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Hearing loss can happen at any age. In fact, nearly 12 percent of kids age 6 through 19 have noise induced hearing loss according to the American Academy of Audiology. Of all birth defects, hearing loss presents itself more often than any other congenital defect in the United States. In fact, the American Speech and Language Association reports that approximately 12,000 babies are born each year with hearing loss.Kids with hearing impairment can benefit greatly from early diagnosis and treatment. – Early identification and assessment of hearing losses is vital. Studies have shown that infants whose hearing loss is detected after 6 months of age did comparably worse on language skill development compared to infants where the loss was detected and treated before 6 months.Childhood hearing losses aren’t necessarily lifelong.– Not all hearing loss is the result of a long term permanent defect. Minor conditions such as a build up of earwax or an infection could cause reversible hearing loss. Some conditions resulting in hearing loss are temporary and can be resolved with medical treatment or minor surgery. Ear infections left untreated could cause permanent hearing loss, so be sure to seek medical attention right away when there is a possibility of ear infections.Some hearing loss can be prevented. – You may not realize that noise related hearing loss is very common and it can be avoided all together. Using protective ear plugs or ear muffs is a must for protecting kids from noise induced hearing loss. Also, parents should lower the volume on stereos and other electronics.Hearing loss may delay your child’s ability to learn normal language skills. – Children learn more about language from birth to 3 years of age than they do at any other time in life because during that time the brain is more receptive to learning language. Young children need to have proper hearing function in order to develop normal speech patterns. In order for children to learn proper reading skills, they must first develop good language skills.Hearing loss signs and symptoms are often times initially observed by parents. – In many instances parents are the very first to notice something is not quite right in young kids with hearing loss. Signs to watch for include: response to music and making jabbering sounds. Around 9 months of age kids should be repeating back sounds and should also understand some simple phrases and commands. For a more in depth list of normal milestones for babies and young children to assess possible hearing loss, ask your hearing specialist or audiologist. Be sure to find out about recommended screenings as well.

Nearly all public places and businesses have modified their buildings for accessibility to wheelchairs, an extremely visible disability, but may be unaware of the less obvious challenges confronted by people who have hearing loss. Installing a hearing loop clarifies speech and other sound for patrons with telecoil compatible hearing aids, is less expensive than other modifications and may increase visitors or customers. If you or your loved ones notice that hearing the goings-on at venues you visit regularly is a difficult task, you can help instigate positive change.Churches, synagogues & mosques. Few places of worship have modern hearing loops installed. Many don’t have any assistance for the hearing impaired. Others are using outdated technology that is not convenient or hard to use. If this is the case, let the leadership team know of the advantages of this type of system, such as using a telecoil to hear the sermon clearly through your own hearing aid or implant. Outline the idea in a page of your weekly bulletin or community newsletter.Theatres, auditoriums & athletic arenas. In the United States, it is a legal requirement for pubic assembly spaces to have audio amplification. A hearing loop is an easy way for a venue to comply with this law. To promote this need, you can write to or meet with the people in charge of these public spaces and business to explain the need and benefits. For example, accommodating the hearing challenged will increase the number of visitors in these places.Information to share. When you approach the managers of these venues, you’ll want to be prepared with information so you can build understanding and awareness. You’ll probably need to start at the beginning by explaining what a hearing loop system is and how it works. You’ll want to have some ballpark figures on cost. Have a prepare list of benefits from the patron’s perspective and the venue’s perspective. Explain to them the benefits of their increased business. Even if they don’t engage in the concept the first time, make yourself available as a resource for additional information and inquire if you can touch base with them every few months to continue the conversation.

