Audiology is that branch of science that deals with the ear & hearing mechanism. It deals with both the normal as well abnormal aspects of hearing. It is a clinical profession that has its unique mission in evaluating the hearing ability and amelioration of impairment due to hearing loss.
Audiologists are ‘Hearing Professionals’ in the scientific field of Audiology, engaged in autonomous practice, to promote healthy hearing, communication competency, and quality of life for persons of all ages, through prevention, identification, assessment & (re)habilitation of hearing, auditory functions, balance and other related systems. Audiologists are the qualified and authorized group of professionals to treat people with hearing problems & difficulties.
With the recent advancements in technology, it is possible now to detect the presence of hearing deficiency right immediately after the birth of a child; and has enabled the Audiologists (Hearing Professionals) to carry forward with necessary (re)habilitative procedures right from the first month after birth.
Recent research studies have repeatedly proved that early intervention could enable every individuals with communication problems to overcome the deficiencies, resulted from the handicapping conditions; and can very effectively be integrated into the mainstream with the most suitable remediation.
Audio logical Services are provided to individuals who have concerns with regard to their hearing ability. Individuals may be self-referred or referred by a physician/ENT or professionals in any field of medicine. Services in general include the following:
Services are available for infants through adulthood whenever there is a concern regarding hearing, listening, and discrimination of speech or processing of speech.
a. Audio logical Consultation/Counseling
b. Behavioral Tests
c. Physiological Tests
d. Electrophysiological Tests
e. Hearing Aids
f. Ear Moulds & Accessories
g. Auditory (Re) Habilitation
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Anyone with likely hearing impairment or suspected hearing loss or with any discomfort of hearing can consult the Hearing Care Professional (Audiologist) at CAPAAR. Anyone with previously diagnosed impairment in hearing can also have consultation for Audio logical advice & remediation.
Appropriate intervention & recommendations would be provided by our experienced Clinical Audiologist to ameliorate the hardships due to hearing disability. Post-Audiogram counseling is also rendered imparting excellent comprehensive overview of the prevailing hearing status and judicious recommendations on further follow up measures. In-depth orientation is given to individuals on hearing aid usage, care and maintenance of every hearing aid dispensed, which might extend over multiple sessions.
Behavioral Tests are those hearing evaluation procedural methods/tests, which is administered and evaluated with the cooperation of the patent. Here, the patient actively participates in the test administration procedure, such that the behavioral responses from the patient towards various sound stimulation are considered for the final assessment of the test result. There are various test methods that are employed under this category, which determines various aspects of hearing related mechanisms & functions. The different behavioral test procedures available at our clinic include the following:
This is the most basic of the hearing tests, performed by an Audiologist (Hearing Health Care Professional), to determine the hearing ability of an individual. It comprises a number of different procedures, which when taken together can determine whether or not a person is suffering from hearing loss or not, and if so, to what extent. In this test procedure, numerous puretone (beep sound signals) of different frequencies are delivered to the patient’s ear via headphones, ear inserts and/or bone vibrators at varying loudness.
And the physical behavioral responses (by some visual methods; commonly by way of press of a switch) from the patient towards/against the audibility of the sound are recorded. These recorded results are normally illustrated in a graph called ‘Audiogram’, which provides better picture of one’s hearing sensitivity. This is the basis for auditory diagnosis & management since it identifies hearing threshold levels of an individual, enabling determination of the degree, type, nature & configuration of the hearing loss, if present.
This is a method of measuring one’s ability to understand, recognize & discriminate speech. This test procedure is similar to the Pure tone test, bust instead of the patient listening to different tones, the testee listens to certain calibrated words (spondees) spoken by the examiner at different loudness level and is instructed to repeat back. This test result would give a fair indication of how well one hear and understand ordinary conversation. The different test procedures under this domain include ‘Speech Recognition Test’ (SRT), Speech Discrimination Scores (SDS), Performance Intensity Function for Phonetically Balanced Words (PIPB), Roll Over Index (ROI) & Speech in Noise Tests.
These are fundamental test procedures employed as a part of basic pure tone audio metry, using bone vibrators; which would enable the audiologists in refining & correlating the test results. The test includes ‘Audiometric Weber Test’, ‘Audiometric Rinne Test’, & ‘Audiometric Bing Test’. The correlative study of these test results gives a fair indication of the status of middle ear/inner ear condition.
These are conclusive low cost traditional test procedures designed for the differential diagnosis of various inner ear disorders. These tests, individually or in correlation, aid in the detection of specific site of lesion in the sensory neural pathway. (Cochlear Vs Retro-cochlear pathology). These test procedures include ‘Short Increment Sensitivity Index Test’ (SISI), Tone Decay Test (TDT), Alternate Binaural Loudness Balance Test (ABLB), Supra Threshold Adaptation Test (STAT).
