Online Health Chat with Sarah Sydlowski, AuD, PhD

October 14, 2014


Approximately 17 percent of American adults (36 million) report some degree of hearing loss – a condition in which a person is partially or totally unable to hear in one or both ears.

Most people with hearing loss, however, can be helped by hearing devices. On average, people unnecessarily wait seven years before investigating management options for their hearing loss. One reason for waiting may be the misconception of what it is like to be a hearing aid user. Hearing aid technology has improved tremendously in recent years, with devices becoming smaller, more sophisticated and easier to use. Recent advances have also made it possible to connect wirelessly to tablets, smartphones and other devices.

About the Speaker

Sarah Sydlowski, AuD, PhD, is Audiology Director of the Hearing Implant Program. She completed her clinical doctorate in audiology at the University of Louisville in Kentucky and her PhD in audiology at Gallaudet University in Washington, D.C. Her dissertation focused on the auditory and vestibular impact of superficial siderosis of the central nervous system. She previously coordinated the cochlear implant program for the Department of Audiology at the Mayo Clinic in Scottsdale, Ariz.

Dr. Sydlowski is board certified in audiology with specialty certification in cochlear implants. She is also a fellow of the American Academy of Audiology and holds her Certificate of Clinical Competence in Audiology from the American Speech-Language-Hearing Association. Her clinical and research interests include auditory implants, electrophysiology and auditory-vestibular pathology. She sees patients at Cleveland Clinic’s main campus.

Let’s Chat About Hearing Loss and the Latest Hearing Aid Technology

Understanding Hearing Loss

Alec: What do I need to know to figure out if a loved one or even I can benefit from hearing aids?

Sarah_Sydlowski,_AuD,PhD: There are several common signs that a loved one may be struggling as a result of a hearing loss. Someone with hearing loss may complain that people are mumbling or may turn up the volume on devices like the television. You may notice that they are withdrawing from social situations. They may avoid what used to be favorite functions, or they may stop initiating conversation. You may also notice that their responses during conversations may be vague or off topic, or they cannot understand you if they are not facing you. They may also be more impatient, irritable, frustrated or withdrawn. If this is the case, then they should speak with a hearing health provider who can determine the appropriate intervention.

flyboy: I can hear a normal conversation reasonably well, but in a noisy room I have great difficulty. What can be done? (I have known hearing loss in the high frequencies.)

Sarah_Sydlowski,_AuD,PhD: The most common type of hearing loss is called sensorineural hearing loss, and it is most typically due to aging or noise exposure. This type of hearing loss impacts the high frequencies (pitches) first. Low-pitch sounds give volume and strength to speech, but high-pitch sounds are important for clarity and are responsible for the consonant sounds that help us tell the difference between "fat, sat, chat." In a quiet room, individuals with sensorineural hearing loss may be able to "hear" fairly well, but clarity may be diminished. The result is that it might sound like people are mumbling because high-pitched consonants like s, sh, th and f are not audible. In background noise, understanding becomes particularly challenging because the low-pitched background noise further masks the soft sounds of speech. Depending on the results of a comprehensive audiologic evaluation (and barring medical contraindications), someone with this type of hearing loss is most often a candidate for hearing aids. Hearing aids can help amplify the softer, high-pitch sounds of speech (without unnecessarily amplifying other sounds) to help restore clarity and make listening easier.

clara: I have trouble with some female voices on TV. I have the ears for TV now. Does that indicate I need hearing aids?

Sarah_Sydlowski,_AuD,PhD: Having difficulty understanding higher-pitched female voices, feeling like people are mumbling or needing the TV volume louder than your family members all tend to be early signs of hearing loss. I would recommend that you pursue an audiologic evaluation (hearing test) to learn more about your hearing needs.

vanenglm: Does lack of hearing aids speed up loss of hearing?

