Generated by All in One SEO Pro v5.0.1.1, this is an llms-full.txt file, used by LLMs to index the site. # Hearing Health Center ## Posts ### [Blog](https://hearinghealthcenter.com/blog/) **Published:** February 5, 2025 **Author:** muneeb --- ### [How Much Do Hearing Aids Cost?](https://hearinghealthcenter.com/ask-the-audiologist/how-much-do-hearing-aids-cost/) **Published:** August 10, 2026 **Author:** Ronna Fisher **Excerpt:** Hearing aid prices vary widely, making the price range unhelpful as a decision-making tool. Before you spend any money on hearing aids, let’s get into what you might be paying for. **Content:** Hearing aid prices vary widely, making the price range unhelpful as a decision-making tool. A [2025 clinical trial tested this directly](https://pmc.ncbi.nlm.nih.gov/articles/PMC12082484/) by comparing a $4,400 hearing aid against a $1,100 one from the same manufacturer in the same study and found no meaningful difference in performance. The largest differences in hearing outcomes were associated with comprehensive professional fitting and follow-up care rather than device price. Before you spend any money on hearing aids, let’s get into what you might be paying for. ## What Hearing Aids Actually Cost Right Now Depending on where you’re looking, the quoted price for a hearing aid can include anything else bundled with it. There are three categories: self-fitting over-the-counter (OTC) devices, preset OTC devices, and prescription or professionally fit devices. The prices for all three vary based on your location, health insurance, and provider. What’s more important than the price itself is knowing what else is included. Prescription pricing oftentimes bundles in the professional fitting appointment, one or more follow-up visits, and ongoing maintenance. OTC pricing generally does not, because there’s no professional involved to bundle in. That single distinction accounts for a large share of the spread you’re seeing. When hearing aid coverage is available, it is more commonly applied to professionally fitted prescription hearing aids than OTC devices. ## Why the Range Is So Wide The technology in your hearing aids is part of it, as are the services attached to your purchase. Brand and features matter with each offering: basic, mid-level, and advanced technology tiers, with advanced tiers costing more. What often gets left out of the conversation is that OTC devices can be priced so much lower because they remove the services an audiologist or hearing aid specialist offers. That means no fitting appointments, no fine-tuning, and no follow-up visits. Removing everything an audiologist offers changes what you’re actually buying. The study found that comprehensive professional fitting and verification had a greater impact on outcomes than moving from a lower-priced to a higher-priced technology tier. ## Price vs. Care Researchers at the University of Iowa and Vanderbilt University Medical Center ran a randomized trial involving 245 people aged 55-85, all with mild-to-moderate hearing loss and no prior hearing aid experience. They split participants across combinations of device tier and service model: a high-end device (around $4,400 a pair) or a low-end device (around $1,100 a pair), from the same manufacturer, paired with one of three levels of support: full audiologist-fitted care, limited audiologist support for an OTC-style preset device, or no professional support at all. The biggest finding was that the group with full audiologist care did meaningfully better than either OTC-style group. These participants could hear better and ended up wearing their devices more consistently. One specific note was that the group with professional help still ran into acoustic feedback problems that switching between presets couldn’t resolve. Fixing it required probe-microphone measurements, a technique that checks the actual sound reaching the eardrum, and the flexibility of professional fitting software to adjust accordingly. A preset device doesn’t have access to that tool set. The trial proved that price alone was a poor predictor of outcome, and that the gap between “some support” and “full support” mattered. ## What Professional Care Looks Like A hearing aid fitting usually includes follow-up visits and adjustments to ensure your hearing aids are effective. This includes an in-person fitting, tests to ensure your hearing aids are delivering the right sounds to your ears, and a follow-up visit within the first few weeks to catch anything that isn’t quite right yet. Expect ongoing adjustments as your hearing or your life changes. That first follow-up matters more than people expect. As you move around from different locations and sound profiles, you may experience gaps in your hearing aids. An adjustment is based on what you report to your audiologist to help close any gaps you might have. OTC hearing aids generally do not include the same level of individualized fitting, verification, and follow-up care that accompanies professionally fit prescription hearing aids. ## What to Ask Before You Buy Always compare what’s included versus just the price of the hearing aid. Before you commit to anything, here are some questions to ask yourself and your hearing aid specialist. 1. What’s included in this price? Is it just the device, or the fitting and follow-up too? 2. Is there a trial period, and how long does it run? 3. What does the warranty actually cover, and for how long? 4. How many follow-up or adjustment visits come with this, and what happens after that runs out? 5. And if your hearing or your fit changes a year from now, what’s the plan? If you’re trying to figure out what actually makes sense for your hearing and your budget, come in and see us. ## Schedule Your Hearing Aid Fitting Today Are you struggling with your hearing? Hearing Health Center offers complimentary baseline hearing tests for anyone seeking more information. If you’re in need of hearing aids, our team of audiologists is experts in fitting, tuning, and adjusting to make sure your hearing aids work for you. We offer all major brands and tiers. [Schedule your hearing aid appointment today at any of our five locations.](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Why You Should Wear Earplugs To Your Next Music Festival](https://hearinghealthcenter.com/ask-the-audiologist/wear-earplugs-at-next-music-festival/) **Published:** July 21, 2026 **Author:** Ronna Fisher **Excerpt:** Every summer, Chicago holds hundreds of live concerts and music festivals, drawing thousands of people from all over the country. But, you might notice more and more people wearing earplugs. **Content:** Every summer, Chicago holds hundreds of live concerts and music festivals, drawing thousands of people from all over the country. But, if you’re one of the many audience members at Grant Park for Lollapalooza, Union Park for ARC Music festival, or the countless other festivals and free shows like the Millennium Park Summer Music Series, you might notice more and more people wearing earplugs. Keep reading to find out why earplugs are a must-have for any concert-goer this summer. ## Why Wear Earplugs? The link between hearing loss and loud noise exposure is clear. According to one report, “[nearly one in four (24.4%) U.S. adults aged 20-69 years show evidence of noise-induced hearing loss](https://pmc.ncbi.nlm.nih.gov/articles/PMC5657963/).” Loud music in headphones and live events put nearly 1 billion teenagers and young adults at risk for hearing loss worldwide. It’s been cited that “noise-induced hearing loss remains the second most common cause of sensorineural hearing loss after age-related loss, affecting approximately 5% of the world’s population.” For perspective, the safe decibel level is 70 dB. That’s most conversations with your friends or noises around the house. At 85 dB (city traffic, blenders), around 8 hours of prolonged exposure can cause hearing loss. At 100 dB (chainsaws, sporting events), safe exposure is around 15 minutes. Concerts and festivals often reach around 110 dB. At that volume, NIOSH recommends limiting exposure to about 2 minutes per day before the risk of permanent hearing damage increases. Without hearing protection at a concert, you’re risking permanent hearing loss before the band even finishes its first song. ## Who Should Wear Earplugs? Everyone. Whether you’re young, old, or in between, you should be wearing earplugs at every concert or festival you go to. You obviously want to avoid bringing infants to loud environments as much as possible, but if you have to, they should wear earmuffs rather than earplugs to avoid damaging their ear canals. Older children who can safely insert and remove earplugs on their own may be able to use musician-style earplugs designed for smaller ears. Parents should follow the manufacturer’s age recommendations or ask an audiologist for guidance. And as you grow up, the need for earplugs continues, as hearing loss isn’t a young or old person’s problem; it’s everyone’s problem. ## When Do You Need Earplugs? Concerts, live music, festivals, and even sporting events all reach sound levels high enough that earplugs are recommended to avoid serious hearing problems. ### Concerts and Live Music Peer-reviewed research found that popular concerts ranged from 85 to 110 dB, and some shows push way past that. Guinness World Records no longer tracks the loudest band in the world, but in 1994, one band proclaimed 129.5 dB as the loudest show ever recorded. ### Nightclubs Research found that the average continuous noise level in nightclubs hits around 91.2 dB, high enough to cause damage after a single night out. ### Sporting Events Noise levels recorded during a World Series game averaged 97 dB. The Guinness World Record for stadium crowd noise was set at 142.2 decibels during a 2014 NFL game, breaking a previous record of 137.6 decibels set the year before. Peer-reviewed sports-safety literature is direct about the consequence: hearing loss from these exposures is cumulative and irreversible, and children who regularly attend games with season-ticket-holding parents can sustain permanent hearing damage over time if not wearing protection. ### Festivals Measured research on outdoor music festivals has recorded sustained main-stage sound levels above 100 dB throughout full sets, and front-of-crowd areas at outdoor festivals commonly exceed 115 dB. At those sound levels, recommended daily exposure limits can be reached in about 15 minutes, increasing the risk of permanent hearing damage. ## How Do You Put In Earplugs? The Noise Reduction Rating (NRR) printed on earplug packaging is a laboratory number, measured under ideal, expert-fitted conditions. In the real world, a poorly fitted earplug delivers a fraction of that protection. That’s exactly why NIOSH recommends derating a foam earplug’s labeled NRR by 25%, and OSHA’s own simplified formula — roughly (NRR − 7) ÷ 2 — cuts the rating by around half to account for real-world use. An earplug rated for 30 dB of noise reduction might only provide 11–15 dB if it’s not fitted properly. Earplugs fit differently depending on the type you purchase, so please follow the directions to ensure they’re as effective and protective as possible. ## What Type of Earplugs Should I Use For Music Festivals? There are multiple types of earplugs for purchase, and not all work as effectively. ### Foam Earplugs The cheapest and most widely available option is still effective (as long as they’re inserted correctly). The problem is that foam earplugs work as a physical barrier and not a filter, which means everything sounds muffled rather than quieter. Most disposable foam earplugs are designed for single use, making them less economical if you attend concerts frequently. ### Noise-Reduction Earplugs These use an acoustic filter rather than a solid plug. Noise-reduction earplugs use filters that let in some frequencies but not others, reducing the overall decibel level reaching your ear while preserving the balance of the sound, unlike foam, which blocks all sound. ### Custom Molded Earplugs Usually fitted by an audiologist and molded to your ear, these earplugs offer the most reliable seal of any option. Many musicians prefer custom-molded plugs over off-the-shelf options for exactly this reason. ## Struggling With Your Hearing? Schedule Your Baseline Hearing Test Today! Summer is here, which means that outdoor concert season is in full swing. If you’ve noticed ringing in your ears after a concert, or just want to protect your ears before your next show, [schedule an appointment with Hearing Health Center ](https://hearinghealthcenter.com/book-my-hearing-test-appointment/)for a free baseline hearing exam. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Protection --- ### [Why Do My Ears Feel Clogged?](https://hearinghealthcenter.com/ask-the-audiologist/why-do-my-ears-feel-clogged/) **Published:** July 13, 2026 **Author:** Ronna Fisher **Content:** If you suddenly feel a full, muffled, or underwater sensation in your ear, you might be tempted to use a cotton swab or ear drops to clear things up. But sometimes you need some professional help to deal with your clogged ears. Our blog helps you better understand the causes of a clogged ear and whether or not it’s time to reach out to an audiologist. ## Why Does My Ear Feel Clogged? That stuffed, underwater sensation is your ear telling you something is interfering with sound reaching your eardrum. Unfortunately, the source could be anywhere from your ear canal to the back of your nose. Here’s the short anatomy lesson: sound travels down the ear canal, hits the eardrum, and gets transmitted inward. Anything that blocks or pressurizes that pathway creates a sensation of fullness or muffling. The four most common causes of clogged ears include: ### Earwax Build-Up Earwax is normal and necessary, but it accumulates. A 2024 study published in [Laryngoscope Investigative Otolaryngology](https://pubmed.ncbi.nlm.nih.gov/38525118/) found that nearly 1 in 5 adults has some degree of earwax impaction, and that number rises to nearly 1 in 3 for adults over 70. ### Eustachian Tube Dysfunction The eustachian tube runs from your middle ear to the back of your throat, and its job is to equalize pressure and drain fluid. When you’re congested, the tube swells and can’t do its job. For Chicagoland residents, this is a near-seasonal experience as tree pollen, grass pollen, and ragweed give the eustachian tube something to fight from April through October. ### Pressure Changes That familiar ear-pop sensation on a flight is the eustachian tube trying to equalize cabin pressure. When it can’t fully catch up, you land with ears that won’t clear. ### Fluid After Illness After a cold, sinus infection, or ear infection, fluid can collect in the middle ear and linger for weeks after your other symptoms have resolved. The illness is gone. The muffled feeling is not. ## Be Careful of At-Home Remedies ![Smiling audiologist in a white coat with arms crossed, speech bubble says,'Still stuck? An audiologist can clear it in a quick in-office visit.'](https://hearinghealthcenter.com/wp-content/uploads/2026/07/2-when-to-see-an-audiologist.png "2 when to see an audiologist - Hearing Health Center") It’s important to think twice before using any at-home remedies to clean out your clogged ears, as the risk of further injury is high. Your ear canals are self-cleaning; the skin lining them actually migrates outward, slowly carrying earwax toward the opening where it naturally falls out. Jaw movement also helps move things along. If you’re dealing with earwax buildup, there are safe at-home options to try. Over-the-counter cerumenolytic drops (mineral oil, baby oil, or dilute hydrogen peroxide) soften wax and can help it move out naturally. If that doesn’t work, reach out to an audiologist who can perform a quick, in-office procedure that takes just a few minutes to solve your problem. If pressure or congestion is the culprit, try swallowing or yawning deliberately, or the Valsalva maneuver: pinch your nose closed, close your mouth, and gently blow. Antihistamines or a nasal steroid spray can help if allergies are driving the eustachian tube swelling. ## Could My Clogged Ears Be a Sign of Hearing Loss? For many people, the first sign of gradual hearing change is when everything sounds slightly muffled. Harvard Health has noted that [hearing loss sometimes manifests as a plugged-up feeling](https://www.health.harvard.edu/diseases-and-conditions/by-the-way-doctor-plugged-up-feeling-in-an-ear) rather than obvious auditory difficulty. The only way to know is a hearing test. ## Sudden Hearing Loss is a Problem If your ear suddenly went muffled without a clear cause (especially if it’s only one ear), it could be sudden sensorineural hearing loss, or SSNHL. [SSNHL comes on within 72 hours](https://pmc.ncbi.nlm.nih.gov/articles/PMC10348034/) and affects roughly 66,000 Americans annually. Failure to treat within 72 hours of onset greatly diminishes the likelihood of permanent damage. If you have ear pain, dizziness, drainage, or fever alongside the muffled hearing, see someone that day regardless of how it started. ## How Hearing Health Center Helps with Clogged Ears An appointment typically starts with a visual examination of the ear canal. If [earwax is present and causing the blockage](https://hearinghealthcenter.com/hearing-services-chicago/#ear-wax-removal "earwax is present and causing the blockage"), it can be removed during the same visit using professional instruments. Alongside or following the wax check, an [audiologist will often run a hearing test](https://hearinghealthcenter.com/hearing-services-chicago/#baseline-hear-checkup "audiologist will often run a hearing test") to establish a baseline and rule out any hearing change that might be contributing to the muffling. If there’s a question about middle ear pressure, a tympanometry test can check whether the eardrum is moving normally and whether fluid might be present behind it. If what you’re dealing with turns out to need ENT involvement, an audiologist can refer you directly. They’re often the right first stop, not the only stop. ## Ears Feeling Clogged? Call Hearing Health Center Today If your ears have been feeling full or muffled, come in and see us. We’ll take a look, run a hearing test, and tell you what’s actually going on. [Book an appointment online](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) or call the location nearest you. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Issues, Symptoms --- ### [How to Bring Up Hearing Aids Without Starting a Fight](https://hearinghealthcenter.com/ask-the-audiologist/how-to-bring-up-hearing-aids-without-starting-a-fight/) **Published:** May 12, 2026 **Author:** Ronna Fisher **Excerpt:** Welcome to the hearing loss conversation. It rarely goes the way you planned. Here's what you need to understand before you try again: the person you're worried about isn't being difficult. They genuinely don't know how bad it's gotten. **Content:** You’ve noticed it for a while now. The TV volume rattles the windows. The “huh?” and “what?” have become their own conversational soundtrack. The way family dinners have quietly reorganized themselves around the one person who can’t quite follow along. You love this person, and you are losing your mind. So you bring it up, and somehow, within thirty seconds, you’re in a full argument about something that happened in 2011. Welcome to the hearing loss conversation. It rarely goes the way you planned. Here’s what you need to understand before you try again: the person you’re worried about isn’t being difficult. They genuinely don’t know how bad it’s gotten. Hearing loss is sneaky. It doesn’t show up one morning like a broken arm. It creeps in over the years, and by the time you’re frustrated enough to say something, they’ve long since convinced themselves that restaurants have gotten noisier, that everyone mumbles now, and that the TV volume is completely reasonable. Denial isn’t stubbornness. Their brain has been quietly gaslighting them for years, and it’s very good at its job. ## Pick Your Moment And Your Words ![Purple line-art icon of a person sitting cross-legged in meditation with hands resting on knees](https://hearinghealthcenter.com/wp-content/uploads/2026/05/2-pick-your-moment.png "2 - pick your moment - Hearing Health Center") Timing matters more than you think. Don’t bring this up mid-argument, mid-meal, or mid-anything. Find a quiet moment, one-on-one, when neither of you is already irritated, and lead with love, not logistics. “I miss talking to you” lands completely differently than “you need to get your hearing checked.” One opens a door. The other reads like a summons. Don’t say: “You never hear anything I say.” Do say: “I want to hear your voice, and I want you to hear mine, and lately I feel like we’re losing that.” ## Don’t Lead With The Hearing Aids ![An elderly couple and two children walk hand‑in‑hand through a sunlit grassy park with trees in the background.](https://hearinghealthcenter.com/wp-content/uploads/2026/05/3-don_t-mention-hearing-aids.png "3 - don_t mention hearing aids - Hearing Health Center") The minute you say “[hearing aids](https://hearinghealthcenter.com/hearing-aids-chicago/ "hearing aids"),” a significant portion of the population will mentally check out because what they hear is “you’re old,” “something is wrong with you,” and “everyone is going to notice.” Which, to be fair, is a lot to absorb before dessert. So, skip the devices entirely in the first conversation. Talk about what’s actually being lost: grandkids’ voices at the dinner table, phone calls that have gotten shorter because the connection always seems “bad,” the Sunday night shows they used to watch with you that have quietly stopped. That’s the real conversation. The appointment with the audiologist is just the next step. ## Use Evidence From Their Own Life ![Clipboard with a purple border showing four checked boxes in red, teal, purple, and yellow with lines of text next to each item](https://hearinghealthcenter.com/wp-content/uploads/2026/05/4-use-evidence-858x1024.png "4 - use evidence - Hearing Health Center") Point to the turn signal they didn’t hear. Mention gently that you said their name three times before they looked up. Do this without the tone of someone keeping score, which, be honest, is hard when you have been keeping score. If they push back, skip the debate about whose perception is accurate and suggest a simple baseline hearing screening instead. Frame it like any other routine health check. You get your eyes checked. You go to the dentist. You let someone look at that mole. Your ears have been working very hard for a very long time, and they deserve a little attention, too. ## Know When To Stop Pushing You may not win this conversation the first time…or the third time. In my experience, the record is considerably higher than that, and both parties had aged visibly by the end. Planting the seed matters, though. Saying something once, calmly, with love, is more powerful than a weekly campaign. They heard you. The irony of that sentence is not lost on me. But they did. Give it time. Sometimes it takes a grandchild saying, “I want to tell you something, and I really need you to hear me.” Sometimes it takes a doctor mentioning it offhandedly in an appointment. Sometimes it takes one bad moment at a wedding, when they feel completely cut off from everyone they love, for them to come home quieter than usual. Your job isn’t to force the decision. Your job is to make sure they know you’re asking because you love them, and that when they’re ready, you’ll be right there. ## A Note For The Person This Is Actually About If someone handed you this article, it’s because they love you. They want you at the table, fully present, not nodding along and hoping for the best. Getting your hearing checked takes about an hour. You’ve spent more time than that looking for your keys. [Come in and see me. We’ll figure it out together.](https://hearinghealthcenter.com/book-my-hearing-test-appointment/ "Come in and see me. We'll figure it out together.") ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [The Risks of Over-The-Counter Hearing Aids](https://hearinghealthcenter.com/ask-the-audiologist/the-risks-of-over-the-counter-hearing-aids/) **Published:** May 28, 2026 **Author:** Ronna Fisher **Excerpt:** As more and more people turn to over-the-counter hearing aids, misinformation about them is increasing. Our guide provides you with the critical information you need to make the right decision about your hearing aids. **Content:** As more and more people turn to over-the-counter hearing aids, misinformation about them is increasing. While not for everyone, if you are looking to purchase OTC hearing aids, there are a few considerations. Our guide provides you with the critical information you need to make the right decision about your hearing aids. ## What To Evaluate Hearing Aids On When looking for a [pair of hearing aids](https://hearinghealthcenter.com/hearing-services-chicago/#hearing-aid "pair of hearing aids"), there’s a lot to consider. How they fit and how they sound are just some of the criteria I use when making suggestions to patients about their next pair. Before offering any options, here are the 13 factors we consider for your hearing aids: ![Hearing specialist fits OTC hearing aids for a patient in a clinic setting.](https://hearinghealthcenter.com/wp-content/uploads/2026/05/2-what-to-evaluate-hearing-aids-on.png "2 - what to evaluate hearing aids on - Hearing Health Center") 1\. **Speech understanding** (most important). People want to hear people, not just sounds. If you cannot be part of the conversation because of your hearing, then your hearing aids aren’t working as they should. 2\. **Evaluate speech understanding in various environments** (moderate noise, heavy noise from behind, groups). Different locations require different settings for your hearing aids. If they aren’t adaptable, they might not be your best choice. 3\. **Evaluate clarity, ease of understanding, and listening effort.** When wearing hearing aids, it shouldn’t be a struggle to understand what people are saying. 4\. **Noise management.** We need to see how quickly your hearing aids adapt to environmental changes. Does noise overpower the ability to understand? This is an important element to consider before purchasing. 5\. **Sound quality**. Simply, how do they sound listening to music, to TV, to everyday sounds (footsteps, paper)? Is it clear? Fuzzy? If the sound quality isn’t great, then look for other options. 6\. **Comfort and physical fit.** If your hearing aids are not comfortable or do not fit perfectly, the “best” hearing aids will fail. That’s where working with an audiologist is so important. Our team works with you to ensure your comfort levels and fit align to get the most out of your hearing aids. 7\. **Streaming and connectivity.** This is where many products fail. How do your hearing aids sound on the phone? Do they drop calls? How do they handle streaming music and switching devices? 8\. **Customization and flexible fitting** allow us to assess fit, tinnitus features, and adjustments for specific needs. The less flexibility, the fewer options you have to make the hearing aids work for you. 9\. **Feedback.** Do the hearing aids whistle when talking, eating, or wearing a hat? That could make things annoying and difficult to hear. 10\. **App features** matter a lot these days. Depending on the brand, it’s important to consider what adjustments the patient controls – volume, programs, customization, and the learning curve for older or non-techy patients. 11\. **Battery life,** like how long will the battery last in quiet and with streaming? How long do they take to charge? Purchasing a set of OTC hearing aids doesn’t pair you with a doctor who knows the ins and outs of what makes a set great. That’s why it’s so important to work with an audiologist when making this important decision. ## What are the Major Risks of OTC Hearing Aids? Over-the-counter (OTC) hearing aids can be genuinely helpful for many people, but they are not risk-free. As an audiologist who has worked with patients and hearing aids for decades, I’ve seen firsthand the benefits of custom fitting and adjustments for a better hearing experience. One of the major risks of purchasing OTC hearing aids is that without a professional diagnostic evaluation, you may overlook serious medical issues and delay proper treatment. Hearing aids might not be the solution to your problems. Some potential issues include: - [Earwax blockage](https://hearinghealthcenter.com/hearing-services-chicago/#ear-wax-removal "Earwax blockage") - Ear infection - Fluid in the ear - Sudden or one-sided hearing loss - [Tinnitus caused by something serious](https://hearinghealthcenter.com/hearing-services-chicago/#tinnitus-consultation "Tinnitus caused by something serious") ![Close-up of an older man touching his ear with two fingers, suggesting ear discomfort or pain.](https://hearinghealthcenter.com/wp-content/uploads/2026/05/3-major-risks.png "3 - major risks - Hearing Health Center") No audiologist means no fine-tuning for your specific needs and hearing profile. Another risk factor is the adjustments you make on your own. Some sounds may be over-amplified, which can worsen hearing damage. Other sounds may be under-amplified, making the device useless. That’s the quickest way for your OTC hearing aids to end up in the trash. Plus, your hearing won’t always stay the same. If there’s no adjustment to your devices as your hearing changes, then you risk a poor hearing aid experience. Don’t forget about fit. If devices do not fit properly, it can cause: - Ear canal irritation - Soreness or pressure - Moisture buildup that leads to infections That’s not to say OTC hearing aids aren’t good products, but they can lead to more serious problems if not addressed early. ## What to Expect When Adapting to OTC Hearing Aids? Over-the-counter hearing aids are not programmed, customized, or fine-tuned to your hearing configuration, lifestyle, or needs. Therefore, adaptation will take longer. The first suggestion is to ease in. While this is true for all hearing aids, it’s important still. Your brain has not heard many sounds in a long time; it takes time for your brain to accept and normalize them. Start in quiet environments and one-on-one conversations. Gradually try small groups, and then noisy places. Also, be consistent. Your brain adapts through repetition, so if you’re not using your hearing aids, you will never get used to them. Focus enough time on fit. Hearing aids should fit well and be comfortable. You should stop and get help if: - You feel any pain or pressure. - Your hearing gets worse. - You get ringing in your ears. - There is a big difference in the way you hear between your ears. - There is no improvement in your hearing. It generally takes 1-2 months to fully adapt to amplification. If you are still struggling after 4-6 weeks, it means the settings are not right, or the aids are not a good match for you. ## Want A Better Hearing Aid Experience? Book Online With Hearing Health Center. The audiologists at Hearing Health Center want to help you have a better experience with your hearing aids. [Book an appointment online](https://hearinghealthcenter.com/book-my-hearing-test-appointment/), or call any one of our five Chicagoland locations for a hearing test, hearing aid fitting, and so much more. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [What Your Ears Might Be Warning You About Your Heart](https://hearinghealthcenter.com/ask-the-audiologist/what-your-ears-might-be-warning-you-about-your-heart/) **Published:** June 5, 2026 **Author:** Ronna Fisher **Excerpt:** Have you been turning up the TV volume lately? Have you also been managing your blood pressure for years? Or your cholesterol? Or both?What many patients do not realize is that their hearing and cardiovascular health tend to move together. **Content:** Have you been turning up the TV volume lately? Are dinner conversations just a little bit harder to understand lately? Have you also been managing your blood pressure for years? Or your cholesterol? Or both? What many patients do not realize is that their hearing and cardiovascular health tend to move together. Continue reading to understand why they’re connected, and what you can do to improve your overall well-being. ## Your Inner Ear Has One Blood Supply Unlike most organs, the cochlea receives its entire blood supply through a single artery with no collateral circulation. Any disruption to that supply hits your hearing with nothing to soften the blow. ![Cross-section of the human ear showing outer ear to inner ear structures: ear canal, eardrum, middle ear with ossicles, cochlea, and auditory nerve.](https://hearinghealthcenter.com/wp-content/uploads/2026/06/2-Your-Inner-Ear-Has-One-Blood-Supply.png "2 - Your Inner Ear Has One Blood Supply - Hearing Health Center") For most parts of your body, you have neighboring blood vessels that can compensate, but not your inner ear. The cochlea, the spiral-shaped structure in your inner ear that converts sound waves into a signal, is supplied by[ a single terminal vessel, the labyrinthine artery, an end organ with deficient collateral circulation](https://pmc.ncbi.nlm.nih.gov/articles/PMC11097239/). When that supply is restricted, reduced, or interrupted, the cochlea absorbs the full impact. Inside the cochlea, a tissue called the stria vascularis maintains the precise electrochemical environment that enables hearing. It depends on a constant flow of oxygen and nutrients. A large 2025 population study found that[ hearing loss may serve as an early marker of systemic vascular dysfunction](https://pmc.ncbi.nlm.nih.gov/articles/PMC12680764/). Particularly for people managing diabetes, where elevated blood sugar damages the same inner ear microvasculature that cardiovascular disease affects. Because the cochlea depends on a delicate blood supply, hearing changes may sometimes appear alongside, or even before, other vascular complications. ## The Cardiovascular Conditions Most Linked to Hearing Changes ![Man seated on a couch clutching his chest in pain, with the chest area highlighted in red to indicate distress.](https://hearinghealthcenter.com/wp-content/uploads/2026/06/3-Cardiovascular-Conditions.png "3 - Cardiovascular Conditions - Hearing Health Center") Hypertension, atherosclerosis, elevated cholesterol, and heart disease restrict or injure the blood supply that the cochlea depends on to function. **High blood pressure** is both a direct threat and an accelerant. Sustained elevated pressure damages the linings of blood vessels. It also accelerates atherosclerosis, the progressive buildup of plaque that narrows the labyrinthine artery over time.[ A 2024 study found that nearly half of people with hypertension showed measurable hearing impairment: 49.4%, compared to 34.8% of those with normal blood pressure.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11107936/) That difference appeared across all frequency ranges, not just the high-frequency loss typically associated with aging. **Elevated cholesterol** has its own cochlear mechanism. High LDL and elevated triglyceride levels thicken vessel walls and reduce oxygen flow to inner ear structures.[ ](https://pmc.ncbi.nlm.nih.gov/articles/PMC11097239/) [Research has specifically linked dyslipidemia to sudden sensorineural hearing loss](https://pmc.ncbi.nlm.nih.gov/articles/PMC11097239/), the abrupt, often one-sided hearing drop that appears without obvious cause or warning. **Heart disease** is broadly evident in the prevalence data.[ ](https://pmc.ncbi.nlm.nih.gov/articles/PMC12680764/) [In one large study, cardiovascular disease was present in 16.7% of participants with measurable hearing loss, compared to 4.8% of those with normal hearing.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12680764/) A separate analysis of national health survey data found that[ individuals managing two or more cardiovascular risk factors carry an estimated 90% increased risk of hearing loss](https://pmc.ncbi.nlm.nih.gov/articles/PMC11929821/). These are associations that do not guarantee hearing problems. Having high blood pressure does not mean your hearing will decline, but there is often a clear overlap between the two. ## Pulsatile Tinnitus If the sound in your ears beats in time with your heartbeat, that’s [pulsatile tinnitus](https://hearinghealthcenter.com/hearing-services-chicago/#tinnitus-consultation "pulsatile tinnitus"), and it’s your ear picking up the sound of blood moving through your arteries. Most tinnitus, the ringing, buzzing, or hissing that many people experience, originates in the hearing system itself. Pulsatile tinnitus is different. It has a rhythm. It pulses. If you sit quietly and pay attention, you may notice it matches your heartbeat exactly. It’s the sound of turbulent blood flow in vessels near the ear, and the inner ear is sensitive enough to detect it. In older adults,[ the most common underlying cause of pulsatile tinnitus is atherosclerotic carotid disease](https://pmc.ncbi.nlm.nih.gov/articles/PMC12317842/), plaque buildup in the carotid artery, which changes the way blood sounds as it moves.[ ](https://pmc.ncbi.nlm.nih.gov/articles/PMC12317842/) [Pulsatile tinnitus accounts for about 4% of all tinnitus cases.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12317842/) The inner ear can sometimes reflect broader vascular health in ways many patients don’t realize Other symptoms with vascular origins are worth noting: gradual, low-frequency hearing loss; sudden one-sided hearing changes; or a persistent feeling of fullness or pressure in the ear that doesn’t resolve on its own. ## A Hearing Test Makes Sense as a Cardiovascular Health Step ![A small clinic with a windowed sound booth door open, next to a desk with a computer and medical equipment.](https://hearinghealthcenter.com/wp-content/uploads/2026/06/4-Hearing-Test.png "4 - Hearing Test - Hearing Health Center") A hearing test can detect changes in cochlear function that reflect how your circulation is performing, and it gives you a documented baseline to track against in the years ahead. You already monitor your blood pressure. You get your cholesterol checked on a schedule. Your inner ear is part of the same vascular system, and a hearing evaluation gives you a specific, documented picture of cochlear function at a moment in time. The pattern of the results (which frequencies are affected, how the loss is distributed, whether it’s symmetrical) can tell an audiologist something about its likely origin. If you’re managing hypertension, elevated cholesterol, heart disease, or if you’ve experienced any of the symptoms described here, a hearing test is a reasonable addition to the picture you’re already building. ## Schedule Your Free Comprehensive Hearing Exam Today Struggling with hearing loss or cardiovascular issues? [Schedule a free comprehensive hearing exam](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) with Hearing Health Center to understand your current situation better and find solutions to any of your hearing problems. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health --- ### [Itchy, Itchy Ears: Common Causes and Solutions](https://hearinghealthcenter.com/ask-the-audiologist/itchy-ears/) **Published:** April 24, 2026 **Author:** Ronna Fisher **Excerpt:** When asking about ears, every audiologist has heard this: “My ears don’t hurt, but they itch a lot!” Whether or not a person uses hearing aids, itching in the ears is very common. **Content:** When asking about ears, every audiologist has heard this: “My ears don’t hurt, but they itch a lot!” Whether or not a person uses hearing aids, itching in the ears is very common. But why? A lot of things can cause itching all over the body, and the ear is no different. I’ve briefly listed some common causes and solutions, but saved an in-depth look for conditions related to hearing aid issues. ## 3 Common Causes of Itchy Ears Itchy ears, while annoying, are often not a sign of more serious problems. Here are the three most common reasons we see patients with itchy ears. ### Dry Skin Itchy, dry skin in the ear canal can be caused by your environment. This includes cold, dry air in the winter and over-air-conditioned air in the summer. It can also be caused by over-cleaning (especially with cotton swabs, which can absorb natural oils too quickly) and by natural aging. #### Solution: Moisturize A drop or two of an oil like Miracell® in each ear at night will absorb while you sleep and often provides fast relief, but take care to never place oil in an ear that has a history of holes in the eardrum. Lotion on a little finger or a cotton swab can also be placed in the ear canal. Often, a humidifier can help with dry skin. ### Medical Conditions Medical conditions such as allergies, outer ear infections like “swimmer’s ear,” and eczema or psoriasis can cause or worsen itching in the ear canal. Surprisingly, high levels of stress or anxiety can be felt as itching and discomfort all over, including inside the ears. #### Solution: Seek Medical Treatment Ear, nose, and throat physicians can determine whether allergies or ear infections are the issue; physicians specializing in the ears, nose, and throat (“ENTs” or “otolaryngologists”) can prescribe appropriate treatments. Dermatologists, skin-specialized doctors, can help with diagnoses such as eczema and psoriasis, for which many treatments are available. If you think stress might be the problem, talk it out with a licensed counselor, psychologist, or psychiatrist. You may relieve yourself of more than just an itch. ### Hearing Aid Issues Although hearing devices don’t usually cause allergic reactions, there are other ways they might contribute to itching. If there is a **build-up of earwax**, a hearing aid can make it worse, causing itching or irritation until the ear is cleaned. If a **hearing aid sits too loosely inside the ear**, it can “tickle” the ear canal and cause itching. If a **hearing aid has a very tight fit in the ear** and is worn for a very long time each day, moisture can accumulate behind the hearing aid, causing a damp, itchy feeling (kind of like when you sweat in the summertime). While the hearing aids themselves are usually hypoallergenic, clients rarely experience **allergic reactions to cleaning solutions**, whether in our clinic or to over-the-counter versions used at home. #### Solution: See Your Hearing Care Provider The hearing care providers at HHC can work with you to assess the fit of your hearing devices (loose/tight) and recommend next steps and other changes or treatments. We can also look deeply into your ears, a process called “otoscopy,” to see whether dry skin, earwax, or an allergic reaction is the problem. When in doubt, contact your audiologist. ## How to Scratch Your Itchy Ears There’s nothing else like scratching an itch, but we have some recommendations for how to go about it to avoid causing more problems. Here are some techniques: #### The Push and Wiggle Placing a finger on the space in front of the ear and “wiggling” can help ease itching with or without a hearing aid in place. This is using the flat of your finger, not your fingernail! #### Re- adjust your hearing device If possible, remove and re-place your hearing aid, or pull the earbud in and out, to apply some pressure inside the ear and scratch that itch. #### “Referred” itching This one is a bit weird…Often used by people with missing limbs, “referred” itching is when you scratch an itch without actually scratching it. Instead of trying to reach deep inside your ear canal, gently scratching another part of your body (like the back of your hand) while thinking about your itchy ear (“referring” the itch to the ear) can provide surprising relief. I’ve used this myself when I get an itch on the bottom of my foot in the car. Sometimes it works. ## Could Itchy Ears Be Something Serious? ![Healthcare professional in blue gloves examining a patient’s ear with an otoscope.](https://hearinghealthcenter.com/wp-content/uploads/2021/03/image-1.png "image - Hearing Health Center") Most ear itching is minor and easily managed, but there are situations where it warrants prompt professional attention. Contact your audiologist or physician if you experience: - Persistent itching that doesn’t respond to home remedies after a week or two - Pain or pressure inside the ear, alongside the itching - Discharge or fluid coming from the ear canal - Muffled or changing hearing that coincides with when itching began - Visible redness or swelling around or inside the ear - Itching after a recent illness, including some viral infections, like shingles, can affect the ear canal and require prompt medical treatment These symptoms don’t always mean something serious is wrong, but they’re worth a professional look. Catching an infection, skin condition, or wax impaction early is almost always easier than waiting it out. ## Never Stick Something in Your Ear ![Close-up of a person’s ear with a cotton swab near the ear canal, overlaid by a red X indicating this is not advised.](https://hearinghealthcenter.com/wp-content/uploads/2021/03/image.png "image - Hearing Health Center") It’s always important to remember, don’t place foreign objects like Q-tips, bobby pins, long fingernails, pens or pencils, paperclips, or golf tees (yes, we’ve been told someone used a golf tee!) in your ears for itching or wax removal. These objects can push earwax toward the eardrum or cut the skin inside the ear, causing bleeding. When that cut begins to scab over and heal…it will itch even worse! ## Itchy Ears? Dealing with Hearing Loss? Book an Appointment at Hearing Health Center Today! If itching is persistent, worsening, or accompanied by pain, discharge, or muffled hearing, don’t wait it out. The team at Hearing Health Center is here to help identify the source and get you comfortable again. [Schedule an appointment](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) at any of our five convenient Chicagoland locations. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Earwax, Hearing Health, Symptoms --- ### [Roger Daltrey, Chicago (April 2016)](https://hearinghealthcenter.com/roger-daltrey/roger-daltrey-chicago-april-2016/) **Published:** May 2, 2016 **Author:** Ronna Fisher **Content:** I got my new hearing aids from Hearing Health Center when I was in town for a concert. I didn’t know I could hear like this. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press, Roger Daltrey, Testimonial --- ### [Dr. Ronna Fisher featured in Daily Herald](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-featured-daily-herald-4-3-17/) **Published:** April 5, 2017 **Author:** Ronna Fisher **Content:** **Please see the original article published here:** **http://www.dhbusinessledger.com/article/20170402/business/170409846/** ![Photo of Hearing Health Center audiologist Herald Daily](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Daily-Herald-4-17-17-300x169.jpg "Daily-Herald-4-17-17 - Hearing Health Center") # Audiologist serves the poor, celebrities for hearing health ![Photo of Hearing Health Center audiologist Kucec](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Kucec.jpg "Kucec - Hearing Health Center") Dr. Ronna Fisher, founder and audiologist with the Hearing Health Center, has worked with some of the biggest names in the music industry, including Lady Gaga, Kenny Rogers and Roger Daltrey. She fits the musicians and singers with ear monitors, so they can regulate what they hear on stage during their performances. She does that by making impressions inside the ear with a pliable material so the custom fit allows the monitor to fit well. ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Daltrey.jpg "Daltrey - Hearing Health Center")Fisher often goes to Chicago area music venues when doing ear monitors. But in the case of Hall of Fame rocker Roger Daltrey, lead singer of The Who, she went to his suite at the Ritz Carlton in downtown Chicago. “I was joking and asked him ‘Are you deaf,’ and his whole entourage nodded their heads,” laughed Fisher, 62. “I then asked him when was his last hearing test.” For 33 years, Fisher has been working with adults and children around the suburbs by providing hearing tests and hearing aids. She now has five offices in Naperville, Oak Brook, Highland Park and two in Chicago. She said many people lose their hearing for various reasons, including long-term exposure to loud noise, age and certain medications. As for Daltrey, he went to Fisher for a hearing test and was fitted with an aid about 3 years ago. Since then, Daltrey returns to her for a check up whenever he’s in town, she said. ![Photo of Hearing Health Center Dr. Ronna Fisher of Hearing Health Center, her patient and Batman](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Batman.jpg "Batman - Hearing Health Center")Fisher, who was born and raised in Pittsburgh, Pennsylvania, grew up while her father exhibited hearing problems. That’s what led her to become an audiologist. Besides local residents and the occasional celebrity, Fisher helps those who cannot afford to get a tests or aids through her Fisher Foundation for Hearing Health. “I’ve been in this business for 33 years and I still want to help people,” she said. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Dr. Ronna Fisher interviewed by Walter Jacobson](https://hearinghealthcenter.com/fisher-foundation/dr-ronna-fisher-interviewed-walter-jacobson/) **Published:** August 9, 2017 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation, Media & Press --- ### [Headphone Dangers](https://hearinghealthcenter.com/media-press/headphone-dangers-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Dr. Ronna Fisher and HHC featured on an NBC Chicago segment discussing the dangers of earbuds. Aired 5/2/06 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Protection, Media & Press --- ### [Ronna 40th Anniversary Video](https://hearinghealthcenter.com/news-press/ronna-40th-anniversary-video/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [EXTRA, EXTRA: Dr. Ronna Fisher Made the Cover](https://hearinghealthcenter.com/media-press/extra-extra-dr-ronna-fisher-made-the-cover/) **Published:** December 16, 2025 **Author:** Ronna Fisher **Excerpt:** In this feature, Dr. Fisher shares the personal loss that led her into audiology, the breakthroughs that shaped Hearing Health Center, and why hearing care has never been just about devices. **Content:** For more than 40 years, Dr. Ronna Fisher has helped people hear the moments that matter. Conversations at the dinner table. A grandchild’s laugh. The simple comfort of feeling connected again. Now, her story is front and center on the cover of *Highland Park Neighbors*. In this feature, Dr. Fisher shares the personal loss that led her into audiology, the breakthroughs that shaped Hearing Health Center, and why hearing care has never been just about devices. It’s about staying present in your life and the people you love. ## **Read the full *Highland Park Neighbors* feature below or by clicking [here](https://hearinghealthcenter.com/wp-content/uploads/2025/12/November-2025-HighlandParkNeighbors-Dr-Ronna-Fisher.pdf).** [November 2025 HighlandParkNeighbors Dr Ronna Fisher](https://hearinghealthcenter.com/wp-content/uploads/2025/12/November-2025-HighlandParkNeighbors-Dr-Ronna-Fisher.pdf)[Download](https://hearinghealthcenter.com/wp-content/uploads/2025/12/November-2025-HighlandParkNeighbors-Dr-Ronna-Fisher.pdf) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [A "Clarity Problem" featuring Walter Jacobson](https://hearinghealthcenter.com/hearing-issues/a-clarity-problem-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents ""A 'Clarity Problem'" featuring Walter Jacobsen **Content:** Hearing Health Center presents “”A ‘Clarity Problem'” featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues, Walter Jacobson --- ### [People Are Listening featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/people-are-listening-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents People Are Listening featuring Walter Jacobsen **Content:** Hearing Health Center presents People Are Listening featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [Brain Hearing and Ex Presidents featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/brain-hearing-and-ex-presidents-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents Brain Hearing and Ex Presidents featuring Walter Jacobsen **Content:** Hearing Health Center presents Brain Hearing and Ex Presidents featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [Dreading the Holidays featuring Walter Jacobson](https://hearinghealthcenter.com/ask-the-audiologist/dreading-the-holidays-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents Dreading the Holidays featuring Walter Jacobsen **Content:** Hearing Health Center presents Dreading the Holidays featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues, Walter Jacobson --- ### [What is a Balance Disorder?](https://hearinghealthcenter.com/ask-the-audiologist/about-balance-disorder/) **Published:** May 9, 2017 **Author:** Ronna Fisher **Content:** Balance disorders are very difficult to diagnose and treat because there is often more than one underlying cause. Knowledge of all the sensory systems that contribute to balance as well as how each system works together and interacts with the brain is essential. ##### How are balance disorders caused? - Benign Positional Vertigo (BPPV) – BPPV is the number one cause of all dizziness. It involves intense, brief episodes of vertigo associated with a change in the position of your head, often when you turn over in bed or sit up in the morning. - Vestibular Neuronitis – inflammation of the inner ear - Ménière’s Disease – a buildup of fluid in the inner ear - Vestibular Migraine – dizziness and vertigo that may or may not be accompanied by headaches - Head Trauma - Multiple Sclerosis - Stroke and heart attack - Slow-growing tumors - Joint and muscle weakness - High or low blood pressure - Viral infections ##### How are balance disorders diagnosed? - **Case History:** one of the most important components in diagnosing balance disorders. Details about the imbalance can often determine which part of the inner ear or brain is involved. - **Diagnostic Hearing Evaluation:** the hearing system and the vestibular system are very close in physical proximity. They function together. Any part of the ear can cause and/or contribute to a loss of balance. - **Auditory Brainstem Response:** tests both the ear and the brain by measuring the timing of electrical waves from the brainstem. - **Voluntary Eye Movement Testing:** measures the ability to coordinate eye movements with head movements crucial for walking, driving, etc. - **Videonystagmography (VNG):** computerized testing that measures, records and analyzes eye movements under various conditions. - **Computerized Dynamic Posturography (CDP):** measures and tracks all of the components (eyes, inner ear, muscles and joints) involved in maintaining balance. ##### How are balance disorders treated? Treatment of balance disorders consists of Vestibular Rehabilitation and Balance Retraining. An individual treatment plan is designed for each patient based upon the patient’s history, the findings from the diagnostic testing performed and the functional limitations caused by the imbalance. ##### The goals of all treatment plans are: - Decreasing or eliminating dizziness/vertigo - Improving balance function and safety - Improving visual motor control and tolerance of motion - Increasing activity levels - Reducing falls or risks of falls ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Symptoms --- ### [Hidden Hearing Loss](https://hearinghealthcenter.com/ask-the-audiologist/hidden-hearing-loss/) **Published:** June 13, 2017 **Author:** Ronna Fisher **Content:** OR WHY YOU CANNOT UNDERSTAND WHEN YOUR HEARING IS NORMAL *by Dr. Ronna Fisher Au.D. FAAA* “How is your dad?” Jeremy asked his boss sitting across the table at a recent dinner party. “He died,” said his partner. “That’s great. Tell him I said hello.” Jeremy knew something was wrong from the stricken look on everyone’s face. When his wife leaned over and whispered, “He said his father died.” Jeremy wanted to crawl under the table and disappear. He thought his boss said, “He’s fine.” Jeremy called his doctor the next morning to get his hearing checked. He was only 42, but this was not the first time Jeremy had misunderstood. He was having more trouble hearing in court, making out what his wife said from another room and sometimes even when he was in the same room. He was surprised when the doctor told him the tests were normal and his hearing was fine. “You just need to pay more attention,” his doctor said. Jeremy’s struggle to understand in everyday listening situations is not uncommon. Studies over the last 10 years show that changes and deterioration of auditory processing in the brain begins at age 40. These changes are not detectable on a hearing test. **SO WHAT HAPPENS WHEN YOU TURN 40?** Hearing vs understanding. They are not the same. **Hearing** is about loudness. If your hearing goes down, you just make the sound louder, right? ***Wrong!*** As any wearer of hearing aids knows, making them louder does not make them clearer. Turning up the volume does not mean you are going to understand any better. **Understanding** is about processing. Your brain has to sort out, filter and make sense of all the sounds it receives. How does it do that? What does your brain need so you can understand clearly? - **Temporal Processing** – the rate at which we can process auditory information. The ability to follow rapid changes in speech, music and other sounds. - Have you ever thought that kids talk too fast? They are on their third sentence and you are still processing the first one. Kids do not talk any faster than they always did. Your temporal processing has slowed down. The slower your temporal processing, the more time you will need to understand what someone is saying. - **Working Memory** – the mental sticky note we use to temporarily store and use information. Often used synonymously with short-term memory, working memory is critical for learning, reasoning and decision-making. - When you have difficulty understanding, your brain has to concentrate more and listen harder. You brain is so intensely focused on trying to understand, that it does not have the resources to transfer the information to your memory. Therefore, even if you “get it” your brain cannot store it. - **Auditory Distraction** – irrelevant sounds that break through your attention and focus and impairs your cognitive function. In order to participate in a conversation, especially in a difficult listening environment, your brain has to separate all of the incoming sounds and focus on one of them. Beginning at around age 40, the brain cannot filter out distracting information as well as it used to. The ability to encode and retrieve words severely erodes in “background babble.” **WHAT CAN YOU DO?** While you cannot change Mother Nature, there are a few things you can do to help you understand more clearly - If you can, turn off the TV, Radio, Music and any other distracting sounds - Eyes help make up for what the ears miss. Try to face and look at the person with whom you are speaking - In restaurants, try to sit in a booth or a table where you are facing the wall and the noise is behind you. - Hearing aids and PSAP’s (Personal Sound Amplifying Products). The solution for most people with a hearing problem, attention deficit disorder, or focus issues, is usually to make the signal (speech) louder than the noise or distraction. Amplifying the speech, even when hearing tests are normal, allows for easier listening and less distractions. Increasingly, hearing aids and the lower cost counterparts, PSAP’s (which are not intended to correct hearing but make sound louder) are being fit and worn to use in those distracting and difficult situations or anytime when understanding clearly is a problem. --- ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/staff_ronna.jpg "staff_ronna - Hearing Health Center")**Dr. Ronna Fisher, Au.D., FAAA, Founder and President of Hearing Health Center** Dr. Fisher received her doctoral degree in Audiology from the Pennsylvania College of Optometry. She is a fellow of the American Academy of Audiology, has earned the Certificate of Clinical Competence from the American Speech-Language and Hearing Association, and is an active member of the Academy of Dispensing Audiologists, American Tinnitus Association, and the Illinois Academy of Audiology. --- - – Beck DL. (2015) [Invisible Hearing Loss](http://www.audiology.org/news/invisible-hearing-loss) American Academy of Audiology Web site. - – Fullgrabe C, Moore BCJ, Stone MA. (2015) [Age-group Differences in Speech Identification Despite Matched Audiometrically Normal Hearing: Contributions from Auditory Temporal Processing and Cognition](http://journal.frontiersin.org/article/10.3389/fnagi.2014.00347/abstract). *Frontiers*. - – Grose GH, Mamo SK, Buss E, Hall JW. (2015) Temporal Processing Deficits in Middle Age. *American Journal of Audiology* 24:91. - – Helfer KS, Vargo M. (2009) Speech Recognition and Temporal Processing in Middle-Aged Women. *Journal of the American Academy of Audiology*20(4):264-271. - – [**Baycrest Centre for Geriatric Care**](http://www.baycrest.org/). - – [bit.ly/bg-babble](http://Bit.ly/bg-babble) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues --- ### [Why you may have normal hearing, but still can’t understand](https://hearinghealthcenter.com/ask-the-audiologist/may-normal-hearing-still-cant-understand/) **Published:** July 10, 2017 **Author:** Ronna Fisher **Excerpt:** Scientific evidence shows that there is a difference between what causes problems with hearing speech while in a noisy area versus the causes of problems hearing sound. **Content:** Scientific evidence shows that there is a difference between what causes problems with hearing speech while in a noisy area versus the causes of problems hearing sound. Exposure to loud noises effects the brains ability to listen selectively to speech. [Click here ](http://www.foxnews.com/health/2016/09/27/cant-hear-in-noisy-places-its-real-medical-condition.html)to read more about why you may have problems hearing someone talking in a noisy area, but still have normal hearing. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Communication Issues, Hearing Issues --- ### [Dr. Ronna Fisher Featured on WCIU's "The Jam" Morning Show Discussing Early Hearing Loss](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-featured-wcius-jam-morning-show-discussing-early-hearing-loss/) **Published:** September 13, 2017 **Author:** Ronna Fisher **Content:** The Jam’s Danielle Robay sits down with Dr. Ronna Fisher from the Hearing Health Center to get details on a particular hearing loss, and to make people aware of these happenings at an early age. Watch the video here: ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [10-Year-Old Raises Hearing Awareness](https://hearinghealthcenter.com/fisher-foundation/10-year-old-raises-hearing-awareness/) **Published:** October 16, 2017 **Author:** Ronna Fisher **Content:** At Hearing Health Center, we are always inspired by those giving back to their communities. Meet 10-year-old Braden Baker, who is hearing impaired and has dedicated his young life to raising funds for those who can’t afford to buy hearing aids. Watch his recent segment on the Ellen show to see how he’s been changing lives around the world! Similar to Braden’s efforts, the [Fisher Foundation](http://fisherfoundationforhearing.org/our-story/) (founded by Hearing Health Center’s president, Dr. Ronna Fisher) provides hearing healthcare and support to those in need and unable to afford services. It is heartwarming to know that the Fisher Foundation belongs to the same community of people who want to make a difference in someone’s life. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [Hunting & Hearing Loss: And POP! Goes my Hearing!](https://hearinghealthcenter.com/hearing-issues/pop-goes-hearing/) **Published:** January 15, 2018 **Author:** Ronna Fisher **Content:** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/hunter-640x405-1.jpg "- Hearing Health Center")University of Wisconsin conducted a study and found that men aged 48 to 92 who hunted regularly were more likely to experience high-frequency hearing loss, a risk that increased seven percent for every five years a man had been hunting. **People who regularly participate in target shooting or have done so in the past year are more at risk for hearing loss.** Did you know the kind of gun you use changes your risk of hearing loss? THE ONLY SHOOTING THAT DOES NOT HURT YOUR HEARING IS FROM A BB OR PELLET GUN! Even bystanders are at risk! If you shoot a bow but are around others using guns, you need to have hearing protection on as well! **Tips for Shooters to Reduce Hearing Loss Risks** - Keep disposable hearing protective devices on hand. - Double-protect when using large-caliber guns or when many shots will be fired. - Consider smaller calibers (for example, a 7mm-08 rifle instead of a .30-.06, or a 20-gauge shotgun rather than 12-gauge). - Choose a single-shot or bolt-action over a semi-automatic weapon. - Avoid shooting in groups, especially at indoor or enclosed firing ranges. - Choose firearms with longer barrels (farther from the ear). - Consider using low-recoil (low-noise) ammo. - When hunting in a blind, make sure the muzzle is outside the blind before pulling the trigger. - Use nonlinear or appropriate electronic ear protection for hunting. If you plan to be in any sort of loud environment, contact Hearing Health Center to discuss your hearing protection options! *Written by: Ali Marquess, Audiology Technician* ***Citations*** *Flamme, G. A., Wong, A., Liebe, K., & Lynd, J. (2009). Estimates of the auditory risk from outdoor impulse noise II: Civilian firearms. Noise Health, 11, 231–242.* *Nondahl, D. M. “Recreational Firearm Use and Hearing Loss.” Archives of Family Medicine, vol. 9, no. 4, Jan. 2000, pp. 352–357., doi:10.1001/archfami.9.4.352.* *Stewart, PhD Michael. “Bigger Caliber, Bigger Boom.” The ASHA Leader, American Speech-Language-Hearing Association, 1 Feb. 2013, leader.pubs.asha.org/article.aspx?articleid=1784775.* *Feb 2013, ASHA Leader, Vol 18, 48-53.* ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues, Hearing Protection --- ### [The Link Between Heart Issues and Hearing Loss](https://hearinghealthcenter.com/hearing-issues/the-link-between-heart-issues-and-hearing-loss/) **Published:** February 13, 2018 **Author:** Ronna Fisher **Content:** ![The Link Between Heart Issues and Hearing Loss](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/valentines-day-background_fkFs_jO_-612x252-300x124-1.jpg) February is American Heart Month. The American Heart Association reports that heart disease is the leading cause of death in both men and women, with nearly 787,000 deaths in the United States linked to heart disease, stroke and other cardiovascular diseases in 2011 or 1 in 3 people. For women, cardiovascular disease ranks as the number 1 killer, resulting in more deaths than all forms of cancer. These statistics alone push cardiovascular disease to the top of the list for America’s most serious health issue. Cardiovascular disease presents a variety of different complications including high blood pressure, arrhythmia, stroke and heart attack. Recently a growing body of research is also linking hearing loss and heart disease. A study conducted by Harvard University cited a staggering relation between heart disease and hearing loss finding “hearing loss occurred 54% more often in people with heart disease then in the general population.” Hearing loss is one of the most common physical ailments for the general public, third only to heart disease and arthritis respectively. So what is the heart-hearing link? Cardiovascular disease is a disease of the heart and blood vessels. Many of the problems surrounding heart disease are a direct result of a condition called atherosclerosis in which plaque builds up on the arteries, narrowing the arterial path, making it harder for blood to flow through the veins, arteries and ultimately bodily organs. The inner ear is extremely sensitive to blood flow. If blood flow is inadequate, interrupted or the vessels suffer a trauma, the result can be damage to the inner ear nerves, negatively impacting a person’s ability to hear. In fact, the nerves in the inner ear as so fragile that Harvard researches believe they may be the first organ affected by cardiovascular disease. In essence, hearing loss may be one of the earliest indicators of heart disease. A leading researcher in the area of the heart-hearing link is David R. Friedland, MD, PhD, Professor and Vice-Chair of Otolaryngology and Communication Sciences at the Medical College of Wisconsin in Milwaukee. He has been studying the relationship for years and says “The inner ear is so sensitive to blood flow that it is possible that abnormalities in the cardiovascular system could be noted here earlier than in other less sensitive parts of the body.” Subsequently, a healthy cardiovascular system can have a positive impact on hearing. It’s important to adopt a lifestyle that supports both a healthy heart and healthy hearing. The American Heart Association suggest the following to a healthier life: get active, reduce stress, eat healthy, lose weight, quit smoking, get adequate sleep, watch your cholesterol, manage blood pressure, and reduce your blood sugar and risk for diabetes. Also, incorporate hearing checks into your routine medical exams. Cardiovascular disease is the cause of more deaths than cancer, chronic lower respiratory diseases, and accidents combined. It is not only the leading cause of death in America, but globally accounts for 17.3 million per year with the American Heart Association estimating that number to grow to more than 23.6 million by 2030. A healthy heart and hearing are not only beneficial to one’s physical well-being but are also beneficial to a positive outcome and an optimum quality of life. