I am sometimes asked why my initial appointments for hearing assessment are up to 90 minutes long and why do I charge a fee for these appointments when some of the competitors do it for free. I thought I will write this post to justify the use of the time and evaluation to make it all worthwhile. 

If you are having a hearing issue, it is vitally important that your hearing is thoroughly assessed by a qualified and expert hearing care professional. One of the most common tests used in hearing clinics is called puretone audiogram. It is a graph of your minimum hearing levels across the tones of the speech.  This is a genius of a test that was developed during the World War II when all the soldiers were coming back from the war and the Work and Pension department had to have a measure of their hearing difficulty to decide on the benefit they could allocate to the individual. Puretone audiogram provided that number.

Sadly, many hearing care professionals and other colleagues will still rely on the sanctity of the puretone audiogram to confirm the hearing profile of an individual. However, the science of hearing has progressed rapidly since the War and we know much more about how the tiny structures inside the ears work. For example, we know that many individuals can have a perfectly normal audiogram but great difficulty in hearing in background noise. Sometimes the listening issues are disproportionate to the basic hearing ability depicted via audiogram. One of the explanations for this kind of profile is something known as ‘cochlear synaptopathy’.  It is a term used to describe the loss of synapses i.e. the neural connection between the hair cells of the inner ear and auditory nerve fibres. When a synapse is lost, its associated nerve fibre is silenced.

Cochlear synapses can be lost from noise exposure and aging, or their function can be altered or disabled due to a genetic mutation.

A large chunk of these nerve fibres responds only to high thresholds. By the virtue of relatively high thresholds, they do not contribute to threshold detection in normal ears so, their loss does not elevate the audiometric thresholds. They also have a low rate of firing so are particularity resistant to the continuous noise masking, making them important in passing the speech information to the brain in noisy areas (coding responses to transient signals in the presence of background noise).

Synaptopathy of these fibres cannot be determined by audiograms or even some other physiological tests such as distortion product otoacoustic emissions. Astute clinicians will have to perform a series of tone and noise based tests (sometime electrophysiological tests with special sensors placed on the head), in order to confirm the best ability of hearing system as a whole. There are many other explanations of why compromised hearing function may not be obvious from puretone test alone e.g. auditory neuropathy spectrum disorder, auditory processing disorder, and other conditions that affect the structure or behaviour of neural cells inside the ears or neural cells within the hearing nerve and brain’s hearing system etc. Without a thorough assessment, a decision on the management of hearing needs cannot be made. 

Therefore, all my appointments are longer than the time that some of my colleagues will spend on assessing hearing. Furthermore, there is a saying that there are no free lunches. So, when you actually go for a ‘free’ hearing appointment- the hope and pressure are that a product or service has to be sold to you to fund someone’s else’s free test.  Whereas, with me, your appointment fees covers my time to be able to offer you the most independent advice on your hearing predicament. I feel strongly about providing a customised hearing solution to everyone I see, on the basis of the latest evidence available, and with the help of best technology in instrumentation and devices. The measure of my service is the improvement in the quality of your life, not just your hearing. The hearing solutions are not necessarily the traditional hearing devices. In many cases, it may just be that you need some minor adjustments to your lifestyle and use the technology other than traditional devices. I have seen some people where only a non-conventional bone conduction device is suitable for long-term ear health. Sometimes it is as simple as getting a better phone with bigger speaker and others, it is some training with the family on how is it best to have a communication with the person with better hearing needs.

I provide service to all age groups. The youngest person I have seen was a one-week-old baby and the oldest person was a 105-year-old gentleman. A lot of my clients come to me for a second opinion about their situation so, even if you have existing devices from somewhere else, I will be happy to see you. Appointments are also avaialble for balance/dizziness, tinnitus, auditory procesisng disorders, and noise/music/swim plugs etc. Book an appointment via email/phone or online: https://www.audiologyplanet.com/appointments/

Jay Jindal, Au.D. FSHAA, Consultant Audiologist and CEO, Audiology Planet