hearing test for children from Art of Hearing

1. Health & Hearing
Hearing Health
Do you have hearing loss?
1-minute self assessment test
Hearing Technology
How much do hearing aids cost?
A guide to the range of financial assistance that is available
“Nothing like the old days!”
Virtually invisible and Bluetooth enabled
Hearing Science
Importance of early intervention in the
treatment of hearing loss

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3. > Forward Contents
Dear Reader,
Thank you for taking the time to request and read through our magazine, Health
& Hearing.
For many of you, this may be a your first step towards addressing hearing loss or
that of a loved one. In this magazine, we hope to enlighten you about hearing,
hearing conditions and modern solutions.
Although there are many causes for hearing loss, the incidence of the condition
grows steadily as people age. While 30% of adults will be showing signs of
the condition by the age of 50-years, this will rise to 70% of the population by
70-years of age. Hearing loss affects lives, lifestyles, relationships, and often
leads to feelings of isolation.
Studies have shown that when not managed, the condition reduces the
effectiveness of people in the workplace and led to decreased household
income. Even more importantly, people who address their hearing loss earlier
reported feeling younger, more confident, and eager to once again enjoy the
social situations that had become tedious. These findings are consistent with
the experiences of the hundreds of clients who I have helped over the years to
achieve better hearing and a better quality of life.
But as you will read in Health & Hearing, there is some great news for Australians
too. Our government recognises the impact that hearing loss has on both its
citizens’ lives and the national economy. Subsequently, they provide pensioners
and veterans with access to free digital hearing aids. Assistance is available
to all people with hearing loss through tax rebates, health insurance, and
compensation for hearing loss that has developed as a result of exposure to noise
in the workplace.
Who are The Art of Hearing?
Australians are often shocked to learn that most hearing clinics are actually
owned by hearing aid manufacturers or global retail chains – and thus are really
just well disguised vehicles for pushing their own range of hearing aids. In
contrast, The Art of Hearing is proudly independent. My staff and I will find you
the best treatments from the full range of available solutions, including tinnitus
management, rehabilitation, counseling, and hearing aids from all leading
manufacturers.
We are accredited to provide free hearing aids to pensioners and veterans under
the Australian Government Hearing Services Program*.
We are here to help you at every step of the way and find a solution that works for
you. If you have any questions, or
would like to arrange a hearing test or
trial of the latest digital hearing aids,
please don’t hesitate to call.
How the ear works.............................................................. 4
Understand how the ear works and
processes sound
Hearing Loss...........................................................................5
We all know somebody affected by
hearing loss
Tinnitus..................................................................................... 8
This buzzing in my ears is driving me mad!
“I’m too young for hearing aids”.............................. 10
The importance of addressing hearing loss
early – a scientific perspective
Hearing Loss & Dementia..............................................11
New study find links between untreated hearing loss and
dementia
Hearing tests....................................................................... 12
This story explains common types of hearing tests and
how to interpret the results
Reading your Audiogram.............................................. 14
Results of the air conduction and bone
conduction hearing tests
Hearing Aids.........................................................................17
“Nothing like the old days”
Cochlear Implants............................................................ 21
How they can help
How much do hearing aids cost?.............................22
A common question
References
would like to acknowledge
the following sources in the
development of this magazine:
Health & Hearing page 3
Best regards,
Ravi Gupta
Owner and Audiologist
The Art of Hearing
* Condtions apply under the OHS Voucher Scheme Health & Hearing
© - Spinach Effect Pty Ltd
PO Box 2019, Glenelg SA 5045, Australia
Ph: (08) 8294 7928 www.spinacheffect.com.au
Owner and Audiologist
Listen Hear! – The economic impact and cost of hearing loss in Australia, Access
Economics 2006
Cochlear Ltd – www.cochlear.com
Office of Hearing Services – http://www.health.gov.au/hear
Spinach Effect – www.spinacheffect.com.au
The Impact of Untreated Hearing Loss on Household Income – Sergei Kochkin, Ph.D.
August 2005
Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman A, Ferrucci L. Hearing loss and
incident dementia. Arch. Neurol. 2011; In press.
Hearing in South Australia: Disability, Impairment and Quality-of-life, Wilson DH (1997)
Late-onset auditory deprivation: Effects of monaural vs binaural hearing aids. Silman,
Gelfand, Silverman. (1984)
Leading manufacturers
GN Resound – www.gnresound.com.au
Unitron – www.unitron.com.au
Other suppliers
Oticon – www.oticon.com.au
Bernafon – www.bernafon.com.au
Phonak – www.phonak.com.au
Siemens - hearing.siemens.com/au/
Other links
Australian Tinnitus Association - http://www.tinnitus.asn.au/tinnitus.htm
Ravi

4. > The Ear
How the ear works
In order to better
understand
hearing loss and
what can be done,
it is first important
to understand how
the ear works and
processes sound.
Outer Ear
Sound first enters our ear at the Pinna, which is the visible part of
the ear on the outside of our head. The Pinna is designed to collect
sound waves and funnel them down the Ear canal towards the
Tympanic membrane (eardrum). Together the Pinna and Ear canal are
referred to as the outer ear.
Middle Ear
The middle ear starts with the Tympanic membrane. As sound
waves travelling down the Ear canal reach the Tympanic membrane,
it vibrates like a drum. Behind the eardrum is an air-filled space
containing three tiny bones, the smallest bones found anywhere in
the human body. The vibrations in turn cause these bones to vibrate.
The Middle Ear consists of the eardrum these tiny bones (Malleus,
Incus and Stap-es) and the air pocket in which they reside.
Inner Ear
The cochlea and the semi-circular canals are our organ of both
hearing and our sense of balance. The cochlea, semi-circular canals
and the cochlear nerve (auditory nerve) comprise the parts of the
Inner Ear. Sound passes to the Inner Ear via the vibrations of the
Middle Ear bones, which are connected to the Cochlea at one end.
Outer Ear
Thousands of tiny sensory hair cells within the Cochlea convert
the vibrations into an electro-chemical signal that’s carried by
the auditory nerve to the brain, where sound is processed and
interpreted.
Electron Microscope image of healthy hair receptors
page 4 Health & Hearing

