Hearing Testing

Audiometry for all ages

including

Pediatric Sound Field Testing

and Cochlear Implant Evaluation

Tinnitus Assessment

Ringing in your ears?

We can diagnose and treat that!

Ear Wax Removal

Impacted earwax can diminish hearing

Newborn Hearing Screening

Auditory Brainstem Response (ABR) Screening

Hearing Aid Fitting

We fit based on your needs:

  • Severity of Hearing Loss

  • Lifestyle & Listening Needs

  • Budget & Benefits

Hearing Aid Programming

  • All major manufacturers

  • Real-Ear Measurements

Cochlear Implant Mapping

  • Cochlear Americas

  • Med El

  • Advanced Bionics (Coming Soon)

Hearing Aid Repair

  • Same-Day, In-Office

  • Manufacturer Warranty

  • Remakes & Custom Fits

Custom Earmolds and Earplugs

Custom-Fit Hearing Aids

Musicians' Earplugs

In-Ear Monitors

Balance Therapy

Treatment for

Benign Vertigo

Hearing Aid Accessories

Phone Connectivity

TV Accessories

Remote Microphones

And More!

Coming Soon

  • Videonystagmography (VNG)

hearing testing

Audiometric Evaluations for Hearing Loss

Doctors of Audiology have tools and clinical protocols to help evaluate and diagnose hearing loss.  A comprehensive audiological evaluation measures the patient’s overall hearing health. General hearing tests include:

  • Speech recognition test: A subjective measure of how well the patient hears and can repeat certain words. Sometimes called speech audiometry.

  • Speech-in-noise (SIN) test: A subjective test that is used for clinical diagnosis and measurement of functional capacity of the hearing system, providing clinicians with highly valuable information of how patients perform in real world listening conditions.

  • Pure tone audiogram: A subjective test that measures the patient’s hearing across multiple frequencies (measured in Hertz or Hz) and volumes (measured in decibels of dB).

  • Tympanogram: An objective test that measures the functioning of the middle ear, specifically the mobility of the tympanic membrane and the conduction bones.

  • Acoustic reflex testing: An objective test that measures the contraction of the middle ear muscles in response to loud sounds.

  • Otoacoustic emission testing: The use of very sensitive microphones to objectively measure the movement of hair cells within the middle ear.

*All of our test equipment is calibrated annually to comply with The American National Standard (ANSI S3.1--1999) and OSHA Noise Standard.

 
tinnitus assessment

Audiometric Evaluations for Tinnitus

Trained audiologists have tools and clinical protocols to help evaluate and diagnose tinnitus.  Because tinnitus is so often caused by hearing loss, most audiologists will begin with a comprehensive audiological evaluation that measures the patient’s overall hearing health. General hearing tests include:

  • Speech recognition test: A subjective measure of how well the patient hears and can repeat certain words. Sometimes called speech audiometry.

  • Pure tone audiogram: A subjective test that measures the patient’s hearing across multiple frequencies (measured in Hertz or Hz) and volumes (measured in decibels of dB).

  • Tympanogram: An objective test that measures the functioning of the middle ear, specifically the mobility of the tympanic membrane and the conduction bones.

  • Acoustic reflex testing: An objective test that measures the contraction of the middle ear muscles in response to loud sounds.

  • Otoacoustic emission testing: The use of very sensitive microphones to objectively measure the movement of hair cells within the middle ear.

 

It is important to determine the specific gaps in a tinnitus patient’s hearing, because this often correlates to the nature and quality of their particular tinnitus. (For instance, high-frequency hearing loss often corresponds with high-frequency tinnitus.) Moreover, specific hearing markers may inform different potential treatment options for tinnitus.

Tinnitus Assessments

While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test:

  • Tinnitus sound matching: The presentation of common tinnitus sounds back to patients, to help them identify their specific perception of tinnitus. The audiologist may adjust the pitch and layer multiple sounds to create an exact audio recreation of the the tinnitus.  Sound matching provides an important baseline for subsequent tinnitus management therapies, which are often customized for each patient.

  • Minimum masking level: The volume at which an external narrowband noise masks (or covers) the perception of tinnitus. Determining the minimum masking level provides an approximate measure of how loud a patient perceives his/her tinnitus and can be used in subsequent tinnitus masking and sound therapies.

  • Loudness discomfort level: The volume at which external sound becomes uncomfortable or painful for a tinnitus patient. This measurement informs the feasibility of sound therapy, masking, and hearing aids as potential tinnitus treatments. Determining loudness discomfort levels is particularly important for patients with hyperacusis, an extreme sensitivity to noise.

 
Ear Wax Removal

What's the deal with ear wax?

