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Author: admin, 01.01.2016
Hearing loss is common in the trucking industry, especially for the drivers who have been on the road for more than ten years. However, with 265 known medications on the market that report tinnitus as a possible side effect, there are literally hundreds of reasons why someone may experience symptoms. The three most common causes of inner ear cell damage are: age-related hearing loss, prolonged exposure to loud noises and ear wax buildup or a foreign object in the auditory canal. Objective tinnitus can arise from muscle spasms that cause clicks or crackling around the middle ear, and the sound is audible to both the patient and doctor. If someone tells you they can hear you buzz or ring when you sleep, and you experience a whooshing or ringing sound in your ears, you should go have it checked out. RelatedSkin cancer: What you need to knowA general understanding of what to look for and how to prevent it is your best defense in fighting the disease. The vestibulo-cochlear nerve, or eighth cranial nerve, carries signals from the inner ear to the brain.
As with any medical condition, if it disrupts your daily life you should see a medical professional about it. Notice: Overdrive is transitioning to a new comment platform due to technical problems with the former commenting system. To offer the best hearing care possible, neurotologists or otologists, audiologists, and hearing instrument specialists should form into a hearing care group that makes the most of the expertise of each of the three professions involved. However, if you get the right group of professionals together in one place who foster a mutually respectful culture, each has the chance of performing at the highest level while providing comprehensive services, products and devices—the perfect formula for a one-stop hearing care resource that would be difficult to find anywhere else.
Growing up, I had the opportunity to spend a lot of time with two of the greatest golfers who ever lived: my father, Jug McSpaden, and his best friend and my godfather, Byron Nelson. I learned many lessons from these two golfing greats who were accustomed to being the best at what they did. All good golfers have confidence, but golf in particular has a way of punishing those with too big an ego. Neurotologists, otologists, and ENTs are experts at diagnosing the “what” of the patient’s problem.
The “neuroaudiologist” needs to know the anatomy of the auditory system very well—how a sound hits the eardrum on one side and travels through the entire ear system from the outer ear to the middle ear, into the cochlea or inner ear, and back into the middle ear. Both the otologist and audiologist need to know that there is one thing that can cause hearing problems for many people, and this is diabetes. If the patient has a normal hearing loss with hearing falling off and getting worse as time goes on, especially into the mid ranges or higher ranges, then the patient has a typical sensorineural hearing loss. Once the audiologist determines that the signal has gone in, and whether there is diabetes, head trauma, a history of stroke, or some other issue that may be the underlying cause of the hearing loss, then he or she knows to expect if this is a central auditory processing problem or not. The HIS takes the patient’s audiogram or physician’s report, and then with the patient helps decide the type of hearing aid that should be tried to help a patient with the particular hearing problem.
An HIS will tell the patient: I’m going to teach you the steps to follow so you get the most out of your hearing aid. If the HIS works one-on-one, week to week with the patient for a month, and then works with the patient and partner for the second month, and if the patient reads aloud daily, then the patient’s ability to understand the voices of strangers will go up 20%-40%. An additional issue with hearing aids that everyone on the care team needs to understand is “recruitment,” or the perceived loudness of the hearing aid even when applying only small amounts of gain above threshold.
Everyone on the team has to make sure the patient’s hearing is treated appropriately and optimally.
Something must be said about the rehabilitative role the audiologist performs as part of the hearing healthcare team.
When patients receive top-notch care and follow-up, they appreciate the entire care team, because they know that comprehensive, coordinated care has put them back in the world and hearing all the things they want to.
For too long, those of us in the hearing healthcare industry have allowed our egos to get in the way. Other causes of tinnitus range from Meniere’s disease to a malformation of capillaries in the head and neck. Subjective tinnitus can only be heard by the affected person and is caused by otology, neurology, infection, or drugs. When subjective tinnitus is a medication side effect, it almost always goes away when the drug is completed or changed, however it’s important to know that some drugs are ototoxic, which means you are more susceptible to hearing damage while taking these drugs. If you are experiencing what you think is tinnitus, alleviating it may be as simple as changing your medications.


