Styles of Hearing Aids
There are many different styles or ways a hearing can look when being worn. Most modern hearing aids remain small in size even if they need to provide a lot of amplification for people with moderate to severe hearing loss.

• Completely in the Canal: the smallest type of hearing aid. Fits deeply in the ear and is virtually invisible unless looking directly into someone’s ear. This hearing has the most limitations as far as being able to fit all losses, however. Generally, it is only suitable for a mild to moderate hearing loss at all frequencies.

• Canal aid: Second smallest type of hearing aid. A little more visible than the CIC, but allows patients much more control over their hearing aid. It is only able to be appropriately fit to a mild or moderate hearing loss.

• Half Shell: The size of this hearing aid is roughly equivalent half the size of the concha bowl of the ear. The size allows for higher level noise reduction capabilities such as directional microphones. It is appropriate to fit moderately severe hearing loss.

• Full Shell: The largest of the in the ear hearing aids. The size of this aid fills the concha bowl fully, and creates a better acoustic seal allowing for a little more power. This hearing aid fits a larger type of battery which allows for larger battery life as well as all of the other benefits of the half shell.
• Micro-Behind the ear (open): A very small hearing aid specifically designed for a more natural sound and better comfort than the in the ear hearing aids. Able to fit hearing losses previously difficult to fit with in the ear hearing aids.

• Micro-Behind the ear (RIC): A receiver in canal (RIC) micro-BTE allows for comfort and clarity of the open fit hearing aid, but is more applicable to moderate and moderately severe hearing losses. When worn, the RIC looks virtually identical to the open BTE and has similar features.

Levels of Technology
Most hearing aid manufacturers have similar technologies, and arrange those technologies in a hierarchy based on the patient’s activity level.

• Entry Level: This level technology is based on the mild activity level. Patients, who do not go out often or are not in many different listening environments, do well with this level of technology. This level has very reduced noise reduction capabilities as well as fewer channels for fine adjustment than the other levels.

• Mid Level: This level of technology is appropriate for most people who are in several listening environments throughout the day. This level is comparable to the state of the art 2-3 years ago. It has an adequate number of channels and noise reduction capabilities, compared to what is available in the higher end instruments.

• Advanced Level: This level of technology is appropriate for people who are very active throughout the day. It is the state of the art as far as features and technologies are concerned. These aids offer the best hearing experience in a variety of environments.

All of the hearing aids come with a 30 day trial period and a manufacturer’s warranty ranging from 1-2 years. ENT Specialists of FL also offers financing plans through Care-Credit specifically for hearing aids, and will file the paperwork for insurance coverage for hearing aids.

Originally from Massachusetts, Dr. Whitelaw worked with a large Ear, Nose and Throat practice in Providence, Rhode Island before relocating to Florida in 2004.

Professional Affiliates:
She is a member of the American Speech and Hearing Association (ASHA) and also served on the board of the Rhode Island Academy of Audiology.

Heather B. Whitelaw, AuD, CCC-A
Doctor of Audiology
Ear, Nose and Throat Specialists of FL
8800 Bernwood Parkway, Suite 6
Bonita Springs, FL 34135
(239) 676-2990

Dr. Py received his Associate in Arts degree from the Ft. Myers, Florida campus of Edison College in 2000. By 2003 he had received his Bachelor in Science degree focusing on communication disorders from Florida State University in Tallahassee, Florida. In 2007 he had achieved his Doctorate in Audiology from East Tennessee State University in Johnson City, TN. Dr. Py says about Audiology, “As soon as you have a grasp of how sound flows, and then how people hear it, hearing healthcare as a science also becomes art.” It is this creed with which Dr. Py approaches the discipline of Audiology.

In 2008 Dr. Py joined Ear, Nose and Throat Specialists of Florida working with all populations. Dr. Py considers himself not only a practitioner or a therapist but an artist. His expertise in the field of Audiology along with his love of music and technology brings exceptional care to his patients.

Dr. DeVore brings to the practice personal care, from diagnosing whether a child is experiencing a hearing loss, or interpreting hearing test results for adult patients and explaining the type of hearing loss the patient is experiencing. She counsels families and individuals about the issues of hearing loss, the impact it can have and the positive news about today’s solutions.

When it comes to finding the right hearing aid, Dr. DeVore bluntly says, “Size of the hearing aid is not the issue; it is the sophistication of the circuitry inside and the expertise of the audiologist that dispenses it.”
“It is hearing with a personal touch,” Dr. DeVore says. She will let patients choose what best fits their needs and what their budgets can tolerate.

Hobbies:
She and her Clydesdale “Eris” keep Lee County safe as part of the Sheriff’s office Mounted Patrol Unit.

