And so does Raney Ray

Dr. Ted Benke with Raney D. Ray, Au.D., CCC-A
Raney Ray, a native of Fort Worth, received her Au.D. (Doctor of Audiology) degree from Arizona School of Health Sciences in Mesa, AZ in March of 2006. She received her Master of Science in Communication Disorders, specializing in Audiology, from the Texas Tech University Health Science Center in Lubbock. Raney worked for one year at Cook Children's Medical Center in Fort Worth where she received her Certificate of Clinical Comptetence in Audiology (CCC-A). She also has a broad background in adult diagnostic audiology and has experience in fitting hearing aids for both children and adults. Raney lives in Fort Worth with her husband B. J., their son Owen, and their rescue greyhound Lolli. Raney enjoys interior decorating, gardening and travel.

Five Minute Hearing Test
Autoimmune Inner Ear Disease
Buying a Hearing Aid
Hearing Health Center
Noise & Hearing Protection
Tinnitus

You may have hearing loss, and not even be aware of it. People of all ages experience gradual hearing loss, often due to the natural aging process or long exposure to loud noise. Other causes of hearing loss include viruses or bacteria, heart conditions or stroke, head injuries, tumors, and certain medications. Treatment for hearing loss will depend on your diagnosis.

How does the hearing sense work?

The aural or hearing-sense is a complex and intricate process. The ear is made up of three sections: the outer ear, the middle ear, and the inner ear. These parts work together so you can hear and process sounds. The outer ear, or pinna (the part you can see), picks up sound waves and the waves then travel through the outer ear canal.

When the sound waves hit the eardrum in the middle ear, the eardrum starts to vibrate. When the eardrum vibrates, it moves three tiny bones in your ear. These bones are called the hammer (or malleus), anvil (or incus), and stirrup (or stapes). They help sound move along on its journey into the inner ear.

The vibrations then travel to the cochlea, which is filled with liquid and lined with cells that have thousands of tiny hairs on their surfaces. The sound vibrations make the tiny hairs move. The hairs then change the sound vibrations into nerve signals, so your brain can interpret the sound.

Test your hearing

Answer the following questions then calculate your score. To calculate your score, give yourself 3 points for every “Almost always” answer, 2 points for every “Half the time” answer, 1 point for every “Occasionally” answer, and 0 for every “Never.” Please note: If hearing loss runs in your family, add an additional 3 points to your overall score.

The American Academy of Otolaryngology—Head and Neck Surgery recommends the following:

• 0-5 points—Your hearing is fine. No action is required.
• 6-9 points—Suggest you see an ear, nose, and throat (ENT) specialist.
• 10+ points—Strongly recommend you see an ear, nose, and throat (ENT) specialist.

What can I do to improve my hearing?

1. Eliminate or lower unnecessary noises around you.
2. Let friends and family know about your hearing loss and ask them to speak slowly and more clearly.
3. Ask people to face you when they are speaking to you, so you can watch their faces and see their expressions.
4. Utilize sound amplifying devices on phones.
5. Use personal listening systems to reduce background noise.

Tips to maintain hearing health

1. If you work in noisy places or commute to work in noisy traffic or construction, choose quiet leisure activities instead of noisy ones.
2. Develop the habit of wearing earplugs when you know you will be exposed to noise for a long time.
3. Earplugs quiet about 25 dB of sound and can mean the difference between a dangerous and a safe level of noise.
4. Try not to use several noisy machines at the same time.
5. Try to keep television sets, stereos and headsets low in volume.

Autoimmune Inner Ear Disease up^

What is AIED?

Autoimmune inner ear disease (AIED) is an inflammatory condition of the inner ear. It occurs when the body's immune system attacks cells in the inner ear that are mistaken for a virus or bacteria. AIED is a rare disease occurring in less than one percent of the 28 million Americans with a hearing loss.

How does the healthy ear work?

The ear has three main parts: the outer, middle and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

What are the symptoms of AIED?

The symptoms of AIED are sudden hearing loss in one ear progressing rapidly to the second ear. The hearing loss can progress over weeks or months. Patients may feel fullness in the ear and experience vertigo. In addition, a ringing, hissing, or roaring sound in the ear may be experienced. Diagnosis of AIED is difficult and is often mistaken for otitis media until the patient develops a loss in the second ear. One diagnostic test that is promising is the Western blot immunoassay.

What is the treatment for AIED?

Most patients with AIED respond to the initial treatment of steroids, prednisone, and methotrexate, a chemotherapy agent. Some patients may benefit from the use of hearing aids. If patients are unresponsive to drug therapy and hearing loss persists, a cochlear implant maybe considered.

