How to read my audio-gram? Interpretation and results

An audiogram is the graph plotted by an Audiologist when a hearing test is performed.  Quite simply, it shows the softest sounds you can hear.  As there is often a lot of information given during the initial test appointment (test results, coming to terms with the fact you have a hearing loss and may need a hearing aid, hearing aid information itself, financing or funding options for hearing aids) it’s no wonder it can be hard to remember what everything means!

For a quick hearing test or screening, this audiogram may be the only information gathered about your hearing.  If you have a more comprehensive assessment there may be other information as well including speech test results and middle ear results.  Some clinics are happy to provide you with your audiogram, whereas others may request you obtain this through your GP if you have had a medical referral for a hearing test.

If we look at the basic audiogram, it is a graph with two axes.  Top to bottom is the volume of sound going from soft up the top to loud down the bottom.  Sound is measured in decibels relative to hearing levels, or dB HL, where 0 is the threshold of normal hearing (Interacoustics, March 2016).  Although 0 is where normal hearing starts, the normal range of hearing is actually from 0 to 20, and this normal range is the same no matter what age you are.

Across the graph from left to right is frequency or pitch of sound.  This is measured in Hertz (Hz) or Kilohertz (kHz) for the higher frequencies.  Think of a piano keyboard that goes from bass to treble if you sweep your finger left to right – the audiogram is effectively the same.  Most speech sounds fall between the range of 500-4000Hz and the frequency range for a hearing test is usually 250-8000Hz.  In rare cases either lower frequencies (down to 125Hz) or higher frequencies (up to 12kHz) may also be tested depending on the purpose of the test. 

The audiogram should have a table nearby explaining what the symbols plotted on the graph mean.  Circles indicate the right ear, crosses indicate the left ear.  If your audiogram is in colour: red is for right and blue for left.  A basic hearing screening will only have these symbols, but a comprehensive test will also have other symbols such as < or >, [ or ] or Π, sometimes there are even letters printed on the audiogram! What do they all mean?

Circles and crosses (even filled in circles and crosses) are air conduction results, which are from headphones or earphones.  These indicate how loud you can hear sound when it goes through all 3 parts of your ear (outer, middle and inner) and is the primary measure of the softest sounds you can hear.

The different types of brackets indicate bone conduction which was the tight headband you may have worn that sat behind your ear – this bypasses the outer and middle ears and sends the sound directly into the cochlea in your inner ear.  Bone conduction is normally performed during a comprehensive hearing test and indicates what part of your ear the hearing loss is in – and can often help your Audiologist to know whether any medical treatment should be considered rather than just a hearing aid.  As a rule if the bone conduction is much higher on the audiogram than the air conduction this could indicate a conductive or mixed hearing loss, and medical referral should be undertaken to investigate the cause and any treatment, especially if a hearing aid is being considered.

On your audiogram there might be different letters printed, or a banana shape or shaded area.  This area is where the different speech sounds occur, and each letter is actually a speech sound  - so you can see for yourself what sounds you can hear and which you can’t – at a normal conversational volume.  This can help you make sense of what your audiogram actually means!  If your hearing levels (circles and crosses) are above the letter then you can hear it well, if your hearing is below the letter then you can’t hear that sound well unless it is made louder in volume.  You may see that your audiogram is a mix - some speech sounds you can hear well (typically vowels and sounds like M, N, D) and some you may not hear well (typically F, S, TH). This is why people frequently say “I can hear but not understand” as they are not hearing all the sounds they need for speech to make sense. 

As mentioned above, the range of normal hearing is from 0 to 20dB.  If any results fall below 20 this indicates a hearing loss. Below normal hearing is graded by the terms mild, moderate, severe and profound. Mild is down to 45, moderate to 70, severe to 90 and profound below this. Hearing is not explained using a percentage which is a common misunderstanding, it will be described using these terms (for example mild to moderate, moderate to severe etc).

The most common shape for a hearing loss is where it slopes downwards towards the right, meaning that higher pitched (treble) sounds are harder to hear. This is typically what happens with age and exposure to loud noise. Hearing loss does vary from person to person with some people having flat hearing losses and others having a reverse slope where the deeper sounds are worse and the audiogram slopes upwards from left to right.  Often left and right ears are similar on the audiogram, but if one ear is worse, then that line will be below the other on the audiogram. 