5. Hearing Loss
We all know somebody affected
by hearing loss, as nearly
1 in 5 Australians live with
the condition. Hearing loss
progresses over time and
it is best to recognise the
signs early.
Quality of life can be significantly
compromised for people with
hearing loss and their families. The
extent of the hearing loss varies too,
from a mild to a severe hearing loss
where loud safety signals may not be
heard. More commonly it is manifested
as a difficulty with word understanding,
particularly in the presence of
background noise.
Health & Hearing page 5

6. Your Hearing
Self Assessment
Hearing Test
1. I feel discomfort or embarrassment when
meeting new people because of my
hearing
o Never o Sometimes o Often
2. I find that following conversations in
a noisy environment, such as a busy
restaurant, can be very difficult
o Never o Sometimes o Often
3. People seem to mumble more these days
when they talk, and find myself asking
them to repeat themselves more often
than I used to
o Never o Sometimes o Often
4. Others comment that I have the radio or
television turned up too loud for their
liking
o Never o Sometimes o Often
5. If I did not see the source of a sound,
I find it hard to know what direction it
came from
o Never o Sometimes o Often
6. Family members have commented that
they think that I may have a hearing
problem – and they become frustrated
when I’ve not fully heard what they have
said
o Never o Sometimes o Often
7. Following conversations on the telephone
is particularly difficult, particularly with
children
o Never o Sometimes o Often
8. I used to be more active in group
conversations. (E.g. dinner table)
o Never o Sometimes o Often
9. I mishear what people have said and
respond inappropriately
o Never o Sometimes o Often
10. Sometimes I experience a persistent or
prolonged ‘ringing in my ears’ (known as
tinnitus)
o Never o Sometimes o Often
Adding up your score
Never = 0
Sometimes = 1
Often = 2
If your total score is more than 5, then your
life is very likely to be affected by hearing
loss and we would recommend a hearing
assessment. If your score is more than 10,
then there is little doubt that your life would
be significantly improved by addressing
your hearing loss and adopting a hearing
solution.
Signs of
hearing loss
In contradiction to many people’s
understanding, hearing loss is rarely
similar to the effect of turning down
the volume on a stereo. It usually
affects different frequencies of sound
by varying amounts. This can lead to
conversations being difficult to follow
– particularly in noisy environments
where competing background noise
“scrambles” speech and conversations.
Not surprisingly, being able to follow
conversations is the single biggest
reason that people seek our help.
If you feel that your hearing is not what
it used to be, or are concerned that a
loved one may be experiencing hearing
loss – take a couple of minutes to do
the short self-assessment test provided
here.
Types of
hearing loss
There are three forms of hearing loss,
Conductive, Sensorineural and Mixed
hearing Loss.
Conductive
Hearing Loss
Conductive hearing loss results from
a problem with the passage of sound
through the outer ear and/or middle ear.
Some common examples include:-
• Excessive cerumen (earwax) in the ear
canal
• Perforation of the eardrum
• Middle ear infection with fluid
build-up
However, conductive loss accounts for
only 10% of all hearing losses, and they
range from mild to moderate in severity.
The good news is that conductive
hearing loss can often be medically
treated. In many cases hearing can be
completely restored.
page 6 Health & Hearing
• Turning up the volume on the
TV or radio
• Asking people to repeat what
they’ve said
• Hearing in one ear better than
the other
When volume is sufficiently
increased, clarity and
understanding are usually intact
for someone with a conductive
hearing loss. Other symptoms
may also be present, such as ear
pain, drainage from the ears, or a
feeling of pressure or a blockage.
Sensorineura l
Hearing Loss
Hearing loss that originates
in the inner ear is referred to
as sensorineural hearing loss
or, in laymens’ terms, “nerve
deafness”.
The vast majority of hearing
losses are sensioneural losses,
and common causes include: -
• Genetic factors (i.e. hearing
loss can run in families)
• Excessive noise exposure -
either sudden or prolonged
• Changes in the inner ear due to
ageing
Less common causes include: -
• Reactions to ear-toxic
medications
• Auditory nerve tumours
• Conditions acquired prior to
birth (congenital)
• Infections such as meningitis
and mumps
• Kidney disease
• Vascular disease
Each cause can lead to damage
to the sensory hair cells or
nerves. Once damaged, the hair
cells can’t repair themselves nor
be medically treated. Therefore,
90% of hearing losses cannot be
cured.
A sensorineural hearing loss
can be of any degree – mild,
moderate, severe or profound.
In more than 95% of cases
involving sensorineural hearing
loss, hearing aids or cochlear
implants are the recommended
course of treatment.
Symptoms of
Conductive
Hearing Loss
With conductive hearing loss, the overall
volume of sound is reduced.
Signs of conductive hearing loss may
include:-

7. Why can I hear low
pitched sounds
better than high
frequency sounds?
Nerves have different sensitivities
to deformation of the sensory hair
cells within the cochlea. A sound that
has high frequencies of vibration
will excite receptor cells near the
opening of the cochlea, while a sound
mostly containing low frequencies
will stimulate cells at the end of the
cochlea.
Over time the high frequency hair cell
receptors receive more movement
by the incoming pressure waves of
the fluid inside the cochlea. For this
reason, high frequency receptors are
more prone to long term damage than
the low frequency hair cell receptors,
which are more protected further up
the cochlea.
Health & Hearing page 7
Symptoms of
Sensorineura l
Hearing Loss
While the overall volume of sound
may be reduced, the clarity of sounds
or voices is also affected. People
with sensorineural hearing loss will
often hear people speaking, but can’t
always understand all the words, even
when the volume is adequate. Music
may also sound distorted, leading to
decreased enjoyment.
The symptoms of sensorineural hearing
loss may include: -
• Turning up the volume on the TV or
radio
• Asking people to repeat what they
have said
• Perception of people mumbling or
not speaking clearly
• Lack of clarity when listening to
speech
• Difficulty hearing in noise.
Mixed Hearing Loss
The transmission of sound can be
blocked in multiple places along the
auditory path. When a hearing loss
occurs from conditions in the inner ear
as well as the outer and/or middle ear,
this is known as mixed hearing loss. An
example of a mixed hearing loss may
be someone with inner ear damage due
to exposure to noise in their workplace
over many years, who also currently
has an infection that has led to a fluid
build up in the middle ear.
Causes of
hearing loss
While the ageing process is a major
contributor to hearing loss, it is
certainly not a condition reserved
for the later stages of life. Studies
have shown that exposure to noise
is thought to be a contributing
factor in around 37% of cases of the
condition. Interestingly, around 50% of
Australians with hearing loss are still of
traditional working age (i.e. under 65
years).
Other contributing factors of hearing
loss include:-
• Infection or injury (17.1% of cases)
• Born with hearing loss (4.4% of
cases)
• Other causes (16.8% of cases)
Noise induced
hearing loss
Given the impact of noise, it is not
surprising that males are considerably
more likely to have hearing loss than
women – including being twice as likely
to have a moderate to severe hearing
loss.
These days, people are more aware of
the damage that noise can do to their
hearing. This is illustrated through
mandatory provision of ear protection
on work sites and within factories.
Nevertheless, every day millions of
Australians are exposing themselves
to noise levels that will surely lead to
long-term damage to their hearing,
including the use of personal stereo
systems.
The chart below illustrates the time it
takes to cause permanent damage to
your hearing when you’re exposed to
different levels and sources of sound.
“What is the
best protection
against noise
damage?”
Noise attenuating
ear plugs
Ear protection is extremely important for
people who are exposed regularly to noise.
The best form of protection are custom fitted,
noise attenuating ear plugs.
These can purchased and fitted at
a The Art of Hearing clinic