History

Until recently it was thought that the inner ear could not be attacked by the immune system. Studies have shown that the perisacular tissue surrounding the endolymphatic sac contains the necessary components for an immunological reaction. The inner ear is also capable of producing an autoimmune response to sensitized cells that can enter the cochlea through the circulatory system.

Current Research

A multi-institutional clinical study, Otolaryngology Clinical Trial Cooperative Group (OCTCG) co-sponsored by the NIH and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, is being conducted to measure the benefits and risks of treating AIED with two different immunosuppressive drugs: prednisone and methotrexate, a chemotherapy drug.

Buying a Hearing Aid up^

Answers to common questions

I don't hear well. What should I do? What should I expect?

Because some hearing problems can be medically corrected, first visit a physician who can refer you to an otolaryngologist (an ear, nose, and throat specialist). If you have ear pain, drainage, excess earwax, hearing loss in only one ear, sudden or rapidly progressive hearing loss, or dizziness, it is especially important that you see an otolaryngologist. Then, get a hearing assessment from an audiologist (a nonphysician health care professional). A screening test from a hearing aid dealer may not be adequate. Many otolaryngologists have an audiologist associate in their office who will assess your ability to hear pure tone sounds and to understand words. The results of these tests will show the degree of hearing loss and whether it is conductive or sensorineural and may give other medical information about your ears and your health.

• Conductive Hearing Loss

A hearing loss is conductive when there is a problem with the ear canal, the eardrum and/or the three bones connected to the eardrum. Common reasons for this type of hearing loss are a plug of excess wax in the ear canal or fluid behind the eardrum. Medical treatment or surgery may be available for these and more complex forms of conductive hearing loss.

• Sensorinural Hearing Loss

A hearing loss is sensorineural when it results from damage to the inner ear (cochlea) or auditory nerve, often as a result of the aging process and/or noise exposure. Sounds may be unclear and/or too soft. Sensitivity to loud sounds may occur. Medical or surgical intervention cannot correct most sensorineural hearing losses. However, hearing aids may help you reclaim some sounds that you are missing as a result of nerve deafness.

Where do I go to get hearing aids?

Because federal regulation prohibits any hearing aid sale unless the buyer has first received a medical evaluation from a physician, you will need to see your physician before you purchase a hearing aid(s). However, the regulation says that if you are more than 18 years old and are aware of the recommendation to receive a medical exam, you may sign a waiver to forego the exam.

An otolaryngologist, audiologist, or an independent dispenser can dispense aids. Hearing aids should be custom fitted to your ear and hearing needs. Hearing aids purchased by mail-order typically cannot be custom fitted.

How expensive are hearing aids?

Hearing aids vary in price according to style, electronic features, and local market conditions. Price can range from many hundreds of dollars to more than $2,500 for a programmable, digitalized hearing aid. Purchase price should not be the only consideration in buying a hearing aid. Product reliability can save repair costs and the frustration of a malfunctioning hearing aid.

What kinds of hearing aids are available?

There are several styles of hearing aids:

• Behind-the-ear (BTE) hearing aids are placed over the ear and connected with tubing to custom-fitted earpieces.
• In-the-ear (ITE) hearing aids fill the entire bowl of the ear and part of the ear canal.
• Smaller versions of ITEs are called half-shell and in-the-canal (ITC).
• The least visible aids are completely-in-the-canal (CIC).

Hearing aid options, which are appropriate for your particular hearing loss and listening needs, the size, and shape of your ear and ear canal, and the dexterity of your hands will all be considered in deciding what type of hearing aid is the best for you. Many hearing aids have special telecoil "T" switches to aid in use of the telephone and certain public sound systems. Discuss your need for a T-coil switch while you are considering hearing aid options.

Will I need a hearing aid for each ear?

Usually, if you have hearing loss in both ears, using two hearing aids is best. Listening in a noisy environment is difficult with amplification in one ear only, and it is more difficult to distinguish where sounds are coming from. If, however, the quality of hearing in one ear is very different from the other, one hearing aid may be better than two.

What other questions should I ask?

• Ask about charges for the hearing evaluation, dispensing fee(s), and future servicing and repair.
• Inquire about the trial period policy and what fees are refundable if you return the hearing aid(s) during the trial period.
• Ask about the warranty coverage for your hearing aids and the consumers' protection program for hearing aid purchasers in your state.

What will happen at my hearing aid fitting?