Ear wax, also known as cerumen, is not only normal, it’s necessary. Ear wax has both anti-fungal and anti-bacterial properties. It protects the tympanic member (aka - the ear drum) from harmful substances such as dust, hair or small insects.

Some factors that can affect your amount of ear wax include:

It’s all about balance — too much wax can block your ears and cause temporary hearing loss or infections. 

When to see a doctor about a clogged ear:

Generally, ear wax is more annoying than dangerous, but sometimes you need a doctor to clear it. If home remedies don’t work, your ear hurts or you have trouble hearing, it's time to a seek medical evaluation. The audiologist can use special lighted microscopes to magnify inside the ear canal, loosen the wax, and remove it with tools specifically designed for patient comfort.

A clogged ear may have other causes, such as: middle ear infection with fluid filling up the space behind the eardrum; or a viral infection that affects the inner ear. In those cases, a doctor can diagnose and treat you to prevent permanent hearing loss.

Things to Avoid:

  1. Cotton Swabs - Dr. Pratesi says "Q-tips should only be used for arts and crafts!" A cotton swab acts like a ramrod in an old-style cannon, packing wax deeper into the ear canal. Push too far and you may rupture your ear drum. The skin in the ear canal is paper-thin. So even something soft like cotton can abrade the skin. Scratches in the ear canal can get infected because of dirt and bacteria.

  2. Ear Candles - These candles don’t work, AND they may cause burns.

 
 
Newborn Hearing Screening

Because of the need for prompt identification of and intervention for childhood hearing loss, universal newborn hearing screening programs currently operate in all U.S. states and most U.S. territories. With help from the federal government, every state has established an Early Hearing Detection and Intervention program. As a result, more than 96 percent of babies have their hearing screened within 1 month of birth.

Why is it important to have my baby’s hearing screened early?

The most important time for a child to learn language is in the first 3 years of life, when the brain is developing and maturing. In fact, children begin learning speech and language in the first 6 months of life. Research suggests that children with hearing loss who get help early develop better language skills than those who don’t.

When will my baby’s hearing be screened?

Your baby’s hearing should be screened before he or she leaves the hospital or birthing center. If your baby’s hearing was not tested within the first month of life, or if you haven’t been told the results of the hearing screening, ask your child’s doctor today. Quick action will be important if the screening shows a possible problem.

How will my baby’s hearing be screened?

A newborn undergoes a hearing screening.

Two different tests are used to screen for hearing loss in babies. Your baby can rest or sleep during both tests.

  • Otoacoustic emissions (OAE) test whether some parts of the ear respond to sound. During this test, a soft earphone is inserted into your baby’s ear canal. It plays sounds and measures an "echo" response that occurs in ears with normal hearing. If there is no echo, your baby might have hearing loss.

  • The auditory brain stem response (ABR) tests how the auditory nerve and brain stem (which carry sound from the ear to the brain) respond to sound. During this test, your baby wears small earphones and has electrodes painlessly placed on his or her head. The electrodes adhere and come off like stickers, and should not cause discomfort.

Hearing Aid Fitting

What's the best hearing aid?

Hearing aids come in many different shapes and sizes. Certain types of hearing aids are better for certain types of hearing losses. There is no "best" hearing aid, but there may be a specific style or brand that will work better for a particular patient, based on their hearing loss and listening needs. At Citrus Hearing Clinic, we work with all the major hearing aid manufacturers, because they all have different styles or features at which they may excel. Regardless of who makes it, we want our patients to have the option to get the "best hearing aid on the market" for their specific situation. Technology is always changing, and it's a lot to keep up with, but that's why audiologists go to school for such a long time! They are the experts, so you don't have to be. 

Our process is to perform a communications needs assessment. That includes comprehensive, diagnostic audiological evaluations to determine: type, degree and severity of hearing loss. We also perform speech-in-noise testing, to get a measure for how our patients perform in real world listening situations. That data, combined with patient case history questions, allows us to determine what are our patient's listening goals, and how we can best help our patients achieve their desired outcomes. Our job is not just to sell hearing aids, it's to rehabilitate and treat hearing loss from a medical perspective.

We want our patients to feel empowered and confident that they are making the best, most well-informed decisions about their hearing and balance healthcare possible!

What can I expect in a hearing aid fitting appointment?

Fitting appointments are when we program and calibrate hearing aids to a patient's hearing loss prescription. It's typically an hour long appointment where we teach patients how to use their devices, clean them, change/charge the batteries, practice taking them in and out, discuss good listening/communication strategies etc. We encourage family members or loved ones to participate in these appointment types. 

 
Hearing Aid Programming

We perform Real-Ear Measurements!

