I’ve noticed something recently-  When I call to have my patients come in for a routine hearing test, many of them ask why or indicate that they don’t want to come in because they think their hearing hasn’t changed. 

Hearing loss is like any other important health-related issue.  It should not be neglected.  Even a mild hearing problem can cause you to retreat from the world around you and studies have shown that untreated hearing loss can have a negative effect on your health and attitude, even resulting in stress, depression, isolation and reduced earning power.

Hearing problems are also harder to detect than vision problems, so it’s even more important to come in for an exam.  We wouldn’t want to miss something that could be cause for concern. 

I recommend the following guide for check-ups:

If you are between the ages of:

18-45 –every five years

45-60 –every  three years

60+ –every two years

This may differ based on what I find in your audiogram.  If I find something that needs monitoring, I may want to see you more often to ensure that you’re receiving the best attention for your hearing.  Also, anyone exposed to hazardous noise should have an annual hearing test- we want to make sure your hearing is protected!

If you’re a patient that is using hearing devices, it’s also important that your hearing aids are matched to your loss- so coming in to have it checked will also increase the benefit from your devices!

So hopefully I’ll see you for your check-up this year!

For years, Home Audiology Services was located at 250 Montauk Highway in East Moriches, NY.

It was a great place to get our office started, we could afford the rent, we had a nice flow of patients and our Landlady, Ms. Patricia Gillard of The Law Offices of Patricia Gillard was wonderful.  The office was built only in the early 21^st century, but all our patients felt the building was built back at the turn of the 20^th. 

However, last March our office made the tough decision to move away from our small office and take on bigger endeavors at 201 Montauk Highway in Westhampton Beach.  While our employees and our patients loved the convenience of the office to the Moriches and Riverhead area, we were expanding and needed the space to accommodate that growth.

Our office is now located on the ground floor of a beautiful, cedar shingled office with plenty of parking, with three designated handicap spaces.  We continue to have a handicap ramp and a handicap accessible bathroom but now we have a comfortable waiting room for our patients to relax in before their appointment; complete with complimentary coffee, tea or hot chocolate.

The one office space has now expanded into five individual spaces, including a testing room, counseling room, conference space, back-area and waiting/reception area.  It definitely has given our employees some space to move about in, which they are definitely happy about- no more sharing desks!

Ms. Hillary Bieling did a fantastic job decorating the office as well, pulling in a beach theme to match our proximity to one of the best beaches on Long island!  The move, though tough because of the pressure to transition quickly, was made easier by the help of my employees—all of which I am lucky to have.

We have heard of the saying “behind every great man is an equally great woman.”  Well, behind every great practice, there are great employees.  Have a great new year, ladies and gentlemen, you deserve it!

Today was Martin Luther King day; however Dr. Hersh (as well as most Doctor’s offices) had hours today.  The pace of the day was very good; the first four patients that I tested were right after the other!  After I finished with one test, another patient was coming out of Dr. Hersh’s consultation room with an audio request.  I tested one patient who I had seen last year.  Stanley had a high frequency sensorineural hearing loss starting at 1500 Hz in both ears, and the loss was worse in the right ear.  He remembered me from last year and asked about what can be done to make speech more clear.  I recommended open ear hearing aids like the ones I was wearing, as his low frequency hearing is very good.  He did acknowledge that they were expensive, and asked about other means for making speech more clear.  I showed him some personal amplifiers on the internet, but indicated that the clarity of speech probably wouldn’t improve much.  He was encouraged (as was I) that his hearing sensitivity had not changed much from the previous year.  I even offered him a 2 week no-obligation trial with an open ear hearing aid, however he said he would think about it and follow up if things got worse.  Research does show that people wait an average of 5 years after being diagnosed with hearing loss before obtaining hearing aids.  Dr. Hersh finished early today around 5:20pm.  I was waiting for a patient’s daughter to show up and pick up her mom’s repaired hearing aid, luckily she was on foot and she met me near my car on 112^th Street.  I made excellent time driving home to Shelter Island, as the traffic was much lighter than usual because of the holiday.

