- In this video, I'm gonna help you understand
the results of your hearing test
and why it will dictate your performance
with hearing treatment.
Comin' up.
(pleasant music)
This video is sponsored by Natus, formerly Otometrics,
the preferred diagnostic equipment supplier
of Doctor Cliff, AuD.
Since the 1950s, Otometrics has been one of the most
innovative manufacturers of hearing aid fitting equipment
and diagnostic hearing and balance equipment
in the industry.
When it comes to testing and treating my patients,
I only want to work with the best.
This is why I use Natus in my clinic.
If you've ever had your hearing tested
inside of an audiology clinic or an ENT clinic,
then you probably remember having to raise your hand
or click on a button every time that you heard those beeps.
You also probably remember having to listen for words
and repeating them back as accurately as possible.
You may even remember them reviewing your results
like the graph with the Xs and Os
and your word recognition percentages.
But there is a solid chance
that you were never actually told
how those results impact your hearing,
at least not in a way that you were able to understand
and remember.
That's why I believe that how those results are explained
has a huge impact in your ability
to understand your own hearing loss
and how it impacts your hearing and communication abilities.
So, I'm gonna use the counseling tools
inside of the Otosuite software for my Astera 2 audiometer
to give you a better understanding
of exactly how your hearing loss is impacting your hearing.
First, let's discuss air conduction testing
on the graph portion of your audiogram.
These Xs and Os represent air conduction testing,
which is, basically, the pathway of sound
from your outer ear through your middle ear
and to your inner ear which is your cochlea.
Here, hearing care professional
will perform this air conduction testing
by either placing headphones on your head
or foam earphones inside of your ear canals.
Then they will start by playing audible beeps to you,
having you raise your hand or click a button
every time you hear one of these beeps,
eventually finding your hearing thresholds,
which are the softest sounds that you can hear.
We plot the responses to these beeps
on the graph portion of your audiogram.
The blue Xs represent the hearing thresholds
of your left ear,
and the red Os represent the hearing thresholds
of your right ear.
And, yes, the left and the right
are supposed to be flip-flopped on the screen.
These beeps measure two things,
how severe your hearing loss is,
and at what frequency or pitch your hearing loss is at.
The further down you see these markings on the graph,
the worse your hearing sensitivity is.
If you can hear the beeps when they are really soft,
you would see them towards the top of this graph.
If you could only hear the beeps when they are really loud,
you would see them towards the bottom of the graph.
When we look at the frequencies tested,
you have low frequencies on the left side of the graph,
mid frequencies in the middle of the graph,
and high frequencies on the right-hand side of the graph.
You can think of this like a piano keyboard
that has low-frequency bass tone keys on the left side
that increase in pitch to high-frequency treble tone keys
on the right side.
Next, we need to discuss the brackets
that you see on this graph.
These represent bone conduction.
Instead of sound passing from outer ear
through your middle ear to your inner ear
like it does with air conduction,
bone conduction, basically, just travels through your skull
and vibrates the cochlea directly,
bypassing these other middle ear and outer ear structures.
For this part of the evaluation,
a bone conduction headband will be placed on your head
and make contact with your mastoid bone,
which is the part of your skull directly behind your ear.
This will vibrate your skull at the same frequencies
that were tested during air conduction testing
that gave us the Xs and Os.
When you hear the beeping sounds,
you will raise your hand or click a button
just like you did with air conduction testing.
The results of bone conduction testing
are recorded on your audiogram as brackets.
These brackets represent the hearing sensitivity
of your inner ear.
If these brackets are within close proximity
of the Xs and Os, like you see on this graph,
then we know that your hearing loss
is isolated to your inner ear
and is not being caused by your outer ear or middle ear.
This is called a sensorineural hearing loss.
If these brackets are significantly better
than your Xs or Os, like you see on this graph,
then we know that your outer ear and/or middle ear
are contributing to either a portion
or all of your hearing loss.
If these brackets are in the normal range,
then you have a conductive hearing loss.
If these brackets are in the mild range or worse
but there is still a significant gap between them
and the Xs or Os,
then you have a mixed hearing loss.
This is the combination between a sensorineural hearing loss
and a conductive hearing loss at the same time.
For simplicity's sake, I'm gonna go ahead and explain
how a sensorineural hearing loss
impacts your hearing ability
because it is the single most common from of hearing loss.
The graph on the left
shows a normal sloping to severe,
high-frequency sensorineural hearing loss in the right ear.
The thing that is particularly interesting
about this hearing loss
is the speech sounds that the individual would be missing.
The Astera 2 allows us to place
an overlay of these sounds on the graph
so we can see exactly which sounds
would not be audible to this individual.