Audibility (the ability to hear speech clearly) is the goal of hearing aid fittings. So why do so many hearing aids "not work" and end up in the drawer?

What is Real-Ear Measurement?

Real-ear measurements are the "secret ingredient" in the recipe that leads to successful hearing aid fittings! Real-ear Measurements should be included as part of the initial hearing aid fitting. What are real-ear measurements? Real-ear measurements (also known as probe microphone measurements) is the gold standard used to determine whether or not a hearing aid user is receiving the precise level of amplification needed at every frequency in order to achieve the best hearing improvement possible. Depending on the type, degree and severity of the hearing loss, 100% improvement is not always possible, but the goal is to maximize the benefit to get as close to 100% as possible.

How does Real-Ear Measurement work?

During real-ear measurements, a thin probe microphone is placed into the ear canal alongside the hearing aid. The audiologist obtains readings of the exact sound levels the user is receiving from the hearing aid while listening to various recorded speech samples. The audiologist can then precisely adjust the sound levels to match target amplification levels based on the hearing aid user’s hearing loss across the speech frequency spectrum.   

Performing verification during the initial fitting process helps ensure that the user is receiving the correct level of amplification - not too much where everything is too loud (overamplified), and not too little where the user has significant trouble understanding speech even with the hearing aids on (underamplified). Everything is "just right"!

Does Your Provider Follow Best Practice Guidelines?

A recent survey performed by the Hearing Review indicated that only about 34% of hearing healthcare providers surveyed across the United States are performing real-ear measurements. Hearing aid fittings using real-ear measurements resulted in superior outcomes and improved aided benefit both in quiet and in noise. Every patient deserves to have their provider follow best practices and provide them with quality healthcare. We are proud to say that Citrus Hearing Clinic provides evidenced-based care to bring you the best hearing results from hearing aids that work!

 
Cochlear Implant Mapping

What is Mapping?

Mapping (or MAPping) is the term for programming a cochlear implant to the specifications and needs of its user.

MAPs are programs that optimize the cochlear implant (CI) user’s access to sound. They do this by adjusting the input to the electrodes on the array that is implanted into the cochlea (organ for hearing). All three FDA-approved CI brands essentially have similar capacities for various MAPs on their processors, although they may use different terminologies and programming strategies. Dr. Pratesi works with all three FDA-approved CI brands: Advanced Bionics, Cochlear Americas and MED EL.

What happens in a Mapping session?

The audiologist will connect the cochlear implant processor to the computer. The audiologist sets T- and C- levels for each electrode, by using a series of “beeps,” and measuring the CI user’s response (in a way, it's kind of like performing a hearing test through the cochlear implant). T-Levels (aka Thresholds) are the softest sounds a person can detect.  C-Levels (aka M-Levels or Comfortable levels) are loudness levels that are tolerable for the patient.  

The audiologist may also make changes to the stimulation rate or programming strategy in the MAP — these are various computer algorithms that convert acoustic sound (how people naturally perceive sound) into electrical pulses that stimulate the hearing nerve and deliver sound to the hearing center of the brain.

When does a patient need a Mapping session?

Mapping is key to optimizing performance with a cochlear implant.  Most centers have a standardized protocol for the initial activation and follow-up appointments.  Over time, MAPs  stabilize and audiology appointments may become less frequent.  Indicators that a patient might need a new MAP include:

  • Complaints of things sounding too quiet, distorted, or unclear

  • Changes in listening performance (missing quiet phonemes like s, th, f, etc., increased difficulty listening in noise or challenging listening situations)

  • Major changes in health, or in medications (patients with chronic health conditions such as Diabetes, or patients undergoing chemotherapy may need to have their MAPs checked more frequently)

  • Changes in speech production (sounding slushy, having sloppy speech, changes in sounds previously achieved)

  • Growth spurts or hormonal changes (examples: puberty or menopause, patients undergoing fertility treatments)

  • As the CI user’s listening skills grow, he/she may be ready for more “power” in a MAP, and might need an adjustment

 
Hearing Aid Repair

 Hearing Aids not working?

We work with all major hearing aid manufacturers for in and out of warranty repairs, and utilize All-Make Facilities for devices that are no longer in production. Regardless of make or model, we can discuss solutions. Schedule an appointment for a consultation, to find out about your options. 

Have trouble functioning without your hearing aid? We have loaner devices*!

*Subject to availability. Programming fees may apply.

 
Custom Earmolds and Earplugs

What are custom earmolds?

Custom earmolds can include: earplugs for noise reduction, sleep plugs, swim plugs, musician's plugs, in-ear monitors, Bluetooth streaming devices, molds for hearing aids, etc! 

