Pearls of Wisdom

Posts for: June, 2018

When is the right time to think about a Cochlear Implant?

    For people with hearing loss, hearing aids are a great option to gain access to speech and communicate with those around you. But for some, hearing aids are not enough. Some people have too great of a hearing loss that even a hearing aid cannot help. For those people, cochlear implants are possible option.

Most people on the street are familiar with hearing aids. However, many people have likely never heard of a cochlear implant. So what is it? A cochlear implant is a surgical prosthetic to help someone with severe to profound hearing loss. These devices are composed of two parts- an internal and external unit.

The external unit contains a transmitter, microphones, and a speech processor. The microphone and speech processor are housed inside of a device that is similar to a behind-the-ear hearing aid. A cable connects the processor and microphone to the transmitter that attaches to the outside of your head via magnet. The microphone picks up sounds and sends it the speech processor that analyzes and digitizes the signal before sending it to the transmitter. Cochlear Implant Austin, TX Who is a Candidate?

The internal unit is comprised of an electrode array and a receiver. The receiver is located under the skin on the temporal bone. The electrode array is located within the cochlea, or the organ of hearing. The receiver collects the signal sent from the transmitter and converts it to an electrical pulse. This pulse is then sent to the electrode array which then directly stimulates the auditory nerve. This signal then travels the length of the auditory system up the brain where it is processed as sound.

Now surgery may seem scary, but for some, a cochlear implant is a good option to regain functional hearing again.


Who is a candidate for a cochlear implant?

  • Adults:

    • Have a moderate to profound hearing loss in both ears
    • Get little to no benefit from hearing aids
    • Have no medical contra-indications that would put them at risk during a surgery
    • Is psychologically ready to undergo the time commitment required with a cochlear implant
  • Children

    • Have a severe to profound hearing loss in both ears
    • Get little to no benefit from hearing aids
    • Have no contra-indications that put them at risk for surgery
    • Have familial and educational support that will emphisize the development of auditory skills

What is the process for getting a cochlear implant?


    A potential cochlear implant candidate should talk with their ear, nose, and throat surgeon and their audiologist. From there, the audiologist would perform a candidacy evaluation. This candidacy appointment is completed in the best aided condition, meaning the individual would wear his or her hearing aids for the testing. FDA guidelines must be met that shows the individual is not getting functional benefit from amplification. Once approved for the implant, the individual will undergo a medical exam, imaging studies, and a psychological exam. After the child or adult is determined to be a candidate, he or she will undergo implantation surgery.

    Now a cochlear implant is no walk in the park. Even after getting an implant and “turning it on,” an extensive amount of follow ups must occur to appropriately program this device. Also, practice on the patient’s part must occur that includes at home listening exercises to retrain your brain how to accept an auditory signal again. It can be frustrating at times because progress can be slow.

However, with appropriate follow up and effort on the patient’s part, cochlear implants can allow individuals to rejoin the hearing world again! So do you think you are ready to talk about cochlear implants?


For more information contact the Hearing & Balance Center of Austin at Great Hills ENT at (512) 258-2300.



Television Sound Waves Austin, TX


Why Can't I Undestand the Television Clearly?

Living with Hearing Loss and Hearing Aids


     Well, this is a very good question, and unfortunately not one with a super easy answer. If you have hearing loss or hearing aids you are already behind the 8 ball, and this has to be the #1 complaint my patient's have and always makes the Top 5 things people in Austin want to hear clearly. 

How does television process speech signal?

In a perfect world the entire signal would be processed and come out your television's speakers. But we don't live in that world. A normal human ear at birth can hear between 20-20,000 Hz. That is a very broad range. When we test hearing we look at 250- 8,000 Hz because that is the range in which all of the parts of speech fall. Vowels are in the lower frequencies, giving volume to what we hear. While the higher frequencies are the endings of words, or high frequency consonants. Think /s/, /t/, /p/, /sh/, /ch/ sounds. A high frequency hearing loss will affect the clarity of sound and not so much the volume. When you think about it, even reducing the range to 250- 8,000 Hz is still a pretty big range, so we have to cut it down further. 

Now, in order for an auditory signal to go from Point A (broadcast station, satellite, server) to Point B (your living room T.V.) at some point it has to travel along an electrical cord. In the U.S our electrical outlets are 110v, 120 Hz with 15 amp of resistance. So, the signal has to travel at a multiple of 60Hz. Telecommunications standardly cut out everything above 2,500 Hz. Poof, gone. That would be most of the consonants that tell us the difference between "tear," "care," "fare," "pair," & "share." Couple that with an English accent from British programming or dramatic sound effects (which are low frequency heavy) and we have a recipe for disaster on the undertanding front.

Will hearing aids help me understand the television better?

Yes. Will it be perfect, no. Will the overall volume decrease? Yes. Please remember, a hearing aid is a therapy tool. It is the cornerstone of an amplification SYSTEM. Albiet the most important, but if you still aren't hearing the television as clearly as you would like but everyting else sounds better, it might be time to look at an assistive listening device. Most hearing aid manufacturers have a device that will transmit television signal directly into your hearing aid(s). 

Why are some television channels louder than others?

Quite simply, it is based on average age of viewing demographic. Certain stations are louder. For example, PBS, HGTV, Food Network, TCM and network television tend to be louder (from personal experience) than Comedy Central, TBS, USA, and TNT. My husband is always asking me if I have my ears in after I've been watching say The Big Bang Theory marathon on TBS and he changes the channel to network TV. The volume goes up and he instantly has to turn things down. I usually have him set the volume to where he can hear it and then instruct him to hit the "back" button. And 9 times out of 10 he has to turn it up too. For added measure I'll then point out that YES I am wearing my ears. I'll admit, I still use closed captions from time to time.


At the end of the day, if you are constantly having difficulty understanding speech on the television, at home or in noise it is a good idea to have a baseline audiogram. Believe it or not, they are actually used for more than selling hearing aids. Chances are, if you're having that much trouble, you are missing out on a lot more than just Downton Abbey.



Paige Peterson, AuD, PhD