All About Your Audiology Appointment- Episode 7
Welcome back to the All About Audiology podcast, the podcast that’s well, all about audiology. I’m your host, Dr. Lilach Saperstein. I’m an audiologist who’s passionate about this field because it makes a difference in people’s lives. Understanding how our hearing works, what kind of hearing loss people have and how that effects their communication is the reason I am making this podcast. It’s important to understand what your needs are so that those needs can be met. And it’s especially important if that person is your child or your spouse or your parent, and that’s why I make these episodes.
In the last episode we talked all about hearing loss and it got a bit technical for some of you. But I hope that the information was useful in understanding that if there is damage to the different parts of the ear, it corresponds with different kinds of hearing loss which means that treatments are going to be different. We also talked a little bit about of how there are different levels of hearing loss and that means that different people have different experiences with hearing loss.
Today’s topic is all about, “What to expect at your audiology appointment”. In this episode we are going to be talking about adults and in the next episode we’ll talk about how this appointment is very different for children. So today I’m going to walk you through the different parts of a typical audiology appointment when you’re coming in for your hearing test. There are also different kinds of appointments and we’ll talk about those at the end but in general if you are coming in to an audiologist it’s going to be for a comprehensive, audiological evaluation or a full hearing test.
First and foremost, the audiologist is going to ask you many questions. Sometimes, these questions come in a form when you first come in, an intake form on paper or they’ll ask you the questions in person. What the audiologist is doing is getting a medical history, and specifically a history of your hearing issues or communication trouble, any specific history that’s affecting the head and neck, ear, nose and throat, and talking about your current symptoms.
After a thorough history the audiologist is going to look into your ears with a light, the otoscope, checking the health of the outer ear, the ear canal and looking at the ear drum. Now, for the rest of the testing there is going to be two different kinds of testing. Some are automatic tests that you don’t need to do anything for, just different measurements of your ear and different ways that we can test your hearing without your participation. The second kind is the kind where your participation is required, where you are asked to raise your hand when you hear a sound, a beep or a tone. This kind of testing is done in a sound proof booth and we make sure no other sounds are interfering with the tests from the environment. We do have both of the different kinds of tests because we are getting a full picture and everything needs to match. The audiologist is putting all the different pieces together, like a puzzle and seeing where the breakdown is that needs to be consistent across the different kinds of tests.
As discussed in another podcast, in regards to raising your hand during the test, you absolutely will not be able to hear every single beep that’s presented. That’s actually the point of the test. It’s supposed to be softer than what you are able to hear. We are trying to find your threshold, what’s the softest sound that you can hear. So when you are in there, try to relax and do your best. Every time you hear a sound, raise your hand. And if you’re not sure, you can also raise your hand and wave it around or make a facial expression that shows you think you heard something but you’re not sure. Your audiologist is watching you. They’re watching your face, watching your hesitancy and that’s also giving them information. So just be honest, your audiologist can hear you on the other side of the booth. They’ll give you directions. If you are raising your hand too often when there is no sound, called a false positive, then they’ll just let you know. Really, just wait until you are sure you hear a sound. Almost everyone who is in the sound-proof room and doing the hearing test has some false negatives and some false positives and it’s also controlled for in the testing method.
Besides for having hearing tests where you either insert earphones inside the ear or headphones that go around your ear, you’ll also have bone conduction testing. We put the bone oscillator on the hard part of bone right behind your ear that’s called the mastoid process and it’s part of your skull. When we put the bone oscillator on there, we’re actually directing the sounds straight into the cochlea through bone conduction, through the movement of the bones of your skull and into your temporal bone where the cochlea is. That’s how we are able to test the hearing of the cochlea skipping the outer and middle ear, bypassing any of the conductive pathway.
Now for some people, especially if there’s conductive hearing loss or if there’s a difference between the ears, where one ear is better than the other, than you might also experience this other part of the test, called masking. During masking you have one earphone in and the bone oscillator in, and through the earphone there’s a “shh”, a static or white noise that’s coming in through one ear, while you have to listen out for the beeps and raise your hand for the beeps while that “shh” sound is going on. What’s essentially happening is that we are keeping one ear busy and this is equivalent to covering one eye while you are testing the other eye in an eye exam. This is kind of like covering one ear with that sound so that we can test the other ear. This is because sounds actually cross over from one ear over to the other ear and we want to isolate each ear when we are testing in that way.
Another part of the hearing test is where you will have to repeat words backwards. This part is supposed to be difficult. The words are first presented at a volume that’s loud enough for you to hear so you know what the words are, words like ice cream, baseball, toothbrush, and popcorn. After these words are presented to you they are going to start getting softer and quieter and softer and quieter up to the point where you can’t repeat back the words, we get a threshold for your abilities to repeat backwards. Now, again, it can be very frustrating where you are trying to hear the words and they are just too quiet. A little frustration is going to come with this but that is the point of the test.