Any of these speech sounds above the Xs and the Os
inside of the shaded gray region
are sounds that can literally no longer make it
from this individual's right ear to their brain
when spoken in normal conversational speech
without the use of hearing treatment.
Any of these speech sounds below the Os
are sounds that this individual can hear
without hearing treatment.
In the case of the hearing loss like this,
we typically hear the two following reports from patients.
First, they feel like they can hear people talking,
but they just can't understand them.
Second, they typically report hearing difficulty
in background noise.
Let's take a look at why someone would report
difficulty with speech understanding
otherwise known as speech clarity.
The high-frequency sounds are the consonant sounds.
The low-frequency sounds are the vowel sounds.
Consonants equal clarity.
Vowels equal volume.
When your brain loses access
to high-frequency consonant sounds,
clarity goes away,
and it starts to sound like people are mumbling.
This is why you can hear people talking,
but you just can't understand them.
Now, there are a few things that you can do
without hearing treatment to get these sounds back.
First is by looking at the mouth of the person talking
to obtain visual cues.
If you can see their mouth moving,
your brain can start to associate their mouth movements
with the missing consonant sounds,
filling in the gaps of what your ears can't hear.
Second, you can use the context
surrounding what someone is talking about.
This is how you can hear and understand
everything that I'm saying right now
even if you have an untreated hearing loss
like the one you see in this graph.
While the use of these compensation techniques
are not recommended as a longterm solution
for individuals with hearing loss,
they can definitely help.
Next, let's take a second to talk about
why individuals with this type of hearing loss
have difficulty in background noise.
When someone with normal hearing
finds themselves in background noise,
their brain utilizes good, high-frequency hearing
to separate the speech from the background noise,
which happens to be low frequency in nature.
According to the test results,
this individual would hear background noise really well
because of their good, low-frequency hearing ability,
but wouldn't have access to the proper
high-frequency speech components
that are needed to help separate speech from noise.
This creates a listening environment
that is nearly impossible to hear in successfully.
Let's jump over to the other graph
to look at the left ear results.
Right off the bat, you can see that the biggest difference
is the moderate low-frequency hearing loss
in addition to the severe high-frequency
sensorineural hearing loss.
Remember, a low-frequency hearing loss
would take away the perception of vowel sounds
that give volume to speech.
This individual would likely report
that people don't talk loud enough,
especially soft-spoken individuals.
Now, what we don't wanna do is just jump to the conclusion
that this individual needs hearing aids
as their best and only treatment option.
We still don't know the whole story.
At this point, we only know exactly how much amplification
we need to give this individual
to return these speech sounds to their brain,
but what we need to do now is speech testing
so we can see how well this individual
can comprehend speech.
We first start by doing speech reception thresholds
which are when we play recorded sounds to you
and have you repeat them back to us.
We make these sounds softer and softer
to the point where you can only repeat
50% of the words correctly.
We check to see if these levels
that you can repeat words back
is in agreement with your pure tone average
from the air conduction testing performed earlier,
which is an average between your thresholds at 500,
1,000, and 2,000 hertz.
However, the type of speech testing that will determine
how well you perform with hearing aids
is your word recognition score, or WRS.
This is when we play recorded words to you
at levels that are high enough
to ensure that your brain has access
to most or all of the speech information
you've been missing due to your hearing loss.
After presenting a list of words at an amplified level
to accommodate for your hearing loss,
the software calculates the percentage
of words that you got correct.
The higher this percentage correct, the better off you are.
These percentages indicate
how well you should expect to hear speech
in a quiet situation,
when you can't see the mouth of the person talking to you,
and when you don't have access to context.
If these percentages are really high,
then you should expect to receive a lot of benefit
from hearing treatment.
If these percentages are really low, however,
you should not expect to receive
a lot of benefit from hearing treatment.
I often tell my patients
that I care more about the percentages
than I do about the Xs and Os that are on the graph.
As long as I can amplify adequately for those Xs and Os
and get audibility to you,
then I know that you're gonna be able
to understand that information
once it makes it to your brain.
So, even if you have a really have a really bad,
severe to profound hearing loss,
but you have good word recognition percentages,
I could expect to place hearing aids in your ears,
amplify them appropriately,
and have you perform pretty well.
There are a lot of different hearing losses
that are out there,
but as long as you understand the basics
of the type of hearing loss that you have,
the severity of your hearing loss,
and your word recognition percentages,
you should be able to understand
how hearing treatment can impact
your overall hearing ability.
That's it for this video.
If you have any questions,
leave them in the comments section below.
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go ahead and hit that subscribe button.
Also, feel free to check on my website,
drcliffaud.com.
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