplify or provide help in the classroom. These children are at greater risk than their normal-hearing peers for academic difficulty and grade retention because it is widely assumed that they will have fewer difficulties than children with greater hearing loss.
They may not be recommended for hearing aids or academic support services, when in fact, they are very much in need of these services. Even a mild loss or unilateral hearing loss causes auditory deprivation to a brain that is still learning how to process language and sound and can have long-term consequences if not treated.
Hearing aids can be expensive, but help is available. Health insurance companies may give a benefit, including Grace’s Law which in New Jersey requires insurance companies to provide $1000 per hearing-impaired ear to hearing aid purchases for children age 15 and younger. Some manufacturers of hearing aids have loaner banks to provide hearing aids for children for several months before parents decide to purchase. Help and guidance with these decisions can be made with the audiologist.
If you live in the states of New Jersey or Pennsylvania, Penn Medicine Becker ENT & Allergy Center offers hearing healthcare among its services. For a full list of services, please visit our Locations page.