How Hearing Works

Normal Ear Function

Sound is transmitted through the air as sound waves from the environment. The sound waves are gathered by the outer ear and sent down the ear canal to the eardrum.

The sound waves cause the eardrum to vibrate, which sets the three tiny bones in the middle ear into motion.

The motion of the three bones causes the fluid in the inner ear, or cochlea, to move.

The movement of the fluid in the inner ear causes the hair cells in the cochlea to bend. The hair cells change the movement into electrical impulses.

These electrical impulses are transmitted to the hearing (auditory) nerve and up to the brain, where they are interpreted as sound.

The Outer Ear

The part of the outer ear that we see is called the pinna, or auricle. The pinna, with its grooves and ridges, provides a natural volume boost for sounds in the 2000 to 3000 Hz frequency range, where we perceive many consonant sounds of speech.

The ear canal, also called the external auditory meatus, is the other important outer ear landmark. The ear canal is lined with only a few layers of skin and fine hair, and is a highly vascularized area. This means that there is an abundant flow of blood to the ear canal. Wax (cerumen) accumulates in the ear canal and serves as a protective barrier to the skin from bacteria and moisture. Ear wax is normal, unless it completely blocks the ear canal.

The Middle Ear

The eardrum, or tympanic membrane (TM), is the dividing structure between the outer and middle ear. Although it is an extremely thin membrane, the eardrum is made up of three layers to increase its strength.

The ossicles are the three tiny bones of the middle ear located directly behind the tympanic membrane. These three bones form a connected chain in the middle ear. One of the bones is embedded in the innermost layer of the tympanic membrane, and the third bone is connected to a membranous window of the inner ear. The ossicles take mechanical vibrations received at the tympanic membrane into the inner ear.

The Eustachian tube is the middle ear’s air pressure equalizing system. The middle ear is encased in bone and does not associate with outside air except through the Eustachian tube. This tubular structure is normally closed, but it can be involuntarily opened by swallowing, yawning, or chewing. It can also be intentionally opened to equalize pressure in the ears, such as when flying in an airplane. When this happens, you might hear a soft popping sound.

The Inner Ear

The inner ear is an organ located deep within the temporal bone, which is the bone of the skull on both sides of the head above the outer ear. The inner ear has two main structures: the semicircular canals and the cochlea.

– Semicircular canals – These structures do not contribute to hearing, but assist in maintaining balance as we move.

– Cochlea – This is the hearing organ of the inner ear, which is a fluid-filled structure that looks like a snail. The cochlea changes the mechanical vibrations from the tympanic membrane and the ossicles into a sequence of electrical impulses. Sensory cells, called hair cells, bend in the cochlea as the fluid is disrupted by the mechanical vibrations. This bending of the hair cells causes electrical signals to be sent to the brain by way of the auditory nerve. The cochlea is arranged by frequency, much like a piano, and encodes sounds from 20Hz (low pitch) to 20,000Hz (high pitch) in humans.

Wax Management

Is My Problem a Result of Earwax?

Too much earwax? One common cause of hearing loss is a buildup of earwax or cerumen.  Earwax protects your eardrum by trapping dirt and debris, preventing it from moving deeper into your ear canal.  Earwax also repels water and acts as a moisturizer. Do you think you have an earwax problem? Do you wonder if you need to get rid of earwax? Clear Ear offers earwax removal services, and we will safely remove earwax in the privacy of our clinic.

Earwax problem? We remove earwax!

Too much earwax can block the ear canal and cause hearing loss.  Impacted earwax must be removed to improve your hearing. Never use cotton swabs, fingernails or other small instruments to remove earwax yourself, you’re likely to make matters worse.  You will push the earwax farther down, making it harder to remove. Please see a professional to determine if earwax is your problem and have it removed.

Too much earwax? How do I get rid of earwax?

Everyone has it, but we don’t always know the best way to get rid of it. In this video the audiologist talks about earwax, aka cerumen, why we have it and how to get rid of earwax.

Earwax removal can be a time consuming process and Clear Ear is here to help make the process a little more pleasant for our patients.

Call us at (904) 247-4327 or make your manual earwax removal appointment today!

