hearing
How do I know if I have a hearing loss?
Hearing loss is common, particularly as you become older. For people over 60 years old, one person in five will have a hearing loss; over the age of 70, one person in three. Most hearing losses develop gradually, making it difficult to self diagnose. As a result, gradually being left out of conversations can create communication problems within families and workplaces, as well as limit social life and educational opportunities.
You may have a hearing loss if you have noticed the following:
- increased difficulty distinguishing speech in noisy environments
- a history of exposure to industrial noise without hearing protection
- a family history of developing a hearing loss
- family or spouse comments on your hearing difficulties
- frequently asking people to repeat themselves
- struggling to understand a whisper or softly spoken person
- struggling to hear conversation from a distance
- increased volume for TV and radio compared to others
- difficulties hearing on the telephone
- missing the telephone or door bell
What are the possible effects of a hearing loss?
- impaired communication with family, friends, at work
- fatigue from the effort of listening
- social isolation
- an increased awareness of tinnitus
- the emotional impact of all the above
Hearing assessment
We carry out a range of hearing assessments. The cost of the assessment will depend on the level of detail required and therefore on the time we spend assessing your hearing. You do not need a medical referral for a hearing assessment.
The results of your hearing assessment will be clearly explained to you, and a detailed report written if required. When the hearing assessment is carried out for a third party, such as an employer or WorkCover insurance company, we will provide you with a copy of the report.
A hearing screening test is a basic test of hearing levels, and requires a 15 minute appointment.
If the hearing screening test shows the presence of a hearing loss, or a drop in hearing levels compared to a previous test, a full hearing assessment is recommended. For a child, a half hour appointment is required. If you have concerns about the way your child is processing or making sense of sound, a central auditory processing (CAP) screening and evaluation can be carried out.
For an adult, a three quarter hour appointment is required for a full hearing assessment. If tinnitus (noises in the ears) is a dominant issue for you, please arrange a tinnitus evaluation appointment, which will often include a hearing assessment if this has not already been carried out.
If you are arranging a hearing assessment appointment with a view to the likely purchase of hearing aids, we request that a one and a half hour appointment is made, but will charge you for one hour. This allows time for:
- loudness discomfort testing (to ensure you have an appropriate level of protection programmed into your hearing aids against intolerably loud sound).
- a detailed discussion of your results, the suitable hearing aid options for you and the level of benefit you can expect from hearing aid fitting.
- if you wish to choose hearing aids at your initial appointment, we will have time to make ear impressions. Many people like time to consider their choice, and you will not be expected to make a decision at your initial appointment.
Wax removal
We have the training and equipment to remove a wax build-up using a probe, as long as it is not too deep in your ear canal. You will need to arrange a quarter hour appointment for this to be carried out. A build-up of wax can affect your hearing. It can cause reduced hearing aid performance; feedback (whistle) from your hearing aid; and damage to your hearing aid.
Customised ear plugs
We provide a range of custom-made ear plugs to fit the unique shape of each person's ear. An initial quarter hour appointment is required to make customised ear impressions. The plugs will be ready in up to two weeks, with a quarter hour appointment required for the fitting of the plugs. This is to ensure they fit correctly and for you to be instructed in correct insertion. The cost of the plugs includes both these appointments.
Customised ear plugs are available to provide:
- hearing protection to high noise levels at work
- hearing protection for musicians
- as swim plugs for water protection. This is recommended for people with a history of ear canal and/or middle ear infection, or if a middle ear ventilation or grommet tube has been fitted. Our swim plugs carry a three month warranty to be waterproof, provided they are inserted correctly and used while swimming at the surface of the water. When diving below the surface, the increase in water pressure will reduce the waterproof fit of the plugs.
Our hearing aid services include:
- fully independent guidance to hearing aid selection
- fitting and fine-tuning of the latest digital hearing aids
- independent evaluation and fine-tuning of your hearing aids
- as many appointments as needed for 12 months after fitting free of charge
- hearing aid cleaning and maintenance
How do I know if I need a hearing aid?
How do I know if I have a hearing loss?
We will advise you if your hearing test results indicate the need for hearing aids.
Regardless of the degree of hearing loss, if you are experiencing significant communication difficulties, there will be a hearing aid suitable for you. If you have tinnitus and a hearing loss, hearing aids will be effective in both the management of your hearing loss and reducing your tinnitus awareness.
Assistive listening devices are available for the telephone, television, doorbells and alarms and can be used either instead of hearing aids or in addition to hearing aids.
Choosing a hearing aid
We take pride in offering a fully independent hearing aid service, so that we can help you choose the most suitable and cost effective hearing aids from a wide range of hearing aid companies. We aim to make hearing aids as accessible as possible by keeping our prices fair, and usually below the industry average. Please refer to our ethical policy for further details.
