Traumatic Brain Injury

Roughly 450,000 people in the United States will suffer from head injuries this year. The numbers are growing as people spend more time in extreme sports, ride vehicles without proper protection, particularly head gear, and as our service men and women fill military assignments in hostile environments. The majority of individuals who have moderate to severe injuries will have vertigo and balance problems for up to 5 years; many will not be able to be employed. Traumatic brain injury can result in multiple symptoms such as auditory processing disorders, balance problems, hearing loss and tinnitus.  Audiologists are in the forefront in evaluating patients with these hearing and balance disorders.

Forensic Audiology

This is really an intriguing aspect of audiology.  Dr. David Lipscomb, of Correct  Service, Inc. out of Stanwood, Washington is responsible for exposing me to forensic audiology. He has been involved in testifying in court cases mostly in industrial settings where there is workers compensation case involving exposure to loud noise. Dave has been a colleague over many years and always ready to listen and encourage as well as teach. It is because of his inspiration and encouragement that I have ventured off into forensic audiology. I find this area of audiology to very intellectually stimulating. As I am expected to be an expert witness I like the challenge of trying to answer questions in a manner that lawyers, judge or jury can understand the underlying concepts.  In essence this is another teaching opportunity.  I am neither for the defendant or the plaintiff; I am looking at data and interpreting it based on my knowledge and expertise.  I look forward to being involved in forensic (a.k.a. investigative) audiology for many years.

Noise induced hearing loss

The majority of hearing loss in the U.S. is due to exposure to loud noise. Noise-induced hearing loss is, painless, progressive, permanent and PREVENTABLE! How loud is too loud? Any easy rule of thumb is that if while you are speaking to someone who is 3 feet away and you have to raise your voice, you are probably in a listening environment that is loud enough to cause damage.  If you have ever attended a live concert where the music was loud and after the concert noticed that your hearing was muffled or that you experienced tinnitus (ringing in  your ears), that was an example of a temporary threshold shift in your hearing. It was temporary because a few hours later or even the next day hopefully you were able to hear normally again and the tinnitus subsided. Repeated exposure to loud noise can result in permanent threshold shift.

The answer for dealing with noise induced hearing loss is simply to prevent it by wearing personal hearing protection (ear plugs or ear muffs or a combination of the two). Sometimes I am asked about the possible damage from iPODs or MP3 players. Can listening to these devices cause permanent hearing loss? Absolutely! It is a question of how long you listen and at what volume. If you have one of these devices you may want to use the 60/60 rule. Limit your listening to 60 minutes and make sure the volume control is set at or below 60%.

Audiology as a career

I have been an audiologist for over 29 years and have enjoyed the profession and the association with other colleagues .  Audiologists work in various settings such as: clinics, hospitals, medical centers, schools, research laboratories, and a host of others.  The role of the audiologist varies from location to location.  I have had opportunities to 1) work in hearing conservation in the US Army,  2) teach in an ENT residency program, manage a large military clinic with 19 satellite clinics, 3) evaluate hearing of newborns up to individuals who were in there 90s and patients who fell somewhere in between, 4) evaluate patients with hearing loss, balance problems, and/tinnitus,  conduct research at an Army aeromedical research laboratory, 5) direct the audiology program at one of the premier hearing clinics in the world, 6) fit hundreds of hearing aids and other devices designed to assist the hard of hearing, 7) be a spokesman in the community for hearing health related topics, 8) teach in a college setting, and 9) provide forensic services involving malpractice suits.  This is a great profession that is very rewarding.

Cerumen (ear wax)

I have had many patients who are concerned about the cleanliness of their ears when I perform a visual inspection of the outer ear canal (otoscopy).  Cerumen in small amounts is perfectly normal. Cerumen provides a defense against insects that might wander in, has a pH factor that is not conducive to the growth of bacteria or other microbes, and helps keep the outer ear canal moist. The ear actually sloughs off debris through a process called migration.  Dead skin cells coupled with cerumen travel at very slow speeds from the inside of the canal toward the lateral (outside) portion of the canal. Some individuals produce more cerumen than the system can handle and as a result there is a buildup. Normally this does not affect hearing, until the ear canal is nearly or fully occluded.  Removal in most cases is fairly straightforward. An audiologist or ENT specialist (physician) is trained to remove cerumen. This is an outpatient procedure and can usually be performed in a few minutes. Sometimes the removal is a little more involved and may require the use of ear drops (cerumenolytics) that soften the wax and make it easier to remove.  In some instances a small curette will be used to extract the cerumen, while for other cases an irrigation will be performed where a stream of water is directed into the outer ear canal, eventually resulting in the removal of the debris. While this type of approach can be disconcerting to a patient who has never undergone through this procedure, it is normally well tolerated.

Audiological Consulting

Procedures to provide expertise to other professionals, business, industry, courts, attorneys, public and private agencies, and/or individuals in all areas related to the profession of audiology including program development, evaluation, or supervision.

Consulting services enhance the understanding of auditory and vestibular systems and the appropriate management of hearing loss, related auditory disorders, and vestibular dysfunction.

Consulting services facilitate changes in the acoustic environment and development of programs or instrumentation for the prevention, identification, diagnosis, treatment of auditory and vestibular system dysfunction, or referral to appropriate resources

Expected outcomes of consulting services are variable and are negotiated between the consultant and consultee(s).

From Preferred Practice Patters for the Profession of Audiology (December 21, 2006)


Tinnitus is a symptom characterized by sounds perceived in the listener’s head that are not generated from outside the body. Often described as ringing, buzzing, chirping, these sounds can be constant or intermittent, loud, soft or somewhere in between and affect 10-15% of the population.

Severe debilitating tinnitus is reported in 1-2% of the population and can have an adverse effect on the quality of life.  Until the last 5-10 years there have been few treatments to help patients deal with tinnitus.  Fortunately today there is a great deal of research with a focus on finding a cure for tinnitus. The American Tinnitus Association ( has been leading the charge to find answers. There is no reason today for any professional to tell a patient, there is nothing that can be done and he/she will just have to get used to it. Help is available.

Basics of Audiology

Audiology is a relatively new allied healthcare field dealing with hearing and balance disorders.  The real beginnings of audiology date back to World War II when Raymond Carhart coined the term.  There has been a rapid growth in the field of audiology since that time. Audiologists are trained in evaluating patients who present with symptoms such as ear pain, hearing loss, dizziness, difficulty hearing in noise. The scope of audiologists has continued to increase in magnitude over the past  5-6 decades. My hope is to contribute information regarding hearing and balance issues to this blog that will be of value to the reader.