Signs of Hearing Loss

What to look for… 

Hearing loss is an insidious health malady in that most people don’t know they’re experiencing it until too late — and even then, they may assume that it’s a temporary problem.

If no single significant event occurred that may have caused a sudden change in hearing ability, it’s typically a slow decline. These are among the most common signs that you or someone you know might have a hearing loss:

• Asking people to repeat themselves often
• Difficulty following conversations that involve more than two people
• Thinking that others are mumbling or speaking quietly
• Difficulty hearing speech in noisy situations
• People commenting about how loud your TV or radio is
• Inappropriate responses during conversation
• Stress from straining to hear what others are saying
• Withdrawing from enjoyable social situations more often
• Family history of hearing loss
• Taking medications that can harm the hearing system
• Diabetes, heart, circulation, or thyroid problems
• History of exposure to loud sounds at work or leisure

Hearing loss is usually gradual, and by identifying these symptoms, you’ve covered step one in the diagnosis process. But only an accurate hearing exam can reveal if you are having difficulty with specific sounds or if your hearing as a whole is suffering. Please contact us today to schedule an exam if you have identified one or more of these common signs of a hearing loss.

Types of Hearing Loss

There are three primary types of hearing loss: Conductive, Sensorineural and Mixed

Hearing loss is described by varying degrees at various pitches and is classified as mild, moderate, moderately-severe, severe, or profound. The volume (or intensity) of sounds you hear is measured in decibels (dB), with 0 dB being the softest whisper and 120 dB being a jet engine. The softest sounds a person can hear are called thresholds. Normal hearing thresholds for adults are considered 0 to 25 dB.

Conductive Hearing Loss

Conductive hearing loss occurs when there is a problem with the way sound is conducted to the inner ear and the cochlea. The problem may lie in the ear canal, eardrum (tympanic membrane), or the middle ear (ossicles and Eustachian tube). The inner ear remains unaffected in this type of hearing loss.

Symtoms of Conductive Hearing Loss:

Individuals with conductive hearing loss may report that sounds are muffled, low or quiet and may describe a plugged or fullness sensation in the ear or head.

Causes of Conductive Hearing Loss:

Some causes of conductive hearing loss can include: Outer or middle ear infections, earwax blockage, deterioration of the middle ear bones (ossicles), otosclerosis (fixation of the ossicles), and perforated tympanic membrane (hole in the eardrum).

Conductive hearing loss may be temporary or permanent, depending on the source of the problem. Medical management can correct some cases of conductive hearing loss, while amplification may be a recommended treatment option in long-standing or permanent cases.

Sensorineural Hearing Loss

Sensorineural (sen-sor-ee-nuhral) hearing loss occurs when there is a problem with the sensory receptors of the hearing system, specifically in the cochlea of the inner ear, typically called a nerve loss. The majority of sensorineural hearing loss occurs as a result of an abnormality or damage to the hair cells in the cochlea. This abnormality prevents sound from being transmitted to the brain normally, which results in a hearing loss.

Symptoms of Sensorineural Hearing Loss:

Individuals with sensorineural hearing loss may report muffled speech, ringing in the ears (tinnitus), difficulty hearing in background noise, and/or complain that others do not speak clearly.

Causes of Sensorineural Hearing Loss:

Some causes of sensorineural hearing loss are congenital (abnormal since birth), damage to hair cells (as a result of genetics, infection, prescription drugs, trauma, or over-exposure to noise), presbycusis (damaged as a result of the aging process).

Sensorineural hearing losses are generally permanent and may stay stable or worsen over time. Routine hearing tests are needed to monitor the hearing loss. Amplification is the most common treatment, which includes hearing aids or cochlear implants in the most severe cases.

Mixed Hearing Loss

Mixed hearing loss occurs when a person has an existing sensorineural hearing loss in combination with a conductive hearing loss. This type of hearing deficit is considered a mix of sensorineural and conductive hearing losses, which means there is a problem in the inner ear as well as in the outer and/or middle ear.

Treatment for a mixed hearing loss may be a combination of medical treatment and amplification (hearing aids).