If you’re using or considering purchasing a hearing aid with a telecoil function, you might be curious about what it does. This tiny coil of wire may seem simple, but the advantages it can provide to individuals who use it are manifold. This short article explains the fundamentals of what a telecoil is and how it operates to improve your hearing ability.Telecoils inside hearing aids detect magnetism. Standard microphones and amplifiers in hearing aids amplify all the sounds that they encounter, but a telecoil only transfers magnetically created sounds. The telecoil was first introduced to enhance listening ability on the telephone. Older telephones used highly effective magnets in their speakers, generating magnetic signals that telecoil-equipped hearing aids could pick up on. Modern phones don’t naturally create these signals, but many are equipped with supplemental electronics that make them telecoil compatible.The telecoil feature isn’t just used in phones. Many public places, including auditoriums, stadiums and movie theaters, are equipped with Assistive Listening Systems that employ telecoil technology. You may find that a venue will offer you a headset to assist in transmitting these signals. Users often say that the clarity of the sound they pick up magnetically surpasses the sound quality transmitted through the air acoustically.The way you use your telecoil will vary depending on the age, type and size of your hearing aid. The telecoil function is more prevalent in larger hearing aids, including those with a case that fits behind the ear. Older hearing aids can be switched between telecoil and non-telecoil modes using a physical switch on the device. Newer models are often pre-loaded with program modes, allowing the user to switch on their telecoil by pressing a button on the device or on a remote control.You may have learned about interference when using a telecoil: it can happen, but it’s uncommon. You may notice a buzzing sound that grows louder the closer you get to a CRT computer monitor, old fluorescent light, or another cause of interference.The rare interference is the only downside to telecoils. They are really wonderful additions that offer many added benefits. Telecoils are generally inexpensive and well worth including in any hearing aid.

Whenever a sound wave strikes your ear, miniature nerve endings in your inner ear translate them into electric signals that your brain understands as sounds. If these nerve endings are destroyed, or if damage occurs in other areas of the inner ear,sensorineural hearing loss can result.A person who is suffering from sensorineural hearing loss is not necessarily completely deaf. In fact, in many instances only particular sounds become hard to hear. An individual affected by sensorineural hearing loss make claim that some sounds are actually too loud while other sounds are muffled and indistinct. Noisy conditions can make it difficult for you to single out speech patterns. Men’s voices frequently sound clearer than higher-pitched women’s voices and following conversations with several speakers is particularly difficult. Individuals with sensorineural hearing loss may also find themselves feeling dizzy or experiencing ringing in the ears.Sensorineural hearing loss can be caused by a number of factors. In some cases the individual has this problem from birth. Congenital sensorineural deafness can be caused by genetic syndromes, as well as by infections that can pass from mother to infant..Sensorineural hearing loss that starts later life can have many different underlying causes. Acoustic trauma, contact with an exceedingly loud noise, can lead to this issue. Steady exposure to lower level noise, such as listening to loud music or working with noisy equipment, can also lead to inner ear damage.Sensorineural hearing loss can come on suddenly, such as in the case of viral infections. These infections include measles, meningitis and mumps. Meniere’s Disease, a syndrome that causes vertigo, hearing loss and tinnitus, can also lead to fluctuating sensorineural hearing loss. Both conditions can potentially be treated with corticosteroids.Abrupt changes in air pressure and head trauma can cause sensorineural hearing loss, as can other physical issues such as tumors. Otosclerosis, a hereditary disorder in which a bony growth in the middle ear disrupts hearing, is another physical cause of sensorineural hearing loss.While sensorineural hearing loss can have a profoundly negative effect on your quality of life, there are treatment options available.

Excerpt: “Because tinnitus is such a widespread issue in the U.S. and in Phoenix in particular, the audiologists at Arizona Balance & Hearing Associates are regularly researching new treatments. Tinnitus research is a very active field with many studies and research trials conducted each year.”Read full press release at: https://www.prweb.com/releases/tinnitus-treatment/phoenix/prweb11666130.htmDownload PDF: Click Here

Shopping for hearing aids will expose you to a variety of styles, including receiver-in-canal (RIC). The receiver in canal hearing aid shares numerous benefits with behind-the-ear (BTE) hearing aid while possessing some distinct advantages unique to the receiver in canal. This short article explores some of the main pluses and minuses of the RIC hearing aid style.Many readers will be familiar with behind-the-ear and in-the-ear hearing aids where all the components are housed inside a single case. RIC hearing aids, on the other hand, separate the components into two major sections. A case behind the ear holds the aid’s amplifier and microphone, while a small bud that contains the receiver is used inside the ear canal. A small tube connects the receiver to the case.Separation of the receiver into its own compartment has several advantages. Feedback and occlusion tend to be much less of a problem with RIC devices than they are with other hearing aids. Listeners also enjoy a more natural sound, making the listening experience much more comfortable. This type of device a great choice for listeners with mild to moderate hearing issues because it amplifies high-pitched tones exceptionally well.The physical configuration of RIC devices also provides a number of advantages. Separating the two components allows the device to remain very small, making it unobtrusive and easy to hide. This small size also makes it very comfortable and easy to fit.RIC devices do have several disadvantages. Compared to other types of hearing aids, RIC aids are particularly vulnerable to moisture in the ear, necessitating frequent repairs. Because they are so comfortable they are actually easier to lose: if you are not used to feeling them in your ear, you may not notice when they are gone. Lastly, this style of hearing aid is often higher in price than its cousins, so some shoppers may have difficulty fitting them into their budgets.Receiver-in-ear hearing aids do have their flaws, but their numerous advantages make them a worthwhile choice for many listeners. Seeking the advice and assistance of a hearing specialist is the next step in selecting the best hearing aid for your hearing loss and lifestyle.