There’s also another part of the test with words where you have to repeat back many words that are either said by the audiologist or presented to you on a recording. This is a test of clarity seeing if the sounds are loud enough for you to be able to hear them and are they clear. The score given on this test, called the speech recognition score is given in a percentage. But remember from last time hearing loss is not said in terms of percentages. Sometimes the speech recognition score is used as a way to explain how the hearing is affecting the person. If they, let’s say have a very severe hearing loss and sounds are made very loud, they get a good score of 92 or 86. As opposed to another person who might have a less severe hearing loss, maybe mild to moderate hearing loss and their speech recognition score is maybe 50 or 60 percent. Even when sounds are louder and they are able to hear them, there’s something about the quality of the speech that is degraded because of the kind of hearing loss that they have.
Here are a couple of tips for your audiology appointment. Try to schedule your audiology appointment at your best time or the patients’ best time. For example, if you know that your mom is very groggy in the morning and has a hard time starting the day, and does a little better later on in the morning, don’t schedule the 8 am appointment for her. You want the patient to be ready and calm, not tired or distracted. The same goes for you if you have a super long day at work and you are going to come to an audiology appointment after work very tired and not at your freshest, it might affect your experience. This is not a pass / fail test. The hearing test is there to find out what’s going on specifically, what’s your hearing ability and what communication difficulties are you having. At the end of all this testing, you’ll be brought into review the results with your audiologist and they’ll talk to you about any course of action they recommend.
Until now we have been talking about a hearing test or an evaluation appointment, also known as a diagnostic appointment. But you can have all different kinds of appointments with your audiologist, such as coming in for a hearing aid evaluation where you can discuss if you can benefit from hearing aids or other assistive devices. If you do choose to go that route then there will be fitting appointments where the hearing aids will be programmed and set specifically to your hearing loss. It’s very important to know that hearing aids are not a quick fix for hearing loss as we have discussed in past episodes. Sometimes people think they will go in for a hearing test and that same day they will walk out with a “solution”. The process will likely take more than just one appointment. There are many considerations that have to be taken into account.
Even after a person does get a hearing aid it can take several days, if not a few weeks to get used to the hearing aids and during that time you will have follow up appointments for fine tuning of the settings. We want to make sure that sounds are both comfortable, not too amplified, loud or jarring, but also to make sure that they are audible so that the hearing aids can do what they are meant to do and make things louder so the person can hear them. We have verification testing that will ensure your settings are giving you different amounts of amplification for different sounds, so that soft, medium and loud sounds are different to you.
Let’s talk about the concept of dynamic range. When a person has typical, normal hearing their dynamic range is very wide. That means we can hear very soft sounds, medium sounds and louder sounds and super loud sounds. We have this big range from very soft to very loud. But when a person has hearing loss and their hearing becomes diminished, then maybe they don’t hear soft or very soft sounds and they only start hearing around medium. So their dynamic range is smaller from medium to loud to very loud sounds. If you can imagine, someone with a severe hearing loss, has a dynamic range even smaller because they are hearing loud to very loud sounds. So when the dynamic range is smaller, the hearing aid comes in to take soft sounds in the environment and make them louder so that they go into the person’s dynamic range so that soft and medium sounds are made louder into the loud and very loud range. But one of the consequences of that is that a lot of sounds are being compressed into this much smaller range. There needs to be a good balance still to maintain the difference between what are softer, medium and loud sounds within a smaller dynamic range.
That’s where a skilled and competent professional is needed to make sure the hearing aid is programmed and that the settings reflect exactly the needs of the user which are individual to each user. Make sure that the audiologist you are seeing makes you feel comfortable, makes you feel heard, and answers any questions that you have. I hope that by talking and thinking about this, your experience at an audiologist office or your hearing test is a little bit more calmer. Just remember that it’s all about you. When you are a patient, the doctor or audiologist or any kind of medical professional is there working for you. They are working to help you make sure that you or your family member are heard, have your questions answered and that you feel comfortable and that you get out of the appointment what you came in to get.
I’d love to hear about an experience you had when you went to get your hearing tested or when you took a family member to get their hearing tested. I’m always excited to hear any of your comments or your questions. Contact me through my website at allaboutaudiology.com or send me a direct message on Instagram @allaboutaudiology podcast. A review on Itunes would mean a lot to the show and any of the comments, questions or feedback you leave for me might make it into our next mini episodes which are all about your comment and your experience with audiology.
On our next full episode we will be talking about how to prepare your child for their audiology appointment and how testing is done for children.
Thank you for joining me for today’s episode. I’m Dr. Lilach Saperstein and you have been listening to All About Audiology.