The Basics
The outer ear funnels sound to the eardrum, whose vibrations pass through the tiny bones of the middle ear — the malleus, incus, and stapes. The Eustachian tube equalizes pressure in this space.
Those vibrations travel into the fluid-filled cochlea, where tiny hair cells convert movement into nerve impulses the brain interprets as sound. The inner ear also houses the vestibular system, which governs balance and coordination.
Diagnostics
Your audiogram maps the quietest sounds you can hear across pitch (Hz) and volume (dB). Red marks the right ear, blue the left; air conduction is tested with headphones and bone conduction with a device behind the ear. We also measure word recognition — how clearly you understand speech in quiet.
The audiogram is a picture of your hearing. Pitch (frequency, in Hz) runs left to right — low to high, like keys on a piano — while volume (in dB) runs top to bottom, quiet to loud. Anything better than 20 dB HL is considered normal; greater levels indicate some degree of hearing loss.
Red symbols map the right ear and blue the left. Circles and X's mark air conduction (through headphones); brackets mark bone conduction (through a device behind the ear). Your word-recognition score shows the percentage of words you understand clearly in quiet.
Most common · often permanent
Damage to the inner ear or hearing nerve. Common causes include aging, genetics, noise exposure, and ototoxic medications. Hearing aids or other amplification often help.
Often treatable
A problem in the outer or middle ear blocks sound from reaching the inner ear — middle-ear fluid, a perforated eardrum, earwax, infection, or Eustachian tube dysfunction. Often correctable with medication or surgery.
Combination
A conductive hearing loss layered on an underlying sensorineural loss. The conductive part may be correctable, while the sensorineural component is permanent.
Determines the type and degree of hearing loss so your doctor can plan appropriate treatment.
Many causes of ringing in the ears connect to hearing — we check for underlying concerns first.
Pressure and fullness can stem from many conditions; the test helps pinpoint the cause.
The inner ear governs both hearing and balance, so the two are closely linked.
Amplification
From consultation to fitting to lifelong follow-up, we guide every step — and verify every device with Real-Ear Measurement.
Manufacturers we work with
We have no agreements, affiliations, or incentives with any manufacturer to sell their products — our recommendations are based solely on what's best for your hearing.
A ~1-hour visit covering your hearing history and needs, with a hands-on listening experience. Bring a spouse or family member for added insight.
Your audiologist helps you choose the right hearing aids from manufacturers including ReSound, Oticon, Phonak, Widex, and Starkey.
Devices are programmed to your exact hearing loss and verified with Real-Ear Measurement, with a 45-day adjustment period.
Your hearing aid prescription includes either 1 or 3 years of office visits to maintain your devices and adjust the prescription as your hearing changes. We provide all follow-up care — even for aids purchased elsewhere.
The Gold Standard
Every ear canal is a different shape and size, so the same hearing aid delivers different sound in different ears. Real-Ear Measurement (REM) places a tiny probe microphone in your ear canal to measure exactly what the device is producing at your eardrum — not an estimate, but your real, individual output.
We use that measurement to match your hearing aids to research-based prescription formulas like NAL-NL2 and DSL v5 — validated targets that specify precisely how much amplification you need at each pitch. REM-verified fittings can improve speech understanding and patient satisfaction over fittings tuned by ear alone.
Featured Style
RIC / RITE
The speaker sits in your ear canal; the microphone and processor rest behind the ear. The workhorse style — durable, rechargeable, and easy to live with, because the speaker can be replaced here in the office rather than sent away for repair.
Featured Style
Ready-fit completely-in-canal
A pre-made deep-canal device fit with a soft sleeve instead of a custom impression — which means it can often be fit the same day. Discreet without giving up modern processing.
IIC
The smallest style made. It sits deep in the canal and is practically invisible — the trade is tiny batteries that need frequent changing and fewer features.
CIC
The second-smallest style, custom-molded to your ear. Its position in the canal helps with wind noise and feedback, though small batteries and wax exposure ask a little more upkeep of you.
ITC / half shell
A custom style with room for controls you can actually feel — volume and program buttons on the device itself — plus longer battery life, with rechargeable and phone-connected options.
ITE / full shell
The largest custom style, filling the bowl of the ear. Easiest to handle and insert, with the most room for features and the longest battery life — at the cost of some discretion.
BTE
The full device rests behind the ear and connects to a custom earmold. The most powerful and most durable style — often the right answer when hearing loss is significant or handling small parts is hard.
