crossroads yes and you're in all the audiologist and you just center on the hearing aspect of the practice that's correct so what what goes on within the office and crossroads speech and hearing well we do diagnostics for speech language and hearing so in the office when you diagnosing speech or you're listening to patterns and how people form words and and that type of thing yes and we have pathologists that actually do those tests and they are trained with masters degrees they have all different types of the evaluation there could be for speech delay they could have articulation errors  receptive language expressive language so what is receptive and expressive language receptive is how they understand and process it versus being able to speak and express their needs so if someone is glass window glass window something right and and you would i think i had a headset on you had a headset on and it's been it's been this had been twenty years ago eighteen years ago so i guess yeah and you would i would hear tones yes and then he would he would do a left ear in the right ear and so what are those tones that i'm hearing or not hearing tell you well we're looking at trying to find out how you hear and for speech basically so that we know that you have a hearing loss the difficulties that you may have because they work together they were so but it's also right and the sounds of speech you know each letter of the alphabet comes in at a different frequency so we're testing you a different frequencies so that we can have some sense of how you hear conversation but it's also to diagnose a loss we do a variety of things with the tones you not only had headphones on but you also had a bone conduction i don't remember the library to run that directly stimulates the nerve of hearing so we're testing to find out diagnostically what the cause of the hearing loss is and if we find certain issues with with the test sometimes we refer you otolith just which is in your nose and throat specialist because you need further further look to find out why your hearing is down so what are some of the causes of hearing loss it could be genetic it could be noise related loud noise if you have a particular job or you work right out of a jet engine you would have a problem correct or could be military yeah military exposure if you're a hunter and don't wear protection you could have a hearing loss or your hurts when you listen to music or listening to it to a loud that's that could happen also if you stop listening and you have ringing in your ears that's a sign you know if you sometimes have a temporary ringing especially after iraq concert you where your hearing actually changes slightly people have come in saying i cannot hear and their hearing is down and then hopefully it'll recover because it's temporary but if you continue to keep exposure at that level it could cause permanent damage have you noticed an increase since we've been supporting the use of these ear buds i mean we nationally i remember the days when we had the big headsets that would go over the top of your ears and then we moved into these small ones and then there's bluetooth and so forth now have you noticed an increase in hearing loss of cell this is how there are studies out there that it has had to affect our i see a lot of teenagers we're not sure if that's what's causing it because it could be something in their genetic history or their family history as well but the interesting thing is just in the past year i also worked with hearing aids and fit hearing aids and i was looking at the numbers because the same like i was fitting more people under the age of seventy than over but i actually wanted to figure that out and it was about forty five percent from teen age up to seventy were getting fit with hearing aids and the fifty five percent in the  hearing aids and so that's something that you had ten years ago for yes there is always been children with hearing loss and hearing aids has been an increase of children it's hard to say yeah i was think that there's going to be more because over time with this exposure to and have been for a year now an interesting story just aside from that last night i was i was flying it and i was out of town for the weekend and the fella sitting next to me is a musician and on his he had an apple phone on and he has an app that measured the sound of the airplane in inside the cabin and it measured at ninety decibels i was shocked so what's the damaging best you have to watch after eighty five decibels so at ninety on a three hour flight you could have earplugs that he wore they were saying always wears them to protect his hearing because he's a musician and in this very concerned about that i had one time had a pair of noise canceling headphones yes and would those help yes because they they tone down the yes so you're talking about frequencies is what you're talking about well that would be decibel level in this ninety is a level of how loud the sound is so there's you know there's ways to measure it but it was just interesting that he had long and how steady and how loud it is are deep sounds like bass sounds more damaging than a high pitched sound if it's probably the it's the loudness level that just a lot of so does it isn't that aids tend to produce a little bit more woks than the average person because it's just the body's natural reaction of the body reacts to things that aren't that are foreign and sometimes tries to reject reject and we know that right and we still do things that cause that but possibly saying what did you say or the in this or is that what you see i see that and i also see difficulty hearing in a crowd or i go out to a restaurant and i'm having trouble now i can hear one on one but when there's noise in the background chatter kind of it and yes it is makes it difficult to