My Doctor Online The Permanente Medical Group

Symptoms

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Losing your hearing can be a distressing and isolating problem, as you become less able to communicate with your family and friends. Sounds may seem distant or muffled, especially when there is background noise. If the hearing loss is gradual, a person with hearing loss is sometimes the last to know. Others may complain that the television is too loud, or that they have to repeat themselves too often. Additional symptoms that can be associated with hearing loss, depending on the cause, include the following:

• Ringing in the ears (tinnitus)
• Balance problems
• Ear pain
• Drainage or a plugged sensation

Types

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There are 3 types of hearing loss:

Conductive hearing loss happens when sound is not transmitted to the inner ear because of a blockage caused most often by:

• Ear infections
• Wax build-up
• Fluid build-up from colds and allergies

This type of hearing loss is temporary and we treat it medically or surgically.

Sensorineural hearing loss occurs when there is damage to the nerve pathways in the inner ear. Some common causes are:

• Viruses
• Loud noise exposure
• Aging

This type of hearing loss is permanent, but a hearing aid can help.

Mixed hearing loss means both the inner and outer ears are affected so you experience both conductive and sensorineural hearing loss at the same time.

Screening and Diagnosis

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If you suspect you or a loved one has hearing loss, an audiogram test will help determine the severity and type of hearing loss. Sometimes the results of the audiogram can lead us to order another diagnostic test. We will discuss your options with you.

Causes and Prevention

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To understand hearing loss, it helps to understand how the ear works. Sound travels through the ear canal and vibrates the eardrum. The eardrum is attached to 3 ossicles, the tiniest bones in your body, which help amplify the vibration in the middle ear. From there, the vibration travels to the cochlea in the inner ear, where the mechanical energy of sound is converted to electrical impulses. These impulses travel to the brain, which makes sense of these signals as the sound you hear.

With such a complicated system, you can imagine that many different things can go wrong. Sound can be blocked at the ear canal by earwax or infection. Sound can also be affected by a hole or fluid behind the eardrum that prevents vibration from getting to the inner ear. The ossicles can be affected by infection, skin growing from the eardrum (cholesteatoma), or bony overgrowth that causes the bones to "stick" (otosclerosis). The specialized inner ear cells in the cochlea can begin to lose function, often related to age or to noise exposure, and less commonly by exposure to infection or certain medications. Sometimes hearing loss can result from problems with the nerve that connects the cochlea to the brain.

Prevention

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Limiting your exposure to loud noise is one thing you can do to prevent hearing loss. It is important to contact us if you suspect a problem. We can arrange a hearing test and appointments with specialists, as needed.

Please do not use Q-tips or cotton swabs to try to remove earwax in the ear. Q-tips can push earwax deeper into the ear canal and traumatize the eardrum.

Treatments

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For conductive hearing loss:

• Medications and surgery may be appropriate for conductive hearing loss related to problems with the ear canal, eardrum, middle ear and/or ossicles. Infections of the ear canal or middle ear respond to antibiotics. Holes in the eardrum, a skin cyst (cholesteatoma), or problems with the ossicles are usually surgical issues.
• Hearing aids are a viable option for many people with conductive hearing loss. Bone-anchored hearing aids, which are physically attached to the skull, are also an option for a small group of people who can't wear a conventional hearing aid.

For sensorineural hearing loss:

• Hearing aids and other assistive listening devices attached to the telephone or television can be helpful.
• Medication is usually ineffective for this type of hearing loss. However, if your hearing loss occurs suddenly we might prescribe a medication and we will discuss this option with you, as appropriate.
• Surgery in the form of a cochlear implant is available for those whose hearing loss is so severe that hearing aids can't help.

Lifestyle Management

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Hearing loss is not a hopeless situation. There are things you can do to continue to enjoy your favorite activities, remain independent, and feel safe. Here is a list of some helpful aids and devices:

Hearing aids can help you manage your hearing loss. It can take several weeks or months to get used to a new hearing aid because it amplifies all sounds, including background noise. You might find that it takes extra effort to have a conversation in situations where there is a lot of background noise, such as a family party, restaurant, airport or train station.

Assistive listening devices make certain sounds louder by bringing the sound directly to your ear and reducing background noise. You can use different types of devices for different situations. Some museums, theaters, and places of worship provide listening devices. Assisted listening devices include telephone amplifiers, personal listening systems and FM systems, as well as hearing aids that connect directly to a television, stereo, radio or microphone.

Alerting devices call attention to a particular sound like a doorbell, ringing telephone or baby monitor by transmitting louder sounds, lights, or vibrations to get your attention.

Speech reading is a listening technique that can help you adjust to hearing loss. It is different from lip-reading. You don't need to know how to lip read in order to successfully speech-read. When you speech-read you pay close attention to people's gestures, facial expressions, posture, and tone of voice. Reading these clues helps you understand what a person is saying and enhances your part of a conversation. Be sure to face the person you are talking to so you can see his or her face clearly.

Television closed-captioning displays the words at the bottom of your screen so that you can read instead of hear them. Most TVs have a built-in closed-captions option.

TTY/TTD is a newer technology that includes TTY (text telephone) and TDD (telecommunication). This device allows you to type messages back and forth on the telephone instead of talking or listening. When messages are typed on the TTY keyboard, the information is sent over the phone line to a receiving TTY and shown on a monitor. A telecommunications relay service (TRS) makes it possible to call from a phone to a TTY or vice versa.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history. I will also perform a thorough ear exam. In some cases, I will need to remove earwax from the ear canals in order to see the eardrums. This may require that I use a suction device specifically designed for the ear. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you have not already had a hearing test, I will order one for you. I will also determine if any other diagnostic exams or procedures are necessary.

If you are a candidate for hearing aids, I will give you a medical clearance form and additional instructions about how to obtain hearing aids.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures we will schedule an appointment with the Radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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