8. This buzzing
in my ears is driving me mad!
Causes of Tinnitus
Most commonly, tinnitus is related
to hearing loss. Current theories
suggest that because the cochlea is
no longer sending the normal signals
to the brain, the brain becomes
confused and essentially develops
its own noise to make up for the lack
of normal sound signals. This then is
interpreted as a sound, tinnitus.
This tinnitus can be made worse by
anything that makes our hearing
worse, such as ear infection or excess
wax in the ear.
Other causes of Tinnitus include
trauma to the ear resulting from:
• Loud noise exposure
• Adverse reaction to medications
drugs such as aspirin, antibiotics
and quinine
• A symptom of Meniere’s disease,
which can also cause dizziness,
nausea, and fluctuating hearing
loss
• A rare cause is a certain type of
brain tumor known as an acoustic
neuroma. The tumors grow on the
nerve that supplies hearing and can
cause tinnitus. This type of tinnitus
is usually only noticed in one ear
page 8 Health & Hearing
• Pregnancy, anaemia and an
overactive thyroid can cause
certain types of tinnitus
• Benign intracranial hypertension -
an increase in the pressure of the
fluid surrounding the brain
• Jaw joint misalignment or muscles
of the ear or throat ‘twitching’ can
cause a ‘clicking’ type of tinnitus
• Stress and fatigue can sometimes
worsen the symptoms of tinnitus,
as can caffeine, smoking and
alcohol
> Tinnitus
At some stage our lives, all of us are likely to
experience ringing in our ears when there is no
apparent source of a sound.
It may be evident coming home from a rock
concert, or for a short period as a result
of a sudden extreme noise, such as a gun
discharging nearby.
Unfortunately for many people, this buzzing or ringing sound can
be persistent, intermittent, and prolonged – and this is a condition
known as tinnitus. It can cause frustration and great distress.
While it does occur in every stage of life and affects
both men and women, the condition is most
common amongst men. According to an
American study, almost 12 percent of
men who are 65 to 74 years of age are
affected by tinnitus.
Tinnitus is not a disease
in itself but rather
a reflection of
something else
that is going on
in the hearing
system or
brain.

9. Unfortunately, tinnitus is
not a simple problem with
a simple solution.
Everybody’s
tinnitus noise
is specific to
them, and
as a result
treatments
need to be
tailored to the
individual.
If you would like to
discuss your problem or
arrange an assessment,
we recommend that you
call us to arrange an
appointment with one of
our experts.
Health & Hearing page 9
Treatments
for Tinnitus
Most cases of tinnitus should be
evaluated by an Ear, Nose, and Throat
physician to be sure that the tinnitus is
not caused by another treatable problem.
While research has yet to discover a
cure, there are a number of treatments
to help sufferers manage the condition.
Generally the process begins with trying
to identify the cause.
If hearing loss is present, a hearing aid
is likely to reduce the problem. Some
wearers report that hearing aids have
completely alleviated their condition.
Another option to help people manage
is the use of a Therapeutic Noise
Generator, a device which looks like
a hearing aid and is recommended
for people with no hearing
loss. It produces a blend of
external sounds which
stimulate fibres of the
hearing nerve,
helping deviate
attention away
from the
tinnitus.
Cognitive Behaviour Therapy (CBT),
offered by clinical psychologists, can
also be effective in alleviating distress
and adapting to tinnitus. CBT is
threefold: changing the way a person
perceives tinnitus; teaching ways to
focus attention away from tinnitus;
and achieving control over stress.
For the vast majority of people there
is no specific surgical procedure that
provides a treatment for tinnitus.
However, following successful
surgical treatment for some ear
problems, tinnitus may sometimes
disappear (e.g. otosclerosis, middle
ear effusion). Accurate diagnosis and
treatment of Meniere’s disease
may also result significantly reduced
tinnitus.
There is some school of thought that
herbal remedies and Vitamin B12,
taken under medical supervision, may
be helpful for some people. It really
depends on the cause of the tinnitus
and we recommend that you consult a
specialist to discuss these options.
Where tinnitus is related to a jaw
alignment problem, it is treatable.
If you suspect this is a possible cause,
it is worthwhile consulting your
dentist.
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10. “I’m too
young for
hearing
aids”
People often wait many years from the
time that they first notice that their
hearing is not what it used to be before
they take the step to address their
hearing loss. For most people, hearing
loss occurs gradually and they often are
not fully aware how much their hearing
has changed.
The thought of wearing a hearing
aid can cause many people to feel
a little anxious – they worry (largely
unnecessarily) about not wanting to be
perceived as old or a possible stigma
that may be associated with having a
‘disability’. Self image and pride are
great inhibitors to people addressing
hearing loss – more so than the
perceptions others truly have about us.
All around the country there are Aussie
blokes sucking in their tummies,
poking out their chests and thinking to
themselves - “I’m doing alright for my
age” and “you’re a handsome devil”.
Unfortunately, hearing loss does not
discriminate based on how young and
sexy someone appears to themselves!
Time and time again our clients tell
stories about how they wish they had
done something sooner. They feel
younger and more confident as a result
of wearing hearing aids.
Now, research has revealed two scientific
reasons to consider wearing hearing
aids earlier – and these have arisen
from studies on the topics of Sensory
Deprivation and Neural Plasticity.
Sensory Deprivation
– “Use it or lose it”
Studies looked specifically at people with
hearing loss in both ears (binaural loss),
comparing people who were fitted with
hearing aids for both ears against people
fitted with a single hearing aid.
The research revealed conclusively that
a person’s ability to understand speech
in an unaided ear deteriorated over time
faster than their ability to understand
speech in their aided ear. For most
people, this deterioration in the unaided
ear was reversible if a hearing aid is later
fitted to this ear.
However, if the period without a
hearing aid is long enough, then not
only is recovery unlikely but other full
advantages of hearing with both ears
may never be attainable. That is, if we
don’t use it, we may lose it.
This provides the rationale for addressing
hearing loss sooner and fitting hearing
aids to both ears, if both are affected by
hearing loss.
Neural Plasticity
– “Use it or it will start
doing something else”
In basic terms, the role of a hearing
aid is to amplify sounds to the amount
required to restore normal hearing
levels. Often newly fitted clients would
say:- “It sounds horribly tinny”. The
audiologist would then adjust the
page 10 Health & Hearing
hearing aids to suit the preferences of
the wearer – however we now know
that this may not have been the best
approach.
Sounds are processed in the brain by
neurons that are ‘wired’ to process
sound at specific frequencies. Research
has now shown that when those neurons
are denied those frequencies due to
hearing loss, the brain will reprogram
those neurons to do something else. In
simple terms, this could be described
as “use it, or it will start doing
something else”.
This process can be reversed over time,
at least to some degree, in most people.
This has led to three key improvements
in the field of hearing care:
1. Someone’s ability to process the full
range of sounds that make up speech
is lessened over time by hearing loss,
so earlier fitting of hearing aids is
beneficial to the wearer
2. When introducing a hearing aid to
someone who has lived with hearing
loss for a long time, we need for them
to hear those ‘tinny’ sounds as this
helps retrain their brain, until the
sounds no longer seem tinny at all.
This is known as Aural Rehabilitation.
3. A client’s expectations need to be
managed when being fitted with a
hearing aid. As great as modern
technology is, hearing aids cannot
replicate normal hearing.
> The science
The importance of addressing hearing loss early
– a scientific perspective

