What is an Audiologist?

Audiologists have extensive education and specialized training in prevention, assessment, and treatment of non-medical hearing disorders. They are the most qualified professionals to:

  • Conduct specialized hearing assessments for infants, children, and adults
  • Refer patients for hearing medical treatment
  • Perform balance evaluations
  • Recommend hearing aids, assistive listening devices, and personal alerting devices
  • Make custom ear molds and protection
  • Provide hearing rehabilitation for patients and loved ones
  • Educate patients on prevention of hearing loss

How the Ear Works

The ear is divided into three major parts:  the outer ear, the middle ear and the inner ear.

The outer ear works like a sound funnel to capture sound and channel it down the ear canal.  At the end of the ear canal the sound strikes the eardrum and causes it to vibrate like the head of a drum.

The eardrum is attached to the first of three bones (ossicles) in the middle ear.  The sound vibrations of the eardrum are passed to this chain of bones known as the malleus (hammer), incus (anvil) and stapes (stirrup).  The footplate of the stapes (stirrup) rests in the oval window which leads into the hearing portion of the inner ear, the cochlea.  The cochlea is shaped like a snail shell and is filled with fluid. The movement of the footplate of the stapes sets the fluid of the cochlea in motion, which in turn creates movement in tiny haircells located along the entire length of the cochlea.  This haircell movement is then converted into neural impulses that travel from the haircells up the auditory nerve to the brain where they are perceived as sound.

Hearing Loss in Children/NB Screening

Newborn screening allows children with hearing loss to be identified as early as possible. Early identification and intervention can help a child with hearing impairment to develop speech and language alongside their hearing peers.

There are two tests used for newborn screening: Otoacoustic Emissions (OAEs) and Auditory Brainstem Response (ABR). Both are safe and reliable. For OAEs, a small probe is placed into the ear. Sounds are played and a response is measured. An “echo” is reflected back into the ear canal and measured by the microphone. OAEs will be present or absent. For the ABR, sounds are presented into the ear and recorded using electrodes. This test measures how the hearing nerve responds to sounds and can identify degrees of hearing loss.

If a hearing loss is identified, the audiologist, ENT physician, pediatrician and an early intervention program will work together to help your child with their hearing needs. After medical evaluation, the child will be fit with hearing aids. The audiologist will monitor the progress with regular visits. Parents also need to watch for progress and encourage the use of the hearing aids. Research has found that the one common denominator among successful hearing-impaired children is the parent’s willingness to help the child throughout their lifetime.

Hearing Screening vs. Diagnostic Testing

A hearing screening is a quick test which gives the audiologist basic information about your hearing. A screening generally gives a pass/fail score. A passing score indicates hearing is within normal limits. A failing score indicates hearing is outside of the normal range. While a screening will determine whether or not you have hearing loss, it will not provide detailed information (such as the degree of hearing loss).

Common methods of hearing screening include:

  1. Pure tone screening: The audiologist presents beeps across a few pitches at a volume within the normal range of hearing. If you hear the beeps, a passing score is given. If you do not hear the beeps, a failing score is given.
  2. Otoacoustic Emissions (OAEs): The OAE test is performed on an individual who is resting quietly or in a sleep state. A small tip is placed in the patient’s ear. A tone is presented through the tip to stimulate the auditory system. Once the sound reaches the inner ear, hair cells become stimulated and reflect a sound back out of the ear. This response is then recorded onto a computer and analyzed by an audiologist.

A diagnostic evaluation gives the audiologist a wide range of information about your hearing. Results from a diagnostic evaluation allow the audiologist to determine not only if you have hearing loss, but to what degree and at which pitches or frequencies. Common tests performed during a full diagnostic hearing evaluation include:

  1. Otoscopy: The audiologist looks into your ear canal.
  2. Tympanometry: A pressure test which gives information about eardrum movement.
  3. Pure tone audiometry: The audiologist presents beeps across a wide range of pitches; the lowest volume that you can hear the beeps is found at each pitch (commonly referred to as threshold).
  4. Speech testing
  • Speech Reception Threshold: The lowest volume where you can correctly repeat words.
  • Word Discrimination: How many words you can correctly repeat at a comfortable volume.

