Center for Advanced Subspecialty Care and Otolaryngolgy providing otolaryngology services for Plymouth County and surrounding southeastern Massachusetts.
We perform a full spectrum of diagnostic audiology including ABR, ECoG, ENG and OAE’s. Our audiology services are overseen by Melanie Vail, MS, CCC-A, and Heather Pianfetti, Au.D., CCC-A, superb clinical audiologists with extensive experience in testing pediatric and adult patient.
Mel joined the practice in September 2006. She and her husband recently relocated to Cape Cod from Long Island, NY where she spent the past four years working as a clinical and dispensing Audiologist for HearUSA, Inc. Before she left the company her duties were split between her position as the Regional Quality Manager for Y, as well as working in one of HearUSA’s Long Island centers. Mel received her BS in Speech & Hearing Sciences from The Ohio State University, and went on to obtain her MS in audiology from Rush University a part of Rush-Presbyterian – St. Luke’s Medical Center in Chicago, IL. She is currently in the midst of the application process to pursue her Au.D.
Heather M. Pianfetti, Au.D., CCC-A
Heather joined the practice in May of 2007. She, along with her family, recently moved to Massachusetts from Rhode Island but is originally from Minnesota. She obtained her doctorate in audiology from the University of Rhode Island in December 2006 and has a BA in Communication Sciences and Disorders from the University of North Dakota. Her training involved performing diagnostic evaluations as well as hearing aid evaluations and fittings at various clinical placements. Her clinical training was done at several ear, nose and throat practices in Rhode Island as well as at Rhode Island Hospital, Women and Infants’ Hospital, and the VA hospital in Boston. She is currently a member of the American Speech-Language & Hearing Association and is pursuing membership in the American Academy of Audiology.
Barbara A. Ginnetty, CMA
Barbara has been with the practice for the last 14 years, and has obtained a wealth of knowledge and experience in the field of audiology. She is a Certified Medical Assistant and is also a Certified Occupational Hearing Conservationist. Barbara is an ototechnician as well, and obtained her education through the American Academy of Otolaryngology. She currently performs electrocochleography (ECoG) evaluation, auditory brainstem response testing (ABR), and electronystagmography (ENG) evaluations, as well as hearing evaluations. She has been working toward her BS degree in Leadership, and she graduates in May of 2007. Her course work is complete this February.
HEARING NEWS Discussion of Hearing Loss
FACT: “More than 28 million Americans have some type of hearing problem. Hearing difficulties are often unrecognized by the person involved.” (www.audiology.org)
How We Hear
Sound travels in waves. These sound waves are gathered by the pinna, which is the ear lobe. They are then funneled to the ear canal. The pinna and the ear canal comprise the outer ear. Sound waves next reach the eardrum. These sound waves cause the eardrum to vibrate, and move the ossicles. The ossicles are the three smallest bones in your body, and they work like a lever because they are connected like a chain. This ossicular chain is connected to the eardrum, or tympanic membrane, on one side, and the inner ear, specifically the cochlea, on the other side. The ossicles are in an air filled space called the middle ear cavity. These components, the tympanic membrane, ossicles, and middle ear cavity, comprise the middle ear. Once the ossicles are set in motion, they in turn vibrate, and because they are connected to the cochlea, sound is then transmitted to the inner ear. The inner ear is comprised of the cochlea and the auditory nerve. The cochlea is filled with fluid, and a traveling wave is then set in motion. The cochlea houses three fluid filled canals. The middle most canal, the basilar membrane, contains hair cells. There are sensors on the top of these hair cells. These sensors, called cilia, respond to movement of fluid from the traveling wave. The hair cells, once stimulated, then in turn stimulate the auditory nerve. Lastly, the signal is sent to the brain from the auditory nerve. Hearing loss occurs when the hair cells are damaged. When they are damaged they no longer are able to transmit the auditory signal to the brain. Essentially the brain receives an incomplete picture. We do not hear with our ears, we hear with our brain. Our ears are merely sensors. Hearing loss occurs for many different reasons. Some examples of the reasons are noise exposure, aging, genetic causes, and sometimes even sudden hearing loss can occur with no known cause.
Helpful Association Websites:
Self Help for the Hard of Hearing www.shhh.org
American Tinnitus Association www.ata.org
American Speech Language and hearing Association www.asha.org
American Academy of Audiology www.audiology.org
Dangerous Decibels www.dangerousdecibels.org
National Institute on Deafness and other Communication Disorders www.nidcd.nih.gov/health/hearing www.nidcd.nih.gov/health/hearingaid.asp
ISSUE I Evaluations
Have you ever wondered why you are being referred for certain tests? Here are some explanations of the evaluations we conduct in our office.
