Real Ear Verification

Real Ear Verification

Are you satisfied with the performance of your hearing aid? Do you feel the quality meets your expectations? Unless your audiologist relied on real-ear verification during the fitting process, your hearing device may not be living up to its full potential.

When fitting patients for hearing aids, real-ear measurements provide a level of accuracy unavailable with software programs. Real-ear verification takes into account an individual’s unique anatomy, such as ear canal volume, providing a true measurement of a hearing aid’s effectiveness for that patient’s specific hearing loss. Without an accurate assessment of a hearing aid’s amplification levels, a patient can walk away with a hearing aid that delivers substandard performance.

Yet, studies show that only approximately 40 percent of audiologists use real-ear verification technology. Why the reluctance to embrace a system that has been proven to provide the most accurate measurements available? For many audiologists, the answer amounts to time and money. The process can be time-consuming, especially for audiologists unfamiliar with the equipment, which can be expensive. Some audiologists believe the fitting algorithms included with the programming software are accurate enough, but these do not allow for real-ear target matching to measure the correct amount of hearing aid gain and output required, based on the patient’s level of hearing loss as well as his/her natural ear anatomy.

The process is actually fairly straightforward and, once mastered, should take fewer than five minutes per ear. A probe microphone is inserted into the ear, and hearing aid output is measured on a chart, where different test results (directional, noise reduction, feedback suppression and frequency lowering) can be compared. This objective process utilizes scientific data rather than guesswork to provide true data.

San Diego Hearing Center treats patients on an individual basis with their unique ear acoustics in mind, which is why we offer real-ear verification. We are committed to our patient-first philosophy, and we always go the extra mile to verify that your hearing aids are performing to the highest standard possible.

Hearing Protection

We are exposed to sound on a daily basis. Volume levels vary considerably, and can easily exceed 85 decibels (dB) – the threshold that is considered safe. Any prolonged exposure to noise exceeding this is harmful and can cause permanent, irreversible hearing loss.

Excess noise exposure isn’t the only cause of hearing damage. Diseases, drugs and injury may all contribute to hearing loss. Fortunately, there are steps you can take to protect your hearing and help prevent hearing impairment.

Protecting Your Hearing from Loud Noise


Noise-induced hearing loss is the most common cause of hearing loss in the U.S. The good news? It is easily preventable. Follow these tips to protect your hearing:

  • Wear hearing protection when exposed to loud noise. Earplugs are a must in noisy environments such as rock concerts and sporting events. They should also be worn when riding a motorcycle or snowmobile, mowing the lawn, using power tools, etc. If your job exposes you to loud noise, your employer is required by OSHA to supply hearing protection.
  • Turn down the volume. When listening to music or watching television, keep the volume low.
  • Limit the number of noisy appliances running at the same time.
  • Buy quieter products. Many appliances list dB ratings in their specifications.

Preventing Hearing Loss from Diseases

Some diseases can cause hearing loss. Viruses that might damage hearing include measles, mumps, whooping cough and rubella. Bacterial diseases such as meningitis and syphilis can also lead to hearing damage. Acoustic neuroma – tumors on the hearing nerve (usually benign) – may contribute to hearing loss. Tips for preventing hearing loss from disease include:

  • Make sure your child is vaccinated. Immunizations offer protection from many childhood infections that can cause hearing damage.
  • If you are sexually active, use protection to prevent the spread of sexually transmitted diseases, some of which can cause hearing loss.
  • Don’t delay seeking medical attention should you fall ill.

Protection from Ototoxic Drugs

Some drugs cause damage to the sensory cells responsible for hearing. These include certain antibiotics, chemotherapy drugs, salicylate pain relievers (e.g., aspirin), quinine (for treating malaria) and diuretics. In order to reduce your odds of hearing loss when taking medications, follow these tips:

  • Take medications only as directed.
  • If you experience symptoms of hearing loss such as tinnitus while taking new drugs, see your doctor immediately.

Preventing Ear Injuries

Head trauma can damage the temporal bones in the lower lateral walls of the skull, leading to hearing loss. To help prevent this type of injury, take the following precautions:

  • Wear a seat belt at all times when in a car.
  • Wear a helmet when riding a bike or motorcycle, and participating in contact sports.
  • Don’t take unnecessary risks, such as standing on the top rung of a ladder.

