Hearing Library


Hearing Loss

Hearing Aids

Other Ear Conditions

What is an audiologist?

An audiologist is a person who has a masters or doctoral degree in Audiology – the science of hearing.  There are 6000 audiologists across America who are focused on evaluating and treating the effects of permanent hearing loss.

An audiologist must hold a license to practice audiology, abide by rules of practice and ethics, and obtain continuing education every year.

The Au.D. (Doctor of Audiology) is the clinical doctorate degree and is the required minimum degree for all new audiologists in North Carolina.  The Ph.D. remains a highly regarded degree for researchers and academicians.

Audiologists work in a variety of settings including hospitals, clinics, private practices (such as ours), ENT physician offices, medical centers, universities, rehabilitation facilities, cochlear implant centers, and speech and hearing centers. Although the vast majority of hearing problems do not require medical or surgical intervention, audiologists are clinically and academically trained to determine those that do need medical referral.

As a licensed healthcare provider, the audiologist appropriately refers patients to physicians when the history or audiological evaluation show the possibility of a medical or surgical problem.

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Practical Advice for Communicating
with Someone with Hearing Loss

Frustrated by the hassles of talking to someone with hearing loss? They are too! That’s why they have hearing aids – but this doesn’t do it all.

You can easily help.

  1. Speak clearly and naturally
    It is not necessary to shout.  Loud speech may overload their hearing and be painful.  Maintain normal tone of voice but articulate your words more clearly.  Speak more at a slightly slower rate and you’ll automatically speak clearly.
  2. Move closer
    Reduce the distance between you and the listener.  Your listener will always hear you more clearly if you’re within 6 feet.  Just assume they will never understand you from more than 10 feet away.
  3. Face the listener
    Position yourself so that your listener can see your face and lips.  Lip reading is instinctive – everyone does it even without knowing it.  It is particularly important for those with impaired hearing.
  4. Attract the listener’s attention
    Tired of repeating everything you say?  Your listener will understand you the first time if you get their attention before speaking.  This can be done by saying their name, touching them, or getting in their sight.
  5. Restate rather than repeating
    If you have to repeat something try saying it a little different. Some words are more difficult to understand so restate it different words.  If you first said “Let’s go to Olive Garden for supper”, repeat it by saying “I’d like to eat tonight at Olive Garden.  Let’s go.”
  6. Be aware of the surroundings
    Avoid trying to have conversations from one room to another or in rooms with distracting noises, e.g. washing machine, TV playing in background, dishwasher, etc.
  7. Be aware of listening limitations
    Never put the hearing impaired listener under too much pressure.  Remember that their hearing loss is as frustrating to them as it is to you.
  8. Understand that hearing loss can be tiring
    When talking with your hearing impaired listener remember that it’s tiresome work to be attentive all day long.  Anything you can do to help will be a welcome gift.

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How do I know if I have Hearing Loss?

Hearing loss can occur at any age from a variety of factors.  Most often hearing loss occurs as a combination of influences, such as the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. In 2010 it is estimated that 34 million people in America have some degree of permanent hearing loss. Hearing loss is the single most common medical disorder at birth. Hearing loss in adults, particularly in seniors, is common.

You may have hearing loss if…

  • You hear people speaking but you have to strain to understand their words.
  • You frequently ask people to repeat what they said.
  • You don’t laugh at jokes because you miss too much of the story or the punch line.
  • You frequently complain that people mumble.
  • You need to ask others about the details of a meeting you just attended.
  • You play the TV or radio louder than your friends, spouse and relatives.
  • You cannot hear the doorbell or the telephone.
  • You find that looking at people when they speak to you makes it easier to understand.

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Types of Hearing Loss

There are two main types of hearing loss, Sensorineural and Conductive.


Sensorineural refers to the most common type of hearing loss.  The tiny hearing hair cell receptors in the inner ear are not as sensitive as they used to be.  This commonly occurs from:

  • A natural change from aging or family history of hearing loss
  • Damage caused by loud sound or noise exposure – even if that exposure occurred many years ago.  The hair cell receptors are damaged at the time of exposure but may not show as hearing loss until many years later.
  • Disease or infection in the inner ear may result in sensorineural hearing loss in 5-10% of people.  There are usually other symptoms that lead us to this diagnosis.

85% of people with hearing loss have sensorineural hearing loss.  This type cannot be corrected with medication or surgery.  Appropriate hearing aids are the best way to improve your hearing and regain understanding.