• The hearing aids will be fitted for your ears.
• Then, while wearing your hearing aids, you will be tested for word understanding in quiet and in noise and for improvement in hearing tones.
• Next, you will receive instruction about the care of your hearing aids, the batteries used to power them, a suggested wearing schedule, general expectations, and helpful communication strategies.
• You will also practice properly inserting and removing the hearing aids and batteries.

How should I begin wearing the aids?

• Start using your hearing aids in quiet surroundings, gradually building up to noisier environments.
• Note where and when that you find the hearing aids beneficial.
• Be patient and allow yourself to get used to the aids and the "new" sounds they allow you to hear.
• Keep a diary to help you remember your experiences.
• Report any concerns on a follow-up appointment.

Hearing Health Center up^

Noise & Hearing Protection up^

One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Excessive noise exposure is the most common cause of hearing loss.

Can noise really hurt my ears?

Yes, noise can be dangerous. If it is loud enough and lasts long enough, it can damage your hearing.

The damage caused by noise, called sensorineural hearing loss or nerve deafness, can be caused by several factors other than noise, but noise-induced hearing loss is different in one important way - it can be reduced or prevented altogether.

Can I "toughen up" my ears?

No. If you think you have grown used to a loud noise, it probably has damaged your ears, and there is no treatment‚no medicine, no surgery, not even a hearing aid that completely restores your hearing once it is damaged by noise.

How does the ear work?

The ear has three main parts: the outer, middle, and inner ear. The outer ear (the part you can see) opens into the ear canal. The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear canal, and strike your eardrum, causing it to vibrate. The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound: music, a slamming door, a voice, etc.

When noise is too loud, it begins to kill the nerve endings in the inner ear. As the exposure time to loud noise increases, more and more nerve endings are destroyed. As the number of nerve endings decreases, so does your hearing. There is no way to restore life to dead nerve endings; the damage is permanent.

How can I tell if a noise is dangerous?

People differ in their sensitivity to noise. As a general rule, noise may damage your hearing if you have to shout over background noise to make yourself heard, the noise hurts your ears, it makes your ears ring, or you have difficulty hearing for several hours after exposure to the noise.

Sound can be measured scientifically in two ways. Intensity, or loudness of sound, is measured in decibels. Pitch is measured in frequency of sound vibrations per second. A low pitch, such as a deep voice or a tuba, makes fewer vibrations per second than a high voice or violin.

What does frequency of sound vibration have to do with hearing Loss?

Frequency is measured in cycles per second, or Hertz (Hz). The higher the pitch of the sound, the higher the frequency.

Young children, who generally have the best hearing, can often distinguish sounds from about 20 Hz, such as the lowest note on a large pipe organ, to 20,000 Hz, such as the high shrill of a dog whistle that many people are unable to hear.

Human speech, which ranges from 300 to 4,000 Hz, sounds louder to most people than noises at very high or very low frequencies. When hearing impairment begins, the high frequencies are usually lost first, which is why people with hearing loss often have difficulty hearing the high pitched voices of women and children. Loss of high frequency hearing also can distort sound, so that speech is difficult to understand even though it can be heard. People with hearing loss often have difficulty detecting differences between certain words that sound alike, especially words that contain S, F, SH, CH, H, or soft C sounds, because the sound of these consonants is in a much higher frequency range than vowels and other consonants.

What about decibels?

Intensity of sound is measured in decibels (dB). The scale runs from the faintest sound the human ear can detect, which is labeled 0 dB, to over 180 dB, the noise at a rocket pad during launch.

Decibels are measured logarithmically. This means that as decibel intensity increases by units of 10, each increase is 10 times the lower figure. Thus, 20 decibels is 10 times the intensity of 10 decibels, and 30 decibels is 100 times as intense as 10 decibels.

Approx. Decibel Level		Example
0		Faintest sound heard by human ear.
30		Whisper, quiet library.
60		Normal conversation, sewing machine, typewriter.
90		Lawnmower, shop tools, truck traffic; 8 hours per day is the maximum exposure to protect 90% of people.
100		Chainsaw, pneumatic drill, snowmobile; 2 hours per day is the maximum exposure without protection.
115		Sandblasting, loud rock concert, auto horn; 15 minutes per day is the maximum exposure without protection.
140		Gun muzzle blast, jet engine; noise causes pain and even brief exposure injures unprotected ears. Maximum allowed noise with hearing protectors.

 

How high can the decibels go without affecting my hearing?

Many experts agree that continual exposure to more than 85 decibels is dangerous.

Does the length of time I hear a noise have anything to do with the danger to my hearing?

