2009

Technology, Ingenuity & One Operation Erase A Lifetime Of Hearing Loss For This Young Patient |

It’s amazing that she can now hear normally!

By the time Caitlin Echave was a high school sophomore, she and her family were resigned to the fact that her hearing loss, which began when she was 11 years old, would never get better. She had reluctantly started wearing hearing aids, but still hid that fact from everyone except for close friends. After moving to Charlotte, Caitlin never imagined that a trip to yet another otolaryngologist would change her life forever.

Caitlin was referred to CornerStone Ear, Nose & Throat after complaining that her ears felt stopped up during an office visit with dermatologist John VanGurp, MD. She had her first appointment with Bill McClelland, MD, FACS, on May 17, 2006, and her mother remembers that day well.

“He examined Caitlin’s ears under a microscope, which her former ENT didn’t have,” said Mrs. Echave.
A CT scan (actual scan pictured above) indicated that a thick plug of bone and skin was obstructing Caitlin’s ear canal, but the space behind the ear drum and the bones in her ear were normal.

Dr. McClelland observed an abnormal anatomy in Caitlin’s left ear and ordered a CT scan. He also diagnosed her with chronic otitis media and chronic mastoiditis of the left ear, prescribed a course of antibiotic drops, and recommended an audiogram and tympanogram at her follow-up visit.

A CT scan (actual scan pictured above) indicated that a thick plug of bone and skin was obstructing Caitlin’s ear canal, but the space behind the ear drum and the bones in her ear were normal.

A CT scan (actual scan pictured above) indicated that a thick plug of bone and skin was obstructing Caitlin’s ear canal, but the space behind the ear drum and the bones in her ear were normal.

The CT scan revealed that the space behind Caitlin’s ear drum and the bones in her ear were normal, but a thick plug of bone and skin was obstructing her ear canal, causing the hearing loss in her left ear. Surgery would be required to remove it, but for the first time in years, there was hope that Caitlin’s hearing could be improved.

On July 7, 2006, Dr. McClelland performed a left ear canal reconstruction on Caitlin. He used specially designed drill burrs from Stryker® to clear away the obstruction.

“As I drilled away at the bone that was blocking the ear canal, I found that the original cause of the problem was a myringotomy tube that had been left in place from the procedure she’d had as a young child,” Dr. McClelland explained. During the surgery, the tube was removed and Caitlin’s ear drum and canal were both repaired.

Caitlin’s Pre & Post-Op Audiology Results. Results Pre-Op (RED) • Results Post-Op (BLACK)

Caitlin’s Pre & Post-Op Audiology Results. Results Pre-Op (RED) • Results Post-Op (BLACK)

Caitlin’s recovery time was minimal. She saw Dr. McClelland several times during the weeks following the surgery. As the final packing was removed, Caitlin experienced normal hearing for the first time since she was 11.

“I wanted to jump up and down right there in the office, but I waited until I got on the elevator,” said Caitlin.

Her chronic ear infection had resolved, and an audiogram confirmed that Caitlin had normal hearing in her left ear. Things that other people take for granted, like going to the movies, hearing a whisper, or swimming were now accessible to her.

“We couldn’t be happier,” said Mrs. Echave. “After believing that Caitlin’s hearing would likely worsen, it’s amazing that she can now hear normally!”

Not All Digital Hearing Aids Are Created Equal: New Technology Options Offer Patients Greater Clarity |

Thanks to recent technological advances, digital hearing aids offer greater comfort and audio quality than ever before. They are available in both high-end and entry-level models based on their features and capabilities. For some patients, however, the increased options have made the process of choosing a digital hearing aid very confusing.

At CornerStone Ear, Nose & Throat, our certified audiologists have the training and experience to help your patient choose the hearing aid and options that best suit his or her individual lifestyle, environment, dexterity and financial considerations. Unlike most retail hearing aid providers, our audiologists are not paid commission based on hearing aid sales or technology sold.

New Digital Hearing Aid Features

Extra options are typically available on both the entry-level and high-end hearing aid products. Following are some key features that are available:

Directional microphones: This feature makes it easier for patients to hear in noisy environments. On entry-level products, directional microphones reduce noise from one specific direction. In contrast, advanced technology has introduced adaptive directional microphones that automatically detect the specific location of the noise source and negate it without adjustment from the patient.

