Hearing and Ears

At Carolina Hearing Institute, our audiologists specialize in the prevention, diagnosis, and treatment of hearing and balance disorders for infants, children, and adults. We offer comprehensive audiological services, including:

• Hearing evaluations and hearing aid consultations
• Digital hearing aid fittings and repairs for most makes and models
• Tinnitus management
• Vestibular testing for dizziness and vertigo
• Auditory evoked potential testing for neural hearing disorders
• Custom-fitted earplugs, including musician’s and swim plugs

Hearing loss has a lot of different causes and manifestations. It can be sudden or gradual. It can occur in one ear or both ears. It can be temporary or permanent. It happens to people of all ages and is associated with the aging process. Before discussing causes and treatments for hearing loss, it is important to understand how hearing works. We see patients from the Columbia, SC area with many questions about hearing loss

HOW WE HEAR

There are three sections of the ear: the outer ear, middle ear and inner ear. Each section helps move sound through the process of hearing. When a sound occurs, the outer ear feeds it through the ear canal to the eardrum. The noise causes the eardrum to vibrate. This, in turn, causes three little bones inside the middle ear (malleus, incus, stapes) to move. That movement travels into the inner ear (cochlea), where it makes tiny little hairs move in a fluid. These hairs convert the movement to auditory signals, which are then transmitted to the brain to register the sound.

CAUSES OF HEARING LOSS

Hearing loss occurs when sound is blocked in any of the three areas of the ear. The most common cause of hearing loss and one of the most preventable is exposure to loud noises. Infections, both of the ear or elsewhere in the body, are also a major contributor to hearing loss.

• In the Outer Ear: Earwax build-up, infections that cause swelling, a growth in the ear canal, injury or birth defects can restrict hearing in the outer ear.
• In the Middle Ear: Fluid build-up is responsible for the most common infections and blockages in the middle ear. Fluid in the middle ear prevents the bones from processing sounds properly. Tumors, both benign and malignant, can also result in hearing loss in the middle ear.
• In the Inner Ear: The natural process of aging diminishes hearing from damage to the cochlea (mechanism for converting sound vibrations to brain signals), vestibular labyrinth (which regulates balance), or the acoustic nerve (nerve that sends sound signals to the brain). Additionally, inner ear infections, Meniere's disease and other nerve-related problems contribute to hearing loss in the inner ear.

OTHER CAUSES OF HEARING LOSS INCLUDE:

• Presbycusis: Age-related hearing loss, such as having difficulty hearing in noisy places, having trouble understanding what people are saying or not registering softer sounds.
• Heredity and Genetic Causes: There is a wide variety of diseases and syndromes that are either genetic or hereditary that can cause hearing loss. Some, like rubella (German measles) occur when a pregnant mother has the disease, which causes hearing loss in the baby. Other, rarer types of hereditary and genetic causes include CHARGE Syndrome, Connexin 26 disorder, Goldenhar Syndrome, Treacher Collins Syndrome, Usher Syndrome, Waardenburg Syndrome and otosclerosis (growth of spongy bone tissue in the middle ear).

Most causes of outer ear hearing loss can be remedied. But problems of the middle and inner ear can lead to permanent hearing loss, which is why it is important to seek medical attention quickly if you are experiencing a problem hearing.

TYPES OF HEARING LOSS

There are five types of hearing loss:

• Conductive hearing loss: Caused by conditions that block the transmission of sound through the outer ear and eardrum to the middle ear.
• Sensorineural hearing loss: Inner ear damage that occurs as part of the natural process of aging.
• Mixed hearing loss: Mixed hearing loss refers to people who have both conductive and sensorineural hearing loss. Most people experience more than one type of hearing loss.
• Central hearing loss: This occurs when the central nervous system fails to send a readable signal to the brain, which is called a central auditory processing disorder. People with central hearing loss generally can hear all sounds, but can’t separate or process them.

Hearing loss is measured in four degrees: mild, moderate, severe or profound. The degree of hearing loss drives the selection of the best form of treatment on a case-by-case basis.

HEARING LOSS TREATMENTS

The location, type and degree of hearing loss impact the choice of treatments for any hearing problem. The most common treatment options include:

• Antibiotics, decongestants and pain medication to overcome ear infections.
• Myringotomy, a piercing of the eardrum to allow for fluids to drain out of the outer ear.
• Insertion of a tube into the Eustachian tube (part of the anatomy that connects the middle ear to the back of the throat) to keep it open and allow for normal fluid drainage. This technique may be recommended for people who get frequent ear infections.
• Hearing aids.
• Surgery to remove benign or malignant tumors or correct bone- or nerve-related problems.

If you experience sudden or prolonged hearing loss with dizziness, fever or pain, please contact our office right away and schedule an appointment with one of our otolaryngologists. We'll conduct a physical examination as well as a hearing test to determine the type and severity of your hearing loss. We'll then recommend the best treatment.