Sarah_Sydlowski,_AuD,PhD: While we can't say that lack of hearing aids speeds up hearing loss necessarily, waiting to pursue appropriate amplification can certainly have very negative consequences. Research has taught us much about "auditory deprivation," which refers to the lack of appropriate stimulation to the hearing system. If someone has hearing loss that would benefit from the use of hearing aids but chooses not to pursue appropriate amplification, then the hearing system will not be perceiving all the sounds it used to perceive because it will not be receiving stimulation in the same way. It is best to pursue amplification as soon as possible once it is recommended because the transition is usually easier. After many years of not hearing certain sounds, their reintroduction can be much harder and clarity is often not as good. Currently, the average person with hearing loss waits seven years to obtain a hearing aid! That's far too long and I'd love to see that number decrease dramatically.

You and Your Audiologist

stagedoor: What kind of information should I provide to my audiologist in order to be sure the most appropriate devices are recommended?

Sarah_Sydlowski,_AuD,PhD: Your audiologist will want to know about the types of environments that you’re in and the situations where you are having the most difficulty. Are you in business meetings often? Is the telephone a challenge? Are noisy restaurants the most frustrating for you? It will also be important to let your audiologist know how comfortable you feel trying new devices or how often you use technology like cell phones, iPads, laptop computer etc.

nojoro: Are all audiologists licensed doctors?

Sarah_Sydlowski,_AuD,PhD: Audiologists are masters- and doctoral-level trained professionals who specialize in the evaluation and management of hearing and balance disorders, and yes, practicing audiology requires licensure. As of 2007, a doctoral degree became the minimum requirement to enter the field. You may see audiologists with an AuD (clinical doctorate in audiology) or PhD, and with these degrees, they are appropriately referred to as "Dr." Audiologists do not have medical degrees (MD). If your audiologist suspects that there is a medical cause for your hearing loss, they will suggest that you see a physician for evaluation. You may also see the term "hearing instrument specialist." This is not the same as an audiologist, and that profession does not require a doctoral degree, although these individuals are licensed for the fitting of hearing aids.

papayatina: We are flooded with hearing aid ads, all claiming to be excellent. Is there an objective resource – a Consumer Reports – that evaluates hearing aids so we can narrow the choices. We don't mind spending money for value, but we do not want to waste money on $8,000 aids that are no better than $500 aids.

Sarah_Sydlowski,_AuD,PhD: You are absolutely right. The hearing aid ads can be very overwhelming! In my opinion, the focus is on the hearing aid, but the focus is misdirected. The important question should not be about the right device, the question is finding the right person to select the device! A hearing aid is a medical device but is frequently viewed similarly to purchasing a car or other electronic gadget. In fact, you are purchasing a prescribed medical device, so the approach needs to be different. The success is partly based on having the right device, but even more important is having a professional who understands your hearing loss and hearing needs, who can select the appropriate device, who can appropriately program the device, who uses appropriate measures to evaluate the success of the fitting and who makes those decisions based on time spent talking with you and understanding your situation. Audiologists are uniquely trained to provide all of these critical aspects of a successful device selection and fitting. It is our job to help you to find the best options for your benefit.

Hearing Aids 101

arlo54: Is it true that hearing aids do NOT help in noise?

Sarah_Sydlowski,_AuD,PhD: No. It's not that they DON'T help in noise; it's that noisy situations will always be more challenging than quiet environments, even for people with normal hearing. There is constantly improving technology for these situations, but people with hearing loss – even those using hearing aids – will still find noisy environments challenging. There are many options that your audiologist can discuss with you to optimize your understanding in background noise. These may include different programs on your device, special wireless accessories or supplementary devices, such as an FM system.

willes: I have basic BTE (behind the ear) hearing aids, and I wonder if purchasing mid-level hearing aids would enhance my ability to understand words, especially in noisy situations? Is it worth the added cost?