Tinnitus

Tinnitus is an abnormal perception of a sound, reported by patients as being a ringing, roaring, buzzing, or other type of sound in the ear. With tinnitus, the reported distress is difficult to record and appreciate by others. Tinnitus will not cause you to go deaf, and statistically, 50 percent of patients may express that their tinnitus decreases or is hardly perceptible as time passes.

Tinnitus is a very common disorder, and may be: Intermittent, constant, or fluctuating; mild or severe; varied in nature, from a low roaring sensation to a high-pitched type of sound; and often associated with a hearing loss

Types of Tinnitus

Tinnitus is also classified further into subjective or objective types:

Subjective tinnitus – This is a noise perceived by the patient alone and is quite common.

Objective tinnitus – This is a noise perceived by the patient as well as by another listener. This form of tinnitus is relatively uncommon, and the location of tinnitus may be in the ear(s) and/or in the head.

Tinnitus Causes

The cause of tinnitus may originate from various sites within the ear. The auditory system involves highly complicated inner ear structures, many nerve pathways, and a great amount of nuclei that form a complex neural network. Pinpointing the cause of tinnitus to a certain structure becomes questionable.

There are many other causes related to the ear which would result in tinnitus: abnormal activity in the auditory nerve fibers, chronic cochlear disorders of the hair cells, neurons and cochlear fluids, side effects of medications (such as aspirin or some prescription drugs), ear wax (cerumen), otosclerosis (fixation of the stapes bone in the middle ear), Meniere’s disease, sudden trauma or injury to the head, neck or ear, vascular abnormalities, lesions or tumors.

Diagnosing Tinnitus

If the tinnitus is severe and disabling, a complete cochleovestibular evaluation is necessary by a qualified specialist, specializing disabling forms of tinnitus.

Tinnitus Treatment

Generally, most patients will not need any medical treatment for their tinnitus. For patients who are greatly bothered by tinnitus, they may use masking techniques and other tinnitus treatments, such as: listening to a fan or radio (usually when attempting to go to sleep), a tinnitus masker (electronic instrument resembling a hearing aid), hearing aids (if hearing loss is present), biofeedback and relaxation training, and avoid triggers (i.e. anxiety, fatigue, caffeine, smoking). Prescription medications or homeopathic remedies may be recommended, with varying degrees of success.

Contact Dr. Coughlin at Hearing Care Professionals if you have questions about tinnitus treatment therapy.

Impacts of Untreated Hearing Loss

Are There Consequences Later in Life if Hearing Loss Goes Untreated?

Protecting your hearing is important, as hearing loss is connected to a number of serious health ailments later in life. The relationship between hearing loss and dementia has been established in research, and it’s a close association. There is strong evidence that hearing loss accelerates brain-tissue atrophy, particularly in areas of the brain that auditory nerves would stimulate but can’t because they aren’t receiving a signal (due to a hearing loss). These areas of the brain are also related to memory and speech.

Individuals with a mild hearing loss are also three times as likely to fall down than those without, and the likelihood of falls increases as degree of hearing loss increases. Hearing loss has been linked to a variety of other diseases, such as diabetes, cardiovascular disease, sickle-cell anemia, and other circulatory conditions.

How Loud Is Too Loud?

As a general rule, if you have to raise your voice to be heard over the music or noise, it’s probably too loud and might be on the cusp of damaging your hearing. Things like lawn mowers or heavy freeway traffic tend to hover between 80 and 90 dBs, which is when hearing is at risk of damage. Those who are regularly exposed to noises of 85 dB or more should have their hearing tested regularly to see if the effects of hearing damage are already present.

If you face continuous loud noise exposure in your leisure activities or at work, please contact us for advice on the latest hearing-protection methods that best suit your needs, or to schedule an appointment to be fit for custom hearing protection.

Repeated noise exposure early in life can be compounded as you get older. Since the hair cells in your inner ear never regenerate, your hearing is unlikely to get any better on its own after experiencing repeated traumatic events. Hearing damage suffered during teen years may not surface until your late 20s or early 30s — or even your 50s or 60s, when presbycusis, age-related deterioration of hearing, becomes a greater factor.