Multiple programs or memory slots: With entry-level devices, a button on the aid must be pushed to access the different program settings. More advanced hearing aids offer automatic program selection, where the hearing aid evaluates the surrounding environment and automatically adjusts accordingly.

T-coil or telephone program: This is a function created to improve hearing when a patient is on the telephone. T-coils are standard on most current digital hearing instruments. Entry-level hearing aids require the user to press a button to access the t-coil feature, while high-end products offer a touchless t-coil that will automatically switch to the phone program when the telephone is placed over the hearing aid.

Feedback managers: With newer technology, audio feedback does not occur as often as older models because most hearing aids are equipped with a digital manager that detects when the aid is producing feedback and automatically eliminates it. Entry-level hearing aids have a simplified feedback manager, while more sophisticated devices eliminate feedback while also preserving the needed amount of gain.

Noise reduction: The most common complaint from patients who wear hearing aids is that it is difficult for them to hear in the presence of background noise. The noise reduction feature, coupled with directional microphones, helps to reduce background noise so the patient can follow conversations. Entry-level hearing aids have limited noise reduction capabilities, with one setting that is either turned on or off. High-end digitals use noise tracking technology and more acute noise reduction systems. They also reduce steady state noises that the entry-level system may miss.

Extra Options Only Available On High-End Hearing Devices

Wireless (FM) system compatibility: A wireless communication system transfers the speaker’s voice directly into the patient’s hearing aid, making communication in very difficult situations much easier. This feature is especially useful for school-age children in the classroom or for business personnel who regularly attend large meetings.

Remote access: With this option, a remote or wristwatch can be used to adjust the hearing aid volume or change programs.

Bluetooth compatibility: Using this technology, any device that is Bluetooth compatible can be heard through the hearing aid, including laptop computers, cell phones, and MP3 players.

At CornerStone Ear, Nose & Throat, our certified audiologists can help patients choose a hearing aid that fits their specific lifestyle and budget. For more information about hearing aids or our audiology services, contact us today or call CornerStone Ear, Nose & Throat at 704-752-7575 in Charlotte or 704-289-8220 in Monroe.

Infant Hearing Screening Is Critical in Avoiding Impact on Speech and Social Development |

Hearing loss is one of the most frequently occurring congenital disabilities, affecting approximately three in 1,000 people. Without early detection and intervention, hearing impairment in infants and young children can negatively impact speech and language acquisition, academic achievement, and cognitive and social development. It is a potential source of liability for the patients’ physicians if the problem is not caught and addressed in a timely fashion. If detected and treated, however, these negative impacts can be greatly diminished and even eliminated through early intervention.

In 1993, the National Institutes of Health (NIH) recommended that all infants be screened for hearing impairment at birth, preferably prior to hospital discharge. Since then, there has been a rapid increase in the number of universal newborn hearing screening (UNHS) programs. CornerStone Ear, Nose, & Throat pioneered UNHS in our region by starting the first program in the Charlotte area in 1997, long before the state mandated this testing.

There are two types of hearing tests that are used to evaluate infant hearing:

  1. Otoacoustic emissions (OAE) measure the response of outer hair cells within the cochlea to a particular stimulus. The hair cells must be healthy to produce robust sound emissions, allowing us to know that the cochlea is working properly and hearing is within normal limits.
  2. Auditory brainstem response (ABR) testing measures the brain’s response to a “click” delivered through earphones, much like an EEG of the brainstem. Sensors measure the baby’s entire hearing pathway to determine if the sounds are heard normally.

Both tests are non-invasive and require no action by the patient (a key quality for a newborn test). Currently CornerStone Ear, Nose, & Throat performs all of the newborn hearing screenings in CMC-Union hospital and provides follow-up testing and care for patients and their families across the Charlotte region. All infants who do not pass the original hearing screening in the hospital should be referred for re-screening or diagnostic testing. Ideally, audiological evaluations on infants who fail the newborn hearing screening should be performed before three months of age, or as soon as possible after discharge. Infants with confirmed hearing loss should receive early intervention services before six months of age.