I made really good time getting to Dr. Hersh’s office in Forest Hills from Shelter Island.  After being on the first ferry leaving the island at 5:40am, I was on 108^th Street by 7:35am.  It gave me enough time to go to TD bank before going to his office.  Normally I have to park about a half mile from the office, but I was thrilled to find a parking spot right on 72^nd Ave!  It was a light day at his office; I did a total of 4 hearing tests.  Unfortunately, the last patient didn’t show until 12:07pm, and consequently I was not able to leave until 12:30pm.  Luckily, I made great time going back out east.  I had time to stop at Bank of America in Shirley to deposit my secretary’s checks for her (she was recovering from tonsil surgery on 1/11).  I just made it back to the office by 2:01pm for my 2:00pm patient.  Maria was back into the office because her hearing aid was set too high.  Thankfully she told me to set it where I thought it should be.  I reset the fitting to acclimization level 1 (she wears an Oticon Dual M5 receiver-in-the ear hearing device in her right ear) and enabled the automatic adaptation controller.  The hearing device will gradually increase the output until it reaches level 2 in 30 days.  I informed Maria this would be the best way to gradually increase the gain without her getting an adverse reaction.  After Maria left, I did some clerical work (Maggie was working from home and my secretary was out), then set up Persona Medical’s hearing aid software in my ‘house call laptop’.  I invested in their Speech Pro package which was really an excellent one.  Persona gets you a MedRx Avant real ear system (which only works with Persona Medical hearing aids unless you purchase a firmware upgrade from MedRx) and a pair of powered Logitech speakers.  The best part about the Avant system is it’s binaural real ear measurement and the probe microphone setup is far superior to the system I purchased from MedRx back in 2006 (Digital Speech Mapping).  What I like about the Avant system is that you have binaural probe microphone assemblies. Unfortunately, there was a problem with the sound card on the laptop but I was relieved when I learned that the MedRx box has its own separate sound drivers.   I also purchased a pair of Persona Medical’s Evok 900 behind-the-ear hearing aids.  These aids are their top of the line model, and I had a chance to have their software demonstrated to me by allowing Michael Steinman (inside sales) remote access to my computer.  He had me actually put the probe tubes in both ears and couple the BTEs to foam molds.  I remember just how uncomfortable having the real ear probe hit your tympanic membrane is!  I programmed a moderate flat loss and Steinman fit the hearing aids with Speech Pro.  This is a revolutionary system where you can use either composite speech waited noise or real live speech as a stimulus and you can have the software automatically program the hearing aid to within 3dB of target!  Steinman was also able to demonstrate the difference in sound quality of real ear verified versus predictive.  It’s amazing that there was a clear difference.  The real ear verified was more natural; the predicted was tinnier.  This entire process took a little longer than expected, but I’m really excited about being able to fit their product on some of my prospective patients.  I am really looking forward to when they are able to introduce connectivity to BlueTooth devices as a feature of their product.  In the meantime, I look forward to using their amazing software on some of my patients to see what they think.

My first patient, Joseph, found me from the phone book.  He saw the Nurse Practitioner at his primary physician’s office.  During the examination the NP saw his right ear canal to be completely occluded with wax; consequently he recommended having the ear irrigated.  Unfortunately, the NP did not make a direct recommendation so Joseph found me in the Yellow Pages.  This will be a good opportunity to market my services to that office!  Joseph was indeed completely occluded in the right ear and had a moderate cerumen buildup in the left ear.  I irrigated his right ear about 10 times before the block of wax had egressed to the point where I could remove it with a curved buck curette.  After the large block of wax removed, there was some residual wax located near the eardrum, so one more irrigation was all that was needed to remove it.  The left ear was irrigated just once, and the canal was clear.  As is customary, a hearing test was performed after the wax was completely removed.  He had a high frequency sloping sensorineural hearing loss typical of presbycusis (age related hearing loss).  He reported being able to hear much better after the wax was removed, and did not feel his measured hearing loss affected his quality of life.  He felt that he was in pretty god shape for a 91 year old man.  I agreed with him.  I recommended to have him come back in 6 months so I could look in his ear and see if there was buildup occurring again.  The second patient was another Joseph (it must have been the day for Josephs).  He had been approved for two hearing aids from Medicaid after a long application process (about 5 months to be exact), and came in to be fit.  I had given him a loaner BTE for his left ear and he had an old ITE for the right ear (but it was insufficient for his loss); after today he had a brand new set of non-programmable digital BTE hearing aids from Personal Medical.  After an initial hiccup with the telecoil inadvertently being activated in the right ear, it was determined that both were operating quite well and he was very pleased with having both ears working together again.  I left for Dr. Hersh’s office