Audiogram: An Audiogram is the formal name for a haring evaluation. The purpose of a hearing test is to determine the degree and type of your hearing and/or hearing loss. During this test we are obtaining the softest levels that you are able to hear for each test frequency, and we are evaluating your ability to understand speech at a conversational level as well as the softest levels for which you are able to hear.
Immittance:
Tympanometry: This is a pressure test that helps to determine the mobility of the eardrum. This test lets us know whether the middle ear system is healthy, because we are unable to see beyond the eardrum. This test helps us to determine if there is fluid or abnormal pressure behind the eardrum, or if there is a perforation. It can also let us know if a PE (pressure equalization) tube that is in place is open or not.
Reflexes: During this test you will hear a loud tone which is necessary in order to determine if a muscle, the Stapedius Muscle, is contracting. This muscle is connected to one of the middle ear bones in the middle ear space, and this bone connects to the eardrum. When this muscle contracts it helps to immobilize the eardrum. This is one of our body’s defense mechanisms to harmful sounds in the environment. The presence or absence of this reflex lets us know if the reflex arc in the central auditory pathways of the brainstem is working normally.
OAEs: OAE stands for Otoacoustic Emissions. OAEs measure a sound that your inner ear creates in response to sounds administered during the test. These responses are only present when the hearing ranges from normal to mild hearing loss, and occasionally these are absent even in people with hearing in this range. The best use of this test is for monitoring purposes. For example, this test is primarily conducted on new patients with normal hearing to mild hearing loss, patients who have tinnitus along with hearing ranges from normal to mild hearing loss, and also pediatric patients, because this is an objective measure. Often this is the only measure able to be obtained in some children. OAEs will disappear or change as a pre-indicator of hearing loss, and tinnitus can also be a sign of hearing loss in some cases.
ABR: ABR stands for Auditory Brainstem Response, and this is an evoked potential. This test is conducted any time that there is a difference in the hearing between ears that is permanent or a difference in the ability to hear speech clearly between ears. It is also sometimes conducted when there is a unilateral symptom on its own, such as tinnitus in one ear. It assesses how well sound travels up the auditory pathways in the brainstem. It measures whether sound travels up the auditory pathway at the same rate when the stimulus is presented to the right as well as the left ear.
ENG: ENG stands for electronystagmography. It is a test battery that by measuring eye movements assesses the balance system in the inner ear. It attempts to differentiate the source of dizziness, and whether a patient’s dizziness is caused by the inner ear or not. It ultimately assists in compiling a final diagnosis for a cause if dizziness.
ECoG: ECoG stands for electrocochleography, and is an evoked potential too. It primarily attempts to determine if a patient’s dizziness is caused by an excess build up of fluid in one inner ear system over the other. If this is the case, the ECoG results are considered positive. If this build up of fluid is not the cause, then the test is negative.
HEARING AIDS Choosing a hearing aid that is appropriate for your hearing loss and for your lifestyle can seem like an overwhelming process. At Plymouth Ears, Nose & Throat one of our two Audiologists can assist you in the selection process, the fitting process, and the ongoing servicing of the hearing aid while making the entire experience as simple and as enjoyable as we can for you. After all, making the decision to wear a hearing aid should be an exciting step for you, and the benefits that you see should ultimately help to improve the quality of your life!
The first step is to have your hearing tested by one of our Audiologists. Once the evaluation is completed, we are able to discuss with you the type and degree of your hearing loss, whether the loss is permanent, some of the sounds you may have trouble hearing, and examples of listening environments in which you may have difficulty communicating. From our evaluation and discussion we are able to determine whether a person would be a good candidate to wear hearing aids or other assistive listening devices. This marks the beginning of the hearing aid evaluation process.
When we talk about choosing the appropriate hearing aid/s for you, the discussion can be broken down into two smaller topics. The first topic deals with the type or style of hearing aid that is appropriate for your hearing loss. At this time we discuss any existing conditions, such as dexterity issues or vision impairments that may affect your ability to handle or adjust the hearing aid as well as change the batteries. We also discuss any cosmetic concerns you may have.
The second topic involves selecting the type and level of digital technology that is right for you. There are two basic types of technology, analog and digital. They differ in the way they process incoming sounds. All hearing aids require three basic components, a microphone, an amplifier, and a receiver (speaker). The microphone picks up incoming sound waves and converts them into electric energy. The amplifier increases the strength of the signal. The receiver converts the electric energy back into sound waves that are sent to the ear drum.
Analog hearing aids pick up incoming signals and convert them into electric energy. This electric energy is amplified. Some of the better-quality analog instruments have something called AGC, which stands for automatic gain control. AGC amplifies soft sounds (whisper) to make them audible and compresses loud sounds so that they are no uncomfortably loud for the listener. Although analog hearing aids do not have the same features and are not as flexible as digital hearing aids, they are a less expensive alternative. They may be an appropriate choice for someone who does not lead a very active lifestyle.
