Frequently Asked Questions
- What is the difference between an audiologist, hearing instrument specialist, and otolaryngologist?
- What types of tests and treatments do audiologists perform?
- How do I know I have hearing loss?
- What causes hearing loss?
- How is hearing loss diagnosed?
- What are the different degrees of hearing loss?
- What are the different types of hearing loss?
- What are the signs of hearing loss in children?
- What style of hearing aid do I need?
- What are assistive listening devices (ALDs)?
- What is tinnitus?
- What causes tinnitus?
- How is tinnitus treated?
What Is The Difference Between An Audiologist (RAUD, Aud(C)), Hearing Instrument Specialist (HIS), and Otolaryngologist (ENT)?
There are multiple professionals that work with individuals with hearing loss, including but not limited to, Audiologists, Hearing Instrument Specialists (HIS), and Otolaryngologists (ENT). It is important to understand the difference between the professionals.
Speech Audiology Canada, the organization that supports audiologists within Canada, defines audiologists as those that “...assess, identify and treat hearing loss, auditory processing disorders, tinnitus and other auditory disorders as well as balance problems for people of all ages. We also advocate for the prevention of these disorders. We work independently or as part of interprofessional teams in: hospitals, clinics, schools, early intervention programs, research centres, private practices, rehabilitation centres, government agencies, manufacturing companies, industrial settings, colleges and universities.”
Audiologists are professionals qualified to assess, diagnose, monitor, and treat hearing and balance disorders. Audiologists have an extensive education background - they have a bachelor degree, followed by a Master of Audiology degree (Canada) or a Doctorate degree (US). Audiologists have training in hearing disorders, amplification (hearing aids), auditory processing disorders, tinnitus (ringing in the ears), hyperacusis, electrophysiology, cochlear implants, balance disorders, and aural rehabilitation. Audiologists select, prescribe, and fit hearing aids to patients of all ages as part of the treatment and rehabilitation program.
Upon completion of graduate school, audiologists working in British Columbia must pass a national standardized examination (Speech Audiology Canada Certification Exam) and be registered with the College of Speech and Hearing Health Professionals of BC. Yearly continuing education requirements (conferences, courses) must be met in order for an audiologist to maintain their license.
Hearing Instrument Specialist (HIS)
In order to become a hearing instrument specialist, a college diploma course is taken. Hearing instrument specialists work with adult patients, perform hearing examinations, and fit hearing aids.
An otolaryngologist is a Doctor of Medicine and surgeon who specializes in disorders of the ear, nose, and throat. They are also called Ear, Nose, and Throat Doctors (ENT). An otolaryngologist has completed medical school, and has completed their fellowship to specialize in otolaryngology. Otolaryngologists perform many surgical procedures for treatment of the ear, nose, sinuses, throat, and other head and neck regions.
What types of tests and treatments do audiologists perform?
Common services and treatments provided by an audiologist include:
Diagnostic hearing tests
Hearing aid fittings and consultations
Hearing aid repairs and maintenance
Pediatric hearing loss detection and treatment
School hearing screenings
Hearing loss prevention and protection programs
Earmold and earplug fitting and consultation
Custom musician’s earplugs and monitors
Tinnitus treatment programs
Dizziness and balance testing and treatment
Hearing rehabilitation and auditory training
Cochlear implant candidacy evaluations and implant programming
Depending on the audiologist’s place of work (clinic, hospital, school, government), he/she may provide all, or some, of the services above.
How do I know if I have hearing loss?
