Provider Notes are a collection of information for our referring physicians and health professionals. We typically send out monthly notes via fax that are designed to help you recognize the signs of hearing loss and the comorbidities associated with untreated hearing loss to better manage the health and well being of your patients. If you would like to receive your copy via e-mail, please send us a note at info@goodsoundaudiology.com and we will update your delivery preferences.
Here’s a small sample of the types of articles we write and send out:
More to Hearing Than Sound
Hearing and understanding are two different things. This is what people mean when they say they “hear” they just do not “understand”. Hearing loss is a loss of “sound”, either in its entirety, or in parts of the hearing spectrum. Sometimes it does not matter if “sound” is restored if the brain does not know what to do with the sound when it hears it. No discrimination results in no identification and thus no “understanding”. This means that the brain does not know if the sound is an “s” or an “h”. When other cues are available to help you to determine what the sound might be then you have another tool in your toolbox to understand. With speech you can have tools to help you figure out what the sound of speech was trying to tell you by putting together the pieces. Were you familiar with the topic? Are you familiar with the speaker? Are there any related visuals? All of these things can give your brain more information to help it to “understand” the sound input it received. This is all being done at lightning speed so that you can attempt to make an appropriate response in a timely manner. Not much pressure, huh? Hearing aids are supposed to improve this? That is why they cost the big bucks, right? The answer to this question is purely dependent on each patient and their ability to detect a sound as registered on the audiogram and their ability to interpret speech that is presented at a comfortably audible level as registered in their speech discrimination percentage. 90-100% excellent, 80% good 70 % fair and so on down the line. So if two people have identical audiograms and one has 90% discrimination score and the other has 50% discrimination score hearing aids will bring both to understanding speech equally, right? Wrong even the most advanced hearing aid will not restore understanding to 90% for the latter or even to 100% for the former. Those hearing aids will get the cleanest signal to the brain for it to work with by making it first audible and then cleaning up the signal utilizing directional microphones and frequency shaping to make the speech sounds come through the noise better, but it’s just cleaning the brain is the bottom line. So why do some people “understand” better than others well it all depends on the damage to their auditory systems and the auditory nerves conduction ability. Different exposures be it intensity of sound or intensity of chemical or drug, can cause different levels of nerve damage. So when it seems like spending a substantial amount of money to “hear” but still not understand makes little sense remember the brain can only work with what it gets and with a hearing aid we can give it the best signal to work with to help understanding be the best it can be. You owe it to yourself and your family to try to hear the sounds of life.
Quality of Life
Hearing Loss is the invisible thief of a patient’s Quality of Life. By the time a person is fit with amplification, years of hearing loss have gone untreated. Thousands of conversations were misinterpreted. Many relationships have been negatively impacted. Loneliness and isolation are being experienced. Cognitive function has possibly decreased. All of these potential effects caused by hearing loss can be reduced or even removed by a simple conversation with you, the patient’s primary medical provider. The person your patient respects and depends on to improve their quality of life. When a patient presents for their “Welcome to Medicare” visit for new beneficiaries many aspects of the patient’s health are reviewed and documented. Unfortunately, the ones that are not visible such as hearing loss often go unaddressed. There may be no questions on the history form relating to hearing for the patient, or even more likely, the family to comment on. There may be no standard of care to provide a screening of hearing or recommendation of a baseline hearing evaluation with an Audiologist. It is likely due to the fact that “Screening for asymptomatic hearing loss in adults 50 and older has been assigned an “I” rating by the U.S. Preventative Services Task Force meaning the current evidence is insufficient to assess the balance of benefits and arms of the service.” This is so unfortunate! It also does not apply to those who are symptomatic for hearing loss which does recommend a objective hearing assessment. The need to determine if the patient is experiencing “symptoms” of hearing loss is crucial. This is important for so many and a little can go a long way to making a big difference in many people’s lives. Hearing loss is a health concern and evidence has determined it is linked with: functional dependence, cognitive decline, social isolation, falls, poor physician-patient communication and even mortality. There are treatment options and you, as a primary healthcare provider, can make such a difference. Inquire about hearing ability with patient and family (family may be the only one to notice or admit it for the patient), provide screenings or recommendations for Audiological evaluations, and/or perhaps provide material for patients regarding treatment for hearing loss, whether it is mild or severe. There are so many “unintended consequences” of neglecting a sense that is crucial to engagement with friends, family, co-worker’s, health care providers, warning signals, sounds of life etc.! As in all things, early detection is key and you are the gatekeeper to this detection.
