Frequently Asked Questions

Hearing

What's involved with a hearing test?

A hearing test takes place in a sound-proofed room. The hearing care professional will play sounds. You will be asked to push a button when you hear a sound. It takes approximately 30 minutes and it's pain free.

Do I have a hearing problem?

Ask yourself the following questions. If you answer "yes" to three or more of these questions, you could have a hearing problem and may need to have your hearing checked.

• Do I have a problem hearing on the telephone?
• Do I have trouble hearing when there is noise in the background?
• Is it hard for me to follow a conversation when two or more people talk at once?
• Do I have to strain to understand a conversation?
• Do many people I talk to seem to mumble (or not speak clearly)?
• Do I misunderstand what others are saying and respond inappropriately?
• Do I often ask people to repeat themselves?
• Do I have trouble understanding the speech of women and children?
• Do people complain that I turn the TV volume up too high?
• Do I hear a ringing, roaring, or hissing sound a lot?
• Do some sounds seem too loud?

What should I do if I have a hearing loss?

Hearing problems are serious. The most important thing you can do if you think you have a hearing problem is to go see a doctor. Your doctor may refer you to an otolaryngologist, a doctor who specializes in the ear, nose, and throat. An otolaryngologist will try to find out why you have hearing loss and offer treatment options. He or she may also refer you to another hearing professional, an audiologist. An audiologist can measure your hearing. Sometimes otolaryngologists and audiologists work together to find the treatment that is right for you. If you need a hearing aid, an audiologist can help you find the right one. Although children must be seen by a physician before they can be fitted for a hearing aid, adults do not always see a physician as long as they sign a waiver.

Why am I losing my hearing?

Hearing loss happens for many reasons. Some people lose their hearing slowly as they age. This condition is known as presbycusis. Doctors do not know why presbycusis happens, but it seems to run in families. Another reason for hearing loss may be exposure to too much loud noise. This condition is known as noise-induced hearing loss. Many construction workers, farmers, musicians, airport workers, tree cutters, and people in the armed forces have hearing problems because of too much exposure to loud noise. Sometimes loud noise can cause a ringing, hissing, or roaring sound in the ears, called tinnitus.

What treatments and devices can help?

Your treatment will depend on your hearing problem, so some treatments will work better for you than others. Hearing aids are the most common treatment. They make sounds louder. Things sound different when you wear a hearing aid, but an audiologist can help you get used to it. You and your audiologist work together until you are comfortable. Other assistive listening devices or methods available are TV listening systems, personal listening systems (e.g. FM systems), telephone amplifying devices, Auditorium-type assistive listening systems (available at many auditoriums, movie theaters, churches, and other public places), and lip reading or speech reading skills.

Tinnitus

What is tinnitus?

Tinnitus is commonly described as ringing or sound in the ears. It can also sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You may hear it in one or both ears. In the past year, experts estimate that 22.7 million adult Americans experienced tinnitus for more than three months, which is roughly 10 percent of the adult population of the United States. 80% of them do not consider it bothersome but the remaining 20% do.

What causes tinnitus?

Tinnitus is not a disease. It is a symptom that something is wrong within the auditory system, which includes the ear (outer, middle, inner) and the auditory nerve that connects the inner ear to the brain and the parts of the brain that process sound.

What causes tinnitus?

• Hearing loss (90%)
• Noise induced trauma
• Trauma to the head or neck
• Ear conditions (ear wax, infection, inflammation, Meniere’s disease, otosclerosis, presbycusis, acoustic neuroma, etc.)
• Heart problems, stroke, thyroid disease, drugs, surgery, stress, diabetes, multiple sclerosis, TMJ disorder, GERD, etc.)

What is the impact of tinnitus?

When tinnitus is severe and intrusive it may impact activities of daily living (ADLs) and quality of life.

• Sleep
• Mood
• Concentration
• Mental health
• Relationships

What should I do if I have tinnitus?

• Receive a comprehensive tinnitus diagnostic evaluation from us.
• With our test results, if indicated, see an otolaryngologist (ENT) to examine your issues medically. The ENT will examine your head, neck, and ears often with imaging such as an MRI and/or a CT scan. Your ENT doctor may refer you to a Neurologist if further examination is required.
• Once you are medically cleared, meaning that you do not have any underlying medical conditions, and you are still bothered by tinnitus, come back to us to discuss tinnitus treatments.

