What is an Audiologist?
An audiologist is a person who has a masters or doctoral degree in audiology. Audiology is the science of hearing. In addition, the audiologist must be licensed or registered by their state (in 47 states) to practice audiology. Although the vast majority of haring 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, the physical presentation, or the results of the audiometric evaluation (AE) indicate the possibility of medical or surgical problem. Many Audiologist also dispense (sell and service) hearing aids and related assistive listening devices for the telephone, TV and special listening situations.

What is an Otolaryngologist, neurotologist and Otologist?
Otolaryngologist (also called ear-nose-and-throat, or ENT, doctors) are physicians who have advanced training in disorders of the ear, nose, throat and head and neck. Otologist or neurologist are physicians who in addition to their ENT requirements continue their specialized training for an additional year or more in the diagnosis and treatment of disorders of the ear. They are physicians who typically treat disorders of the ear (or hearing mechanisms) requiring medical or surgical solutions.

What is a 'Hearing Instrument Specialist'?
The hearing aid specialist has training in the assessment of patients who specifically seek rehabilitation for hearing loss. The hearing aid specialist is licensed or registered to perform basic heating test and can sell and service hearing aids and related products.

How do I know if I have Hearing Loss?
Hearing loss occurs to most people as they age. Hearing loss can be due to 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. Hearing loss is the single most common birth “defect” in America. Hearing loss in adults, particularly in seniors, is common.

You may have a hearing loss if:

You hear people speaking but you have to strain to understand their words.
Your 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.

If you have any of these symptoms, you should see an audiologist to get an “audiometric evaluation”. An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test.
Type and Degree of Hearing Loss
Results of the audiometric evaluation are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. Frequency, from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) and is described in general categories. Hearing loss is not measured in percentages.

The general hearting loss categories (for adults) used by most hearing professionals are as follows:

Normal Hearing (0 to 25 dB HL)
Mild Hearing Loss (26 to 40dB HL)
Moderate to Severe (41 to 70 dB HL)
Severe Hearing Loss (71 to 90 dB HL)
Profound Hearing Loss (greater than 91dB HL)

The external and middle ear conduct and transform sound; the inner ear receives it. When there is a problem in the external or middle ear, a conductive hearing impairment occurs.
When the problem is in the inner ear, a sensorineural or hair cell loss is the result.
Difficulty outer, middle and inner ear result in a mixed hearing impairment (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain that the ear.

Conductive hearing loss occurs when the sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstruction in the ear canal, perforations (holes) in the eardrum membrane, or disease of any type of the three middle ear bones. All conductive hearing losses should be evaluated by an audiologist and physician to explore medical and surgical options.

Sensorineural hearing loss in the most common type of hearing loss. More than 90% of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. Sensorineural hearing loss is also called “cochlear loss” an “inner ear loss” and is also commonly called “nerve loss”.

Central hearing impairment occurs when auditory centers of the brain are affected by injury, disease, tumor, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although understanding of speech, also though of as the “clarity” of speech may be affected. Certainly both loudness and clarity may be affected too.

Hearing Loss in Children
For a child, hearing and speech are essential tools of learning, playing and developing social skills.
Children learn to communicate by imitating the sounds they hear. If they have a hearing loss that is undetected and untreated, they can miss much of the speech and language around them. This results in delayed speech/language development, social problems and academic difficulties.
Hearing loss, in varying degrees, affects two in every 100 children under the age of 18. Fortunately, there are few hearing losses that cannot be helped with modern technology.
The most effective treatment is achieved through early intervention. Early diagnosis, early fitting of hearing aids, and an early start on special education programs can help maximize a child’s hearing.

There are two primary categories of hearing loss in children, congenital (present at birth) and acquired (occurring after birth). These hearing losses may be sensorineural, conductive or mixed.

A Discussion of Eustachian Tube Problems
The ear is comprised of three portions: an outer ear (external), a middle ear and inner ear. Each part performs an important function in the process of hearing.
The Eustachian tube is a narrow channel which connects the middle ear with the nasopharynx (the upper throat area just above the palate, in the back of the nose). The Eustachian tube is approximately 1 ½ inches long. The narrowest portion is that area near the middle ear space.
The Eustachian tube functions as a pressure equalizing valve of the middle ear, which is normally filled with air. Under normal circumstances the Eustachian tube opens for a fraction of a second in response to swallowing or yawning. In so doing it allows air into the middle ear to replace air that has been absorbed by the middle ear lining (mucous membrane) or to equalize pressure changes occurring with altitude changes. Anything that interferes with this periodic opening and closing of the Eustachian tube may result in a hearing impairment or other ear symptoms.