Today was a light day at Dr. Hersh’s office.  I believe I performed a total of 4 hearing tests when I typically perform about 6.  He has hours from 9am-12pm.  Afterwards I went to Avalon Gardens Nursing Home in Smithtown to deliver two hearing aids.  The first was to Maureen; her story has a happy ending but the entire process took 6 weeks to complete.  6 weeks ago on one of my previous visits, her hearing aid had a broken battery door.  I took it with me to Dr. Hersh’s office, since there were extra battery doors there from several different types of hearing aids.  Unfortunately, none of them fit.  The same thing happened at my office.  So I called Starkey to order battery doors for her specific ITE.  A follow up call a week later by my secretary revealed that nobody had acted on my request.  So I placed a call myself to Starkey and explained that I had already ordered these doors and nobody acted upon the request.  The representative stated that since I didn’t hold an account with Starkey, the request could not be fulfilled because the computer system they use does not allow them to place an order without an account number.  I stated my growing frustration with the situation and that if I needed to, I would have my colleague order the doors for me since he held an account.  The rep sympathized with my situation and somehow got the doors shipped out to me.  Unfortunately, after I got the door replaced, the hearing aid was completely non-functional.  It took me 2 weeks to get in contact with my local repair guy, as he was alternating being sick with his wife and kids.  I got the hearing aid out to him and asked him to ship it directly to Avalon Gardens after it was fixed.  He was able to comply with my request, however it was lost at Avalon upon delivery (note to self, no more shipping hearing aids to Avalon) on December 10!  I was there on December 16 and the situation was not good, as this patient has a severe to profound hearing loss and cannot function without a hearing aid.  I took a new earmold impression, raced back to the office, got a DVS approval from Medicaid for a new digital ITE, completed an order form for a Phonak Certena Power ITE and JUST made the 5pm FedEx pickup.  I got a call from the Ombudsman from Avalon Gardens on December 17, who informed me that Maureen called the State to complain about the situation.  I informed him of my extraordinary efforts and that if the hearing aid arrives before I go on vacation on December 23, it will be programmed and dropped off at the facility by my secretary while I was on vacation.  I was thrilled when I stopped at the office on December 22 and the hearing aid had arrived already.  I was crushed when I discovered the volume wheel popped out of the faceplate and I couldn’t program it.  So, it was sent right back to Phonak to be fixed.  It came back while I was on vacation and my secretary informed me that there were a number of problems with the hearing aid that was sent in to be serviced; Phonak made a brand new aid and put the same serial number on it.  I installed the latest version of their software and this solved the problem of programming.  I programmed it in the morning on January 8 at Dr. Hersh’s office and dispensed it that afternoon.  Marueen was thrilled with the quality of sound and very grateful to receive a new hearing aid.  The other patient was Barbara who received a replacement hearing aid (her previous one was lost).

I went to two nursing homes today; the first being Hampton Care Center.  The first patient was Paula.  She had a mild to moderate high frequency SNHL and did not meet the MMIS requirements for a hearing aid through the Medicaid program.  She was counseled as such, and did not feel that she needed a hearing aid in particular.  The second patient was.  Her main concern was wax which was affecting her hearing adversely.  I removed two significant pieces of wax from her ears using a curved buck curette.  She immediately voiced improvement in her hearing.  She had a mild to moderate high frequency SNHL with asymmetry at 3000 Hz, but did not feel she needed a hearing aid.  The next patient was Menika; she was a simple check for wax in the ears.  I removed a small piece of wax with a curette from her left ear.  The forth patient was Helen.  I did not actually see her, just replaced the oto-clips on her ITE hearing aids.  The fifth patient was Antoinnete; she was completely unresponsive to all forms of testing and not a suitable candidate for amplification.  The last patient was Margaret; whose hearing aid was completely non-functional and taken for repair.  The next stop was Riverhead Care Center.  There were only two patients for earmold impressions Fred and Mary.  While I was at Riverhead Care Center I chatted with a lawyer who has an 8 year old daughter that wears Phonak hearing aids, and he was inquiring about a connection to a cell phone.  I informed him that I would be in touch with him via email and give him information about the iCom so he could investigate whether this would be a feasible option for his daughter.  The day was complete after that.