These are special procedures that include ‘Bekesy Audiometry’ –which employs an automatic mode of hearing threshold determination; ‘Tinnitus Matching’ –which is employed to approximately match the tinnitus frequency; & ‘TEN Test’ –which is employed to determine the cochlear dead regions.
A variant and flexible approach is utilized for the assessment of hearing in pediatric population. This may take a prolonged single session or multiple sessions in arriving at an auditory conclusion. The various test procedures that could be employed are ‘Behavioral Observation Audiometry’, ‘Free-Field Audiometry’, ‘Play Audiometry’, & ‘Conditioned Response Audiometry’. Infants and children who do not cooperate with conventional pure tone audio metry could be assessed under these test procedures.
These are highly objective tests which do not require active participation from the patient. i.e., the patient need not respond verbally or physically towards the test administration process. Tests are based purely on the ongoing physiological activities in the auditory system against the sound stimulation. High precision equipments are employed to achieve this. It includes the following test measures:
The Middle Ear Analysis is a test to determine the status of the middle in our auditory system. The middle ear is an air filled enclosed cavity consisting of 3 tiny bones, small tendons & muscles. Middle ear plays an extremely important role in conducting the sound waves from the external ear canal to the inner ear. There are many clinical conditions that adversely affects the normal conduction of the sound to the inner ear, there by resulting in loss of sensitivity of hearing. Hence it is very essential to incorporate this test in the routine clinical battery of tests to be performed for hearing evaluation.
The Middle Ear Analysis shows how the eardrum reacts to varying air pressure in the ear canal. A small probe is inserted into the ear, and while listening to different sounds, the air pressure in the ear canal is increased and decreased, the results of which would give a fair indication of middle ear functioning. This test serves as a diagnostic tool for differentially diagnosing many of the middle ear disordered conditions. This assessment procedures includes test measures like “Tympanometry”, “Reflexometry”, “Reflex Decay Test” & “Eustachian Tube Function Test”. This is purely an objective & highly accurate method of investigation, using microprocessor based instrumentation.
Thus in general, this test procedure is a measure of effectiveness of the sound transmitting chambers of the external ear & middle ear. i.e., it serves as an effective measure in the measurement of the mobility of the middle ear structures when the air pressure in the ear canal is varied over a given limited range; thereby extracting a fair amount of information about the functional status of the middle ear, while the sound is being conducted/transmitted to its internal structures.
This is another physiologic test, which is highly automative in nature and could be used for hearing screening as well for diagnostic purposes. This tests serves as an objective measure in screening the hearing of newborns before they leave the birthing hospital. This test also has its utility in early identification of hearing loss besides being explored for various pathology related measures. The different test measures include “Distortion Product Otoacoustic Emission” (DPOAE) Test, “Transient Evoked Otoacoustic Emission” (TEOAE) Test.
Otoacoustic emissions are nothing but low intensity sounds detectable at the ear canal of normal hearing subjects, either spontaneously or in response to acoustic stimulation. Test using this phenomenon is an objective measurement of the active micro-mechanical function of the outer hair cells of the inner ear cochlea. In general terms, this test determines the functional status of the inner ear, especially the cochlea –the main organ of hearing in the human auditory system.
In this test, specific acoustic signals of pre-determined frequency & intensity are delivered to the ear canal of the patient through a probe that is placed at the entrance of the ear canal. Subsequently and in response to the delivery of the acoustic signals, the low intensity emissions are scanned for at the level of ear canal. The presence, absence or magnitude of these emissions would give a fair estimate of the efficiency with which the sensory cells (Outer hair cells) are functioning in the cochlea.
This test has wide variety of applications in routine Clinical Audiology and is a boon in detecting the cochlear efficiency, apart from the benefits of hearing screening utility in newborns & infants.
These are objective test measures, wherein the physiologic neural responses (electric/neural potentials) against acoustic(sound) stimulation are acquired through various metal electrodes placed over the scalp (head) of the individual under test. This test is employed for subjects of all ages ranging from newborn to old aged population. Therefore, it’s a powerful objective method in assessing the neural integrity of the auditory system right from the hearing nerve in the inner ear to the cortical structures deep in the brain.
The electrical potentials (neural activity) are nothing but the electrical/neural activity at various levels in the neural pathway of the auditory system that occurs in response to appropriate auditory stimulus. These potentials occur at specific time intervals after the onset of the stimulus; and could be classified as ‘Short Latency Response’, ‘Middle Latency Response’ & ‘Late Latency Response’.
There are different test measures falling under these three categories. For instance, test measures under short latency response includes – Auditory Brain Stem Response (ABR), Electrocochleography (ECochG), Frequency Following Response (FFR), & Slow Negative Potential (SN10). Test measures under middle latency response includes the various MLR waveforms and the 40Hz response.
And the test measures under late latency response includes P300, Mismatch Negativity (MMN), & N1 –P2 complex. Other test measures include Vestibular Evoked Myogenic Potential (VEMP), & Cortical Mapping. Auditory Steady State Responses (ASSR) is another test measure that could be employed to track the hearing thresholds of newborns, infants & difficult it test subjects.