Parents and health care providers should understand that a “pass” on the newborn hearing test does not rule out later development of hearing problems in infancy or early childhood. Speech and language development should be continuously monitored as an indicator of hearing difficulties. Infants who are at risk for progressive or late-onset hearing loss should be tested more frequently than those with no known hearing loss risks. These elevated risks may include, but are not limited to:

  • Toxoplasmosis
  • Syphilis
  • Maternal Rubella
  • Cytomegalovirus
  • Hyperbillirubin
  • Low birth weight
  • Recurrent ear infections before three months of age
  • Strong family history of congenital hearing loss

At CornerStone Ear, Nose & Throat, our staff of otolaryngologists and audiologists is well trained to meet the hearing rehabilitation and diagnostic needs of your patients, as we continue to provide the most technologically advanced care available for congenital hearing loss. Follow-up screenings do not require a physician appointment. For more information, call CornerStone Ear, Nose & Throat at (704) 752-7575 in Charlotte, (704) 289-8220 in Monroe.

How Does the Ear Work? |

The ear is comprised of three parts: the outer, middle, and inner ear. Each part plays its own unique and vital role in hearing.

The outer ear includes the pinna, ear canal, and eardrum. Sound is channeled in to the middle ear via these structures. The design of the pinna, or outermost visible part of the ear, is to gather sound waves and direct them down the canal towards the eardrum.

The middle ear is comprised of the three smallest bones of the human body. When sound reaches the eardrum, the eardrum vibrates which in turn causes movement of the tiny bones in the middle ear, also known as ossicles. The sound is then mechanically transmitted through to the inner ear.

The inner ear converts the sound to an electrical impulse. The movement of the ossicles causes movement of inner ear fluid, stimulating hair cells (cilia) in the cochlea. This impulse then travels along the auditory nerve (8th nerve) to the brain.

A problem in any site along this transmission can result in hearing loss. Type of hearing loss is determined by which part of the ear is not functioning properly.

How do I get a hearing aid? |

The Process of Obtaining Hearing Aids

Before purchasing hearing aids, it is important to have a complete hearing evaluation.  If you have not had your hearing tested within the last six months, you will need to make an appointment for a hearing evaluation with an audiologist.

Medical clearance from one of our physicians is ideal to obtain prior to hearing aid use.  This is to make sure that your hearing loss cannot be treated with medicine or surgical procedures.

After hearing testing is completed, a hearing aid evaluation will be conducted.  Appropriate selection of hearing aids will be discussed with you, and is based on several factors, including amount of hearing loss and lifestyle needs.  Ear impressions will be taken, and hearing aids will be ordered.

At the hearing aid fitting appointment, you will receive your hearing aids.  Use and care of the hearing aids are discussed.

You will return for follow-up appointments so that proper adjustments can be made to the hearing aids.

Once you have completed the initial fitting process, we encourage you to return consistently for hearing aid check-ups.  The audiologist will check, clean, and adjust your hearing aids as needed.  If you have a problem with your hearing aids between check-ups, please call our office for an appointment.

You should undergo hearing evaluations annually (or as recommended by your audiologist), so that your audiologist can monitor your hearing and help you maintain optimal hearing aid use.

Information About Hearing Aids

Hearing aids are available in various styles, including:  Behind-the-Ear (BTE), In-the-Ear (ITE), In-the-Canal (ITC), and Completely-in-the-Canal (CIC).  A wide range of hearing aid technologies are offered, including digital, programmable, and conventional.  Each of these technologies can be obtained in any style of hearing aid.  Your audiologist will recommend the most appropriate hearing aids for your particular hearing needs.

Hearing aids are purchased with a 30-day trial period, beginning on the date the hearing aids are fit.  If the aids are returned with 30 days, a refund will be issued for the price of the hearing aids, less a minimal restocking fee.

Hearing aid purchases come with a dehumidifier, a limited supply of batteries, accessories/cleaning tools, repair warranties, and insurance policies.  Prior to the end of the warranty period, extension of the warranty period and insurance policy can be purchased from our office.

For Behind-the-Ear (BTE) hearing aid users, earmolds are not covered under the hearing aid warranty.  There will be a charge for replacement earmolds, if needed.

The following services are included in the purchase price of the hearing aids:  the hearing aid fitting appointment, follow-up appointments, hearing aid check-ups, and annual hearing evaluations.  Hearing evaluations required by a physician for medical purposes will be charged.

Payment for Hearing Aids

There is no charge for the hearing aid evaluation appointment.

Hearing aids vary in price, depending on the style and technology.

Payment in full is required when a hearing aid order is placed at the hearing aid evaluation appointment.  You may use check, cash, MasterCard, Visa or Discover.  A payment plan is also available.