It certainly does. The longer you are exposed to a loud noise, the more damaging it may be. Also, the closer you are to the source of intense noise, the more damaging it is.

Every gunshot produces a noise that could damage the ears of anyone in close hearing range. Large bore guns and artillery are the worse because they are the loudest. But even cap guns and firecrackers can damage your hearing if the explosion is close to your ear. Anyone who uses firearms without some form of ear protection risks hearing loss.

Recent studies show an alarming increase in hearing loss in youngsters. Evidence suggests that loud rock music along with increased use of portable radios with earphones may be responsible for this phenomenon.

Can noise affect more than my hearing?

A ringing in the ears, called tinnitus, commonly occurs after noise exposure, and it often becomes permanent. Some people react to loud noise with anxiety and irritability, an increase in pulse rate and blood pressure, or an increase in stomach acid. Very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

Who should wear hearing protectors?

If you must work in an excessively noisy environment, you should wear protectors. You should also wear them when using power tools, noisy yard equipment, or firearms, or riding a motorcycle or snowmobile.

What are the laws for on-the-job exposure?

• Habitual exposure to noise above 85 dB will cause a gradual hearing loss in a significant number of individuals, and louder noises will accelerate this damage.

• For unprotected ears, the allowed exposure time decreases by one-half for each 5 dB increase in the average noise level. For instance, exposure is limited to 8 hours at 90 dB, 4 hours at 95 dB, and 2 hours at 100 dB.

• The highest permissible noise exposure for the unprotected ear is 115 dB for 15 minutes/day. Any noise above 140 dB is not permitted.

The Occupational Safety and Health Administration, in its Hearing Conservation Amendment of 1983, requires hearing conservation programs in noisy work places. This includes a yearly hearing test for the approximately five million workers exposed to an average of 85 dB or more of noise during an 8-hour work day.

Ideally, noisy machinery and work places should be engineered to be more quiet or the worker's time in the noise should be reduced; however, the cost of these actions is often prohibitive. As an alternative, individual hearing protectors are required when noise averages more than 90 dB during an 8-hour day.

When noise measurements indicate that hearing protectors are needed, the employer must offer at least one type of earplug and one type of earmuff without cost to employees. If the yearly hearing tests reveal hearing loss of 10 dB or more in higher pitches in either ear, the worker must be informed and must wear hearing protectors when noise averages more than 85 dB for an 8-hour day.

Larger losses of hearing and/or the possibility of ear disease should result in referral to an ear, nose and throat physician (otolaryngologist).

What are hearing protectors? How effective are they?

Hearing protection devices decrease the intensity of sound that reaches the eardrum. They come in two forms: earplugs and earmuffs.

Earplugs are small inserts that fit into the outer ear canal. They must be snugly sealed so the entire circumference of the ear canal is blocked. An improperly fitted, dirty or worn-out plug may not seal and can irritate the ear canal. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. For people who have trouble keeping them in their ears, they can be fitted to a headband.

Earmuffs fit over the entire outer ear to form an air seal so the entire circumference of the ear canal is blocked, and they are held in place by an adjustable band. Earmuffs will not seal around eyeglasses or long hair, and the adjustable headband tension must be sufficient to hold earmuffs firmly around the ear.

Properly fitted earplugs or muffs reduce noise 15 to 30 dB. The better earplugs and muffs are approximately equal in sound reductions, although earplugs are better for low frequency noise and earmuffs for high frequency noise.

Simultaneous use of earplugs and muffs usually adds 10 to 15dB more protection than either used alone. Combined use should be considered when noise exceeds 105 dB.

Why can't I just stuff my ears with cotton?

Ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors; they reduce noise only by approximately 7 dB.

What are the common problems of hearing protectors?

Studies have shown that one-half of the workers wearing hearing protectors receive one-half or less of the noise reduction potential of their protectors because these devices are not worn continuously while in noise or because they do not fit properly.

A hearing protector that gives an average of 30 dB of noise reduction if worn continuously during an 8-hour work day becomes equivalent to only 9 dB of protection if taken off for one hour in the noise. This is because decibels are measured on a logarithmic scale, and there is a 10-fold increase in noise energy for each 10 dB increase.

During the hour with unprotected ears, the worker is exposed to 1,000 times more sound energy than if earplugs or muffs had been worn.

In addition, noise exposure is cumulative. So the noise at home or at play must be counted in the total exposure during any one day. A maximum allowable while on-the-job followed by exposure to a noisy lawnmower or loud music will definitely exceed the safe daily limit.

