Frequently Asked Questions

• What is an audiologist?
• What types of tests and treatments do audiologists perform?
• How do I know I have hearing loss?
• What causes hearing loss?
• How is hearing loss diagnosed?
• What are the different degrees of hearing loss?
• What are the different types of hearing loss?
• What are the signs of hearing loss in children?
• What style of hearing aid do I need?
• What are assistive listening devices (ALDs)?
• What is tinnitus?
• What causes tinnitus?
• How is tinnitus treated?
• What is the difference between an audiologist and a hearing instrument specialist (HIS)?

What is an audiologist?

Audiologists are the primary healthcare professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in individuals of all ages from infants and teens to adults and the elderly. Additionally, audiologists assist in hearing conservation (prevention of hearing loss) by monitoring hazardous sound levels and providing custom-fitted hearing protective devices (HPDs) for those at risk of developing noise-induced hearing loss. Audiologists often specialize in certain areas of hearing healthcare, including hearing aid dispensing, cochlear implants, vestibular assessment, or pediatrics. Currently, audiologists are required to obtain a doctoral degree and must be licensed by the state in which they practice.

In addition to their education and state licensure, an audiologist may be awarded the Certificate of Clinical Competence in Audiology by the American Speech-Language-Hearing Association (ASHA), otherwise known as the CCC-A. With additional training and expertise, the audiologist may receive the Honor of Fellow, which is awarded by the American Academy of Audiology (AAA).

What types of tests and treatments do audiologists perform?

Common services and treatments provided by an audiologist include:

• Diagnostic hearing tests
• Audiologic evaluations
• Hearing aid fittings and consultations
• Hearing aid repairs and maintenance
• Aural rehabilitation
• Pediatric hearing loss detection and treatment
• Hearing loss prevention and protection programs
• Earmold and earplug fitting and consultation
• Custom musicians earplugs and monitors
• Tinnitus treatment programs
• Dizziness and balance testing and treatment
• Hearing rehabilitation and auditory training
• Cochlear implant candidacy evaluations and implant programming

How do I know if I have hearing loss?

If you’re concerned you or a loved one may be experiencing hearing loss, you are not alone. Because hearing loss can come on gradually, it’s often the people around you who notice your hearing problems before you do. Typically, it takes people an average of seven years to seek treatment. If you exhibit the following symptoms, consider visiting an audiologist:

• You hear mumbling when people are speaking to you
• You have to ask people to repeat what they said
• You laugh at jokes even though you may not have heard the details
• You frequently complain that people mumble
• You need to ask others about the details of a meeting you just attended
• You play the TV or radio louder than your friends, spouse or relatives
• You cannot hear the doorbell or the telephone
• You find that looking at people when they speak to you makes it easier to understand
• You miss environmental sounds, such as birds chirping or leaves blowing
• You find yourself avoiding certain restaurants because they are too noisy
• You hear a ringing sound in your ears, especially when it is quiet.

What causes hearing loss?

Hearing loss can be due to several factors such as the aging process, exposure to loud noise, medications, infections, head or ear trauma, congenital (birth) or genetic factors, diseases, as well as a number of other causes. It is estimated that nearly 20 percent of adults in the United States (48 million) report some degree of hearing loss. Hearing loss often occurs gradually throughout a lifetime.

How is hearing loss diagnosed?

If you exhibit symptoms of hearing loss, you should see an audiologist to have a formal hearing evaluation. This hearing test, or audiologic evaluation, is diagnostic and allows the audiologist to determine the type and degree of your hearing loss. There will also be a hearing test that evaluates your sensitivity, acuity and accuracy to speech understanding. Your audiologist may also test for speech understanding at different volume levels and conditions – like noise – to help the professional recommend the best hearing aids for your particular needs.

The hearing evaluation will also include a thorough case history and a visual inspection of the ear canal and eardrum. Additional tests of middle ear function may also be performed depending on your symptoms. The results of the evaluation can be useful to a physician, if the audiologist believes your hearing loss may benefit from medical intervention.

Results of the hearing evaluation are plotted on a graph called an audiogram. The audiogram provides a visual view of your hearing test results across various pitches or frequencies, especially the ones necessary for understanding speech. The audiogram and results from your speech understanding tests are used to create a prescription by which hearing aids are programmed, if necessary.

What are the different degrees of hearing loss?

The results of your hearing test are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. The top of the graph is very quiet and the bottom of the graph is very loud. Frequency, or pitch, from low to high, is plotted from left to right. Hearing level (HL) is measured in decibels (dB) and is described in general categories. The general hearing loss categories used by most hearing professionals are as follows:

• Normal hearing (0-25 dB HL)
• Mild hearing loss (26-40 dB HL)
• Moderate hearing loss (41-55 dB HL)
• Moderately-Severe hearing loss (56-70 dB HL)
• Severe hearing loss (71-90 dB HL)
• Profound hearing loss (greater than 91 dB HL)

What are the different types of hearing loss?

There are three main types of hearing loss and each can be caused by different factors and require different hearing aid technology and features to have the best listening experience. The three types of hearing loss include:

1. Sensorineural hearing loss: When the problem is in the inner ear or a problem with the auditory nerve, a sensorineural hearing loss is the result. This commonly occurs from damage to the small hair cells, or nerve fibers, in the auditory system. Sensorineural hearing loss is the most common type of hearing loss in adults and accounts for more than 90 percent of hearing loss in all hearing aid wearers. The most common causes of sensorineural hearing loss are age-related processes and noise exposure. Sensorineural hearing loss is best treated with medical-grade hearing aids, which can dramatically improve speech understanding and quality of life.
2. Conductive hearing loss: When there is a problem in the external or middle ear, a conductive hearing loss occurs. Conductive hearing loss develops when sound is not conducted efficiently through the ear canal, eardrum or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstruction of the ear canal, perforation (hole) in the eardrum membrane or disease of any of the three middle ear bones. Individuals with conductive hearing loss can benefit from hearing aids, medical implants, medication or surgical options.
3. Mixed hearing loss: When there are problems in the middle and inner ear, a mixed hearing impairment is the result. Because mixed hearing loss involves both sensorineural and conductive hearing loss, treatment options from hearing aids to surgery depends on the nature of the impairment and the symptoms experienced.