11. Dementia
A research team commissioned by the renowned John
Hopkins School of Medicine in the United States has
found a strong link between dementia and hearing loss.
The research concluded that Seniors with hearing loss are
significantly more likely to develop dementia over time
than those who retain their hearing.
“Researchers have looked at what affects
hearing loss, but few have looked at
how hearing loss affects cognitive brain
function,” says study leader Frank Lin (M.D,
Phd). “There hasn’t been much crosstalk
between otologists and geriatricians, so
it’s been unclear whether hearing loss and
dementia are related.”
To make the connection, Lin and his
colleagues used data from the Baltimore
Longitudinal Study on Aging (BLSA), which
has tracked various health factors in
thousands of men and women since 1958.
First published in the February Archives
of Neurology, the research focused on
639 people whose hearing and cognitive
abilities were tested as part of the BLSA
between 1990 and 1994. While about a
quarter of the volunteers had some hearing
loss at the start of the study, none had
dementia.
These volunteers were then closely
followed with repeat examinations every
one to two years, and by 2008, 58 of
them had developed dementia. The
researchers found that study participants
with hearing loss at the beginning of the
study were significantly more likely to
develop dementia by the end. Compared
with volunteers with normal hearing,
those with mild, moderate, and severe
hearing loss had twofold, threefold, and
fivefold, respectively, the risk of developing
dementia over time. The more hearing
loss they had, the higher their likelihood of
developing the memory-robbing disease.
Even after the researchers took into
account other factors that are associated
with risk of dementia, including diabetes,
high blood pressure, age, sex and race, Lin
explains, hearing loss and dementia were
still strongly connected.
“A lot of people ignore hearing loss because
it’s such a slow and insidious process as
we age,” Lin says. “Even if people feel as if
they are not affected, we’re showing that it
may well be a more serious problem .”
Health & Hearing page 11
Hearing Loss and
Linked in study
The findings, the researchers say, could
lead to new ways to combat dementia, a
condition that affects millions of people
worldwide and carries heavy societal
burdens. The scientists report that their
finding may offer a new starting point
for interventions — even as simple as
hearing aids — that could delay or prevent
dementia by improving patients’ hearing.
Although the study did not investigate
the cause of the link between the two
conditions, the researchers propose that
the strain of decoding sounds over the
years may overwhelm the brains of people
with hearing loss, leaving them more
vulnerable to dementia. They also speculate
that hearing loss could lead to dementia by
making individuals more socially isolated,
a known risk factor for dementia and other
cognitive disorders.
“...hearing aids... could
delay or prevent dementia
by improving patients’
hearing.”
Footnote: The research was supported by the intramural research program of the National Institute on Aging and results were first published on February 2011
So maybe you are too young
not to wear hearing aids!
There are many reasons to
address hearing loss early
- even if you feel that you
can “manage a little longer
without hearing aids”.
As well as feeling the
benefits to your life and
lifestyle sooner, you will also
stop any permanent loss of
future benefits and positive
experience that you will
enjoy when you get around
to experiencing hearing aids
for the first time. You could
reduce risks of a range of
physiological conditions that
have been strongly linked to
‘unaided’ hearing loss.
> Dementia