Loss of sleep, inability to concentrate and irritability are all good reasons to make a home time stop at the family doc.
If you put the best of these three specializations together in one group, the patient will benefit from the strengths of all three disciplines and won’t have to go to specialists in three different locations. Byron Nelson was one of only two players in history to average below 70 for 100 consecutive golf tournament rounds—he generally shot around 69, which is about what Tiger Woods shot in his prime before they started “Tiger-proofing” courses. It is about making sure that, when patients come to your group, they get the best possible care from each professional on the team and learn how to succeed with their hearing treatment and hearing solution. In other words, the otologist deciphers a patient’s symptoms and tells the patient what is wrong and what needs to be done.
The audiologist must be familiar with how the cochlea works with the hair cells and nerve fibers, the anatomy involved in the entire hearing process, and how all that affects a patient’s hearing.
It is important when gathering a Family History or Patient History that the experts determine if a patient has diabetes, or if it runs in the family. On the other hand, if the patient has a low frequency rising hearing loss that rolls off in the middle frequencies and then falls in the high frequencies, this could indicate a central auditory processing problem that has to do with how he hears, and also what he hears.
The audiologist determines where in the auditory system the patient is having a problem—if the patient has binaurality or localization, for example.
If the audiologist finds XYZ, then indicates where the hearing problem or lesion is most likely to be. For some reason, hearing instrument specialists are sometimes not considered to be “on the same level” as audiologists and ENTs. It doesn’t matter if the hearing aid is a BTE, or an ITC, ITE, or IIC; the trick is figuring out what kind of information the patient can receive with the hearing aid. That is, the patient hears the signal loud enough to understand clearly, and loud enough to distinguish one phoneme from the other, and also can distinguish voiced and unvoiced consonants and unusual combinations of consonants. In addition to providing hearing testing and diagnostics, the audiologist should also be helping patients with aural rehabilitation. By proposing a new group approach with professionals working together as a first-class team in one location, we’re not talking about competing for patients.
We have worried more about our own professional identities than about the ultimate needs of the patient.
McSpaden, PhD, is an audiologist and hearing instrument specialist who has retired from private practice, but continues to write about hearing healthcare. They may sound like ringing, blowing, roaring, buzzing, hissing, humming, whistling or sizzling. Avoiding loud noises and wearing hearing protection when appropriate is recommended by the Mayo Clinic website. Finding out why you’re having symptoms is the most important key to curing them, or making the symptoms as manageable as possible.
Because of the wide range in causes, subjective tinnitus is broken up into two categories: otic subjective tinnitus, caused by disorders of the inner ear or the acoustic nerve, and somatic objective tinnitus, caused by disorders outside the ear and nerve, but still within the head or neck. If you have multiple prescriptions, or are being treated by more than one physician, it’s a really good idea to use one pharmacist, the same one, all the time. This is a rare form of tinnitus, occurring in less than 1 percent of cases, and indicates vascular problems within the head and neck.
Compared with tinnitus from other causes, tinnitus due to head or neck trauma tends to be perceived as louder and more severe. We are currently in the process of moving all of the comments from the old system into the new system. This idea has been attempted in the past, but the results have been mediocre at best—often because egos have gotten in the way. My father was the first pro to shoot 59 in a tournament on a par 71 course (Brackenridge Park Golf Club in San Antonio) while playing with Nelson, Paul Runyan, and Ben Hogan. Nearly every day in the winter, my father would leave our house with a bowling bag full of golf balls and one club.
What has happened in the past in hearing healthcare when we have tried to put the three hearing care professionals together in one group is that all the egos involved were so large they got in the way of each other.
The group should be about using all the clubs in the bag—all their unique skills—to their greatest potential.
The “neuroaudiologist” or audiologist, on the other hand, is concerned with the “where” of the patient’s problem, or where in the auditory system the lesion or hearing loss is occurring.


If it does, it is very likely affecting the patient’s hearing, resulting in a high frequency hearing loss (or a low-frequency loss that falls off at the high end). It is the audiologist who will use the hearing tests and behavior the patient reports (ie, understanding speech or hearing in the high frequencies) to figure out the type of hearing loss.
This ability to locate the hearing loss in the anatomy and also identify the type of the hearing loss is a unique skill of the audiologist. It’s the hearing instrument specialist’s job to give patients the correct hearing aid for their individual needs and to teach them how to get the most out of the hearing aid. The patient needs to understand from the HIS that every hearing aid will have a different acoustic response, so it takes practice to learn with a new aid.
If a patient reports that things sound uncomfortably loud with a new hearing aid, the audiologist may be able to interpret the problem as recruitment. This is where the combined skills and training of the audiologist and the hearing instrument specialist are truly complementary, because both pros can be involved in providing long-term rehabilitative services for patients.
If every hearing care professional is doing his job right, there are more than enough patients to go around. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Medication interactions will automatically be triggered by a computer system if all your meds come from one place.
It is accompanied by more frequent headaches, greater difficulties with concentration and memory, and a greater likelihood of depression. There, with that club, he would hit every conceivable type of shot—low fades, high draws, line drive rollers, etc—to a specific point on the fairway. Instead of each professional doing his or her best to get the optimum outcome for the patient, they focused on who was the biggest fish in the pond or the most important. The more uncontrollable or uncontrolled the diabetes is, the more serious the patient’s hearing loss will be. The HIS understands psychoacoustics, the acoustics of audition, loudness, perception of sound, and processing of phonemes through hearing aids.
This is not something you were born knowing, so reading aloud with a new hearing instrument is critical. The audiologist will notify the HIS to get the hearing aid adjusted to correct the problem so it doesn’t stimulate recruitment for that patient.
Further, if each professional can suppress his or her own ego—whether an otologist, audiologist or hearing instrument specialist—then putting this kind of a group together will make each one so busy there is no time to worry about anything else.
It is time to work together to form a collaborative elite team of hearing health specialists and quit handicapping ourselves. In fact, when they asked my father how he shot a 59, he answered, “Well, I missed the putt for 58.” Being a wise-ass runs in our family.
If he didn’t hit these shots perfectly and “on command” to his expectations, the same club went with him the next day, and he did this with each club until he ran through his entire golf bag. If the patient doesn’t have diabetes or symptoms of diabetes, that can be eliminated as a source of the hearing problem. The physician can take that information and decide what the problem is, based on its location in the auditory system. The HIS is the pro on the team who programs the hearing aid, and 90% of the problems with most hearing aids are based on how they are programmed, how they are tuned to achieve a clear intelligible signal in a variety of environments, and the comfort of the devices (physically and acoustically).
For example, my dog’s name might be “Fido” or might be “Phydeaux.” Patients need to use, and listen to, those 44 phonemes through the new hearing aid to be able to assign meaning to what is said, and to be able to hear and understand all of these in various situations.
And it’s not practice that makes perfect; it’s doing the right things—or “perfect practice”—that makes perfect. As explained by Maurice Miller in his article in the March 2015 issue of The Hearing Review, only a small percentage of audiologists are currently applying their skills in rehabilitative audiology for patients, and this audiology service is necessary to providing comprehensive care.
As with great golfers, isn’t it time to forget all the plugged lies and turf battles, and instead start appreciating and using all the clubs in our bag? When the weather turned too cold, he’d hit balls into netting on our front porch—endlessly.




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