There are other general steps you can take to protect your hearing. Refrain from inserting foreign objects in the ears; these can lead to impacted earwax, a perforated eardrum or damage to the skin. Cotton swabs and safety pins are notorious offenders. Use swim plugs when engaging in water activities and be sure to dry your ears thoroughly after swimming or bathing. Seek prompt medical attention if you are suffering from an ear infection.

Contact San Diego Hearing Center for more information or to schedule an appointment.



Hearing Test

Audiology evaluations consist of a series of tests used to determine whether a hearing loss exists and, if so, measure its type, degree and configuration. An audiologist will assess the results of each individual test in order to develop a treatment plan geared toward your unique hearing loss.

Who Should Be Given an Audiology Evaluation?

hearing loss San Diego

An audiology (or hearing) evaluation can benefit patients of all ages, even those who do not exhibit signs of hearing loss.

Hearing loss is a progressive condition that often develops slowly. Many people are not aware of a change in their hearing because they gradually adapt to the subtle changes in their hearing ability over time. Studies indicate that it takes seven years, on average, for a hearing impaired individual to seek treatment.

An audiology evaluation should be the first course of action for anybody who even suspects a hearing loss. The sooner a diagnosis of hearing loss is made, the more successful treatment will be. Early detection means more options for the patient.

Many physicians urge making audiology evaluations a routine part of your overall health care, much like regular vision exams and dental checkups. They are quick, painless and provide immediate results.

What Does Diagnostic Testing Entail?

A comprehensive audiology evaluation consists of a series of individual diagnostic tests that measure different aspects of your hearing. Following a physical examination and a review of your medical history, you will be given any or all of the following tests:

Pure Tone Testing

Pure-tone testing (also known as pure tone audiometry) uses air conduction to measure your ability to hear sounds of various pitches and volumes. Wearing headphones, you will be asked to identify a series of tones by raising a hand, pressing a button, or responding verbally.

The results are charted on an audiogram, a graph that shows the type, degree and configuration of your hearing loss by comparing pitch (frequency) with loudness (intensity). The pattern recorded will help your audiologist determine your hearing threshold.

Bone Conduction Testing

Bone conduction testing is another type of pure-tone test that measures the inner ear’s response to sound. If there is damage or a blockage in the outer or middle ear, bone conduction audiometry testing may be used.

Instead of sending the tones through the ear, this type of testing is able to bypass the outer and middle ear and send the tone directly to the inner ear. A small vibrator is placed behind the ear. The device sends out a vibration that passes through the skull bone to reach the inner ear.

If the results of this test are different than the air conduction test, your audiologist can use this information to determine whether you have a conductive or sensorineural hearing loss.

Alternatively, a two-pronged metal tuning fork may be placed behind the ear or on the forehead. When vibrated, it produces a tone that travels to the cochlea via the skull. Your response determines how well sound travels through different parts of your ear, helping the audiologist diagnose your type of hearing loss.

Bone conduction testing is often used in place of air conduction testing when an obstruction in the outer or middle ears is present.

Speech Testing

Speech (or word recognition) testing is used to measure your speech reception threshold (SRT), or the faintest speech you can understand 50 percent of the time. This is compared with your pure-tone test results to confirm the diagnosis. In addition, your ability to separate speech from background noise will be recorded.

Speech testing may be administered in either a quiet or noisy environment; results are recorded on the audiogram for easy visual reference.


Tympanometry is a test of the middle ear used to detect fluid, wax buildup, eardrum perforations and tumors. It measures movement of the eardrum in response to air pressure; the results are recorded on a chart called a tympanogram.

Acoustic Reflex Testing

The acoustic reflex test measures involuntary muscle contractions of the middle ear, and is used to determine the location of your hearing problem (the ossicles, cochlea, auditory nerve, etc.) as well as the type of hearing loss.

Auditory Brainstem Response (ABR)

Auditory brainstem response testing is used to determine whether a specific type of hearing loss – sensorineural – exists. It is also frequently used to screen newborns for hearing problems.

In an ABR test, electrodes are attached to your head, scalp or earlobes, and you are given headphones to wear. Your brainwave activity is measured in response to sounds of varying intensities.