If you were given a speech test where you heard a man’s voice say words you then had to repeat, then this will be the percentage you were given, which is often confused with your hearing levels.  This percentage score is called speech discrimination and what this actually means is how clearly you can hear speech when the sound is made loud enough for you.  The volume that you hear the words is usually dependent on your audiogram therefore for some people these words may be at a normal conversational speech volume, whereas for others the volume of speech may be made quite loud.  This score is a good indicator of your overall hearing ability, and if you have a hearing loss then it can indicate how well you are likely to do with a hearing aid. 

As hearing is complex and not about simply turning up the volume, if you have average speech discrimination then a hearing aid won’t be the answer to your hearing difficulties by itself.  For example, if you have a severe hearing loss and your speech discrimination for amplified speech is only 60%, then even with a hearing aid you will still have difficulty understanding what people say.  Unfortunately, generally the poorer your hearing is the worse your speech discrimination is; and the longer your leave your hearing loss untreated (without a hearing aid) the worse your speech discrimination is likely to get in the long run.

So how do you know whether you actually need a hearing aid?  Generally if your audiogram shows you are missing many or most of the speech sounds, or you are well below the normal hearing range (20dB or lower on the graph) a hearing aid may benefit you.  

There has been abundant research into early intervention for hearing loss and fitting hearing aids to people even with a mild hearing loss.  The biggest finding has been from The Lancet International Commission on Dementia Prevention and Care, where untreated hearing loss in middle age was found to be the single biggest modifiable risk factor for cognitive decline later in life (Livingston, et al., 2017).

Even for a mild hearing loss a hearing aid can make a big difference to your communication and levels of fatigue by the end of the day.  Certainly if the hearing loss is more than mild a hearing aid should be considered as an option.  As technology improves, hearing aids are becoming smaller in size, and there are even completely invisible shower-proof hearing aids available!

Your Audiologist can discuss suitable hearing aid options with you based on your hearing ability, your individual ear, and your needs and lifestyle.  It is also important to have realistic expectations of what hearing aids can and cannot do, so you know what to expect.  Your Audiologist can also discuss finance and funding options available for hearing aids.  Many clinics have interest free finance packages available and many private health funds offer a rebate on hearing aids if you have extras cover.  In Australia, if you are on a pension or DVA funded you may be eligible for hearing aids through the Hearing Services Program.

Understanding your own audiogram is easy, and is an important step to help you take control of your communication needs, especially when considering a hearing aid.  If you have any questions when looking at your audiogram or other results, or want to discuss hearing aid options, your Audiologist at Attune Hearing will be more than happy to help.

References

Interacoustics. (March 2016). The Variety of Decibel - Basics. Retrieved from https://www.interacoustics.com/guides/basics/the-variety-of-decibel-basics

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S., Huntley, J., Ames, D., & al, e. (2017). Dementia Prevention, Intervention and Care. The Lancet, 390(10113), 2673-2734.

Are Diabetics twice as Likely to have a Hearing Loss?

It is not uncommon for hearing loss and health problems to go hand in hand. On the face of it this may seem obvious but even though we may readily acknowledge this fact, we don’t automatically link specific diseases to hearing loss or recognise that we may have a hearing loss.  It is thought that approximately 1 in 6 Australians have a hearing loss and the health causes of hearing loss are still being researched. Furthermore, recent studies have shown that diabetes, a prevalent health condition which is on the rise, may be linked to hearing loss. Approximately 1.7 million Australians have diabetes (www.diabetesaustralia, 2018), and studies recognize that “As diabetes becomes more common, the disease may become a more significant contributor to hearing loss.” (Dr Catherine Cowie NIH, 2008). Cowie also identified that the likelihood of adults with diabetes having a hearing loss doubled. This finding is also supported by various other studies all of which have indicated that hearing loss is in fact twice as likely to occur with the disease, diabetes. 

What is the Connection?

The precise link between hearing loss and diabetes is not yet fully understood, however, it is thought that having a high blood sugar level seems to increase the likelihood of developing hearing loss by as much as 30% (Dr Catherine Cowie NIH, 2008). This finding pertains to anyone who is either diabetic or in the process of developing the disease. It is not clear why this is the case, however, the most likely hypothesis considers what is already known about the damaging effect of having high blood glucose levels. When this happens the sugar or glucose levels become toxic. This glucotoxicity begins to break down different parts of your body’s organs including your nerves, arteries and blood vessels. The body’s healing reaction to fight this breakdown is to form plaque which can build up in your arteries. Of all the organs in your body, your kidneys are the most vulnerable to the effects of glucotoxicity. This is because your kidneys have to work extra hard to remove the glucose from your blood. The excess of glucose gradually destroys the kidney’s, which leads to dialysis. How all this relates to your hearing is still being researched, however, since the glucotoxicity effect from high blood sugar levels is known to damage blood vessels, nerves, arteries and organs, it is thought that this must therefore almost certainly apply to the blood vessels of the organ of hearing, known as the cochlear or inner ear; damaging the vessels and nerves and the nerve pathway from the inner ear to the brain (Lorenzi, 1992). The link between hearing loss and diabetes is clearly present and how this affects the hearing is also still being researched. However, studies around the world in Brazil, the United States of America, Australia and Asia have all had supporting results to strongly suggest that there is a very strong association between diabetes and hearing loss. 