Insurance and Medicare do not typically cover hearing aids or related services.  However, many insurance companies will cover the audiological testing.  Please check with your insurance company to verify covered services.

Need-based funding organizations sometimes help cover the cost of hearing aids.  Audiologic and income criteria must be met in order to receive funding through these programs.  Your audiologists can inform you on which organization may best serve your needs.  Please check with our office to find the organizations with which we participate.

What are the types of hearing aids? |

Behind-the-Ear (BTE)

The electronic components of the hearing aid are housed in a casing that fits along the back side of the ear.  An earmold, a piece custom fit to the ear, is fit inside the ear.  The two pieces are connected using clear tubing.  When worn, the hearing aid hangs over the ear and the earmold holds it securely in place.  The sound is picked up by the device behind the ear and amplified.  The amplified sound is then routed through the tubing into the ear through the earmold.  The behind-the-ear style hearing aid supplies the most power of all the styles available.

Open-fit Hearing Aids

Open-fit hearing aids are a variation of the BTE style aids.  They follow the same general idea but the portion behind the ear is typically much smaller in size and they do not use a custom earmold.  Instead they use a very flexible non-custom tip to hold the tubing in the center of the canal.  This style hearing instrument is very cosmetically appealing but is designed for a very specific type and degree of hearing loss.  Your audiologist will determine if this aid is an option for you.

Receiver-in-the-Ear (RITE)

The receiver-in-the-ear style the hearing aid components are divided and placed in two separate locations.  Part of the hearing aid components are housed in a very small casing that sits behind the ear and the other portion of the components are housed at the end of the tubing in the canal of the ear.  This style hearing aid can be fit with either a custom earmold or a non-custom earmold.  Your audiologist will tell you which earmold is appropriate for you hearing loss.  The receiver-in-the-ear hearing aids are cosmetically appealing and provide significant power.

In-the-Ear (ITE)

The in-the-ear style hearing aid house all the components in the bowl portion of the ear.  The hearing aid is typically flesh tone colored but is visible in the ear.  This style hearing aid is easy to handle and is a great option for patients with dexterity issues.

In-the-Canal (ITC)

The in-the-canal style hearing aid fits primarily in the slender canal portion of the ear with only a small portion of the hearing aid being in the bowl portion of the ear.  This style hearing aid is less visible than the in-the-ear models but offers significantly less power than the larger style hearing aids.

Completely-in-the-Canal (CIC)

The completely-in-the-canal hearing aid fits deeply into the ear canal.  The aid easily hides behind the tragus, often referred to as the ear flap, an is very difficult to see in the ear.  This hearing aid is the least noticeable of all the hearing aids, however it also offers the least amount of power.

Because all patients are unique, Cornerstone Ear, Nose and Throat offers analog and digital hearing aides from many manufacturers.  From hearing aids that are hidden entirely in the canal to behind-the-ear models, patients will find the latest technology at competitive prices.  Our audiologists provide a comfortable atmosphere to answer every question, explain the options, and ensure that the proper hearing aid is selected and fitted.

What are some hearing aid options? |

Not All Hearing Aids are Created Equal

Thanks to recent technological advances, digital hearing aids offer greater comfort and audio quality than ever before. They are available in high-end, entry-level and everything in between based on their features and capabilities. For some patients, however, the increased options have made the process of choosing a digital hearing aid very confusing.

At CornerStone Ear, Nose & Throat, our certified audiologists have the training and experience to help your patient choose the hearing aid and options that best suit his or her individual lifestyle, environment, dexterity and financial considerations.

Extra options are typically available on both the entry-level and high-en hearing aid products. Following are some key features that are available:

Directional microphones

This feature makes it easier for patients to hear in noisy environments. There are two microphones on the hearing aid, one facing forward and one facing the back of the head. The microphones work together to help the patient hear conversations and improve speech intelligibility in noisy environments. On entry-level products, directional microphones reduce noise from one specific direction. In contrast, advanced technology has introduced adaptive directional microphone that automatically detect the specific location of the noise source and negate it automatically.

Multiple Programs or Memory Slots

With entry-level devices, a button on the aid must be pushed to access the different programs. More advanced hearing aids offer automatic program selection, where the hearing aid evaluates the surrounding environment and adjusts accordingly without the patient having to press a button.