Hearing someone who is seated next to you in a silent room is not the same thing as following a lively conversation around a busy restaurant table. The majority of digital hearing aids can adjust to different conditions like these by using a variety of “listening programs”. Having access to multiple listening programs helps to ensure that you can hear at your best whatever situation you are in.When you first receive your hearing aid, your hearing professional will program your device with an external computer. This process allows a number of individual processing characteristics to be fine-tuned into a number of distinct listening programs. When you start wearing your device, these programs can be accessed manually or automatically to match whatever situation you find yourself in.Today’s hearing aids are quite powerful, and many are capable of running a wide variety of listening programs. Some programs work to reduce background noise, eliminate feedback or shift higher-frequency sounds into a more comfortable range, while others are designed to make speech patterns easier to identify. These are just a few of the programs you can take advantage of – talk to your hearing professional to find programs that are most relevant to your situation.The method you use to access these different programs varies from device to device. Some hearing aids are sold with a small external controller that allows you to switch from program to program as well as access other features. You may be able to switch from program to program via a small switch, or your device may determine the best program for the situation without requiring your input.Young children with hearing issues may be good candidates for hearing aids with multiple listening programs. Having a number of available programs allows parents to quickly find a setting that is most comfortable for their child. This can help audiologists determine what settings will lead to the best hearing experience for the child.The additional flexibility and convenience that come with multiple listening programs helps hearing aid wearers achieve a more comfortable listening experience.

Tinnitus (ringing in the ears), vertigo (dizziness) and intermittent hearing loss are three of the more discernable indications of a condition called “Meniere’s disease”. Meniere’s disease is an inner ear condition that may cause disruptions in your hearing and balance.Although science has not yet discovered a cure for this disorder, there are several things you can do to decrease its symptoms and lessen its effect on your day-to-day life.Many people experience Meniere’s disease symptoms in episodes. An episode may begin with a feeling of fullness in the ear accompanied by tinnitus and a decrease in hearing. Vertigo is likely to come next, causing you to feel as though the room is spinning around you. You may feel nauseated and your balance may be impaired. Episodes vary in length, sometimes ending as quickly as twenty minutes or lasting for hours.Many people who suffer from Meniere’s disease experience several such episodes in a short period of time with long periods of ‘remission’ in between. The frequency and severity of each symptom can vary from episode to episode. Vertigo can sometimes signify a more serious condition, so be sure to check in with your doctor if you find yourself experiencing this symptom.There is no clear cause of Meniere’s disease, but researchers theorize that abnormalities in the volume or composition of fluids in the inner ear may be to blame. Scientists have discovered that the amount and pressure of fluid in the inner ear is critical to your hearing and balance. Allergies, head trauma, improper drainage, and viral infections may act as triggers for these fluid abnormalities.While there is no known way to cure Meniere’s disease, you do have options when it comes to managing its symptoms. If you experience nausea during episodes of vertigo, your doctor may prescribe medications to help you feel more comfortable. Physicians may also prescribe drugs that reduce fluid retention as a way to control the disorder. Rehabilitation and hearing aids can help manage vertigo and hearing loss. The effects of vertigo may also be lessened by sitting or lying down as soon as possible after an episode starts and by avoiding triggers that seem to make vertigo symptoms worse.Meniere’s disease does carry some uncomfortable symptoms, but with the help of your doctor it does not need to significantly disrupt your life.