Conductive hearing loss is caused by a condition with your eardrum, middle ear, or middle ear bones.  These structures can become stiff and this stiffness prevents the sound from entering the inner ear at full strength.  Conductive hearing loss can be caused by:

  • Hardening of the eardrum from scar tissue
  • Hole in the eardrum
  • Middle ear infection or progressive tumor
  • Stiffening of the middle ear bones – often called Otosclerosis.

Conductive hearing loss can frequently be corrected with medication and/or surgery.  If you have this hearing loss we may be referring you to an Otologist, a physician specializing in treatment and surgery of the ear.

If you are not a candidate for treatment or surgery, hearing aids are very effective in improving conductive hearing loss.


Another condition that can effect your hearing is worth mentioning, although it is not a distinctive type of hearing loss.  Central hearing loss is caused by changes in the neural system within the brain.  In addition to hearing loss changing the perception of sound, the brain is not able to accurately decipher sounds to make them understandable words.  Central deficits may result from:

  • Family history
  • Other central influences like stroke and vascular problems.
  • Progressive neurologic disease like multiple sclerosis, dementia, etc.
  • Injury from trauma, motor vehicle accident, localized brain injury.

This problem looks like hearing loss but is actually a change in processing within the brain since the understanding centers in the brain are not reacting to sound as quickly or as accurately.  This problem almost always occurs with sensorineural hearing loss and is most frequent in the elderly, particularly those who have untreated hearing loss for many years. Hearing aids can be helpful to reconnect you to people and things around you but expectations for improvement must be realistic.  Your hearing clarity will improve through a combination of hearing aids and improved listening habits.

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Degrees of Hearing Loss

The amount of hearing loss is measured by it’s degree:  normal, mild, moderate, moderately severe, severe, and profound.  It is important to understand that most, regardless of degree of hearing loss, observe that “my hearing is fine, I just don’t understand words as clear as I used to”.  This is the first and most common sign of hearing loss.

The graph above, an audiogram, shows the degree of hearing loss down the right side.

Mild hearing loss makes it challenging to understand speech in specific situations, such as with a soft speaker or when listening in background noise. In quiet a mild hearing loss is manageable.

Moderate hearing loss creates problems understanding conversations, particularly with women, children, and other people who may not project their voices.  This is particularly noticeable while in background noise such as a restaurant or social gathering.  The TV or radio may be somewhat louder for some programs in order to be heard clearly.  Others may notice your hearing problem before you do.  Hearing aids are very helpful when used at this level.

Moderately-severe hearing loss is obviously noticeable to others. Clarity of speech is affected whether in quiet or busy gatherings. You will begin to mis-understand words more frequently, thinking the speaker said one word when they actually said another.  The punch lines to jokes will become harder to hear. Others complain that the TV is too loud and hearing people from a distance becomes more difficulty. At this level the person with the hearing loss begins to question their hearing, noticing that it is obviously changing.  Hearing aids are very useful when used at this level.

Severe hearing loss requires people to speak directly to you with a louder voice. All communication must be direct and purposeful.  Often you will need to watch the speaker in order to understand. Usually the hearing loss has been present for years and has finally reached this level where communication is no longer easier or enjoyable.  Hearing aids are vital at this stage to remain engaged with the communication around you. Hearing aids are useful but often the hearing loss has been present for so long that expectations must be tempered.

Profound Hearing loss creates difficulty hearing even the loudest sounds: Thresholds are 91 dB and higher. At this level, people with profound hearing loss may have difficulty understanding even amplified speech.  Hearing aids or other amplification is vital to remain connected to the hearing world around you.

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What if I delay treatment for my hearing improvement?

Often people resist any examination or treatment of hearing difficulty until it reaches the moderate range – where it creates daily frustration in several listening environments.   Elderly people often wait until the hearing problem extends into the severe category.  They finally resign themselves to help when their hearing problem becomes pervasive. Often it is too late to regain optimal understanding because the decline has persisted for far too long and changes in neural pathways have occurred.

It is vital that family members insist on early diagnosis and treatment when faced with a person who is often reluctant and unbelieving about their hearing problem.