How Hearing Works

Normal Ear Function

Sound is transmitted through the air as sound waves from the environment. The sound waves are gathered by the outer ear and sent down the ear canal to the eardrum.

The sound waves cause the eardrum to vibrate, which sets the three tiny bones in the middle ear into motion.

The motion of the three bones causes the fluid in the inner ear, or cochlea, to move.

The movement of the fluid in the inner ear causes the hair cells in the cochlea to bend. The hair cells change the movement into electrical impulses.

These electrical impulses are transmitted to the hearing (auditory) nerve and up to the brain, where they are interpreted as sound.

The Outer Ear

The part of the outer ear that we see is called the pinna, or auricle. The pinna, with its grooves and ridges, provides a natural volume boost for sounds in the 2000 to 3000 Hz frequency range, where we perceive many consonant sounds of speech.

The ear canal, also called the external auditory meatus, is the other important outer ear landmark. The ear canal is lined with only a few layers of skin and fine hair, and is a highly vascularized area. This means that there is an abundant flow of blood to the ear canal. Wax (cerumen) accumulates in the ear canal and serves as a protective barrier to the skin from bacteria and moisture. Ear wax is normal, unless it completely blocks the ear canal.

The Middle Ear

The eardrum, or tympanic membrane (TM), is the dividing structure between the outer and middle ear. Although it is an extremely thin membrane, the eardrum is made up of three layers to increase its strength.

The ossicles are the three tiny bones of the middle ear located directly behind the tympanic membrane. These three bones form a connected chain in the middle ear. One of the bones is embedded in the innermost layer of the tympanic membrane, and the third bone is connected to a membranous window of the inner ear. The ossicles take mechanical vibrations received at the tympanic membrane into the inner ear.

The Eustachian tube is the middle ear’s air pressure equalizing system. The middle ear is encased in bone and does not associate with outside air except through the Eustachian tube. This tubular structure is normally closed, but it can be involuntarily opened by swallowing, yawning, or chewing. It can also be intentionally opened to equalize pressure in the ears, such as when flying in an airplane. When this happens, you might hear a soft popping sound.

The Inner Ear

The inner ear is an organ located deep within the temporal bone, which is the bone of the skull on both sides of the head above the outer ear. The inner ear has two main structures: the semicircular canals and the cochlea.

– Semicircular canals – These structures do not contribute to hearing, but assist in maintaining balance as we move.

– Cochlea – This is the hearing organ of the inner ear, which is a fluid-filled structure that looks like a snail. The cochlea changes the mechanical vibrations from the tympanic membrane and the ossicles into a sequence of electrical impulses. Sensory cells, called hair cells, bend in the cochlea as the fluid is disrupted by the mechanical vibrations. This bending of the hair cells causes electrical signals to be sent to the brain by way of the auditory nerve. The cochlea is arranged by frequency, much like a piano, and encodes sounds from 20Hz (low pitch) to 20,000Hz (high pitch) in humans.

Wax Management

Is My Problem a Result of Earwax?

Too much earwax? One common cause of hearing loss is a buildup of earwax or cerumen.  Earwax protects your eardrum by trapping dirt and debris, preventing it from moving deeper into your ear canal.  Earwax also repels water and acts as a moisturizer. Do you think you have an earwax problem? Do you wonder if you need to get rid of earwax? Clear Ear offers earwax removal services, and we will safely remove earwax in the privacy of our clinic.

Earwax problem? We remove earwax!

Too much earwax can block the ear canal and cause hearing loss.  Impacted earwax must be removed to improve your hearing. Never use cotton swabs, fingernails or other small instruments to remove earwax yourself, you’re likely to make matters worse.  You will push the earwax farther down, making it harder to remove. Please see a professional to determine if earwax is your problem and have it removed.

Too much earwax? How do I get rid of earwax?

Everyone has it, but we don’t always know the best way to get rid of it. In this video the audiologist talks about earwax, aka cerumen, why we have it and how to get rid of earwax.

Earwax removal can be a time consuming process and Clear Ear is here to help make the process a little more pleasant for our patients.

