There are seldom things more embarrassing than to constantly ask for clarification, repetition, or for others to tell you what is being said in a conversation. This has been especially prevalent in the times of using masks for health and safety reasons. This lack of the ability to hear and understand conversations in social situations, restaurants, or other noisy environments, is not “normal.” This is a sign that you are missing nuances of sound and speech clarity that is necessary to follow conversational speech. Most of the time this hearing loss begins in the high frequencies where we attribute clarity to words. The high frequencies are responsible for the consonants like (z, f, t, p, s, etc). If you are not able to hear these sounds when they are embedded into words, it causes you to guess.
It is also not uncommon to have others tell you that you are missing conversations, that you may be talking louder than others around you and that you look distracted or distanced from everyone else. This happens when you can’t hear well and begin to separate yourself from locations and people where you have to listen.
The difficulty with hearing loss is that it generally happens gradually over time so it doesn’t seem so bad until one day you realize you may have a hearing loss. It isn’t unlike the need for glasses. One day you don’t need them and the next moment, you do. It’s a normal process of age and certain medical conditions. When this happens and you notice that you are having difficulty hearing, it is recommended to schedule an Audiological Examination here at Optimum Audiology.
The outer ear consists of the pinna. The pinna is responsible for funneling sound down to your ear canal and bringing sound to your tympanic membrane. This is what is often called the eardrum. The sound coming into the ear canal is called acoustic sound because the sound comes from air molecules moving from a person talking, across the span of space, to your ear canal. The air molecules meet the tympanic membrane where the sound is transmitted behind the tympanic membrane as mechanical energy through the three small ear bones, called the malleus, incus and stapes. The small ear bones move because the largest of the three ear bones is attached to the tympanic membrane.
Things that can hinder your hearing in the outer ear are: earwax, ear infections which make the tympanic membrane tight and more difficult for the air molecules to move and create sound. Ear wax or cerumen is the most common difficulty in the outer ear canal. One interesting fact is that if you have a full blockage of wax in the ear, it can create up to a 40% loss of hearing that is correctable simply in removing the wax and allowing the sound waves to reach the tympanic membrane.
Once the sound reaches the tympanic membrane, the sound is changed into mechanical energy through the three small ear bones, called the malleus, incus and stapes. The small ear bones move because the largest of the three ear bones is attached to the tympanic membrane. The movement of the tympanic membrane moves down the chain of bones until it touches the oval window that is attached to the smallest bone in the entire body, the stapes. The pressure of the sound waves on the oval window is some 20 times higher than on the eardrum. The pressure is increased due to the difference in size between the relatively large surface of the eardrum and the smaller surface of the oval window. Can you imagine the sound increasing 20 times in that small space of the middle ear in order to allow you to both hear and understand words? This is how amazing the ear is for listening.
When you have difficulty with the middle ear system, this can be related to ear infections, perforated tympanic membranes, calcified or hardened middle ear bones, ossicular discontinuity (ossicles not touching one another), cholesteotoma, history of ear surgery or ear infections as a child and other middle ear diseases. When you have a middle ear difficulty, the mechanical portion of the transmission of sound is inhibited and this causes you to need the sound to be louder. The louder sound is needed in order to have the middle ear bones and tympanic membrane to oval window transmission work.
A wonderful test for this portion of the ear is called a Tympanogram. The tympanogram determines if the tympanic membrane is functioning well and if there is any perforation or middle ear pressure that must be addressed.
Once the sound passes through the middle ear it stimulates the oval window which is the membrane which allows the sound to move from mechanical to hydraulic transmission in the cochlea.
If you were to take the cochlea, and straighten it out of the coil that it is in, then you would find the cochlea is like a piano keyboard. The long line of the cochlea, stretched out, reveals that the cochlea has high frequency hair cells at the base of the cochlea and low frequency hair cells at the apex of the cochlea. When sound crosses over the hair cells, it does so much like an ocean wave that you can see visibly. The wave moves over the miniscule hair cells and causes them to be “excited” or to move up and down. This up and down movement moves to a neural network where the sound moves up various portions of the brain where it finally is processed by the temporal lobe. When the sound moves along correctly, in a normal hearing individual, the temporal lobe receives information that correlates to words and speech. When the individual has hearing loss, the temporal lobe receives sound with “gaps” of sound wherein the word is not transmitted properly and therefore can’t be perceived properly by the temporal lobe.
This causes the misunderstanding of words. For example, in a normal hearing individual the words “baseball” would be transmitted correctly through the ear and up to the temporal lobe where the word would properly be heard as “baseball.” When there are gaps, there are portions of the word that are not transmitted properly and therefore the temporal lobe receives only a portion of the word. In this case, the individual could hear “b b ll.” When this happens, the individual has to fill in the gaps of what they can’t hear and try to make sense of words. If you add in background noise or complex noise environments like crowds, this becomes increasingly harder. The end result is that the individual begins to retreat from various aspects of their life and begins to become isolated and depressed.
What is pure tone audiometry?
A pure tone test is when you sit in a soundproof room and listen to the “beep” sounds that are presented by the Audiologist/Hearing Professional. You will be invited into the booth where you will sit down and get comfortable.
A pair of headphones, or insert earphones, will be placed in or on your ears. This is how you will hear the beep tones. The testing will start, generally, with the right ear first and then it will proceed to the left ear. The instructions will be to listen for the softest sound possible and the sounds will vary from low pitched (humming type of sound) to a high pitched sound (whistle sound). The reason this is the first test and one of the most important tests of the battery of tests you will receive, is because it helps to see what areas of sound that you hear well and what areas of sound that you don’t hear as well.
This will be followed by bone conduction where a device will be placed behind your ear and the sound of the tones will be emitted from this device. It helps to determine if your hearing loss is sensorineural, mixed or conductive in nature.
What is speech audiometry?
A wonderful way to assess how you are understanding words, is to complete what is called speech audiometry. Speech audiometry is when you are sitting in a soundproof room and you have headphones on your ears. One headphone is for the right ear and the other is for the left ear. This helps us to determine how each ear is responding to speech, more specifically, words.
The words will be presented at two levels. One level is very soft, almost at a slight whisper. This test is called the Spondee test. It is a way to verify that the pure tone test that was completed first, is consistent with this test result. It consists of hearing two syllable words, like baseball/hotdog, etc and seeing at what level you are able to hear the words. It should correspond to a term we call the pure tone average of the beep test.
After that has been completed, we will complete a Speech Discrimination Test at your most comfortable listening level for hearing speech. This test consists of having you repeat words after a carrier phrase, such as: “say the word, xxxx.” You will repeat the word that you heard and this will give us an idea of how you hear speech in a normal, quiet environment. This helps us to understand how your hearing loss is affecting your ability to hear conversational speech and to help you understand the types of words and sounds that you are missing.
Following these tests we will complete a speech in noise test called the Quick SIN. The Quick SIN provides us information about how you hear in a noisy or more complicated environment. The more difficulty that you have on this test, you will have a greater need for more advanced hearing technology that utilizes greater noise reduction for noise and greater enhancement to speech.
If you struggle to hear the television, or understand conversations, even in restaurants or other or other noisy environments, it's time to see an audiologist. We're here to help.
A hearing test can provide the answers you need to help you hear at your very best. Schedule your appointment for a comprehensive hearing evaluation and find out how you can better communicate and connect with the people in your life.