Otoacoustic Emissions (OAEs)

Otoacoustic emissions (OAEs) are sounds generated by vibrations of the hair cells in the cochlea of the inner ear. OAE testing utilizes a tiny probe fitted with a microphone and speaker that is used to stimulate the cochlea and measure its response. Individuals with normal hearing will produce emissions; when a hearing loss exceeds 25-30 decibels, no sound will be produced.

This test helps determine whether there is a blockage in the ear canal, excess fluid in the middle ear or damage to the hair cells of the cochlea. OAE testing is often included in newborn hearing screening programs.

Contact San Diego Hearing Center for more information or to schedule an appointment.

Hearing Loss Signs

hearing aids san diego

Hearing loss is one of the biggest health concerns in the U.S. It is the third most commonly reported physical condition, following arthritis and heart disease. Hearing loss affects roughly 20 percent of the American population, and can strike people of all ages.

The most common causes of hearing loss are noise exposure and aging.

What Are the Signs of Hearing Loss?

Hearing loss is a progressive condition that worsens over time. Symptoms appear so gradually, you may be completely unaware of your affliction for some time; even when hearing loss is suspected, it takes an average of seven years for a person to seek medical treatment. Take a quick look at the signs of hearing loss. If you are experiencing any of these symptoms, you should make an appointment for a hearing evaluation. The sooner you address the issue, the quicker you can begin treating it.

Any of the following might indicate hearing loss:

  • Frequently asking people to repeat what they have said
  • Feeling like others mumble when they speak
  • Having difficulty following conversations in which background noise is present
  • Turning up the volume on the television or radio
  • Avoiding social gatherings in noisy places

Often, a family member or friend will be the first to notice a hearing problem. Since treatment is most effective when begun early, if you think you might be suffering from diminished hearing, do not hesitate to schedule an appointment with a hearing specialist. The sooner hearing loss is treated, the better your chances of finding a successful treatment solution. Recognizing the signs and symptoms early can lead to an improved quality of life.


Types of Hearing Loss

Hearing loss affects an estimated 48 million Americans. There are many different causes, which translate to different types of hearing loss. An understanding of the cause and type of hearing loss is essential in developing a successful treatment plan.

Types of Hearing Loss


There are three main types of hearing loss. They are:

  • Conductive Hearing Loss. Conductive hearing loss occurs when there are problems with the ear canal, eardrum or middle ear. There are a variety of causes including structural deformities, fluid in the middle ear, ear infection, allergies, impacted earwax, perforated eardrum, foreign objects in the ear, otosclerosis and benign tumors. Conductive hearing loss may be correctable with surgery or medication.
  • Sensorineural Hearing Loss.Sensorineural hearing loss involves problems with the inner ear and is sometimes referred to as “nerve deafness.” Causes include aging, noise exposure, trauma, viruses, autoimmune disorders, otosclerosis, Meniere’s disease, malformations of the inner ear and tumors. Treatment for sensorineural hearing loss usually requires hearing aids.
  • Mixed Hearing Loss.This is a combination of conductive and sensorineural hearing loss and affects both the inner ear and middle or outer ear. Treatment options depend on the exact cause and may include a combination of medications, surgery and hearing aids.

In addition to the different types of hearing loss, it is important to consider the extent to which a patient is experiencing symptoms. Hearing loss is further categorized as being either monaural or binaural.

Unilateral hearing loss (sometimes referred to as single-sided deafness) affects one ear only, while bilateral hearing loss affects both ears. Patients with unilateral hearing loss have normal hearing in one ear and impaired hearing in the other; they have difficulty hearing on one side and localizing sound.

This type of hearing loss is usually associated with conductive causes. Individuals with bilateral hearing loss have impaired hearing in both ears. The condition is most often treated with hearing aids (two are more effective than one) or cochlear implants.

The difference between a hearing exam and a hearing (audiology) evaluation is subtle: the exam refers to a single test that makes up part of the overall evaluation. There are many different types of hearing exams that may be administered.

Contact San Diego Hearing Center for more information or to schedule an appointment.