If you’re concerned you, or a friend or family member, may be experiencing hearing loss, you should consider a baseline audiological evaluation. Because hearing loss can develop gradually, it’s often the people around you who notice your hearing troubles first. Typically, it takes people an average of seven years to seek treatment. If you exhibit some of the following symptoms, consider visiting an audiologist:
You hear mumbling when people are speaking to you
You have to ask people to repeat what they said
You laugh at jokes even though you may not have heard the details
You need to ask others about the details of a meeting you just attended
You “check in” with your spouse to ensure you have heard correctly
You play the TV or radio louder than your friends, spouse, or relatives
You cannot hear the doorbell, telephone, or home security system
You cannot hear the turn signal indicator in your vehicle
You find looking at people when they speak to you makes it easier to understand
You miss environmental sounds, such as birds chirping or leaves blowing
You find yourself avoiding certain restaurants because they are too noisy
You hear a ringing sound in your ears, especially when it is quiet
What causes hearing loss?
Hearing loss can occur due to several factors such as the aging process, exposure to loud noise, medications, infections, viruses, head or ear trauma, congenital (birth) or genetic factors, diseases, as well as a number of other causes. It is estimated that there are 3.21 million hard of hearing Canadians. Hearing loss can occur at any age during an individual's lifetime.
How is hearing loss diagnosed?
If you are experiencing any of the above symptoms of hearing loss, you should see an audiologist to have a formal audiological evaluation or “hearing test”. The evaluation allows the audiologist to determine the type and degree of your hearing loss.
The diagnostic hearing evaluation begins with a thorough case history, where information regarding not only the health of the ear, but the human body, is documented. The audiologist will then visually inspect the ear canal and eardrum, and perform a test to determine your eardrum’s mobility.
The audiologist will then evaluate your sensitivity to frequency specific tones as well as speech. Your audiologist may test for speech understanding in different conditions, such as at conversational levels or in noise.
The result of the audiological evaluation assists the audiologist to determine if there are any medical “red flags” and whether a referral to another medical professional is warranted. If the audiologist believes your hearing loss may benefit from medical intervention, the results of the evaluation are useful information to your physician. As well, the outcomes assist the audiologist in recommending the best hearing aids for your specific needs. The results are also used to create a prescription, by which the hearing aids are programmed.
What are the different degrees of hearing loss?
The results of your hearing test are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. The top of the graph refers to soft sounds and the bottom of the graph refers to very loud sounds. Frequency, or pitch, from low to high, is plotted from left to right. Hearing level (HL) is measured in decibels (dB) and is described in categories from normal hearing to profound hearing loss. The hearing loss categories used by most hearing professionals are as follows:
Normal hearing (0-25 dB HL)
Mild hearing loss (26-40 dB HL)
Moderate hearing loss (41-55 dB HL)
Moderately-severe hearing loss (56-70 dB HL)
Severe hearing loss (71-90 dB HL)
Profound hearing loss (greater than 91 dB HL)
The audiogram below shows a patient who has normal hearing in both ears:
To learn more about degrees and types of hearing loss:
What are the different types of hearing loss?
There are three main types of hearing loss and each can be caused by different factors and require differing medical management and rehabilitation. The three types of hearing loss include:
Conductive hearing loss occurs when there is a problem with the outer or middle ear. The problem may lie in the ear canal, the eardrum, or the middle ear (middle ear bones/ossicles or Eustachian tube). The inner ear (cochlea) and auditory nerve are functioning normally. The patient with a conductive hearing loss may perceive sounds and voices as soft or muffled, and may say that their ears feel plugged.
Sensorineural hearing loss occurs when there is a problem with the inner ear (cochlea) or auditory nerve. The majority of sensorineural hearing loss occurs as a result of damage to the hair cells in the cochlea, or the connection between the hair cells and the auditory nerve. This abnormality prevents sound from being transmitted to the brain, and as a result, the sound is not heard by the individual. Individuals with sensorineural hearing loss may say that speech is unclear or muffled. They may also have tinnitus (ringing in the ears).
Mixed hearing loss occurs when a person has a sensorineural hearing loss in combination with a conductive hearing loss. This means there is hearing loss in both the outer and/or middle ear, as well as the inner ear.
To learn more about the different types of hearing loss:
What are the signs of hearing loss in children?