What tinnitus treatment options are available?

There is no cure for Tinnitus, but there are several treatment options to help people manage and cope. We combine treatments to create an effective multi approach plan. Treatment methods will be determined based on the severity of your tinnitus, lifestyle, and areas of your life affected most by tinnitus.
TRT (tinnitus retraining therapy) - Combines low level sound (broadband noise, nature sound, and/or music) and educational counseling to achieve the habituation of tinnitus).
Hearing Aids - For those who also have hearing loss, the use of a personal hearing system can improve your hearing and often reduce or eliminate your perception of tinnitus.
Bimodal Neuromodulation (Lenire) - Combines custom audio with mild tongue pulses to stimulate the brain and drive significant relief from tinnitus. It is the first device of its kind to receive a grant of approval from the FDA to treat tinnitus.
Counseling - Can help to change the body’s emotional reaction to tinnitus by altering negative thought patterns and learning how to cope and manage stress, anxiety, or depression. This treatment is offered by a counselor or psychologist.

Can I do anything to prevent tinnitus or keep it from getting worse?

The most common cause of tinnitus is noise induced hearing loss. By limiting your exposure to loud noise, moving away from loud sounds, turning down the volume, or wearing custom earplugs will help prevent tinnitus or keep it from getting worse. Check out our earplugs page for more information about the custom hearing protection we offer.

Where can I find more information?

Go to the American Tinnitus Association website at www.ata.org for more information.
To learn more about Lenire, visit www.lenire.com.

Misophonia

What is Misophonia?

Misophonia is a condition in which certain sounds trigger emotional or physiological responses that to some, may be perceived as unreasonable. Individuals with Misophonia may describe it as a sound that “drives them crazy.” Their reactions can range from anger, fight-or-flight response, annoyance, isolation, or anxiety. It may impact aspects of quality of life such as: relationships with family and friends, jobs, school, hobbies, and mental health.

What are triggers?

We define triggers as an automated response someone with Misophonia has when they hear one of their trigger sounds. Trigger sound examples are the noise someone makes when they eat, breathe, or chew. Other sounds include keyboard or finger tapping. They may also respond intensely to repetitive motions such as pen clicking or someone fidgeting or wiggling their foot. Most triggers are considered soft sounds. Similarly, individuals with Misophonia say they often react to visual stimuli that accompanies the sounds.

What causes it?

Nobody knows exactly what causes Misophonia. Researchers believe that those with Misophonia acquired the problems when they were young. It is not an innate reaction. Life changing events may initiate Misophonia, or it may be genetic.

How is Misophonia treated?

There is no cure yet. Treatment should involve a multidisciplinary approach combining sound retraining therapy by audiologists and supportive counseling, in which coping strategies are emphasized. However, many counselors and psychologists in Washington state have never heard of or dealt with individuals with Misophonia.

Some have tried psychotherapeutic interventions such as cognitive behavioral therapy (CBT), exposure therapy, acceptance, and commitment therapy (ACT), dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR). Some take medication to manage their mood or anxiety.

How is Misophonia treated at PAC Audiology?

Dr. Mamiya is the only audiologist in the state of Washington helping to diagnose and treat Misophonia patients for the past 10 years. Her expertise, empathy and treatment options have helped many patients take control of their Misophonia.

Many patients who proactively work on Dr. Mamiya’s treatment plan notice they do not have an intense automated trigger response as they did before starting treatment. They no longer go to fight-or-flight, anger, anxiety, or isolation. Their reactions are lower in intensity. Their trigger sounds become more of an annoyance. For example, the sound of fingernails on a chalkboard. An unpleasant sound, but they can identify it as an annoying sound and move on without experiencing heightened automated responses.

Our sound retraining therapy consists of acoustic therapy with a pair of devices, counseling, education, and homework assignments. Counseling and education are designed to help patients track their progress throughout the treatment process. They will see how well they can tolerate their triggers and compare their progress from the first time they started treatment. They will notice significant changes in how well they can tolerate their triggers.