Sarah_Sydlowski,_AuD,PhD: Hearing aids do have a variety of technology levels, and there may be a different "right level" for different individuals. Higher levels of technology tend to be more automatic (requiring less user adjustments) and may be better equipped to handle challenging listening environments such as noisy situations. Of course, as technology level increases so does cost. For most individuals, higher levels of technology can certainly offer distinct advantages, particularly if you are in many complex listening environments like noise or groups. Talk with your audiologist about what types of situations you're in (for example, business meetings, church, luncheons, etc.) and what you'd like your hearing aids to be able to do for you. This conversation should also include budgetary considerations. Our job is to determine the most appropriate device to meet your needs, which may include a balance of hearing needs and budget needs.

SteveH: Is Cleveland Clinic Weston a good place to purchase hearing aids?

Sarah_Sydlowski,_AuD,PhD: Cleveland Clinic Weston does have an audiology department that provides audiologic evaluation and hearing aid services. All Cleveland Clinic facilities function under one umbrella of the Cleveland Clinic, so whether you are in Ohio or Florida you can expect the same high level of patient-oriented service.

Patrice: I don’t want to wear a big clunky device on my ear. Is that what I can expect?

Sarah_Sydlowski,_AuD,PhD: Actually, despite all the exciting new features hearing aids can offer today, they are significantly smaller than they have ever been. For many people, they are nearly invisible and certainly much more comfortable to wear than in the past.

flyboy: What are directional hearing aids and how do they work?

Sarah_Sydlowski,_AuD,PhD: Most current hearing aids utilize directional technology. "Directional" refers to the way that the microphones pick up sounds in the environment, and many hearing aids will adjust this automatically. In a quiet room, they may pick up sound from all directions, whereas in a noisy environment, they may not pick up as many sounds from the back and sides while focusing toward the front (where the person with whom you are speaking is likely located). Some higher-level technologies will even focus toward the side or behind to try to capture voices in a setting like riding in a car.

flyboy: Does wearing a hearing aid (amplifying sound) in itself cause hearing loss?

Sarah_Sydlowski,_AuD,PhD: Wearing a hearing aid that amplifies sound CAN cause further hearing loss if it is not properly programmed for your hearing loss. This is just one of the many reasons that it is important to work with a licensed professional who is trained in the safe and appropriate fitting of hearing aids.

ubiquity: I am concerned that because hearing loss is due to loud noises that using a hearing aid would destroy more of my good hearing. Could you please speak to this?

Sarah_Sydlowski,_AuD,PhD: When your audiologist programs your hearing aid, we know how much amplification is necessary to improve the audibility of sounds without over-amplifying and potentially causing further hearing loss. This is one factor that we consider when selecting an appropriate hearing device with you. That being said, it continues to be important to use hearing protection in loud noise, even if you wear hearing aids. If you are going to be in a loud environment, use hearing protection, turn down the volume or walk away from the source of the noise. Noise-induced hearing loss is 100 percent preventable if you take the appropriate precautions.

bjsheart: I have ReSound hearing aids, behind the ears. I can't hear a thing without them but can't hear with them. Noise is still too loud and voices too soft. I have worn aids for 15 years now and cannot find an audiologist who can adjust my aids correctly. (I've lived in several states.) All the audiologist wants to do is sell you new hearing aids, saying yours are not powerful enough. Believe me, I buy the most expensive – out of my pocket. I'm 68, so I've lived with this hearing problem since I was 53 years old. I wear my aids approximately 18 hours a day. I put them in the first thing every morning and take them out the last thing every night. I'm totally deaf without them, but I can't seem to get the help I need. There's no place to go or turn. What's the answer? I'm an RN, and believe me, most hearing aid users buy the aids and put them in the drawer. "I can't hear” and “They don't fit right" are the two biggest complaints.

Sarah_Sydlowski,_AuD,PhD: It sounds like you have been facing a frustrating, although not always uncommon, situation. The best advice I can give you is to return to your audiologist with a detailed description of the situations where you continue to have difficulty. Regarding hearing aids, there are literally hundreds of brands of hearing aids and within each brand there are different models with different levels of technology. Different devices are appropriate for different individuals, and different hearing aids allow the audiologist different degrees of flexibility when programming the devices. A variety of factors will determine which device is most appropriate for you, including your hearing loss, your perception of the sound quality and the listening situations in which you participate.

