{"id":316,"date":"2019-07-08T11:51:34","date_gmt":"2019-07-08T17:51:34","guid":{"rendered":"https:\/\/santafeent.fm1.dev\/?page_id=316"},"modified":"2020-01-09T14:56:52","modified_gmt":"2020-01-09T21:56:52","slug":"first-time-visit","status":"publish","type":"page","link":"https:\/\/santafeent.com\/resources\/first-time-visit\/","title":{"rendered":"Your First Audiology Appointment"},"content":{"rendered":"\n<p><strong>Our office\nprovides diagnostic, medical hearing evaluations and state-of-the-art hearing\nrehabilitation hearing aid services through Southwestern Hearing Center. &nbsp;<\/strong><\/p>\n\n\n\n<p><strong>HISTORY\nAND PHYSICAL EXAM<\/strong><\/p>\n\n\n\n<p>So let\u2019s\nbegin the discussion with, \u201cHow do I know I have a hearing problem?\u201d&nbsp; Well, in each our ENT exam rooms there is a\nposter that is titled, \u2018How is your hearing?\u2019.&nbsp;&nbsp;\n<\/p>\n\n\n\n<p>This is\nhow the initial office visit starts \u2013 in fact, both Dr Brown and the Audiologist\ncompleting your hearing test (audiogram) will continue to ask about situations\nthat seem to create your hearing difficulties.&nbsp;\nThis is how we get an idea of how to help you gain back your hearing\u2026\nmore later.&nbsp; We will also ask about a\nvariety of \u2018risk factors\u2019 for hearing loss\u2026 some of these are pretty obvious:<\/p>\n\n\n\n<ul><li><strong>Noise Exposure<\/strong>\u2026 work related noise exposure, use\nof guns without hearing protection, exposure to loud music.&nbsp; (Parents\u2026 if you can hear the music from your\nkids headphones or ear buds \u2013 it\u2019s too loud!!!)&nbsp;\nThis may now be the #1 cause of hearing loss.<\/li><li><strong>Age<\/strong>\u2026 30% of us over the age of 60 will\nhave hearing loss\u2026 and it gets worse as we all get older!<\/li><li><strong>Family History<\/strong>\u2026 your parents give you both the\ngood and the bad!<\/li><li><strong>Medications<\/strong>\u2026 certain antibiotics and cancer\n(chemotherapy) medications are associated with the loss of the inner ear \u2018hair\ncells\u2019 (see below). <\/li><li><strong>Health Conditions<\/strong>\u2026 acute illnesses such as severe\ninfections or trauma may cause hearing loss.&nbsp;\nPoorly controlled high blood pressure, diabetes, and high cholesterol are\nchronic health conditions that create a higher risk of hearing loss.&nbsp; <\/li><li><strong>Outer Ear<\/strong> canal conditions such as recurring\near wax impactions and chronic eczema of the ear canal skin create recurring\nproblems with the sound wave passing to the ear drum.&nbsp; (See ear diagram)<\/li><li><strong>Middle Ear<\/strong> infections prevent the sound wave\nfrom passing efficiently from the ear drum, through the three hearing bones,\nand into the inner ear.&nbsp; (See ear\ndiagram)<\/li><li><strong>Inner Ear<\/strong> conditions such as viral\ninfections that cause the sudden loss of hearing, certain autoimmune diseases,\nan inner ear condition called Meniere\u2019s Syndrome that is associated with\nprogressive hearing loss and episodes of a severe spinning sensation (vertigo)\n\u2013 all can cause permanent loss of the \u2018hair cells\u2019 in the inner ear. (See ear\ndiagram)<\/li><li>\u2018<strong>Brain Problems\u2019<\/strong>&#8230; one way to think\nabout this possible cause of hearing problems is that the ear takes the energy\nof sound waves and creates nerve energy for the brain to use \u2013 but its really\nthe brain that \u2018hears and understands\u2019 the information present in the sound\nwave of speech, music, a car horn, or doorbell. &nbsp;This is such an important health problem that\nI\u2019ve included a separate discussion at the end of this page\u2026 see <strong>\u2018Hearing and the Brain\u2019<\/strong>.<\/li><\/ul>\n\n\n\n<p>Following\nthis initial discussion, Dr Brown will examine your outer ear (auricle), ear\ncanal (auditory canal) and eardrum (tympanic membrane).&nbsp; Many times, I will use an operating\nmicroscope to clean your ear canal of ear wax (cerumen) before I have the\naudiologist complete the hearing test (audiogram).