What are the signs of hearing loss in children?

Hearing loss in children can occur at any time in life from acquired factors such as ear infections, head trauma, certain medications and genetic factors. You may suspect your child has a hearing loss if you observe any of the following:

• Failed newborn hearing screening
• Delays in speech and language acquisition, including baby babbling
• Frequent ear infections
• Not startled by loud sounds
• Not turning to the location of sounds after six months of age
• Difficulty following verbal directions
• Daydreaming in many situations
• Concerns by school teachers or failed school hearing screening
• Loud volume on the TV or radio
• Complaints from the child that they cannot hear

A pediatric audiologist is trained to test children of all ages. Any symptom of hearing loss in children should be addressed promptly so that speech, language and academic development are not delayed or negatively impacted.

What style of hearing aid do I need?

There are many types of hearing aids today and the style or device depends on your lifestyle, budget and hearing loss needs. There are in-the-ear styles as well as behind-the-ear styles. In addition to selecting the right style of device, it’s also important to consider what features would be most beneficial to you. From directional microphones to waterproof options, there are numerous varieties to meet everyone’s personal needs. Today’s hearing aids are even equipped with Bluetooth connectivity to work with wireless technology like a cell phone or television.

Hearing aids are available in many different sizes and styles, thanks to advancements in digital technology and miniaturization of the internal components. Many of today’s hearing aids are considered sleek, compact and innovative – offering solutions to a wide range of hearing aid users. When selecting a style of hearing aid, the following should be considered:

• The type/degree of the hearing loss
• Power requirements
• Manual dexterity and visual abilities
• Budget
• Cosmetics and aesthetics
• Anatomical and medical considerations
• Lifestyle requirements

What are assistive listening devices (ALDs)?

People with all types and degrees of hearing loss can benefit from an assistive listening device (ALD). Since the microphone of a typical hearing aid is worn on or behind your ear, its ability to enhance the talker-to-background-noise ratio can be limited. However, ALDs are designed to increase the loudness of a desired sound, such as a radio, television or a public speaker, without increasing the background noise. This is because the microphone of the assistive listening device is placed close to the talker or device being used, while the microphone of the hearing aid is always close to the listener.

ALDs include alarm clocks, TV listening systems, telephone amplifying devices and auditorium-type assistive listening systems. Many newer devices are small, wireless and compatible with a person’s digital hearing aids. Alarms and other home ALDs may be small devices that are placed discreetly on tables, next to the TV or on the wall.

What is tinnitus?

Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, buzzing or clicking. Tinnitus is not actually a disease, but a symptom of another underlying condition of the ear, auditory nerve or other influencing factor. Tinnitus can be intermittent or constant, with single or multiple tones. The perceived volume can range from very soft to extremely loud and may be recurrent or constant.

What causes tinnitus?

The exact cause of tinnitus is not known in every case. However, there are several likely factors that may worsen tinnitus. These include:

• Noise-induced hearing loss
• Wax build-up in the ear canal
• Certain medications
• Ear or sinus infections
• Age-related hearing loss
• Ear diseases and disorders
• Jaw misalignment
• Cardiovascular disease
• Certain types of tumors
• Thyroid disorders
• Head and neck trauma

How is tinnitus treated?

Depending on the severity and underlying condition causing the tinnitus, there are several treatments available to improve the perception of unwanted noise. The most common treatments for tinnitus include:

• Hearing aids with tinnitus-masking features
• Tinnitus retraining therapy
• Sound therapy
• Avoidance measures
• Avoidance of certain medications
• Behavioral therapy

What is the difference between an audiologist and a hearing instrument specialist (HIS)?

There are a number of different hearing healthcare professionals available, but each has different education and training requirements. An audiologist and a hearing instrument specialist (HIS) are two of the most common professionals when seeking treatment for hearing loss. To better understand which professional is best for you, it’s important to distinguish the differences between the two.

Audiologist: An audiologist is trained to diagnose, treat and monitor disorders of the hearing and balance system. They are trained in anatomy and physiology, amplification devices, cochlear implants, electrophysiology, acoustics, psychophysics and auditory rehabilitation. Doctors of Audiology complete, at a minimum, an undergraduate and doctoral level degree in audiology, as well as a supervised externship prior to state licensure and national certification. This usually requires eight years of post-secondary education (four years of college and four years of graduate school). The graduate school years focus on the medical, diagnostic and rehabilitative aspects of hearing loss, hearing aids and the vestibular system. Upon completion of training, audiologists must also pass a national standardized examination in order to be eligible for state licensure. Continuing education requirements must be met in order for an audiologist to maintain state licensure. For individuals with hearing loss, auditory issues or balance problems, an audiologist is the most qualified professional to assist with diagnosis and treatment.

Hearing instrument specialist (HIS): A hearing instrument specialist is licensed to perform audiometric testing to sell and fit hearing aids. In order to obtain a license, a HIS generally has to take a certification program in hearing aids, complete in-the-field training hours and pass an exam. Hearing instrument specialists are able to fit and repair hearing aids, however, they cannot diagnose a hearing loss.