12. Otoscopic inspection
Before performing a hearing test,
an Audiologist will first examine
the health of the Ear canal and
the Tympanic membrane with an
instrument called an otoscope.
This inspection can provide a
lot of information about what’s
happening within the middle ear.
It also identifies if there are any
visible problems that may influence
the results of hearing tests, such
as a perforation in the tympanic
membrane or compacted build up of
cerumen (ear wax).
Tests
What will happen when I see an audiologist?
Audiogram and pure
tone tests
Air conduction tests
The most simple and common test
of hearing ability is called ‘pure tone
audiometry’ where you listen to a range
of different pitched beeps (called pure
tones) and indicate when you can hear
them, generally by pressing a button.
The loudness of each tone is reduced
until you can just hear the tone. The
softest sounds you can hear are known
as your hearing thresholds, and these
are marked on a graph called an
audiogram.
When hearing is measured with pure
tones presented through headphones,
this measurement is called air
conduction. The sounds go via the air,
down the ear canal, through the middle
ear, and to the very delicate organ of
hearing in the inner ear—the cochlea.
page 12 Health & Hearing
Bone conduction tests
The sensitivity of the cochlea can also be
tested by placing a small vibrator on the
mastoid bone behind the ear and again
measuring the softest sounds that can
be heard.
Sounds presented this way travel
through the bones of the skull to the
cochlea and hearing nerves, bypassing
the middle ear. This type of testing
is called bone conduction. The air
conduction and bone conduction hearing
levels on the audiogram can tell us a
lot about where a hearing problem is
originating.
For example, if bone conduction tests
indicate less hearing loss than a test
through headphones, results would
indicate that at least part of the hearing
loss can be attributed to conductive
hearing loss. Reasons could include
fluid in the middle ear, excessive wax,
a perforated tympanic membrane, or
that the bones of the middle ear are not
functioning normally.
Speech Tests
The ability to interpret speech is a
function of the ability to detect and
understand the sounds of speech.
The range of audible sounds, not just
the degree of hearing loss, varies
considerably from person to person.
Unfortunately, when hearing is damaged
it is usually not just the volume of sound
heard that is lost, often the quality of the
sound is also distorted.
Speech tests are used to determine how
clearly someone can understand speech,
when visible cues such as lip-reading
are removed. They usually involve
using common lists of words played (or
spoken) at a constant volume that is
appropriate to the client’s hearing loss.
Hearing
> Tests

13. Hearing tests are designed to find out what you can and can’t
hear. Audiologists are skilled at using a range of techniques
and equipment to assess your hearing health.
Health & Hearing page 13
The client responds by guessing the
word that was spoken and correct and
incorrect answers are tallied.
Speech -in-Noise tests
Given that people with hearing loss
commonly have the greatest difficulty
understanding speech in the presence
of background noise, it makes sense
that speech discrimination tests are
also performed with the addition of
a “noise” stimulus. This is often a
‘speech babble’ played at different
volumes relative the loudness of the
speech (words or phrases). The client
responds by guessing the word or
phrase that was spoken in the presence
of background noise. Again, the results
are tallied.
Aided vs Unaided Tests
Following the fitting of a hearing device,
a hearing care professional will run
the tests again to compare how their
client is able to perform in the speech
discrimination tests with the benefit of
a hearing aid compared to when they
are not wearing a hearing aid.
Tympanograms and
Reflex Tests
Tympanograms measure the movement
and flexibility of the tympanic
membrane to identify whether it is
moving normally.
Results may indicate a problem in the
middle ear that can cause a conductive
hearing loss. When a child has a normal
tympanogram, it may also be possible
to test for the presence of a muscle
reflex (acoustic reflex) in the middle ear.
The absence of this reflex to different
sounds gives information about the
functioning of the auditory system.
Testing children
and babies
The ability to test babies and
young children has a unique set
of problems, related to the child’s
age and ability to understand
instructions on how to respond.
Most children will be assessed
using a combination of behavioral
and physiological tests.
Behavioural tests
(Less than 7-months of age)
Behavioural tests are based on
observing a change in an infant’s
behaviour in response to sound –
such as startling to loud noises and
stirring from sleep in response.
Visual reinforcement
orientation audiometry
(7-months to 3-years of age)
These are used to test the hearing
of children between seven months
and three years of age. VROA
involves the child turning towards
the loudspeaker when a sound is
presented. By altering the frequency
and intensity of the sounds, it is
possible to find out about the child’s
ability to hear sounds across a range
of frequencies.
Play audiometry
(Over 3-years of age)
This involves testing the child’s
hearing when headphones are worn.
Play audiometry works the same way
as pure tone audiometry (person
indicates when they can hear a tone),
except when the child hears a tone,
they put a marble in a marble race,
press a computer key or put a piece
in a puzzle.
Electro-physiological tests
Physiological tests help determine
which part of the auditory system is
involved in the child’s hearing loss.
Physiological tests measure a physical
response of a specific part of the
auditory system and require little or no
co-operation from the child.
Oto-acoustic emission testing (OAE)
Provides an idea about how hair cells
in the cochlea are working. They
respond to sound by producing a very
soft sound of their own called an oto-acoustic
emission.
Brainstem evoked response
audiometry (BERA)
These look at the electrical activity
generated in response to sound along
the Cochlea nerve to the brain. It may
be carried out while a baby is in natural
sleep.
Electro-cochleography
(ECochG or EcoG)
This is a medical test performed in
hospital, under anesthetic. It picks up
the tiny electrical signals generated
in the cochlea in response to sound
and provides information about the
functioning of the cochlea and cochlea
(hearing) nerve.

14. > Your results
Reading your Audiogram
The Audiogram is the graphical representation of the results of the air
conduction and bone conduction hearing tests.
The vertical lines represent the test
frequencies, arranged from low pitched
on the left to high pitched on the right.
The horizontal lines represent loudness,
from very soft at the top to very loud at
the bottom.
The Audiogram shows the minimum
volume at which a person can detect a
tone played at a particular frequency.
“X” is used for the left ear and “O”
represents scores for the right ear. The
scores are compared to results obtained
from persons with normal hearing – the
line at 0dB.
Sometimes the audiogram will also
show bracket symbols “[“ and “]”. These
represent scores based on bone conduction
tests, which as discussed earlier, bypass
the outer ear and middle ear.
Interpreting the
Audiogram
The Audiologist will use the following
characteristics of the audiogram to
explaining the results of the audiogram: -
This diagram shows the approximate sound levels of some common sounds. Speech and conversation usually falls into
the yellow shaded area and, not surprisingly, this is commonly called the speech banana. We have placed some vowels and
consonants within this area to show where those speech sounds fall in conversation at normal levels.
page 14 Health & Hearing
Type of hearing loss :
• Conductive – Normal hearing for bone
conduction scores ([ & ]), and showing a
hearing loss for Air Conduction scores (X &
O)
• Sensioneural – Hearing loss (equally) for
both air and bone conduction
• Mixed - Hearing loss for bone conduction
score, and an even greater hearing loss for
air conduction scores
Severit y of loss :
• The lower the scores fall on the Audiogram,
the more severe the hearing loss.