Noise and Hearing Loss

Noise Induced Hearing Loss (NIHL) is a preventable type of inner ear hearing loss and can affect people of all ages and backgrounds.  NIHL occurs when very loud sounds are transmitted through the auditory system, causing damage to the sensitive inner ear hair cells.   These loud sounds may come from occupational, or work-related, noise exposure, or they may come from recreational noise exposure.  NIHL can gradually worsen over time, or it can be a result of a single traumatic noise exposure.

The Occupational Safety and Health Administration (OSHA) requires that workers exposed to excessive noise levels be enrolled in a hearing conservation program, which includes monitoring of hearing levels as well as the use of hearing protective devices (HPDs).  Recreational noise also can cause NIHL.  Shooting, power tools, motorsports, loud music through earphones or earbuds, and many other recreational sounds may result in NIHL.  If a sound is loud enough that you feel you need to speak up to be heard over it, the sound is loud enough to potentially damage your hearing.

The good news is that NIHL is preventable.  When possible, reduce your exposure to excessive noise levels by reducing the volume of toys and personal music players, and by reducing the amount of time you are exposed to noise.  When volume reduction is not possible or practical, make use of HPDs, which come in a variety of styles to best meet your needs.  Existing hearing loss is NOT protective against noise damage.  Even people with existing hearing loss can further damage their hearing with noise exposure.

Hearing Protection

There are many different types of hearing protection available, in both non-custom and customized options.  Over the ear earmuffs and foam insert plugs are common non-custom hearing protectors.  The Noise Reduction Rating (NRR) for each type of hearing protection will be expressed on the packaging.  The higher the NRR, the more noise reduction that type of protective device will afford when worn correctly.   Custom hearing protection is available through your audiologist.  The main benefit to customized hearing protection is that with a custom fit, the potential for improper use is practically eliminated.  Custom hearing protection can truly be customized, not only to the individual fit of each ear, but to the noise applications in which the earplugs may be used.  Solid earplugs, filtered earplugs, and electronic shooters protection are all types of custom plugs available.  Ask your audiologist which type of custom protection may be right for you.


As many as 50 million people experience tinnitus, or head/ear noises; only about 10 million seek help with diagnosis and possible treatment. Tinnitus may be intermittent or continuous in one or both ears and may often be described as “ringing,” “roaring,” “hissing,”  “clicking,” etc. In most cases, it is certainly a real occurrence but is termed “subjective,” only heard by the individual.  Tinnitus may or may not be associated with hearing loss.

The exact physical mechanisms behind tinnitus are unknown and are, most likely, numerous. Potential causes include conditions of the outer, middle, and inner ear; effects of some medications; trauma to the head or neck, cervical neck problems, and jaw joint misalignment; and systemic medical conditions. Some people experience tinnitus for which no exact cause can ultimately be determined.

Because of this complexity, careful assessment by the otolaryngologist/audiologist  team is needed to ensure that the medical history is explored in detail, that all necessary diagnostic measures are completed, that treatment options are explored, and that counseling strategies are provided to both minimize the tinnitus and to explore the associated stress that may arise.

Do I need a Hearing Aid?

This is a question commonly asked by many first time hearing aid wearers. If you are considering whether you need hearing aids, the first step is to schedule an appointment for a hearing evaluation with an audiologist (a hearing health care professional). Once the hearing evaluation is complete, your audiologist can determine if you have hearing loss and will recommend hearing aids if appropriate.

Warning signs of hearing loss include:

  1. Everyone sounds like they are mumbling.
  2. You can hear, but not understand speech.
  3. Frequently asking others to repeat what they have said.
  4. Difficulty understanding others when in a group of people or in noisy environments, such as restaurants.
  5. Social situations are no longer of interest, as you feel you are unable to participate in or follow conversations.
  6. You prefer the television volume set louder than others watching with you.

Hearing loss may not be recognized because it often occurs gradually. Individuals with hearing loss do not necessarily know what is being missed. Family members and friends may be the first to point out hearing problems. High-pitched hearing loss is common and leads to difficulty hearing speech clearly.

Hearing Aid Styles

Most hearing aid manufacturers only manufacture digital hearing aids, which allow better sound quality and improved clarity.  Digital hearing aids can be finely tuned to any degree of hearing loss and can help to reduce surrounding background noise for better speech understanding in demanding listening environments.

Do I need one or two hearing aids?