Know the signs

It is important to arm yourself with a good knowledge of the disease if you are either a diabetic, or if you think that you may be pre-diabetic. If this is the case, it is important to understand that you may be at risk of hearing loss as a complicating factor of diabetes disease. In particular, there seems to be an increased risk of high frequency hearing loss (Vasilyeva et al, 2009). If you have not already done so, book an appointment with your audiologist. If you have never had a hearing test, or only recently been diagnosed with diabetes, or are pre-diabetic, it is very important to establish a base-line of your hearing, so that your hearing can be monitored over time. Make sure that you have regular hearing tests so that your audiologist can tell you if there are any changes in your hearing thresholds. This is very necessary so that, should you start to develop a hearing loss, your audiologist can discuss rehabilitation options with you before your hearing loss deteriorates too much (Vasilyeva et al, 2009).  

Prevention is better than Cure

The most common diabetes in adults is Type 2 and it is possible to avoid the onset of this disease and even reverse the condition, especially if pre-diabetic. It is important to know what the relationship is between your lifestyle and the onset of this disease and take active steps to avoid diabetes, which in turn will lower the risk of complicating factors such as hearing loss (www.nih.gov). The causes are varied but if you remember that disease is due to high blood sugar levels, we can look at a few things that trigger this. Diet is primary; carbohydrates increase your blood sugar levels, so try and reduce or avoid foods high in carbohydrates such as pasta and potatoes and sugary foods like sweets. Eating a healthy diet is essential and you can easily do this by introducing more vegetables and foods high in fibre. Other big risk factors for diabetes is obesity, being sedentary, and high blood pressure. Exercise is vital for good health and well being and also for keeping trim. Reducing alcohol intake and Regular exercise assists you in losing weight and will also help you to maintain a healthy blood pressure. If you smoke, try to reduce it until you have given it up. People who smoke greatly increase their risk for diabetes.  

Summary

The number of diabetes cases is increasing and it is known that if you have diabetes you double your chances of hearing loss. The reasons why having diabetes contributes to the complication of a hearing loss so significantly are not completely clear, however, we do know that very high blood sugar levels lead to glucotoxicity which breaks down the nerves, arteries, blood vessels and organs of the body. It is thought that in the same way glucotoxicity may very likely damage the blood vessels and nerves of the delicate mechanism of your inner ear, which will cause hearing loss. Taking positive steps to prevent this disease and even reverse it involves not only changing your lifestyle, but also to regularly check your hearing with your audiologist. You can do this every year just as you have an annual check-up with your general practitioner.

If you’re looking to get your hearing tested, trust Australia’s only hearing healthcare provider, Attune Hearing. With clinics nationwide, visit one of our friendly Audiologists for a professional hearing test to determine your level of hearing loss or to manage your hearing health. Contact Attune Hearing today. 

Do You Experience Visually-Evoked Auditory Response?

A little while back this popular gif of three telephone towers playing jump rope circulated the internet. The gif evoked a reaction from people from all over the world and polarised audiences to a “white and gold or blue and black dress” standard. Why? Because the gif consisted of zero sound yet many people could hear the thud of the middle telephone tower landing on the ground. So, how could this be?

While there is no scientific evidence consensus on this particular gif, many experts speculate that people are experiencing a phenomenon known as visually-evoked auditory response (vEAR). This involves the convergence of visual and auditory events, similarly to synesthesia – a condition where the experience of one sense triggers another. For example, seeing sounds and tasting numbers (yes, these are real examples). 

While not a lot is known about vEAR, it’s looking more common than originally believed with 21% of participants in one study claiming to experience this phenomenon. So, what is actually happening?

A plausible explanation is that our brain is filling in for sounds that don’t occur in our reality. Throughout our lives, we are exposed to many sounds created by certain movements: typing on a keyboard, footsteps on the ground, chatter with lip movements, the shattering of a glass when it’s dropped, and more. When we see an action with no sound accompanying it, it could be that our brains are still producing the accompanying sound, just inside of our own brains. 