Hearing aids are extremely effective at enhancing a person’s ability to hear, but when worn in a crowded atmosphere they can quickly bombard the listener with unwanted noise. Auditoriums, concert halls, theaters, and places of worship are especially tricky for the hard of hearing. Hearing loop systems offer a straightforward solution to this dilemma, making it very easy for individuals with hearing aids to enjoy movies, sermons, concerts, and other oral presentations without distraction.Hearing loops are a relatively simple bit of technology that works in conjunction with the telecoils that are installed in many modern hearing aids. Originally, the telecoil feature was used primarily to pick up on magnetic signals created by telephones. This allowed the wearer to easily listen to telephone conversations without distraction from background noise. Hearing loop systems use this same concept but on a larger scale, creating magnetic signals that anyone in the area with a telecoil can pick up on.The first part of a hearing loop system is an audio input, often from a PA system or a dedicated microphone feed. This audio signal is fed into a hearing loop amplifier, which drives a current through a cable (or series of cables) looped around the room. Properly installed loops do not have dead zones, which means that anyone with a telecoil who is inside the loop can pick up on the transmitted audio.While newer technology such as FM transmission neck loops are becoming more established among many establishments, hearing loop systems can still offer a number of advantages to the hard of hearing. Their convenience alone makes them a popular choice among venues and patrons alike. Listeners also appreciate their more subtle nature, which allows them to enjoy a concert, presentation, or worship service without the self-consciousness that can accompany wearing a neck loop.Though no hearing technology is perfect, hearing loop systems offer a huge service to many people, giving many listeners a much more enjoyable experience.

Using ear plugs is one of the simplest things you can do to protect your ears from harmful noise levels. When these small devices are inserted into your ear canal, disruptive or dangerous sounds are blocked out. Shopping for ear plugs can be confusing, as there are a large variety of styles available, but with patience and a little bit of know-how you can find the plug for you.Start by assessing the amount of noise dampening you require. Take a look at the noise reduction rating (NRR) on the box to find out how much sound it cancels out: better quality plugs have a rating between 21 and 33. Think about where you plan to use your ear plugs. For example, you will find that plugs with a lower NRR will be sufficient if you plan to use them to block out traffic noise while working or studying. However, if your profession requires you to spend time around loud equipment or music, a higher rating is more appropriate.The composition of your ear plugs is another important factor to consider. Foam ear plugs are made from a type of memory foam that is inserted into the ear canal. The foam is compressed during insertion then expands to plug the canal. Silicone ear plugs differ from foam in that they are molded over the outside of the ear canal. Both foam and silicone ear plugs need to be replaced periodically.Lastly, evaluate whether you’d be better served with non-disposable, custom ear plugs. You can get away with using a simple silicone or foam plug in many situations, but there are specific plugs made for certain environments. Musicians often wear custom-made, non-disposable earplugs to help protect their hearing while they are performing. These plugs are carefully crafted to fit your ear, allowing you to hear what you are playing while blocking out harmful sounds.Many people shop for earplugs to wear while sleeping to block out the sound of their partner’s snoring. Look for specialized plugs that will block out the sound of snoring while still allowing you to hear your alarm clock, fire alarm, and other important sounds. Try out these plugs with your head tilted to the side. This simulates the changes that take place in your ear canal while lying down, helping you determine whether the plugs will be comfortable while you are sleeping.If you take the time to really think about what you need your earplugs for, you should not have any problems finding a pair that suits you.

You’ll probably be exposed to a number of hearing aid styles and features when choosing a device for a loved one or for yourself, and one of the most common is in-the-ear (ITE). In-the-ear hearing aids are a popular choice for individuals with mild to moderate hearing loss. They are custom-made to fit comfortably in the lower portion of the outer ear. What follow is a summary of the advantages and disadvantages of the ITE hearing aid style.Each in-the-ear hearing aid is custom made for the wearer because it must fit the exact shape of your ear. The custom fit is achieved by first creating an ear mold which becomes the template for the device’s shape. By doing so, you will enjoy high quality sound, low feedback, and an extremely comfortable overall experience. Unlike behind-the-ear devices, ITE hearing aids don‚Äôt require any tubes or wires: all the device‚Äôs components are included in a single case. This makes them lightweight and easy to wear.The ITE hearing aid style has certain distinct advantages. It tends to be excellent at handling high-frequency sounds (which is the range where many people have the most significant hearing loss). Unlike a behind-the-ear model, these devices can take advantage of the outer ear‚Äôs ability to collect and focus high frequency sound waves. ITE devices are also recessed far enough into the ear that headsets and telephones can usually be used normally. This type of hearing aid‚ small size can be both an advantage and a disadvantage.Their small size keeps them from being very obvious, making them a great choice for listeners who are a little self-conscious about wearing a device. However, this small size also causes a short battery life and keeps them from having all the features found in some other devices. Handling the device and changing the battery inside requires good finger dexterity and eyesight.As with all the hearing aid styles available, in-the-ear hearing aid has both advantages and disadvantages. A hearing aid specialist can help you evaluate your options and make recommendations based on your needs and preferences.