We encourage our patients to receive professional counseling from experts simultaneously to improve their mental health. Encouragingly, many patients on this treatment program receive some degree of relief within a few weeks unless they have some known neurological condition. In our experience, some patients who wear the devices and do their homework thoroughly may reach a point where they no longer need to rely on the devices within 1 to 3 years. We may use special earplugs instead of devices, but the outcome is unknown.

Our goal is to reconnect those suffering with Misophonia back to conversations, family, friends, and life.

Unfortunately, we cannot work with people who cannot physically come to our clinic for each visit. Our treatment uses devices that need to be fit, adjusted, and followed up with in person. We cannot work remotely. Individuals with Misophonia frequently get triggered by listening to other people’s mouth sounds through remote communication (Skype, Zoom) and choose to mute voice and sound.

Where can I find more information?

Go to the Misophonia Association website at https://misophonia-association.org/ for more information.
Go to the Misophonia Treatment Institute website at https://misophoniatreatment.com/ for more information.

Hyperacusis

What is Hyperacusis?

Hyperacusis is a rare hearing disorder; sounds which would otherwise seem normal to most people can be unbearably loud. For example, car engines, dishes clanking, rustling of paper, or even loud conversation. Those with hyperacusis feel uncomfortable enough to avoid such situations, impacting school, job, social life, and relationships.

There are some diseases or disorders that are linked to hyperacusis. Superior semicircular canal dehiscence (SSCD), Bell’s palsy, Chronic fatigue syndrome, Lyme disease, Meniere’s disease, posttraumatic stress disorder, stress, and depression. Additionally, hyperacusis is seen in patients who have experienced head trauma. One major cause of hyperacusis is loud noise exposure. It may be triggered by a single intense noise such as a gunshot, or it may develop gradually from listening to loud noise without hearing protection.

Depending on the cause, hyperacusis may get better with time. Specifically, in cases of trauma to the brain or hearing system, there is a chance that sensitivity to sounds will become more tolerable over time.

There are four things you can do if the sound is too loud for you:

• Keep yourself surrounded with comfortable sound.
• Listen to sounds that you like or sounds that bring calmness or peace as often as you can.
• Wear earplugs or headphones when you really need to.
• Do some activities that will help you reduce stress and improve your sleep quality.

However, in case you feel like that your sensitivity has not improved, follow these steps:

• Receive comprehensive sound sensitivity diagnostic testing from us.
• With our test results, see an otolaryngologist (ENT) to examine your issues medically. The ENT will examine your head, neck, and ears often with imaging such as an MRI and/or a CT scan. Your ENT doctor may refer you to a neurologist if further examination is required.
• Once you are medically clear, meaning that you do not have any underlying medical conditions, and you still have your sensitivity issues, come back to us to discuss sound retraining therapy.

Sound Retraining Therapy

Our sound retraining therapy consists of acoustic therapy with a pair of devices, sound tolerance evaluation, and counseling. The goal is to reduce your reactions to loud sounds and connect you back to your life. A sound tolerance evaluation and counseling are designed to help you view your progress and realize how well you can tolerate sounds since the beginning of the therapy. Encouragingly, many patients practicing this treatment option receive some degree of relief and report being more relaxed. In our experience, patients who do not have any medical contradictions may complete this therapy within 12 months. We may use special earplugs instead of devices, but the progress could be slower.

What to avoid

Many people who suffer from hyperacusis wear earplugs or earmuffs to reduce incoming sound levels that may be bothersome or withdraw from social situations that may have uncomfortable sounds present. This is a logical response. However, these strategies may not work in the long run—hyperacusis sufferers may be furthering their poor tolerance to relatively soft sounds. Wearing earplugs or earmuffs may provide temporary relief from an environment that seems uncomfortably loud, but when the individual eventually removes the earplugs or muffs, that environment will seem even louder than it might have otherwise.

Hearing Aid

What is a hearing aid?

A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations.

How can I find out if I need a hearing aid?

If you think you might have hearing loss and could benefit from a hearing aid, visit your physician, who may refer you to an otolaryngologist or audiologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and will investigate the cause of the hearing loss. An audiologist is a hearing health professional who identifies and measures hearing loss and will perform a hearing test to assess the type and degree of loss.