Hearing loss in children can occur at any age, and can result from acquired factors such as ear infections, head trauma, certain medications, and genetic factors. You may suspect your child has a hearing loss if you observe any of the following:
Failed newborn hearing screening
Delays in speech and language acquisition, including baby babbling
Frequent ear infections
Not startled by loud sounds
Not turning to the location of sounds after six months of age
Difficulty following verbal directions
Daydreaming in many situations
Concerns by school teachers
Failed school hearing screening
Loud volume on the TV or radio
Complaints from the child that they cannot hear
Risk factors for pediatric hearing loss include:
Infections (viral, bacterial, fungal, parasitic) e.g. meningitis
Premature birth or time in the Neonatal Intensive Care Unit (NICU)
Oxygen deprivation (asphyxia)
Elevated bilirubin levels
Ototoxic drugs e.g. certain drugs for chemotherapy
Exposure to harmful noise levels
Syndromes associated with hearing loss
An audiologist is trained to test children of all ages. Any symptoms of hearing loss in children should be addressed promptly so that speech, language and academic development are not delayed or negatively impacted.
What style of hearing aid do I need?
There are many styles of hearing aids to choose from, from in-the-ear styles to behind-the-ear styles.
When selecting a style of hearing aid, the following should be considered:
Lifestyle and listening needs
The type/degree of the hearing loss
Shape and size of your ear canal
Manual dexterity and visual abilities
Cosmetics and aesthetics
Select "learn more" to learn about hearing aid styles and hearing aid technology.
What are assistive listening devices (ALDs)?
People with all types and degrees of hearing loss can benefit from an assistive listening device (ALD). ALDs are designed to increase the loudness of a desired sound (telephone, television, person) without increasing the background noise. ALDs include amplified alarm clocks, TV listening systems, amplified telephones, and remote microphones. Many newer devices are small, wireless, and compatible with modern hearing aids.
A few examples of assistive listening devices are discussed below:
The Connect Clip is a remote microphone. When the patient wearing hearing aids wants to hear someone’s voice more clearly, the conversation partner will wear the Connect Clip. The conversation partner’s voice will be heard directly in the patient’s hearing aids, even if the conversation partner is up to 20 meters away. This is a great assistive listening device for listening to lectures or presentations, or when listening in a vehicle.
The TV Box allows a hearing aid wearer to hear the TV directly in their hearing aids, similar to wearing wireless headphones. It also allows the hearing aid wearer to adjust the TV volume independently of whoever they are watching with.
Amplified telephones are designed for individuals with hearing loss, and they allow for an extended volume range and high frequency boost, assisting those with hearing loss on the telephone.
Amplified or Vibrating Alarm Clock
An amplified alarm clock has an extended volume range to be heard by individuals that are hard of hearing. Many have a vibrating bed shaker attachment, helping to wake the individual from their sleep.
What is tinnitus?
Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, buzzing or clicking. Tinnitus is not actually a disease, but a symptom of another underlying condition of the ear, auditory nerve or other influencing factor. Tinnitus can be intermittent or constant, with single or multiple tones. The perceived volume can range from very soft to extremely loud and may be recurrent or constant.
What causes tinnitus?
The exact cause of tinnitus is not known in every case. However, there are several likely factors that may worsen tinnitus. These include:
- Noise-induced hearing loss
- Wax build-up in the ear canal
- Certain medications
- Ear or sinus infections
- Age-related hearing loss
- Ear diseases and disorders
- Jaw misalignment
- Cardiovascular disease
- Certain types of tumors
- Thyroid disorders
- Head and neck trauma
How is tinnitus treated?
Depending on the severity and underlying condition causing the tinnitus, there are several treatments available to improve the perception of unwanted noise. The most common treatments for tinnitus include:
- Hearing aids with tinnitus-masking features
- Tinnitus retraining therapy
- Sound therapy
- Avoidance measures
- Avoidance of certain medications
- Behavioral therapy