understand the conversation so that's usually the first song as we get older is it you the notices that or somebody that you're with says it's usually somebody well it could be both ways you know if you're always saying what did you say every else is having a conversation and you're having a little bit more difficulty thank you become aware but often the patients that i see it's the family members well i think i'm fine but my family is getting tired and and they're complaining so they're selective hearing could be  engrossed in a book or reading something and you've just learned to tune things out and you may not hear people around you so my first step would be if if i'm being told that  diagnostic tools and you kind of say well you have a scale of where you're hearing the range that you're hearing you know what we do is always the first thing is i would look in your ears to make sure that they are clear of wax because if they weren't we would not want to proceed at that point we want to make sure everything is clean and then we would proceed with the test the first part of the test i would have you repeat words we do a list of two syllable words and we get softer and softer we want to measure the softest that you can understand speech and then we go to a more comfortable level and go through a longer list of single syllable words to see if how well you your discrimination ability is are the words clear are you making errors on the words there's words that sound alike you may not hear the first letter of the word we need to record that and give a percentage of your word recognition then the last part of the test is the different tones where you listen and signal if you've hear the softest tone we do it through headphones we also do it through bone conduction and that's all for diagnostics reasons because you can have a hearing loss noted through testing through headphones but your nerve of hearing might be perfectly fine so that tells us that you would have a certain type of hearing loss that might be corrected by surgery or medication if the scores between the headphone and the bone conduction  identical then that's what we call a sensory neural hearing loss and then we can work ahead to rehabilitate if necessary through hearing aids so you can lose hearing with infection with trauma  disease like a tumor or something like that's correct or what are some of the other causes like we had said before noise noise generally those are the most common ok so i come to you and i get diagnosed and then we you do your testing and we have a skill that or i fall in right we go over the results and discuss you know why you're having difficulty in certain areas if you are you know try to explain that you understand about your loss as well and that point and talk about ways that we can help you if if you fall in that area sometimes it's just even just making suggestions for the family you may be on the borderline  i always tell people if they're having trouble but their hearing is still within the normal range but at the lower end of normal maybe have to have your family always call your name you always react to your name to get your attention because you could if you have just a little on the border a between normal amount hearing loss you make your say about selective hearing well it's not necessary selective that you may just be missing if they're calling from another room or trying to ask a question from another room it's always best to have the family come in the same room call your name and get your attention it was in talking years ago when i saw you and kersti i didn't have was clueless and i had a problem and one day i had a phone in my ear and i was i had in my left ear of course those were the and i think you found them sir you don't remember and i don't remember right but there was a hardly anything if anything yet it didn't sound right to me so your diagnostic tools kind of said i was hearing ok all right but there was a difference in what i was perceiving right and then probably within a month it was back to normal and so that was probably eighteen years ago yeah and i've never ever had an issue that's that's very good but i i know people that and i had a problem with chocolate or caffeine it's something to me so these things do impact it depends on what if the diagnosis if you have a certain disease process it definitely could affect it so so do we know the at that same two right either way it is that pretty common is that on the excuse i don't know if it's on the increase but it is common and unfortunately there's not really a cure for that for the tentative this for many years that there's certain treatments believe now that the overlearned ologists can do to help with that but it is a disease and it can come it can fluctuate your hearing and it can come and go usually it's you know you're fine and then that all of a sudden it rears itself and you know you're having a problem again and then it and then it settles down again or will see their hearing changes in one usually in one ear two it's what i hear from people that have this problem is that they they they're hearing  about it it can be on and off it can be in both ears one ear can be loud it can be tolerable now there's some hearing aids actually have to the to smash cars that have a sound that they can  project into the ear that that mask the sound of their own natural tendencies and it helps them taller and sometimes just wearing a hearing aid when i put people complain of tinnitus along with their hearing loss when i first try hearing aid on after a few minutes they say i'm not noticing my tinnitus as much because that's going to be annoying to sit there yeah i hear that all the time that doesn't happen to everybody but i had a lot of people say that they don't notice it when they're wearing their hearing aid which