A Discussion of Chronic Ear Infections (Otitis Media)
Chronic ear infection is inflammation or infection of the middle ear that persist or keeps coming back and causes long-term or permanent damage to the ear. A chronic ear infection occurs when fluid or an infection behind the eardrum does not go away. A chronic ear infection may be caused by an acute ear infection that does not clear completely, or repeated ear infections. Fluid in the middle ear may become very thick. Sometimes, the eardrum (tympanic membrane) may stick to the bones in the middle ear.
Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much more less common that acute ear infections.

Auditory-Brain Stem Response Testing (ABR)
Hearing problems may be caused by a variety of problems affecting one or more components of the auditory, or hearing, system that begins with the outer ear and ends with specialized parts of the brain. At times, a hearing loss may be caused by a benign tumor arising near the hearing nerve or by loss of the special layer of insulation that normally covers the nerve.
The Auditory brain stem response or ABR is a test used to diagnosis or rule out such problems. If you have hearing loss affecting only one ear, or hearing loss that is more pronounced in one ear or the other, your physician may suspect a problem involving the hearing nerve and has therefore referred you for an auditory brain stem response test.

This is a painless, non-invasive test involving the attachment of skin recording electrodes to your ear lobes, forehead and possibly scalp. It also involves the placement of small foam-tipped earphones into each ear.

What is an Auditory Processing Disorder (APD)?
Auditory Processing (also called Central Auditory Processing) is a term used to describe what happens to when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The “disorder” part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.
The cause of APD is unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive development disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

Types of Hearing Aids
There are many styles of hearing aids. The degree of the hearing loss, power and options requirements, manual dexterity abilities, cost factors, and cosmetic concerns are some of the factors that will determine the style the patient will use.

The most common styles are listed below:

BTE: Behind-the-Ear hearing aids are the largest hearing aids and they are very reliable. BTE’s have the most circuit options and they can typically have much more power than any of the custom made in the ear units. BTE’s are the units that “sit” on the back of your ear. They are connected to the ear canal via small tubing for in the ear receivers or custom-made plastic tubing. The custom-made tubing is part of the earmold and the small tubing with the receiver that goes in the ear.

ITE: In-the-Ear units are probably the most comfortable, and easiest to operate. They are also the largest of the custom made style.

ITC: In-the-Canal unites are a little more expensive that ITE’s. They require good dexterity to control the volume wheels and other controls on the faceplate, and they are smaller than ITE’s.

CIC: Completely-in-the-Canal units are the tiniest hearing aids made. The usually require a “removal string” due to their small size and the fact that they fit so deeply into the canal. CIC’s can be difficult to remove without the pull string. CIC’s do not usually have manual controls attached to them because they are too small.

Digital Hearing Aid Technology
Digital technology is the most sophisticated hearing aid technology. Digital technology gives the audiologist maximum control over sound quality and sound processing characteristics. These are qualitative indications that digital instruments do outperform digitally programmable and analog hearing aids. Digitals are not perfect, but they are very good. Digital hearing aids have been widely available since 1996.

The term Digital is used so often today, it can be confusing. When the term “digital” is used while referring to hearing aid, it generally means the hearing aid is 100% digital. In other words, the hearing aid is indeed a “complete computer”.

Digital technology is tremendous and it allows the audiologist maximum control over the sound quality and loudness If the hearing aid. Importantly, digital technology allows the audiologist to tailor or customize the sound of your hearing aids to what you need and want to hear. In summary, if you want the best technology—get 100% digital hearing aids.

Binaural Hearing: Do I Need Two Hearing Aids?
Basically, if you have two ears with hearing loss that could benefit form hearing aids, you need two hearing aids. It is important to realize there are no “normal” animals born with only one ear. Simply stated, you have two ears because you need two ears. If we try to amplify sound in only on ear, you cannot expect to do very well. Even the best hearing aid will sound “flat” or “dull” when worn in only one ear.

There are many advantages associated with binaural (two ear) listening and importantly, there are problems associated with wearing only one hearing aid –if you are indeed a candidate for binaural amplification.