&nbsp; <\/p>\n\n\n\n<p>Before we\nmove into a discussion of how we measure your hearing with an audiogram, I\nthink I should describe the basics of how hearing works. <\/p>\n\n\n\n<ul><li>The\ninformation of sound and speech travels in the energy of a soundwave.<\/li><li>The\nsoundwave travels down your auditory canal to the eardrum (tympanic membrane)\nwhere the energy of the soundwave moves the eardrum back and forth.<\/li><li>The\nmovement of the eardrum is then \u2018concentrated\u2019 by movement of the hearing bones\n(malleus, incus, stapes) down to the inner ear.<\/li><li>Inside\nthe inner ear, the energy within the movement of the hearing bones stimulates\nthe hair cells of the inner ear. These hair cells have the ability to transform\nthe energy in the soundwave into nerve energy that the brain uses for hearing.<\/li><\/ul>\n\n\n\n<p>After both\nDr Brown discusses how your hearing seems to be affecting your day-to-day\nactivities; 2) discusses potential risk factors for your hearing difficulties;\nand 3) examines your ear, you will walk over to the Southwestern Hearing Center\nto have the Audiologist complete a comprehensive hearing test or <strong>AUDIOGRAM<\/strong>.&nbsp; <\/p>\n\n\n\n<p><strong>HEARING\nTEST OR AUDIOGRAM<\/strong><\/p>\n\n\n\n<p>A couple\nof words about hearing tests or audiograms.&nbsp;\nThe actual hearing test is conducted by one of the Audiologists at\nSouthwestern Hearing Center.&nbsp;&nbsp; Our\nAudiologists are healthcare professionals with doctorate level degrees in\ndisorders of hearing and balance. <\/p>\n\n\n\n<p>For\nadults, the audiogram is a graph representing individual<strong> Frequencies<\/strong> (cycles of sound\/second) of sound that a human uses\nfor speech compared to the <strong>Hearing Level<\/strong>\n(decibels) of how loud the speech has to be for a human to hear the sound.&nbsp; (Note: there other kinds of audiograms the\nAudiologist will use for infants and children younger than 5 years of\nage.)&nbsp; In order to understand the\ninformation on an audiogram, let\u2019s look at an <strong>\u2018Audiogram of Familiar Sounds\u2019<\/strong>:<\/p>\n\n\n\n<ul><li>Notice\nthe frequencies of familiar sounds of our environment compared to how loud these\nsounds usually are in our day-to-day activities.&nbsp; For instance, a loud rock and roll band is at\n120 decibels.<\/li><li>Notice\nthe frequencies of individual speech sounds\u2026 f, s and th sounds are consonant\nsounds of speech at the \u2018higher\u2019 frequency of 4,000 Hz and usually \u2018quiet\u2019\ndecibel level of 20 dB.<\/li><li>Notice\nthe grey shaded \u2018speech banana\u2019 that represents the frequency and hearing level\nfor normal human conversation.&nbsp; This\nspeech banana is what we compare to your own audiogram.<\/li><\/ul>\n\n\n\n<ul><li>This\nis an actual audiogram from our office showing normal hearing.&nbsp; Note the markings for the right ear (O) and\nthe left ear (X).&nbsp; Again, it represents a\ngraph of how loud the sounds and speech need to be for you to be able to hear\nthem for the frequencies of speech.&nbsp; 0 dB\nis \u2018quiet\u2019 and 120 dB is really loud; for the frequencies, 125 is a low\nfrequency sound (vowels), and 8,000 (8k) is a really high frequency sound\n(consanants).<\/li><li>Also\non this graph is the \u2018speech banana\u2019 (irregular box shaped area) mentioned\npreviously\u2026 this is the range of normal conversation.<\/li><li>The\nother important addition to audiogram is the \u2018Speech Discrimination\u2019.&nbsp; This is measure of how well your brain\nunderstands speech.&nbsp; It\u2019s not a perfect\ntest, as it measures only the percent of words you understand in the quiet of a\nhearing booth\u2026 it doesn\u2019t measure what happens in the conversations of a party or\nin the loud background noise of a restaurant.<\/li><li>Lastly,\nnote the markings of Normal, Mild, Moderate, Moderate-to-Severe, Severe and\nProfound on the left side of the graft.&nbsp;\nThese represent the \u2018Levels of Hearing Loss\u2019 present for everyday sounds\nand speech.<\/li><\/ul>\n\n\n\n<p>After the\nAudiologist completes your audiogram you will return back to Dr Brown to discuss\nyour audiogram.<\/p>\n\n\n\n<p>&nbsp; The audiogram will likely show four possible\npatterns:<\/p>\n\n\n\n<ul><li><strong>Normal Hearing<\/strong> as shown by the first audiogram.