For the treatment of hearing loss, when medical management is beyond scope of relief or when surgical management is contraindicated; then as an auditory mode of habilitation, to retain the sense of hearing, hearing aid trial is carried out with various models of hearing amplification devices to custom suit the specific configuration of hearing loss as outlaid in the audiogram. However, these days various speech in noise tests are administered on the patient to explore the possible benefits from the prospective use of hearing aids. This along with suitable simulation procedures using various software programs would enable the ‘Dispensing Audiologist’ to prescribe the most preferred hearing aid for the needed clients.
At CAPAAR, hearing aids of all models & range are made available for the needy. This includes Analog Hearing aids, Digital Hearing aids, Digitally Programmable Hearing aids, Single channel hearing aids, Multiple channel hearing aids, Body worn hearing aids, Behind the Ear (BTE) hearing aids, Custom Hearing Aids (ITC –In the Canal & CIC –Completely In the Canal).
For all hearing aids dispensed to its clients, CAPAAR also takes care of the client’s post sale needs of the hearing aids. Since hearing aids are electronic devices, which are constantly used by the hearing impaired irrespective of the physical, physiological , environmental or contextual conditions; these devices may be very much prone to wear & tear, handling errors, or can cede in to any kind of damages due to various user related reasons. So, we also render services in meeting the client’s requirements with regard to optimum functioning of these amplification devices. All services regard to repairs & rectification of mal-performing devices are attended to at CAPAAR and made available to the client in a very reasonable time frame.
Ear Molds are coupling devices between the ear canal and the hearing device, which is specifically required for all models of body worn hearing aids and few models of Behind the Ear (BTE) hearing aids. Ear molds are custom made products which are processed after taking the ear impression of the subject’s ear using high quality silicone material. These silicone impressions are then processed through precise ultra-violet curing procedures before it is finally handed over to the clients. Since these products are custom made from the impressions of the patient, it would precisely match the dimensions of the subject’s ear and would facilitate a precise & easy fit without any acoustic leakage.
Similar ear impressions also need to be taken for custom hearing aids like ‘In the Canal’ (ITC) or ‘Completely In the Canal’ (CIC) hearing aids.
Services related to the supply of various standard and custom made ‘Ear Protective Devices’ (Ear Plugs, Ear Muffs) are provided to the clients, who mandatorily require them while working in any hazardous noisy environments as a means to protect the hearing against loud sounds. “Swim Plugs” are also provided to clients to avoid the entry of water into ear canal.
All the accessories related to the hearing aids are also made available to the needy clients. This would include ‘chords’ for body worn hearing aids, ‘receivers’ for body worn hearing aids, ‘Ear tips’, ‘Adaptors’, ‘Tubing’ for BTE’s, batteries of all sizes to suit the various models of hearing aids, Ear Hooks, ‘Remote Control’ for those hearing aids which has this facility, ‘Transmitters’ for stream-lining the audio signals, and much more.
Auditory (re)habilitation is a clinical treatment program for the hearing aid users to improve communication ability with the help of hearing aids. The treatment program mainly anchors around “Auditory Training” with hearing aids. This treatment program is applicable for first time hearing aid users of all ages. Auditory Training is given to those young children who have not yet developed spoken language under ‘Auditory Habilitation Program’; and is also given to those hearing impaired individuals who have developed spoken language under ‘Auditory Rehabilitation Program’.
The goal of auditory training is to maximize the auditory benefits with the use of hearing aids, thereby making hearing aids a meaningful communicative device in getting familiar & aware of the various sounds (both speech & non-speech) in the user’s immediate context; enabling the hearing aid user to discriminate the various sounds, helps him/her to identify the heard sounds, and provide meaning to it thereby enhancing the comprehensive ability of all sounds heard.
It is a strategic training procedure with specific activities to be carried out at various levels of the training program. Individualized Educational Programs are charted for children with hearing impairments of various age groups. Subject oriented approach of auditory training is also provided to adults with hearing impairment to enable them to reap maximum benefits out of their respective amplification devices.
Cochlear Implant is a surgically implantable device that is placed in the cochlea (inner ear) and which by- passes the cochlea to electrically stimulate the auditory nerve thereby providing hearing sensation to individuals with severe to profound hearing loss. This is mainly recommended for those hearing impaired persons, who derive very little or literally no benefit with the use of conventional hearing aids.
Individuals undergoing cochlear implantation need to be thoroughly assessed for its candidacy before implantation and further need to undergo specific period of strategized post-implantation training to reap maximum benefits with the implantable device. At CAPAAR, we provide services in selecting & preparing prospective clients for implantation, guide them through the implantation process and undertake intensive post implantation training, with periodic mapping of the implant. We also provide our services in procurement of the implants and its post-purchase services.
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