Localization (knowing where the sound came from) is only possible with two ears, and just about impossible with one ear. Localization is not just sound quality issue; it may also be a safety issue. Think about how important it is to know where warning and safety sounds (sirens, screams, babies crying, etc) are coming from. Using both ears together also impacts how well you hear in noise because binaural hearing permits you to selectively attend to the desired signal, whole “squelching” or paying less attention to undesired sounds such as background noise.

Binaural hearing allows a quality of “spaciousness” or “high fidelity” to sounds, which cannot occur with monaural (one ear) listening. Understanding speech clearly, particularly in challenging and noisy situations, is easier while using both ears. Additionally, using two hearing aids allows people to speak with you form either side of your head, not just your “good” side.

People cannot hear well using only one ear. There are studies in the research literature that show that children with one normal ear and one “deaf” ear are ten times more likely to repeat a grade as compared to children with two normally hearing ears. Additionally, we know that if you have two ears with hearing impairment, and you wear only one hearing aid, the unaided ear is likely to lose word recognition ability more quickly than the ear wearing the hearing aid. 

Hearing Aids in the Presence of Background Noise
Virtually all patients wearing hearing aids complain about background noise at one time or another. There is no way to completely eliminate background noise.
Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter, however, not only was the background noise made quieter, but so too, was the signal (the speech sound).

Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.

The best and most efficient way to eliminate or reduce background noise is through the use of FM technology. Please speak with your audiologist about this.

Realistic Expectations for the Hearing Aid User
Hearing aids work very well when fit and adjusted appropriately. They amplify sound! You might find that you like one hearing aid better than the other. The left and right hearing aids will probably not fit exactly the same and they probably won’t sound exactly the same. Nonetheless, hearing aids should be comfortable with respect to the physical fit and sound quality. Hearing aids do not restore normal hearing and are not as good as normal hearing. You will be aware of the hearing aids in your ears. Until you get used to it, your voice will sound “funny” when you wear hearing aids. Hearing aids should not be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable; however, hearing aids cannot eliminate background noise.

When you hear your own voice for the first time, you will probably notice your voice sound funny! You will hear your voice amplified through the hearing aids. You may describe this sensation as feeling “plugged up” or hearing you voice echo. This is normal and will usually go away in a few days after you have given yourself a chance to get accustomed to your new hearing aids and learning to adjust the volume control. There are adjustments that the audiologist can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.

People learn at different rates. Some people need a day or two to learn about and adjust to their hearing aids, most need a few weeks and some may need a few months. There is no perfect way to learn about hearing aids. It is usually recommended to wear the hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aid. Eventually you will wear the hearing aids most of your waking hours. It is recommended that you interact with those people you are most familiar with during your first few days. Start off listening with your hearing aids in a favorite listening environment and work towards more difficult listening situations. Let your friends know that you are using new hearing aids.

Helpful Steps to Learning to Use a Hearing Aid:
Use the aid at first in your own home environment.
Wear the aid only as long as you are comfortable with it.
Accustom yourself to the use of the aid by listening to just one other person.
Do not strain to catch every word.
Do not be discouraged by the interference of background noises.
Practice locating the source of the sound by listening only.
Increase your tolerance for loud sounds.
Practice learning to discriminate different speech sounds.
Listen to something read aloud.
Gradually extend the number of persons with whom you talk, still in your own home environment.
Gradually increase the number of situations in which you use your hearing aid.
Take part in an organized course of aural rehabilitation; see your audiologist to learn about these courses.

One concern with all new hearing aids is the physical fit. Hearing aids needs to be comfortable, not too tight and not too loose, they should fit just right. Do not wear the hearing aids if they cause any discomfort or irritations. Do call your audiologist to schedule an appointment time to remedy the problem as soon as possible.

Taking an Impression of the Ear
All custom made hearing aids and earmolds are made from a "cast" of the ear. The cast is referred to as an ear impression. The audiologist makes the ear impression in the office. It takes about 10 to 15 minutes. The audiologist places a special cotton or foam dam in the ear canal to protect the eardrum, and then a waxy material is placed in the ear canal. When the material hardens the wax cast, along with the dam are removed from the ear canal. Often, the ear canal will be “oily” after the impression is removed. This is normal. The oil comes from the wax material and prevents the wax material from sticking to the skin. Tell the audiologist before the ear impression is obtained if you are allergic to plastic or dyes!