15. Health & Hearing page 15
Slope of loss :
• Flat loss – A hearing loss where hearing
is relatively even across all frequencies,
which is more common for conductive
hearing losses.
• Sloping loss – Increasing degree of
hearing loss the higher the frequency.
This is the most common hearing loss
that will be shown due to the ageing
process and noise damage.
• Other: Less common shapes include
reverse slopes, cookie bites, corner
audiogram
How the ears compare:
• Monaural loss: Loss is only in one ear
• Binaural loss: Loss is in both ears
• Symmetrical: Hearing is relatively even
in both ears
• Assymetrical: Hearing loss in one ear is
significantly worse than the other ear.
“My hearing is pretty
good other than FOR
those high frequencies”
In interpreting an audiogram, it is a
common for clients to misinterpret the
results ~ looking at the good news rather
than taking in the whole story. Low
frequencies of sounds found in speech
(125dB – 1000 dB) are largely responsible
for a person’s interpretation of the
volume of speech. High frequencies are
responsible for the clarity that someone
interprets speech.
Some of the high frequency elements
of speech include those made by words
containing letters such as “f ”, “ph”, “th”,
“s” and “t”. Because these sounds are
difficult for someone with high frequency
loss to hear, they may often mistake what
has been said.
For this reason, many people with greater
losses in the higher frequencies commonly
feel that: “I can hear ok, it is just that
people sound like they’re mumbling”.
Common Audiograms
Here we can see the Audiograms of three people: -
1. Annie (75 years) – Housewife and grandmother of 12
wonderful grandchildren
2. Bill (55-years) ~ Carpenter
3. David (12-years) ~ Great cricketer
Annie has a moderate hearing
loss that is known as Presbycusis.
This results from degeneration
of the hair receptors within
the cochlear due to the ageing
process. Before she was fitted
with hearing aids, Annie always
found conversations with her
younger grandchildren particularly
difficult - especially when in a
noisy situation. She also found
telephone conversations difficult
and noisy restaurants were the
“bane of her existence”:
Bill has been on the tools
for 40-years as a carpenter
and admits to rarely using ear
protection for most of that time.
His sharply sloping loss in the
higher frequencies can largely be
put down to the damage produced
by electrical saws and other
equipment that he has used in his
job.
David is currently suffering
from a nasty illness that has led to
fluid gathering in his middle ear.
He is not hearing very well at the
moment and his ears are hurting
and “feel tight on the inside”. This
infection is causing a problem
with the passing of sound through
his middle ear, as can be seen by
the Normal hearing scores he has
from his Bone conduction tests,
represented by the “[“ and “]”, but
impaired Air Conduction results.

16. Rediscovering
a full world of
sound
Although describing his life as fairly relaxed,
Moshe Bernstein (59) was increasingly frustrated
by difficulties he was finding in following
conversations in noisy environments and clearly
following the dialogue within a good movie. Six
months on from being fitted with the practically
“There is no doubt that wearing hearing aids greatly
enhanced my ability to communicate when in China. I am
very much looking forward to returning to continue my
research next year.” Moshe said.
Being able to give the hearing aids a thorough test and
assess the difference that they could make to his life,
before purchase, was also greatly appreciated. While
reporting that it took a little bit of time to adapt to
wearing the hearing aids. Moshe concludes: -
“My wife has also noticed a change in my ability to hear
and converse more freely with others. I am extremely
grateful to the team at The Art of Hearing for the
opportunity to trial the hearing aids and would encourage
others to do the same.”
The Oticon Intiga is amongst a range of discreet hearing
solutions available at The Art of Hearing
invisible Oticon Intiga hearing aids, Moshe is again
greatly enjoying the ease with which he can head
out into the world.
Fluent in Chinese (Mandarin) and currently working on his
Ph.D. in Asian studies at the University of Western Australia,
Moshe noticed that he was finding it increasingly difficult
to remain actively involved in conversations – particularly in
noisy settings. Moshe remembers: -
“It could be extremely frustrating sitting around a table
participating in seminars... when the fan was whirring and the
speaker was across from me I often could not understand a
word. The hearing aids have changed that... sounds are now
discernible.”
These problems extended to great difficulty in social
situations and parties, during which Moshe would feel “on the
outside of conversations.”
But like many in his situation, it took some time before he
took the steps to do something about it. He responded
to an invitation from The Art of Hearing earlier this year to
undertake a free trial the latest in discreet hearing solutions.
In addition to tackling the effects of hearing loss, the Oticon
Intiga also promised to be ‘practically invisible’ to others.
Moshe recalls: - “I definitely had a vanity issue and preferred
that other people did not notice that I was wearing hearing
aids… even my son did not notice that I was wearing the
hearing aids for a couple of months before I told him!”
Now life is much easier with the use of his hearing aids. In
an ultimate test of hearing in noisy environments, Moshe and
his wife were in China earlier in the year. It was part of his
research into a 1,000 year old Jewish community living within
central China in a town named Kaifeng.
The Art of Hearing is offering free trials of the latest hearing aids
from all leading manufacturers. To arrange your own free home trial,
call The Art of Hearing on (08) 9390-8811.
page 16 Health & Hearing

17. > Solutions
Hearing
Aids
– “nothing like the old days”
This time last century,
the only assistance
that someone with
hearing loss could
use was an ear
trumpet.
While ear trumpets increased volume of
sound, most people would still have major
issues of clarity. Now 100 years on, there
have been many advances in both medical
solutions and hearing aid devices. Hearing
loss can now be managed to ensure that
it need not greatly affect the lives of most
people with the condition.
In this section we will look at modern day hearing
aids and medical solutions such as the Cochear
Implant.
Health & Hearing page 17