Lithium-ion batteries hold up to 30 hours of charge — convenient and great for dexterity concerns.
Stream calls directly to your hearing aids and adjust volume or programs from an app.
Picks up induction-loop signals for clearer sound in noisy public spaces.
Remote microphones and TV connectors stream sound straight to your hearing aids.
Single-Sided Hearing
When one ear has hearing that can't be helped by a standard hearing aid — often called single-sided deafness — sound arriving from that side is easy to miss. CROS and BiCROS systems restore awareness of your weaker side by wirelessly routing its sound over to your better-hearing ear, with no surgery involved.
How it works
A discreet device worn on your poorer ear picks up sound and streams it wirelessly to a device on your better ear — so speech and sounds from your weaker side reach an ear that can actually use them.
CROS for a normal-hearing better ear
Contralateral Routing of Signal. Sound from your poorer ear is sent across to your good ear, which hears normally and needs no amplification of its own.
BiCROS for a better ear that also needs help
Bilateral CROS. Sound from your poorer ear is routed across and your better ear is amplified for its own hearing loss — one system doing both jobs at once.
What to expect
A non-surgical alternative to a bone-anchored implant — worth comparing side by side with your audiologist.
Ask about CROS / BiCROSClinic vs. Over-the-Counter
OTC and big-box hearing aids can seem convenient, but hearing is medical. Here's what doctor-led care gives you that a retail shelf can't.
Doctor-led, personalized care
Off-the-shelf, self-guided
Ringing in the Ears
Tinnitus — ringing, hissing, roaring, or whooshing when no sound is present — affects 10–15% of Americans. It's a symptom, not a disease, and is often tied to hearing loss, noise exposure, medications, stress, or earwax.
The most effective approach treats the underlying cause; when the cause is unknown, tinnitus can still be managed effectively.
Recommended apps
Beyond Hearing Aids
For individuals who no longer benefit from hearing aids, a surgically implanted electrode directly stimulates the hearing nerve. The journey includes a candidacy evaluation, an outpatient surgery (~2–3 hours), activation 3–4 weeks later, and ongoing programming and rehabilitation with your audiologist.
For conductive or mixed hearing loss or single-sided deafness, the device converts sound into vibrations that travel through the skull to the inner ear. A simple outpatient implant, with processor fitting one to three months after surgery.
Manufacturers we work with
Prevention
Sounds below 70 dBA are generally safe; above 85 dBA can damage hearing depending on exposure time. For every 3 dBA over 85, safe listening time is cut in half.
Use earplugs or earmuffs with a high Noise Reduction Rating (NRR). Custom earplugs from an audiologist ensure proper fit.
Keep device volume at or below 50%.
Take breaks from noise and move away from loud sources when you can.
Check noise ratings on appliances, tools, and equipment.
Filtered plugs that reduce volume evenly across frequencies to preserve sound quality. Choose 10, 17, or 26 dB attenuation.
Maximum attenuation for high-noise occupational or recreational settings.
A semipermeable vent lets sound through while keeping water out — helping prevent surfer's ear.
Floatable material keeps water out — ideal for recurrent ear infections, perforations, or ear tubes.
FAQ
No. Hearing aids programmed to your prescription and verified with real-ear measurement have output limits that keep sound within safe levels. The world may seem sharp at first while your brain re-adapts — that settles with steady wear.
Over-the-counter hearing aids are devices you set up yourself, and for some adults with milder loss they're a reasonable place to start. A prescription fitting is different: it's programmed to your measured hearing and verified in your ear canal with real-ear measurement. If you're weighing the two, we'll walk you through the trade-offs honestly — including when trying OTC first makes sense.
Because the speaker sits separately from the body of the device. That makes maintenance and repairs simpler, and it means the speaker can be upgraded on its own if your hearing declines — without replacing the whole hearing aid. Smaller is a trade, not an upgrade. We'll walk through which style fits your hearing, your hands, and your habits.
There isn't one. The major manufacturers all make good instruments with similar styles and features, and sound preference varies from person to person. What matters more is the fitting: whatever the brand, we verify it against your prescription with real-ear measurement.
Often, yes. Tinnitus tends to be loudest when hearing loss leaves it nothing to compete with, so bringing back the sounds you've been missing can make the ringing much less noticeable. Some hearing aids can also add quiet background sound that helps. Relief varies from person to person — we'll be honest with you about what to expect.
Schedule a comprehensive hearing evaluation with our audiology team in Carlsbad.