<\/li><li>Problems\nwith the outer\/middle ear function, where the auditory canal, eardrum or\nhearing bones are not able to effectively conduct sound to the inner ear.&nbsp; Reasons for this type of hearing loss <strong>(conductive hearing loss)<\/strong> would be ear\nwax in the auditory canal; fluid behind the eardrum; a perforation of the\neardrum; fixation of hearing bones from scar tissue of recurring ear\ninfections.&nbsp; Most of these conditions can\nbe managed by medications or surgery.<\/li><li>Problems\nwith the inner ear function, where the inner ear is not able to take the energy\nin a sound wave and create nerve energy for the brain to use for understanding\nsound and speech.&nbsp; The most common\nreasons for this type of hearing loss <strong>(sensorineural\nhearing loss)<\/strong> would be age, genetics, and excessive noise exposure.&nbsp; This type of hearing loss can be improved by\nthe use of hearing aids.<\/li><li>A\ncombination of the last two\u2026 having both a conductive and sensorineural\nproblem.<\/li><\/ul>\n\n\n\n<p>However,\nover 90% of the patients we see will have problems of the inner ear\u2026 usually\ndue to the combined effects of aging, genetics and noise exposure.&nbsp; <\/p>\n\n\n\n<p><strong>HEARING&nbsp; AND THE BRAIN<\/strong><\/p>\n\n\n\n<p>I would\nlike to finish this introduction to hearing loss with a brief discussion of one\naspect of hearing loss that is not widely appreciated \u2013 the association of\nage-related hearing loss (presbycusis) with dementia.&nbsp; Two points:<\/p>\n\n\n\n<ul><li>Hearing\nloss is known to cause individuals to isolate themselves from family and\nfriends.&nbsp; This loss of social engagement\nand resulting depression is a major problem for those of us trying to maintain\ngood health as we age.&nbsp; <\/li><li>Individuals\nwith a mild hearing loss have twice the risk of developing dementia; those with\nmoderate hearing loss have three times the risk of developing dementia; and\nthose with severe hearing loss have five times the risk of developing dementia.<\/li><\/ul>\n\n\n\n<p>So, how\nare age-related hearing loss and dementia linked?<\/p>\n\n\n\n<p>Hearing\nloss is \u2018associated\u2019 with dementia.&nbsp; But,\nthis is different than saying, \u2018hearing loss causes dementia\u2019.&nbsp; At this time, while hearing loss has not been\nshown to cause dementia, a current area of aging and hearing research suggests\nthat hearing loss makes the brain use its \u2018cognitive reserves\u2019 in its effort to\nunderstand the world around us.&nbsp; In other\nwords, hearing loss makes our brain work extra hard to understand what is going\non in our immediate surroundings.&nbsp; But as\nour brain does all this extra work associated with our hearing loss, we damage\nother brain functions such as memory and the ability to interact socially.&nbsp; The end result of combining hearing loss with\naging and dementia is that we pull away from world \u2013 social isolation leading\nto depression and loss of our family and community connections.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Our office provides diagnostic, medical hearing evaluations and state-of-the-art hearing rehabilitation hearing aid services through Southwestern Hearing Center. &nbsp; HISTORY AND PHYSICAL EXAM So let\u2019s begin the discussion with, \u201cHow do I know I have a hearing problem?\u201d&nbsp; Well, in each our ENT exam rooms there is a poster that is titled, \u2018How is your&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":113,"menu_order":70,"comment_status":"closed","ping_status":"closed","template":"","meta":{"schema":"","fname":"","lname":"","position":"","credentials":"","placeID":"","no_match":false,"name":"","company":"","review":"","address":"","city":"","state":"","zip":"","lat":"","lng":"","phone1":"","phone2":"","fax":"","mon1":"","mon2":"","tue1":"","tue2":"","wed1":"","wed2":"","thu1":"","thu2":"","fri1":"","fri2":"","sat1":"","sat2":"","sun1":"","sun2":"","hours-note":""},"service_tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Your First Audiology Appointment - David R Brown MD Ear, Nose and Throat<\/title>\n<meta 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