More important is working with a professional who understands your needs and concerns and is familiar with the device you are using. In some circumstances, reprogramming or trying a different device may be appropriate. In certain circumstances, hearing aids may no longer be adequate and a cochlear implant evaluation may be appropriate.

Better With Both

mimsy111: Is it necessary to wear aids in both ears if one ear seems OK without an aid?

Sarah_Sydlowski,_AuD,PhD: If hearing loss is present in both ears, unless there is a medical reason to not wear a hearing aid in one ear, I absolutely advocate the use of two hearing aids. We have two ears for several reasons: so that we have sound awareness on both sides, so that we can hear better in noise and so that we can tell the direction that sound is coming from, to name a few. It is very important that both ears receive adequate stimulation to hear the best that they can, and if hearing loss is present, that means through the use of a hearing aid.

jacque: Is there an advantage to having two hearing aids? For example, will a hearing aid on the left side help in hearing on the right side also?

Sarah_Sydlowski,_AuD,PhD: There are many advantages to hearing with two ears, most of which are related to hearing better in background noise. We have two ears for a reason, so if you have hearing loss in both ears, it will likely be in your best interest to pursue amplification in both ears. Some of the highest level hearing aids even have the capability to talk to each other wirelessly to better react together to noisy environments rather than independently.

ubiquity: I don't understand your answer to mimsy. Why would it be necessary to have a hearing aid in a non-impaired ear that can hear just fine? That exact question hasn't been answered. If there is a deficit, then I would understand. Without a deficit, the extra cost seems unjustified.

Sarah_Sydlowski,_AuD,PhD: Let me clarify my response. I agree with you that it is absolutely unnecessary to use a hearing aid in a non-impaired ear. If the hearing is normal in one ear, then it is not advised to use a hearing aid in that ear. But often, someone with hearing loss in two ears will consider using only one hearing aid because they feel that they "get along fine" with only one hearing aid. In that case, I would not recommend "just getting along" with only one hearing aid. If there is hearing loss in both ears, even if it seems you can get by with one hearing aid, two hearing aids are recommended because of all the advantages hearing evenly through two ears can provide.

Technology To Go

dorothyH.: Shouldn’t my new hearing aid be enough? Why do I need other gadgets to help me hear?

Sarah_Sydlowski,_AuD,PhD: Hearing aids do a wonderful job of making many important sounds of speech audible and clear, but the sound you hear can only be as good as the quality of the sound that reaches the hearing aid microphone. If you are in a noisy restaurant, for example, the voice of the person you are listening to is mixed in with noise from the restaurant. It gets softer the further it travels from the speaker’s mouth, and it bounces off hard surfaces, like the table, on the way to your ear. The hearing aid will do the best it can to separate speech from all that noise, but it can be hard to do! A wireless accessory like a remote microphone or an FM system can be extremely helpful in this situation. The speaker wears a small clip-on device on their lapel so that their voice is picked up BEFORE it gets mixed in with all that noise. Then it is wirelessly streamed right into your ear!

dannyboy: What other wireless accessories are available today?

Sarah_Sydlowski,_AuD,PhD: Hearing aids have many options for connectivity to hearing devices. Many people enjoy being able to talk on their cell phone without even taking their phone out of their pocket. They don’t have to find the “sweet spot” near their hearing aid where they can hear best; the speaker’s voice is wirelessly streamed into their ear. There are even some hearing aids available today that use the cell phone as a remote control to adjust the sounds the hearing aid recipient is hearing in different environments. There are also options to stream landline phones or TV. One particular advantage of the TV accessory is that each person watching a program can set the volume to their own particular comfort level.

tiggertoo: I’ve been hearing a lot about looping lately. What is that?