If you’re having trouble understanding conversations or notice your quality of life is affected by hearing issues, it may be time for a hearing evaluation. Our audiologists  provide comprehensive diagnostic evaluations and personalized treatment plans for varying degrees of hearing loss. A simple hearing screening is all that’s needed to determine the type and extent of your hearing loss.

Finding the Right Hearing Aid

Once your hearing loss is assessed, the next step is choosing a hearing aid that fits your lifestyle, hearing needs, and budget. Modern hearing aids come in many styles and designs, with features such as Bluetooth connectivity and wind noise reduction.

During your consultation, our audiologists will:

• Explain the different types and styles of hearing aids

• Learn about your daily routines, job, and activity level to recommend the most suitable options

Hearing Aid Styles

In-the-Canal (ITC) & Completely-in-the-Canal (CIC):
Smallest style, fits partly or completely in the ear canal. Offers cosmetic and listening advantages.

In-the-Ear (ITE):
Fits in the outer ear, easier to handle than smaller canal aids.

Behind-the-Ear (BTE):
All components sit behind the ear and connect to an earmold. Often chosen for children or those needing larger devices.

Receiver-in-Canal (RIC):
Small case behind the ear with a wire leading to the speaker in the ear canal. Popular among adults for both cosmetic and functional benefits.

• Ensure the hearing aid fits comfortably and meets your hearing needs

How Hearing Aids Work

All hearing aids have similar basic components:

• Microphone: picks up sound

• Amplifier: increases sound volume

• Receiver: delivers sound into the ear

• Batteries: power the device

• Earmolds (optional): direct sound and enhance quality; often replaced for children as ears grow

Getting a Hearing Aid

To obtain a hearing aid, you will need:

1. A comprehensive audiological evaluation (within 6 months)

2. Medical clearance from a physician, preferably an ENT

3. A hearing aid consultation to discuss your hearing needs, lifestyle, and technology options

Follow-up visits are necessary to fine-tune your hearing aids and ensure the best outcomes.

Financing & Trial Periods

• Financing: Interest-free options are available; ask your audiologist for details.

• Trial Period: Most states, including SC, require a trial period for hearing aids. If you’re unsatisfied, you may return or exchange them. A small fitting/restocking fee may apply.

Hearing aids do not restore normal hearing, but they can greatly improve conversations, social engagement, and overall quality of life. Our audiologists will work closely with you to ensure your hearing aids provide the maximum benefit.

Tinnitus is the perception of noise or sounds in the head or ears in the absence of an actual stimulus. The noise may be perceived as a variety of sounds (e.g. ringing, rushing, roaring, or hissing).

What happens during the tinnitus evaluation?

During the evaluation, you and the audiologist will

• Discuss the nature of the tinnitus
• Review the history of tinnitus, hearing loss and sensitivity to sounds
• Determine the category of the tinnitus
• Discuss individualized treatment program

How is tinnitus treated?

While there is no "cure" for tinnitus, some patients are able to acclimate to their tinnitus on their own without intervention. However, there are many approaches proven to provide relief from tinnitus, such as:

• Amplification (hearing aids)
• Biofeedback
• Cognitive therapy
• Sound therapy

The American Tinnitus Association is a wonderful resource for patients who experience tinnitus. You can visit their website here.

Protect your hearing with custom-fit earplugs designed for noise reduction and swimming.

• Swim plugs are
  • Used to protect the ear from water for people with tubes in their ears or who are prone to outer ear infections
  • Available in various colors
  • Customizable by taking earmold impressions
• Personal listening earbuds are customized earbuds that work for music headsets like mp3 players and iPods.
• Musician monitors allow musicians to monitor music and voice quality accurately during performances.
• Hearing protection earplugs are available with different noise-filtering levels. These can be used for
  • Hunting
  • Music concerts
  • Noisy work conditions
  • Blocking out unwanted sound while sleeping
  • Loud environments

South Carolina ENT is an all-encompassing diagnostic audiology facility.  Unlike other hearing health practices, our audiologists work side-by-side with board-certified physicians for a more comprehensive approach to manage your hearing loss or balance problems.

OAEs

Otoacoustic emission testing allows the audiologist to understand how the outer hair cells of your inner ear are responding to sound stimulation. OAE testing is commonly performed on infants and young children as an accurate method of screening for hearing impairments.

Tympanometry

Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) by creating variations of air pressure in the ear canal. Many children develop fluid behind the eardrum due to upper respiratory infections. This procedure can make a direct measurement of the middle ear system to rule out the possibility of a middle ear problem.

Hearing Evaluations

Hearing testing begins with an auditory history. For example, you will be asked if there is family history of hearing loss, any previous ear infections, tinnitus (ringing in the ears), or noise exposure. Next, there will be a series of examinations in a sound-treated booth, including

• Otoscopy, a visual examination of the ears
• Tympanometry, to assess the status of the middle ear
• Audiometry, which measures hearing ability

How long does the hearing test take?

The test takes approximately 30 minutes.

Should I bring anything?

Please bring any previous audiograms, if they are available.

Recommendations will be made based on all of these results

Pediatric Hearing Evaluations

The child's age and ability determine which of the following test methods are used.