With numerous charitable organizations available to consider, selecting one can feel like an overwhelming task. Selecting which charities to support financial is based on several factors including the cause itself, the reputation of the organization and the intended use of the funds. You can become a part of one of many national and international charity organizations that lend their time and resources to helping those in need of better hearing health.Hearing Health Foundation – Collette Baker Ramsey, a woman who suffered fromhearing loss herself, created Hearing Health Foundation in the 1950s. This organization fosters research to treat and cure hearing loss and promotes the prevention of hearing conditions through public education. Currently, the foundation is researching a cure for tinnitus, which is ringing in your ears that often signals a loss of hearing. There are many ways to help out with this foundation. You can make any cash donations or contribute gifts in the form of stock. You can write and share a personal experience with hearing loss, assist in fundraising, and even name a research grant. For the most up-to-date information of the Foundation’s activities and current needs visit their website at www.hearinghealthfoundation.org.Hearing Loss Association of America – Hearing Loss Association of America (HLAA) prides itself as being the largest national organization for helping people with hearing loss across the U.S. Its mission is to provide resources and support to individuals with hearing loss and their families while educating the public about hearing impairments. HLAA does work on a local, state and national level and part of its mission is to influence legislation that impacts the hearing impaired. You can begin by signing up for their newsletter, becoming a member of the organization, or registering for one of their bi-annual fundraiser walks called Walk4Hearing. Donations are also accepted online at www.hearingloss.org.Starkey Hearing Foundation – As a huge national and global foundation, Starkey Hearing Foundation provides hearing health services in three ways: Hear Now, Listen Carefully, and Hearing Aid Recycling. Anyone can donate new and used hearing aids to the Hearing Aid Recycling program, which gives them to people in need. Hear Now provides financial assistance to U.S. residents in need of hearing aids. The Listen Carefully Program is provides education to youth in schools about the dangers of loud music and headphone use. To get contact details for each organization or to give a monetary gift, visit www.starkeyhearingfoundation.org.

Noise is a fact of modern life. From packed restaurants to sport stadiums to the train station, noise is all around and may become overwhelming sometimes. People who use hearing aids are particularly sensitive to this problem as it becomes difficult to differentiate between meaningless noise and important sound. Digital noise reduction technology embedded inside hearing aids is one approach to combating this problem. It allows the wearer to block unwanted noise and focus on specific sounds.Hearing aids that utilize digital noise reduction technology are able to pick up on the unique differences between speech and noise. In quiet environments, picking up the sounds of speech is easy because they are the primary sounds in the room. Likewise, if you are listening to someone in a crowded room, your device understands that there noise present. Once your device picks up on sounds that may interfere with your ability to follow a conversation, it automatically lowers the volume in the noisy channels.While no hearing aid can completely eliminate unwanted noise, it can go a long way in reducing the frustration brought about by trying to communicate in loud environments. The general consensus among hearing aid wearers with this technology is that speech sounds better and background noise is less overpowering.Users are most pleased with their results when the device is used to counteract a constant background noise. This means that steady sounds such as an air conditioner or engine running are more effectively blocked than dynamic music or a nearby conversation.To make the most out of the digital noise reduction feature in your hearing aid, you might want to consider taking some common sense steps to reduce the noise around you. For example, if you find yourself in a noisy part of a restaurant, ask to be seated somewhere that isn’t quite as hectic.Digital noise reduction technology is not perfect, but it can go a long way in helping to counteract the unwanted noise you encounter in your day to day life.

Dr. Dana Day was featured in Heather Lindsey’s article,Sports-Related Concussions: Call for Hearing Healthcare to Get in the Game in the February 2014 Volume of the Hearing Journal, you can access the article online here as well…

Audiologists have a key position to play in managing athletes who sustain a concussion.