A good rule of thumb is to seek treatment when any of the following occur:

  1. Family members begin commenting about your hearing difficulty.  Even a joke can be a gentle prod for you to recognize the emerging problem.
  2. When you find that a growing number of people seem to “mumble”.  It is easy to blame others for their poor speaking habits when it’s likely your hearing.  If other listeners around you seem to understand the speaker then it’s likely your hearing, not their speaking.
  3. When you rely on watching people as they speak.  We use our eyes to augment what our ears have stopped doing.  If you understand noticeably better when watching someone, it’s time to have your hearing checked.
  4. When background noise interferes with your ease of listening.  An obvious sign of hearing loss is when your hearing seems satisfactory in quiet situations but is obviously more frustrating when in crowded rooms like restaurants, parties, socials, and other busy gatherings.  It is easy to dismiss this as simply a problem with the crowd, or the room, or the speaker – when it is likely related to your hearing.
  5. When you start dropping out of conversations because it requires too much effort, or you avoid challenging listening situations altogether – its time for a hearing evaluation.  Isolation is a common effect of untreated hearing loss and usually starts as withdrawal from specific situations – “I’m not going to church anymore because I just can’t hear anyone”.

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Is it true that Hearing Aids will help preserve my hearing?

Hearing aids do not stop hearing loss.  However, studies have shown that the sound provided by hearing aids allow auditory pathways in the brain to remain open and functional.  These pathways are important for speech understanding, clarity in background noise, and separating what you want to hear from what you don’t.  Untreated hearing loss causes these pathways to atrophy and actually to be taken over by other senses.  A 2009 study showed that under-used hearing pathways are actually recruited by the tactile senses (touch).  So, the idea of “use it or lose it” truly does apply to hearing.

Another study in the 1990s showed that ears using hearing aids preserved better speech intelligibility than ears that had not benefited from hearing aid correction.  The interesting factor was that they studied people who had hearing loss in two ears but used a hearing aid in only one ear.  The ear using the aid preserved 10-20% better understanding than the ear with no hearing aid.

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I was told that Hearing Aids won’t help me

Hearing aids help 95% of people with hearing loss to some degree.  While people who have mild to severe hearing loss for a shorter period of time receive more optimal benefit, almost anyone with hearing loss will receive meaningful benefits from hearing aids.  Every hearing situation is different so every outcome with be somewhat different.

  • An 82-year-old can expect a different improvement than a 62-year-old.
  • A lifelong machinist exposed to 30 years of noise will receive different benefit from an office worker.
  • A person with no family history of hearing loss will receive unique benefit compared to someone who has several family members with hearing loss.

No two people share the same genetics, medical history, work background, or noise exposure.  As a result no two people will have the same benefit from hearing aids.  However, as a whole most people with hearing loss achieve noticeably better hearing and clarity with hearing aids.

It is important to understand Realistic Expectations about the improvement you will receive.  If your expectation is to return your hearing to normal then you will be sorely disappointed. However, if you accept that your hearing will never return to “normal” BUT that it can be improved over it’s damaged level – then you will notice a return to more normal communication and an easier time listening to those around you.

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Do hearing aids need Batteries?

Yes. Hearing aid batteries, or button cell batteries, are the standard in powering hearing aids. Typically they last 7-14 days based on use of 12-16 hours/day; some smaller batteries may last only 4-6 days. Generally, the smaller the battery size, the shorter the battery life. The sizes of hearing aid batteries are listed below along with their standard number and color codes.

  • Size 10: YELLOW
  • Size 13: ORANGE
  • Size 312: BROWN
  • Size 675: BLUE

All hearing aid batteries are “zinc-air.”  The cell is filled with zinc that is activated when the factory-sealed sticker is removed and air combines with the zinc to turn the battery “on”.

Unlike other batteries that start losing power from the day they are made, zinc air batteries have a long shelf life since they aren’t “activated” until the tab is removed.

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Are all hearing aid Batteries the same?

No. It is important to recognize that your hearing aids sound only as good as the battery that is powering them. The electronics in your hearing aids depend on a reliable power source that is provided by a high quality battery. Using cheap, store brand batteries will cost less money but these have up to 50% less activator (or charge) in them. With less power available the battery will constantly starve the electronics in your hearing aids. This ultimately leads to more distortion, less clarity, and less amplification. This is also true of very old hearing aid batteries.

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Are Hearing Aid Batteries rechargeable?

A couple hearing aid manufacturers have tried to make rechargeable hearing aids and/or rechargeable batteries. This technology is still very young and not yet perfected.  Once they develop a button cell that can be recharged 1) a multitude of times efficiently, and 2) to consistently work for a 20-hour period, we will see rechargeables in widespread use.  The technology is not yet perfected but is likely to be in the next couple of years.

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