Hearing Aid Battery Information
All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery it is a medical emergency and the individual needs to see a physician immediately.
Typically batteries should last 7-14 days based on the amount of time the hearing aids are worn and the power consumed over time. Most Hearing aids have battery warning indicators. Before the battery goes out, the hearing aid will “beep, beep, beep” to tell you that you have another hour or so before the battery fails. Using excellent, fresh batteries is important.
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

Today’s hearing aid batteries are “zinc-air”.  Because the batteries are air-activated, a factory-sealed sticker places them “inactive” until you remove the sticker. Once the sticker is removed form the back of the battery, oxygen in the air contacts with the zinc within the battery, and the battery is “turned-on”. Placing the sticker back on the battery will not prolong its life.

Assistive Listening Devices (ALD’s)
An Assistive Listening Device (ALD) is used to provide hearing ability for people in a variety of situations. A common usage is to aid people who are hard of hearing. You may have certain communication needs that cannot be solved by the use of hearing aids alone. These situations may involve the use of the telephone, radio, television, and the inability to hear the door chime, telephone bell, and alarm clock. Special devices have been developed to solve these problems. Like hearing aids, assistive listening devices make sounds louder. Typically, a hearing aid makes all sounds in the environment louder. Assistive listening devices can increase the loudness of a desired sound (a radio or television, a public speaker, an actor, someone talking in a noisy place) without increasing the loudness of the background noises. This is because the microphone of the assistive listening device is placed close to the speaker, whole the microphone of the hearing aid is always close to the listener.

Candidates for ALD’s
No. People with all degrees and types of hearing loss — even people with normal hearing can benefit from assistive listening devices. Some assistive listening devices are used with hearing aids; some are used without hearing aids.

Types of ALD’s
There are many assistive listening devices available today, from sophisticated systems used in theaters and auditoriums to small personal systems.

Various Kinds of assistive listening devices are listed below:

Personal listening devices: There are several types of personal listening systems    available. All are designed to carry sound from the speaker (or other source)
directly to the listener and to minimize or eliminate environmental noise. Some of these systems, such as personal FM systems and personal amplifiers are especially helpful for one-to-one conversations in places such as automobiles, meeting rooms and restaurant.

TV Listening Systems: These are designed for listening to EV, radio, or stereos without interference from surrounding noise or the need to use very high volume.
Models are available for use with or without hearing aids. TV Listening systems allow the family to set the volume of the TV, while the user adjusts only thevolume of his or her own listening system.

Telephone Amplifying Devices: Most, but not all, standard telephone receivers are useful with hearing aids. These phones are called “hearing aid compatible.”
The option on the hearing aid is called the T-coil. The T-coil is automatically activated on some hearing aids and manually activated on others. Basically, the telephone and the hearing aids T-coil communicate with earth other electromagnetically, allowing the hearing aid to be used at a comfortable volume without feedback and with minimal background noise. Not all hearing aids have a “T” switch. Make sure your hearing aids have a T switch before purchasing a new hearing aid compatible phone. Speak with you audiologist to get the most appropriate system for your needs.

Cell Phones: Most hearing aids can be used with most cell phones. Importantly,
digital hearing aids and digital phones may create constant noise or distortion.
There may be significant problems for some hearing aids when used with    particular cell phones. The best person to address this problem is your audiologist
BEFORE you buy a cell phone or hearing aids.

Regarding “hands free” systems, there are many to choose from and hearing impaired users usually benefit maximally by using binaural hands free systems.

Financial Assistance for Hearing Aids and Personal Assistive Technology
Check your health insurance as it sometimes provides limited coverage of hearing aids. Children with hearing loss may be able to receive assistive technology at no cost of their individualized Education Program specifies that they need assistive technology in order to receive a Free and Appropriate Public Education. In some states, people with low income may qualify for hearing aids through Medicaid. Prospective and current college students and other people of working age may qualify for financial assistance for hearing aids, assistive technology and other rehabilitative services form state vocational rehabilitation agencies.

What is Tinnitus?
Tinnitus (pronounced tin-NY-tus or TIN-u-tis) is not a disease. Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. Tinnitus can be intermittent or constant with single or multiple tones.  Tinnitus can be temporary (acute) or permanent (chronic).