Sarah_Sydlowski,_AuD,PhD: Induction loop technology is actually fairly old technology that has recently gained renewed attention. It is a relatively low-cost way to allow people to connect directly to a speaker’s signal particularly in situations where the speaker is at a distance. For example, some conference centers, theaters or auditoriums may indicate that they have a “room loop.” This means that there is a loop embedded in the walls that is connected to the speaker’s microphone or speaker system. Anyone with a hearing device with a feature called TELECOIL can connect. The telecoil is a small component that connects to an electromagnetic signal emitted by a phone or loop system that allows the speaker’s voice to stream directly into the hearing device. Some public places will have neckloops available to rent – movie theaters or churches for example. These systems work much like a room loop except you will have a personal loop to wear around your neck.

Logan: All of these gadgets sound complicated. Am I going to be able to work these things?

Sarah_Sydlowski,_AuD,PhD: Although hearing aids have gotten more sophisticated, they have often gotten much simpler to use. Talk to your audiologist about your concerns. There are many options they will help you to consider in order to make the best choice for your lifestyle. Hearing aids can be very automatic, or they can allow you to make different changes depending on your environment. You have the option to use wireless accessories, or you can work with the hearing aids alone. Your audiologist will help you discover what works best for you. Also remember, that in the state of Ohio, there is a 30 day right-to-return period on hearing aids. This return period gives you the opportunity to feel comfortable with your new hearing devices and to return to your audiologist for questions before you decide if you will keep them or try a different option.

ubiquity: Can hearing aids with T-coil capability be used to connect with Bluetooth or are they separate technologies?

Sarah_Sydlowski,_AuD,PhD: T-coil and Bluetooth are both wonderful, but separate, technologies. That being said, if you have devices that have telecoil but not Bluetooth capabilities, there are intermediary devices that can utilize T-coil to connect you to your Bluetooth devices. Most current hearing aids also have the capability to connect more directly (sometimes with an intermediary device) to Bluetooth-enabled accessories. I can't underemphasize the wonderful help these accessories can be for hearing aid users! These devices can directly stream your cell phone, laptop, TV, etc. right into your hearing aids. Many devices also have a remote microphone option that can be a wonderful asset in noisy environments or even at a distance (as in a lecture hall). Talk to your audiologist about the latest technology or if there are options available to you through your current hearing aids using telecoil.

papayatina: Please provide the brand name or what the TV device is called so we can search and buy them for each of us to use. Sounds great, but we don't know where to buy it or what to call it.

Sarah_Sydlowski,_AuD,PhD: Talk with your audiologist! Many devices are not available for direct purchase by consumers because they are utilized with hearing aids that must be fit by licensed professionals. For those that are available, your audiologist can point you toward those that are appropriate for your individual situation.

The Cochlear Implant Option

pelican21: I am 76 and profoundly hard of hearing. I wear the most powerful BTE's and have worn the present ones for about eight years. Have there been any substantial improvements in new technology that would help me? As with most people, volume is not a problem, instead it’s clarity and distinction. My greatest loss is in the upper ranges of sound.

Sarah_Sydlowski,_AuD,PhD: There are two important components to successful hearing: detecting sound and understanding speech. The normal hearing system works when sensory cells in the inner ear respond to sound vibrations and send the signals up the hearing nerve to the brain. In the most common types of hearing loss, some or all of those sensory cells stop working the way that they normally would. Hearing aids make particular sounds louder to stimulate remaining sensory cells more effectively. But if there are not many cells left to respond, even if hearing aids are making sounds loud enough, and even if you can detect certain sounds, they may not be clear. In circumstances where even current, appropriately fit hearing aids are not providing adequate benefit, a cochlear implant may be the best option to help improve clarity. Rather than making sounds louder, a cochlear implant directly stimulates the hearing nerve, which can potentially provide a clearer signal for individuals who no longer have sensory cells that respond well to hearing aids.

ramona rosamond: I am 79 years old, receive Medicare and have AARP supplemental insurance, and I live in Las Vegas, Nevada. Will Medicare pay for the new hybrid cochlear implant? Is there a doctor in Las Vegas who does this procedure?