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues, Symptoms --- ### [Roger Daltrey & Hearing Loss: “You’ve Let Me Keep Doing What I Love.”](https://hearinghealthcenter.com/roger-daltrey/roger-daltrey-hearing-loss-youve-let-me-keep-doing-what-i-love/) **Published:** July 16, 2018 **Author:** Ronna Fisher **Excerpt:** Roger Daltrey, lead singer of the iconic rock group, The Who, said, “Dr. Ronna Fisher, at Hearing Health Center, is the only person I trust with my hearing.” Near the end of Monday night’s performance of the rock opera, Tommy, at Ravinia Festival, Daltrey talked about the struggles with his hearing loss. “Do yourself a favor, he told the standing ovation crowd, go get your hearing checked. It’s more important than you know.” Learn more tag www.hearinghealthcenter.com **Content:** Roger Daltrey, lead singer of the iconic rock group, The Who, said, “Dr. Ronna Fisher, at Hearing Health Center, is the only person I trust with my hearing.” Near the end of Monday night’s performance of the rock opera, Tommy, at Ravinia Festival, Daltrey talked about the struggles with his hearing loss. “Do yourself a favor, he told the standing ovation crowd, go get your hearing checked. It’s more important than you know.” Learn more tag www.hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Roger Daltrey, Testimonial --- ### [Hearing Loss and Depression](https://hearinghealthcenter.com/ask-the-audiologist/hearing-loss-and-depression/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** **Hearing loss is the most common chronic condition associated with depression in people 60 years or older** (JAMA Otolaryngology – Head and Neck Surgery. 2017), particularly in women. The National Council on Aging found that wearing hearing aids helps prevent social isolation and depression. Most impressive is the study published in the Archives of Gerontology and Geriatrics showing a marked improvement in emotional, social and cognitive conditions after wearing hearing aids for just three months. Individuals with hearing loss show a 40% accelerated rate of cognitive decline (*Frank Lin, MD., Ph.D., Johns Hopkins*). With significant to profound the hearing loss, there is a greater the likelihood of developing a cognitive disorder and the steeper decline in mental function. Even those with a very mild hearing loss (even before the hearing loss becomes noticeable), these individuals show accelerated rates of gray matter shrinkage in the brain. **THE LINK** “Belongingness” is a basic and innate human emotional need. According to Roy Baumeister and Mark Leary, all human beings need a certain minimnum quantiy of regular, satisfying interactions. Inability to meet this need results in loneliness and mental distress. The desire to form and maintain social bonds is among the most powerful human motives. Without social bonds, the ability to self-regulate suffers. (*Baumesiter, R. F., DeWall, C. N., Ciarocco, N. J., & Twenge, J.M. (2005),* Social exclusion impairs self-regulation. Journal of Personality and Social Psychology, (88)4, 589.) Humans have a profound need to connect with others and gain acceptance into social groups. **[When relationships deteriorate or when social bonds are broken, depression may set in.](https://hearinghealthcenter.com/blog/definitive-link-between-hearing-loss-and-alzheimers/)** The world over, in every country, culture and religion, people are most happy when they are with those they care about and love**[. It is a frustrating and isolating feeling to be with those who you hold dear only to feel left out because you do not understand the conversations and cannot participate in sharing](https://hearinghealthcenter.com/blog/how-hearing-loss-affects-your-family/).** According to Steger, M. F., & Kashdan, (T. B. 2009) people who are depressed often feel unable to satisfy their need for belonging, leading to having fewer intimate relationships. They also induce negative feelings and reactions in others, which consequently elicits rejections. The effects of rejection are more potent than the effects of acceptance because rejection causes emotional hurt and pain (Buckley, Winkel and Leary). **WHAT YOU CAN DO** **[Get a baseline hearing test](https://hearinghealthcenter.com/make-an-appointment/)** and brain processing evaluation now. If you have any hearing or processing difficulties, seek immediate treatment. ![RONNA-2017-HEADSHOT](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg) Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues, Symptoms --- ### [Your Hearing and Balance](https://hearinghealthcenter.com/ask-the-audiologist/your-hearing-and-balance/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** #### **Falls and Balance** **Dizziness and balance problems increase significantly with age.** Over 70% of those over age 65 seek treatment and one third of everyone over 65 will fall. (Center for Disease Control). Falls are the leading cause of death over age 65. **THE LINK** **A recent study done by Johns Hopkins School of Medicine and the National Institute on Aging found that hearing loss significantly increase the risk of falling. The news could have far-reaching implications when it comes to preventing falls and maintaining independent lives.** **[There are several reasons why a decrease in hearing increases balance problems and the risk of falling.](https://hearinghealthcenter.com/blog/about-balance-disorder/)** Hearing loss decreases awareness of of people, pets or other sounds in the environment. Spatial awareness, i.e. where the body is positioned in relation to other people and objects around it, and is crucial for maintaining gait and balance. In addition, many researchers point to cognitive overload as a hindrance to balance Research as to whether hearing aids helped maintain balance were resoundingly conclusive – the results were overwhelmingly **YES.** Sound information alone, coming through the hearing aids, plays a large role in maintaining balance. **WHAT YOU CAN DO** [**Get a baseline hearing test now**](https://hearinghealthcenter.com/book-my-hearing-test-appointment/)**. Make a list of your current medications. Report any balance, dizziness or vertigo issues and symptoms to your audiologist. Physical therapy, balance training and exercises are effective in treating 85% of all balance and dizziness problems. If you have any balance, hearing or clarity problems, seek treatment immediately.** ![RONNA-2017-HEADSHOT](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg "RONNA-2017-HEADSHOT") Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues, Symptoms --- ### [Sudden Hearing Loss (SSHL)](https://hearinghealthcenter.com/ask-the-audiologist/sudden-hearing-loss-sshl/) **Published:** December 18, 2019 **Author:** Ronna Fisher **Content:** ### What to do if you suddenly experience hearing loss As a Patient Care Coordinator, nothing is more alarming then getting a frantic call from a patient in panic mode because they suddenly lost their hearing. Working at the front desk and handling calls from patients at the Chicago office for the last six years, I’ve noticed an increase in these cases of sudden idiopathic hearing loss, or “sudden deafness”. This phenomenon, known as Sudden Sensorineural Hearing Loss (SSHL) is often unexplained. Although the exact cause, in many cases, is unknown, some causes for SSHL are barotrauma, certain medications, a viral attack and autoimmune disorders. SSHL is characterized as a rapid loss, usually in one ear, either all at once or over the course of a few days. It concerns me that patients often do not realize the severity of their sudden hearing loss. Permanent ramifications, such as irreversible hearing impairment and/or constant ringing in the ear, called tinnitus, can result if the loss is not treated immediately. Working in one of the premier audiology offices in the world, I know what is at stake for these patients, and always find ways to fit them in to see one of our Doctors of Audiology. The audiologist first determines that the sudden hearing loss is not due to allergies, sinus infection, earwax clogging the ear canal, or other common conditions. If the loss is indeed SSHL, we refer immediately to an ENT (Otolaryngologist), or the nearest ER. Oral steroids or steroid injections into the ear is the standard treatment for SSHL. Steroids can minimize and/or reverse the hearing loss. Most importantly, know that you are not alone. If you experience sudden deafness, the hearing professionals at the Hearing Health Center will do everything they can to combat the hearing loss and return your hearing back to normal. **Resources:** NIDCD (National Institute on Deafness and other Communication Disorders) Fact Sheet (1) Sudden Deafness NIH Pub. No. 00-4757 March 2018 The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech and language. Visit the NIDCD website at to search the directory. NIDCD Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 Toll Free Voice: 800-241-1044 Toll Free TTY: 800-241-1055 Email: Web: [www.nidcd.nih.gov](http://www.nidcd.nih.gov/) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Issues, Symptoms --- ### [Am I Suffering From Tinnitus?](https://hearinghealthcenter.com/ask-the-audiologist/am-i-suffering-from-tinnitus/) **Published:** April 1, 2025 **Author:** Ronna Fisher **Content:** Struggling with ringing in your ears? Dealing with a constant buzzing sound? If so, you might be among the millions affected by tinnitus, a sometimes debilitating condition that causes ringing, buzzing, or hissing sounds in your ears. Tinnitus is one of the most common yet difficult conditions to deal with. Symptoms include sleep loss, difficulty concentrating, and even dizziness. If you’re unsure whether you have tinnitus or want to learn more about it for a loved one, our guide to tinnitus helps you identify the common symptoms, causes, and available relief options to keep your and your loved ones’ hearing health in mind. ## What is Tinnitus? Tinnitus is the perception of sound in one or both ears without an external source. This sound may take different forms, including: - Ringing - Buzzing - Hissing - Clicking - Roaring Tinnitus is most often caused by an underlying ear condition, such as hearing loss, an ear injury, or a problem with the circulatory system. There are four common types of tinnitus: subjective, objective, pulsatile, and somatic. Each affects people differently; some struggle with daily activities, whereas others’ symptoms fluctuate. Hearing loss, stress, and anxiety all have the potential to increase the intensity of tinnitus, so it’s best to work with a trained audiologist if you or someone you love is suffering from tinnitus. ## How Common is Tinnitus? ![](http://new.hearinghealthcenter.com/wp-content/uploads/2025/04/2-1.png)Tinnitus is relatively common in the United States. Around 25 million adults reported experiencing tinnitus in the past year, with approximately 14% worldwide suffering from the condition. Around 2% of those cases are severe, resulting in difficulty concentrating and other negative impacts on daily life. As you get older, you become more likely to experience tinnitus. That’s because of normal age-related hearing loss, and the wear and tear experienced on your inner ears cells. When those cells become damaged, the brain interprets the electrical signals along the nerve from your ear to your brain as sound. ## What Causes Tinnitus? Tinnitus is often linked to hearing loss, but several factors can contribute to its development, including exposure to loud noises, age-related hearing loss, ear infections, ear wax blockages, medications, and other health conditions. You increase your risk of tinnitus if you work in a noisy environment like a construction site, frequently attend loud concerts, or use headphones for extended periods. The same goes for ignoring ear infections or ear wax blockages. If left untreated, you will likely experience temporary or permanent tinnitus. Tinnitus is sometimes linked to other medical conditions, including: - High blood pressure - Cardiovascular diseases - Ménière’s disease While occasional tinnitus symptoms might not be an immediate concern, please contact your doctor if the ringing persists for more than a day, you’re experiencing hearing loss, or you’ve lost the ability to concentrate during the day due to the noise. At that point, an expert audiologist can examine your ears and provide the right treatments to protect your hearing and mental health in the long term. To diagnose tinnitus, an audiologist will perform a series of hearing exams, and if there is a more serious concern, schedule imaging and blood tests to ensure any other underlying problems can be addressed. ## How Do You Treat Tinnitus? ![](http://new.hearinghealthcenter.com/wp-content/uploads/2025/04/3.png)Unfortunately, there is no cure for tinnitus. That being said, numerous treatment options are available that can help reduce its impact on everyday life. The first is hearing aids. Since most tinnitus cases overlap with hearing loss, hearing aids amplify sound to help make tinnitus less noticeable. Another option is to use white noise machines, nature sounds, or background music to help mask tinnitus and provide relief. Lifestyle adjustments are also recommended to help with tinnitus treatment. These might include avoiding situations with loud noises, reducing caffeine intake, and maintaining a healthy diet. Some audiologists might suggest cognitive behavioral therapy to assist with any anxiety, stress, or other reactions to tinnitus symptoms. The good news is that tinnitus is treatable, and millions of people living with the condition live happy, fulfilling lives. ## Ready to Protect Your Hearing Health? Tinnitus is frustrating, but you don’t have to deal with it alone. If you’re experiencing persistent ringing, buzzing, or phantom sounds, schedule an appointment with Hearing Health Center to help diagnose and manage your tinnitus. Don’t let tinnitus take over your life; [schedule a hearing exam](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) with Hearing Health Center today. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues, Symptoms, Tinnitus --- ### [Crackling in Ear: What Does it Mean and How to Treat It](https://hearinghealthcenter.com/ask-the-audiologist/crackling-in-ear-what-does-it-mean-and-how-to-treat-it/) **Published:** February 10, 2026 **Author:** Ronna Fisher **Excerpt:** Have you ever experienced a mysterious crackling sound haunting your ear, seemingly attacking you out of the blue? If so, you may be wondering about this irritating sound and if you should be concerned about it. **Content:** Have you ever experienced a mysterious crackling sound haunting your ear, seemingly attacking you out of the blue? If so, you may be wondering about this irritating sound and if you should be concerned about it. This blog will unveil the secrets behind this peculiar yet annoying sound. Let’s dive into the captivating journey of crackling sounds in the ear, understanding what they are, the early signs, and the treatments to explore. ## What Is Crackling In The Ear? Crackling in the ear symbolizes a peculiar sound similar to the crinkling of paper or the rustling of leaves. It can be annoying and even unnerving if it happens frequently enough. We often refer to it as a clicking, popping sound in the ear or a persistent snapping noise. These noises make it difficult to focus on the work or their surroundings. Causes include: - Eustachian tube movement - air pressure fluctuation - excessive earwax - muscle contractions While harmless, ear crackling can be bothersome and may indicate an underlying issue that warrants further investigation. *Struggling with popping in your ear? Schedule your free consultation with Hearing Health Center today.* ## The Three Biggest Causes of Crackling in Ear Sometimes the crackling in your ear is coming from an area near the ear, or a more specific medical condition. If the crackling conditions continue, consider one of the following: ![](https://hearinghealthcenter.com/wp-content/uploads/2023/08/2-three-biggest-causes-of-crackling-in-ear.png "2 three-biggest-causes-of-crackling-in-ear - Hearing Health Center") ### TMJ Disorders Your temporomandibular joint (TMJ) sits right next to your ear canal. If your jaw is misaligned or you’re dealing with teeth grinding, the clicking you hear is actually your jaw joint popping. ### Middle Ear Myoclonus (MEM) Think of this as a “twitchy eye” but inside your ear. Tiny muscles (the stapedius or tensor tympani) can sometimes spasm rhythmically, causing a seemingly random thumping or clicking noise. ### Patulous Eustachian Tube (PET) Dysfunction Most of the time, the Eustachian tube remains closed and only opens when you swallow or yawn. For people with PET Dysfunction, the tubes stay open constantly, causing “autophony,” a condition in which your breathing sounds echo or distort, often accompanied by crackling. ## Five Early Signs Of A Crackling Sound In The Ear Early signs of ear crackling can vary depending on the underlying cause. Listed below are five common early signs that you must watch out for in case of something more serious going on: 1. **Popping & Clicking:** You may notice popping or clicking sounds in one or both ears, similar to popping bubbles. 2. **The Sensation of Pressure:** You might feel pressure in the ear, as if something is blocking it. 3. **Mild Discomfort:** You may experience slight discomfort in the ear, which can be referred to as a sensation of mild pain or extreme itchiness. 4. **Fluctuation in Hearing Sensitivity:** You might observe subtle changes in your ability to hear or even a slight reduction in hearing sensitivity, especially in the affected ear. 5. **Temporary Hearing Loss**: Frequent episodes of temporary hearing loss or muffled sounds in your affected ear lasting for short periods are early signs of ear crackling. It is essential to remember that these signs vary depending on the underlying causes. If you experience any of these signs or have concerns about ear crackling, it is advised to consult medical professionals, including ENT specialists, for a proper diagnosis. ## How To Preserve Your Ear From Crackling Sounds? To preserve ear health and minimize crackling sounds, the best approach is simple ear health maintenance. ![](https://hearinghealthcenter.com/wp-content/uploads/2023/08/3-how-to-preserve-your-ears-from-crackling.png "3 how-to-preserve-your-ears-from-crackling - Hearing Health Center") First, keep your ears clean and prevent excessive earwax buildup. Excessive earwax is a key contributor to the crackling sound and could lead to hearing damage if not treated appropriately. If you work in a noisy environment or just love concerts, wear protective headphones (or safety earbuds). This is another instance of something that may not bother you in the moment but could cause serious injury later in life. During activities like flying or swimming/scuba diving, it is advised to yawn or swallow to equalize pressure in your ears. Also, this is very important. Do not use cotton swabs, car keys, or any other object to clean your ears. Wonder why? Other than the obvious, any foreign object inserted into your ear pushes earwax deeper, causing damage to your delicate structure. Lastly, drink enough water to maintain proper Eustachian tube function, facilitate equalization of pressure, and minimize the likelihood of crackling sounds. ## How To Get Rid Of The Crackling Sound In The Ear? The different treatments for the crackling sound you’re hearing really depend on the underlying cause. That’s why your audiologist will first focus on finding the reasons why it’s happening, then present you with a treatment plan. One of the most common treatments begins with earwax removal. An audiologist will perform ear irrigation or use specialized tools to remove the buildup in a safe manner. If you have issues caused by blockages, nasal congestion, or improper pressure equalization, the next step might be Eustachian Tube Dysfunction Management. In case of ear infection or inflammation, antibiotics or anti-inflammatory medications should be prescribed to alleviate symptoms and resolve the underlying problems. If the crackling sound is accompanied by tinnitus, treatments like CBT (Cognitive Behavioral Therapy), Sound Therapy, and TRT (Tinnitus Retraining Therapy) are recommended to help manage the symptoms. For cases where muscle tension or spasm contributes to the crackling sound, techniques such as physical therapy, jaw exercises, and relaxation exercises help reduce tension and offer immense relief. The best way to address ear crackling is to identify the underlying cause and work with your audiologist to resolve it. ## When to Worry About Crackling in Your Ear ![](https://hearinghealthcenter.com/wp-content/uploads/2023/08/3-how-to-preserve-your-ears-from-crackling-2.png "3 how-to-preserve-your-ears-from-crackling (2) - Hearing Health Center") While most of the time, nothing to worry about, if you suddenly experience any of these additional symptoms, it is time to call a doctor right away. ### Sudden Hearing Loss If everything suddenly goes quiet, this becomes a medical emergency. The sooner you get treatment (often within 48 hours), the better the chance of recovery. ### Vertigo Vertigo is when the room starts to spin, or you become dizzy. If you are suffering from this, it might mean you have an inner ear infection or Vestibular issues that, when left untreated, can cause long-term hearing problems. ### Drainage It can be unsettling to see blood, pus, or clear fluid leaking from the ear canal, and it’s time to call a medical professional because this is an emergency. ### Facial Weakness Any drooping or facial numbness can be a sign that the nerves running near the ear are under significant stress. You should call a doctor immediately if you notice these signs. ## How To Safeguard Young Kids Against Loud Noises? Studies have shown that long-term hearing damage isn’t always the result of a single instance, but rather the combination of loud noises over significant periods of time. Since you don’t lose all of your hearing at once, you’ll gradually lose your ability to hear if you don’t get regularly scheduled hearing checks. Step one is to limit exposure. Minimize exposure to loud sounds, especially during fireworks, machinery, and TV time. Also, offer properly fitted ear protection, such as earplugs or earmuffs to kids when in a noisy environment. Second, make sure all electronic devices, media, and toys have volume limitations. The goal is to avoid prolonged exposure to loud noises. You may also consider creating separate quiet areas at home for young kids where they can relax and take a break from the noise. By practicing these measures, parents can safeguard their kids against damage caused by loud sounds. ## Need Your Hearing Checked? Contact Hearing Health Center Today! If you experience ear crackling with no pain, consult an ENT specialist or other medical expert to identify the issue and recommend treatment. It could be an earwax build-up, managing Eustachian tube dysfunction, or treating infections. [Consult our professionals at Hearing Health Center](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) to get proper treatment, including earwax removal. We have a team to help patients find the treatment that best suits their unique hearing needs. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Issues, Symptoms --- ### [Should I Buy Or Lease A Hearing Aid?](https://hearinghealthcenter.com/ask-the-audiologist/should-i-buy-or-lease-a-hearing-aid/) **Published:** December 5, 2019 **Author:** Ronna Fisher **Content:** Hearing Health Center recently introduced the option to lease hearing aids. It certainly makes sense. After all, we lease our cars, our smart phones, and office equipment. Why not lease our hearing aids? Although cost isn’t the number one reason for the 80% of Americans who need hearing aids but don’t wear them,\* it can certainly be a barrier to getting help. Why Leasing? Most people think of cars when they hearing the word leasing. Today, more people lease their cars than actually buy them. Why? - Because they want to upgrade to the latest model every couple of years - Because as the car gets older, it will need more maintenance and more repairs. - Because they can drive a better, more expensive car, with affordable monthly payments. Leasing quickly spread to other industries, including office equipment, medical and laboratory supplies, computers and IT equipment. The latest leasing trend is our smartphones. By the time we’re done paying for it, in low monthly installments, we are really to trade-in for the latest and greatest phone on the market. Leasing Hearing Aids The average life of hearing aids is between 3 and 5 years. Nationally, hearing aid users get new devices every 3.6 years. The reason is not necessarily because their hearing aids are bad. People get new hearing aids because: - The prescription changed. Hearing never gets better. The hearing aids you got 3 years ago may no longer be appropriate for you. - Ears change. The size and shape of the ear and the ear canals change with age, and wearing hearing aids often stretch the ear canal. Weight loss and weight gain also have an effect on the ears. Hearing aids may not fit correctly after a while. - Technology advances and improves. New hearing aids increase clarity, especially in background noise, and enhance ability to communicate and participate in important conversations and activities. If one of the things holding you back is the expense, leasing is a great solution. Most hearing aids leases are for three years. Monthly payments are as low as $99, for good hearing aid technology. Payments for the best, most advanced, premium hearing aids are approximately $200/month. At the end of the three year lease, you can buy the hearing aids outright at a discounted price, or better yet, simply sign a new lease and get the newest developments in hearing aid technology. You’ll always have the best hearing and clearest quality of sound. **The Advantages of Leasing Hearing Aids** There are a lot of reasons why a lease may be the right option for your circumstances. Just a few of the benefits of leasing include: - Affordability - No large, out-of-pocket expenditure - Buy-out options - Flexible payment plans and financing - No maintenance, repairs, or follow up costs\*\* #### **Is a Hearing Aid Lease Right for Your Needs?** Only you will be able to answer this question. If you intend to wear your device until it is completely worn out and do not care about having the best possible technology, this may not be the best option. If you are interested in having a technologically advanced device, the ability to upgrade your device and want any potential issues taken care of properly, a lease is the ideal solution. \*The number one reason for not treating hearing problems is that most people don’t think their hearing is “bad enough.” \*\*Many leasing options include all maintenance, cover routine maintenance, clearings, reprogramming and adjustments, and manufacturer repairs. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Healthcare Coverage, Hearing Aids, Hearing Health Center Services --- ### [Medicare Made Easy... Should You Switch Plans?](https://hearinghealthcenter.com/ask-the-audiologist/medicare-made-easy-should-you-switch-plans/) **Published:** November 4, 2025 **Author:** Ronna Fisher **Excerpt:** Should you stay with Traditional Medicare or try an Advantage Plan? Here’s a quick, clear breakdown of what’s what, so you can make the smart choice without the headache. **Content:** *I did the research so you don’t have to.* ## Understanding Traditional Medicare vs. Advantage Plans ### Traditional Medicare Traditional Medicare is operated by the government and is a combination of Medicare Parts A (hospitalization) and Parts B (Physicians and testing), and Part D (drug plan). Traditional Medicare covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap, or supplemental, policy. ### Cost The cost for traditional Medicare for 2026 is estimated to be $206.50 monthly. The cost for a supplemental plan (G Plans), the most popular supplemental plan costs $100-$200/month. ## Traditional Medicare ### The Good News - You cannot be turned down for the best, most comprehensive (and expensive) plan (currently Plan G), even if you already have health issues. - Almost all doctors and hospitals accept Traditional Medicare. You have the widest access to health providers. - Out-of-pocket costs are limited to the annual Park B deductible, estimated at $288 in 2026. ### The Bad News - The premium for a supplemental policy is more than for Advantage Plans. - You still must buy a separate drug plan (Part D). --- --- ### Advantage Plan Advantage plans are operated by private insurance companies that contract with Medicare. ### Cost You still must pay the cost for traditional Medicare (estimated 2026 premium of $206.50/month. ## Advantage Plans ### **The Good News** - They often include additional benefits (dental, vision, hearing), that traditional Medicare does not cover. - They usually include coverage (Part D), which is extra in Traditional Medicare. ### **The Bad News** - Many doctors and hospitals are dropping out of Advantage Plans because of declining reimbursement and paperwork nightmares. - They require permission for testing and limited access to physicians and hospitals that are part of the group. Going out of network can mean higher costs or no coverage at all. - Prior authorization is required for many services, which can delay or prevent needed care. - Although premiums may be lower, Advantage Plans have higher co-payments, deductibles, and out-of-pocket maximums (in 2025, the out-of-pocket maximum for Medicare Advantage Plans is $9350 for in-network services). - They may not offer coverage outside of their service area, which can be a problem when you travel. ## **Bottom Line** - Open enrollment occurs from Oct. 15th to Dec. 7th. This is the only time you can choose or change plans. - Check the notice your current plan sent you. How much have premiums and costs risen? Are your doctors and hospitals still in the Plan? **Resources to help you:** - Medicare.gov - eHealth.com - Boomerbenefits.com - For personalized help, make sure you use a licensed individuals – not from an Advantage salesperson who earns a larger commission for selling those plans. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Healthcare Coverage --- ### [Financing for Hearing Aids](https://hearinghealthcenter.com/services/financing-for-hearing-aids/) **Published:** July 30, 2016 **Author:** Ronna Fisher **Content:** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/hearing_difficulties-300x172-300x172-1.jpg "hearing_difficulties-300x172-300x172 - Hearing Health Center") At Hearing Health Center, our goal is try and help everyone that walks through our door despite cost. As part of our evaluation we work with you to find the right solution for your hearing loss and your hearing healthcare budget. Not only do we accept insurance benefits, but we also offer payment plan options for patients to pay over time. ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/fisher-foundation-logo-3201.png "fisher-foundation-logo-3201 - Hearing Health Center")Additionally, we don’t want anyone not hearing because of cost, so we work with many charitable foundations that provide support for those that qualify. From the Department of Rehabilitation Services of Illinois to our very own [Fisher Foundation](http://fisherfoundationforhearing.org/), we offer a wide range of help to fit the needs of each and every patient. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Healthcare Coverage, Hearing Aids, Hearing Health Center Services --- ### [My Invisible Hearing Aids featuring Walter Jacobson](https://hearinghealthcenter.com/hearing-aids/my-invisible-hearing-aids-featuring-walter-jacobsen/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents My Invisible Hearing Aids featuring Walter Jacobsen **Content:** Hearing Health Center presents My Invisible Hearing Aids featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, Walter Jacobson --- ### [What is the best way to clean my hearing aids?](https://hearinghealthcenter.com/ask-the-audiologist/hearing-aid-cleaning/) **Published:** October 30, 2017 **Author:** Ronna Fisher **Content:** Hearing aids, like all electronic or mechanical devices, need routine maintenance! No matter what style of hearing aid you have, they are all electronic devices that are put in a sweaty, waxy, moist environment for an average of 18 hours a day so they need daily maintenance to function properly and consistently. Below, are some tips to help keep your hearing aids functioning well: - **Wipe down** hearing aid and/or dome daily with a tissue or moist wipe - **Brush microphones, receivers, and other parts of hearing aid daily**– you can use what was given to you by your audiologist, or a small soft baby toothbrush - Hearing aids that have **wax guard systems**—check and change at least once month, or anytime the wax guard is clogged and you’re not hearing well. Wax guards are available for purchase at all offices! - **Domes** should be replaced if they start to get loose or saggy, so they don’t get stuck in the ear canal. Consider changing your domes every couple of months to prevent this from happening. - **Open battery door** at night to turn your hearing aids off and let air into the battery compartment. This should also save you some battery life! - **Do not store the hearing in a humid environment** (i.e. bathroom). - **Put the hearing aids in a Drying Unit** at night! Most units have fans to circulate the air, UV lights to kill bacteria, and a desiccant to remove moisture and humidity from the hearing aids. If you don’t have one, GET ONE! IT’S VERY IMPORTANT TO PROTECT YOUR INVESTMENT *Remember—daily maintenance will improve the performance of the hearing aid, but it will not necessarily extend the life of a hearing aid. National average lifetime of a hearing aid is 3.8 years—at that point it is time to consider upgrading technology so that you can continue to hear as best as you can!* ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [How to Insert or Remove a Lyric Hearing Aid (Video)](https://hearinghealthcenter.com/ask-the-audiologist/how-to-insert-or-remove-a-lyric-hearing-aid-video/) **Published:** October 3, 2018 **Author:** Ronna Fisher **Content:** Dr. Ronna Fisher, Founder of the Hearing Health Centers in Chicago, demonstrates how to insert and remove a Lyric Hearing Aid. [Learn more about Hearing Aids here](https://hearinghealthcenter.com/hearing-aids-chicago/) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To, Video **Tags:** Lyric Hearing Aids --- ### [How to Insert or Remove a Lyric Hearing Aid by Dr. Ronna Fisher](https://hearinghealthcenter.com/ask-the-audiologist/how-to-insert-or-remove-a-lyric-hearing-aid-by-dr-ronna-fisher-2/) **Published:** October 3, 2018 **Author:** Ronna Fisher **Excerpt:** Dr. Ronna Fisher, Founder of the Hearing Health Centers in Chicago, demonstrates how to insert and remove a Lyric Hearing Aid. To learn more about Hearing Aids, visit https://hearinghealthcenter.com/hearing-aids-chicago/ **Content:** /div> Dr. Ronna Fisher, Founder of the Hearing Health Centers in Chicago, demonstrates how to insert and remove a Lyric Hearing Aid. To learn more about Hearing Aids, visit https://hearinghealthcenter.com/hearing-aids-chicago/ ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [An unforgettable two days: Adam Felman’s first 48 hours with hearing aids](https://hearinghealthcenter.com/hearing-aids/an-unforgettable-two-days-adam-felmans-first-48-hours-with-hearing-aids/) **Published:** May 7, 2019 **Author:** Ronna Fisher **Content:** ##### **I recently came across a story by Alan Felman, a 30 year old writer for Medical News Today. I want to share it with you because it expresses so many of the emotions and behaviors I felt and exhibited before getting my hearing aids…and after.** “The big kicker with gradual-onset hearing loss is that you are not aware of how it’s changing you until the physical symptoms have become moderate to severe,” said Adam. Hearing ability diminishes so slowly that you don’t realize that one day the sound of the turn signal disappeared. You no longer hear the key in the lock or the footsteps behind you. The “sounds of life” that keep us in touch with our environment, that soothe, reassure, and alert us, are gone. Then there are the misunderstandings, mistakes, embarrassment. Your hearing is crucial for understanding the world around you. When your ability to hear and understand the spoken word diminishes, so too does your enjoyment of the things you love doing, the people you love being with and your ability to achieve closeness and bond with others. It is a frustrating and isolating feeling to be with those whom you hold dear only to feel left out because you do not understand the conversation and cannot participate in sharing. Adam writes, “Communication is a huge part of navigating every stage of your life. If any element of communication is lacking, it can have a significant impact on the way our personality develops, and the methods you use to connect with the outside world.” Even though your friends are probably understanding, and although subtitles exist to significantly improve the viewing experience for people who cannot hear as well as others, it can still be hard to ignore the underlying feeling of being ‘different’ and stigmatized. “I developed subtle, invisible coping mechanisms to anchor my social interactions. For example, I cycle between a set of 10-15 stock phrases that I wheel out based on the tone of voice and the context.” **“Absolutely!”** **“100 percent!”** **“I can fully understand that!”** **“Tell me about it!”** None of these seems out of place in a conversation. However, once they become a substitute for genuine responses and coherent conversational flow, they develop into a cornerstone of shame and awkwardness in daily encounters. Especially when they are the wrong response. Socializing becomes too much of a risk. Every pang of guilt or embarrassment after saying “what?” or “huh?” might lead to another night when you don’t risk going out to socialize. You end up distancing softly spoken colleagues, friends, and even family members, simply because the effort it takes to process their speech can become draining. **“I have a lot to learn about life with hearing aids, but my first lesson was that no one close to me sees it as a negative life event. Everyone has been congratulating me as if I’ve just become a parent for the first time. I’ve realized that however self-conscious you might feel about wearing hearing aids, people only see it as a connection with the world, and this is huge.”** Adam’s hearing aids gave him back the intimate details of life: easily hearing and understanding those around him and whispering a joke to a friend helped him close the gap that hearing loss drives between individuals. Our need to socialize with others is [innately human](https://hearinghealthcenter.com/hearing-issues/hearing-loss-and-depression/). Adam says his new hearing aids are discreet, nearly invisible, yet powerful. Sometimes, to his underused ears, things sound a little too powerful. A packet of chips opening across the room, wheels of the stroller on the balcony above, even the “cacophony during bathroom breaks sounds like a National Geographic documentary.” “There are unexpected changes, too. My experience of food has completely altered — the additional frequencies and sounds add a lightness of bite and extra crunch that I was previously unaware of.” “My hearing no longer feels impaired — that is, until I remove the hearing aids. Those few moments in the day without them, such as going to the gym or grabbing a shower, are now pretty draining by comparison. **“I have a lot to learn about life with hearing aids, but my first lesson was that no one close to me sees it as a negative life event. Everyone has been congratulating me as if I’ve just become a parent for the first time. I’ve realized that however self-conscious you might feel about wearing hearing aids, people only see it as a connection with the world, and this is huge.”** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, Testimonial --- ### [Changing Wax Filters - Signia Hearing Aids](https://hearinghealthcenter.com/hearing-aids/changing-wax-filters-signia-hearing-aids/) **Published:** May 6, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [Hearing Aids and Television by Dr. Ning Jing](https://hearinghealthcenter.com/hearing-aids/hearing-aids-and-television-by-dr-ning-jing/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Hearing Aids, Media & Press --- ### [Tom Shaer on OTCs at HHC](https://hearinghealthcenter.com/services/tom-shaer-on-otcs-at-hhc/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, Hearing Health Center Services --- ### [Signia Active Hearing Aid Earbuds at Hearing Health Center](https://hearinghealthcenter.com/services/signia-active-hearing-aid-earbuds-at-hearing-health-center-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Finally, a hearing aid smartly designed to look and function like an earbud. Unlike traditional earbuds, Signia Active’s proven hearing ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, Hearing Health Center Services --- ### [How to Clean Your Hearing Aids: 7 Top Tips](https://hearinghealthcenter.com/ask-the-audiologist/how-to-clean-your-hearing-aids-7-top-tips/) **Published:** May 7, 2025 **Author:** Ronna Fisher **Content:** Hearing aids, like all electronic or mechanical devices, require routine maintenance. Otherwise, sounds become muffled or – in the worst-case scenarios – fail altogether. Regardless of the style of hearing aid you have, they are all electronic devices that are placed in a sweaty, waxy, and moist environment for an average of 18 hours a day. That means gunk and dirt from your ears enter the hearing aids, causing malfunctions and unnecessary costs. That’s why daily hearing aid cleaning and maintenance is important. With decades of experience, we’ve compiled the following tips to help keep your hearing aids working under the toughest of conditions. ## Why Hearing Aid Maintenance Matters Hearing aids improve the quality of life for anyone struggling with their hearing health. A 2022 study reported [80% of hearing aid owners are satisfied with their devices](https://pubmed.ncbi.nlm.nih.gov/36466566/), and 64% acknowledged that hearing aids have improved the quality of their lives. Despite that, a 2013 research paper identified that [80% of adults aged 55–74 years who would benefit from a hearing aid](https://pmc.ncbi.nlm.nih.gov/articles/PMC9715311) do not use them. Some of that is due to poor fits or broken hearing aids, but there’s a portion of the population that struggles with the daily maintenance required to keep their hearing aids working properly. They might wear their hearing aids for a few months, then stop once the maintenance becomes too much. But it’s important to note that hearing aids are electronic devices. Just like any other device in your home, they are susceptible to gunk, earwax, and dirt. Sensitive components, such as microphones, receivers, amplifiers, and batteries, are all vulnerable to moisture and ear buildup. Regular upkeep helps prevent repairs and keeps your hearing devices functioning better and longer. It’s not just about protecting your hearing aids, it’s about maintaining a healthy quality of life. ## 7 Tips to Keep Your Hearing Aids Clean ![](https://hearinghealthcenter.com/wp-content/uploads/2025/05/2-cleaning.png)### 1. Wipe Down Your Hearing Aids This first step you should do at least once a day. Take out your hearing aid and wipe it down as well as the dome with a tissue or moist wipe. You can do this first thing in the morning or right before bed to ensure any buildup from the day isn’t still on the electronic parts. ### 2. Brush Parts of Your Hearing Aid Your audiologist probably gave you a small brush when you picked up your hearing aids. Use that brush to clean your microphones, receivers, and other parts of hearing aids daily. If you cannot find the original brush, use a small, soft baby toothbrush as an alternative. ### 3. Change Your Wax Guards Hearing aids that have wax guard systems—check and change at least once a month, or anytime the wax guard is clogged and you’re not hearing well. If you need to buy new ones, wax guards are available for purchase at all Hearing Health Center locations. ### 4. Replace Your Domes Domes should be replaced if they start to become loose or sag, so they don’t become stuck in the ear canal. Consider changing your domes every couple of months to prevent this from happening. ### 5. Air Out Your Batteries Open the battery door at night to turn your hearing aids off and allow air to enter the battery compartment. This limits additional buildup and allows you a chance to clean any dirty areas. As a bonus, this saves you some battery life. ### 6. Store Hearing Aids in a Dry Environment Do NOT store the hearing in a humid environment like the bathroom. Hearing aids spend most of their day in the humidity of your ear canal, so give them space to breathe and avoid picking up any additional bacteria that may exist due to the humid temperatures. ### 7. Use a Drying Unit Place the hearing aids in a drying unit overnight. Most units have fans to circulate the air, UV lights to kill bacteria, and a desiccant to remove moisture and humidity from the hearing aids. If you don’t have one, get one. ## Need Help with Cleaning, Parts Replacement, or Hearing Aid Troubleshooting? Visit Hearing Health Center Today. The team at Hearing Health Center is on your side and ready to help with all of your hearing aid problems. [Schedule a visit with our audiology team today](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) at any of our five locations, and we will work to make sure you never miss a conversation again. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [How Do I Clean My Hearing Aids?](https://hearinghealthcenter.com/ask-the-audiologist/clean-disinfect-hearing-aids/) **Published:** October 10, 2025 **Author:** Ronna Fisher **Excerpt:** Reinserting your hearing aids without cleaning, sanitizing, and disinfecting them can irritate the lining of your ear canals, leading to redness, swelling, itching, pain, unpleasant odors, and infections. Here are our best tips on how to clean and disinfect your hearing aids. **Content:** The ear is a dark, warm, moist place…the perfect environment for growing fungi, germs, and bacteria. Hearing aids reside in this environment 13 to 16 hours/day. Guess what? Every time you remove your hearing aid from your ear, it is loaded with fungus, germs, and bacteria. Reinserting your hearing aids without cleaning, sanitizing, and disinfecting them can irritate the lining of your ear canals, leading to redness, swelling, itching, pain, unpleasant odors, and infections. Here are our best tips on how to clean and disinfect your hearing aids. ## Do I Have To Clean or Disinfect My Hearing Aids? There are three key reasons why you should always clean and disinfect your hearing aids: - Protect your ears - Upkeep for optimal performance - Avoid broken parts A hearing aid, similar to an earbud or any type of headphone that sits in your ear, collects earwax, dirt, dust, and debris over time. While little bits of that won’t hurt, over time, all of those materials mixed within your ear can lead to ear infections and skin irritations. Long-term, you might experience other ear-pain-related issues, all because you didn’t clean your hearing aids. Like most electronics, the better you take care of them, the better they’ll work. Hearing aids are no different. To maintain your ability to hear and the clarity with which sound comes through your hearing aid, you must clean it regularly. Debris (especially earwax and moisture) clogs microphones, receivers, and vents. And of course, when your hearing aids start to break down, they just won’t last as long. Well-maintained hearing aids can last anywhere from 3 to 7 years, but if you aren’t keeping up with cleaning, that time will shorten quickly. While Hearing Health Center is always ready to help with any repairs you might need, we also want your hearing aids to last as long as possible to save you money and protect your hearing. ## How To Clean Your Hearing Aids ![Audio Wipes, Dry and Store, PerfectClean](https://hearinghealthcenter.com/wp-content/uploads/2017/06/3-howproducts-1024x326.png "3 howproducts - Hearing Health Center") **Step 1:** Wipe with a non-alcohol sanitizing wipe ([like Audio Wipes](https://hearinghealthcenter.com/product/audiologists-choice-audio-wipes/)). **Step 2:** Keep your hearing aids in a drying system ([Dry and Store](https://hearinghealthcenter.com/product/dry-and-store-zephyr/)) or the new ([PerfectClean](https://hearinghealthcenter.com/product/perfectclean/)) explicitly designed to sanitize and pull out the moisture inside the hearing aids that accumulated from your ear. Drying systems utilize desiccants and heated, moving air to dry the hearing aid both inside and out. The built-in ultraviolet light sanitizes and kills germs while removing moisture. Using a drying kit will: - Increase the life of your hearing aids - Prevent costly repairs - Increase battery life - Maintain the peak performance of your hearing aids - Relieve itchy ears by killing germs > **\*\*Pro Tip!