Call us at (904) 247-4327 or make your manual earwax removal appointment today!

Signs of Hearing Loss

What to look for…

Hearing loss is an insidious health malady in that most people don’t know they’re experiencing it until too late — and even then, they may assume that it’s a temporary problem.

If no single significant event occurred that may have caused a sudden change in hearing ability, it’s typically a slow decline. These are among the most common signs that you or someone you know might have a hearing loss:

• Asking people to repeat themselves often
• Difficulty following conversations that involve more than two people
• Thinking that others are mumbling or speaking quietly
• Difficulty hearing speech in noisy situations
• People commenting about how loud your TV or radio is
• Inappropriate responses during conversation
• Stress from straining to hear what others are saying
• Withdrawing from enjoyable social situations more often
• Family history of hearing loss
• Taking medications that can harm the hearing system
• Diabetes, heart, circulation, or thyroid problems
• History of exposure to loud sounds at work or leisure

Hearing loss is usually gradual, and by identifying these symptoms, you’ve covered step one in the diagnosis process. But only an accurate hearing exam can reveal if you are having difficulty with specific sounds or if your hearing as a whole is suffering. Please contact us today to schedule an exam if you have identified one or more of these common signs of a hearing loss.

Types of Hearing Loss

There are three primary types of hearing loss: Conductive, Sensorineural and Mixed

Hearing loss is described by varying degrees at various pitches and is classified as mild, moderate, moderately-severe, severe, or profound. The volume (or intensity) of sounds you hear is measured in decibels (dB), with 0 dB being the softest whisper and 120 dB being a jet engine. The softest sounds a person can hear are called thresholds. Normal hearing thresholds for adults are considered 0 to 25 dB.

Conductive Hearing Loss

Conductive hearing loss occurs when there is a problem with the way sound is conducted to the inner ear and the cochlea. The problem may lie in the ear canal, eardrum (tympanic membrane), or the middle ear (ossicles and Eustachian tube). The inner ear remains unaffected in this type of hearing loss.

Symtoms of Conductive Hearing Loss:

Individuals with conductive hearing loss may report that sounds are muffled, low or quiet and may describe a plugged or fullness sensation in the ear or head.

Causes of Conductive Hearing Loss:

Some causes of conductive hearing loss can include: Outer or middle ear infections, earwax blockage, deterioration of the middle ear bones (ossicles), otosclerosis (fixation of the ossicles), and perforated tympanic membrane (hole in the eardrum).

Conductive hearing loss may be temporary or permanent, depending on the source of the problem. Medical management can correct some cases of conductive hearing loss, while amplification may be a recommended treatment option in long-standing or permanent cases.

Sensorineural Hearing Loss

Sensorineural (sen-sor-ee-nuhral) hearing loss occurs when there is a problem with the sensory receptors of the hearing system, specifically in the cochlea of the inner ear, typically called a nerve loss. The majority of sensorineural hearing loss occurs as a result of an abnormality or damage to the hair cells in the cochlea. This abnormality prevents sound from being transmitted to the brain normally, which results in a hearing loss.

Symptoms of Sensorineural Hearing Loss:

Individuals with sensorineural hearing loss may report muffled speech, ringing in the ears (tinnitus), difficulty hearing in background noise, and/or complain that others do not speak clearly.

Causes of Sensorineural Hearing Loss:

Some causes of sensorineural hearing loss are congenital (abnormal since birth), damage to hair cells (as a result of genetics, infection, prescription drugs, trauma, or over-exposure to noise), presbycusis (damaged as a result of the aging process).

Sensorineural hearing losses are generally permanent and may stay stable or worsen over time. Routine hearing tests are needed to monitor the hearing loss. Amplification is the most common treatment, which includes hearing aids or cochlear implants in the most severe cases.

Mixed Hearing Loss

Mixed hearing loss occurs when a person has an existing sensorineural hearing loss in combination with a conductive hearing loss. This type of hearing deficit is considered a mix of sensorineural and conductive hearing losses, which means there is a problem in the inner ear as well as in the outer and/or middle ear.

Treatment for a mixed hearing loss may be a combination of medical treatment and amplification (hearing aids).