The advantages and limitations of the range of hearing aids suitable for you will be discussed in detail at your initial appointment. This will help you make an informed choice and have realistic expectations with regards to the level of benefit you can expect. You will not be expected to make your choice at your initial appointment, but you could if you wish to.
Hearing aid technology
Digital signal processing hearing aids are miniaturised computers, and are able to:
- automatically adjust and set the required volume for each sound in your environment - so that you don't need a volume control (unless you want one!)
- highlight speech through competing noise
- provide multiple listening programs to suit different environments such as: speech in quiet, speech in noise, music, telephone, telecoil, FM amplification
- automatically switch between different listening programs, depending on the environment you are in
- provide multiple microphones and adaptive directional listening - where the hearing aid restricts amplification from the noisier parts of your environment
Hearing aids come in a range of technological sophistication, so that you can choose from a basic model to a "top of the range" model. In between these two extremes is a range of models with some of the features listed above.
Hearing aid styles
Each hearing aid model comes in a range of sizes, depending on the extent of your hearing loss, your cosmetic preferences and handling ability. The smallest is the completely-in-the-canal (CIC) hearing aid, which is inserted deeply into the ear canal. The in-the-canal (ITC) hearing aid is slightly bigger and cannot be seen from the front but may be noticed from the side. The in-the-ear (ITE) style hearing aid is bigger than the ITC and fills the bowl of the ear. The behind-the-ear (BTE) hearing aid consists of a customised plastic or silicon ear mould, joined with plastic tubing to the hearing aid which sits behind the ear. A recently developed discreet style of hearing aid is the open fitting miniature BTE with narrow tubing, designed for people with a mild to moderate hearing loss.
The features provided by the hearing aid need to be matched to your individual communication needs and handling ability. People who rarely communicate in high levels of background noise may not need a sophisticated and expensive hearing aid.
The cost of the hearing aids will vary depending on the features provided. Most private health insurance funds will give a rebate for hearing aid fitting under extras cover. An income tax rebate can be claimed for out of pocket health expenses over $1500 per family.
Which hearing aid is right for me?
What can I expect from hearing aids?
We receive many enquiries with regard to effective hearing aid fitting from the medical profession. It seems that despite the technological advances, in the wider community too many hearing aids are used infrequently, often with disappointment at the level of benefit obtained.
With hearing aid technology rapidly changing, we have written an article for doctors focusing on various aspects of successful digital hearing aid fitting including a contemporary update on hearing aid technology.
Digital hearing aids and sensorineural hearing loss - information for the medical profession.
Steps to hearing aid success
Fitting hearing aids
Following the purchase of hearing aids, you will be provided free of charge with as many appointments as needed for 12 months after hearing aid fitting. This allows us time to carry out our approach to hearing aid fitting where you are gently eased into the level of amplification required for optimal speech intelligibility. Over this period, we work closely with you to complete the fine-tuning of your hearing aids.
Fine tuning hearing aids
As computer software and hearing aid technology have become more sophisticated, the skills required by the clinician to carry out effective fitting and finetuning of hearing aids have increased enormously.
We have extensive training, experience and expertise in fine-tuning digital hearing aids to individual communication needs. This enables you to receive the best possible level of speech intelligibility from your hearing aids.
Adapting to hearing aids
Because of the gradual onset of most hearing losses, a person with a hearing loss will slowly change their concept of what "normal" hearing is to them. Additionally, our brain subconsciously selects and highlights sounds that are important to us. Unimportant sounds are heard, but not fully perceived, unless we consciously pay attention to them.
With an initial hearing aid fitting, your concept of "normal" hearing and the process of subconscious selection will need to be relearnt, which can take up to several months. You will notice that unimportant sounds will seem both louder and unnaturally noticeable through your hearing aids at first.
Many people approach hearing aid use as likely to be required on an occasional basis only. However, wearing your hearing aids most of the time will ensure that your concept of "normal" hearing will be successfully redefined. As a result, you will rely on your hearing aids and will find it harder to communicate without them. This is an inevitable part of a successful hearing aid fitting, and does not mean that hearing aid use has aggravated your level of hearing loss.
Hearing Aid Satisfaction Survey
The EarTrak survey is run completely independently of our practice and mailed to clients 3 to 6 months after hearing aid fitting. The responses obtained are confidential and remain anonymous, unless specified otherwise. The survey is designed to give us detailed feedback about our clients' satisfaction with their hearing aids and the services provided by our practice. This allows us to act on any comments made that will guide us to improving our services. It also allows us to compare how our practice is performing compared to the group average of the other participating audiology practices, both in Australia and overseas.
While we do not carry out this survey with all our clients, we are committed to carrying out this survey regularly.