Sarah_Sydlowski,_AuD,PhD: Unfortunately, while Medicare does cover cochlear implantation if an individual meets candidacy criteria, they do not currently cover implantation of the hybrid device.

ajr00: An addition to Pelican21's comment: I am 70 and have a similar problem. Recent adjustments on my 7-year-old hearing aids have helped. When does an individual make the decision to investigate a cochlear implant, and does Medicare cover any of the cost?

Sarah_Sydlowski,_AuD,PhD: If you are using appropriate hearing aids that are programmed to their best capabilities and are still not receiving adequate benefit, it may be time to consider a cochlear implant evaluation. During that evaluation, your hearing aids will also be evaluated to determine whether they really are adequate or whether there is different technology that could be more appropriate for you. You can expect to have your speech understanding ability tested with hearing aids on (yours and possibly clinic loaner aids) in a variety of quiet and noisy environments. Based on these results, we can determine whether you are audiologically a candidate for cochlear implantation or if different programming or different hearing aids would be best for you. If you meet candidacy criteria, then yes, Medicare does cover a substantial portion of the cost. In order to have a cochlear implant evaluation, you need to a have a current hearing test (no more than six months old) and you need to be evaluated in a cochlear implant center by an audiologist specializing in cochlear implants and a physician (typically an ENT, otolaryngologist or otologist) who performs the surgery.

ramona rosamond: What is the difference in the cochlear implant Medicare will cover and the one they won't cover?

Sarah_Sydlowski,_AuD,PhD: Cochlear implants are a covered benefit for beneficiaries who meet candidacy criteria. They do not currently cover Hybrid cochlear implants because candidates for these devices have more residual hearing and therefore do not meet the candidacy criteria for traditional cochlear implantation. I would recommend that you talk to your cochlear implant audiologist about any potential candidacy questions; candidacy and coverage is not always straightforward and we frequently need to review on an individual basis.

Tinnitus and Other Troubles

violetp: What if you have extremely sensitive ears and horrible ringing in the ears? Can you help with both, eliminate ringing and also the sensitivity to sound? Thank you!

Sarah_Sydlowski,_AuD,PhD: The combination of sensitivity to sounds and tinnitus (or ringing in the ears) can certainly be a challenge. Tinnitus can often be helped by using hearing aids or devices called "sound generators" that help to mask or cover-up the annoying ringing sound. There are also other techniques that can be taught to help manage ringing in the ears. Here at Cleveland Clinic, we offer a program called Tinnitus Management Clinic, which is a group appointment involving a variety of specialists who both evaluate each individual's tinnitus and provide education on ways to manage the tinnitus.

violetp: I was wondering about having earaches and sensitivity to cold almost constantly, in one ear primarily. Are there any products or a routine I can use to alleviate this or help? I often have fluid in the ear and sometimes wax. Thank you.

Sarah_Sydlowski,_AuD,PhD: These complaints are likely of a more medical nature (as opposed to hearing related specifically) so I would recommend you discuss this concern with an ear, nose and throat physician.

safety1: I have had ringing in both ears periodically, and now I have continuous ringing in both ears. I wear my hearing aids to reduce the ringing, but it is hard to concentrate and to sleep. Do you have any suggestions?