Still, not much is known about this condition – especially as many people with varying degrees of hearing loss report a mixture of hearing the thud, feeling the thud, or hearing nothing at all. For now, this event remains in speculation. However, if you want to continue to test your vEAR, a subreddit community has emerged that posts “noisy gifs” that you may also hear. 

Other Hearing Troubles 

On the other hand, if you’re at the other end of the spectrum – seeing visuals accompanied with no sound – then your hearing troubles may be more understandable. If you’re experiencing hearing loss there may be many reasons as to why. As there are various types of hearing loss, the best way to get to the bottom of your symptoms is to go and see a professional by booking a hearing test. These are quick, pain-free, and easy to conduct. The sooner you book in a test, the sooner you can work towards getting your hearing back.

Attune’s team of experienced audiologists and experts provide the highest standard of care in hearing healthcare. With skill, expertise, and a dedication to each patient, Attune’s team works to vastly enhance the lives of those experiencing hearing loss. Book in your test with Attune by enquiring online today. 

What Type of Incidents Can Lead to Hearing Loss?

Hearing loss can occur as a result of many things. The causes of hearing loss can be environmental, physical, neurological, and sometimes just unknown. Some people are simply born with hearing loss, while others develop it over time. Whilst there is sometimes no way to predict or avoid this condition from occurring, there are some incidents that are well known to cause hearing loss. So, what are these incidents and what can you do to protect yourself?

Loud Noises

Remember when an elder would warn you about listening to your music too loud? Well, they were right. Frequent exposure to loud music (or generally, any loud noises) for extended periods of time can damage the cells and membranes in your cochlea, as they become overworked and begin to die. Unfortunately, this damage is permanent. To prevent damage to your hearing, use protective wear for your ears (earplugs or ear muffs) during exposure to loud noises.

Ear Wax Build Up

Ear wax, or cerumen, is a natural substance produced by the ear to protect it against dust, foreign particles, and bacteria. While our ears were designed to naturally rid themselves of excess ear wax (it typically makes it way out of the ear and falls out or is washed away), people often like to remove ear wax for hygienic purposes. Unsuitable methods of ear wax removal can cause ear wax to build up and block up ear canals. This causes temporary hearing loss. To prevent this from happening, avoid using cotton tips that push ear wax further into the ear. If you’re worried about excess ear wax build up, get a professional to clean out your ear.

Unhealthy Habits

There is a strong correlation between smoking and obesity, and hearing loss. Leading an unhealthy lifestyle prevents all parts of the body from functioning in their optimal condition; it also leads to slower recoveries from health conditions. To keep your ears healthy and functioning properly, keep your whole body in good health with a balanced diet and active lifestyle.

Physical Accidents

Skull fractures and brain injury can cause issues with your hearing, such as sensorineural hearing loss (affecting the way your brain perceives sound waves). Some accidents can also cause physical damage to the ear, which can contribute to hearing loss (like a perforated eardrum). If you’ve had a knock to the head and you’re noticing your hearing has decreased, see a hearing specialist. Sometimes these accidents are unavoidable; however, if you’re participating in any contact sport or extreme activities, you can ensure you’re wearing the appropriate protective gear.

When Hearing Loss is Unavoidable

While you can do your best to protect yourself from developing hearing loss with the right gear, sometimes due to genetics, age, or malformations, hearing loss is simply unavoidable. In that situation, the best thing you can do for your overall health is to ensure you are managing your condition with the best possible care and equipment.

Attune is here to support you throughout your hearing loss journey with high-quality services and medical care. Call to book an appointment today on 1300 736 702.

Is There A Difference Between In-ear Headphones And Over-ear Headphones When It Comes To Hearing Loss?

When it comes to using external devices for listening purposes, people are inundated with various options that can be used to plug into their phones, be used wirelessly for music or even Bluetooth for when you’re on the go. If you suffer from hearing loss however, the options can be narrowed and need a little more consideration when choosing a type of headphone or earphone. So what are the differences between the in-ear headphone and over-ear headphones, and which ones suit better for those that have hearing loss?

In-ear headphones

These devices, as the name suggests, goes directly inside the ear and funnels the sound down the ear canal. These are typically very portable and are small in size so you can easily take them with you wherever you go, especially if you use them for exercising. While some in-ear headphones still use cables, a majority of brands use wireless or Bluetooth technology which helps them sync seamlessly with your devices.

In-ear headphones, because a lot of them are cordless, have shorter battery life. This is an important factor to consider before purchasing in-ear headphones. Another key element to consider is comfort. The in-ear headphones usually come with varying sizes of attachable silicone buds to suit your ear size. This can be great because you can customise the in-ear headphones to be more comfortable and secure while you’re using them.