First day back at the office.  My first patient was Janice.  She is a delightful woman who was initially seen at my office, referred to Dr. Rezvani for ENT clearance as she has a mixed hearing loss in her left ear and a perforated eardrum in that ear and returned to my office to be fitted with a Phonak Audeo Yes III RITE with a custom mold.  She agreed to have my office craft a letter stating that she is a satisfied patient of my practice and that she would hope he would consider sending other patients to my office.  The second patient of the day was Betty.  I originally saw Betty back on 7/15/09.  Her story is rather interesting of how she found my practice.  She and her husband moved out to Hampton Bays and were looking for a hearing health care professional to service her Phonak hearing aids (Eleva 411 dAZ).  She called one of my competitors, left a voicemail and did not receive a call back.  Then she went to Phonak’s website and they listed another one of my competitors, who she made an appointment with.  She was not treated very well at all after she got there.  Betty was told “I don’t know much about Phonak”.  She informed my competitor that Phonak’s website lists the business as someone who works with their product.  The response was “I can’t help you”.  Betty was very frustrated (as anyone would be given the circumstances), so she called Phoank and they finally directed her to my office.  She also told them about her unacceptable experience at the other office.  I knew I could help her as soon as I examined her earmolds.  They were really insufficient for her needs.  Betty told me she had 3 separate sets of molds all from the same place!  Her previous audiologist did the only thing possible to counter the feedback; run the feedback manager and reduce the gain.  I took earmold impressions which were overnighted to Microsonic with instructions to perform a same day lab with overnight shipping (Betty has family coming into town and she wanted to have the problem fixed before their arrival).  I saw her 7 days later to be fit with her new earmolds.  I chose M2000 plus, a soft material which does a great job sealing off the ear.  These new molds were fantastic!  After hooking up her present hearing aids, I followed Phonak’s audiology support by running the feedback manager first.  The output limiting curves immediately were raised for both ears, allowing for a significant improvement in gain output without feedback.  Betty was a happy camper after that.  A follow up call several days later produced the best compliment an audiologist can get (I haven’t heard this well in years!)  Back to the present moment..her FM system was sent in to Phonak to be serviced.  It arrived at my office and was sent overnight to her house just before Christmas.  Unfortunately, it does not work with her hearing aids.  There was a horrible static sound whenever it was put into use.  We troubleshot as best we could, and it was determined that the FM system was to blame.  Phonak advised me to send it in for servicing and that they would test it with compatible hearing aids at the factory.  We also ran the feedback manager, as she was starting to get feedback.  Unfortunately, I saw a significant drop in the right ear output limiting curve and I suspected that the earmold wasn’t fitting as well as it should.  So, I took an earmold impression for the right ear to have the earmold remade.  I informed Betty that she would be notified when the FM system returns from being serviced.  The third patient was Mike.  He is one of my longest standing patients, dating back to 2005.  He had given me his Siemens Centra hearing aid about 5 weeks prior so I could look at it.  He claimed that it was noisy and the output wasn’t clear.  He had lost this hearing aid some time ago and it turned up when he was doing some house cleaning, so I suspect that it had picked up some moisture from somewhere.  While I was a graduate student doing an externship, I had learned about the benefits of the Dry and Store Professional conditioning system.  My supervisor at the time was the owner of a private practice who swore by these machines.  He would get hearing aids from his patients that were weak.  After running them through the Dry and Store box three times, he was able to significantly improve their function.  So, I decided to use the same remedy for my patient’s hearing aid; it was run through the Dry and Store box two separate times.  I returned his Siemens Centra RITE hearing aid to him, and he was satisfied with its performance.  He also agreed to have a video testimonial taken of his positive experience with my practice.  My last patient was Robert.  He came in to pick up supplies for his hearing aids.  He was overdue for a hearing test, so we performed a complete audiological assessment.  I checked on the warranties for his hearing aids and realized that his Loss/Damage warranty expired on 1/2/10.  Since this was a Saturday, I called Oticon and was able to secure a ‘piece of mind’ warranty which entitled him to an additional two years of Loss/Damage and one year repair warranty.  We were both pleased that we could get the extended warranty.