Sarah_Sydlowski,_AuD,PhD: There are a variety of management techniques that can potentially help alleviate tinnitus. For example, there are some hearing aids available now that also have a feature called a "tinnitus masker" – a low-level sound that is applied to help cover-up or draw attention away from the annoying ringing sound of tinnitus. At night when not using the devices, you can try playing the radio softly between stations to produce a low static; using a fan or apps like nature sound generators can also help distract your mind from the tinnitus to allow you to sleep. There are many other techniques that have been utilized for tinnitus management. Programs like the Cleveland Clinic Tinnitus Management Clinic can offer detailed options and support for tinnitus sufferers.

chickbull: I have had hearing aids for eight years now and am currently using Phonak behind the ear devices. The only problem I've had is where the wire breaks from the earpiece. I get by with one OK, but my hearing is very poor. Is there any way to prevent this or is there another type of aid that is better? I am 80 years old and a VA patient.

Sarah_Sydlowski,_AuD,PhD: Without seeing your hearing aids, it is difficult to say for sure what is causing you to have this issue, but one of the most common reasons that the piece that goes in your ear can stop working is wax. It is normal to have ear wax, called cerumen, and it typically works its way out of your ear on its own. But when hearing aid users have a piece in their ear canal all day, it can prevent the wax from exiting the ear and the wax can build up in the ear canal. It can clog the delicate components of the hearing aid and cause it to not function. Some individuals need to have regular ear cleanings to prevent this. That may be the case for you. You can talk to your physician and/or audiologist about whether wax is the culprit and how to schedule cleanings if it is.

houska: Hello. Close to a year and a half ago I had a tumor removed from my esophagus that was second stage cancer. Before my surgery, the chemo doctor I was assigned had me get a hearing test at the Clinic. He told me that there would be a possibility that I would lose some of my hearing after treatment. I had six weeks of radiation and two chemo treatments. I have lost some of my hearing and now wear hearing aids. I was not really happy with the way the hearing test was administered, and I am going to ask one of my doctors about having a hearing test done at Cleveland Clinic. My hearing test for my hearing aids was not done at the Clinic and compared to the test I had done two years ago, I don't think my aids are the right ones. I am wondering if there is a better solution to my problem and the right testing and the right type of hearing aids.

Sarah_Sydlowski,_AuD,PhD: I would certainly agree that another evaluation may be beneficial to answer your questions.

violetp: The program you offer for tinnitus, is it available in satellite locations, or is there perhaps a way to attend online or something like this if you don't live in the area?

Sarah_Sydlowski,_AuD,PhD: The Tinnitus Management Clinic is offered monthly at Main Campus in Cleveland. It is not available at satellite offices or remotely at this time.

percussion: To further clarify regarding tinnitus, I am 70 years old with hearing within the normal range per a hearing screening up to 4000Hz. I have a constant ringing and also scratching noises in both ears. Please talk about tinnitus: what causes it, what can be done about it, does it interfere with hearing ability.

Sarah_Sydlowski,_AuD,PhD: Tinnitus is the word used to described noises that you hear that aren't the result of an actual sound in the environment. It is most commonly described as a ringing, but can also be buzzing, roaring, chirping or one of many other sounds. It is experienced by more than 30 percent of the population and usually goes hand-in-hand with damage to the hearing system. Therefore, it also frequently goes hand-in-hand with hearing loss. We don't completely understand all of its causes, but a simplistic explanation might describe it as similar to phantom limb syndrome. In phantom limb syndrome, patients might experience sensation from a limb that is no longer there. With tinnitus, patients may experience the generation of sounds perhaps to fill a void where parts of the hearing system aren't responding as they used to respond. Tinnitus that is experienced after exposure to loud sounds (such as a concert or gunshot) may be temporary or permanent, but it is a sign that permanent damage has likely been done.

TedP: My mother had stapes surgery when it was new in the 1950s. I was recently tested and found to have hearing loss, and the audiologist thinks I may have the same problem. She has referred me to an ENT doctor whom I haven't seen yet. What can I expect?

Sarah_Sydlowski,_AuD,PhD: The ENT will likely do an exam and learn more from you about your family history. Recommendations today are often very different from what they were 60+ years ago, so I think you are on the right track to talk with a physician about your recent results.