Ongoing successful use of hearing aids
We recommend an annual review of your hearing levels to check for any changes in hearing. In this way, adjustments can be made to ensure your hearing aids keep matching your hearing loss. You are encouraged, however, to arrange a hearing assessment at any time if you suspect a change in your hearing has occurred.
A build up of wax in your ear canals can damage your hearing aids, as well as affect hearing aid performance. An increase in feedback from your hearing aid(s) may indicate that wax removal is required.
Hearing aid maintenance
As part of your hearing aid fitting package, we provide maintenance equipment and information, including a moisture absorbent kit.
We provide all our hearing aid clients with:
- free in-house hearing aid cleaning, using pressurised drying and vacuum suction equipment.
- Minor in-house repairs
- hearing aid accessories at cost price
- bulk discount battery purchase
These services are available without an appointment between 9.00 and 5.00 pm.
Hearing aid repairs are arranged through the manufacturer, with loan BTE hearing aids available for use while your hearing aid is being repaired.
Noise control management
For employees in high levels of industrial noise - that is, in an environment where the noise reaches or exceeds 85 dBA LAeq8h (evaluated by a qualified assessor using a sound level meter) - the employer is required to provide a noise control management strategy. This should include:
- An attempt to reduce the noise levels
- Information and training on noise management to minimise risk of hearing injury
- Hearing protection (in the form of ear plugs and/or ear muffs)
- A hearing screening test as soon as possible after starting the job and then every 2 years
What Are The Noise Dose Limits?
Under the Occupational Health and Safety (Noise) Regulations 1992, employers are required to ensure that employees are not exposed to noise exceeding prescribed noise dose limits.
| dBA sound level | Duration per day |
|---|---|
| 97 | 30 minutes |
| 94 | 1 hour |
| 91 | 2 hours |
| 88 | 4 hours |
| 86 | 6 hours |
| 85 | 8 hours |
Hearing assessment for workplace needs
How do I know if I have a hearing loss? We provide a hearing screening test, which is a basic test of hearing levels. The test results will be explained to the employee, and a report sent to the employer, with a copy provided for the employee.
If the hearing screening test shows the presence of a hearing loss, or a drop in hearing levels compared to the last test, a full hearing assessment is required. As WorkCover accredited audiologists, we are able to carry this out, and will provide a detailed report subsequently, with a copy provided for the employee.
A noise induced hearing loss is the most common cause of tinnitus (noises heard in the ears).
Hearing protection
For employees with normal hearing, there is a variety of hearing protection available in the form of ear plugs or ear muffs. They vary in the amount of protection provided, which should be matched to the noise dose in the workplace. Ear plugs need to fit correctly to be effective. We provide a range of custom made ear plugs to fit the unique shape of each person's ear. These include solid silicon rubber plugs, or hard acrylic "flat attenuation"plugs.
If the noise hazard is moderate (up to 100 to 105 dB leq 8), we can provide "flat attenuation" hearing protection in the form of a custom moulded earplug with an acoustic filter. They are designed to be worn all day and provide a baseline level of protection, with additional protection from ear muffs required for periods of exposure to higher noise levels. They allow easier communication once in place compared to solid earplugs, are easy to fit correctly, have a long life and are very comfortable to wear.
For employees with a hearing loss, there are safety issues in the workplace to consider. The use of conventional ear muffs and ear plugs will distort high frequency sounds, leading to reduced understanding of speech and reduced awareness of high frequency warning signals. Depending on the total noise dose the employee is experiencing, either active noise reduction (ANR) ear muffs or flat attenuation custom ear plugs are recommended.
Hearing protection supply companies, listed in the telephone directory under "Safety Equipment and Accessories", have a range of ear muffs fitted with active noise reduction (ANR) electronics. These are designed to electronically amplify certain sounds, such as voices and warning signals, in a noisy environment. However, they are heavier and cost significantly more than conventional ear muffs.
WorkCover entitlement
The NAL (1988) Binaural Percentage Loss of Hearing guidelines are used to calculate the degree of compensable hearing loss. In the calculation of hearing loss attributable to noise damage, there will be a deduction related to age. Deductions can also made if part of the hearing loss is caused by conditions other than noise exposure. An Ear, Nose and Throat Specialist opinion is needed to determine the percentage of a hearing loss that is related to noise damage.
An employee is entitled to submit a WorkCover claim for a noise induced hearing injury. To obtain financial compensation, as well as hearing rehabilitation, the Binaural Percentage Loss of Hearing needs to equal or exceed 10%. Below 10%, assistance in hearing rehabilitation only is available.
Hearing rehabilitation involves identifying the person's hearing needs and determining how they can best be met.
Hearing rehabilitation following a successful WorkCover claim includes:
- hearing aid fitting. Following a hearing assessment, we advise whether hearing aids are required and will give a recommendation for the type of hearing aids most suitable for the person's hearing loss and communication needs. The hearing aids will be provided and fitted once we have obtained approval from the WorkCover insurance company.