T-coil or Telephone Program

This function improves the patient’s ability to hear on the telephone. T-coils are standard on most current digital hearing instruments. Entry-level hearing aids requires the user press a button to access the t-coil feature, while high-end products offer a touchless t-coil that will automatically switch to the phone program when the telephone is placed over the hearing aid.

Feedback Managers

With newer technology, feedback does not occur as often as it did in older models because most aids are equipped with a digital manager that detects when the aid is producing feedback and automatically eliminates it. Entry-level hearing aids have a simplified feedback manager, while more sophisticated devices eliminate feedback while also preserving the needed amount of gain.

Noise Reduction

The most common complaint from patients who wear hearing aids is that it is difficult for them to hear in the presence of background noise. The noise reduction feature, coupled with directional microphones, helps to reduce the background noise so the patient can follow conversations. Entry-level hearing aids have limited noise reduction capabilities, with the option of having this feature either turned on or off. High-end digital hearing aids use noise tracking technology and more acute noise reduction systems. They also reduce steady state noises that the entry-level system my miss.

Wireless (FM) System Compatible

A wireless communication system (FM system) transfers the speaker’s voice directly into the patient’s hearing aid(s), making communication in very difficult situations much easier. The system consists of a transmitter, which picks up the voice from the speaker and sends it via radio waves (no wires) directly to the tiny radio (FM) receiver, which is connected to the patient’s hearing instrument. This feature is especially useful for school-age children in the classroom or for business personal who regularly attend large meetings.

Remote Access

With this option, a remote or wristwatch can be used to adjust the hearing aid volume or change programs.

Bluetooth Compatibility

Using this technology, an device that is Bluetooth compatible can be heard directly though the hearing aid, including laptop computers, cell phones, MP3 players or an iPod. Using Bluetooth with hearing aids allows the sound to come directly though the hearing aid, making the sound amplified to the patient’s hearing loss and presented clearly and at a comfortable level for the individual.

At CornerStone Ear, Nose & Throat, our certified audiologists can help patients choose a hearing aid that fits their specific lifestyle and budget.

What should I expect after the fitting? |

Continued follow-up care is essential for successful hearing aid use.  These appointments may be more frequent directly after being fit with new hearing aid devices because you may need further instruction and setting adjustments as you familiarize yourself to the new sounds and the hearing aid experience.  After the initial adjustment period we recommend that annual follow-up care is performed.  Annual follow-up appointments include retesting hearing to monitor the hearing loss, making adjustments to the settings of the hearing instruments if necessary (based on the audiometric testing), checking the function of the hearing aids and cleaning the hearing aids.  These services are included in the initial cost of the instruments.

We believe it is vital that every patient who is fitted with hearing aids from our practice is satisfied with his or her purchase.  That is why we offer a thirty day satisfaction guarantee.  After the initial fitting, we make additional adjustments as needed to help enhance the effectiveness of an individual’s hearing aids.  However, if at the end of thirty days, a patient is not satisfied with the benefit he or she is receiving, the hearing aids may be returned for a refund less a minimal restocking fee or exchanged for another model.

Why should I have my hearing tested? |

Hearing loss can affect many aspects of life. You may not understand the sound of a loved one’s voice, the television, or a phone conversation. For someone who has hearing loss, everyday activities can be frustrating or even embarrassing. Over time, hearing loss can become isolating and disruptive to relationships with family and friends.

Cornerstone Ear, Nose & Throat offers comprehensive services for detecting and correcting hearing loss in adults and children. With a combination of board certified ENT physicians and doctors of audiology, we offer surgical and non-surgical options for hearing loss all at one practice. Our certified audiologists have extensive training and knowledge to provide a thorough and accurate hearing examination. Once your hearing has been tested, we will make the proper recommendations, whether it’s medical, surgical, or amplification with a hearing aid.

What is an audiologist? |

An audiologist is a professional who diagnoses, treats, and manages individuals with hearing loss or balance problems. The audiologists at Cornerstone Ear, Nose, and Throat have earned a doctor of Audiology degree (Au.D.). They have completed extensive academic and clinical training in the field and are licensed through the state of North Carolina. Our audiologists’ training provides the foundation for managing patients of all ages. They counsel families though a new diagnosis of hearing loss in infants, and help teach coping and compensation skills to hearing impaired children and adults. They dispense and fit hearing aids as part of a comprehensive rehabilitative program. As a primary hearing health provider, audiologists refer patients to our ear, nose and throat physicians when the hearing or balance problem requires medical or surgical evaluation or treatment.