RMB118720: I'm 48 years old and have a severe sensorineural hearing loss in one ear. While I was in my early twenties, it was thought that I had Meniere's disease. About seven years ago, I tried a hearing aid but found that it was uncomfortable and didn't improve my hearing enough to justify wearing it. Have there been recent improvements in hearing devices that treat this type of hearing loss? If yes, can you recommend any particular type/style? Or could I benefit from another treatment method such as cochlear implants? I'm getting very frustrated with my inability to hear well and becoming more isolated as a result. Thank you.

Sarah_Sydlowski,_AuD,PhD: Great question. While I couldn't comment on your specific hearing loss without much more detail, I can say in general that yes, in recent years there have been great developments in options for hearing loss. In particular, if hearing aids are not enough, evaluation for cochlear implantation has changed substantially. If you are feeling that you are unable to hear well as you describe, I would suggest a comprehensive audiologic evaluation at a center like Cleveland Clinic that works with various devices, including hearing aids and cochlear implants, so that you can hear about any and all options available to you.

General Information

dhessler8: There are many low-cost hearing assist devices now offered in the $200 to $500 range as opposed to most hearing aids from audiologists. Do they help for low loss use?

Sarah_Sydlowski,_AuD,PhD: Personal sound amplification products (PSAPs) and hearing aids are not the same thing. To quote the Food and Drug Administration (FDA): “A hearing aid is a wearable sound-amplifying device that is intended to compensate for impaired hearing. A PSAP is a wearable electronic product that is not intended to compensate for impaired hearing, but rather is intended for non-hearing impaired consumers to amplify sounds in the environment for a number of reasons, such as for recreational activities.” For more information, I would direct you to the following FDA document: PSAPs and hearing aids are not interchangeable, and I would not advise the use of PSAPs in place of appropriate audiologic evaluation and fitting of hearing aids, if appropriate.

jlgentry: If hearing aids are considered a prescribed medical device, why don't most insurance plans cover any or a portion of the cost of hearing aids? I have needed hearing aids for probably five years at least, and I am ready to get them and live that life; however, I can't afford them.

Sarah_Sydlowski,_AuD,PhD: This is a common frustration and I'm afraid I can't answer it satisfactorily for you. Although I have seen an increase in insurance coverage in recent years, I know cost is a challenge for many individuals. I would suggest that you talk with an audiologist in your area, because some areas have local non-profits that can help with financial support or may have centers that provide hearing aids on a sliding scale based on financial need.

SteveH: Does Cleveland Clinic Weston have "live hearing testing?" That is: can they feed test signals directly into the hearing aid while the client is wearing them to give a good evaluation of the client's ability to hear with the new aids and the programming of the aid?

Sarah_Sydlowski,_AuD,PhD: I think you are referring to real ear measures. If so, to the best of my knowledge, the answer is yes.


Moderator: That is all the time we have today for questions. Thank you everyone for participating today; and thank you, Dr. Sydlowski, for your insightful answers to our questions about hearing loss.

Sarah_Sydlowski,_AuD,PhD: Thank you all for attending and for asking such wonderful questions. I hope our chat today has been helpful.

Moderator: On behalf of Cleveland Clinic, we want to thank you for attending our free online health chat. We hope you found it to be helpful and informative.

For Appointments

To make an appointment with Sarah Sydlowski, AuD, PhD, in the Head & Neck Institute at Cleveland Clinic, please call 216.444.8500 or call toll-free at 800.223.2273, ext. 48500.

For More Information

On Cleveland Clinic

The mission of Cleveland Clinic's Head & Neck Institute Section of Audiology is to be a national leader in the provision of collaborative, patient-centered and comprehensive hearing health care for individuals of all ages, exemplified by excellence in patient outcomes, education, research and service.

On Hearing Loss & Hearing Aid Technology - Health Information

Learn more about symptoms, causes, diagnostic tests and treatments for hearing loss:

Clinical Trials

On Your Health

MyChart® is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to:

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2014. The Cleveland Clinic Foundation. All rights reserved.