Over-ear headphones

Over-ear headphones are typically more chunky in size. They are designed to completely encase your ear and cover it to ensure no sound escapes and you are getting the best possible experience. A lot of musicians use over-hear headphones as they also tend to have better for noise-cancelling qualities and drown out background sounds. Because these headphones are bigger and usually have more capabilities, they can also be the most expensive option.

While a lot of the over-ear headphones have cords, they don’t need to be charged. However, with a lot of advancements in technology, there are more and more products that have wireless or Bluetooth capabilities while still enjoying the over-ear headphone benefits. These headphones are also quite comfortable. Usually, the headphones are made with a soft cushioning material that is covered with leather for protection and comfort. You also don’t have to worry about sticking anything into your ear.

For people with hearing loss, over-ear headphones might be a good option. They typically have better noise-cancelling capabilities and are comfortable for the wearer. However, it’s always important to consult your hearing aid specialist because they will be able to help find a tailored solution depending on the severity of your hearing loss.

If you’re looking to get a hearing test or would like to see someone about getting hearing aids, contact Attune Hearing. Attune Hearing is Australia’s only accredited hearing health care provider and has hearing clinics nationwide. Attune Hearing Audiologists conduct hearing aid test and can help you live your life to the fullest.

Easy Steps You Can Take To Protect Your Hearing

The ability to hear is vital a sense that we often take for granted, and don’t realise how much we rely on, on a day-to-day basis. Like our other senses like sight and taste, once they are gone, it is extremely difficult and sometimes impossible to regain, which is why it is so important to take care of them and ensure we can still hear as we get older. So what are some easy steps that you can take to protect your hearing?

1. Don’t have the volume too high when listening to music


When you listen to music, particularly with in-ear buds or earphones that surround your ear or go inside, it’s important not to set the volume too high or you could risk damaging your hearing.

2. Get a hearing test to check your hearing


One of the best ways to protect your hearing is to get it checked. Like the rest of your body, going for check-ups ensures that everything is working normally and there aren’t any issues.

3. Avoid long exposure to loud noises

If you work in a noisy environment like a construction site, this can be hard to avoid however you should be taking the right precautions like wearing ear muffs and other hearing protection to minimise the damage to your hearing. Your workplace should have safety measures put in place so ask them for help if you need. Another common place where people have long exposure to loud noises is concerts or music events. Avoid standing next to the speakers if you can.

4. Don’t use cotton buds

Cotton buds and other small instruments shouldn’t be poked into your ears. They can cause significant damage and also push ear wax further into your ear, causing your hearing to be muffled or obstructed.

If you are interested in learning more about hearing, or you need to get your hearing checked, consider going to a clinic that specialises in providing hearing tests. Attune Hearing is Australia’s only hearing healthcare provider and has professional audiologists that perform tests throughout their 60+ clinics nationwide. Book a hearing test at Attune Hearing today!

Does Ear Shape or Size Affect Your Hearing Ability?

Shape

Researcher, Dr Trapeau concluded in 2018 that changing the outer shape of your ear actually has the ability to change the way you hear. He found that adding a piece of silicone moulded to the participant’s ear meant that they heard the sound differently and said that it was coming from a different place to where the sound was originating from. However, when the testers used the silicone for a week and came back for testing, their results were back to normal which means that our brain adapts to our ear shape to help us hear better. So does this mean that the shape of our ears can change the way we hear?

A lot of tests have shown that the answer to this question is quite technical which has a lot to do with neuron activity, sound waves and other factors. However, the research study conducted by Dr Trapeau does, in fact, show that the shape of our ears can affect the way we hear, especially the way we experience spatial awareness.

Size

But it’s not quite that easy to change your ear shape which means the next variable to consider is the size of your ears. So do bigger ears help you hear better?

Essentially, the outside of the ear is called the pinna which serves to protect the inner ear and also guide sounds into the ear canal. However, the size of your ear doesn’t necessarily mean that you have better hearing. After all, what gives you the ability to hear are the little hairs in the inner part of your ear that send signals to your brain when sound waves interact and vibrate with the three tiny bones in the middle ear.

If you are interested in learning more about hearing, or you need to get your hearing checked, consider going to a clinic that specialises in providing hearing tests. Attune Hearing is Australia’s only hearing healthcare provider and has professional audiologists that perform tests throughout their 60+ clinics nationwide. Book a hearing test at Attune Hearing today!