Missing the diagnosis of concussion’s audiologic consequences may delay return to play, work, or other daily activities, as well as increase the risk of depression, sleep disturbances, anxiety, and change in mood or behavior, said Dana Day, AuD, managing member of Arizona Balance and Hearing Associates (ABHA) and an audiologist with Banner Concussion Center and the Central Arizona Center for Therapeutic and Imaging Services (CACTIS) Foundation, which is creating a concussion management program in Phoenix.

Unfortunately, awareness and understanding of the auditory and vestibular side effects of concussion, which can include benign paroxysmal positional vertigo, hearing loss, tinnitus, noise sensitivity, and auditory processing problems, is “still in its infancy,” Dr. Day said.

This information gap may not come as a surprise, given that data on sports-related concussions are lacking overall, especially in younger populations, as noted in the Institute of Medicine–National Research Council (IOM–NRC) report on Sports-Related Concussions in Youth: Improving the Science, Changing the Culture released Oct. 30, 2013.

Approximately 1.6 million to 3.8 million “sports- and recreation-related traumatic brain injuries (TBIs), including concussions and other head injuries, occur in the United States each year,” the report authors noted, citing a 2006 article from the Journal of Head Trauma Rehabilitation (21[5]:375-378 https://journals.lww.com/headtraumarehab/pages/articleviewer.aspx?year=2006&issue=09000&article=00001&type=abstract). However, because athletic concussions are likely underreported, these figures may be higher, they added.

Awareness of the issue has increased, though, and is partly behind a rise in the incidence of sports-related concussion over the past decade, according to the report. For example, the reported number of people age 19 and younger treated in U.S. emergency departments for concussions and other nonfatal, sports-, and recreation-related TBIs increased from 150,000 in 2001 to 250,000 in 2009.

Generally, concussions are more frequent among high school athletes than college athletes in football, men’s lacrosse and soccer, and baseball, according to the IOM–NRC report. Concussion is also more common during competition than practice, except when it comes to cheerleading.

Sports with the highest incidence of concussion include football, ice hockey, lacrosse, wrestling, soccer, and women’s basketball. Concussion rates also appear greater for youths with a history of concussions and among female athletes.

LESSONS FROM MILITARY RESEARCH

While data on the auditory side effects associated with sports-related concussion are limited, Dr. Day noted, audiologists can learn a lot from TBI research in military personnel.

Tinnitus and hearing loss are two of the most widely reported audiologic consequences of traumatic brain injury, said Paula Myers, PhD, chief of the Audiology Section at the James A. Haley Veterans’ Hospital in Tampa, FL, whose comments for this article are based on her research of injuries from blasts or motor vehicle accidents.

In a report on veterans of the Iraq and Afghanistan wars who were evaluated for traumatic brain injury, 59 percent experienced sensitivity to noise, and 66 percent reported hearing difficulty (Brain Injury2012;26[10]:1177-1184) https://informahealthcare.com/doi/abs/10.3109/02699052.2012.661914. Another study of military personnel with TBI found that up to 38 percent complained of tinnitus (J Rehabil Res Dev 2007;44[7]:921-928) https://https://www.rehab.research.va.gov/jour/07/44/7/page921.html.

Following TBI, audiologic sequelae may arise from debris, tears, or external bleeding in the ear canal; a ruptured tympanic membrane or ossicular damage in the middle ear; cochlear damage with or without eighth nerve complex injury; disruption of the membranous labyrinth; or vascular compromise in the inner ear, Dr. Myers said. The temporal bones and central auditory nervous system pathways may also be affected.

A standardized approach to audiological management of TBI patients does not exist because peripheral and central function; speech perception abilities in quiet and degraded conditions; cognition; and emotional, behavioral, and physical health all vary greatly in this population, Dr. Myers said.

However, audiological assessment of mild TBI should begin with a comprehensive case history that includes pre- and post-injury information about physical and cognitive functioning, visual ability, dizziness, and hearing, including tinnitus and exposures to loud noise, she recommended.

Information gathering about traumatic brain injury should focus on the nature of the injury, use of protective gear, loss of consciousness at the time of injury, history of prior head injuries, and current medications, she said.