Subjective Testing Methods

• Behavioral Observation Audiometry (BOA). This test is typically administered to babies from birth to 7 months. Speech and sounds are made from speakers in a sound-treated room, and the child is observed for changes such as eye movements, changes in sucking pattern, cessation of crying, etc.
• Visual Reinforced Audiometry (VRA). Typically administered to children from 7 months to 3 years, in this test the child is taught to turn his/her head each time a sound is presented from a speaker. The child's responses are reinforced with a light or moving toy.
• Conditioned Play Audiometry (CPA). This test is typically administered to children from 3 years to 5 years. During CPA the child may wear headphones. He/she is taught to play a game during testing (e.g. throw a ball into a bucket) when hearing a sound.
• Conventional Audiometry. This type of testing is typically administered to children 5 years and older. The child wears headphones and raises their hand when a sound is heard. The child will be asked to repeat words

Objective Testing Methods

• Otoacoustic Emissions (as indicated) involves presenting sound into the ear and measuring the response of the outer hair cells to auditory stimulation while the patient sits calmly.
• Auditory Brainstem Response (as indicated) assesses the organs of hearing, the auditory nerve, and the auditory pathways to the level of the brainstem while the patient is quiet or in a natural sleep state.

Videonystagmography (VNG)

This objective test assesses the organs of balance (vestibular system) and pathways to the level of the brainstem with the purpose of evaluating the integrity of the balance system, and if possible, which ear is affected.

How does VNG work?

During VNG, goggles are placed over the eyes and connected to the equipment via wires. The goggles have a camera inside that monitors eye movement. During this test a computer analysis will be performed in response to the data collected. The results are interpreted by an Audiologist to determine the integrity of the balance system

These tests are noninvasive; no needles or x-rays are involved. The patient may feel temporarily dizzy, but under controlled, painless conditions.

What does the patient do during these tests?

There are three part to the test, all of which occur with the patient sitting in an adjustable chair.

Part one takes place with the patient sitting up while watching a moving light or lights. This assesses the visual system.

Part two takes place with the patient laying back. Eye movements are monitored in different head and body positions. This assesses the effect of position changes on the patient.

Part three takes place with the patient laying back at an angle. Cool and warm air will be put into the patient’s ear. This assesses the balance system.

How should I prepare for the evaluation?

To prepare for the evaluation, you should

• Discontinue alcohol consumption for at least 48 hours prior to the evaluation.
• Discontinue eating 3 hours before the exam time, and meals prior to that time should be light.
• DO NOT wear eye make-up.
• DO NOT take certain medications for up to 48 hours prior to the evaluation, however do not discontinue any medications without first consulting your physician.

When will the results be ready?

The audiologist will analyze the data and write the report. The physician will review the results.

A follow-up appointment is typically scheduled with the physician within two weeks of the evaluation.

ECOG

The ECoG is an objective test used to aid in the diagnosis of Meniere’s disease and other disorders. The test measures the electrical potentials generated in the cochlea—a part of the inner ear—in response to sound stimulation.

What should I expect during an ECoG test?

During this test:

• A sticker electrode is placed on the forehead and foil covered earphones are inserted into the ear canals, which are gently cleansed beforehand.
• A sound stimulus is presented to the patient’s ear through the earphones.
• The electrode picks up cochlear activity that occurs in response to the sound.
• Once the measurements are collected, the electrode and earphones will be removed, and the patient can proceed with the day as normal
• The waves are interpreted by the audiologist.

How do I prepare for an ECoG test?

• Do not wear face makeup for easier preparation.
• Relax and sit still in the exam chair with eyes closed during the test.

When will the test results be ready?

After the test, the audiologist will interpret the data and write the report. The report will be reviewed by your physician and a follow-up appointment with your physician is typically scheduled with the physician at least five days after the test.

ABR

The ABR test is an objective test that assesses the organs of hearing, auditory nerve, and auditory pathways to the level of the brainstem with the purpose of evaluating the integrity of the hearing system and estimating the softest sound (threshold) a patient can hear at various pitches.

ABR testing is usually recommended for infants and young children or for patients who may be difficult to test using conventional techniques.

What should I expect during an ABR Test?

An ABR test is non-invasive and not painful. Depending on the age, health, and behavior of the patient, the test can be performed without sedation. During this test:

• Sticker electrodes are placed on the patient’s head and connected via wires to the testing equipment.
• A sound stimulus is presented in the patient’s ears individually through earphones.
• A computer analysis will be performed in response to the data collected.
• The results are interpreted by an audiologist to determine the integrity of the hearing system and/or a patient’s threshold.

Stay informed with our latest articles on hearing health, including:

• When to see an Audiologist
• Signs & Symptoms of Tinnitus
• FAQs About Hearing Aids
• Types of Oticon Hearing Aids
• Myths and Facts about Wearing Hearing Aids
• What you should know before purchasing a hearing aid online
• Recreational Firearm Noise Exposure
• Information about harmful noise levels
• How our balance system works

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