The exact cause (or causes) of tinnitus is not known in every case. Tinnitus is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain process sound. There are several likely factors which may cause tinnitus or make existing tinnitus worse:
Noise induced hearing loss, Ear and Sinus infections, age-related hearing loss, Wax build-up in the ear canal, ear disease and disorders, jaw misalignment, head and neck trauma, Disease of the heart or bleed vessels, Meniere’s Disease, certain types of tumors, certain medications, Hormonal changes in women,  Thyroid abnormalities and many others.  

Tinnitus is sometimes the sign of hearing loss in older people. It also can be a side affect of medications. More that 200 drugs are known to cause tinnitus when you start or stop taking them.

There are many options for people who experience tinnitus. Some wear hearing aids with tinnitus masker and some wear tinnitus maskers. Some patients require counseling to help them develop strategies to manager their tinnitus. If you have been told “learn to live with it”, there are many additional options to explore. Your audiologist is an excellent resource for issues and answers related to tinnitus.

Cochlear Implants
Generally speaking, cochlear implants are for patients with severe-to-profound, sensorineural hearing loss. There are approximately 500,000 patients in the USA with severe-to-profound hearing loss. Cochlear implants are only recommended after patients have tried the most powerful and most appropriately fit hearing aids, and have not shown sufficient benefit from hearing aids. Cochlear implants are devices that are “permanently” surgically implanted into the inner ear.

Cochlear implants are utilized in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the nonfunctional inner ear and converts sound into electrical impulses that directly stimulate the cochlear nerve. The implants consist of an external portion comprised of a microphone, sound processor, and external coil and an internal portion that must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and stimulating electrode array, which is inserted into the cochlea or inner ear. The electrical signals are manipulated and controlled by the audiologist to maximize speech perception. The brain interprets these electrical impulses as sound. Again, not all patients are surgical candidates, and not all cochlear implant recipients receive the same benefit.

Cochlear implants have been FDA approved for almost two decades and the advances and improvements in the technology have been amazing. The Food and Drug Administration (FDA) and the American Medical Association (AMA) recognize cochlear implants as safe and effective treatment for severe-to-profound sensorineural hearing loss.

Appropriately identified adults as well as profoundly deaf children (starting at age 12 months) can be implanted. Research demonstrates that the earlier a deaf child is implanted, the better the long term result will be with respect to speech and language development. Following surgery, rehabilitation is necessary, ad the child must learn to associate the sounds signals with normal sounds. Regarding deaf adults, research suggests that adults who receive cochlear implants are less lonely, have less social anxiety, are more independent, have increased social and interpersonal skills, and of course, they hear better with cochlear implant.

Middle Ear Implants
Middle ear implants are surgically implanted devices. The FDA has approved specific middle ear implants and the FDA is still reviewing others. The middle ear implant is a useful hearing instrument and is quite different from traditional hearing aids. Generally speaking, hearing aids reproduce sound and make them louder than the original sound. When a hearing aid is placed in the ear canal, the loud sound is perceived by the hearing impaired ear. Middle ear implants work by vibrating the middle eat bones, rather than by producing audible sound.

Therefore, middle ear implants are less likely to produce feedback, and they do not occlude, or “plug up’ the ear canal. Additionally, for most people wearing middle ear implants, their hair tends to cover up the external device.

If you are considering a middle ear implant, speak with your audiologist. Your audiologist can direct you to an otolaryngologist, otologist or neurologist with experience an expertise in implanting these devices.

Not all patients are surgical candidates, and each candidate does not receive the same benefit. Nonetheless, middle ear implants are an option, and are worthy of further consideration for appropriate patients. Again, the best source for initial information on this topic is your audiologist.

What is Meniere's Disease
Meniere’s Disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Meniere’s disease usually affects only one ear.
Meniere’s disease can develop at any age, but is more likely to happen to adults between 40 and 60 years of age. 
There is no definitive test or single symptom that your doctor can use to make the diagnosis. Diagnosis is based upon your medical history and the presence of:

Two or more episodes of vertigo lasting at least 20 minutes each
Tinnitus
Temporary hearing loss
A feeling of fullness in the ear

Meniere’s disease does not have a cure yet, but you doctor might recommend some treatments that will help you cope with the condition,

A Discussion of Dizziness
Dizziness is a symptom not a disease. It may be defined as a sensation of unsteadiness, imbalance, or disorientation in relation to an individual’s surroundings. The symptoms of dizziness may vary widely from person to person and be caused by many different diseases. It caries form a mild unsteadiness to a severe whirling sensation known as vertigo. As there is little representation of the balance system in the conscious mind, it is not unusual for it to be difficult for the patient to describe his symptoms of dizziness to the physician. The physician commonly requires testing to be able to provide the patient with some knowledge about the cause of his/her dizziness. Dizziness may or may not be accompanied by a hearing impairment.