Digital hearing aids differ from analog in the way the sound is processed. The microphone picks up the acoustic sound and converts it into a series of numbers or data. This data is then manipulated by a small computer chip inside the hearing aid. The data is then converted back into electric energy and then back into sound waves and sent to the ear drum.
Digital hearing aids are able to be fine tuned more precise for a person’s hearing loss and it results in a more comfortable and natural sound quality.
While analog technology has been around and served its purpose for years, hearing aid manufacturers are attempting to phase out analog technology and in its place offer different levels of digital technology. Digital technology ranges from entry-level digital all the way up through the most advanced, top-of-the line technology. A more advanced digital hearing aid can be fine tuned more exact for the hearing loss, but it can also be re-programmed based on changes in lifestyle, hearing loss, and sound complaints. It has more features to help deal with unwanted background noises and feedback (whistle). Part of our discussion covers the type of lifestyle that best fits our personality, whether you lead a quiet or a more demanding, active lifestyle. We discuss the types of listening environments you find to be challenging, such as at home, at work, on the telephone, in social engagements, or in restaurants. From this discussion the audiologist is able to help you to select a level of technology that is appropriate for your hearing loss, your lifestyle, and your budget.
Once we have established the style of hearing aid and the technology that is right for you we are better able to set realistic expectations and goals for your hearing aid wearing experience. Our goals at Plymouth Ears, Nose & Throat are to help you to make an investment in improving the quality of your life and for you to feel that you are a successful hearing aid wearer! Hearing Aid Styles:
Completely-in-the-Canal (CIC): - Appropriate for mild to moderate hearing loss - Smallest of the custom-made hearing instruments, fits deep inside the ear canal and is barely noticeable to others
In-the-Canal (ITC): - Appropriate for mild to moderately-severe hearing loss - Custom-made style that is designed to fit in the ear canal and extends slightly into the concha (bowl-like outer portion of the ear)
In-the-Ear (ITE): - Appropriate for mild to severe hearing loss - Custom-made style that is designed to fit in and fill the concha portion of the ear - Suitable for dexterity problems because the instrument and hearing aid battery are a little larger and easier to handle
Behind-the-Ear (BTE): - Appropriate for mild to profound hearing loss - The hearing instrument sits securely behind the ear and is attached to a custom-made earmold that is molded to your outer ear - Most appropriate style for a child and also used in cases with chronic ear infections
Open Ear BTE: - Appropriate for mild to moderate high frequency hearing loss - The hearing instrument is a small, compact design that sits discretely behind the ear, and a very thin tube attaches to a soft dome-like tip that sits comfortably inside the canal
Digital Technology:
- Digital technology came about in the mid to late 1980’s and over the past 5 years manufacturers have made vast improvements
- Digital refers to how the sound is processed, the incoming signal is converted from an analog signal into a string of numbers (i.e., 1,2) for processing
- Utilizes digital signal processing (DSP), which changes the incoming electrical signal into a digital signal which is then analyzed and adjusted quickly according to how it is programmed (Let’s Talk, ASHA)
- Allows the audiologist to program a miniaturized computer chip inside the hearing aid for your hearing loss, your listening comfort as well as for you communication demands, making it more compatible for the individual
- Results in a cleaner and more natural sound quality over the older analog technology
- Analyzes and differentiates incoming sounds so that soft, medium and loud sounds are amplified separately (example: a whisper is amplified differently than an ambulance siren)
- Newer technology employs feedback (a high pitched whistling noise from the hearing aid) management systems that continuously monitor incoming signals and react quickly to avoid potential feedback without compromising important information for speech understanding
- Digital technology incorporates noise reduction systems that work to reduce competing noises while enhancing speech understanding
Analog Technology:
- Still available today; however, hearing aid manufacturers have focused their efforts on improving digital technology for more comfortable listening
- Basic technology that allows the user to make sounds louder or softer
- Better analog circuits have automatic gain control (AGC) to help differentiate between a soft and loud sound - Trim-pot controls allow the audiologist to makes some basic adjustments to the sound quality
- Volume is adjusted manually via a volume control
Hearing Aid Services:
- Plymouth Ears, Nose & Throat provides hearing aid services
- Hearing aids are selected together with the patient and are purchased through our hearing aid vendor, Northeast Hearing Instruments
- Services include but are not limited to: the selection, ordering, and dispensing of the hearing instrument/s, regular hearing aid cleanings and check-ups, re-programming of digital hearing aids for sound comfort as well as for any hearing level changes, verification measurements including Real Ear Measurements, and Electroacoustic verification
- Hearing aid supplies including batteries, dry-aid kits, and earmold tubing are just to name a few
- Hearing protective devices, Assistive Listening devices (television and telephone), Custom Swim Molds and other Specialty Earmolds are available upon request