- all hearing aid maintenance costs, such as battery provision and repair costs
- regular hearing re-assessment
- replacement of hearing aids for the remainder of the person's life, whether they are still in the workplace or have retired (under current legislation).
- provision of assistive listening devices, both at home and in the workplace. Assistive listening devices are available for the telephone, television, doorbells and alarms and can be used either instead of hearing aids or in addition to hearing aids.
- provision of devices to support any safety problems that may occur as a result of the hearing loss, such as active noise reduction (ANR) ear muffs, flat attenuation custom ear plugs and supplementary visual warning signals.
- provision of acoustically treated meeting areas with low noise and low reverberation (echo) may be required in the workplace.
Musicians, as well as other workers in the music industry, such as roadies, sound technicians, D.J.'s and bar staff, are regularly exposed to potentially dangerous levels of sound. Musicians in particular are exposed to high levels of sound from participating in recording sessions and rehearsals, as well as from playing and listening to other musicians.
All types of music from rock and roll to classical music pose some risks. An American study indicated peak noise levels of up to 130 dB on stage at rock concerts and 115 dB for the audience. In classical music performances the noise levels on stage can exceed 100 dB. The level of noise in many venues and nightclubs also exceeds these dangerous levels.
Did you know?...
Under the Occupational Health and Safety (Noise) Regulations 1992, employers are required to ensure that employees are not exposed to noise exceeding prescribed noise dose limits.
How do I know if music is too loud?
If you have to shout to be understood when practising, performing or listening to music, the likelihood is that the volume level is potentially damaging. Another indicator is noticing symptoms of temporary damage to your hearing after exposure to loud music. These include:
- tinnitus (ringing in the ears)
- muffled or distorted hearing for voices/music
If temporary damage occurs repeatedly, the damage will become permanent. And having a noise induced hearing loss will not protect you against on-going damage.
The risk of injury varies significantly amongst different performers, depending on the type of instrument(s) played, the degree of amplification used, the position on stage and the type of stage monitoring that is used. For example, drummers tend to have more damage to the ear closest to the crash cymbal, violinists experience more hearing damage on the side they hold the violin, and orchestra members closest to the wind and percussion section are at greater risk. People also vary significantly in their susceptibility to noise induced hearing injury.
What are the effects of noise injury?
How do I know if I have a hearing loss? Apart from the communication difficulties associated with a hearing loss, clear non-distorted hearing is essential to you as a musician. A noise-induced hearing injury also involves:
- A reduced ability to follow changes in the pitch and time pattern of sounds
- A distortion in the relative loudness of sounds
- The risk of acquiring persistent tinnitus
What Should I Do?
In an ideal world, the problem should be easily resolved by just turning everything down. But, in the real world, many patrons and therefore promoters expect the music to be at high volume levels for full enjoyment. If you are exposed to sound at that volume level for more than a few hours per week, you are at risk of hearing damage.
As a musician you may not be able to change these expectations. You can, however, reduce your own risk of noise induced hearing injury by controlling your level of noise exposure when performing and when practising.
How can I protect my ears?
Musician's Ear Plugs
An American company called Etymotic Research has developed a range of personalised ear protection specially designed for musicians, which we can provide for you. These earplugs have a flat frequency response, which significantly reduces the high frequency distortion found with solid plugs, typically used with industrial noise protection. Additionally, they have a bore or open channel reducing the occlusion (blockage) effect experienced with solid plugs. As a result, they provide attenuation (reduction) of sound without sacrificing the quality of music. They also reduce the feeling of detachment from other band members and the audience often noticed with solid plugs.
Because they are custom-fitted deep within the ear canal and include a passive filtering device, the ER 15 (15 dB attenuation - suitable for classical musicians) and ER 25 (25 dB attenuation - more suitable for rock/jazz musicians) are comfortable to wear yet allow natural sound perception. Personal ear protection, compared to radio-monitors, is relatively cheap, can be used in any environment and doesn't require the co-operation of other band members.
Radio Monitors
Another way of limiting the level of on-stage noise is an in-the-ear monitoring system, where your own vocal and instrument monitoring is fed directly to you via a radio signal to a small receiver worn in the ear. The level of sound in your ear can be controlled and noise levels on stage substantially reduced.
While these systems are very good at reducing the risk of hearing damage, they are expensive, and tend to be used only by financially successful groups. Often hearing injury has occurred prior to commercial success.
How we can help
If you recognise any of the signs and symptoms of noise-induced hearing injury, contact us for a detailed hearing assessment. We can advise you about hearing conservation and ear protection measures that are appropriate for your needs.
The risk of damage varies significantly amongst different types of performers. Regular monitoring of your hearing is recommended to evaluate the effectiveness of your personal hearing conservation program.