Hearing Loss Causes

Hearing loss is caused by damage to the inner, middle or outer ear. The most common cause of damage is noise exposure and aging. Determining what is causing your specific type of hearing loss is necessary in order to provide you with the right treatment plan.


The most common type of hearing loss is presbycusis, or age-related hearing loss. Diminished hearing is a common side effect of aging, usually coming on gradually and affecting high-pitched sounds most frequently.

It occurs as a result of natural changes in the inner ear of an individual over time due to a variety of reasons including constant, cumulative daily noise exposure; hereditary factors; changes in the blood supply to the ear thanks to heart disease, high blood pressure, vascular conditions and circulatory problems; and side effects of some medications.  Cognitive changes may also occur in many individuals as a result of aging.

An estimated one third of adults aged 65 or older experience age-related hearing loss; that number jumps to nearly 50 percent by the age of 75. Presbycusis usually affects both ears equally. It may be mild, moderate or severe.

Noise-Induced Hearing Loss

Noise-induced hearing loss is the most common type experienced by younger individuals. It can be caused by exposure to a single loud sound, such as a gunshot or explosion, or by continuous exposure to loud noise over a period of time.

When sounds exceed 85 decibels (dB) they are considered hazardous to your hearing health. Continuous exposure to volume levels that high causes permanent damage to the hair cells in your ears. Activities that put people at risk for noise-induced hearing loss include hunting, riding a motorcycle, listening to music at high volumes, playing in a band and attending rock concerts.

An estimated 15 percent of Americans aged 20 to 69 have hearing loss that may have been caused by noise exposure. This type of hearing loss can be prevented by wearing earplugs and protective devices.

Sensorineural Hearing Loss

Many other factors can contribute to hearing loss, which is divided into three separate categories: conductive hearing loss (associated with problems in the middle ear), sensorineural, or nerve-related, hearing loss (associated with problems in the inner ear) and mixed hearing loss.

Presbycusis and noise-induced hearing loss fall into the latter category. Additional causes of sensorineural hearing loss include head trauma, viruses or disease, malformations of the inner ear, Meniere’s disease, otosclerosis, tumors and heredity.

Conductive hearing loss

Conductive hearing loss can be caused by ear infections, colds, allergies, impacted earwax, foreign objects in the ear canal, perforated eardrum, poor Eustachian tube function and malformation of the outer ear or middle ear, including the ear canal.

Mixed Hearing Loss

Mixed hearing loss is a combination of both. Individuals with this type of hearing loss have damage to their outer or middle ear and their inner ear or auditory nerve.

Contact San Diego Hearing Center for more information or to schedule an appointment.

How Hearing Works

The ear is a surprisingly complex organ responsible for collecting and processing sounds and transmitting them to the brain for interpretation. Many take hearing for granted, but understanding the process is the key to treating hearing loss.

How Is the Ear Structured?


The ear consists of three sections: the outer ear, middle ear and inner ear. Each plays an important role in hearing.

The outer ear is called the auricle or pinna. It is the external portion visible to others and is responsible for collecting sound waves and funneling them into the ear canal. There, they are amplified and sent to the tympanic membrane (eardrum), causing it to vibrate.

The middle ear consists of the auditory canal and tympanic membrane. When the eardrum vibrates, it stimulates movement of the ossicles, a trio of tiny bones comprised of the malleus (hammer), incus (anvil) and stapes (stirrup). The stapes attaches to the oval window, which connects the middle and inner ears.

The inner ear contains the cochlea, a fluid-filled structure where vibrations transmitted from the eardrum cause hair cells to move. This movement is converted to electrical impulses that traverse the auditory nerve to the brain. There, they are interpreted as sound and the hearing process is complete.

How Does Hearing Loss Occur?

When the outer or middle ear are damaged, conductive hearing loss can occur. This may result from trauma or disease. Damage to the inner ear is known as sensorineural hearing loss, or nerve deafness. This occurs when the hair cells of the cochlea have been damaged, preventing electrical signals from reaching the auditory nerve. Without any information to transmit to the brain, hearing is compromised. Sensorineural hearing loss can be caused by injury, disease, aging, genetics or ototoxic medications. Patients with damage to both the inner ear and outer or middle ear have what is known as mixed hearing loss.