Are there different styles of hearing aids?

There are three basic styles of hearing aids. The styles differ by size, their placement on or inside the ear, and the degree to which they amplify sound.
Behind-The-Ear (BTE) - BTE models are available for all degrees of hearing loss and, as the name suggests, can be worn comfortably behind the ear. These models are available in many different colors, styles and designs.
Receiver-In-Canal (RIC) - These models are smaller than standard BTE models and it has a speaker inside the ear. The are available for mild to severe hearing loss. They can be worn comfortably behind the ear. These models are available in many different colors, styles and designs.
In-The-Ear (ITE) - These models are made specifically to fit the shape of your ear canal for maximum benefit and the best possible comfort. They are available in many skin tones, are unobtrusive and very effective. The smallest models sit in your ear canal and are virtually invisible. These models are suitable for mild to severe hearing loss.

BTE

RIC

ITE

Which hearing aid will work best for me?

The hearing aid that will work best for you depends on the kind and severity of your hearing loss. You and your audiologist should select a hearing aid that best suits your needs and lifestyle. Please note that a hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, options and upgrade opportunities, and the hearing aid company's reputation for quality and customer service.

How can I adjust to my hearing aid?

Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them. It usually takes about 3 to 4 weeks. Work with your audiologist until you are comfortable and satisfied. You may experience that your voice sounds too loud and this is very common for new hearing aid users. Check with your audiologist to see if a correction is possible. Most individuals get used to this effect over time.

Balance

Did you know these?

• According the National Institute of Health (NIH), dizziness or loss of balance will affect 90 million Americans sometime during their lifetime.
• Dizziness is the number one complaint reported to medical providers in adults 70 years of age or older.
• Balance-related falls account for more than one-half of accidental deaths in the elderly.
• Balance-related falls cause over 300,000 hip fractures in individuals over 65 years of age.
• Inner ear disorders or ear infections can result in imbalance and vertigo affecting a person’s ability to walk, roll over in bed, see or think clearly, or to read or watch television.
• Many times, disorders of the inner ear are misdiagnosed as a more severe neurological condition such as multiple sclerosis, or as clinical depression.
• Inner ear disturbances account for 85% of dizzy disorders.
• Children can also be affected by inner ear disorders and are sometimes incorrectly diagnosed as learning disabled, dyslexic, or psychologically disturbed.
• Illness, infections, disease, head injuries and whiplash are frequent causes of imbalance, dizziness, and vertigo.

What is balance and the vestibular system?

The medical term for the part of the inner ear involved with balance is called the vestibular system. The vestibular system is an organ located within the inner ear which relays information to the brain about balance and orientation of the head and body. Balance is a complex interaction which requires input from our vestibular system, in addition to our vision and the sensation from our feet, muscles, and joints. If any one of these systems are not working properly, you will suffer loss of balance.

What are balance disorders?

Balance disorders fall into two main categories:

• The first is dizziness, vertigo, or motion intolerance. This condition may be caused or worsened by rapid head movement, turning too quickly, walking, or riding in a car. These symptoms can be acute or sharp attacks lasting for seconds or sometimes for several hours.
• The second is a persistent sense of imbalance or unsteadiness. Some people refer to this as a loss of surefootedness. There can be many causes of dizziness and imbalance, with the largest percentage coming from the vestibular system.

A balance disorder may be caused by viral or bacterial infections in the ear, a head injury, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they get older. Balance problems and dizziness also can result from taking certain medications. However, many balance disorders can begin all of a sudden and with no obvious cause. Your physician may have referred you to our clinic as the balance experts who will help in the process of determining possible causes and best treatment options.

What is neurodiagnostic testing?

The inner ear is home to the hearing and balance centers. The receptors within the ear allows signals to be received and processed by a variety of locations within the central nervous system and the brain. Unlike imaging studies which show only the anatomy or structures, this family of tests allows your doctor to better understand how the system is working and where a problem may arise. Depending on your condition, your physician may recommend evaluation of the hearing and/or balance centers as they are all part of the inner ear. All testing is easy, comfortable and use advanced technology.