Why do I need custom earmolds?

Ears come in different shapes and sizes. One size doesn't fit all! Do you find Air Pod Pros fall out? Over-the-counter earplugs don't stay in? Over the ear heaphones are too hot or tight to wear for long periods of time? Custom ear molds can help! It's form fitted for your ear shape. This improves comfort and reduces issues like sound leakage or feedback.

 
Balance Therapy

What is benign positional vertigo (BPV)?

Benign positional vertigo (BPV) is the most common cause of vertigo. It causes a sudden sensation of spinning (like riding the Mad Hatter's Tea Cups at Disney World).

You can have episodes of mild or intense dizziness if you have BPV. Changing head position can trigger an episode. Actions that can trigger BPV include:

  • tilting your head up or down

  • lying down

  • turning over

  • getting up

The biggest risk factor of BPV is the dizziness can cause someone to fall.

 

What causes benign positional vertigo?

BPV is an inner ear disorder. The semicircular canals (one of the inner ear organs for balance) are sensitive, fluid filled organs. This fluid moves in response to changes in your body’s position. 

Small crystals of calcium carbonate (called "otoliths") float in portions of the inner ear called the utricle and saccule. These "rocks in the head" can sometimes break free and mistakenly enter the semicircular canals. This causes your brain to receive confusing messages about how your body is oriented in space.

 

Who is at risk for benign positional vertigo?

Many people who experience BPV also have relatives who have the condition.

There are other risk factors that can make some people more prone to developing BPV. These include:

 

What are the symptoms of benign positional vertigo?

The symptoms of BPV can include:

Symptoms of BPV can come and go. Episodes are typically short in duration, lasting less than a few minutes.

A variety of activities can bring on BPV (examples: whiplash, yoga, dental work, chiropractic work, swimming, sleeping in a new bed, or any activity where you may had your head and neck at a distended or odd angle for a period of time). Symptoms usually occur when there’s a sudden change in your head’s positioning. Abnormal eye movements (called nystagmus) usually accompany symptoms of BPV. Having BPV in both ears in extremely rare, but can happen.

 

How is benign positional vertigo diagnosed?

BPV is diagnosed by performing a maneuver called the Dix-Hallpike test. Your doctor will hold your head in a certain position while laying you in different directions. They’ll look for nystagmus (abnormal eye movements) during this test.

Your doctor will also get a complete medical history to rule out any other disorders or diseases.

Additional tests might include:

  • a hearing evaluation

  • tympanometry/fistula test, which involves pressure to check ear drum movement

  • Romberg test, which tests postural stability

  • Fukuda Stepping Test, patient marches in place with eyes closed

 

Other recommended tests may include:

What are the treatments for benign positional vertigo?

A variety of treatments are available to help treat BPV. These include:

  • Epley’s maneuver - Some doctors consider the Epley maneuver the most effective treatment for BPV. It’s a simple exercise that doesn’t require any equipment. It involves tilting your head in order to move the piece of calcium carbonate to a different part of your inner ear. 

  • Home treatment Be aware of your surroundings and avoid placing yourself at risk. Losing your balance is always a possibility. Falls can lead to serious injuries. Sit down whenever you feel dizzy. Take precautions such as having good lighting and using a cane or walker for stability. Avoid movements that trigger your episodes. 

  • Medication* Your doctor may prescribe medications to relieve spinning sensations. These may include:1) sedative-hypnotics, or sleeping aids, 2) anticholinergics, which work by blocking the neurotransmitter acetylcholine, 3) antihistamines, 4) anti-nausea medications, 5) anti-anxiety medications

*Medications are often not effective in treating vertigo.

 
Hearing Aid Accessories

What do you do when Hearing Aids are not enough? 

Most hearing aid manufacturers have developed a wide range of wireless accessories to boost the performance of your hearing aids and keep you connected.

In what situations do you still struggle to hear clearly? The TV? On the phone? In background noise? There's an app (or accessory) for that! TV streamer, remote microphones, FM systems, phone clips - are all designed to help improve signal to noise ratio and help you get the most out of your devices.

Not a hearing aid user? No worries! Assistive Listening Devices (ALDs) are designed to help improve your listening experience as well. TV Ears, Pocket Talkers, Shake Awake, Neck Loops, are all inexpensive ways to connect, in the way you need!

Using a landline? We work with multiple companies to get FREE captioned or amplified telephones into the hands of the people who would most benefit. All you need is a recent hearing test, performed by an Audiologist, and we can help! How does it work? We all pay for service charges on our phones. The federal government uses this money to pay for captioning services for the d/Deaf and Hard of Hearing.

 
Coming Soon

More information coming soon!