Musician Earplugs

Exposure to loud music is one of the leading causes of noise-induced hearing loss. Musicians spend many hours practicing and performing and depend on good hearing in order to compose their music. Unfortunately, consistent exposure to loud music carries a high price.

Damaging sounds can lead to a host of hearing disorders including long-term hearing loss, tinnitus and more. Musicians earplugs can help prevent noise-induced hearing loss while allowing musicians to enjoy the music and reduce their risk of developing permanent hearing damage.

What Makes Musician’s Earmolds Different?

Musician Earplugs in san diego

Unlike traditional earplugs that block out noise, resulting in music and speech that is muffled or distorted, musician’s earplugs are high-fidelity, meaning they reduce sound levels evenly while keeping the original quality of the music intact. This translates to music and speech that is clear and natural, and allows musicians to hear their own instruments and how well they blend in with the other band members.

Musicians earplugs are made up of a diaphragm and earmold that work together to produce attenuation (reduction in sound) that is smooth and flat across the entire frequency range. Many feature interchangeable attenuators that provide multiple levels of sound reduction for different listening situations (e.g., private rehearsals vs. full-scale concerts).

They can be used in place of loudspeaker monitoring systems, which typically crowd the stage and increase noise levels significantly. Despite their name, these earplugs aren’t solely for the use of musicians; they also benefit concertgoers, allowing them to enjoy live performances while protecting their hearing. Musicians earplugs can be used in other noisy environments such as airshows and sporting events.

Contact San Diego Hearing Center for more information or to schedule an appointment.

Assistive Listening Devices

Assistive listening devices (ALDs) are portable systems that help individuals with hearing loss communicate more effectively. Unlike hearing aids, which amplify sounds, ALDs work by separating speech from background noise. This allows the person with the hearing impairment to hear more clearly.

Some ALDs are used in conjunction with hearing aids, while others work as standalone devices. ALDs are useful in a number of situations, primarily those involving distance, poor acoustics and noisy backgrounds.

What Types of Assistive Listening Devices Are Available?

assistive listening device san diego

There are several different types of ALDs available, for both large facilities and personal use. Some focus on amplifying speech, while others utilize computer programs to convert text to speech. Some of the different types include:

FM Systems

FM systems rely on radio signals to transmit amplified sounds directly to your hearing aid. They consist of a microphone, transmitter and receiver, and are used in a variety of public places such as classrooms, restaurants, movie theaters and churches.

The microphone is worn by the person speaking (or placed in close proximity to the sound source) and the signal is broadcast from the transmitter to the receiver, which is tuned to a specific frequency.

Personal Amplifiers

Personal amplifiers are essentially small FM systems used in smaller, more intimate settings where radio signals are less effective; they are often used when watching television, traveling by car or spending time outdoors.

The microphone is built directly into the unit, and is often directional, allowing you to aim it in the direction of the sound source in order to pick up the signal most effectively.

Infrared Systems

Infrared systems work on the same principle as FM systems, but use infrared light instead of radio waves to transmit sound. The transmitter converts sound signals into light and beams those to the receiver, which then translates the light signal back into sound.

An advantage to infrared systems is the fact that their signal is unable to pass through walls as it does with FM systems, eliminating competing broadcasts that might hamper the listener and preventing confidential information from being disseminated. They are particularly useful in courtrooms and large movie theaters.

Hearing Loops

Hearing loop, or induction loop, systems utilize electromagnetic energy to transmit sound directly to your hearing aid or cochlear implant. They consist of a sound source (public address systems are popular), an amplifier, a loop of wire and a receiver or telecoil (t-coil), a tiny wireless receiver built into many devices.

When you are in close proximity to the loop, you will receive clear sound free of background noise. Hearing loops can be connected to all types of audio sources, and are often set up in public facilities such as airports, churches and lecture halls.

Alerting Devices

Alerting devices hook up to telephones, alarm clocks, doorbells and other electronic devices. They alert you through a loud sound or flashing light, making you aware of an incoming phone call, a visitor at the door, etc.

Contact San Diego Hearing Center for more information or to schedule an appointment.