Patients with mild TBI should then receive an audiologic evaluation with otoscopy, pure-tone audiometric thresholds up to 12,000 Hz or the frequency limits of the individual’s hearing, speech recognition testing in quiet and in noise, a complete immittance battery, otoacoustic emission testing, evaluation for central auditory processing disorders, and electrophysiological evaluation with appropriate referrals to otolaryngology, Dr. Myers said.

Reassessing patients with TBI six months post-injury and annually thereafter—sooner if subjective changes are noted—is advisable due to the potential for latent sequelae, she added.

INVISIBLE INJURIES

One of the greatest challenges for audiologists addressing sports-related concussion is that both audiological problems and brain injuries are not readily visible, Dr. Myers said.

Another difficulty is that auditory symptoms are only one of many sensory problems seen in these patients, Dr. Day said. Testing in a well-lighted room may not be possible due to light sensitivity. Additionally, the optokinetic stimulus itself may induce motion intolerance.

“The audiologist must be able to adjust testing on the fly at times to get the diagnostic information needed,” Dr. Day said.

Lack of awareness is another obstacle to care, she added. While audiologists know mild TBI can cause ossicular bone dislocation, they’re not as familiar with the cognitive and oculomotor aspects of concussion. Consequently, they may assume patients are “not giving their best effort” during diagnosis.

In her clinic, Dr. Day most often sees the audiologic sequelae of tinnitus, noise sensitivity, hearing loss, and auditory processing difficulties.

“These complaints are likely explained by damage to the outer hair cells of the cochlea, damage to the ossicular chain, cognitive deficits in the speed at which auditory information is processed, attention to auditory information, and memory,” she said.

Dr. Day also commonly sees dizziness, vertigo, headaches, and sensitivity to light in her patients.

To provide the best possible evaluation and management of sport-related concussion, audiologists should work with a multidisciplinary team, she said.

This approach is especially useful in patients who continue to experience symptoms beyond a three-month follow-up period. Some individuals “do not get better on rest alone,” she said.

MULTIDISCIPLINARY APPROACH

At Banner Concussion Center and the CACTIS Foundation, the multidisciplinary team includes a physician trained in sports-related injuries and concussions; neuropsychologists familiar with neurocognitive testing; professionals experienced in comprehensive neurovestibular assessment and therapy; providers of vision services, including optometric evaluation and treatment; and audiologists who conduct a comprehensive evaluation.

Protocols for working with concussion patients at Arizona Balance and Hearing Associates involve a complete medical history and the performance of tests for high-frequency distortion-product otoacoustic emissions, ultrahigh-frequency (12,000 Hz to 20,000 Hz) hearing thresholds, ipsilateral and contralateral acoustic reflex thresholds, and speech in noise, which, if abnormal, may require full evaluation for a central auditory processing disorder.

The center also conducts videonystagmography (VNG), with a well-defined protocol for ocular motor testing. “Our clinic prefers to utilize water calorics whenever possible to assure the most accurate caloric findings,” Dr. Day said.

She and her colleagues may consider other tests such as ice water calorics, rotary chair testing, computer dynamic posturography, and cervical vestibular-evoked myogenic potential with or without ocular vestibular-evoked myogenic potential.

Video head impulse testing is still being evaluated by the practice for use in patients with a concussion.

“I believe [its] greatest value may come in testing the pediatric patient, but the final verdict is still out,” Dr. Day said.

GETTING A BASELINE

Arizona Balance and Hearing Associates is working with the CACTIS Foundation to offer baseline testing services to its youngest patients and athletes, who are 6 to 14 years old.

“We hope that by gathering this information prior to injury it will offer an objective measure for making the critical return-to-play decision,” Dr. Day said.

At a minimum, an audiogram and VNG need to be conducted to assure a baseline measurement in case tinnitus or dizziness present as late-onset symptoms, meaning three to six months after injury, Dr. Day said.

In addition to testing, audiologists at Arizona Balance and Hearing Associates directly manage several concussion-related sequelae, such as sensorineural and conductive hearing loss and benign paroxysmal positional vertigo, Dr. Day said.

Tinnitus can be the most challenging condition to address because therapy must be personalized to the patient, she said.

Appropriate medical and psychological referrals should be made for tinnitus, Dr. Myers added.