Tinnitus

Tinnitus is an abnormal perception of a sound, reported by patients as being a ringing, roaring, buzzing, or other type of sound in the ear. With tinnitus, the reported distress is difficult to record and appreciate by others. Tinnitus will not cause you to go deaf, and statistically, 50 percent of patients may express that their tinnitus decreases or is hardly perceptible as time passes.

Tinnitus is a very common disorder, and may be: Intermittent, constant, or fluctuating; mild or severe; varied in nature, from a low roaring sensation to a high-pitched type of sound; and often associated with a hearing loss

Types of Tinnitus

Tinnitus is also classified further into subjective or objective types:

Subjective tinnitus – This is a noise perceived by the patient alone and is quite common.

Objective tinnitus – This is a noise perceived by the patient as well as by another listener. This form of tinnitus is relatively uncommon, and the location of tinnitus may be in the ear(s) and/or in the head.

Tinnitus Causes

The cause of tinnitus may originate from various sites within the ear. The auditory system involves highly complicated inner ear structures, many nerve pathways, and a great amount of nuclei that form a complex neural network. Pinpointing the cause of tinnitus to a certain structure becomes questionable.

There are many other causes related to the ear which would result in tinnitus: abnormal activity in the auditory nerve fibers, chronic cochlear disorders of the hair cells, neurons and cochlear fluids, side effects of medications (such as aspirin or some prescription drugs), ear wax (cerumen), otosclerosis (fixation of the stapes bone in the middle ear), Meniere’s disease, sudden trauma or injury to the head, neck or ear, vascular abnormalities, lesions or tumors.

Diagnosing Tinnitus

If the tinnitus is severe and disabling, a complete cochleovestibular evaluation is necessary by a qualified specialist, specializing disabling forms of tinnitus.

Treatment of Tinnitus

Generally, most patients will not need any medical treatment for their tinnitus. For patients who are greatly bothered by tinnitus, they may use masking techniques and other treatments, such as: listening to a fan or radio (usually when attempting to go to sleep), a tinnitus masker (electronic instrument resembling a hearing aid), hearing aids (if hearing loss is present), biofeedback and relaxation training, and avoid triggers (i.e. anxiety, fatigue, caffeine, smoking). Prescription medications or homeopathic remedies may be recommended, with varying degrees of success.

Contact Dr. Coughlin at Hearing Care Professionals if you have questions about tinnitus.

Impacts of Untreated Hearing Loss

Are There Consequences Later in Life if Hearing Loss Goes Untreated?

Protecting your hearing is important, as hearing loss is connected to a number of serious health ailments later in life. The relationship between hearing loss and dementia has been established in research, and it’s a close association. There is strong evidence that hearing loss accelerates brain-tissue atrophy, particularly in areas of the brain that auditory nerves would stimulate but can’t because they aren’t receiving a signal (due to a hearing loss). These areas of the brain are also related to memory and speech.

Individuals with a mild hearing loss are also three times as likely to fall down than those without, and the likelihood of falls increases as degree of hearing loss increases. Hearing loss has been linked to a variety of other diseases, such as diabetes, cardiovascular disease, sickle-cell anemia, and other circulatory conditions.

How Loud Is Too Loud?

As a general rule, if you have to raise your voice to be heard over the music or noise, it’s probably too loud and might be on the cusp of damaging your hearing. Things like lawn mowers or heavy freeway traffic tend to hover between 80 and 90 dBs, which is when hearing is at risk of damage. Those who are regularly exposed to noises of 85 dB or more should have their hearing tested regularly to see if the effects of hearing damage are already present.

If you face continuous loud noise exposure in your leisure activities or at work, please contact us for advice on the latest hearing-protection methods that best suit your needs, or to schedule an appointment to be fit for custom hearing protection.

Repeated noise exposure early in life can be compounded as you get older. Since the hair cells in your inner ear never regenerate, your hearing is unlikely to get any better on its own after experiencing repeated traumatic events. Hearing damage suffered during teen years may not surface until your late 20s or early 30s — or even your 50s or 60s, when presbycusis, age-related deterioration of hearing, becomes a greater factor.