Hearing Aid Styles

Hearing Aid Styles

Hearing aids have improved greatly with the advent of digital technology. If you’re picturing big and bulky devices with questionable sound quality, you’ll be pleased to learn today’s instruments are smaller, more comfortable and provide sound that is more natural. They are available in a variety of sizes and styles, so finding one that appeals to your lifestyle needs and cosmetic preferences should be easy.

Here are the types available:

Receiver-in-the-Canal (RIC)

An RIC hearing aid consists of a tiny housing containing all electronics except the receiver, which is positioned behind the ear. A thin tube connects the housing to the receiver, which is worn in the concha (bowl-shaped portion) of the ear.

It’s a small and discreet unit but powerful enough for treating mild to moderately severe hearing loss.

Behind-the-Ear (BTE)

The most popular style of hearing aid (about 60 percent of users choose this type), a BTE device is curved to match the contour of the ear and rests directly behind the ear. The housing, which contains all the electronics, is encased in plastic and connects to the ear canal with a thin, clear tube or ear mold.

Though more visible than other styles, the BTE is simple to use, making it a popular choice for children. It’s powerful enough for all types of hearing loss.

Completely-in-the-Canal (CIC)

This hearing aid is placed in the ear canal and is the smallest available. It takes advantage of the ear’s natural ability to collect sound, and its discreet size makes the device virtually invisible to others.

The trade-off is a shorter battery life, and it may prove difficult to adjust for those with poor manual dexterity. This is a good choice for mild to moderate hearing loss.

In-the-Canal (ITC)

This style is also designed to fit in the ear canal, but not as deeply as a CIC device, resting securely in the lower portion instead. It’s a little larger, making it easier to insert and remove and extending the battery life.

Best for patients with mild to moderate hearing loss.

In-the-Ear (ITE)

This hearing aid is designed to fill the outer portion of the ear, and is larger than those worn in the ear canals. It is less discreet, but the size allows for more features and makes the unit easier to adjust.

A bigger battery translates to longer life and means those with severe or profound hearing loss can benefit from this style.

Contact San Diego Hearing Center for more information or to schedule an appointment.


Completely-in-the-canal (CIC) Hearing Aids in San diegoCompletely-in-the-canal (CIC):

This hearing aid is the smallest available. It is placed in the ear canal and takes advantage of the ear’s natural ability to collect sound. Its discreet size makes it virtually invisible to others. The tradeoff is a shorter battery life, and those with poor manual dexterity may have trouble adjusting the controls. This is a good choice for mild to moderate hearing loss.

In-the-canal (ITC) hearing aids in san diegoIn-the-canal (ITC):

This style is also designed to fit in the ear canal, but not as deeply as a CIC device. It rests securely in the lower portion of the canal instead. It’s a little larger, making it easier to insert and remove, which translates to an extended battery life. Best for patients with mild to moderate hearing loss.

In-the-Ear (ITE) hearing aids in san diegoIn-the-Ear (ITE):

This hearing aid is designed to fill the outer portion of the ear and is larger than those worn in the ear canals. It is less discreet, but the size allows for additional features and makes it to adjust. A bigger battery equals a longer life. Patients with severe or profound hearing loss can benefit from this style.

Receiver-in-the-Ear (RITE) hearing aid in san diegoReceiver-in-the-Ear (RITE):

A RITE hearing aid consists of a tiny housing that contains all the electronics except the receiver, which is positioned behind the ear. A thin tube connects the housing to the receiver, worn in the concha (bowl-shaped portion) of the ear. This style is small and discreet but powerful enough for treating mild to moderately severe hearing loss.

Behind-the-ear (BTE) hearing aids in san diegoBehind-the-ear (BTE):

BTE hearing aids are the most popular style on the market due to their simple design and ease of use. They are curved to match the contour of the ear and rest directly behind the ear. The housing, which contains all the electronics, is encased in plastic and connects to the ear canal with a thin, clear tube or earmold. The BTE is powerful enough for all types of hearing loss and is especially popular with children and the elderly.

Open Fit:

The Open Fit hearing aid is a smaller version of the BTE. Like that device, it rests behind the ear and includes a transparent tube that delivers sound to the ear canal through a very small earpiece. Because the ear canal is left unobstructed, there is less occlusion and the smaller size appeals to many adults. Because it is prone to low frequency noise leakage, this style is best for mild to moderate hearing loss in high frequency ranges only.