Tinnitus Goes Mainstream
Hearing Loss is the invisible thief of a patient’s Quality of Life. By the time a person is fit with amplification, years of hearing loss have gone untreated. Thousands of conversations were misinterpreted. Many relationships have been negatively impacted. Loneliness and isolation are being experienced. Cognitive function has possibly decreased. All of these potential effects caused by hearing loss can be reduced or even removed by a simple conversation with you, the patient’s primary medical provider. The person your patient respects and depends on to improve their quality of life. When a patient presents for their “Welcome to Medicare” visit for new beneficiaries many aspects of the patient’s health are reviewed and documented. Unfortunately, the ones that are not visible such as hearing loss often go unaddressed. There may be no questions on the history form relating to hearing for the patient, or even more likely, the family to comment on. There may be no standard of care to provide a screening of hearing or recommendation of a baseline hearing evaluation with an Audiologist. It is likely due to the fact that “Screening for asymptomatic hearing loss in adults 50 and older has been assigned an “I” rating by the U.S. Preventative Services Task Force meaning the current evidence is insufficient to assess the balance of benefits and arms of the service.” This is so unfortunate! It also does not apply to those who are symptomatic for hearing loss which does recommend a objective hearing assessment. The need to determine if the patient is experiencing “symptoms” of hearing loss is crucial. This is important for so many and a little can go a long way to making a big difference in many people’s lives. Hearing loss is a health concern and evidence has determined it is linked with: functional dependence, cognitive decline, social isolation, falls, poor physician-patient communication and even mortality. There are treatment options and you, as a primary healthcare provider, can make such a difference. Inquire about hearing ability with patient and family (family may be the only one to notice or admit it for the patient), provide screenings or recommendations for Audiological evaluations, and/or perhaps provide material for patients regarding treatment for hearing loss, whether it is mild or severe. There are so many “unintended consequences” of neglecting a sense that is crucial to engagement with friends, family, co-worker’s, health care providers, warning signals, sounds of life etc.! As in all things, early detection is key and you are the gatekeeper to this detection. Thank you for providing the best healthcare for your patients.
Hearing Loss & Cognition
In the News: Dementia, Alzheimer’s Disease & Hearing Health Care Encourage your patients to have a baseline hearing test and treat hearing loss EARLY to stave off or slow down cognitive decline due to lack of stimulation caused by auditory deprivation. M. Kathleen Pichora-Fuller reports that Alzheimer’s Disease (AD) is progressive, degenerative, and is the most common form of dementia. She reports for those older than age 70 diagnosed with AD, AD is usually fatal within 10 years! Pichora-Fuller notes that dementia is more common in people with hearing loss, than in those with normal hearing. Indeed, the risk of developing dementia increases dramatically (two to five times greater) for those with hearing loss. Lin (2011) reported that for every 10 dB of hearing loss greater than 25 HL, the risk of developing dementia increases by 10 percent!! In light of the connection between age-related auditory and cognitive declines, questions are raised about what the mechanisms underlying the connection might be and if earlier or better hearing health care could stave off or slow down dementia (Lin et al., 2013; Pichora-Fuller, 2010). The popular “use it or lose it” view of cognitive aging has been supported by evidence that a range of lifestyle factors involving social, physical, or mental activity can help protect older adults from cognitive decline. Such activity includes engagement in social leisure activities, physical exercise and/or eating a Mediterranean-type diet, or cognitive expertise such as being bilingual or a musician. One possibility is that the relationship between hearing loss and incident dementia is mediated by lifestyle factors. Because AD has become a dominant global public health concern, rigorous research is needed to investigate the possibility that hearing rehabilitation could help stave it off or slow it down (e.g., by preventing social withdrawal). In summary, please refer your patients for a complete audiological evaluation (CAE) to aid us in early identification.
What is a CAE?
