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"I almost wish there was some pain involved in noise levels," says audiologist Deborah Pitcher. "Instead, it's insidious."

People who are exposed to dangerous noise levels often suffer hearing loss and don't even know it is happening. "By the time the nerves are damaged, that's it," Pitcher says. "No medicine can cure it."

National surveys estimate the total number of hearing impaired in the United States is slightly more than 28 million people. The risk increases with age. The prevalence rate of hearing loss of those ages 45 to 64 is 14.1 per 100. For ages 75 and above, that rate goes up to 40.3 per 100.

Audiologists are highly trained professionals who deal with all aspects of hearing and hearing loss. They also evaluate and treat dizziness and test for auditory processing disorders.

Pitcher was one of three audiologists who founded Bloomington-Normal Audiology in 1990. "We were the first private practice group in Central Illinois," Pitcher says.

Setting up an audiology practice is expensive because of all the equipment involved. "Bankers were discouraging," Pitcher recalls. "One told us, ‘I don't see how you can make a living listening to peoples' hearing.' "

Pitcher smiles. "We're proud of the fact we started from there," she says.

Bloomington-Normal Audiology, 1404 Eastland Drive, now has four full-time audiologists. It has doubled the size of its physical space and added offices in Pontiac and Clinton.

As the baby-booming, first generation of rock ‘n' rollers begins to deal with hearing loss, demand for audiologists has gone up.

"We're going to have a shortage in this field," Pitcher says, adding a January issue of U.S. News and World Report listed audiology as No. 1 under the heading "best health care fields to consider."

Pitcher says she really enjoys what she does. "I get to deal with patients from birth to 100 years old," she says. "We get to work one-on-one with people and really learn what their lives are like."

"There are always surprises," she continues. "It's like putting pieces of a puzzle together."

Some of those puzzle pieces are brand new. The field of audiology is changing rapidly. "We're in flux right now," Pitcher says.

Technical advances in both evaluation and treatment require a sharp learning curve. "It used to be that audiologists had a master's degree and one year of clinical internship, plus national comprehensive exams," Pitcher says. "We're finding that training is no longer sufficient."

Universities around the country have begun to offer an advanced clinical degree called an Au.D.

"It's different than a Ph.D., which is of benefit for those wishing to do research or teaching," Pitcher explains. "An Au.D. is better for clinicians; it gives us a broader knowledge base to meet our clients' needs."

It's taken three years but Pitcher will complete her Au.D. this spring. "I've been doing this for 25 years," she says, "but there was so much to learn, such as brain mapping.

"It's been good at my age to punch the refresh button," she says.

The other audiologists at Bloomington-Normal Audiology are also in Au.D. programs.

Hearing aids no longer simply amplify sound. They are now fitted with a computer chip that, coupled with Bloomington-Normal Audiology's software, allows for an infinite variety of adjustments.

"Can't hear your granddaughter's voice?" Pitcher asks. "We can adjust for that."

"On your cell phone a lot?" Pitcher continues. "We can adjust for that, too."

Pitcher emphasizes adjusting to a hearing aid is a process. "Most people have waited an average of seven years to act on their hearing loss," she says. "Their world has gotten much softer."

Consequently, after donning a hearing aid, things may suddenly seem too loud. It often takes several calibrations to find the most appropriate settings on the hearing aid. After that, it takes some time for the patient's brain to adjust. Pitcher emphasizes the importance of seeking out the help of a trained audiologist. "We don't just sell someone a hearing aid," she explains. "They become part of our practice.

"Hearing aids are usually out-of-pocket expense," she says. "So be cautious."

Hearing aids range in price from $1,200 to $2,500. What hearing aid is best depends on the patient. "Not everyone needs all the whistles and bells," Pitcher says.

Pitcher wishes everyone would come in during their 50s for a baseline screening. She would use that opportunity to test and also to caution about noise conservation.

"Many people have hearing loss they have no control over because of cancer, diabetes, accident or genetics," Pitcher says. "But we do have control over noise exposure."

She says that farmers, musicians, police officers, firefighters, carpenters and anyone who works with power tools are at particular risk. "They should be using good earplugs, inserted properly," she says.

Bloomington-Normal Audiology sells a variety of custom-designed earplugs for specific uses. Some are custom-fitted to a patient's ear canal.

Pitcher works with a variety of industries to help with Occupational Safety and Health Administration requirements. She goes out, measures sound levels, tests employees and analyzes whether the businesses are in compliance.

Infant hearing tests is another area of Pitcher's expertise. In 1999, Illinois enacted legislation to detect and treat hearing loss in newborns and infants. Pitcher works with BroMenn Regional Medical Center to test babies and follow up when a problem is detected.

"This is an important milestone in our field," Pitcher says. "The earlier these things are caught, the better, in terms of the child's speech, language and learning."

At the other end of the age spectrum, Pitcher says she's seeing many more patients in their 90s. Some of the older patients, she says, are "drug in kicking and screaming" by their spouse (who may be tired of the TV turned up so loud) or an adult child weary of repeating sentences.

By contrast, baby boomers are showing up on their own, armed with lots of information and plenty of digital know-how. If something's wrong, however slight, they want it fixed. Whether these patients fall into Pitcher's category of young-old (age 60-plus) or oldest-old (age 85-plus), they will likely have one thing in common.

They took their hearing for granted until it was a problem.

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