is helpful to them in more ways than one they're hearing better right up against our you're right log in and we're sitting there a lot of people live on their cell phones and i'm wondering if that made that he filled his i haven't seen anything about that i you know what know for sure but i nothing has come up in the literature that i've read rip you know regularly to support that thought i know somebody has and we want to talk about you brought some samples of hearing aids and something with you and i want to talk about how that works and everything but i know someone who had surgery and had coker implants put in and what happens with with that when you know a cochlear well you go through a pretty rigorous test to find out if you're a candidate and usually you can't be helped your traditional hearing aids and there in the pittsburgh there's two centers that usually work with the coakley or implants done at you p m c and also it up on the north side at allegheny general hospital so they go through a very rigorous test to find out if their candidate and at that point they would go into surgery and surgery is you know they implant wires into their coke and then there's a microphone and transducer that attach on the outside but it's a long rehabilitation process but it's very successful it's interesting he has his and both yours and he started off with only one yes and this was several years ago one ear and he said it's really enhanced his life and you can see it's amazing how you can't see it now like you said they used to be pretty large but his other ear is not a candidate so we're fitting a hearing aid on the other ear which i had just ordered but the interesting thing about his is that they are compatible and that their success or ease now available that he can use the accessory to help both the co clear and things have changed yeah it's amazing how how technology is adapting to right issues that would you know if i didn't have things like that he would be deaf for the rest of his life you know what are you going to do right now you know  doesn't work and there's no type of surgery that can correct the problem your just end up being death's very rough but the whole water thing is interesting too with children children that have hearing loss and we're hearing aids you know you think about them going to kennywood and that have to in years past they had to take their hearing aids out then they could hear when they jump in the swimming pool their their impaired again because they have to take the hearing aids up but they've come out some with some coatings now on hearing aids they still don't want you swimming in them but you could if you do get wet not going to damage them so it's a lot easier for families to handle their children with hearing aids you don't have to be quite as cautious as you did in the past because i was always very difficult trying to be a child and playing and then worrying about whether you want to hear or not and then you know and i'm sure that this is was impactful to just the fact that you have something that's different than what everybody else has so the person next to you the kid next to you doesn't have this testament to their ear that all of a sudden you do it differentiates you a little bit that little bit and so you have to deal with that i can remember as a kid seeing the first elderly gentleman that had a hearing aid and it was this big thing and set in there and staring out what the heck is that you know i want one and there was no he can't hear and then you had as a kid you can't and you think about we use cell phone and cell phone bluetooth and sometimes you can even see those your it's by i don't know if you remember the first bluetooth cell phone things that look like antennas coming out i think that did a lot of good for hearing right now so you want to show us how to use well hearing aids have been getting smaller and smaller and they have this is a type of hearing aid they call receiver in the canal all these are all these other ones are  actually they built part of the hearing aid outside of the the hearing aids cell in here is usually a computer chip a battery with a battery and it sends the sound on this wire and in your ear so when it's in your ear you really don't see very much at all this just sits behind your ear tucked in the back and it comes in all different shades we try to match excuse me your hair color or your skin color whatever works best so the different models i usually have a long discussion with the patient about what their individual needs are some are more water resistant than others some have a larger battery so if there's dexterity issues we need to be concerned about that it's a problem for elderly  kids changing about or there's a lot of different so this is an area of the difference in the size of this one right and some are more powerful you know that usually the bigger ones have more power but sometimes people want bigger ones because it has a larger battery too they also come in custom shapes these are just examples we can get them even smaller than this but these are we take a impression of their ear and the computer chip is built inside the shell with the manufacture and then amazing then what do we have here this is a streaming device there's different kinds of streaming today with hearing aids some manufacturers have a direct link with i phones where you can just wear a hearing aid like any any of these and the your i phone connects directly to your your hearing aid so that when your phone rings you can go to it's a bluetooth receiver you can hear right you know your  also a remote control there's an app on it for your hearing aid so you can turn your hearing aid up or down wonderful you can do all sorts of adjustments so with hearing loss there's hope and it's whole it's a lot going yes you know s