Wanting to continue her pursuit of excellence in the field of audiology, she went on to receive her Master of Arts in Audiology and a Doctor of Audiology at the University of Pittsburgh.

It was at the University of Pittsburgh that she was offered the opportunity to teach medical students in Chengdu China about the use of hearing aids. This was an opportunity she simply could not pass up.

After her journey to China, she returned to Denver, Colorado to complete her residency at Denver Health Medical Center, ENT Division.

Dr. O’Neal has worked with all age groups, including implementing newborn hearing screenings. Her special interest is in evaluating and fitting all age groups of patients with hearing aids.

Dr. O’Neal is a fellow of the American Academy of Audiology and has been with ENT Specialists of Florida since early 2007.

• Comprehensive Audiometry: is a battery of tests to assess two aspects of hearing.
Sensitivity is the patient’s ability to hear soft sounds. The tests to measure sensitivity use words and pure tones presented to the patient through ear inserts and a bone vibrator that are connected to an audiometer
Speech Discrimination is the patient’s ability to tell the difference between speech sounds while listening to multiple words at a comfortable level. These are presented to the patient in the same manner as above.

• Tympanometry: is the measurement of how much sound is able to pass through the middle ear. A probe is placed in the ear, sealing it off from the environment. A subtle tone is presented in the ear and measured through a microphone in the probe. The air pressure is gently adjusted in the ear canal and the machine measures how much sound has made it through the middle ear based on the pressure. This test is very quick and painless, and is important in determining the health of the middle ear. If the eardrum does not pass very much sound due to middle ear fluid or the absence of an eardrum, some hearing loss may be present.

• Acoustic Reflex Testing: Measures the presence of a reflex of a middle ear muscle during a loud sound. This test is performed with the same equipment as tympanometry above. An airtight seal is formed with the gentle tone present in the ear. A somewhat loud tone is presented and the sensitive equipment measures the passage of sound. If it changes in response to the loud sound, an acoustic reflex is present. This test measures the health of the 7th and 8th cranial nerves.

• Otoacoustic Emissions Testing (OAE): Measures the presence of sounds in the inner ear that are a by- product of a healthy ear. This test is performed much in the same way as the above tests with a probe in the ear. Two tones are presented to the patient and a microphone in the probe records the expected presence of the sound per specific frequency. These tests are important in the evaluation of children and newborns as well as monitoring noise induced and medication induced hearing loss. If there is an OAE present, then the results rule out anything worse than a mild hearing loss.

• Auditory Brainstem Response (ABR): Measures electrical signals that occur in the brainstem while the patient hears moderately loud clicks. This test is performed with very sensitive equipment that is designed to measure the brainstem’s electrical activity as sound is sent to the brain. Electrodes are placed on the patient’s forehead and behind the ears and the test is performed in a quiet room. This test rules out a very specific type of hearing loss.

How We Hear
Hearing is the perception of sound waves in the environment. Sound waves are the mechanical movement of air particles. This movement occurs when a vibrator such as the speaker of a radio or a person’s vocal cords moves the air in the environment. Human ears are shaped to funnel and amplify this sound in to the ear canal and present it to the eardrum. The eardrum shakes in response to the sound waves, and sends the vibration through three bones in the middle ear called the malleus, incus and stapes. The stapes is attached to the oval window of the inner ear, and the sound is sent into the inner ear by the vibration of the stapes footplate. In the inner ear, sound now vibrates fluid and stimulates nervous tissue corresponding to the frequency of the sound. The nervous tissue then sends this sound to the brain in the form of electrical impulses.

How Hearing Loss Occurs:
Hearing loss is divided in to two categories based on its cause. Hearing loss may often be a mixture of the two types.
(1) Conductive hearing loss: Occurs when something interferes with the transmission of sound through the outer, middle or inner ear as described above. A conductive loss can be described as easily as sticking an earplug in your ear, which gives a mild hearing loss. Other causes for conductive hearing loss include fluid in the middle ear, otosclerosis, or a hole in the ear drum. Conductive hearing loss is often medically correctable, meaning that it may be repaired through surgical or other medical means. People with conductive hearing loss usually only lose sensitivity to soft sounds and retain the clarity of speech as long as it is loud enough.
(2) Sensorineural hearing loss: Occurs when there is no problem with the sound conduction, and the only cause for the hearing loss is damage to inner ear nervous tissue due to noise, medication or just the natural aging process. The sound is conducted as above through the outer and middle ear, but it is not carried to the brain as electrical impulse because there is damaged nervous tissue present. Sensorineural hearing loss is not able to be corrected surgically and relies upon generally making sound louder with a hearing aid or another assistive device in order to correct for the loss caused by this damage.