The importance of Baseline Hearing Evaluations

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Baseline hearing evaluations are critically important. Members of the general public are often unaware of the importance of these evaluations, especially if they believe that they have normal hearing. I feel the public needs to be informed.

During these times of COVID-19, baseline hearing evaluations are especially important because we are learning that the virus can cause potential hearing loss (#1). At this time, the relationship between COVID-19 and hearing loss has not been studied in great detail, but there have been several cases of reported sudden hearing loss (SSHL) following COVID-19 infection (#4). Also, it appears that hearing loss and tinnitus are not initial symptoms of the virus, but develop later (#2).

Vertigo, or dizziness, has also recently been described as a clinical manifestation of COVID-19. Numerous studies, emerging daily from various parts of the world, have revealed dizziness as one of the main clinical manifestations of COVID-19 (#3). Hannover Medical School presented a case study of a 60-year-old, previously healthy male who was admitted to the intensive care unit and later developed complete deafness of one side, and profound sensorineural hearing loss on the other side.

MRI finding showed signs of inflammatory process in the cochlea, which can lead to ossification. Ossification would make CI (cochlear implant) electrode insertion very challenging or impossible for hearing rehabilitation. This paper presented the importance of urgent audiologic and radiologic diagnostics in COVID-19 patients who report hearing loss, especially if neurologic symptoms are present.

This is not surprising, as viral infections often cause inflammatory responses which can lead to damage in the inner ear, which can result in hearing loss, tinnitus, and dizziness.

Acute Profound Sensorineural Hearing Loss After COVID-19 Pneumonia
Chantal Degen, MD Thomas Lenarz, MD, PhD Kerstin Willenborg, MD Hannover Medical School Hannover, German

First Published September 15, 2020

Dizziness and COVID-19
Jeyasakthy Saniasiaya MD, MMED, Jeyanthi Kulasegarah, MB Bch, BAO, MD

Koumpa FS, et al "Sudden irreversible hearing loss post COVID-19" BMJ Case Rep 2020; 13: e238419.

Baseline hearing evaluation

Why should I have a hearing test? My hearing is great.

First of all, how do you know your hearing is great? I have many patients who think they have normal hearing, and they are very surprised after the hearing evaluation... The brain is elastic and adjusts to gradual hearing loss, so hearing loss (especially when minor) is very difficult for someone to notice.

Secondly, a baseline hearing evaluation is very important even if someone has normal hearing. In the case of future hearing loss, the evaluation will provide a comparison, and the patient’s loss can be treated appropriately.

Most people do not think about the importance of having a baseline hearing evaluation. Hearing loss can occur very suddenly. Seemingly minor illnesses--like upper respiratory infections, the flu, a cold, or a sinus infection--can lead to inner ear infections and cause sudden hearing loss.

In that case, it is important to have a baseline hearing evaluation, so the audiologist can compare the results of the hearing tests, and the physician can choose the best treatment for the patient.

How often do I need a hearing test?

The recommended frequency of hearing tests depends on several factors. If you have relatively normal hearing, and you are a young adult, then I would recommend a hearing test every five years, unless there is a noticeable change in your hearing. If you are a middle-aged adult with relatively normal hearing, then I would recommend a hearing test every two years. If you have hearing loss, yearly evaluations are recommended, especially if you are a hearing aid user.

We need to keep up with your hearing loss, so we can appropriately adjust your hearing aids to your current hearing loss. Also, if you are around loud noises often (recreational or work), then you will be at a higher risk for hearing loss. Certain medications can also cause hearing loss, and your hearing should be monitored during the treatment. After your baseline hearing evaluation, your audiologist will tell you how often you should have future hearing tests.

How to prepare for my first hearing test?

Make a list of your medications and health issues. Obtain audiograms/hearing evaluation results, ear surgery reports from the past and send them to your audiologist prior to your appointment for review. Make sure you do not have impacted cerumen. Your audiologist can perform cerumen removal; however, if the wax is deeply impacted, it can be difficult to remove.

In that case, your audiologist may send you to an Ear-Nose-Throat (ENT) physician. Avoid loud noises for at least 72 hours prior to testing (power tools, hair dryer, etc.). Loud noises can cause temporary hearing loss. Also, testing is not recommended for at least 4 days following any loud concert. Such concerts can cause temporary hearing loss that persists for days. You should also reschedule your appointment if you have any illness which causes congestion, such as a cold, or the flu. Congestion can affect your hearing, and your hearing test will not be accurate.

What to expect at my appointment?

You will have to complete an intake form like in any other doctor’s office. The audiologist will take your case history, focusing on your ears and hearing health concerns. At the beginning of the test, your audiologist will look in your ears. Then, the following tests will be performed:

--Middle ear function test (pressure test)
--Inner ear evaluation (tone test, which measures how soft a tone you can hear at different pitches)

--Auditory nerve evaluation (speech test, where you will have to repeat words)

After the test, your audiologist will discuss test results, treatment options, and make referrals if needed.

Is the test painful?

Hearing test are completely painless and non-invasive. However, if you have impacted wax that needs to be removed before the testing, that can be a little uncomfortable.

How long does testing take?

Hearing test take anywhere from 30-45 minutes depending upon your hearing health and testing abilities. You will be scheduled for a one-hour appointment. Patients with medical issues may require additional testing and appointments can be longer.

Will I know the result after the test?

Yes, definitely. Your audiologist will explain all test results and how each test measures and relates to different parts of your ears. You will hopefully have a better understanding of how the auditory system functions. If you have any potentially serious medical issues related to hearing loss, you will be referred to an ENT physician for further evaluation.

The bottom line

A baseline hearing evaluation is very important even if you have normal hearing. If you have sudden changes in your hearing, your providers need to know the quality of your hearing prior to that change in order to compare your hearing and provide the most beneficial treatment.

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