The recommendation for two hearing aids is not made to all patients.  Some people may have normal hearing in one ear or have one ear that may not be able to be helped by a hearing aid.  Your audiologist will help determine whether one or two aids are most appropriate.  If both ears need amplification, your audiologist will recommend two aids.  Two aids provide superior benefit for most people.  They provide better speech understanding in background noise, better sound localization and better quality of sound.

Hearing Aid Options

Directional microphones:  these microphones are designed to help detect sound from all directions and help reduce background and other surrounding extraneous noises.  Directional microphones are not available on completely-in-the-canal or extended wear hearing aids but come standard in all other styles.

Telephone options:  a telecoil, which is the most common telephone option, is designed to detect the signal from your telephone without also detecting surrounding noise.  This feature is only available in larger custom hearing aids as well as most behind-the-ear hearing aids.

Bluetooth compatibility: many newer hearing aids can detect and receive sound from Bluetooth devices, such as cell phones, televisions, mp3 players and other audio devices.  This feature requires the use of an interface that detects the signal from a Bluetooth device and transmits it directly to the hearing aid(s).  The use of this feature allows the user to be hands-free, without requiring use of an additional headset or receiver.  This feature is only available in larger custom hearing aids as well as most behind-the-ear hearing aids.

Hearing aids are available in different style options.  Selecting a style that is right for you depend on several factors:

  • The degree of hearing loss
  • The configuration of hearing loss
  • The size and shape of the ear and ear canal
  • Patient preferences
  • Patient lifestyle
  • Desired hearing aid options
  • Patient dexterity

Your audiologist will discuss the options with you and decide which is best for your hearing loss and personal needs.

Each style has its advantages and limitations.  The options are as follows:

Behind-the-ear (BTE)

Behind-the-ear (BTE) aids are the most versatile aids due to their size.  The electronics are housed in a casing behind the top of the ear and are held into the ear by a custom made ear piece.  BTE aids can be worn by a wide variety of people, those with mild to profound hearing losses.

  • Best durability as the components are placed outside of the ear
  • Larger batteries (longer battery life)
  • Water resistance available
  • Telephone and Bluetooth compatibility

Open fit behind-the-ear (BTE)

Open fit behind-the-ear aids are less visible than the standard BTE style aid.  Their electronics are also housed in a casing that sits behind the top of the ear but are held into the ear by thin tubing with a soft tip.  These aids keep the ear canal open and avoid the occlusion or “plugged up” feeling that users sometimes notice.  These are appropriate for users with normal to near normal hearing in the low frequency range.

  • Mild to severe high frequency hearing loss
  • Best durability
  • Cosmetically appealing
  • Can have larger batteries
  • Water resistance available
  • Telephone and Bluetooth compatibility

Receiver-in-canal (RIC)

Receiver-in-canal aids are a BTE style aid with most of the electronics housed in a casing behind the ear.  They are attached to and held into the ear by a receiver (loudspeaker) and thin tubing.

  • Mild to severe hearing loss
  • Cosmetically appealing
  • Can have larger batteries
  • Water resistance available
  • Telephone and Bluetooth compatibility

In-the-ear (ITE)

In-the-ear hearing aids are the largest custom aid available.  It fills most of the bowl-shaped part of the ear.  All of the electronics are housed in a plastic shell.

  • Mild to severe hearing losses
  • Larger batteries
  • Great for those with poor dexterity
  • Telephone and wireless capability available

In-the-canal (ITC)

In-the-canal hearing aids are smaller custom aids.  They fit into the ear canal and fill part of the bowl-shaped part of the ear.

  • Mild to moderate hearing losses
  • Smaller batteries (shorter battery life)
  • Good dexterity required
  • No telephone and Bluetooth compatibility available

Completely-in-the-canal (CIC)

Completely-in-the-canal aids are the smallest custom aids that fit into the ear canal.  Due to their small size, they are appropriate for mild to moderate hearing losses.

  • Less visible than ITC aids
  • Cosmetically appealing
  • Smaller batteries
  • Good dexterity required
  • No directional microphones
  • No telephone and Bluetooth compatibility available

Extended wear

Extended wear hearing aids are non-custom aids that are placed in the ear canal by an audiologist and can be worn 24/7 for up to 4 months.  Due to their size and deep insertion, these aids can only be worn by a small number of patients.

  • Mild to severe hearing loss
  • Completely invisible
  • No battery replacement required
  • Analog technology
  • No directional microphones
  • No telephone and Bluetooth compatibility available