18. Features of modern
hearing aids
If hearing tests demonstrate that you
have a sensorineural hearing loss, we
have some great news – modern hearing
solutions are nothing like the large, noisy,
clunky and whistling hearing aids of days
gone by!
Hearing aids are equipped with many
incredible features that make even the
most difficult situations manageable and
they come in devices so small, that no one
would ever notice that you’re wearing a
hearing aid.
How do digita l hearing
aids work ?
The most basic function of a hearing aid
is to amplify sound. Digital hearing aids,
which have only been around since late
1990’s, do this in a rather sophisticated
way.
As sound enters the device, it is broken
into multiple frequency bands. Each band
is then amplified by the amount necessary
to return the wearer’s hearing to normal
levels at that band.
ITC
(in-the-canal) Hearing
aid
models
page 18 Health & Hearing
With digital technology, devices can
now break sound into as many as
24 different bands. Given that every
person has a unique pattern of hearing
loss, the sound quality provided by a
modern hearing aid is far better the
previous analogue technologies that
were restricted to two bands – base
(low frequencies) and treble (high
frequencies).
Feedback Cance llation
Historically, one of the greatest
complaints and a source of
embarrassment for hearing aid wearers
is related to feedback – the whistling
sound created when amplified sound
is picked up by the hearing aids
microphone, causing squealing or
whistling.
As you would know, sound travels in
waves. The digital hearing aid can now
detect the frequency of and the wave
shape that is causing the feedback
and counteract it within fractions of a
second. So, there will be no annoying
and embarrassing whistling from your
hearing aid.
Mild to moderate
hearing losses
Very small case
Fits inside the ear canal,
making it practically
invisible
Size prevents the use of
directional microphones
Mild to moderate
hearing losses
Fits deep inside the ear
canal, making it invisible
Less occlusion
Not suitable for people
with narrow ear canals
Size prevents the use of
directional microphones
Mild to moderately- severe
hearing losses
Small, one piece case
Fits inside the ear canal
Directional microphones
are possible with this
model
CIC
(completely-in-canal)
DC
(deep-canal)
Hearing aids are
also available in an
extensive range of
colours and sizes.
This chart shows some
of the more common
hearing aid models
available.

19. Health & Hearing page 19
Open fit acoustics
Improvements in feedback
management have allowed hearing
aid manufacturers to develop devices
that do not obstruct the natural
passage of sound through the ear
canal. Previously, wearers of hearing
aids would complain of a “talking
in a barrel” sensation, like you can
experience when using your fingers
to block your ears and listening to the
sound of your own voice.
Open fit hearing aids have very thin
tubes that enter the ear canal and
smaller cases that rest behind the
ear, making them barely visible.
Additionally, hearing aids that sit
within the ear canal can now have
greater ventilation. The end result is
far more comfort and clarity for the
hearing aid wearer of today.
Noise management
One of the problems with older
hearing aids was that they amplified
all sounds equally – whether the
source of the sound is the person
who the wearer is listening to, or
background noises, such as traffic,
air conditioners, or ambient noise
from a crowded room. This led to
discomfort and did not help the user
to follow conversations in difficult
environments.
Now digital hearing aids can actually
tell the difference between speech
and background noise and do this
individually for every
frequency band. The
hearing aid then amplifies
the speech sounds and
reduces the amplification
of background noise.
Now consider the size
of a hearing aid and the
number of computations
that it must perform every
few milliseconds across
up to 24 frequency bands and then
deliver the enhanced sound into
the ear canal. The mind begins to
boggle!
It may be easier to simply enjoy
the results of noise management –
greater listening comfort and clarity.
Mild to severe losses
Fully featured hearing aids
Larger case can be easier
for wearers with dexterity
considerations
Case contains all features
and sits behind the ear
Many colour options
Mild to moderately-severe
hearing losses
Ear canal is open for a
natural sound quality
Very small case that sits
behind the ear, making it
practically invisible
Many colour options
Mild to moderately-severe
hearing losses
Ear canal open for a natural
sound quality
Smallest external hearing
aid, as the receiver is located
in the end of the tube inside
the ear
Very small case that sits
behind the ear, making it
practically invisible
Many colour options
Profound hearing losses
More powerful
solutions that provide
the greatest levels of
amplification
Larger case worn behind
the ear
BTE
(behind-the-ear)
Open
(open ear)
Power
(high powered)
RIE
(receiver in the ear)

20. Directiona l Microphones
Most people with hearing loss find that
trying to follow a conversation in a noisy
place can be a tremendous struggle.
Logically, most conversations are
with people who we are facing, while
distracting background noise will come
from the sides and behind us.
A modern digital hearing aid can actually
pinpoint the location of sounds. It does
this by using more than one microphone
and gauging the difference in time that it
takes sounds to reach each microphone –
even though the microphones are only a
few millimetres apart!
It will then provide the greatest
amplification to sounds coming from in
front of the wearer and less amplification
to sound coming from the sides and
behind. Directional microphones can be
extremely beneficial in difficult situations,
such as restaurants. This feature
provides the greatest benefit in regards
to improving a hearing aid wearer’s
ability to follow conversations in noisy
environments.
Connectivit y to
mobi le devices and
entertainment
Wearers are increasingly looking for
solutions to improve the effectiveness
of hearing aids in partnership with their
mobile phones, digital radio, plasma
televisions, and personal stereos (i.e.
iPods and MP3 players).
In response, manufacturers have
developed streamers that connect
wireless devices to the user’s hearing
aid. The benefit is that this delivers
improved performance in terms of
speech intelligibility and sound quality
Two ears are better
than one
We were born with two ears for a reason: it helps with
sound location and provides much clearer ‘stereo quality’.
Advanced features such as directional microphones are
far more effective when applied with two hearing aids.
For these reasons, The Art of Hearing strongly
recommend that our clients are fitted with hearing aids
in each ear affected by hearing loss, as this will lead to a
vastly improved benefits and client satisfaction.
page 20 Health & Hearing
as signals from the external devices are
streamed directly into the hearing aid,
without background noise and the need
for the hearing aid to first process a
sound signal.
Multiple and automatic
programming
Different listening environments
often call for different settings within
hearing aids in order to maximise their
effectiveness.
For example, when listening to music,
the user would prefer to turn off features
that may misinterpret elements of the
music as noise. When in a quiet room,
a wearer will not need the benefit
directional microphones and noise
reduction to the same extent they would
in a crowd at the football.
Advanced hearing aids allow the user
to change the settings by pressing a
small button on the device. The most
advanced hearing aids will even listen to
the environment and change the hearing
aids settings automatically, without the
wearer needing to touch or think about
their hearing aids.