Types of Dizziness
Sensations of unsteadiness, imbalance or disorientation in relationship to one’s surroundings may result from disturbances in the ear, neck, muscles and joints,
the eyes, the nervous system connections of these structures, or a combination of any of the above.

Ear Dizziness
Ear dizziness is one most common types of dizziness. Inflammation or infection of the inner ear or balance nerve is also a major cause of ear dizziness.

The inner ear mechanism is about the size of a pea, and is extremely sensitive. There are two inner ear chambers: One for hearing (cochlea) and one for balance (vestibule and semicircular canals). These chambers contain a fluid which bathes the delicate nerve endings. These nerve endings are stimulated when there is movement of the fluid. Nerve impulses are them transmitted to the brain. By the hearing and balance nerves. The nerves pass through a small bony canal (internal
auditory canal), accompanied by the facial nerve.

 Any disturbance affecting the function of the inner ear or its central connections may result in dizziness hearing loss or tinnitus (head noise). These symptoms may occur singly or in combination, depending upon which functions if the inner ear are disturbed.

Ear Dizziness may appear as whirling or spinning sensation (vertigo), unsteadiness, or giddiness and lightheadedness. It may be constant, but is more often intermittent, and is frequently aggravated by head motion or sudden positional changes, nausea and vomiting may occur, but one does not lose consciousness as a result of inner ear dizziness.

 

Central Dizziness
Central dizziness is usually an unsteadiness brought about by failure of the brain    to correctly coordinate or interpret the nerve impulses which it receives. An example of this is the “swimming feeling” or unsteadiness that may accompany emotional stress, tension states and excessive alcohol intake. Circulatory inefficiency, tumors or injuries may produce this type of unsteadiness, with or without hearing impairment. A feeling of pressure or fullness in the head is common. Occasionally true vertigo (spinning) may be caused by central problems.

Persons subject to dizziness should exercise caution when swimming. Buoyancy of the water results in an essentially weightless condition and visual orientation is greatly impaired of one’s head is under water. An attack of dizziness at this time could be very dangerous. Similarly, individuals who have lost both inner ear and balance canals should avoid underwater swimming. 

Aural Rehabilitation
Aural rehabilitation is the process of identifying and diagnosing a hearing loss, providing different types of therapies to clients who are hearing impaired, and implementing different amplification devices to aid the client’s hearing abilities. Aural rehab includes specific procedures in which each therapy and amplification device has as its goal the habilitation or rehabilitation of persons to overcome the handicap (disability) caused by a hearing impairment or deafness.
Aural rehabilitation is frequently used as an integral component in the overall management of individuals with hearing loss and refers to services and procedures for facilitating adequate receptive and expressive communication in individuals with hearing impairments. Aural rehabilitation is often an interdisciplinary endeavor involving physicians, audiologists and speech-language pathologists.
Audiologists and speech-language pathologists are professionals who typically provide aural rehabilitation components. The audiologist may be responsible for the fitting, dispensing and management of a hearing device, counseling the client about his or her hearing loss, the application of certain processes to enhance communication, and the skills training regarding environmental modifications which will facilitate the development of receptive and expressive communication. The speech-language pathologist is typically responsible for evaluating the client’s receptive and expressive communication skills and providing the services to anchor improvement. The speech-language pathologist also provides training and treatment for communication strategies, speech-perception training (e.g., speech reading, auditory training and auditory-visual-speech-perception training), speech and voice production, and comprehension of oral, written, and signed language.

Types of Aural Rehabilitation Therapies:

Hearing aid orientation: The process of providing education and therapies to persons (individual or group) and their families about the use and expectations of wearing hearing aids to improve communication.

Listening strategies: The process of teaching hearing impaired persons common and alternative strategies when listening with or without amplification to improve their communication.

Auditory Training: The process of teaching an individual with a hearing loss the ability to recognize speech sounds, patterns, words, phrases, or sentences via audition.