As is the case in most areas of medicine, there have been remarkable advancements in the treatment of various ear and hearing loss disorders over the last two decades. Because of this rapidly evolving change, the subspecialty of otology/neurotology evolved. Otologists are sub-specialists of the field of Ear, Nose and Throat who deal specifically with various ear, hearing, balance and facial nerve disorders. We are board certified in otolaryngology or Ear, Nose and Throat with additional subspecialty training. My practice of Otology-Neurotology is the only private practice dedicated solely to the medical and surgical treatment of ear and balance disorders.

It is important to realize that hearing loss is extremely common and not necessarily related just to "old age". There are three types of hearing loss. The first and most common is sensorineural or nerve hearing loss. It occurs when the cells within the inner ear or cochlea start to deteriorate. Most commonly, this is an age or genetic phenomena. However, it can also be caused by exposure to loud noise, certain medications, head trauma or even tumors occurring on the hearing-balance nerve called acoustic neuromas. Nerve hearing loss is usually corrected with the use of a hearing aid.

The second type of hearing loss is called conductive. This occurs when sound or the vibration energy cannot reach the inner ear. It can be caused by something as simple as earwax blocking the ear canal. Perforated ear drums, fixation or degeneration of the little ear bones or fluid within the middle ear space can keep sound energy from reaching the inner ear. Typically, these problems are corrected with various medicines, removal of the material from the ear canal or with surgical intervention. The third type of hearing loss is a combination of either senorineural or conductive referred to as a mixed hearing loss.

If one suspects a hearing loss, a good medical evaluation is warranted. It is important to make sure nothing serious is developing or that the problem can’t be corrected with either medicine or surgery. An evaluation of the ear should also include an audiogram or hearing test. This should be done in a sound proof booth by someone who has had specific training in performing this test. Before one purchases a hearing aid for a suspected loss, it is recommended that individuals determine why the loss is occurring.

Hearing aid technology has improved dramatically over the last five years. In essence, hearing aids amplify sound by increasing the vibration of the eardrum and ossicles – ear bones. Until recently, there were only conventional hearing aids which amplified all sounds in all frequencies. Recently, programmable and digital aids have been developed. Programmable aids allow sound to be amplified in varying degrees depending upon the extent and location of the hearing loss. Digital technology allows the sound to be delivered in a much clearer manner.

The first implantable hearing aid has recently been approved by the FDA. This is extremely exciting new technology which will allow us to deliver sound by attaching a device directly into the ossicles in the middle ear. The sound will be clearer and more natural without any device occluding the ear canal. One’s own voice and other sounds are much more normal. This is where many of the new advancements will come with regards to hearing aid technology.

In choosing a hearing aid, it is important to determine the level and location of the hearing loss as far as involving the low, middle or high frequencies. Secondly, depending upon the results of the audiogram, the technology of hearing aids should be chosen such as implantable, conventional, programmable or digital. Then, the size of hearing aid whether it be completely in the canal, in the ear or behind the ear is considered. Typically, the more severe the hearing loss, the larger the hearing aid required to deliver the appropriate amount of energy.

Hearing aids may be dispensed without a physician’s input, but this requires the patient to sign a waiver. Patients should also be given at least a thirty-day trial of the hearing aid. They should be able to return it after thirty days with just a nominal amount of money being charged for the mold, mail and time. Typically, this should run between $60 and $100. Hearing aids are not typically covered by insurance or Medicare. Patients in whom hearing aids are recommended should be encouraged to "shop around". However, they should be advised to check prices on comparable devices. Hearing aids fitted and produced in a local office usually are not comparable to traditional hearing instruments.

A new disposable hearing aid has also been recently FDA approved. There are seven types available for the different types of hearing loss. These retail for $40 each and last approximately forty days. However, they should not be seen as a total replacement of a traditional type of hearing instrument which is fit specifically to the individual patient’s ear and hearing loss.

One of the most preventable forms of hearing loss is that related of noise exposure. A great deal has been done within the last decade to aid individuals in the workplace against noise-induced type of hearing loss. Unfortunately, people at home, at work, those hunting or attending concerts still expose themselves to damaging noise which causes permanent hearing loss. Hearing loss from noise is dependent upon the loudness and duration of the noise. Proper hearing protection should be worn at all times when individuals are exposed to noise. A good rule of thumb is that the noise is injurious if one has to yell to be heard over the noise.

Hearing identification at birth has become a national priority with the advent of new technology allowing us to test infants. Recently, the Nebraska State Legislature passed a law advocating that all children be screened at birth. It has been found that children identified at an extremely early age and properly treated can eventually develop speech and language, even if they are deaf. Universal Newborn Hearing Screening Programs have been and are being developed throughout our state. For example, screening has been done for over a year at both Bergan Mercy and Methodist Hospitals. If a parent suspects a hearing loss in a child, identification or testing of a newborn is now technologically available.

Finally, for those individuals with a severe or profound hearing loss in which hearing aids are of little or no benefit, a cochlear implant is an option. The device restores sound to those who are essentially deaf. Cochlear implants have been available for adults since 1985 and children since 1990. The FDA has approved the cochlear implant for children as young as one year of age. The implants are for those individuals who have a severe or profound nerve hearing loss in both ears. The device is covered by most insurance companies, Medicare and Medicaid. It is a marvelous device that has gone through several technological advancements and in most patients, actually allows individuals to hear individual words.

The field of otology/neurotology continues to expand. The future regarding hearing loss and subsequent treatment continues to be a bright spot in the area of medicine.

WHEN SHOULD YOU SEE AN EAR-HEARING SPECIALIST?

1. Do you notice that you are favoring one ear over the other?
2. Do you find yourself asking others to repeat themselves?
3. Do people seem to mumble more often making it hard for you to understand them?
4. Do you have problems clearly understanding certain women or children’s voices?
5. Do you have difficulty following conversations while riding in a car?
6. Do you find yourself turning up the volume on the TV, radio or stereo?
7. Do you find it difficult to follow conversations in a crowded room?
8. Do you want or need to sit closer to the front in church, theaters or auditoriums?
9. Do you sometimes discover that during normal conversation, you have raised your speaking voice and seem to be almost shouting?

** If you answered yes to even one of these questions, I strongly urge you to see your ear doctor or hearing professional for an evaluation and hearing test.