Even if earplugs and/or muffs are worn continuously while in noise, they do little good if there is an incomplete air seal between the hearing protector and the skin.

When using hearing protectors, you will hear your own voice as louder and deeper. This is a useful sign that the hearing protectors are properly positioned.

Can I hear other people and machine problems if I wear hearing protectors?

Just as sunglasses help vision in very bright light, so do hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. However, it is essential that persons with impaired hearing wear earplugs or muffs to prevent further inner ear damage.

It has been argued that hearing protectors might REDUCE a workerís ability to hear the noises that signify an improperly functioning machine. However, most workers readily adjust to the quieter sounds and can still detect such problems.

What if my hearing is already damaged? How can I tell?

Hearing loss usually develops over a period of several years. Since it is painless and gradual, you might not notice it. What you might notice is a ringing or other sound in your ear (called tinnitus), which could be the result of long-term exposure to noise that has damaged the hearing nerve. Or, you may have trouble understanding what people say; they may seem to be mumbling, especially when you are in a noisy place such as in a crowd or at a party. This could be the beginning of high-frequency hearing loss; a hearing test will detect it.

If you have any of these symptoms, you may have nothing more serious than impacted wax or an ear infection, which might be simply corrected. However, it might be hearing loss from noise. In any case, take no chances with noise - the hearing loss it causes is permanent. If you suspect a hearing loss, consult a physician with special training in ear care and hearing disorders (called an otolaryngologist or otologist). This doctor can diagnose your hearing problem and recommend the best way to manage it.

Tinnitus up^

Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist. An essential part of the treatment will be your understanding of tinnitus and its causes.

What causes tinnitus?

Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and often tinnitus. If you are older, advancing age is generally accompanied by a certain amount of hearing nerve impairment and tinnitus. If you are younger, exposure to loud noise is probably the leading cause of tinnitus, and often damages hearing as well.

There are many causes for “subjective tinnitus,” the noise only you can hear. Some causes are not serious (a small plug of wax in the ear canal might cause temporary tinnitus). Tinnitus can also be a symptom of stiffening of the middle ear bones (otosclerosis).

Tinnitus may also be caused by allergy, high or low blood pressure (blood circulation problems), a tumor, diabetes, thyroid problems, injury to the head or neck, and a variety of other causes including medications such as anti-inflammatories, antibiotics, sedatives, antidepressants, and aspirin. If you take aspirin and your ears ring, talk to your doctor about dosage in relation to your size.

Treatment will be quite different in each case of tinnitus. It is important to see an otolaryngologist to investigate the cause of your tinnitus so that the best treatment can be determined.

How is tinnitus treated?

In most cases, there is no specific treatment for ear and head noise. If your otolaryngologist finds a specific cause of your tinnitus, he or she may be able to eliminate the noise. But, this determination may require extensive testing including X-rays, balance tests, and laboratory work. However, most causes cannot be identified. Occasionally, medicine may help the noise. The medications used are varied, and several may be tried to see if they help.

What are some other tinnitus treatment options?

• Alternative treatments
• Amplification (hearing aids)
• Cochlear implants or electrical stimulation
• Cognitive therapy
• Drug therapy
• Sound therapy
• TMJ treatment

Can other people hear the noise in my ears?

Not usually, but sometimes they are able to hear a certain type of tinnitus. This is called “objective tinnitus,” and it caused either by abnormalities in blood vessels around the outside of the ear or by muscle spasms, which may sound like clicks or crackling inside the middle ear.

Can children be at risk for tinnitus?

Yes, children are at risk too. However, it is not a common complaint. Like people of all ages, children who are exposed to loud noises are at a higher risk for tinnitus. High-decibel recreational events, like car races, music concerts, or sports games, can damage children’s ears. Hearing protection devices should always be worn.

Tips to lessen the severity of tinnitus

• Avoid exposure to loud sounds and noises.
• Get your blood pressure checked. If it is high, get your doctor's help to control it.
• Decrease your intake of salt. Salt impairs blood circulation.
• Avoid stimulants such as coffee, tea, cola, and tobacco.
• Exercise daily to improve your circulation.
• Get adequate rest and avoid fatigue.
• Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible.

What can help me cope with tinnitus?

Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients.

Masking out the head noise with a competing sound at a constant low level, such as a ticking clock or radio static (white noise), may make it less noticeable. Tinnitus is usually more bothersome in quiet surroundings. Products that generate white noise are available through catalogs and specialty stores.

Hearing aids may reduce head noise while you are wearing them and sometimes cause the noise to go away temporarily, if you have a hearing loss It is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.

Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

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