21. > Medical
Cochlear Implants
A Cochlear Implant is an electronic medical device
that replaces the function of the damaged inner
ear. Unlike hearing aids, which make sounds
louder, Cochlear Implants do the work of damaged
parts of the inner ear (cochlea) to send sound
Call The Art
of Hearing
to arrange a
consultation
and
assessment
If you would like to know if
you would benefit from a
Cochlear Implant, call The
Art of Hearing to arrange
an appointment and a
comprehensive assessment.
Health & Hearing page 21
Cochlear Implants can help people who:
• Have severe to profound
sensorineural (inner ear) hearing loss
in both ears
• Receive no real hearing benefit from
hearing aids
• Have poor speech recognition
Children in particular stand to gain
significant benefit in hearing performance as
a result of the increased sound stimulation
during the developmental “window” that
occurs during early childhood.
How do they work?
Many people suffer hearing loss because
they have damage to hair receptor cells in
the inner ear (or cochlea). If some hearing
nerves still work, a Cochlear Implant can
allow you to hear. Here’s how:
1. An external sound processor captures
sound and converts it into digital code
2. The sound processor transmits the
digitally-coded sound through the coil
to the implant
3. The implant converts the digitally-coded
sound into electrical impulses
and sends them along the electrode
array, which is positioned in the
cochlea (inner ear)
4. The implant’s electrodes stimulate
the cochlea’s hearing nerve, which
then sends the impulses to the brain
where they are interpreted as sound.
What factors can affect
these benefits?
• How long has the patient lived with
hearing loss
• How severe their hearing loss is
• The condition of the cochlea (inner
ear)
• Other medical conditions
• Practice using their cochlear implant
system
signals to the brain.
Grace Tern
Listening to
11 year old
Grace’s piano
performances
and energetic
conversations, it’s hard
to believe that she is
profoundly hearing
impaired.
Grace’s mother shares her
inspirational story: “When we first
discovered Grace was profoundly
hearing impaired we despaired
about her future. We thought she
would be confined to just signing
as a means of communication. Then
a friend told us about cochlear
implants.
We went ahead with the operation
when Grace was 1 year old. In the
days after switch on, I knew she
understood me because she would
give actions to familiar nursery
rhymes. Speech followed and,
within a year, she was tracking like
a normal child.
Reproduced courtesy of Cochlear Ltd
Now, at 10 years,
she’s as normal as a
normal child can be.
“My life would be very different
without cochlear implants because
without them I can only hear very
loud sounds like thunder. Without
my implants, I can’t hear voices
and that makes it very hard to
communicate!” - Grace

22. > Costs
How
While entry level hearing aids are
free to pensioners, a ‘privately
funded’ client can spend up to
$12,000 on a pair of premium
hearing aids with all the latest
advanced features.
But what will be the true ‘out of
pocket’ investment for a client will
come down to a number of factors,
such as: -
Assistance with the
cost of hearing aids
• Is the client a pensioner or an
active or retired member of the
armed services (i.e. Army, Navy or
Air Force)?
• Does the client have private
health insurance?
• Does the client have a taxable
income and lodge a tax return?
• Has the client’s hearing
loss occurred as a result of
occupational exposure to noise?
Personal factors
• Does the client have a binaural
loss (two ears) or monaural
hearing loss (one ear)
• The severity and pattern of the
hearing loss will influence the
hearing care professional’s
recommendation
• The client’s budget
FREE hearing aids
for pensioners and
veterans
Ensuring that every Australian has
access to better hearing is one of
the federal government’s key health
priorities. The Office of Hearing
Services Voucher Scheme provides
free hearing tests and hearing aids
to pensioners and veterans, which
are available through accredited
providers, such as The Art of
Hearing.
Who is eligible?
You are eligible if you are an
Australian citizen or permanent
resident, 21 years of age and over,
meeting one of the following criteria:
• Centrelink Pensioner Concession
Card
• Gold Health Repatriation Card
• White Health Repatriation Card
(specifying hearing loss)
• Centrelink Sickness Allowance
You may also be eligible if you are:
• Dependant of a person in one of
the above categories
• Active member of the Defence
Force
• Client of CRS Australia
page 22 Health & Hearing
How do you apply?
If you believe that you may be
eligible, call The Art of Hearing and
we will provide you with, and assist
you to complete, an application form
for the Office of Hearing Services.
much?
A common question from people who call
The Art of Hearing is:
“How much do hearing aids cost?”

23. Insurer Rebate Phone Website
MBF $1000 per aid every 3 years 131 137 www.mbf.com.au
Medibank Private $800 per aid every 5 years 132 331 www.medibank.com.au
HBF $650 for first aid and $325 for second
Compensation for
occupational hearing loss
Health & Hearing page 23
aid every 4 years
Private health funds
Many private health funds offer rebates
on the cost of hearing aids for their
extras and premium plans. At the time of
printing, the rebates above applied to five
of Australia’s largest health insurers on
their premium plans.
Tax rebates on
hearing aids
The government has exempted hearing
aids from GST and provide a tax rebate
of 20% on annual medical expenses in
excess of $1500.
This could
lead to a rebate
of over $1,500 for
advanced hearing
solutions for
clients who lodge
a tax return.
133 234 www.hbf.com.au
NIB $800 per aid every 3 years 13 14 63 www.nib.com.au
HCF $800 per aid every 5 years 13 14 39 www.hcf.com.au
The Art of Hearing recommend that you check with own
health insurer to learn what benefits are available.
Until recent times, the damage
caused by working in noisy
environments was not fully
appreciated by many companies.
As a result, Australians working
in factories, the building industry,
mining industry, and other
noisy workplaces were rarely
provided with ear protection and
hundreds of thousands of people
have subsequently incurred
occupational hearing loss.
The state government provides a
scheme for employees who have
incurred occupational hearing
loss with access to compensation.
This scheme is administered by
WorkCover WA.
If you would like advice regarding a
claim for occupational hearing loss,
call The Art of
Hearing and we
will be happy to
assist.

24. Call now or drop in for more information and to
book a consultation with the audiologist at the top
SOUTH STreet
hearing healthcare centre in Perth.
Gilbertson Rd
NORTH LAKE RD
Kardinya
Shopping
Centre
IGA
N
Brophy St
Gibson Avenue
N
Warburton Avenue
Shopping
Centre
We are here!
Brookton Hwy
Albany Hwy
Ecko Rd
Armadale
Health
Service
N
We are here!
Head Office & Permanent Clinic
2/2 Ecko Rd, Mount Nasura WA 6112
(08) 9390-8811
f: (08) 9390-4592
e: info@artofhearing.com.au
w: www.artofhearing.com.au
Suite 6, Kardinya Commercial Centre
(Next to IGA),
Kardinya 6163
2/73, Gibson Avenue
(Next to Padbury Family Practice),
Padbury 6025
Peel Crt
We are here!
Chisham Ave
Meares Ave
Gilmore Ave
Kwinana
Town
Centre
N
Robbos Pl
Chisham Avenue Medical Centre,
1 Chisham Avenue,
Kwinana 6167
We are here!