Sudden-onset tinnitus, with or without hearing loss, requires same-day assessment by otolaryngology and audiology, she said. If the condition is causing severe distress or challenges with coping, referrals should also include psychology.

COLLEGE-LEVEL CONCUSSION MANAGEMENT

To provide better care for its student athletes with potential concussion, Lamar University in Beaumont, TX, implemented a program in the fall of 2013 that uses cognitive and vestibular tests to assess students.

“Usually a concussion will show up as a cognitive problem or a balance problem,” said program developer Vickie B. Dionne, AuD, who is also associate professor and program director of audiology at the university.

“We’re worried about the player who comes off the field and says he was hit hard and then, the next day, has a headache, or everything is blurry, or he can’t process what you say. These symptoms don’t show up right away.”

Currently, the Balance Error Scoring System (BESS) is widely used to assess balance deficits indicating concussion, Dr. Dionne said. It requires a trainer to subjectively evaluate a variety of the athlete’s stances to see if the body sways.

“This is a test that a lot of teams are using from middle school up through college,” she said.

In addition to BESS, a pencil-and-paper test for cognition such as the Standardized Assessment of Concussion is commonly used.

“It consists of questions about the day, year, and the athlete’s name; immediate recall; concentration; and delayed recall,” Dr. Dionne said.

However, given that only three versions of the paper test are available and athletes have been taking the tests for years, subjects often have responses memorized. “It’s no longer a true test,” she said.

UPDATED TESTING

After a heavy overhaul of Lamar’s National Collegiate Athletic Association (NCAA) concussion management plan, Dr. Dionne and colleagues studied 400 student athletes using updated concussion assessment technology, including computerized dynamic posturography (CDP). CDP provides vestibular evaluation of concussion through the assessment of balance, postural sway, and weight bearing.

In addition, researchers used the computerized ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Since the test is randomly generated each time it’s given, athletes can’t memorize it, Dr. Dionne said.

She and coinvestigators acquired baseline CDP and ImPACT assessments from athletes before practice or play and then tested them after a head injury was sustained.

“We thought we were going to test athletes within 24 hours of concussion, but we found a lot of symptoms didn’t show up until 48 to 72 hours later,” she said.

Athletes were not allowed to play until both tests were back to baseline. “We benched quite a few players throughout the year for up to two to three weeks,” she said.

Most people recover from concussion within seven to 10 days, said Richard E. Gans, PhD, founder and CEO of the American Institute of Balance, which has eight clinics in the Tampa and Orlando, FL, areas.

When patients don’t recover within that time frame, they may then move into a post-concussion syndrome profile. Vestibular rehabilitation is being used to treat many of these patients, he said.

RAISING AWARENESS

As part of future research, Dr. Dionne would like to conduct hearing evaluations in student athletes with concussion and evaluate how long any identified cognitive or auditory processing disorders take to resolve.

Testing for auditory processing disorder would be a valuable addition to the program because such deficits could mean students are functioning poorly in class.

Further studies comparing different approaches to diagnosing and treating the audiologic consequences of concussion would be welcome, as would registries tracking the results of patients seen for mild TBI, the testing performed, and subsequent outcomes, Dr. Day said.

The audiology community also needs to establish best practices for assessing mild TBI and monitoring recovery.

“We need to continue to increase audiologists’ awareness of the diverse sensory and communication disorders that may result from a TBI so that a team-oriented, patient-centered rehabilitation plan can be formulated and implemented efficiently, thereby enhancing the likelihood of improved outcomes,” Dr. Myers said.

For More Information

The government, the American Speech–Language–Hearing Association (ASHA), and other organizations offer resources on the diagnosis and management of concussion, including the auditory and vestibular side effects.

* Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury (TBI): https://bit.ly/TBI-CPG.

* Traumatic Brain Injury Veterans Health Initiative: https://bit.ly/TBI-VHI.

* Centers for Disease Control and Prevention on Concussion and Mild TBI: https://bit.ly/TBI-CDC.

* ASHA Gives Current Perspectives on Traumatic Brain Injury:https://bit.ly/TBI-ASHA.

* ASHA on Tinnitus Evaluation and Management Considerations for Persons with Mild Traumatic Brain Injury: https://bit.ly/mTBI-ASHA.

* Brain Injury Association of America: https://www.biausa.org.

© 2014 by Lippincott Williams & Wilkins, Inc.