Hearing and Balance Services including Hearing Aids.

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Audiology Services

These are separated into three sections although the fitting of hearing aids is necessarily dependent upon a hearing assessment at first.  Costs for these assessments may not be covered by Medicare and range from $45 to $350 each depending upon complexity and time taken. 

  • Hearing testing
  • Balance testing with calorics
  • Electrophysiological tests(BAER;SVR)
  • Hearing aid assessments, fitting & evaluation
  •  In situ hearing aid evaluations & electro-acoustic tests

 

Audiological Investigations:

Audiogram: Air conduction screening 15 minutes
Audiogram: air & bone conduction, with masking required 25 minutes
Audiogram and speech testing or impedance audiometry 40 minutes
Audiogram: speech testing; impedence audiometry 60 minutes
Hearing Aid Assessment 90 minutes
  • The audiogram is the basic building block to most of the services. This is undertaken in a sound treated enclosure with background noise levels reduced to those required by the current stringent Australian standards. 
  • Masking is a technique of using narrow band noise to prevent tones presented to one ear from being heard on the other side. This is not always required. 
  • Speech testing uses a standardised compact disc recording of words in varying levels of noise, usually to one ear at a time. It is perhaps the most normal assessment. It may be assessed binaurally; in background noise; through loudspeakers or split between the ears. 
  • Impedance audiometry involves the assessment of the mobility of the middle ear system (including the ear drum) and recording of acoustic reflexes. It is often used in children to look for problems such as ‘Glue Ear’ but is used to determine the integrity of some of the auditory pathways. 
  • Hearing aid assessments may involve all of the above and assessments of comfortable and uncomfortable loudness levels for speech and tones. Further explanation is included below

Vestibular Investigations:

Caloric testing with EOG 35 mins
Balance testing with EOG 35 mins

The caloric test is the most commonly used  assessment of balance function and involves a process similar to having the ear syringed although with cooler or warmer water.  This should cause a mildly dizzy sensation.  

Balance testing on the other hand records any induced dizziness or unusual eye movements under differing conditions of gaze; eye tracking; neck/body/head position and positioning. 

EOG - electro-oculography, involves recording the natural current generated by the eyes when they move.

Electrophysiological Investigations:

 
BAER - brainstem auditory evoked potentials 60 mins
Slow vertex (cortical) evoked potential SVR 90 -180 mins

 

The BAER is an investigation of the first part of the auditory transmission pathway from the cochlea through the brainstem. The technique uses very fast presentations of short bursts of sound and follows the progress of the sound through the various junctions along the auditory pathway at this level. Due to the short duration of the sounds, it is not normally suitable for threshold estimation. Recording is by way of silver electrodes pasted behind the ears and on the top of the head. The patient is recommended to relax or sleep in a reclining chair.

On the other hand, the SVR is a very late potential and is more suitable for assessing higher level functioning. This technique uses longer tonal stimuli. Patients are allowed to read a book or magazine for this assessment.

Hearing Aid Assessments, fitting and evaluation:

Hearing Aid Assessment 90 minutes
Hearing Aid fitting 45 -60 minutes
Hearing Aid evaluation 45 minutes

A full hearing assessment  involving air/bone conduction audiometry, speech discrimination and comfortable and uncomfortable loudness levels will be performed and the results discussed.  Different approaches to assist the problem will be explored and this includes appliances such as hearing aids if hearing levels are suitable.  At this time, the cost of the assessment it is not refundable through Medicare but some Private Health Insurances may offer this as a rebate.  Depending upon the results of our discussions, impressions are taken of the ear(s) for the hearing aid(s) to be made up. This takes up to 3 weeks.

During the hearing aid fitting appointment, instructions and 'tuning' of the hearing aid will take place.  Full instructions how to wear and care for the hearing aid is given.  It is important to wear a hearing aid as much as possible and under as many situations as possible to evaluate it fully.  For the first few days though you may need to 'break in' the aid and build up the time worn.  After the fitting, you will be advised of the cost of the hearing aid including the manufacture and fitting fee.  Each patient accepts full responsibility for hearing aids fitted.  It is advisable to check with insurance companies regarding the conditions of policies regarding these appliances.

After a fortnight of wearing a hearing aid, the situation is assessed and any adjustments made as required. The hearing aid may be finalised;  adjustments may be required necessitating an extension of the evaluation period, or the aid model may need to be reviewed.  An invoice to purchase the hearing aid once finalised is issued. 

The cost of hearing aids ranges between $1200.00 and $3,500.00 (private health cover may entitle you to a rebate if you were referred by a doctor). Remote controls, digital processing hearing aids or self-adjusting models are more expensive.  A $50.00 trial and manufacture fee will apply although this is normally included as part of the cost of the aid in the first instance.

See also types of hearing aids

In situ hearing aid evaluations & electro-acoustic tests:

 

Real Ear & Hearing Aid Tuning 45 minutes

For the traditional hearing aids, the prescriptive method of fitting has been favoured. This involves adjusting the response of the aid in an artificial ‘ear’ to match a formula dependent upon the hearing levels. This is further refined to match the hearing aid’s response in the patient’s ear canal using microphones placed between the hearing aid and the tympanic membrane (ear drum). Increasingly with the newer technology available, hearing aids adjust their response to the incoming sound and other techniques to allow a prescriptive fitting are employed.  All hearing aids have a ‘factory’ response and this is the first step in checking the functioning of the aid. It can also be used for ‘trouble shooting’

Hearing aids are fitted to a particular ear shape and hearing loss. With the current advances in technology hearing aids can be retuned to keep pace with changes in hearing level up to certain limits.  After two years, it may be necessary to retune a hearing aid and this is performed using  an audiogram and real ear prescription of gain.