Important information for Physicians

Otoscopic EvaluationPAccording to the National Center for Health Statistics, “Hearing impairment is the third prevalent chronic condition among the non-institutionalized elderly, exceeded only by arthritis and hypertensive disease.”

Those with hearing loss must get immediate help otherwise they disconnect with the world and will face more difficulties than they need to.

According to the Journal of the American Geriatrics Society, “The significance of hearing loss in elderly persons results from functional and social isolation produced by it. Depression has been shown to have twofold greater incidence in elderly persons with hearing loss.”

Many people have come to our offices suffering from depression, anxiety, isolation, and have developed other social challenges due to hearing loss. Some have even stopped the use of their medication because it caused problems with their hearing. Patients who suffer from hearing loss can experience pain and frustration from being misunderstood. Society often lacks the patience to deal with this population. Most people do not want to repeat or accommodate the need. Family problems can be caused by miscommunication.

As their family doctor you can help them by recommending a comprehensive hearing test, not just to rule out hearing loss but to find out how the outer, middle and inner ears are functioning.  Most people with hearing loss can hear, but they require repetition and some are very good at lip reading.  They are often able to communicate in one on one on situations but have great difficulty in public places. 

Doctors recommend an Audiologist for many reasons, the most common referrals are due to constant ear infections, balance issues, dizziness, vertigo, ringing in the ears known as tinnitus, sensitivity to sounds, hearing loss, fullness in the ears and to simply obtain a hearing test as part of a physical exam.  Children are often referred to an Audiologist due to language delay issues, articulation problems, ear infections, behavioral problems, and learning issues.

It's crucial that patients have their ears clean and free of wax prior to Audiological Evaluations.  Wax will interfere with the Comprehensive Audiological Evaluation.  Results with excessive wax can yield incorrect results.

Excessive Ear wax can cause tinnitus, vertigo, itching in the ears, ear pain, external otitis, chronic cough and other rare problems.  Please refer to the following link for more information, under the section "Consequences and Complications of excessive/impacted cerumen".

Most doctors recommend over the counter ear wax removal solutions, but in our experience if the wax is too old or severe occlusion is present; this method only softens the wax but the ear or ears remain occluded with wax. A referral to an ENT can be made to remove the wax prior to Audiological examination.

If a patient comes in with excessive wax, we can remove the wax but there would be a charge for this procedure.  Physicians can bill for this service the same day, but Audiologist can not.  Even if an Audiologist obtains an authorization, reimbursement is not guaranteed because our contracted plan may not include the service.   A patient must be free of wax prior to Audiological services, to avoid a second visit.

Indications that would prompt hearing tests:       

Alzheimer’s and dementia: risk can be 5 times higher with hearing loss. According to Dr. Oz Mehmetz “Many of us assume hearing loss is an inevitable part of life, but it’s actually the number one red flag you’re aging too fast and can be a sign of developing dementia or Alzheimer’s disease. As you probably know, the brain has multiple “centers” that control different bodily functions: One part controls sight, another part controls smell, another stores memory, one controls hearing, and so on. One of the hallmarks of Alzheimer’s disease is the formation of plaques in the brain, located between nerve cells. These plaques cause neurons in the brain to stop functioning properly, making it unable to send all the signals it can. As a result, your various brain centers begin to shut down. Thus, the hearing center’s ceasing to function may be directly linked to the formation of the plaques associated with Alzheimer’s. To make matters worse, as hearing ability decreases, our ability to function in daily life decreases as well, contributing to further mental decline.”Direction

DOH recommends that as soon as hearing loss is identified, do not wait. Get fitted with hearing aids to keep your brain active. Doctor Oz also recommends reading, brain games and crossword puzzles to keep the brain active. Even mild hearing losses can benefit from hearing aids.  A mild hearing loss might not be as visible on a one-one situation but normal situations may involve public places where noise can interfere with communication. 

Cardiovascular Disease: Hearing loss and Cardiovascular disease are linked. Research is showing the connection between decreased blood flow from cardiovascular disease and low-frequency hearing loss. Reduced blood flow in the body can cause the restriction of blood flow in the inner ear, causing irreversible damage and low frequency hearing loss.

Diabetes: those with Diabetes are twice likely to have hearing loss. According to the American diabetes association “It's possible that the high blood glucose levels associated with diabetes cause damage to the small blood vessels in the inner ear.”

Chronic kidney Disease: Even moderate kidney Disease is associated with 43% increased risk. Toxins that accumulate in kidney failure can damage nerves, including those in the inner ear, in addition, some of the treatments for kidney disease can further damage the inner ear.

High cholesterol, high blood pressure, and obesity: These have been linked in studies to loss of hearing – in addition to other serious complications, of course, such as heart attacks and strokes.

Cancer: Those who have cancer also experience hearing loss because many chemotherapy drugs are toxic to the hearing organs. These patients should have their hearing check regularly.

Other indications of hearing loss: Depression, sudden hearing loss, sensation of pressure in the ears that won’t go away, difficulty understanding in crowds or noisy places, difficulty on the telephone, academic problems, poor reading skills, those who suffer from dizziness, vertigo, unsteadiness, speech delay, tinnitus, head noises, hissing, whistling, clanging, hyperacusis (abnormal sensitivity to sound), fear of sound, ear infections, and perforated ear drums.

Even patients with mild hearing loss need hearing aids.

Misconceptions of mild hearing loss:

“The term mild hearing loss suggests little or no experienced hearing difficulty resulting in a low priority for rehabilitation and amplification, the consequences of which can be very high. In reality individuals with mild hearing loss often experience difficulties understanding speech especially in the presence of noise and from a distance. Three main reasons individuals with mild hearing loss have problems understanding speech are decreased audibility (can’t hear soft sounds), reduced dynamic range (reduced difference between the softest sound heard and when sounds become too loud and increased listening fatigue. Soft sounds may not be heard especially 'f, s, th, and k'. the reason for this is twofold: these sounds are weaker in loudness and they are higher in frequency (pitch). High frequency is the frequency most commonly affected by hearing loss.”

When someone has a high-frequency hearing loss, they can hear on a one on one basis but they have difficulty understanding speech from a distance or in the presence of noise. This kind of hearing loss is not visible because the patient can still hear. In general, one of the purposes of low frequencies is volume and the high frequencies mainly for clarity. These patients will say, I can hear but sometimes I don’t understand what people say because they talk too low. These patients often times don’t even know that they have hearing loss, their loved ones are the first to notice because they have to keep repeating. Anther misconception is “I can still hear, people just need to speak louder or more clear.” Most of those who need hearing aids do not have difficulty hearing, they have difficulty understanding. One of the most difficult things for an audiologist to say to a patient is “sorry you are not a candidate for hearing aids” These patients can’t hear. For this population, a cochlear implant might be the solution but they still need an evaluation.

When someone needs glasses, even if is a minor correction, the Optometrist still recommends glasses because it will help with clarity; same goes for hearing, mild hearing losses have to be treated to obtain better clarity.   In addition, the sooner the patient gets fitted with hearing aids, the sooner they can get used to them and most importantly enjoy the benefits that come with hearing improvements.  Its also important to start early to help with stimulation of our brain to avoid auditory deprivation.  Auditory deprivation was first reported in 1984 and it’s simply prolonged lack of amplification of auditory stimuli (hearing). In other words, if you don’t use it you lose it.   Most people wait too long to get hearing aids and when they decide to come in to try hearing aids, they struggle getting used to hearing aids, and processing the acoustical stimuli since the brain has been deprived.