Our goal is BETTER HEARING. At Good Sound Audiology, Dr. Tina Jessee and I include with every hearing aid fitting an evaluation of the patient’s auditory status as part of the comprehensive plan to better hearing. Evaluation of Auditory Status includes: Objective verification of hearing aid settings: With the use of Real Ear Measurements (REM) we can evaluate the settings of hearing aids to ensure proper amplification. Adult Group Sessions: Communication about Hearing Aid Management Program or CHAMP is a group session held in our Sun Lakes office twice a month. My goal is to improve the patient’s ability to discriminate and recognize speech by evaluating their auditory status and providing strategies to help in real world situations. Additional Assistive Listening Devices are also reviewed and understood. Providing additional resources for your patients to hear well! During these sessions, I provide the knowledge and skills to communicate more effectively in their real world environments. Good Sound Audiology is the only private practice in the state to offer such a program. Auditory Training: Hearing aids are only one part of the solution. They are not a cure for this horrible disease. Our CHAMP program is a crucial component for your patients to build self-awareness about the realistic expectations of amplification. Another component offered to your patients is Auditory Training through exercises on the computer. These exercises help to re-train the brain to hearing better with the hearing aids. If the patient does not have the ability to complete these exercises at home, we offer time in our office to use our computers at no charge to the patient. By referring your patients to Good Sound Audiology, you can take comfort in knowing that Dr. Jessee and I will address of all their hearing needs; physically, emotionally and psychologically. We proudly sell only the best hearing aid technology in the world but that is not enough and we are committed to doing more and providing more. As always, thank you for your continued trust and allowing us to participate in your patients hearing healthcare.
I will take care of you
“I will take care of you.” These six words are so simple, yet they are extremely powerful. I say this to every patient with conviction, knowing full well that I intend to take care of them, as a person. It is easy to get caught up in the problem and focus on the ‘it’ of the day. However, it is my personal goal to look beyond the ‘it’ problem and realize the issue is more than technical issue with a hearing aid or a communication difficulty caused by a hearing impairment. The ‘it’ impacts each patient physically, emotionally and psychologically. Helen Keller is quoted as saying, ““Blindness separates people from things; deafness separates people from people.” When we think of going blind we are immediately fearful. Not so much when we think of losing our hearing. Interestingly, however, studies performed on the deaf/blind population show that those who suffer from both, overwhelmingly rate the hearing loss as more significant. Please, read that sentence twice this has been documented repeatedly and I see it and hear it every day from patients. Hearing loss is an invisible disease that has a major impact on how my patients interact with other people AND how those people interact with them. Many of my patients report that they stop participating in the social functions that they once enjoyed, e.g. they withdraw from conversations with family and friends; they no longer go to the theater or to restaurants, etc. One patient told me his granddaughter would cry because she thought he was ignoring her when in reality he cannot hear her. Even more so, I have spouses that report to me that they are no longer participating in activities with family and friends because their partner with a hearing loss is not comfortable participating. Hearing loss is not an ‘it’ problem, hearing loss is a physical, emotional and psychological problem. When you refer your patients to me, know my goal is to take care of him or her. Taking care of “it” the hearing loss is not enough. I bring people together through better hearing with a comprehensive rehabilitation plan that includes hearing aids, group sessions, individual auditory training and education. Dr. Jessee and I take care of “you” by caring for your patient. We will change their lives and improve their lives by providing better hearing and re-connecting them to their world. We take this responsibility seriously and never overlook the privilege that it is. As always, thank you for your continued trust and for allowing me to participate in your patient’s life.
When to refer to an Audiologist
When to refer to an Audiologist? Healthy hearing is more than just the loss of audibility! It is just as important to have a complete hearing evaluation if the patient has concerns regarding any issues of abnormal auditory perceptions (i.e. tinnitus, hyperacusis, misophonia). You already refer your patients for the most common concerns the ear: hearing loss, imbalance, and tinnitus. However, abnormal auditory perceptions (ICD-9 Code 388.4) are typically noted but lack the follow up care. Hyperacusis is an abnormal sensitivity to everyday sounds. For people with hyperacusis, the everyday, normal sounds that most people hardly notice suddenly or gradually become irritating and painful. People who suffer from the disease often complain of living in a world in which the volume seems to be turned up too high. (In the news) Misophonia is a distinct irritation or dislike of specific sounds (Jastreboff & Jastreboff, 2013) such as those produced by a family member during activities like eating, chewing, swallowing, and lip smacking. (In the news) Phonophobia is characterized by clinically significant anxiety provoked by exposure to a specific situation(i.e. loud, uncontrollable noises) leading to avoidance behavior (DSM-IV). If your patients report any of the above, make the referral to GOOD SOUND AUDIOLOGY for a complete evaluation. Remember ask your patient “when was your last hearing test?” NEVER ask your patient “how’s your hearing?” Thank you for allowing us to participate in the care of your patients. Cheers to a happy and healthy year! We look for forward to helping your patients with better hearing!