\*\*** Never use alcohol on hearing aids or ear molds. It will ruin and erode the surfaces and special plastic materials used in the manufacturing process. Alcohol will also damage the delicate components of the hearing aid. ## What NOT To Do When Cleaning Your Hearing Aids ### 1. Do NOT use household cleaning products to clean hearing aids. ![**Pro Tip!** Never use alcohol on hearing aids or ear molds. It will ruin and erode the surfaces and special plastic materials used in the manufacturing process. Alcohol will also damage the delicate components of the hearing aid.](https://hearinghealthcenter.com/wp-content/uploads/2017/06/4-pro-tip-1024x838.png "4 pro tip - Hearing Health Center") It might be tempting to grab something underneath your sink to clean out your dirty hearing aids, but let me stop you there. Not only could the chemicals cause your hearing aids to malfunction, but certain products may also harm your ears. Instead, stick to cleaning products specifically designed for use with hearing aids. If you have any questions, don’t hesitate to ask a member of the Hearing Health Center team. ### 2. Do NOT use sharp objects to clean hearing aids. The products around your house, such as pins, needles, or even pencils, should never be used to clean something out of your hearing aids. If an object is sharp, you have a good chance of puncturing and scratching the inner workings of your device, which increases the likelihood of breakage. ### 3. Do NOT submerge hearing aids in water to clean them. We know it sounds obvious, but hearing aids are not waterproof. They might be water-resistant, but that isn’t the same thing. Instead, use a damp cloth with hearing aid-specific cleaning products to wipe them down. ### 4. NEVER use compressed air to clean hearing aids. Your hearing aids are fragile, so a single blast from a can of compressed air could cause a lot of problems. The power is too much for the inner workings of your hearing aids to function, so whatever you do, do not use compressed air. ## Need Help with Your Hearing Aids? Call Hearing Health Center Today. Whether your hearing aids need tuning up or you’re in the market for a new pair, the team at Hearing Health Center has you covered. Our experienced audiologists conduct a comprehensive hearing exam to ensure your hearing aids are a perfect match for your needs. Don’t delay; call Hearing Health Center or [schedule an appointment](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) online today. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [Vertigo and Dizziness](https://hearinghealthcenter.com/symptoms/vertigo-and-dizziness/) **Published:** January 5, 2015 **Author:** Ronna Fisher **Excerpt:** HHC featured on Fox News, 10/24/05 **Content:** HHC featured on Fox News, 10/24/05 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Symptoms --- ### [Headphone Dangers](https://hearinghealthcenter.com/ask-the-audiologist/headphone-dangers/) **Published:** January 5, 2015 **Author:** Ronna Fisher **Excerpt:** Dr. Ronna Fisher and HHC featured on an NBC Chicago segment discussing the dangers of earbuds. Aired 5/2/06 **Content:** Dr. Ronna Fisher and HHC featured on an NBC Chicago segment discussing the dangers of earbuds. Aired 5/2/06 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Protection --- ### [Ear Plugs: A Worthwhile Investment in Your Hearing Health](https://hearinghealthcenter.com/hearing-health/ear-plugs-a-worthwhile-investment-in-your-hearing-health/) **Published:** March 15, 2019 **Author:** Ronna Fisher **Content:** Protecting your hearing doesn’t mean skipping activities you love; learn how to get the most out of your concert experience. ![\"Earplugs.\"](\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZsAAADmCAYAAAADUyhTAAAgAElEQVR4Xuy9V6wkaXYm9oVNn9e78qarutqN5ZAz4jqSAiVS1GpXK4qEVpDZFSDoTdCjHmQgUbt6E7CAHgQBehOftBK0Kw4NuEM3HLKH7Gnvy1fdunV9+gwvnBPx3/pvdGScvJVVXdU9ncBF3szIiPjj/P9/vuOP8d/9ztsJSl5JUnoY0nH90oZh8Ef1Tv+r8/Xr6P9bllU2vBPdv+hCSTqkiS/p+Yxy8hw9q/7M+v9xHJcP4Ckf1Z+vaH6k2zswT0Q/fb6J9qZpIjYerQkag06fKIpKrx+jfAL0axXOfzQb/cXrS/tHWH8S/W0z3R/H6Krdk9ZXfl71z1EiPz9dO78P1DxFYUp//ZpF+3vicxjl95f2n0Qftb8m0UC6fv54nl+Zhn00hEk8TOIv+bHp9yD+l7+n/tmw0v2n5kh/p+8l/intL7qemms1TqIp/dEx2r9lr2N87/MCm0nMtmiCvgIbaQs9ueOK1pPmR7qTBDY6I/wMU5wANjrzkjbDV2DziBnpTEfNmyRMSPQruqaaH1ozBDb5tfNlApuy9UvHnjbY6My8SDCHaRwBDY1HgasCHdt+BIZFe1kSdvPCn7qHAhtJ2PrcwaaIkanv8lJTnqASMkvMUDoubTZJ8nnamo00mdL4pOdXkov63Um1G1tSDbUBfEZCyzQaXbPRgUbfPJOeQ5o/iX6IBdVUIKB0fWl+pPFL82cZjyRLSXArmttp7l+m2cSa4lm0z6Xnx3Ou2ej0L2L2Bh5ZXp6GZiOBjT5/ee2Gxi6BjTQ/Ov9V11dAk+cd0lo1/tv/763Zdpt0B+140WIvmkCdAJKadoLbF/50ms1Wdg8JbPJM/KTMVGJmRRKsLo1Ne74+rpOc8zhgcyQtTwCbog3+FdgUU0CBzSSmITGTaWSFacDmJGvm2JN8AcHm2P56ymAj0TXU0P4zwlySwHGcmVhkXimge+hgIykDxzTrzwtsJtlMdTWuSDKQwEaaDInS09isnyXYSM+vL/yixTbN+UVAMy1dLcHkry/WPDASo6PjpNk8TWZZNn8mZnOaSHSSmP2s62/S+HX7etnzzwo2CU1ewavIPFv4w+ccbMrWLz9PUq5ZSvxH1w7y95pGc9DBRucF6r4SGEjjOxIMM7+drj3RMUlz0vm78d/8yzdLNRtpM0nH9YeZRrPJA47ELE9y/yLCSptdur6k2RRtOv2aks1Uen6dgetgo/6Xzi8zcU6zEKcFm0JQnAA2EoM+pvnMhhX4ooONWn9F85hnPkVWBLL5S68yzUYx20kmJGn/PO9mNH38hfR7ymAj8c882OQFOmn/S3OvazH5fUm0kcBM97l+bmAzyRdQtEiPqV5ZBNskooiLWaDmFx1s6Pl1ZpB3EEqLYZLGqcgm0deMyq2warEXbVQyYeY1m8INXaqalDNLCbh0n4e08YqOS5tZEiak9SeNSRd2iJZ50CmyHByjyRMCG10C1hmeRJ/nHWzK1i/T8RmDjbR+pP0rrU9dk1Gallpn0rVpHTw3YMOMRgv9LQIe6YGk49JmnXWynrVmo8BGbXYliajPs4DNNLSdBWyUCUc3oxVJ0aVzKDDLn1aw0U0yReZVtT5U6GwZjafRbPJgM61m/UUGG35mzYw4SbuTaJsX+PIWikkCIX1fxr903jBpDFK0Z35e6ZoEwOpPOj8Mw6NbiwECkhqpkH8SQaTNLiGrBBaSmUq6vwodLDTzaHHkkxaSynOYNE7p/hJDlyRDiX60GIrmZpKmmX8OaXwnMaPlr01gQ/TJg40+F0Xr79hcaYqNzhSnZXZKs3nc9UvzU8aMpfmfVtjJMyBFSxo/0zDLe6DvFUPIC3NFa1QKkJHmX5fsi64vPf9JwCavtenrQOITk47roKxrZOp/6flVnlHZ/i8yPyntoIg+J3HA50Of1fyr60v8QZqfkxyXlIXHAht9knVmWKTGS4OViCEtoicJNnkUVxOXX4T6Mz3vYHPMQVdgkpxW85k0D88b2OQZkMQsvghgk9/E+mcFNjrgncTMMcnmPy2z/Qpspgvm1fmUPj+6MKjzHzWfkrCprANF8y/xzmnAWuLfk4TwQr4sJXXmkT9/8TzYTL1Isx8+j2CjT1JeFdUlTPqdBDbShEvMUDouLYZJZko1LimaRLq/BDZlzz/JjPa4mk1+8xBtxPFneSqPq9no+yPPUKbZzJJmodOvaGPrYJNft3nhr2guguiRmaPouES/LzvYSPt3UjTepHmbpHnkNfgibbloLGr95MEmLyiXaV7SM5buYa1aRdH61L8zpgUbfeMcu0BOWs4vTmmxPmuwmSb0s4iJqQmY1cEs0Uc6LoFNkVSsfyfF4Uv3f97AJq+FSuNX0WizgE0RYygzk+ibd1qwmTTPks9Qen7JjCcyIs1BXvRbaX0+72Y06fklsClbG7ogm18v6jyJfnmw0QWsaYQN6fri858EbP77778zVehzXqIvUpOKBiapgc8b2OQ3p6QmSmAjbXbpuDTZ0vGiedOf6cum2Sh65DXySXSaFWx0cHvamk1ec+HPWQWESetWYibTClsT19mXHGwk+ukVBIpoRA7y/DXyZk4dFBQAqXMk/qj8nnlwUuthVv4r8SeJPx5TTKYFmzLNZtIN6RzJJyARc1pmqhMlr5KWqoGag7noGpNAVtHjeQebSeq8ei5pMUqLTdJsyjZrUVJnnt6T5vLod7nI5/wciswiE7UeV7NR62ASQ5HuL2k2RULdsTmJH5kK8wBbJFV/Zi/MGM33ZTejSfMngU0QBFODTdFaF/mjVhttkhY1rRms6HfS/n9qYFMEOLoqWLTxJMlZJKaANtJmlBaLLtnl1U76LOUpSEmB0mRJzF4av3T9Y5JFgclTor90/ecJbPKAkTd/Fm6mGcFGB8enrdkUrc8kSqs668fyUu60wtZjmcG+5JqNtD8ss7wcjO/7R2SledHniv5XAQL5OZwkxOTnyLTTQqxFyZfS3mXFWKg6fxL+VAQ8x4S//+F33kliI4aZUKn3z77bho0I0dFxI6byIjHSd8CCgQgJzASF7xXb4d/R8aJ3RHHp8Unnqe+NOA2dpXGo6yemcXQ/dXzi/SlWPlfiniZBEUnKA3o+wGby/Kn5smAhMWmeTH6nz0SvOAhL6a/TNT9/TCchGEcCSwrd5EKc2Tzm3/X7q3Wm/543Zabd5M0R0mbSx67uk3+X1s+zAht+VtpTWQsBGrda90QnGje9l82fCjkvM6WJ8/cV2JSKw5IZjTQftW6LGLtEf8uxJ4KNZBWS9gcdf6Jg81vffztJCDyICRW8JxFt5gnHmdnQeSnTKXonm3LZ8Unnqe8p2muW8/X7c8Z6bpwTSjsdk0bKJi1vuiiSUKaZ9Em/kSQPh8wgJfNnEsiUzB9x+jL6EpgyM9LmUdFxludS57JEVrJ+ONqq5Lg0f9IYSQhRoPk46ywU+sEoM/Ikc6zITIR+TgQmZeOPw4jpp+Yx/66PX5JMH0vzkSZgxuPS/pAur/eDUb+V5qRQQ86sBrpWOdV1BLBWwgQxfZ3XKE3Gdp1j/W7ySd1Km1Jjzmv/U41RImJ2XFm5JmnWxm99v7w2mjiZSXm/hFkfRvL5SHTI3//Yhsok4jKGJY3/2YJNDJebZ02uhimp0klc3pwu/3ysSQgNwaQ50Y9L1yobvx46fZJ76r+VzIBl16X70/4oWz9PG2ykqtsqwzvPZJgx5Mb/Fdiksy2tyZOAjbT/JJ+XMrNJYKPGrPi1Yvj5sT4NsMk/4yTAFcFGJPxTBhtJjZOYTNn4p2FW4vNnA8jb68VFJg08d93in8dwOE/kiws2U5Kh8GfTzJ90/WcNNtL4pPUvgU1eWNTXpV7BIc9k9fVcCrhPUPCQaFF0XBSGhYs+bc1Gmr9pwYYeIy/40RyRz0bNXZFJV+dfj+PTlOakCLx0oDuWVC5pNiKzfc7BRqmhOtGOJk0rlzKJqOLz/5SDjQSqEv1mOf8rsAF+2sFGWl8Ss1RVr4u0OvFc7Qc6EOiSvWiZEcxoUu0xAksdZHShQWf6RZot/XZmsM4Vf9WBj+5/IrARCf6UwUZiRtL41MPqxH6SYJOf6Cftsyl/vhg22+yfnWYjzY/EDGY5/8sANtLzS8clsDmJGfmLaEaT1pfEH77oYFM0/jzgKBoUaTZPAmzyWtdjm9HEyfoCgY0CAkWcaWzu0mL+CmxmK/Evrq+SH3wFNrJm8xXYCCssyzN6WprNrGY0XTvJmzaJn0l5WkXCtg4+kuZ0kv05c4CAJFlBAJsnhZwneWj9tzqxda2jyEH6ODbhpw025fSPYXE01bPTbKTNJM2/BOZf9gABaX9JxyXNRq3pIlOLnlSrS8P6/9L9pfl73H37eZ2nF7LM0+okY5hkRpPoJ/lsFAPXo8zoOxUwIJUbKvLZ6JrIrGBT5KbQNRv9+cUAAZlY5dFoErORJlS8v3CBMrAhFZSIXRZNJI3/K7B51Bb3ccBaom8ZmH2l2ciazVdgU84gnjbYSPxNAhvVwuJJgo3OU2cFm3zVaiWoKMA5Vqj5f/rdt0rT8iTJJY5SZjPJASWen2WwTjpflxhmkTyKJn0aZiUxQ2kxSZL/bGAaw4hIq0mzyNU8nOSaKvR5kpNRcnDqqrNOC91kOUlqzn9fOEcl0U7TzF/RujombYWTtULWGUsyrKe5vxT6LK0PaX1Jmk0ZM8lrNrMKC8foqq3HsmeQ+MOJ1nK2ViZJ80XjUJpBfhzqvtL+l/ZH/vz8PpPARo25iLZ07CSajbSWCukTRaWnSeuXklaP+NJXYJNWNpj0khabNIHSZJxkM332XjFMLsSYMsw8Y5XGxsw+y7N5VmAjjbGMGU3D7HW6FIGx8QUHGyl0e1b6Sev/WLRRAcBI6/t5BxtpfNL+1n0uunB15H9BeZ5b3k+TX89PG2yk+T/J/BpfgU052EiLTWKW0mRIx8uvn4KNodVdOen1JLCRNpPUqVKNf5IDVhrvrJrFJInwCJgFsJmVWSv6TQJzib7S+pLacpfRN59nM4tmUyToSHOrM99JzznNNfJr7ElqNtL+l+avaN0fG58ANnkH/+cNNtL6k+hzbP99BTbPN9iUb7ZHms1JNqW+gJ412EibdVawKTJD6M8vaQaz3v9pg42kmZWZeaaJxpQkW8kB/SSZ1bTXepJgI91T2neThCz1vWmU+7zzFSBOCjbS+Gc9LoGNrtl9pdmQEao8enfW+Sg9X1qsEtioPBtp0icNQgIbaXzEzPKmgiJz1aRNJ4HNrJrFxOfO7PuSz2PW+yv6PS3NZlawkQJkpHUlmXmkzSNdX1p/xwSnp+CzOcn9y551omYvaDZfBrBRGuxXYPOcg005M06TOhOqlpq9pM2b3xDPGmykzSyZgeh5phEWJm32LzrYzGpGI81lltqARNeywABpPUrHpfXxtMFmFmHoM3utAAylAIFZzWgnoV8RWErzIx3/yoymGPMUhTif9mRJ158GbFSAQF56lqRKljiEAAHpGtSvaBbNRrq+ZAaSwCYPMvnPrjGdg7ZwI06xfvJCQH6OJGYm0qc8mK60qOQ0ZjTp/vrxIr+NxIyk49L+eNpgc9Joszy9Jmm2Stqfpq20shSoa+s0kQIETkK/ormWzKjS9Y+ZNGf22WSLnTvWUSn73DsT04jBCF7wHpNQXnBe2XWoU4ckEUy7SXjDlfTbkfqBTNtvZ9Lv0uuX9xOadJxAxsrSXHQmJm3gYwwiE2up90kCk3ugqI1ANKbLq/gDsyB51LZcZmjpedQuIJWUKWjhmFST3YdbUlABwWw9UK8kOjNvyeTjAFTzPV5mtH60l4rZT+evuB+T6udDx+leej8mGq9Nza9K1qe0folmZfOnxnW8D9SjflC2QedP7vdUtr6IFFI/JSn0meZiGs1Q2k+TAjGktSgdl5jZFxlsaOxRKDSEyh5wEn05/6akBYdqKTGxBYwwsbOCDfXzOQLJWcHm0VhV9eHid8OwsqgpYjYRkrRJCuj7VDIvP7/4OEnmsztcppks1c8l39dF6rcj9fMhsCjrJ1TWj4aZOzPuyStG3KxRulhDJAhNEyE1w2OSmjBJEAgj1GyXq0tHYQATCRzHQYwInhfANCopIJgJRuEIoRHAcA3ASeeXzSyxAZP65kQJzNCCGVkwMqKbtRhhQiBAbNvkNuLc2C1MOOH2KE+FhYI0pygNeVYQleV5TejHZBn2RPrStSiNxkyOr8M0ui9dj2maTfH6pPHQOi6bv7Rf0OR+UKqfUJ4pqHVTxix4ZEKemgQ2fI0ZtlCRNq0DyDSaG63R/Dot0paLVrkEVipa8kiAyqUI6PQpYujS9fVz9DGr82bVjKSkS7r/4/RhUuAjCRFF5udj8ysEOBwTbJ8c2JQPW19Q+qSIzFCghtSPRSKmdLxMDWaWbJZn0JcuVtJo+PzHLzdDTLrsVUZf4jFGFPLdA8NAaNK7lYJNYnEpHCs0UHNsOIkB3xsjigIua07DJj7nmDV+BgKfcTRGZPkwHNJuCER8cPO9JIEVW7CNCipmBbbhAhFpGgEiJ0BsBPw7GzYsw0q1lAxslGaTAkx63UQP9eYDk+dAmh/qFMtKk9YyW/9fkuyUJjhpDiRmpdZvEbPNj6voHs8L2OjM/CRgo+8vdV6eV5Stb4m+Umj+0wIbRY9ZwUZafxL/ko6rXLVp1m+RYCFF0z1RM5r0MEcqlCa9fBHB5nE3kwQ26WabDDYSs5wVbJIoZMkoMkirIe3G5uJ+RmylJrQoQcWyub1w4HsI44AQFraTdg6sGjWQKShBiDAcIzYjWDZprjGCcATbqaQNxiKq5+TCMt3UXBcZCOhaFTLfBayhkhbHd6WW42R5DZPMjKbok5roSFNQLzqn7CXRTwIbiZlJnTql85822Eih20/CjFYm/Ur0l8qxSMxWoq8EZkVJqTrIn+T6ah0eY7CaEPM4mpl0/2n570QwEbRaSbNhd0fJ6xh9f9o1G0mzmqTZqEmQNtOsYCONr8yENo1kTCoFgw2Zg2AiVO1tYzNtoR1GMKnwH5nD6GammdVejVPVZpSgYROIxIj9MYzYB/VzcnlgaRkdArLIsBEkCXy6B5m8TAuxRea2OAU39tEYMOi+CmyimMHmkd6iIqcegY1IH0HznBVsZtVs8uWe8gxLej5Js/k8wEYXxPL/S+OXjkvMVjrOZqZcFJi6J73PCjaSRjDr80nnS2AsgZGk2RQB6DGan6Afz8yhz9LDPO+ajTSZeZvsSTfT8w425NpPWTf50khtUM2YyJyVzh45+ehXTsWGXSHQCDAajeCPhjC6I8y5NbhGgnjQB4ZjVI0ErVoV1YoDz/NguQ6iShUjw8QgSeBZJsx6HVatAj/2U+8L++6M1AdHfo6EgMdgn80jq1mcAU86YjKpnWT+itaq0gwnmdGk9T2rZvO0waZs/T3paLQiKViaHzqHBDb60wU71oZjeX4lsClilpM0l6I1IF1fN/1Ja+VxNJtp6Pc49z2iy5T+uiITGvNCweF3zEz5lWZTTm3dwagDzbSLTAKbdNIf32dD5q2yV9liTdcJaRYGaxapMkL/k5+FPTqoVCoYBx7CJIRZsTgQoD/s4aDbQdQfYslw0CLXvjfGeHcf8UEXjSTBYr2BRsWF5TiwajUkjTqGroWuAQxtAxF9V3UQmwa4Na9JmdQGKDqRgQYOMx8SShXose7FyPTIrCZo8TIYZT6vxwUbSbORJM8vOthM0vzVXpmGWdJvisCG9s4050vMtkyzmWTyyj+XpMHoAKb/L82/NPYn8fxl95A0G2l+JbD5yoymUV8ygxUtOkna0Sf3eQebNPIMHC1GpVssAp0ojcYilu5UXHhxiJDMZEaM4XiAg8M99Id9uL6Pq/PLsLo9dDe30bt7D8lOB80YaBkWKoaFZqsFs1GHsdAGluYRtusY1hz0TQNDI0J9cQGwHZiWg4TMbUlq0jMNl0EoiiiSKwWcI7A5CpWOQQpRGqX2eK8jIJsQICBdVQIbaa1E4aNq3UXrRmI2khlNYjRSBQHp+SXNXzqfg0syLUY9i9J01LHSZyipCn4kvSfJZ/KNaNy6iW0SWEjzl9e+1HXVvWcFG4l+0vqQzp8GbMr8Npy6UvI6BuY/7ZrNtGCjJDX9XZpI8be6hD7hYtJimlWzoQg0etmxCStK4FDLCJb2zSxwAIitBLENduh3D/ext7eLMPAwb1l4sd3GePMhHnx4Hfuf3ISx20HTj1HzE8BPY+zNZgP1U2uYv3IBrUvnEC+20TVi7Ice5jbWELukAblZkEIafk3gQ9pOQCXOEwoAplykR4CTsuivwOZ5BBtx3WtrnXxyVIbe93021/JatG24rssh9nqeRtEWkcBAjSX/uycJNjpQPWmwkZ5P4l8Sj5oGbCbxPhqbBDb6/Y1/+vvvfCZ2lhOFctKA7lQrkmYmPZTELEViCJKLZVaOxqrGnB+7WgxqIejvx5KOHkO6lRaDer4imyf5S9LQyMc3o1Ek2LSSRf53jCt2ljwZGrAplDkgvw3Z0UzEJhAaEXreCO2FJo/z5vVP4ff7WJ6fQ9sAFoYjvPVHP8DhzfuYjyw4+wPUhiHmYhthb8jP1wt9dIwYwXwD9fOnsHTtEhYvnYezsoi+ZaIb+nDrDSyur8Ou1NEZjTAmLatSRRgnR3kEKdg80nJSEyA1v5scvqxLnvoaPloTQui4tD4lzUY6Xwrdl/aPlIdRxoymadEgXV96viL663uBjtdqNYzHY2xubqLX66HVamF9fZ3f6ftpHfxFY5HoJ+1f6fxpnr/sN7NeXxq/JIxIbaXF5xM0G6U9skn0n/ze20n+gRmxsmSxvN00j9zSYGY9LhGTzC269KIDjT72PNAoZvMswYZ8D7Pm2cwKNhFFhJG5LDLhUKhxZHLbAnLFx2aM0DIoqBmmY6J/uI/9zU3MVapYm5sDDg/x6V/+EAuGgVO1OSS7XWz+5AMY+30sWzVg5Kc+oJqLkWVhJxxiO/ERzTexdPEsWudOo3H2NKz5NqpkbqvXkFTIl+MiMG2MSKuxKYH0kV9KaTeqHXYR2EwShvJgw2tghjwlOv9Zg41kpiljZs8D2BCYEdjQXu12u6zh0GfyFdJ3UlLmLM+vS+xPS1iedXwS/5T446xgI11f8tl8Bmx0NTDPuI+pQQWSv4TM0mBnJWYR2OiLqEgj0wHz8wIbfUxHNHkOwCbIqjZXIsCN0iROzukkRmoCvpnAcg3EoY+9+w8Qdzs4N7+EZmRg+8YnsP0ufvXn/wZeuvwirv/Z6/h//4//Ew/f/xSt2IE1DrHUXmSfTycIcBCMcGjE8GsuzGYNUbuGja+/jLWrlzG/usqRanG1hsbaKuJqFQejIZJKhc1r6qXK56hAASpBk+9Uqn5L81wU2npszWZJnZPWoWSmeNpgI+2PWY4/iX420v0lzYb2ApnLaE7InEaaMJnQaF8Oh8Mj0Jm0p6e5v/Sbp6l5zAo2s/LPWcFGGr9UNuwY2JDPJq+t5LWDPBjpkyNtxlmJJZ1PUUvqVTRufXz6cyqG87TBRt0nbwrgz0YsmtGkjSJpNmWLhcCEwIZebpgw2JBmw2mmBhCYwDjxOeQ58TyM9vZQH/hYMiyM72/jzkfv4V//pe/il3/1l4FGA4M/fxO//c/+d3z6xjuoeQacIEYVDoIgxDCKEFhAVHERuhZ8w0DPjmFvLOHUyy9i7cJ5hFUXSauJ1sYG0G6hl0TwqYQOOZE5mZNIRkVt0qCBNCqtOOcmT/eJYCKUppKEqWcNNtL4yvbP8wA2ak9yeH0Usb+GtBp6cdh8Jgx9UcFG4l/S/p71/FnBRjKjSkmdnwEbBSZ580PpQs18KdJil47PSmwCm/w49c/6/Yv+l8pVzDw+TRv8jN9mCs1Gur8UIFA2hwQ2Xja+amSlPpuMd9MxCh4IrQRR7AEjD9Wxh3bPR3x/F4Mbd9Hb38I//q/+U5z71qscH/bwj/8Sf/h//Ut88sa7GD/swBpHCPpjtOsNVCt1eFGM3nCAURSgUqvCaNdx3x+gdW4dG5cvYu7sWdjLSzAWWzApSq3dRD+O4VNUWgY2XHoyUcECRJ3ycjPSZpXAWjr/iw42HAlWEj0vPb+0PiXNRh2n+xDg0B4lTeeoJp7mO1ZjKTKHThqHKJkLD/C0+dc09JtF83quwOa3vv/mkWYzydatSxX5/6XJkI5LxBYXezK5013+3KKxTANMZWOUxleapzOFZiNdXwIbSbMhsCG6VEKTwSZtxpYBjRnDqlfgewNEnT6aIx/1nR4673wM48EeFucb+E/+638M5+I6MPDw4I13ceOdD3H/w5vYubWJsDPC7u1NGH6MyIsQByGiOKKsHrbFB66JAzNE2HCxePY0Nl66gtrpMxwebSwvoHZqFSPT5CRQ0rIoNFq9OBw603CKhIgizeYzYE8anVXeKVFiVk8bbKT5n2V/TZPUKd1f2r8S2JD2QuBCfyw6aMmcSuvJz9tJwEaUzIVyMrPQN88rJVoVHZfWnzS+WcFGuv+JzGgENvSQelKVeugijUH/jv6XCs09DoH1c8TFXgI2avFOKxlM0oJmBZuJYD2FZiM9v1SuRtJsqAAnvZzQ5GKb7Hg3Dfis1RD6WHAp9PmgA/PhHpIbW9j7q/fQOhzhhRfP4eqvfgunX7kAeBHufnob8dCH4wPB4RDmKGLw2b69ic3rdzDu9dFw6qg5LgLPx2HUhzPfwmHswWg3sXzlIhrnzwEr87BWluCur8JanINHQQrmI+1GVRSgd4vAMjOFFTGh/HrNz8UXHWyk/VXGjLhMUUTRfNJVHv+4BDakzRDvIfMZ8RL6PY2J5o3GPmuAgLR/JGYtHX98yqRnSuOTwFJyY8wKNtL4ThQg8D/+zk+ONJuigec3a17KUFV5JxFdGqw0WdL5XOKde65QFnpaY0sv6c5Vh8m2X1DqXYHskbT8FEKfdZo+jhlNev5ZwIb9MqmoAZey9llbSJurkC5Zw/kAACAASURBVBktMmK2m68tzMHs9tC/fheDdz/Bg9ffRrPn4dorL6D1zdO4+rOvIB4G+PDNd2F6MRYb86hQlefYwHJrEdv3tnDrg48ZjAZ7BzC8ENS0zLIN2M0Kdr0ehibgbqyheekcaudOw1pbRrLQwsK5MxjZJgLLyLSbNHhB9YAhgKRx660q9BYBaRkeCiIoek/gmOWFBMvWJ42BipemFEz7/uTnI2ZtTLVFUFfLfE7sdkoDMixqc0DgSUyWL5mV5Mn6DKU+K842SplU9h5qFbBV/yF9zPr6Uz2BdDdVFKX9bKS+TEXH6T40ItWCQVGCwSurmZUHG9JG9X1gOmmeDTFVpcmofanGXqbZHJe8P5tCQNGGKZgWpwhIYCIdl/iXdFza388abKTxS3k2x3w2FPqsLkgPflIwkdQsabKk80XkBoXpTm6eRZWDJzcfA1w7dUbqUsYk01oR4Wd6Pu6Hkhas5I37GGA3ixkt9X+km5DpTKVjqMYZjytixmeGMZzARzs24N/fwb2fvIvgwQ42Kg005uqYv7qC1nKLzXBbN+9h85PbCEY+luaXsLi4jOX1DTSbTQx6fdz44CPcePt97N6+j5VGE69evYr33noTgZHAb1QwqLqIl9tYefUlzF+6gK6VYPnSRQ4qiKsOQseEb1EbBKpOnebc2EHMlQ/ST6rHzaN3g5n9Z7/nop8co/H4Yj37tZw0cIGqLlhRmqtkRmnxR7r00POxemoNh4MOtnd3MD/XQqNWgzccwSYg8T00HAfeQQeW72Fjbh4IPAx6XdSbDXhRiCFV0Ka5qtRg1xqwnBqHg3tRBM+IOVqP+irZhs2tGUhrZAGCTITUzI4owK0ZKMIw+2xSAzcqUUT0yYquFjThKuunwzUmYo/7ARGoUhQ5FVzlqt4s9AEWNafjzRWlQEygSj/McqOChOrupXxHaTO0D7gmnmGwsKMqCqjv9L1KeSK8hziEXUFxupd4P2V5WpwYTGBtpO8KrJM4TSTN8z31WbLc6MxU5w/q/ioAKa91q895zW3SOCYxfSkpUwILkb9mKTATr6MV4vyMME1CVBaAxHM7CWzUBEiaiwQWMzFjoV/MUTRNCUWl8bnGI7ApWnTSZMz0fBPARrqm/rizgA0BDZWn4eKbdlopgCUPI0yl7DjEIjG2bhfuIIDV7cPfPoA78rFcraNad2G0DFQaDijAYLTbRffhHgaHffQGHvr+GK3VZaxurKNer6Ozv4/7H36K2+9/iPCwj5VqHd7OHm90r1nFqFFDuNzC8ssvonXpLJe0Wb10AUHVBSoV9vH4Vszh2OTDoZcd0DgnL4AyWlIDt1nAJrBihDYxMKq8YGQVGOxMuyGGm8CLAjTnW+h7A4y8IebaLSAM0N07gBWG8A8PcbrdRtzrwts75KoMFWKFcYTWXBNxxWWwHRkG9sceuqMAcKpYWFpFa2UZ26MBAgqi8H0GmqpbQ73WZDneGwdcqVuBDQFN2pk27QlEz2/G9pHAcVJhimo9mJHH2g1XDOfGexYS2CnYUM08rnmnwIb6RlB9O0oaTquNk5mWQFvvJElCj0VtK0jz9vz0d1pyr94sLG3EmGqD9D9rmPxsBCqUp5Pen8aiwCaV7FKN9lmDjU7zImYtaT7PI9jofFTXTo/Apsi2TSdJyC4xcwlZJWJKNme6/uNXxiJG9chBXEQDCWyk46X00cCmyN+gpKYyGs4KNqlmY1JkQJqJT9KgEfLmtpMINRL8+n2gM4TR6SHZ76MWRFiuNbBAzLBK5yScEEoMlyoQ9LsD3L6/ibsPtzBGhNWzp3H2/Fk0KTx6dw93PvwIN959D707WzgVV9h0F841GGy85SYWX7qC+RcuYVyxMHfmFDNbAhuqdqA0G2Kc9CItgrt+TnhJ64s66Dzui8bgmVThIGGToU2h44mThlhkkj1VYEi4xlvAPYDqlo39nW10tndRj2NsuDUsOg5GD7exc+MW07qKBFXHRr1d59Dv6tIC7MUFeKaLA8/DIIxhVWpcc66ysgSDaBPHGJEWYNio1BtcjZcqc1sOdSpVAKP3BSKmT7SzH7vFehqgQVpUCjZ09QjUD4n+FA1SrSktN/QIbBigDGAQhEgs6mVE6mFWBFYDl1qliiiJkUSqFUWqSRIY0f4II1+rdqLMkzF3RiKgVaG5an9Rawv1YvDRktd1JvmkNJu8GayUn+VaIUyzLp812Cj6SkDJmt6k2mjqZImZSpt5GoI97m9YwmE79uO/qEVxEcicZLGV3b2UPrnaaEVmNIm+EtiUn582KqP7ckFOkoIpaIEomsRwoxjD3T3U6eNhH/3NLQzubcHb62DerWBjbQVL6wtcJ832gaZbRava5K6be51DbB3s4ZP7d+A0q1g9tYGzpzcwV6th1OngwzffwvU/fwPrAxOVxES40MaoVcVgvoqFa1ew9upLMBbmYLQaiCs2DLeCxKacm9RPQmYhMokQ/2LQmdC82SBz1oTjLODOADZkJvMNaj6XsIZoU3dT6sdDgE39emhMVhrSaxnUhM7E+LCL7Tu3EI99nG3N4aXFFRzeuIVb77yL3Zu3YXT7sP0AlhHBrrhcfQGtBiqra5g/cwZ1Snit1DDwQhwEY7gri6gszKM9P8e15Iaeh6EfsGnNtKm4ado2OO1yqsqrPvIZsZQh9CSZuL653XXAegOZ9dK/1IzGfJNKHnGvIlVmiH5BnyMOX2fNhcxulsngocCGTWM5cNE1G/odgVMqjNGvU+2G5zPzd5EPj3SsvElcmdHUM00yW51k/ysToE4nZUaTwKbo3JNws+cFbIqAmled1rbcUNFokxBXMulIzPAkhDvpb79MYDPJXyPRd1aw4XL+CrAzsCFmYMYxrChCf3sHDeriudeBv3sAazDCYGsbfneAhVYTS0uLzGIoebNiO6habipxUmdPM8Kd7Qd4eLiHhPwva8u4cHoDG8vL2N68j49+8DqS9+6jEhoI59sYtqvoz9ex8PJVnPnmq6iur6IbBmxKsh2HwYYrGzDYpEECJLvqZhXdHMNm1ihlavnv1WeprW3ZmqT7R0nI4yCQobkgJpfS02TzEINiGDHQmL6H3Tt3MXi4g9XGHK6urmN+MMA7f/xnuPHGW7AHY7RjwA1Cpj0cE4FtYN8f4RAG7JUlbLxwBaeuXMLc2gaSRg23egcIXRuNhQWuwhCT5kSmNVhwGjX4HBzx6EVMnoIR2ApJYEBMvgRsJGFJdU1lUx0F63DX1gxs2HqW+SMpcpXNW1nIeqYNBVyD7zjYkCZD4ELvymek+450MLKpU1/mczkCnEyjYe0plw9IAMSglPlHKRC/iFE+KbDJWzby9Cyj7zSWjWcNNmr/TALtQrDRJ0D/X2J2EkBI588KZqadSpCTXmX35w0XPVKrizQcaXzS8VL6HBWQfBQflDenSWZKCWyk+eH2y2Ya0aecyUdgEwcY7x3ADWN4ewdYrdbx8rkLiA76uP7ehxj1+ogCDxXHRcOtc9j0uD9k843hWKiQmaddw83Nu+gOD9mMtLw0j9deeRl118HmGx/i/u/+FeKej37dgb/cQrC+iMVXXsTaay/BXprH7nAAZBWA89FJpI1FR5J78ZNK60/Z7iU6TTqelssBm23SV1rtIDYtBpogChm4GxR1ddDF/s1bbIY8t7CKVbeKD//kj3H/nfcQ7h5gxa6iNvLYJ1antgu2xWbDPW+IzX4fe7HPlRVWL1zEhatXMH/uDKzVZTwc9eEZQHttFbWVJfi2hV4UYUQMvkK15dTIqJUEgU0a/cYReqzHTi7mWka/R+a59Poxc74sWu7Ij0LigErCJfMWfSbwT0cVUFfWzJ+iaKykfXpvNBpHZjLaC/Sdeqff+1ltO/5eAxK1j1hj0gq1kilP37NptODTCxA4CdgUmdKl/f+8gE0RDXlN6JqNCn1WE63UP33iH3cj6gOYdA3JTCcRmzZk2Us8P3lU7mYSwcquPyvYpOcfj0Y7thmEaJBZwSbkQK3M56HMepR4SaVDkhDj/QPUiBkMRnjx7Dn84ne+Cf/Aw4/+6I/w4M4mRoMxXNPiUOYwSB3fnU6HN3S9WcPyxgq6oz4MI0J3cAhv3Mdrr72CFy9fhr+5j/f/7z/F3oNd7JoRjFMrqL54EUuvXkXt3Cn0TaAXhzAcFxVqPU2mIQ46IrtMGswQEFCWVL6W5ieeoh9K2fybR6HHaYdTjsTiqK/Ut0BmFGLwNSTwtvcQbG1jo9ZCO7Gxf+sGfvJnf4Rz8wt45dQ5WId9fPLD19Hb3sIC6mSJQ63VZs2lZybY9cfY9z0Gk/r8PJzFebzyC38TUbOGgMCs4sBdXkJtfYWDK7b7PVTajaPgbAIZGgtViWD/CQNjOdiU7R9+PosCJFIKHQu2yCLOTAppBoEMhXjHZAHjOVR0I8mY4wWyaLS82UuBC4VHq7FQ0BIngdoOR/uRFs2/00KuqX05WzOztuDK2K40G7o/gyWDo+pO+1nQkXzWSvvIg7Lio5KZrsiioX8nhT4/T2BTxj+JDgaBDS+UjOH8tIGNhbRq9CRCSZKxxMxKkfCorfFxaevzAhuWwInncFBAJv8S0HB4agQ7ijA8OMBaq4UGbLx0/gK+9eo6RtvAD37vDxhsXLuGiHwEXoTAG6G330W/14EDE/VGlSOCmo0qVlYXsLv3ELdufYoXr72An/vOt2GPErz5L/4MN67fxWYwROXSKSx/81Usv3oNwXwdW4MBYscB5WIQ2NgU3ZSK0Ed5IeSbKNtwkjATSaGdJRPI+TFHsQmpf4Kke/IphZkMxJFRQQDHC+E93IZ90Mel+UX4Dw/wox/8AZaWm/i3/41fwne++7cRvvkefvt/+V9x/cdvoW05MMgESM9cqwD1OnzXRj+O0PHHGHg++maCucvncfk738DyubPYCXwEROsrl2EszGNr0EVSsbNCphR5SH2L0lBxCtGmF9edK9FsysCGc7GodhkDSeofSatykxmMIsNSkx35zRhwKDqMqkeQeYyTcRPsb+8ca57GTCkLW1bv5PPiaDsCSsfhyEbSeJxaA6PYyIIS2HOTRZ2RVklCSOrT4etktfQYbNgvSWCTmhDZ95dzzj8pM9q0YFPEf+k7Atmy17MGGwptL7II5c2XPK96P5s8YabRaKZhtkpq0a+XR/484KnfKmTXQVC/3pHkooGlfh9Js5H6iUxDg9LFUCY5a2AzzX2K1GwpqbOM2bLPgZL6iEkQUzQMcHsbYsCBz0zS8gOOjnIi4JXLl/G1y2dw/cNb+Ou/eJ0d4p4XoeJUEfohegcHGPeGrBUZJHGOR6gYBva2H+C1l67i1Ok1vPPOT2CYMb73vZ/D6ZUNvPcX7+MP//SHOHSAU9/+GnB6GVhfARbnsNnrsPTampvDfGMujUDizp3EzGKE1KOec0ke2e3VeiGJlJ6dNYusxz3RmDPmNdU+E3wnMht9XvL7gyN3TesI+NhHlNNsAm+MtuvA3z9EpT/EiuHi8Pod3Prrt9Dt7eHX/uHfxd/9+78KVKrAm9fxz//Z/4Yf/j/fx3qtjbrtot1ssSlsFCXY7/fR8cagAMEgidGLQuxbIebPn8GVn/kmGqc30LFM1E6vo372NA7iAFargSBOEHK0QpxGzKn22uz/MrgzapnAlRdAlWBGGoVdr2F7dw+ubWF5cQFxFMAbDTl024xD1Byb11YS+Bj0ehgNehgOeqz99g8PcLj9EHW3wpWeib6UV6NAhb4jLYZ62hweHvI5dGxlZQWXL1/G2plzqC+tox/SErBQqTW46d44jLjjK32XYmoGYKxhHQcbChBRprSiPShpFjS+z6wLjRdJ0W7SvheFJRUhI11owvFZhelpkjrVrY/Apgidphn/5wE2kxa7koLyQKUzZQlsVA/4aZ71cX5TOpnPGGxYSWCpLo3mSSVPMrVEgO/DCAMYQQhj7CH2xji9uIRza2s43NnF5p27qDgVjEcx9nYPEYw91Gs17s7ZfbiLqD9E27bgkLM7DrkKwSo1SxscYnd/B8uri3jxpVfx1tsf4cfvfgi/VcXKq1fRpeTOugOvUcPOYIjVjQ1uojXXmINjUbQXmWBS0yNhBvsJKJqJmCYxkog63CT8mb6nBELySVHBTZZ8iRFlzDYt0ZT6yyZJoEVgo36vwOaIUWdgwyCeRYAReLsJEOzvw+oMYO13sfn2+zi8cQfVtotf/y//Y/z83/4eW1LHb13HD377n+PNP/gTWH0P/Yd72FhdZ4YLy+Yos8HIw9j3EPghBgjRtULErRrWX7iClRcvI16aQ7wwh+qZDS5qSuY1jzQQjjpWrb8z7YPDs9OQ5Un7X1UAyO9z+j2BTWha3L6bwCYKfHjDHqq2hRZV8A7GiLwRDna2cef2Tdy7fQsHuzsIowA1t4K6a2F9YR6Huzu4e/cutra2WJJfWFjAuXPnsLq6irm5OW6otr+/z++k5ZB2Q5WhzUoDY7uO1dPncfnFazhz/gJrO14QwQsT1ujSHCMK3Eh9ko+8VKlmk7CgMtlnJfEPVZV6khlNAhuJf0rHOZhihtfnDjbTqEGTnkcihtqYkk0zDxh5SWuSZkPMQwcXvcabsqeWzUWQcoWn9nrewcagAAvi2hGZNiiEN00oJK2G/rxeH8FwgGg4hJMkaLouXNNM/TROBUns4P6DbfS7XQ4UoNbS/Z19oD/CnGkj6Q2wWK0gGg+xtjSPjdNr+Ojmh9je28FrP/Nt3Hq4j4+3tmEutVE/dwoPQg97iBDWqxjFwMWrV9BstNGstxgw2O7PIJHmSNDQDaqtxeYcitiOM02N4+LTWCOqsUXh3eRgzo5bFAFFWeo50WzSfBVp/fQd3ffYK8uvUd1DHcuAFQYwBwMYnQF6N27j3tvvoxnEuHjtMn72138R175+DTUv4T5At//yLWx/cAOjrT3c/ehTDDsDRGPKZaE4iSps02Hpf9jrox+OEVRMHMQe7Pk5nH3tVcy/cBHDWgXW2go2Xn2Jm9ZRbTk2NxJTzTRtpRGnzDZ9FT3jMQdvJrErywJdcxhGHHZN2lJnfxdmHGCx1UAyHmJ76y4+evtNdPb30D3cgzceIvbSfKOVpWVsrCxh3nXQ2dtjoCHthea13W5jcXGRTWX0HQWc0B/NO4OMabK20/N8dEILdq2FueVlnDp/CRevvIjV0+dgOBX0PQpLTwGHnUUZ2BCyk2CVxsVleWaPyQEU79GtLTqvkgIEpuGfZUP7QoFNvoKAvuh0AHiWYFOm2VAl4byNt6io6KTxS2AzM/KX+QSeA82GpH9QyQ5K4iSzEJkcyAQSEOD4MMOQTSDUz2ZweIBht4tWtY52q4EoBCpuC1FssNS5t7OLYDRGDRaqfgxzMOJQaWMwQH93B2fPrOPFV1/Cp7c/wYc3PsbKhXPoGw62hgMY7QaMxQU8DEboUJLo3Dzn1qyfOYNarYGaW8umMO0BxHXJaJyGDQJMqnFGGoyqhUWaDX3W30mjUZoO/Z41BlVGJcdwi9ZLoZmZ6HfUqjqt0aci+zjZMQhQJXD2fXg7u9j/6AZ6d+/h7NwiXnjlBSx/4yLOXTmHRmRi9+Nb6N/ZQnWYAL0RHt7exNbtu9i8cw9bm5uIxiGDPNnEYvKTJSF8J8GhP0InibHywkWc/cbXMG42EC0Q+LyCZL6NwKZSPzYooVGVhnmEMMel+iINb9L+o6wZPzEYAHxvhHg8wvJcHU4S4eP33sL7b/0Vtu5Q+aI+LDNBq1ZlU57njdCo1bG+vIS6Q8+TOv+V6ZPAlECGOnfevHmTh0raDGu4c3Pss6E9HlC4eaONvf4I+90eTKeOC9dewsvf+BmsnbsIy61zt1cGFAIbxpy0rE0KNo8CBGblbzrfLLOs5PmJZCaT+M+zBhupEKdO189UEMgvNokY0yDzLD4bZSorUuN5rCqOP+dUnAYo6Tc/7WCjEuIoId+hXiLkyCMU8UMYgYfFZpPDlG0DbA7Z3dpiJ69jGhj0hhiPIjSb8zAtiwFnNBxyE7ZGYqHqhTB7Q9x+7wOMex28eO0yzl4+j864i5tbd7E/HiF0q+iTqatRRdKihmkJF+U06w3AcdFqteFUanAtN402IkBxbA5pCoiN2C4nLzqWzeacVGBNy51QpCL5VOh79c7JgJbJv7dtcpqnYbnqNWk9FzFhNR5ea1T6J6aQYnWlNMUx8n00KzbcMMThnTvY+/QWqn6IC4vLmF9qActVnDqzgQZc3Hrrfezdvo95q4ZqZCAc+rhw+ix2H27j9o2buH/jDnbuP4DX7aNm2Kg3Kuj5PfhWgt3xCNbCAs58/VVU1tcRUg22M2cwf/ECgloFcbWC0LLg05iycHcGEXbmFGs1+h4qsiyQ1hBlId9kPqtZBpbadTy8fR0/+pN/hTsff4B2zYZPYIMIVcfhiMURRclVKlheWkK7XsN4OOKunAQy9Ecgs7e3h8MOZRel/W3oj3gRCQgENvPz82g023BqdVi1KkI46I48hFYNaxdfwMvf/Bmcvfwiep6XBkhkGhxVFUghRk1UuWYj8bdCAUQLuMprNvnrTXv9SWD4hQIbvYJAEeGeB7BRi75IZeXol8coYKkmL0pmDJ1WHuYJq6HUwfgcaDZRHDCDJqCxE/qLWYuJRiSpesyMyfxFTtxRr4sxtWqOYgTjEcZDD7eu3+XSKM35BXbc0hrq7u7D9WOsVVvo3t3Eez9+nbWjK1cvYW5jAQZVeh528NHNm4hNF0a1iqRWQ1irwLcdDMKIO3uGiQHXqcJyidHYbB5LHAsW+QNswKcQWsdl34xj22xOY/OYbcOlBly2jWqlcvROiaH0O3XcNg3WFNIw4PRVtvnz+4O1K1WjjaTsDGy4Vhtn16ehvlWTAiwi9LceYLi1g41GE2fnF5HEPnw7wEK7hbpZwYdvvIVb73/KlbO93gB2YuLypUtYW1xGs1rD3oOHnN90/9ObGB90EUc+TCeGUbFwGAQYOw4WLl3C0pXLMJeXEbQaWHvpJYQE5I0q+298mBhndcl4b5MGm/HdSfu/TLMJIqDquAjHQ1TMCFbs4+3Xf4Q3X/9TYDzg2mlm7LMfp15xkUQBAwu9qtUq1tY20O30sbe7i739ffR7PQxHIwS+zzlKFCBB80rmz9F4jDAMUKlUsbqygsXFeTSbddjVGiy3hmFsYZiYaC5v4MVvfAdXX/sGm9LSiEWKUCOTa/qwCmzIj1X2ksCgCKjLNJtprlc6oNzBZw02UvUJXTM7KlczCaGfNdjkS48rWittiRa6PuFl/xdNIpXXKHtJDkKJPs872FAhQpL2UxOawX6aYDCA3+shGA4RjkY4tb7MVY0ptLnZqHNY62AwQNWqYOf+Nvb3DjkEdv3UBtqteXiDIaLukLWb++9/hId37rCphIICGmtt2AsN7AcD3Lp3j2vTUS5JRCCTUJFNm+tl9SkogYspWlyGhYKAqQIyV3uuOFwA0yOmSZUFCGzIvJS9O9UK6pUql3tpN5qgz81aHZV6jR3TBF5U7cC2DNQsh8FGZxA66OTNGPo+4bbaGaemdtoUTswJk1keC3kEKq6DQWcfLpn8xiMEFEreaOPM3AKi8QCtmkO9ZrFQn8OD23exe3eL/TQ3Pr0BzwtYW7x47jxOra1zhWvvsIfB9j7uXb+Ou1vXMVepwmPQchBUXFiLS1i79hKDDvluFl+4iLDVRNKqwXcdjGEw2HDpGorSCx+Vriny3erRnp8V9kyMxh7m2m0GG4vqv0UjvPX6j/D2j3+ImhFi2NlFlejMUWkRQjLH9vr8XMPxGC+/9m2MgxCj/gB7hwfoHXbQHw3ZYsHJxiEJHeRrI3MYULVdtObnsLywyKbcU6vz7M8ZUnKoU4Vn1lBpL+OFr30L1775HYxJQySwyoGNCgyZtZmP8gtP8knr0bR5TZE+S/xFAqcvDdgQAadJapKQeBYzmhT6TExFAYy6j84QJJvnUWE+KtlBuSa5d/YfF3yvfsflGkqOR5Q1WXL8aNFLRMzlQqmfzxL6zIs/k/IIaCg4AKMxvF6P/TN+v4fl+TmsLC+is3+AXq+DpcUF+FS1uNvFUnsBS9U2drf3cP/hFsI4wer6OlYXl5gp7t3dxOYnNzm3g2z6lmNi4dQqzFYFu6MOOr0urNBAsz2HYRBgfzCAB5PbR3tRAqdSReATYzTg+T76vg+fmA6VcTESDOIAEYENaSeZw5/MLCQxk6mF3sncQu9k7yeHc61WOzLLENhQef80yTCtopB/T2tCplnvLBNz4mb6TsBHzeeICaY5LCnQcC5LEsNO0npoWzdvwPI81KktwO4umomJ1WYLph+g4RjsON9YP52GZYcJxoMRfvyXf4XOwQEaVHAziDA87ML0I1xYO4X1xWVs3buLd9/4a7RcEx3vELFT4+oCw3oNqy9ew6mvvwK/2UL91DriVh1mu4XQdbiqwDhOS+wwzajNQGZGY4UsqyWn9pQOwup/ivdL+0MB/eEYi/Pz8Pt92ImPpUYVn7z1E7z+J78Pv7ePZNRnjYeCTiKKbqSIR8vhZx36IRYWVjiikBz+FHG2s7PDa4s6ulpkAqW5j9Jck0atiXVaX6urPJ8uVdz2+rAsE5VWG77p4t72IbphjGs/81189xd+GYFRQUCBKlkBTtbSNDOapNlI/IPMy4rvHAuhJnMvGQ+p7JDau0eWjEyDTkz4mU9XdSniOnJZThCvS7acPKrup9+Dk2pLfMKqIOxRDl0Bj5GeTwK7E2k2/+R30k6dk175aBS6uS7t6JJ7XjrMaxlF9zimZhXkyujIX3T9KXj0lD8pLuWYLsZJpRzl70kyT0OLKcEsbeJF6yetoZXAJ/9I9nocc6BUQUDlAehArJf7IOe7P/aYKdYsC93th9h/cB+r8wt46coLOH/6FG7c+BSbm5tcm6xSczH0PRz0+giHY9T8BE3LZe3h4KCD8WCI82fPoeI4+PDd93GwtY0opPL3ETP5ZrsBt1HD2PPQHo1WdQAAIABJREFU6XfhB+PU/EUObIsSEA0uQUKAQ7kSHdKS4oS/o0Zv6XvEdPPiGGPbhJflz9AzKps+MSMCHPqj6KalpSV2LpOvQGWgU78XMu9kBVPSvjRa9WG2gal+KFqJe1VckiTmkWFzzgtJ4hRc4ZgJXHqPI+4DtHPjNqyRh1YI9tVQ1WxrOEbUG6K7fwCnasJtVrF26RyWzmywmXDsBWwye3jzDjp3HqAeGmglNvbub+Fwfx9XX7iChZVl3P3oQ2BnF2NvhH0jxKBJLRoWUL90Hqe+9RrWX7oGzLVSn5hlw6pWEVsGxuSQpzE6FaSh/6r6QdoKQLcsJVTVWgGsAiVimqRJUCHNKEyd+zEwV63C8Ia4/f672L7+AWrRCJ3NO/D6BwjGvZRvUJdWwwTVROP8njBAEgYc8kyAMxinfpuQgiAoj4pallerPHftNpnNmjyHFBTCDd2iAK5rsylt+3AfD/YPsDfycfrFV/Cb/+i/wNB04cU0R4QKJhwDcDmxNODnUlF6RbxFYrS8bmLqNEQVqbOg6izJOE0iMBBEEecQ0ZqL4pBTBIhnWhSlWKlhnIbkpFaFOA3GiX2PLQ20Jx1aD1Trjip9u1TJ2kZAQEyJzrUqusMRh3Zzx1pOXn0U8EH0sSwbvu/xs9I46Hr0v+ePEAakebtT1cabxJt0zU7x8klmREMCG/0Cynar23A/L7B5HEY8JcqU/mxm5NeKBOq0VBFzTxtsVB5AXvtTn91qE95oABcmKkaC8cE+/51ZW8MrV69iYb6N69c/wb3N+1yChYo7ErM67A8QjTx4W/sg3ZKYATFqMmkQQ6CFfvfOHdy/f58jwugYjYUXvG0zQxmM+ggij81f5E8xbIed9wS/5MQmcKHNRADjRxEn66UJimli5hhAL4kRUjAACUGU2Oe6qDcaaLdaqNXrWFxYQKPZxAI7lJvsy6Hf0XsaIJDW6ZIct0UmJpIyCWyy9lsc2GeTy5xMk/4Yjufj4ac30IwNuL0R4oM+zO4I5sCnrmrMZBfWl9FcmsPyxTOIKybu7+6iP+qjbjlwghiDe9tcbWD/ziaCwz4capRmm2i02thYmOdQatI4qQLDYc1BdGaFC5mufeMVLF66iLBa5YRQYqputcL9YxRAcEJs4qb5Jkca2yOw4e8y1VlJpKoWHB/LAjZYIAyBJpWQGQ5x87038eCDd1Hxe2gmAYL+AfxxlyPhIssBdcDxUGGam9GYA1Iof4YAxw8ifudofOqMk2mqFAxAmimFf9OLGC7xHmpCR9UF/MhnsOlRro9p4cKr38K//5/95xgkVYxhIYwd1hhonTtJDCcJj8CGaDNJkC0DHK5xHZOok4UcsPprp6WKKFk0C1f3gjELdFS9jQQul4qyZsVqx4YLzw9ghhGbGltVh4UVynGLghFH76lwb1r3drXCPsuDww4ebD9Ec3ExDfig1AUKDbdTYYp8nGkHW4Npq5KZuTAs5wukVhwKpS975QHkSEvLnaRbrybSchqwyavS+ufPA2yKgEa3Hz8JUJl0DQlsJJ/NJJOeAmzaNE9Ts5GkMwqQ4GKahoWqkcA77CLodbCxvIgrFy5wFNq9e/ewvfsQZsVBtdlirYJCTcf9HpLOEFYYcyIeMXiWTinUudvD9vY2h7CSGUv51lhapSRH8g2FHpxKGsbMheJJa4kzUAljBhmSyBloyK4fhMwo01bWVH/M5C6WVKiTfDFurYpWvYFGu4X5Vpt9NCuLS/w9+WxI+1K+HdJqSLqMQmoUdzwiS18LRevsaE4NEz4xF9b2DVgmhdRGSII0CTYZjTDY2cVypcZazaJTx0Z9Dp0H27j5wcfMKE3KOVlbwdnz50CM/NNPb2Bn5yGqtoOKabO2EA/GHNE32j3EcqON8WEHZgR846WXWTDY6e7hevcQ+66B6gvnsf7t17B87SondY4sEyMu12/AcStc+ofs/FR9gYuvZYmdTE/Kscrej9akBjb6WmYGS8oCNdwj4AkSNChIYzRisLn37lswhvs4Qz2PRh1EXp99L2mAAhBadWa8/uCQwYbGxBo3medI48iqMRP9nYqLipuaPwngSVAhoYZAhvKN2P/jDXE47HNvHzQaOP/KN/EP/qN/hLC2wGATRSlTVWBjx6lmQwVTOVptgpm6jLdwCZ6EfJ6ZZpMDG3VuSldySRiclxWThuON4QUhqrUW/4xCsikSlPxeFL3X39/ngBzycY3p2bpdeIGPeruF02fPYO3UaVSbTfhsiqM2FmliNnVepXcyPxPILCwspS1EaH9R0E3Mqc8p0FOpIi6OOPk1Ddjk14WujBzj3f/0+29NZUZTk5FHLckMJjHrk5z/OGa6WYFIGr/k05qUQazoSRvwaYJNnnHmgXs08jhMuE7FDZFgtH+I4f4umo7NeRBkaydbOkvbjQbqc3PsqN/vdNHvdNEyXfZPKHMVXZ/AhpL0Hj58yGa1VCJ1j0wlyjxCY6vUK6CIOM8PMQ58jMY+hoHHEi5tIsNxWHIjk1kQhmAXGDm2yeFM2lC1CqdaQ7PeQLPdQqvRRGuuze9kZqhTpBKZHBz3WGg0l5mxwFnvRQKB+k4JE0WaDWsEMVEtjXJif4QRcZQYAXjijRH0eqjFYH/Nz776dXzr2hl8+uY9/OH3f48jr0jrq7g21uaXWGt5ePc+dra24I3HGI+HWF1dxpn1DXidLnZu34U7ClEhc1zPg2saOHXuNB70D3Czc4hO1ULr2gtsQqufOwOv6mIYA5QSym3EXCdrpkYlatIQaJXYWPR8vEYzsFEFS3VasRmN+9kARmSwZuMEAe5+/B7uvvsm4s425uh8r4ckGDLYjKlSApm/nNQc1j/YPgIbvg5RJGvfzOYeyvWi+SbfKHUfDSMWaBTYkFlq6I3TUHjqwdSkhn5VrFy6hl/7jX+I1vpFDKmEkA423Fk1BZuAgge0qtOTpPIiPqLARpnZuYK2qiJN8EL0CUI2KTuuhYQEJW+E0Pf4GR0SBEajdM3WqogpX2p3Fzv372J36wE6h/tcOJU010qVKiVscNBEt9fD3MICzl+5imp7EaC9a6fJrtzFJ0nBhVjLyPOPrAbkG6M5I+sBJTpzxfcsdWQSn5TAJg80Ok4oE9sRf5PApqz5j45gkyQDiVlPCzb5RaA+S9EczwvYqHHo6iZLVlrk5eOYCiWfTR7I1JypewVBxNK+S/Zez0NvZw/Dwz1UEmC+UWO7MUuOwyFM10G13uBSLMMxSZcDOJTUR4zcMFiDId8IAQsBzebWg9QfRMl83PAzlUK5mRhl71PtMnLykzkkJMDxmZmEZPYhaY3McqHPdmoCF4tyaqhUSbWKWqPO+TeN+TabhyhJkL4jcKH7UYdH201NJ6rZluprQ1qU6vRIUia9JgFOGdgQo6bOnKScxgZpqCHXfTPMiBkLqLRKksAf9NEwLfzNn/serpyp483Xb+OPf/8HqFE1a8eF3+mjEVKX0xDdrR0MDg4QxiFG4Rh+HGDj9CmcO30K4UEXux/fQH0UwOmHuHPzFl79O9/DpjfAQ38Mf66O5pULmL96mUvWDAxgRMPKQIZykpju1DmUassdAU66SooAh9iXvnaP0cqI4eE42FBL64fXP2KwGe9vwugdMtjEwTANCghjDCl03kw1FdJsKByajvH9yfyTMULa2yPSECkYgyx1JGyEcaYVp74iViaSBNV6BTFpl7UaPMvC0tkX8Cu/8R9g+fw1eLAQxKlmQ4BOZjSXgiSIBlx5YgbNhmFctWtIyz8xjbJ9TSBAPsvQH7JgQ9Dm2Cavz6ptsPnMMWMEoyEDDeWxbd67hTs3ruPB/TvwBiNOgl1ZW8fLr77CdQJ3Owc85vnlVexS1fV6A616i4NfqtU6Wq05zC8uodWeR384AmyX6Ud7i7Q4m0yRJvmTQs43K3tNAzZ5Hq7zGJqzqcFGYua6GelxNA8JbHRCFF1fGt/TBptpzWg6yisHPQNPltmsg3X+/7JnmAZs8mZQ/foONTsj92YQYdztYLjfQeIN0bQdtGs1NCouBt0Oh6WSFkRAQ0wfTiqBkmRJTsfhcMyS/Rkqjtiqc7DAQWc/U+MTjLwAB4d76Bz2QDZs5ZQmyU5V9SUp1g8pxDX1MVAiXkgdLmsNNFpN1BtN1qBqjRbqzTSyjLQmAiIy05HTmEraqFpoqjYaR15R/m9WE029p0D/2dpSRQJSISMmhzNZ2CmYgcwyVA6FNByycZGjnXKYopATJ1fm5vDNV17DXNXCn/7RX+Ddn7yDBQr5HgYwhj6W7BoaUYLO/Yfo7FAl5BChlWAQjOCHI7z80jVcXFnDg3c/ROfGPdidMR7u7eDy3/guHsLHkHKR1hZhbawhmm9i6NoYWTbnKtXaTdSbbQaaNNckrRPH2k1BEU6qsqBeCmzyEqwytyUuRaVRRYMYdctCjVob3P4Ut99+A+Ode3D9IeJRl6PGyIQzDGIuMzMI0/WT+APWAlULAVU+h0El8+XQfgmitOMpS+OZf4m1AzvNv6rWXNZsKBR+bJpYOX8Vv/ab/yHWLr7Mmo0ONuQTsWhuyGzL0TrHW0VPu//S1glatGlWa1DfrxXbSsv0hD7qFQftZp3Ntt3DA/T3d+EmEXp7O3j4YJPNZjUyRSYhHty9gzu3buL6px8fRbQtLC7ipde+hstXr6Bar3Pl77c++AQJ+WiSVKNxHBftuQWsrG9gfmkZ115+DXalwUEZvdEYYyrEytq+w/NP0YezgE1R0upEsPmff/ft0rtJmokEBtL504LNJPX2WYONro1MmjT9N6zNcE2vrItgVu7kaYFNHgzz4yUHIYUAG2TG6nbg94eoJBHaXCjRZc2GTDpkMts/7GI4HnGlZdImyJbeHw7Z17B3cAjqmnjq1GkYFgUKjFFr1LC8uoYoCvl3nc4heoMhfDKTeQHb3skkosCGQqq5cTC19OUqATabxAhk2gtpxjhpT2Q2cysVNj8RuFh2WjGA+5Nwxd/UL6Siy1T0mN52mKLMuCVANml5uuQ150lgUzGctBsoRRpyaCtdNUAcBhxpRUyFzIxzjSaHLFOo8YO797G9tcUREH53BGMYYLnWwnKljvHuPrp7uywJ+2TqsYDDzi7Obmzg2y+/ArM7wPs/eh17N+5yB9PFr7+CfXKszbdQPbMKr95gTadPEnejjti0sbSyhsXFZXYch6RBcGBW9vyUy6IxHO7cmvWXIdKopnDqO/IJKO2GW4jXKAcqQjAK2KzXtC0c3LuFW2+/geHDO6gTLYYdBhu6rx8Z6I49dMcJj8WKPTYtkQmVrSiZz4H8GezXC6gsD+2ZFGTIFETvan64dFEcw61QoAZFALicSzR/+iJ+5d/7TZx/+dsYwYKf9a1Smg31auJ9SGWOcs3bptnTTASDfHSPYPn4/k8rU1AeG8WbuRRcY1AKwBj72w9x7+5t7G9tYvfeXcTeEN5wiJpr4cKZ0zh36hRH2e3vbuPOnVupDyuK2Od4auMMFpaWsbd/iBt3bqO9vMKBM/44pZXB+8GF6dZg2RVc+9o3cerseSyun4Zv2KxZUiV1Mr3x+tc0jyL+JWk2emSrDjIqAOqYZiOBTZEZQR+UFJr8NMGGHk4qAf60NRvp+nlTow42bAbQmr89DTOa5FMKvBC1qosqhRxT1QBSyw1q9pUmepL0R9sx9CP0yBk7oAiyJDVROTZ2DvfZOUu5EZRst7GxwaYPel28fJlt7iShkhmuNxywU5d8L/R5MBhhNBhmwJvmbZDExeaAeoNtzY12m7WaufYCqo06m9R4n1MEGzXu8lOfk1qn+RYC+vyoDaDmgDcxScMFvZzUXKj1VWxiAlzD4fDo1F9D+lqYmk3GQ0TUXqBew8HOHoc5U0HNuUYbpzdOcVLp3sM99Hc62L69iZiO1WpwowQmVQagaCt/zCX5KcKtXqnga1eu4szyMv76h3+ON3/0Opz5NhZeeRmHFJK+uoj62Q0cJDE+3t7idtp1AjfHwfqpM9hY3eC1RqZKbuVsUTtmGvCjttopiGTcM9NuHnUgzZrWZWHSrCmSydBNq4Z7I5/BhtopdLbu4s67b6K/dRtJ7wDJsIMkHDLYxYbDSbudUcxjqdlpGC4JHQpsOIGXhJEgYP9f+kqFCRVAoJujaQ5rtTQcmsxogyhGZXEdv/Brfw9f+94vshnNI9+akZrRiM3aFGasgY0u7E0NNjQqK8uLyTECThSm6DOqIGGbiLwhHty5hU8+eJcrYA8HfbiUhxWFaNXrHKEWhWPUHIeTVal223g44ChPRRsqv0TWhXubW2yi7vWHuPbKywzalC3F5uNag7XVwdBDZ+QhMSv4xne+i6/97PdQX1hmH57HPh2K0IvYpJdlkBWyMgls8gFiit+pvXbsuAQ2ErOSmH1eqldS0ZE8IJR7kR5WSTaKgfCyzKoC07uOrGXIPQk0pOeXri8tXD1AYBrgUr850vQ0k0eR9ieZ+Sg5sUa2fArXpB40VDgz8FB3bDQclzO4CRBIBSBm0e0PsLt3wP/Pryzh9XfeYF8Oz0MW8UKbgjQQt1plsKFnJDqxT4Yiibwxgw7b6SOwo7hez0xkWWMsAhnaPLTZqC8J5YSQtkPPw9WtUlEXFm20knIril55MxB9z60AKAoq+1HRb/Kh4/r6pd9TfkNATljDQIPCUhEioLbYWQFOritHG7w/xO7WQxzuHLDmsDS/hIX2AtpuE/vbu/j400+OkmatMMTo8BB14gP9EUyKXOp28fLVF/Cd73wb773/Dv7wB/8KUcXF8rWXMHBsDCxgYFsYuhY88oXYDld1OH/+AidRUkAEAQvHIplGOmeOyRoF15DjcNm0mRitI9J46TP1O+L9BCv1bJDmQ8epX5BtIjQCzhujjq0kwVPFZ+9gBzfe+is8vPE+GnGAsLcPnwCH81ooujDBMEzzPeJwiF73kEGFq3fbLs8t+RL9MEwZLUeqpXPOYMMFvdNx0NjI39eiStPc2sGEb1poLJ/Gt//WL+J7v/RrGCQGgw099xHYGDH7KimUPq/Z6HNclDqgH2facHBIpiFmjf1oP7n0PWlvSYjrH76Lv/yzP2agI1/Nw61NLLfnuEo6CSE0PXPNBqoVB+NRnyspDIY93i/k5yT6kG+QTddx6tMkkGg0a2mUG/ld3SrnIrXm52G7dYSJCY9UY7eOtfOX8Mt/7x+g60cYUNUIu5IVsk2vUwa2+X1RZJafxLt0Yc2QwEZiVpIZSwIbiRnnmatOFP3/vAaVN4NMIoakeX3ZwYZ8PmSKotBLinzh8iWBB4Rp1nezWkW/N+ASIyRdEtPnxDIqqBgFeNjbwzj0eDNQRQB6p9Bocv6SZkLSEwHNyKdEvTS3gUCDE90sFwtzi6zJzDVbHLJMOTqkyTQomqxS4ZImzFTslPnR/1wjjblPxMzjccGGGK9uSisCG339Fx0nDYtMI2Qqa1YqnHMUDgfcfI60Qwq1XWi0OOmxd3CIYZ+ikQJ09jvY29pFq5bmj1TbTex29rC5tcmRSfNuBcOtLST7PXgUtLG/h5devIpv/WvfwdbhDn74xo+5kKm9uASfapNVKwiqLsYVG2NqK2BQ6UsD8/MLWXUFh7WvNFyZnMSpZurFIc8HR+dxgmtajYF8ebT2LSsVJKgjY0r/VIskcCKzaQSfr0saMoENBZX43T02o93/5B3Yox7McR+IRgyy4zDBYOxjEKTmOMq/oWZqJJ3TOqD7kdbb6Q14jbFpNGslwe+Z5sXMnbL0s26WBDY8lyb5+SzUFjfwjb/xd/C3/s2/n/psyLfGIEprPYabtaoI0qqkn8mzKhJy87yHPrPJNgM+lpwYbGLW8mwzgRX6uPHRB/jo3Z/g9icfo1E10aSyQcM+Tq2uwx9R8ADVp4tQqThsZYjjCL1uF93uIfa2d9giQL5NTjmmvBkKZWcJKUa9QrkyKR1onprNNhYWl1FvziFxKhiFQGC5WDpzCb/y7/4602JEVSMqNU4zoLBt5bcpElZ1DTJPk7zVpojHnghsJGlbOi6BzbTnSyamPGhJIJKXeCeNQwLbk2h2RffQ82ympcUxKWRGzYbyTUh7oY1SsW2uFWbEPka9ASd7UpRXSA5dqvDsB8wQ6rUmhsMRHuzvAjUTA2/M0tcR2GQtfImx9QeDo6QyMnOQg596lah+Jesr66lmUyXTWRqhxOYQikAzTdaA8toEMRXa1PTikvuZZFYEBjpNC7UbLUTgpGDDZhmq0xZ4XMS07pCI72Gwv4+g24MTx1ioNrBKkmZi4fDgAEmYoOpW0OsO8ODeA9z45Donn1779tdh16t4/5MPGWxOzy1g++NPkGwfYvf6LYwPD3Hu4jlc+9bXuZDpB/dv4frmXSR2FUm1gqReR1yrYOxYGMQJl9YnWz5l+nPoMLdgSP1YBDaGm7ZmIFMavdM64Kx8ar1guWnvHCpa6qTZ7xRVZbukAacVmFlYcKjwKfWTSpjPkkWmVXE5r+bu+2/jzgc/Qbi/g0rswTXSqKTBKECnP0QvzYVEEo1YoyMgIUGDyspQR85Bn5hrpnnGaZh26h9IzXwKaOh/Mss2GzUGG/L3heRTnFvFaz/78/ilf+c34JkOArNyVAeE2h2Q/4T0NQU20+w9xVyPeI1pcECLaVFFgtScxrUGCWystJLE4c4W/uT3v4+dzTuomkC7QobJCN6gh/nWPOKIfE7Uq3DMQSG1egU1Cgnv97nyNRUoHWQVsVVxKaomkEbiEVGGaFL+G+WyUVmm5hzmlxbRai/CdKvoeBEGgYHW6mn8W7/+G/CtKsaUyOlUjoFNHmh0YX0WzUYPhhI1G4lpS5qJBDbS+WoRTAIbehjdbMZ4nznf1bGyhSQ9nwQ2kmYnLWLJjKaPr4gGeuTQ45jRuOkYZR8jhkvl28m8QhLoMAUbb0SbACx9+V7IG5oYEqn048iDUXO4EKRKtCMJjLQbksbIBEKbhiQuVZ9sYWmRa1tRiDTlxpD5jDWrzJyqks/UHNbcKkt6MTn0KSEtLUz2yEGchZrqgKT/r2hS5HNhs4sWHlOouWgVxfNzmRB34eizBFXTZpNeb2cbO3fvIeh0ua/PmdVVtKt1TrYbUtWFKGHAdikkNorw0bsf4v72FlZOncKFFy8jjAPEgQ975OHw9iaMTh87N+8gHo+xuLyA+VNraG4sYtcb4P1PP4bj1mG4LuKqy1Wdh/8/d2/+I1mWXoediLfEHpF71tbV23TPkBxKIkEJouVFgA3oBxkGbAEUZUswLcqQZAOG/wmv+lMMWxBg0qKGlOURKXI40zPdPT3Ty/RW3bVk5Z6Rsb94EcY5372RN19FZFRPDUVSAWRF5RIRb7n3O99yvvOhhMssw6VrGqQkiZwTNW/O1N2ek8QQs2YTWc1Q4xZiKStQ3kRCpWnDotO0ogi1Wm0oLZqSnEHiSKWi6ZyV1BQYmHbjoLgq6cfTAZ5++iE+fvePkZ8dI5r0RQRg3DQc5wIb1mwY6TZqEc7OTuS5+6ZN/p/pMsmxdLuWflsBNoxy+T4EG4lSUrSVShS1TXz9l/8K/sbf+q+QpzXMoprYavTiecqsg5kUEXulHIA5okS4j5Z5897ZU9Tl5I00uoLvTykZKhSUZqiUZzh59BC//U//D0x659jrNHUdkjkbNyk2yktfp04ChiOLXqrVFJ1OW/8/On6qpuhB3/qKSJRgaOr9S5bcavEMWxtNOW/cTwIdjsdmtFuKMYsqOO6NUd3cw9/8tf8Ss0pTYDOjksM0k4NwU2RTdPSuObo+orvByH0lsFlnTNcZ43Vgsy5N5T//pwWbde+/DmzWgeG6168Dm3WRzZ802EjmhXIyZMu4ojuNgjYOoOZMzlMhlZmbUt0k2UxpGDZRzpISMg7xomTIZLJQEGCdhwDExU/jSoUBAgzlY6hbxp/7OgHPUUPNnqFhmhGbkTkk2zC1lEfZ1RFcnjykU67ywpaDkZIIi1v004ANadzqm4gi5MMRzg8OcHl4hFaa4tbWFtqVmlKQ7NRmVEcmHwF4MBzLE97sbOgak823vb2JN159TenLR598KqWB6cUlemdnUrFOqgnGpRmau1vI4zI+efAJKlEFsyjClMX/qIzePEef46PHJv2itCPTTxyTPJ9qBlBG9WWmvviV23wf9TIxTRbF1rFfa+mZhossqFq9JYIGvzcvuo40KaFOxRvWp6p1gU2UT1GPcpw/eYAPvvcHKPUvkHVPkA+6pmWGWGm088tMqdVmPVZkQ6Vnny4jeMRJReuG3r3SY7z/jHACZQGfUuUeatarAu9SlAhs8qSF1775l/Cf/fp/g3KjjTypm4grmWsxU8cUPaVGWXKNdOCNaTGKKa4NpZcUJRqFW3tIY8mnqtFUygBjqXxwid/5Z/8nhhdHiLIRhmfH2Giwx4bTRscolRssMqM/ImGmL523drupvSRh0pNjpRVJDOD+k2xqOVJ/FtNu9+7sY6PTkGKGsgJUM2CNis2v07ki34OLnsDmP/+7v4F5o+PApiJBXQIjwWaZo6rzYo3U7ctVwLvOmfepuD/1yEbTEm94FCW6Q2QNX7YqjfaiYLHu9evAZB0Y/WmDjeStqOm1mDg5U/GXi56L9/ToGO+88w4+/OAT1WIiChtmTG2VkdZSjOc0X5a3Vq6fbDIX0pNxtbezKyPLQr+mLNZqJpNBw+FECkUUcHIbtslNZdkDhKZvKlpljtkETOXkqOBtNRz/KG6MdTUXdkqsem3x3j6zIUtmwClTk9LOUOr+vCvq+Jv3X8U3vvY6Dr58hJ/85Cc4P73A7v6e5v6wKe/g6ZGAeaPRwtZmB8ePD9E9PsY3X38T9/Zu4fHnn+Pzjz+RdA2NLyngZabIBkNU61X1Fh0cPEYlipUKyzmrhgYMwIjTMHOW3WaaC0PnQDTifCKwGc+nGjNAQdPeiOw0XgMjXpRZi0lTsQGjShW1elMDymocokfVbCkzWPMgRUyp8jwdDxShEmw4rbOcr55DAAAgAElEQVTTiDE5fYofcabN5Rn6p08xvjgxhfGogtF4KrBh538SWRqOa8tUAbzSnK0RUu0FQkvARl3wrqbTqFXMU49SzJMU41IN9978efzab/xjJO1NzOnRU28sz1FJygIb1s6YLuR7h7UJDzSWfryievu/8WvMakSk6JfFHmPNk2DDqKmKudSuL48O8L0/+DYw7GLaO8fZwSNs1FOU51NcXvZRqZAAE2OUUTFipJYfRo3T6UTZATomdNqyyVz1pjiqao/V69Zntr+/ox6jlNGcA1MeH0kElHf68uAYT7tDtPfv4dd/8x8i2dwV2OTl1OpN7ANbEtH5te+FfJdlC57HNobXbC3YrDOm636/LrJ5UbBZliYphno3HeO6yO15Lug6ZL/p9+vSaMuo5dfO7wVrNvSEDCgoic5NlyutRXkNLurheIwHDx7gwYNH8rBIhJ6QHDAcm4EYDxBXTNafXyx2b3U2sL25pRx8q9FQBENPjO+nfhh6hZTTZ8qBEYHrINd5eeFSKglMJ0rZ+LyBFLPU52HHLHkQvt7JvC+LXkI2Ufj7hZcWzDNaFtksc2gWa6JEvSu661NEOYkVmcRJW5UYb77yGr7x+j7effdTfMEJnecXaHTaaLQ7uMxGOL9gc+sEB48e4tU7d9CapRg+PcJOUsc3Xn4NF2fn+MPv/THOBj2MkKuek1Ri1UZIpyVV+vzoWOwlpsJYt8nTWB3xI8qkqCnSxhXk2VSfxb4dTupk1z8lhzgPiDL/6m1S1MqiO8kDV2CjyIZgwxENrSaqdX4xuiHYlLBP9tngUoVpGtzJoIf9zQZK/XO880f/Cv2njzA5P5ahtfEMTBll6Papd0cW1tSYZPM5jlWfGGmdsKmTdUAZdHb6F9JoBBqtgbJFbgQbvh9rSwSbwSzFrdfeFNhUN3dQqrWlVu7BpoQpppMJqkyxOSALPXcPNMX1E64HpWFZ45Tqsgo2SqUysqmRhFCa4YsPfowP3vkuauCsnwnGF0eI5zlGvQsjVSR1N7ban+dU+4r1G68XJ8br3MRjk5gkCqal66hW6kqHSlCWThf7styIbapnc0rpw6cnUhnYeek1/L1//D+gurWHwZzrhKoCFCS9ObJZxsZclmZcZePCPfWnDjbr0nDF0K0Y2ayjPq+LLMRqemaEgPOqg/kmqy4mRwWEkjP2d1dd6R4sPGPKPParpkMxeG9Ao3XaaS9aszGpDZlhAx0fWfjNzD6BalXaVAz7R2SVsYYznir1QW+Z4Tz/xi9MMptY5KSHxnqQj2I8aPBzElJny0wlDNUUyrKpNg3TGnPOPrGmPi/gKalO5ayv0m1q1kxSo/OKmOsLyFfPVL8N768fGeELzUxM3BTZKMVXGH2x+L4M1VcoC0+vMuGxjcfSmGMK7e7eLbz//vtGLeaUyiSSt3kxHKqbmyA74GC1aY439u+hXU7RPzrFTmtDKZVv/b+/h9r2BrrZSMBAT7bF+TbTGfrHZ7g4ORF7iZNHy7UawLoNmWiSkJ8arZfF52kmQ8wompHNhAXq2RRjCjOS3sy+izw39WAytliTqXECZgXtjU2k1boaaqlE0Kib5pyl0croJGUMBz00GwSbksRZb+9sIB738fYf/iscffoB5v0LzCcDlClBlM3Q64/QG1HBO0e1GmNruy2qM0GZAEPCBPcF00gLNhojNfZE+ShWIzrYmFVWCpbRNFNPSczrXMEgj7Dz8uv4L/7eb6K6cwtRvYXeJFOUSEeqTBmh8VjODK8RnR9qV5TZNFqmNL+9v0/D+2jH2x9zdoAoNakmfbEnLTdxzmp5Bg6rfvzJB/jhH/2+rkG9xFHrIyRsP81nGn1xdt4T2EeJ7Qc6BZZSnMpJ4znp92VjcEalWCQJ7pOEDaxKBVJQlX1ZmcYRdHsmgnt41sXm/m2cjibYf+UN/MZ//z8i7ezgMp9jzPehGjlp8EENNFzrKkmuSKN5Gai19tWrg7MXbR31eV3kojxpwHmXKXUFeh5IWDMp3rAicCz7rNCzD09s3Un69yrWbK5dTB0sUzOkwJK879rOvfml55JNbe69L4Y5eRl9PhVXGfW7n3nQYWbZh48sorqJISq8+6mYHnyyAtQsTL/vrXO/V3HQzOnivTXOmZviBrTSplghSRFupuvX/uoN/aZjzLHw6Hk9FnTRKwOw+JwAEMLPvjLrV59G46ZCu03uso3vAJCvLToj4bA4n0JxXQJ0dhUb+WeDcT/2jNdBH7J4DiOdVet8WRohPE+mNhpUU86nSoP1j08QTXMNZdN0yjlwdHqi+tat+/cENg/ZdDkYosTmzeEAnUqKTquNjXZHkWFv0Mcnn3yCn3z2KfrDgZplOQSOEeeo20P/vIsp8/003vSOY84CilST6GeMWmYCEXaKE1Asf59hwmK65FUiEQU4/I0gRoPN6xzFxjIT/bxtWltKoy0abWtqGvTzWfgRHANNR2NeipFPckWu1XIZWfcMg8PH+OCtP0TDpZPG/a5Sqhe9Pg6Oz+SM9PsXov1KPNKvcQ7bmxowKIVEVWhFwtaAa+vQImSeuxh3nN3CJGu5ghK1v6pNTCs1Sda07t5DXqnjcpKpD4fae2wapaNl+9SNxmYtkGnVoCaYcfoox4y7mTRUq1Bty0kjlWdlOUQxO/a5F2clJMgV2TRLGY4/+xAfvf0dRMMuKhRoHQ3EXux3L+WA6FjJapMuIGtfVbTabZ0fHQ5+ljTspl55BKYlOLGxDE+PDt14hjGmjKypxCBQLiEvx6i0OujlwP6rr+Pv/P1/pJTiJK5iGqfICFT8JDeKgHuAzqa3yxre5mtkBRvjp3/J4dMevhqpHkYzmuPjZKJ+pmATprS8sV0FNqGHcBOgvSjYeKaa/4wi2LAYe90o2V/6wrE3dqGRX1zYOTWXpKdrgOPqHurQdikpMeI0BZMeD1kwdgP5fz7YnOVBKhxaxXdYNHM78+uvqT+W5wGbENCLKcdlxrx4L3yac5V3T281NNrFVNRNacgQWIuAuCyiXeeMFI8x/PtVjso6pyVcv/76L953NkdcigUqWX+Ik8ePMD6/QKuaYpsFdaeLxemT7GnpbG8p6rhgaiybYjoeYTemvlqu9NQWx2ZvbWE0HeHLR0/w6MlD82K5kWdUeBgg640kT0/lAs7uoZQ8I04C1CUVGSaZohcykQgoYh0xmmH9hgVrOgl0gJy+HXVUNDrCpUFFbXeNtQQD1tl4DRZ0Z9f8qSiYLLHpSNJF81mEcUYWVqzRCLPLCwxODvA+x0MjQ+/0AFOOwa43VIs4Pr+QAT8/PbaoyglxEnD4f4INn72ckaTx5SW79JlAYi7AImvFAIc7sSrKb55WMU2r+Cv/8X+C5p17yCoVdMeM5CINbstGGUhkZNrJovuruiMJE9r3TotGquGViqWB2UDJa8BesXKEesTxFjXE1boaUumAMn3WKM3RKmc4+PBdfPL2d5CM+6iXp2qcnowGODw8FjtuxBRZYnVD9aER7hipSKk6R5+qHkojOidzZvNpPBj7NCJrRQs6NKOVUoqcLQTVBnoz4PYrr+PX/4HVr0acXBrXBDY0W37uTRF0loFN6DDKRkk8dTXYcJ1Y5gEvHtmEbLEi2AgpXYEtNDqr/r/MmPy0RsK/V+gZP2MwzZkupNGuH4X3bFWkDDptfaTD8N+DDbWiZHhFqXUCfd5zENCY7pTm1DuPwafJikDj38c/8zrwPb3B09/P5qIr3xTZ+DRQCLr8mY8+bwJ6/o4bLHwUwaNUkCgv3q+b2IB+sfpzvwmYVh3nsppW8X2WraF1ILNs/YSgqt87sKFYKTXljh4/xHwwxF6njY16U9poBBTWIkZ5JsDh2ISZi0SyYR93mnXVPMii2trfVk2nPxng6OQMl/2uaiHj4QD9bh/9i3OMejZsrJZYoXgwmeCy18PFxSX6o6FGMJAwMKXSMZUbGAHQmEkPi6SKROBAIce0bioPUs12I7Ol/JCyz8b6a5RCdYXycC/Z+mEYmqkplP0i4yxHTHPPOsagh8nFMX74b/4VyuMuhmeHzL0q3TUYDnHOkeBJKmqzH5ymZwc8PprxUi38finY1KpG3VeYSyNbQSlKkbOPpFLF/htfR/PWHUzSBGejqQr6VBOfkVHJWTZjksXNOxeA8lzVb0SGXtlmILFWUrFrQlr4gvodxWhXq6hwXlGNg/l4rQi2c7SiElrRFCefvo+P3vo3iAeXqJcyYJIJbJ4+PVIkysiT01Otdpmj17fWAaYR+TkebEjR1/mT+ixhUov2lJ7VHBsDS/q7SttGVYENkqoUFO68+jWBTdQkG42U6KoIJGFkQ5Pi9463T962+Oci2GgfuMxO0Zn19tLvpReObISmK3oReBFWGZubvNCfhUd6E9gIZX246P7wusG+qrmEHrZfkIuUGl+kRg1L1zDnS+l2qekyGlGYbzL3GtvqGr80MLYosbJIm12dvTfColg6oPEG2otLrkuj+ehlGdg8D+AsI3Bcu9/smHaHvMyA31ST47n4Dmx/T4rrYh2BI/zMZWvqRYAmXCfLwI73kGmszVZTHuv50SGSaY69zQ5q5QSD7oWUGagnR6LFYMxZPRnSJg19XbI21VmGYe9SBmJjZxtxrSLw6E9GqsX4gXRDps96PUz6Q6XQmN6VceJoAabJqDlH71a6VzZaO3PaX2m9hma7g6RGkkFdzbNW7K+7UcHJwnP362Sxxt1eCdf+IsJj2pPzbNR3VcI4m6t5leKt0WQI9C/w9r/+PYzPn2J0dogye21KZaUGGYkx5udrlUJiuoyTOt1USW9M+TONFvBMq6C3Q6MiOCqZa1DSCGSFsYeEYFNFllRQ3thC69YtjJOKBEARsTGIOUQWXNiEO1Bhf2E0fR3IqUHzOjEKVGRDSjj7i6RBVlP6jAQNFurrtZbqXFReqMdltJMyNqIck6OH+OC7v4/5xSmiKafbjlTj63Z7kgxi+pNjNHyasHvZF92b/VgEel4PH9mYJ2vpQ14PMXUDFil/rVE1mgSaYqrm3ZpUA+6+9gb+9m/+I9HAhxxVH9cWYKNptYX02WKPu8zFMrAxR9j09cK9EmY3vIyVbN+L1myWbebQGHmwWeVJfhVvdlWUc5N3vswAXY+sLIS9BjZU7/VprpzaTyYJEdIgZQTnuc2BsVZHRTTsX1AqQLVsgq2PDNwNYRojUNVlp0f4KNZs/LH61FkY3fB1f9KRzbr743O6q+7ButerEa8wJTG8Zz8rsAk3QBihrDu+4nldWztzyq2M0Kk3Mae46NmZVAN22i2lWCgZT1CQmvV8ju6wr3HaBBpOPKXa8cXhU5EMOFW0s7mhqORyNDCg2eiI0kqDOxoOkQ1GmAxMvHTY66tPhWBDz5jL1SIDer3sN7E6TrPVUWG/s7ktgEkrdREAbPZJ1eRb3JeiZ1cbKd6ThXca1AAZ2WQcraCUD8R+o6o12XJpPkEy6eG9P/z/cProU0U5KXtbson1jdDDd30xBEuCjXq1NLPGJrJ6YgmPaVlkI5dO+Wh+rqWO4lKKGfXVkirGaaq6Tev2bYHNZDSh0quNFGCOkUZyQt0/x9JRzYjW2p0t1SmYplNNxiJA0/EjYDdQoYAt02m1OpqNjvUgpTU00wgbSYSNco7p6WN88v0/0lyf0uQSEzb2TicYD8aoNOrCvLNeV7RvXv/ROBNJQnOmOC7BaQj6NBqzKJblMOINIxs+GNnoWVV92qRkATaMZO69/qbAplRvCXwY2TCFn7hMS7jnfFottIvL6q38vaqgBQJNuNdEMPCpuhcFG79xi2AShqV+oS4Di3VstHCzvwjYLN881Bq66rPwLDH9rQMBiaKaVJ9JyFMEz2/IfCJhPQKGehWUu6QEiAU87E5mekRApIV8VdgU5cWBmgecEHaKqaWwZuSjGx6aBBb/LT6K96D4+TelsJYdZpg+DA3asjWz7jSXORbLan7LoqFV7x1GtsXj46Yk2LNGwfG9BBdGNlR6riccPTCVoCILv2LeTXOc9XtKadFw0cAePvxSb6sIkmy1iU2epBfNQVmMXAk2VHKYDEeaH0T5oNmERIAJLidDNdYa6047X2mdZqutJkzK0bMvhpGNdZbHKJcsTURHUKldGguuaxowN6JBw+Wiso1PcClbOQZuNIN133PH+Ci+jBkNOAfKzaaozqdI8wE+/+FbePLxj5F1j1BPSkohjQZDUbOHGft8xorMCDRWi7CIzddseEqrI5scM0ZWlJ6Zc5ZRIoLAjAzFOBXA5GTw3bqDrFrFiGATV3i1IUol1Q6yTKlA4Y3+UTLJshXc0zxnAlSSAmlV0aHNVGoKrAk4ZM81miR3tBzYxNiuJNiIZxg+/gyfvvPHSEd9pPkQGUdsjIfoXVhkk83nAhv203CtsblW509KOvulWPQX2Doijhvx4MGG9Telz6TsYRqHatINwGYcJXjpa18X2MyrDaXVGNnM8jnoCl+r1QRNswIv9/0ysPF26CawCYHnhSObEGyWpZyW9Tl8lc0eGq+fBmyeMRBByo9A44c1+b8zYToDG94ESXCzeElJcrJWfBMk50ZQaG82tna4eUlRDdMYGdMrGtZFAUnOLrRxsYxIWfC1oMmk2S03ej26CQ1wSD28RlJwzJ11k/b8/QlTZrymPl2yKuIsXrebIoPrkWLAWvPqzDegRBgtLnMsvkrkcRPYFI9/GbAtO8ximvhaemkONEg5JkmErj1pqhx5wMbByLq8h/2+5sfrjrNvicQAFk1nM1Fce91z9RPRs73o9/QzGlpJx1As0zs3pClPKGXDngumq6zzf0ofJy1b3aDBKY0tdKj822mLOeaHpnHGiQDNMStlUAkYrHeoKdGxwZQGtgZCpkhyN0+GjX8ml2Iq2fzeSCz2zGqN0c/LYtlV8kyzbI4+/wAPfvwDTC+O0EjL6F9e2FiJeQm94QgnXQ5V84PRLCoT24pq4W7WyqrIhn1XczbV0sDOTf+NRpZptCyOMSYNulYXG21WraFP6ijBhgY7Y3G8pHEOpK0vRikvvDwlu9mwJAkcgQ0JANWK5itxgB+lZTizydKSGwKbRrWBViXBViXBZjzD7Pgx3v/OtzE7P0F1PtZkTrLRzo7PjBkYx0qj8f7T+fBKDmTLiY3GGUQuYrVsipn9RQ+Oq9VwpJHuo26BRTYZn9Oa0on33/gGfu3v/0OBDQkDjGyIowQbisQW947/fp0zq1RekEYLszYCT5f+lx/0opENDyqkOptzFRTbgg7cEJied7P/SYINAcDmozC15cJQ8dAMcAg8EoBgsxS75tnwGLOHJLHxw2kZjYQNcRM1htH7oPdKhgnXqEBHUFQW5dK63S1O8nRAhb0ujbfMyw+N8VXd5kqIcl1TrL8/nvHDzzI1X/Nu16Wpitd/ndEOjbG/3zdgzaI3p7g2/Od8lcj3q4INP2Pd+4cEGL+2w2ey8XgLOYeE7LPpaIj+xYVUs6sp9cJiHBw+lfdeb7TUhEqvng2GLJKT9ktl69PzM5ycnVpjImVHSB+e5SqgUwqfqg76XPd5NAKk4e7e2kU5jWQAKQnkBU7JjOL51aqNazIvPmVG50i5/8nEBDfd+4sIY5LCeiwboRHe48F4qDU9K/OYrQeExIhkNkGTLLTDB/jJ23+sNFojAs5ODzHo9bRfLvoDXA7JlbM+H6tFmLKEBxufSltKEBDE2bEyQuM5UQ6HjZZZ2UYtgD1Cd+8KdEbZTOQBMb3GU5SpyTcbm/Y3DbDSZy6NxjlFugDMMzHlxum0MZDWNCWWfUVU0KCaA8eRrwKb9nSA7/zeb6P76AGS6QDVcqQ048nxmVKDcb2m9/c6gqRl8/py8i110RiVWsTnqN+OuurBRg6Ji2x0X5RlYUAWCWzIRiPYvPzmzwlsZqSA55SxqT0f2DiFF98VUugO0bE9s+8ChiqdmIWt/99/54fz0IAUjYlnI/HnIah4w1dkm/mFuMwjXWWobjJGoWfvPzM0YjexzcL3XYbcBBtFHVIcshQBNz9DUgY0BJqoxGapsTzXeq2C7U5bHc80IhzfysiG3QtSqmA0M4O8V0pyDKdTnHUHSpuUOAecKrO+cOtAmZPyVHyMTLafGy3MoZOR4kHBj87VOc/m8oCLYBPeJ+V018gBFWtqzwMmobF90cjIH9+qqHVdZPMnDYbF6xGub/6fcjEmKz/XACwaEjomFN0kiyx3Ta0u2YrhaKKGTtYrGL1oBAOlY6jKMB4psqFHS6VfrzdnHq31lJA6TD01AgvTOXv7WxrLzcjG03N5XIqgCTZpZcFi8vtn4bSQNRmwCZddaw82y9aFEVcYCdFQx2oOZeqY7QQEmzQfIb84xIMP38Hjjz/AfNxDPIe8eI2imE5VfCfY0Kvnz1ij4MPPRrJR0KT+WsRDMPLHz4iGHj3rqazZkKnFGS4cMZAlKSYcfUzppf19JJ0NaYWxhhYldSSIMclGDCww0whvU5I2F5MbWTo4Yu8JbKIKQOehaiPKOcyvUqcSdiywabY3LY2WVNFKYmxUYotszg7ww9//lxgfH+BWp4bZaIzxgEroM3T7pMBTTaHnGGgzJKmx/xjZ8DoRSrXvpV/IVCUDaDZ6GvnKD1/0bDSl/3ke81hgkzbaODm7wF/4D/46/s5/+9/hZDBGzsbgSlPgXNa0VLOUsh0FBXXfZ6d0mhpAjeZcxAx/T3xK1n/P6F5OHe3dP/kX7y3ApuhdCucL2kDFv1lHAAjBYJVBuQls/AYoGjX/fTGFExrC5wEbhvOL92CaTNpGzGVyHsUM2WiIeiXWYKNOo6r5LpofwRuTjzWzgt2+PB51Ys9MBI/qtkM12AGDSaavKV9TTkxxl14YRQFTo1byGOTdkY7oupf5PXs0PA2Vn2FDkgyA+D1TKeHDOwT+eZ3n/u8q2IQOyU1pvnVgGb6PX1sh4NCjZvc5DR8dBjKx5AiMmJsf4ejwGL3eQAwslgnUUOmqgJT6r7dqMro0INQBE9D0+wIeGhnK7XN9cNQDO84ZuVAKiE2ejVoVmxtt9X6o/sJI3QGNjxRYe7FzMPBZOGyu5sKawaoH3+tGsNFrrfeFMQbp1nRqmSiO5wY25w8/xsnDzyTMORv2lWZkfYLnyxlFXN++vSBko9GRIgB5SjC/52uYZvP3jF4zCQcJ5yxxXzGVPQOyUhljOgFEks1N1Pb2UGlvYECwyub6W4Yxdgzsc2M0wKYb19S9IApohoRqNlFSkY5alX1IrZak/KuNCqokDZDt19pQTaySVMVG20widJIZksEZ3vn272Lw9BG2GwmmgyHG/Z7J8Qz66Pb7imB5nXXPXH8Nf8+fcZy6Bxsxu5hBEfg4pm/ARvORTQg2jY1tHPUG+JV//z9SZHM+nirS8ZENwcaPR/ApVgZPkr+RM8LVepVm82vF6xEump6DdbRovKYTRgq5W2ICm3CxLQOEmzZkaKyKkQe/DyOj4sZ9no2+bCOsSq0tS6MsQrglkiOMbOjY8XUmEU5ByDEiHje1jYjkeYatdgN7W5to1atqzlRKjVFQeYZpPjKPwA12kpeWscPX5okwjXZ22cNpr6e0WoWyH4065hHnwRv7ha/x3dJ+Jrj0rNyUPhUkKyYHw4Kx6JeU2eBmKygQLLxW5wGuiwyKNZOvGtkUP794v4rOQvH9fc3pRSOb53Fkljkm69bgMmcnBBuKL/LeMx3KmTBUjIjoCLApcTrF7/zzb4nKenp+ofpgo9lScZnsJtKdOVKbJXZflwgbHHlsLELz/i9Us7e2pDRANllCiX/SXD270TX+kTbrnQ0PNqGTKCeFtSCNGzBPdZUN8MYm3LsLR0/9YrTb1tejFJZkXGzscjofY3R2gKPPP8LTz3+CYfdco7KZMmIzKq/j2emxBDz5nqJA05CqMG50aBoz38RoYqIGNkod8WseKc1IggTtHcFmwgmVHJ3B3qJGHfHOLtJ2GxmdwWkJCcdBkEkoSvUICo8ITnwD2lZJoFs2wqLFCtKKqSeo6bXR0HA/UzSvGhW63kLC8Qts8oxKoj63ylNEl8f4/re/hcvHX6BTKWF82dOwOAZNjF4JJiJtaCpqrshXQ+OcE3x2caHzl2SNAxv73sDGojFjoy0Dm3Kljt50hl/+a/8h/tZ//Q9wOZ2r2XUyj80xyJhvMZLAQnZL6bjrMlrPSnLZipF2IVPzgXq6VyEIe3VUB2cabZlB9wvqpgJpEfGKhoTfFzuwi4Cz0q1yv1iWMw9BJdwMXxVs+BHsrFYNQ2KEU5Ryk93moKMKc+KdFlq1Ctq1Kiokp7BoOR3Li+TwKEqDs9jLqEWGfmYDmTzYMJI57XZx3O1ilM8Qc0E2GmINcfH3B5SXsNCYm0vhJjcvdY6oCkwPlpMcU7JorARrUxKNfSQqdEEq4poHu+YC/3kHm1WnVwSRdaC76n2KaVy/5j3geLAh7HMdVdhQp0K1pXs++OAjPD04wqMnB7jsMXVEKRamzZg+Y/GZ0anV0bhxJRHjaMl01O7cubOYBUQZGf5ukXpUMyO/mAa6ilzCc/HCpn7fXSvgMlPE1MwSh8W/h99/y8Cc78VVSA0NjnumaoFpNlvXGcFmowJ8+qO38dE730P3+HChnDEeZcgmI5TzsYRMmTIi5Zf9SDpW51X71LF614I0mt0Hk4cp8SjczJssJ6uZM5mZ9kqBnV3E7TZKdXbMswZD7zJWGo0jK/LZmBvdiv90SKlCwLlOdPCcNE8lJQnAgGbxRW04TtaskBZNMKorJcioKSnP0YyAJiaYXzzFW9/+Fi4efo52CgwvLwU25I9xvxNsfCqMIOLBhufGNcHfK+pxOmVhGk1RAxs3bwCbETXlogS/8Jf/Kv7m3/67GNIpqNYxyJy+LennxlySHVPK0tGqPZgsnJGgFu/XP9eoEROMQq9aN1tFRKByMkiumb30v/4/7ywFG785Q2PvPyAEmWVgVAShEGBWec6rNnv4/ss+/0XBhrRUn1y0a+EAACAASURBVIKg5ENpxgGyQCvlQorwyu09yU+kVPidT7WxyU6jJ8Ggl3LuauT0uXmG8dReykgSYB9ArBz9yeWlaK9Mp/E1zD1LNiPnECtTAeD5UcBSc0/EBJpKLoRA4z08pmz8TVVjJwu7zrvx1zAEm3VptHWRh3/PIpAv1sdCyWz5Hbzp/QmcLxrZLLzsG4acLTuy533dsjRyuL6TBUHG2E1MadHT1hgE1nTSGrq9Pk7POTJ7gMveAOeXPYyGTsOqNNX8ed+tz3QZQYVrgODjBU59ET+sZXB91GlUZSSuzwOiijcfkkAppMr0PdUuyGwS2NijmJkI9+2y/zM6YJ8GH1k5sWFd7E5nep+JtfkIm9UITz77CF9+9D6ODh5h3B9IKkbnPxmiVs40GVYD92iIRxyScAU2dML891a7sfSSIkBGVmkDs3mE2ZR70LUXMPXVqAG1OtK9PeSVqmo3KvZzmFyJkUSqsGyelNRIywhGmQPOiqlUTB+u1jQHQlGNcwIILIHCghpYowTlKFWbA0GCWRFqOTcwRnl0hh98+1s4f/wFmulcYMOhhByFwPM463aN2u6aWpntsPtl6U8164oRaNeZGmmiiTvFdEZFyswEfTZyPh0bbUw170oNr/3cN/HX/sZ/KrBhZNPlvGimXX0GhIxABzKefMBUmQ20MwARqHCEuCOU8Hv2gfF7k/Ixp10jSvzPGXVS3JWf9b/89tvXwKaYaihuytDg8+SXgUH4N+v6HFaBTGg4iwYvfE34/j9NZEOwYRivNBoN+SxDPYmw1WyiU0+w22lrsh4Bp0JDIj2oCSaDvhhFqNTUrT11bBEueFEVJ1TWNe0jCiNejsY46/dxdnmppj2J69HDqm3Jq2K6gzev7mT6efOULmCjHMNlN5GQtSLVdLhv8qm6wK/orM8ajXUe/YuAjS8UXiduX7+j695fBXavsRQYvZvuefgJoSFdliZbto5WvWbZWvSRTQjg4TqLWL+Tobf0jvocRC0354HaaRx1XKZB0nROU2RWP0pcxmX/XIbfp4YYFWlCptvQjHCvKUg4hQqt+5mNmOZrPYtsARguUb4sTWgm2TXTuhELxWh46esKQ7SYbk4dHXfCGSkRAcdGPpRLlK+foDwdIcoGGF2c4PjRY3z+2Wd4+MVDdC96aqjcrLE+ao2cjG5oXHkuvkbDa6jzg9dMMzVwKQvQCsY1A031rbGQHyt1hlYHYAaBTZlsfCQoM3phmqtSRys1MI/qVxI0EtyMYl1TgUtqAERpf5+6pnPkMwsJsxuK6yIBGO8z/0/pyQqmqMyGqOV9/OD3f3cBNoMuGzj7Ss3ZOY/U5OrrWAxzec4iHDlttGVgQ0AQAJAhpzSWa6igqoPCWY4RIFkiViSzeesuvvErv4ouZxslFZz1xigrdXjVwL5QLHEbgZdXdsiBDaMoSfekNi6EoOLljTjcT9eFYB3b9aJ2H7/3UY7AprhJw+9XeYDPY9iLRiT8ftliXrbZi8aqaDyWGY5lBnaVZz6l8i4RmxvQTdlrVyvY29zATquOKnPxpRzVMnPyJaROfHAyGKCfTTBL6xgRYJx8OY0JQYAjlJmiu+j1xEKj6i7nS3RHA0U3Ekksx0ga2ygnFsko7UjVXIoiOunymWvuUr9DnlsRmtL9lJHPJmhSIXbRO2EGLvRQ14H5quu5Kg0VXsc/C2CzLs1bBKZiOuh5Ij9/PYs0cTlVfpN7+Xunj+fBhgVjE1dMxGxi+oxd4hLYpPZYjWSRqZopVWcpaM35/heBSajNx8Y93mur31prZaid5/5fsq7k4GHUWF+0jeesdVyJqRZBx6+nZeskZgc6HTTqsJUSTCKKf9owNwJoPM9Q4mC1aIZ0NkXv/ASPvnyMR188wqMDG6iWjs+RlKynhkbXd8xrD00mC+KMWHtOO80f75TNtEN21latf6ZaQ1xvIG21kHQ6QLOOUrOFGTMDdeuNaVTraFYaaFIRgMawVlH6LPYkC1LKXW2U156RjgccGXcxVc0xFDFBFppjGozZSqIBKSDpLBPYNGYDvPUHBjb1OEf3/AyD3qXWA8+R70iQ5bnzfDXmQY6lRXDURvM1G89GM/CxtO26mk1OJ4Dss1oTt9/4eREE+P2gNzYAlhCxNQMvnn2mhLfRgQ2p+GRPep047xCxBUR1RY46Z8TnwLpRrUkHj2w0gQ0dZKbRQgNSNMrFDVY0Xt4D90ASLlz+LMx5/zRgs6ymUPyMohf8VcCGg4ps4XBq3UTDhDYbKe5sb2F3o6VRrvRUUlIPS4x8WFw1w8DccG9sc0EW3pZbJCPOE6HsPNkneS5drB47h8cTiTIqjVaKgeoWkmrL8vCkKpdLim54EwksMxaaSaUecf5JLqDhZD5eAxqt5saWKbP5mRqBPL+ud8F46Wd+XQUxrb+m3qA9I6JXIFgsKJAUBgwKzMVis90L57kHMj1+OuCCmu3YUTSCXvdNHpWjWhZ5/t5Y3lTTK67VEIT9+a4Dm3BdF0Gc58Z7YvJQwXm6mUDmxESiu/OiSxUYJnGvNZfQ4DBNZNRm7RfX5CstvUIPm3n4VykNSdO70c8clR06Zov76YzJ4h6RPenul2T5KXfhDFwRrMwGXWcPhHuPkU2Z9GWmZhjRuMjGDCAdpxyxBnoNESuDYKyxwWCIhw8f4+DRA3z5wTuadUPPnsw7inQKPN0EThlgt7+oyMCLzeZYFaaTiiZPxjUO6WurkVXKCZ0O0nYLJZIomi1MmfqRUawjJehz7syMjaxl0ZiNA+ZUn12hW5NjSeF2A//UlybynRlnxTDlMiqsgYgcZH10jGzKmApok9kI7SjH93//Wzh7/AC10hTdkyP0uqe6z3Q85gQdZkHGY9dbZFNVOfeHtslL90j3TRkOlp1cFE3yBAVe3drz52B7PNKYCap+zyt1jEsptu+/inOylKoNDflDrQmwZubTrOGzFfscADkwEnGCvUYpIpc2q1ETrlpDk/I9jGZcFMjvGe2w3qzohoLBYRrtpjREceMWPZ1wYRYjI28Iw/fwC3sZMKz6rKU/965dYHBXHUvx9Wy0JDVZKYvpBKWsj41qhJf2N3G700IjnmOescdm6qpp1gSqfhp+sWDJlNpkbAwb9gKQVZNRGnws+qpqNAKasdJuNDRc3PRMOMAItV3UN7YFLuWccwznprfE1MtshtPjI2xtb2jRH50cShojqsQaLNXe3AHSNualBCml6mNjQbFDmcaskiaSNrkyPJYPVj+ElGJt6iMfPCYVZfl71xXO76l6q8XLQqz3nAlgTj4jSdgcZjLiSnXwfyIs2PtZys9SPvKx1ZNiaRwdlyR+jFnE3BP/hkDsO9b93AzRXLnJxZ4KRp4Fk0qXrY91jolvoltmVPnaVZG1rgmHvrlmSFvPTn0iEIukQfLobu9lEcli/7jc/PVCvtFR7br7krt9z34e/8g5DlrKFG6Mtq6FXTu9VilXi2xEY+U9Ys+l7rUN0SgZR2HlwzuLPk3nWW7aYyQIOJkcTft0zcpXtoGtBDTiXNfXm71LzOHPWcNgLesSZ2dnWtNsZKSn74kBPrpRXaCSLsYfsKYV05htbUkHTmCgUeFUBeEwsljUanCKKeV5nJIzh4/x+numlA1PvHr49WJDCa9Ehi2Kvd5pbwQJW8/WY2TPNPqs7wpwpkN88eG7OPniU+S9E8wHFyhPhshHfZyeXSKqb0rLjWB7dHIimRpjeJXFVuN50WnNnPAqQUf30dVaymTSSVqH9531KHMTCfiM/Ag2jDajzg4au7eRpw30R5ToKXMqIjAecMddAYstnOvrQX07ph6hLz7oHMcVlOvbSGoNtKmq4IgtfBapyY2t8OMp/p0Bm1VpspvATGAzszA5no5Qng6wXY/w8t4m9ts15ZLL2VgKAhody0IkwUaUaeu+n+dD6WJRz8rEA+eiPA+GY/RJ85xk6rcZjCYY6r3cpsccY1IRWntobe3rZnHS3rTfV+TEwiOLz5MRdaQIHiwWjmScz7pnKqa+9vWfQ2XjNvqknPA1aYwG029cPM5gM6/qjYkAhccteR3zoZkW5CLlz7whorNLg6SUuJM40d9Ltdo65rUZ5SK7motTvVYKxWRkMae37Rau6mEB2LCgqTScvoLhdEGherHxr0kMXZfD8fN0VlnLFwWbVe+7ACF3cb3z5NmEC00pP2LDEUB8UktRiySLzEgvWGKufuMLvgK8QM7IPs5VXaim4iZGCr4E6AbsBkxmHGcUhyXm0azw/9I0s/vI67cObMLerRBs6DJwgusVuFyBXPFnxeyJ/z5KaiaZ79SdfX+QwMzdd0V0zrjqvDzzKeL+nUptoRih+r/xHe58LxFrwkjNpa39GvEAHT7fZFc07yWojfHsTdCKYDPTYDmm0x59/GMcP/gY04tDlHsXAqByZtNau9MU3dEEgz4bfd0YhUXqoWSinC6yIzmAD+1jd00qVT+J1oBGd1b31ySyqBGXRymSzg6qO3uYJw30JrQXEVBNgElfLkKJP+LQODqO1JpjxoL7N9dEavue789j4N+xFqSZSB1E9fa1ERVi8jUNbBpNG77H//+ZB5u1kU8hsvGLfO3rXGNdVrKxruXpEMl8jP12RWBDFg2yodIABBuGtSZkw6RapBwtmzlp5KeTkQQUNdAom0nriGDDqGbIUco5u8OpckvWkHkd9EaZRpvVdxBVO5bbdEwmMt7GEizso1mnYF6Gra0NtNvGUnr85BG+973vYTidobZ3D/0x1XQzpEmEJmeT1FM0a3U06jVsdTaus5EImE6WQ5EN6bNOnU1KI4xIuKAlJjoXU8pvfD9MyRtU6lHNOe7RDZujt0xDRpCxVLbpb3mBUwMq87zLXvOQ16IQlRbTVcvuqb+/Lwo2PssYRt/h5xcJKOHfmSG/6miXIXQHK8JJYNg8+ITyHRJtXQgOXzfUFulYL8ozYCBB2LLdI+cUWIrnyhEIVcznZdMzCyNWP9CK3eOrFH39ffeGzRv80DirOB48iuC+bh9muV0nH5mEABN+Tgh4i3Qfg2GmdVzNMgQlDy6hw8KfhcfH/4fagqsckxD4iuDjnQIPAh6oBDbIkE4nOPjsQzz5+AMMjx6jNLxAPBkgzjmBdI7+PMXh6bnkaRi5ERCHg7E1fNeqSi1S3sgYeBZVCEwc+Crd6oa/hWBDtyPjlM9SgjytoNLeQWV7H/O0gUsy8hjZpLEIHGVS8EmdV3REd4WTS1l/mmFGYCL/gRQEgo2yiJxWFzuB0iZQb6HiaPmetUc2HwGGz0yv8ed/7sEm9PrCRb9ukeumEf3ZTcxHNtAo1zubddzb20ArniMbdJFQHWA2tcjGgQ27rqe5NWKyLMjIQznXyVR5VwLLYDS2iIYCe2SlaSZ8LsaKL8aRZD2KWpKOCFUB+H6cxphn7EHIcWtvF6++cl/1nHazqYX2B//62/jBjz9Ar1xBj82joxGmEyoaANudJl595RW8dPcubu/tXzMG4q24dI7AZkYPzDxdjQThl0u7+HTYwthLL86+LA3Cd2Me2dJo4ukzkeasl9JeTDPJODINZ0AjQ+hqND6NVjhI21RBOL/sfuo4bkgBhe8RvldoPHxTb/H9vUELO6hD79j/PdOG/nOUmnTAWRy94Knt/vcG0C4zERS6igZvlai3NwYckOYL/paetGuySMMxLepSpHIGlO6xscHm/wYpySU3wRvokO12HV2uoGqZsQ6va/H3AgeqmoUzalyvB6+7qM7cY8EYhGvRDndwAWx8ZOTf0zeVh58R3q9QaHJZhFN0dIpg40V0tV5cdlQCu0yxzXJUMVVD6+fvvY3u0y9QnY5QGvaR9S/kcFY6Ozi6OFcazYtsMv1ulG9TCWFvlvXaeF0Zl1VhZMY9JdFga8XwaTSSkphGG/MllQbSjV3UtncxqzQxUNqbqcVYKb1FStudbHgdivJZ2g+izrtG2LQF1JuoNBo2esE1IfthfCQKKMKp1f/sg826Au4qsCkal6XGTMOb0oVyQD3KcWerhZd2OqhFOca9c+Ve2X9jyG86ahP20rgFwM3qu/+VMhuP0B9PxCIZU25iOFKdRsU+GkZaD98DUaqiN68hqhqfvz/s4+jsVF3l9ATanSbOT06lx/bSvTvIR2NNgLx9aw8Hjx7j4y++xHuPn+DpRRcXHLiUjRUJvXRnD29+7Q3cv3cXO1vbV4Pa5C77z6eGFZBMuWAtIybn2G8YZ63YNyKjQC/biUBKqJRNZzRUjsziazYyoI72q60hBVorkPuUmmnQuc8KeoRCL3TZ/VrmQa+bp7PKW/VGg7JBHnyWedVhGsYbrPBZNapA2bYY2fjIqBjZKCqij8iO+IWkjEWV10H2euSwKPS7ERVSDnYPDzZefsTXgby0iMBGhAsKT7qRGaTQ3nCxPdiEUcM1A+yGefmfPQOWa+SuStQcc48i4PN7ptdCkBdIO0DyDpIf4+yP0d9P2g4jcFyl0Iqf4e/LKqAprski2Ijy7vbMgi3Ia0oSwjxHPZrj+MvP8fH3v4vu04fYTMvI+xfoHR8pcq2028p4EGwuL3umHlAuqQbMQWqMCsRwFdXb15DcyJLZVOMtrsDC0uGSzSqVDWzY5dpoobKxh8rmDkqVFkhT5+90fcY97c91QBvW7vi3Wr8kH9RbKLkx4gIbRxunhp8UFipVi3DYO/hnnSCwDmx8zrToCT8P2JjCq3V7YzpBrTzD7a0m7m63BTaMbEqUhlhM0jNfkDdSyhaOC6/eCc4zGU0kpDgYjjRpkUQBptLIRprSU5Ot19xWbS9FNrM6Di/6uLjsYkKqaML54E7sTnTrGBcnx3jlpXv4xTffxC9+/eewv7mF995+F3/4gx/g7c8f4ItD0kjPUe+08PXXXsObb7yKe7duo9NqKj2nzeeN+5yRjWllEWxiMqOMzmYeuivu24scvZLeMwkBzI9Lpsfm+0h1gewW9zptOlJyKddCEGEBm+ctoDGLsghW/ATAyGpIyyKPZV5x8T7/LMCm6PX6zygar9DQLMDKjwJ3gFOMbBZsuaBms3itM5xXgY0V+8NzVCTsHq4Ss/heRX86Q+7+yqiqjmDPYvYFBfAF01CqwAY2NHjFAX5F7PFg6p/D++LTaMtA3RulEIiKf5fT+SmMoggjGZIFPFiEzFSLiiyy8WATXjf/HjTaRbC5dvxBZLzqHDx4LXtWPLGIaPy9I2uVDa+5ajMXTx/jg7e+i97BQ+y1apj2e+g+PUBaiTCeTRCnCaioQIKE9ODSBJNJhvOLC+mxGRGJzqqlv7wDQOctlp6bfS7XDp0+S4XHyMiL4/VttlDd2EXa2sK81hJhgPJCIjRQesuRSsR0dKokPrUOzvuhbQhrXWzmJCWaPTeb24jrdae4UJO9YTTjJbbIrOXP/lyk0UK5m+Im4Pdhge7aJi1s2mWvNaIpO1xZCGPjZob9jYbAhoOepsNLyaWPRz0xZNg7w8iEonxJkqpRbzg0hhnD3t5wiF6/r2iGhAFJk0gGYq554/JgWaTkFEWm4uYpepMYp/1MdZ1Ki30CVVyOejg8PcHF5QX29/ZwdnSIn/vam/irv/RL+Mvf/Ab2NoBv/+6P8E9/67fwwePHGOZTNGs1pdp+/s03cPfOHtp1KlMbLZOfJcaMIwjYpjJ/NuIpeXqx5oKwN87vQGp+0WAxsrP6lKd8Mlcsaq+jM3vAEMfJsaQ82HgGjd0DP0jO3REBdyAQGdK4l9Buix7YOmdkXWTjh1qHgBNGKsuclmveMbvQb4hsFmk4d0l9zcZHNlc6u6EOpFGcbT07JyCoBoVUczN2lmtfRE+i4Foqzb8+NPh6X1fwlVzLDY8wsnleh+AmLznco/x/mtQXxe4Q3D1Q+cimGFXqfVhj9M2NTpjW3wsPNj6yKUY0/hhDNmHx2ML7WoxodF1UiDcGanh9RUFmMzZTrKMBxt0zvP/WH+P4iy+wVUsx7XXRPzvF7nYHR8ePVROhw0pg5Jcmu5K1qlQiJbWMAm2OyBXY6BymV2lcHgf3IVNoomKLqlxFqbWJansL5XoLSOrIqF7A2ozScu4rZKCF/6c8lzWN6Zm9YZz0yjlOZabINjY0UM4z0QQslYrSZmyK5fcEJo7Q/jMf2Twv2PiFUjQuayOceSwF8ZgexmyK7U4Vt7c30K5EyMcD5Cz+9y80V8S8rAgVDaXiiN0aLs770kUbC2xGFg5zdC9rOFwpJabd3BRELhSGvZHRFwk2JxdT3Hv1Dbzy5tdQqiT40Wcf4q0fvoOnp4eKEEhfJmf96/dfxXQ4QKuc4he//nVcHp/jO9/9Lj58+AW29vfxtddfw2uv3MdWu4WoTHkddj6biKF1uHvtNvtsb4RYi7oygK4DnsVNGXoqW1NOhFRJY5ZJ1j1iz0isZi2GyaSPMnIjG0/NaJLisTpQRGAVM4aelxlOY+zYo8T59YFsvH4WaDAVDVfx/v5Jg03RDj9jcBmF3gA2izTcErDhe5MpFqbO9F66PFfv6xNd+rkbnmWvtcjGG0IDG3a92PVlhMNa2TWgCdNeJfZyuD6fGyHnOqD6e6TPcGmy0FCH16hIsCh+jE33vLrn/rX+dTRiPm3mRUrD+hEnniqa9koDgQDtM+wzl6IM15sXklzllCzr4/LHa1RnimJePeTYqXEpB5teOUABoyF+/P3v4eFHH6IelTE4P0U+7OPle7fx+RcfYjweoMzon8KsgwHOLs5VI2bdo9vtuX3Fmg3TV1eRLo/tKkq29JlSi1pr/LuyUmglKlK3NtRfM4sqyEhM8SMUqK3G6Nzkup36poZu6fuoZgol7EkinZzgwXk+rUZT47DnVBVwElu+z4apNNVq0orWoAnUJqvBxl++dcZ+1c3wN6SoXVb0EIoS1kUPxF/QZZ4JbywN302PcLEv+7u4XBHVmGm0BBm2WjXsb7VRpRGZDDDqX6iKy6I95dAZ6m5u7eD27TsCjuFkrnnqjGj6w5EAiaNuSRDgqAEuIOmqOq4/De2EWkhs1qTyatTGN/7CX0Rzo4Mffvg+/ujtt3B4cYZ5ap7TN3/+F4z+fDnAlIyV6RxV9mWVjblSp+z8zjb29nbRaTfRpCI09Z409I31JsdgWQI2VqMpq1BIyR52sTNVRpKBTSGdYTTsI6L0iDqDY9Sq9GrMk6kQzJxygppaOUueI36n7C2yc+SESLJuNBSLa5ppISoVU6XXEQ38GlDjVyBrz/M7Pj7WppPKtfO4fNHXe7033X+/blYZkyU9r2vM7vVfiw4aPBbUZgcuPCejyFuE6SNCD6hD0tmZnPV0XqfkbRJ8Vm9QNOwA2Ga2uB4lvi52TYXO8EinK6T4MoLh5zuhzrJLw7D/h3aLYqDPpO4C8PRgGQJMuIeZuLkGZoWa07qLKaxzjzC6XBjRQh9M8f38+cvzd3/L8+d153Nx/z9jRwq6gsX3v8lZVWQ1o9y/PTzQKCoj/ZlyQvRkJxP0T47x8JOf4IuffIjzwyPpLzZrMcbjC0wmA0zYpyc5/7KaNplWkwaaS5+xpUKaZSQqeeeMYMCUG1NdTIdphgUVFSjRU1NUk2zvqtmWLRuIqLRAJYvU1Y7Z0OsmbXJfKiUZm/4ZpXeisgDDg0ylRmWTikaaCzwiToitqq7kxYLVD0XJJcr6SJg2sX4sRturhDjDBXDTgvHhbvHvly2WcDEVwagIQv7369IgYc1m3cJ+9vdkVFGinWGvMpzYqKfY6jTRosRzPkHOSYTTEWZ5jl6PQoFDbG5safwuZ9aQdkx1gMv+EL1BH/3RUE2cYqbRkmnwEsUJ2ZtjYndkbUkZegrs3H4Z5bSOg9NjvP3+j/Dl0yeotBrYub2LZrulQ84GIwwuLzG57CPKZujUGtjf2EKn1cadO3c1TKvTaQsM2KTJyIbNdBxXQC83LBTPGV7LmLg0QGyRjqXH2CJj9SsCsMQU2WRaiQQw/CLAMLrRLPr5VMU/bYjMGDM6L41YINjkIlIwymF0p3A8ThTp+DoW5/lokzpjq/HI7CQfcPBYLpDxopR+rXnmHn+/bjicNwKrDKJPo331tWOvWAc23uMW+y4AG1vf1J4yyZFFk6HIGFMJLnomENcMo1MfpPhIikaH+X6CBe+n/72U/hzj0PZP2Wo0Sq054LJvZOCYCgqvUzGaXAYGi/35MwKbZWkqXd81YEODV2TK8b38elp3X73cy6q/Wwc2ogMHACu6umta5j3LhkPUqblWmmHUvcTRk8d48uABjg+eYHh5gUHvEONxH2OCjaZeWmuCv//8fJPq4b7KLG3mGWEEFqa3RUGMNNyNk0kpQEr1hBJTaG6c9ZwNmGkVUaWOiBFHTOHQCDVK+jjquYQ0gy/+fCFQGurDOe0+qWDAJGyYMvNqCwJ7J2qqQgUdJV6Tm8BmbQoquEPrwCL0KML/h59x03t4NPeLfOG9BX02yxZM0ZO5/jdlqU8wHcTRzuXZFPWkjI1mHa0aRfl400cCHNU13MYid5zve3R2Dqo+kH1GZV+CDdloNLY0smZgSyinFaXaSCBQkZaT+LKpxuJG1TaOLy7x5PApji7OMIvLaG1toNFpy5Cyo5ohQU7ZjvEE1XKM3Y0tvHLvJdza3sWrd++jzTkb1Ypj1WUokWgwpRdktFHfMKhrzT4bl0ZjJM3U3WgyVERTraQCmxmLqnmm6G5no4N6GqNeSxTVUHKEqgmUhye4MMJRAZNgQ++L560RC1S9nuGUaQANPowRcTZItabhcQZIJF/M5MExV+2nNRJweNxc6Lu7uyaY6MRIef+8SOVVymm1SSk6K88Y0iAtsc4wLfv9OrAJCQKy79fehGnGkgiK9AT9RpditEBhLjVk0V6n1FO7UjQQLXiWS95eb+A7y70wpAga1sdje8ZL0XteOn1vzluy4WGhwSz+Pzzk4j6mcfWPVY7hquuqInQWpFQLzbs3HYd/z3XzlNamWV8gstF1dTW7kAJtF9NUILLJWA4g2oCCGAAAIABJREFU09p85tTf4WUPl2dnGF6e4+MP30WfafrzS3R7l4t9wEmdilhoYMTmVB7CVhDbCfRFFQCKjCbShKs26ho9nlZNXaFEkKs35OyWEk4Vrern+koqCyHPMG0d9jvx596x8+Kj/ln1WpR0XoySFQl5Yoq05kyAUw6THzHwv/3zd69N6nyeGxwunnWRzSpjX0xvrAIjT7nzvHttWJ6om2a5UCL8aSwFPb6pdR9T7ZleQlyao1GN0a6naFRi5NMxppMBUiJ+bA1oNII0AIdHJxghQZ80xV4PvcHQ5tIQHNT/5GQa41gzTKQSHcUStGNe9vHhMQ5Oum5M8BT1VhN1CgdGXGOUuxliOhwrFVeLUwnbdZot7O3sim1G0NlvbaKV1lTb4fFTroYTRmNJ0jB94qyNY3+xcMiHJoUSbKoRBqO+ZFAok0Otq9l4KNDl0Lg7e3tqY+WsdykTqBjNOoObGe8KmVK9ptOloVRz03uSEOlAExLZG5bToKapCpcEm9FkjH7XpEkWsvFuhAIBnZMpOTTMrw2fs/eeGO8bDe5Nj5vAxl+Hn2rpuBc9D9hoEzKx4uQ+rlLLLt3CZl7qfQlwTHPLiz1mXAPZ2GpvpbnSEsIWCcLOMZgwMmEDnjUKa9Q5jYtYgbbuNPdFaThTk1AjKSNfGi+m4QqpwPB6hGnw5dfpKo34VcFGxto1BRffu2gfVt0jppZ8JBO+xjunxci36EC/SGQjW+R7X9TDFDAJ/TXlKATeu+lM95V7rMp7yHBknqF3eojh6BK9bh9dzvMZkM06FPGIaWg6EVJ7UF9LWcPZWCOhUC/vHRszkURIOEuHTaExvxgtsxaj2RX27NYDJXwEwKwdl2wctzkjVyoeYQbKp7a9zfVOvgcWrlnfUKwMhWdd0kaXytrben/+nGATeibFBbPOMwiLVP6gw+eQrrhswawCGf9zn3ctylh4BC5qRxU/4+bojBoesUqqJvORqZuWGbR6LUWzyuHQU0wnQ1Q5gTEqYZpl4KwQnjeHoo0Roz/OBDas06h2Ia2kmWo1NCf8ngoDZK3RE2Xq4tGTx/j84UOcDkiRNsYH00UMcTMZF7Z2zzEdjPU7LjCm7ra3t+Xt87ldrWO30tIzFx/PQSOtY4DS/RpdrYlRV70b7Gu2763fYhYxTBcRUp5XKaPExkxD4+7sbqNZixTlUKSUkZKiJiejz3vE+pQ04Qg6U8qKWMNrNpkJbMbzErqDAc77I1zSW3PkgWE2NdZNBon3MedLgPE1Du9VeaHXMHWkdBRleFjjKYzFfh6jFa4Jm5b60z/Wgc1iEzstPa/ebXsEFi26+TdMtXF8BVGbDbCsnbWadWMB0jtmzYx9C6lFQSwIPzw4FpATvDVgjIXyyACH9TimZkz6npESh43xHnmwKYlqv2oKo8B4hXaYXTHPZrLvfhqwKefX+4hCWxTakZVg45yTsE7F4/CptbDWVzw+ge2a9XOT/RDDk/fLXQsfZQl0HNjQSfCqx/LwFzU0OoIZNqg67YVYpRFIt87Sop5pZ/Oy5tpnJBJ4LUFro3Bad75Xju+/0Dk0J4brQNdk6T26HmsXg4Mw6glBSPdGvUTm0Hpw98AvB971IPp7t5jU6Tdz8Yasy4nfVOAvHtyyXHAIZv5Enw3Vr2sjXfNk1qTR1oFNuVQVzZBzSahSa1MPx6glLIZHes4Y2TCqKc8x7FO4zrwpahsNcqiXhnIT9NRJd2ZXN+MAKg0wghhkpi5gjZNlnF928fDLR3h0dIQsYt6fU+3cHAvK4tAbIJc9TeWtEuDUHJym6GxsYGt3B5vbWwKZe81tNXq2GnUJcaYa2FU2sOGic9RIf8MJNos8fompmIleJ0HOjEq1OTYaVdyl6nWnhSkHPYHREplqRiCgErVSaRIVtXrMjONmWZfgjPQpxx+wkTXHMOMsnwlOegN0SaCgpyeDSJkRRmxV0V6U93VTKP3CpUFlpOijZx/N8nuTOq8YC+kGjki4lpYZQ6b6XuSxDmwWtQPNPKLjYvNavIw9PUOSXOhskvnHvgdeX9bFkjKH6cXSyatymF81Rb1KrzbR+XNg1+OjC3QHY1z0LlUj80DD7JRnBFIWx+o2VrOxCMuMkoQ8g0mvRQO/LMK42lP+2hXrFs8P4NHsWW21ELiKxm+ZM3lTZLNMld4fv/p0SCK4Yf2sA5sZsxVOWkj727EJvYyR1iwJMQQRNoOPWfS36yUNzWwk5zXRvCMnJkq3UUrS5lSxGVxpU477nppT4e01JW2YyqTPpH3jqdFOwod7KgRwn/b0UUgSWR/eqoc//zDyCe8Pa+a0MTpe1iAdAai4brSH/VjoEGzCTemZP6sOZl1kI2NQ4KGH3xfpiUXAWeUtLSKfdXolN17JGKVyBXlmM+QrCesbM+TZQJ5+tVJCq1bFcNBFmewsEktGg4VmFb166gwNshmYY6VUjQywSABzgQ4L4f2RgdAsKqF72cPDx49wcnxmowbYlMfRsiycazXaguLK5FTOmAV4ssrYCUzEqVdRJ+DsbKNdb+NeZwc7zQ62Oh3UaxWBIwv67CxW7FqkW/kmOnWt81xHqFU5k52E/gydSoI7O1vYbbdQ40KajJBQKj4yyXhGN5OM0xaHqs1wXgajlRmHMkkKu6zUzZiRzWyGbp8AMxfgMLIZ0CA6yfeU9MioIsl5gormhnDGiBscxrXH+o2PZJi+5H1XYTyOUanVbBLlzYTEa5st3Cj8/7+NyEYOlQMbRjY8B42KSFOpcotKztAlt9oM06GsF3LENEcM19IE9Wqiepl6OBjBaiBbBaM8wtG5KQYPSQipVSSnT3+bg/vYC0aHhyldY6XZ5RDoSDE6IBYUxkh4A7N6/7442MRzk4sq7nP//brMysJrXjEK4boq9/V+rp8F2JTkCJqKNiHWq5577Tm2R9hIa3M21GoQ2YgEru9cIxUM/P3MHoKRUsbzubIdUjlXr4sNTQyboBcKKo74oRpxwGzkZ1rqW1d50ZcoBqQaf01pfdUj7FNaFjxw1MCixFEuLVhsPrr015/Xo/RP/sV7qtks+xL6uln3K4/GhYu+k/jKEylIqTvA8fIetuCJhKbN5GVORI113QLU7CKrio+cKSxKp7DuOcuRZiazMucYGK+8GvRvXAmnBgVId8EXPyG3vVxHNpmqebFSYS6VUzZHSqlxczfqFVz2LpSbjVKOnzVPezbLlR4aTU3lmdLg6jPJbYY3+07okUiKYjhwG36OJwcH+PTTz9Dv95A2W5jw+jH3qj8eqYDPVBs/I2c+lQDkVQckRkbufB0b21vYbLaxXWlhv7OFne1NtFsNE+IkNVG51KvuYtvR/syZ47cxANRUa9CQ0RBNRtjrtPD63TtopzHGl+doNyqAhPqoBGBeN6MaUp6JLSPWY5j+EdgQIIlZ1IgjBXqOAZ9nc/TGuSaVXgwnnMyu/HJabSIpp9YsG5XRarF/qWXHJeUGJwWTm5Q/mW98TGhUSausVdUs68yn0/qy7xY+iKtVXTOYSlu4nh96iTdutxt2otZ+6MUX15qT+Se9nGuYUiTTXLU/Nr3ROWDBOOZoYUbCk5EaiGfZRIrfTIfe3t0R+aNWSXTtSUUnmUKMpHKCKG3i4OgMT09OpIBc63RQ4QyXcoy+o55zC9Hp8WAjlQN+ooREqe5nBAJed2sadAw2zr7R9rvSUvPpVwsHrtJoYee5BFzdb2969vvcX2FvgxbgQ0PIZs0bnAnTdvOg96zZtHSj0wxbqEdb1z8Zej6yMfClAb7+rLTXkp+LwEGDndt4B14xEi6uRTcMXOgo8pq66MacJSYRbBiiJvT6GTouKuLfsD+Nx8a+Pf/asCTB+ym5G1d7WTjtBcKDAMJPZXU22F8v3uaUqeglgai340W5oNAB0TV0M5187cxnH7jWmPZjjdFfk9L/9H9//5lJndqszlMII5diuMq0UubnbWhFkEZsS8jzbkz08UrPiPMXFC3RExiP0YliZOOxjEZeSZFVYkxnZVTnMZrlBOlgJvmFi3iGfjzHNJqhMQN2R2XUZsA4nWFSMikHXyMhckhi2zG/TNGMaTIbn6oMtprpWKg2kQa7iNYHYeoMtpl4sSv1iryO8+4FhpMhYh4/PUd2+7pJmp7nzwvM1yilltmwM4IN+0UINHwmVVrMI3q21CniYvBqqkHTnqEsZ03Q83FGlSMEOm20NzfQqTdxq93BdquFW7t72NzYUGRDhgjzxPoK5U6CAqbfwDRqNHi1+Qy7rSbubbax3ahqiNycg5WoMe5qjbwm3CBKBbhJpEwV8pyZ6mN9gKBjI32N+s061gULnpO55sCzoM1IL6lU0dnYQT4podnuqAs5EzeqjFJcUrqp173EBhvIanWXfpjivN/VWNrb9+8J7KuNpj6fkZVqG06mhcoPBCuqKHivzmaU2BwaK6pbn9FNcjk3p2E5soFqvDZ5kwV5RqgiLjjvlE1wjIajfKb0F7uumCZt1KvY3GjjlZfu4OjwqTTwmP+f5WOBCtNlW7yflVQ/Zz3MG2OutdFoouIum/OeHh3j8PRMk2BLtSpu3X8F9c1tnPZ7kIS/y9l7fToVa526QEidVjpGzaQEeWOrVSt1Rd+qyc0pgU9vj/uExvDKGVzIIXmB1WAYnhwbJ5cUPstSWNlh0Qe0SOlphoqxmbxKubIkwTwg9bKw+C65FWd3CvuH9sZiDvX660AWoEBx2Jntfc3qlQwT2Zq5nCY+x5x06VSR1UBLkOGfss7Lg5czbDWR0JG2Y/UR2/LYgeQEX0BfAKx/jTsPn5Zb5fKYnTIb64EgLOJbzc3ShYuskQMXHrHSXjc8FgX+gr6c/yxlM9zjmeg0uO86vmXaaGGetCj34NFVH/YM2PB+uRysf+aH0HMX4NikJhoTgdh4jDbYgDjHpFzGqFxCn9L+zGOPZoiGGfbKDYzzKZ5GE3TjGfK0hPY8xv1BhBq96noJk7JtEg2F0nbmgnLpOzeQi/7bAmxILXU3iDl7bkZ/8dSXIo/PjVh2M0B4Sdm+pYZF5t2pPhTHGv7Eze8bsHhzyCKhIaDxffjwoXpG2DvCWg1/rnwpbz6HGtWaJpzn8rCesWRVXBf1KMfOjaIqMSqdDja2NtFu1HF3axtbrSZ2NrfQbrZQixKBDBeRCpNO5PGZxewWCJWkCfqNEnCr08TdjTY2qrEUayllQvLAPLboSvIcZJVlpGKbAWINhpGG6hH8yjlMbrJo6mSa6qI/RH/CWk0kACIFPE6qqLc2sLV1C9m8jFE+1n0uJcb1p8HNhiPVKyaDEfoXXdV0xrMM43mOrb1dRUj8fObDE6bVymT6RGL7iNDBc18MbbO0gYDGecpmgrxW3JU+WzFdsHKjq8/BIl3eQ0UHqr25uhib+pIU+XiEEqMO2TPK2s+xv72Fu7dvodmq4fGjBzh8cqAUJZtrWRtTpzbFC73oJKNHXWsqiHN9ZSZSOQcePznAw8NDRY7legP3X38Tm3fuKqpkpkDjih3ALOYRORuh5togcvANntqvbp6RyC5uLLUMirIRtk804iEYYLcq7b3qGtrUal57G2mxcHSdEfTGjE6B7BKNsPPelW2YThwjzAw67Y/X+NKzhqdZBEYrMeO0OFh9Qcc6JTnIs/XsnMIsT/h9eA6LNeLGaoevWZzDmgZX0yg0PbOVBjuUjllyEYtReRgQ+GP3L1uATZByXMOP0J4Oz8eft38vn6VfV+7Qe4R9NssOJiQAhL/X/1lgphektIVvGjOwKTmwofFMKxWlDsjCUklZ4fkM82yCJvsvypR0ydEv5RhUSiilMUrjKcq9MbYjznAHLhoRxrUY06SM6niGreMxyoMxoo0KJlLtd0bDFcC5+cMHC66KtxS9XPUr2GJ+Fmz8ZqOBZ+8MATOt19AfDvAFay5np1ooZFFRu0iUZ9KVh0MNPOLXcDQSyPD1GutMHSfyz11q0sQ8XdwVDIoSyPgUmNvccgGpMdSoiw68tUVwoY7btupKAppKFTUCmJuP7qMa71f5BRFqORGAS9MxWlGEexsbuNtpSam2RC97zpkbEw1Rks6Z78+hl02Qns3kTVtkQfChgoABLembo8wilfPeQL1I4AjcWVlpx1I5QVJrorO9r5+RFcdUKdMOvFYsljOpeZd9NppaOhcV+ssnj/DWu2+LRj6hY8leEhfFsau506hjZ2MTO5sb6j8SRZTioW5De5Vefy3k6gQd8+HGDJ2u5caS6HVFvWb9Q0adkSWPmQ4FB2IRFPIJUkr9zOfYaNXw2sv38corG+BlefDgS6l4k53UqFEBwoAy5vA8R02Vvh470TmUb8iepEypWn76wfERDk9OcdofApWqwGb//svIpFNHT90SZ3JyhLBuFAKzsm74maVV3Z7x2Yig4M3zX1B7vcfqRyp4T/m59AivX0lL2Tl2pDesrrjNn195zlcgc+WhX0U2PpNSmhl4+hEM3Gs2UoFAw3EMRts3YgepXGw4LAxVcyDh10XRLoaGtVwyZYtVa2hZZLx4vbvmYbNu6BQW/79sDRZLssXoxr9HeHxhTWeVar7/rHXUdw92y8CGPwsVaBTZhJuqeGEXkhlBas3/DYdk2YwF6mZdgc0ipKVHlc+QVhM33pRMHObn7VT43vW4iuGwj3GeIUvn6FdYWM/0J51yjKQ3UU2jX08wrEbIogj1PMKdfoxaPseglCGPLPzV4tHet7DYI7vSBi5NRmfXU3f9Ig8NjOeJ63eu2EYDSrCJKqkarz746EO8+957+PLgsSbR2Ual98gu+hzD4QAXvR7y0VDaaDJIQmQWwRKru1iMbRISBDvlYG3csn7pxe8Y1VQoEVOXosAGyQFbWwIcjhPY5nAiNl1SRiJOJAtBr1OpNCdOeKW4bBv7qhHOaaFlGTbSFPd3NnG71UAyyzCfDDGbM5bLkHP4loRDbfgbrzHZZ3Rou6OB6gGsRSi9k1mDpnoFJmOBKdNdTJ8RbObl1NKdvF5JDbX2lrSaSM2ZzHOcXpyrkZXFcYLGz7/6NUUp4/5Qkc3h6RG+89b38OT4ED0BTllARrkPnv+tnW28eu8+Xrl3V4PjOAHVjKudezh/ht9HbGoKjItWTzBfZR3g8J75aJ/DrRjt8TU8FlKU56xtTcYoT8fq4WqmEbY3N/C1V17B/m6C47MRDp4+wfHhkZpy2TzL1B/XgRg+TrKGtUCmYy+6PSmEj0e5rhdJAYOM02CZYhxgNJtj797LuHv/FY3t1XpzS81u/nXAIRtpkQIrWDPhEp1CP5zMYZE0ujwwLIlqnsdIhnvumkF0Bthf9zBNYz+7qikxsimTir9I3fNEA7Dh/RXlyys92LwlP0aZUdLcOZvhqYcA4VUcfMSg93JyMWIVlt3Y9CVisqvec3G+UiIyNtwqY70MYMKfmYNzFRmFkYf/v6eB+78Le2bW9SmG1PcQsBbOmlOwL97z8LMW9/p//q0fLI50WWRTXBTh9/QObKYEF7BJEjCMtZywE9gjurkaB3WEmPcsJ/Y7AtVgNJVxKUcz1HZa6MYjPDl/jPI8x+2NTVSG9LBLOC3nOMsnGM0jbKZNfKO6h/16B718CI4iZq5e05AnzCOTPGBpJAMhJ1gXkTXCO6wQx07Fj9B13lwINj6NQHAwIcm5PPeD40P84J138O77P8LB48eW7vKJ6YjaQzJZzutlRMKuX+oRiUpipVMaWHqvvu9FhsppmTEycWwVRk5Mp9BwEmAINvTwvRYRgYapCIKLpOUJNiRe+MLjEmMQgk2pnIOMmq1qFa/t7WKvXpMseja6tHpN2eRMJByqBk77Yj2E96WfTRTZqb8oMz0ngg0jQA6MG0nSZ4wRLxGLnkkVKPEa0XGIUap3cHLZxzm7p/MM/fFA79Os1rDb6aCdVNFIKjg9fKo+nM7mBp4cHeLg5BAH52d4fHqiXh8ez2ang9fv38ebr38N927ZqG2m18zAOrDhOTlw4XUS2DgpmXATh4Bz04b3jCatZy8xI7AhbT5ByoiQkfF0IkWGjXoVO5ttFf43Nyv49MET9HpdjAYD5ShJQ2fqTLUKSig5oUume7t9zq2/sNrhIMOQ2QA6ACl1qhI5OGeDEbZ3b+P+a19T97hUuF091SI8k77RXuVcLUqaOOVub0x8DSusG8txc3tGb1e4ZqHBW+bNr7qGXlw0NGThtc/ZiOUesk+MQpQPtQI9AdpuqI/fXRpNhX4vFOplFGgHLHnqHwtV7SC6DY/f16yX9fHIcy8bmWdVZHP1OT6Cu3r20eQysFkY8wLLrngdi5GFLE+hQfNFwKYIgsVzpfbhKqApHqsIAv4Aw+fwoFctFIKNibZ6sCFBwEgCfPbvwf2iAv7MNQQyXTJjR/0Ej08uVANpNRO0duo4yM/x0eOPMMkusbvRwn7aUNF1kCa4nM1wkc2QTErYG9fRilLs370jfSjWKiIW/FjTHs8QUYZmTkE4xyPXqGIO/GGPhwMdptMWA8HsLL26/iInyVpPTNJCrmNmIZvCdE+eHuCTBw/w4aefqceBaTWmzCj1IvefG5MLhTlPpnIIuDR4LHooorHaFIYTiVKSNCERuyQRuDAtxuftrS159J1OR+oB/JlGSJMeHJumliI1x8Dyc0wkfCfQfzYffJUOcb0z0zH2ag28ur+DnVoFs8ElsnEPEVNbFBqkU+Hm1tOgsvg9n5jm2YiigS51pmmlUj6wtCHBhmSAbG6NrZqKSk9ajWYJplGMDx89xfFgKNXspF5FrdVU3SIfZ+xUxGwwxr/3K7+CWzu7uHNrT42cf/TWd/HW2z/AF0+f4LB7If0nRkEvv0SgeQ0v3bmrdBqdDUUGugSuJsNzkVCi3esyF3CBsRY6XTcZTlP9vUrX8m+5npiqTekwlCiYysU/QUwdubiEdqOmY2PqM0ljHJ/aEC1mAOhleqARWcCJa9L481r2WPvr9nDe7aHfH2KQTzHgOlI3eaxhW+e9IXZu3cbLr7+BRpNpOidz4/YjmZxa5+6ca0ntGSaqjJNPOwYZjYXhZMTvmwiXrK+vBDaOCbgMbERRkDil3Ss/+uJ6tOnXtwERU6oGPM8W5QU0rn5TvMc+WilGCauM/uLnsMjRv/4aMAbXrhgV6Hvv794Q2ayLrEltLwJC0VEqAsRXSaMtA8vwGoWfH4LOsjVQ8pHNsqhm3Yl6sGEelGm0aHYdbMTUdXRlCVAyqmFXfClXOuq418N5Nket2UCnFmGYX+Lji8/xxfkDDOY9VOM5tkpMR1RQoihlo41JVMVsOEf1ZIp5f6JCMY3wbmcbG5UmKrME8XiOOLPjSehFa7WWVHsg2LA2YJENBSu9cN51sPEXWaJ4vjjK5iv2gZAhNJ+pj4H6Zhe9vlhm/GKURj0rKQZMp7js9+RpmPjl9XCXaS7J0FRsVrcGDrmxqh5YrGM8Fe2XIOM7c31a0BDdc+Zti5nzZj6PDKD72GsdznodiQrskRlhj/Nw9vewXeW8jQuBTZKU0B9cgunSEsMnhvzSAWT/jWm/EWyYwhmO+qpXeY0zjsZm/YUNr3OlzyLVZkgSYFTDdBojmx89fIpSoymHgWw0RkkK3UcZZuMR2mkNf/1XfxWvv/Qy3nhjW3Tr/+uf/Uv8zu/9Lp6cHClNtLm9g9deehmvvvwK7tze1ywfplhEM17Q4a/AhlHawqlQzv66hH64WcM0QtHpkqBo8FqCjEgZev8pyuyTIj01AmpSwC3Z/5MIqZPF9yMCtDbopbOuqbHjpvjL//OasCmYAq8E715/KOHXfjZFjzXuJJLWFWtkFIzYvX0bt26/pGiHaV1FAW7tsZ2A7+llVtjzscxIhJpjobGSTSA1VwQXDuda3dD5PKDjKqmOAeecJpfyVoc+wcb1ieijr4Gf+2xxj51kj2PC+vdlw/YVR8ZYqRr+pz0xU3qcx1n0/kNne1XUYpHWVc2vCJgyO4VJpeG1DMFmlaFeZ4OXgU147EXVff87v5bXEQR8KSJc+9civ0JtfBnwLQB4HUHgpgVDQ0wqstk7G6QVRjZskJSAosbRusanmDO1xzik5PbpCZKdfezd2kd1PsHHX/wY7z39AOelc2TVMeb5EJPDU0vZJCmqWzto77+E3c5t7MwaSPIyfvz+B9IKe+32fdzbvI1OXEdlGiEl2EzLAhyl9AQ2JeTxXM/80iTKqWl9ef/U02P9BWJUwToENxh7Q+jFc5wAJwS2Oh0ZWjXGOdaQ0VJHyq97RhpTS/wSQcBREP3fUy2VQMIxqhK9cywf8t/V/ZxZjwn7ZmxxO/VgDZtghsS6iX1aZCF65zZQyKH33pQ2lwMbRS+TIbZrVbx2ax87NPqX5wKbNC3j5OwYpI+W0kjCfkxPKpVG4c18jv5sqpoJGXeDQW8BNmrsZM8RJ4FyPECUmnwNiQWMcMoxMsrU3HkZjd09jKYZ3vvxj/DDH70r0Lq9vasvsu3Gl308/vxz/OIvfBN/6Zd/Ce99+D7eeuf7olUncQW3bt3Cq6+8gjv7t9RnpEiFwpU5RyN4aqcHezer3XnLc6qR3lCzualA6sGGNSuqZHPjkj1HOvk8s9QZ55m0atTZqywUKpjoIQvQe5gmHZ+ZsoAzpgQbrjv+jBR6qWjr+uVi8/UHQ3THGc7GY1HKa/WmhvqR5be7fwv15gb6vQEiDq3SvvQgcyWFb+bW9VyJJ+OANyAL+HXqPXdfu1A/hZPwX1VzCA1oEagXHnMQ2fiJkwJr13qgMRlOg8wrvOsYFFldgY0JNV0BDidV0vUiKYn1VNbs5ER4LTVdZ076vFKNDqMTb+TV57Poz7liy/l9PJ8ZWD0DyO4E14ENP+cmgsDzgs0yoONrPZus2Dzv7826ES3rPj9U4CgCTQi2Mjds6lzc+CU0u3Vgg4pLlzGqoTedm6S9T09ZUxWLmENE1YTFBHz82cc4OT/B1kt3MWMTWqWCJx+9j48/fw+jzhSj+gSH2RFK0QTZ8Rki6QSYOdknAAAgAElEQVQxPGZEUgEa27i/cQ+3Oru4desOPvngY1weneO1Wy/hL772C7hV30bs0mnVqLoYIEUpD2ZN2Nmvt6LiPSdvBmCz8Hj9GGVHFBDCMy+/qO0bXVNquoWBVj4NwWsnrS+XwuH3PsLxi4NeFt/be+ALcHA5cV1Tp7CqzeLplG6+BQUB/D0SaNK4BxGNB6nFgvZ0SwEOa0eM7iYiCNzb6mC/XkU5G+H/5+29YmRL1yyhFTu2Cx/pTx5TvupWXdfdt92dHnpmpB6BECMhRGsA8cYDD7zwwitvvAxG8AgaJBAjITQ8oBkk6GYM3XTTPe1u3bqu3Kmq4/Kkz/Bmx96xA631/3/kzn3S3O4CUqrKky7MNt/6zPrWWkyHUrw+H5xrz8KvRWi2Wto7oEhgOl1o0D9OTfXCam46Gwtg2RJjUGTrkcKAXIGhPS1lahY5/1vJN2MZ1vALf+O38PHTp/jwJx/hsy+/UAtua2MTbz58gHvdLcwHA0x6A6TjqVENqEdi9Ok8rFZ469Gb2Op0sb25JRKF5IYy0qFXOrdUYTA3lqO7XhXuLKn5vBITBeSlzXp3vLWZX/HM3hRWao/R+yeZjLWgG/se2rUQUbUikkPomRBotsAKCs68PiTeykU/U824D1WHs7mkkQg2pPbz2E5niZiAJ/0hcp+Vbx3tThebG7todrqaB7LdyWuR1HAGbwVTK/8jyrHVUDN2w6wAjDS8xp+Wys4KphxML4HCZO6OQOACa7ElVZ55uEx5ff1bNWp+n9UeXR3FjeHx4fVjmaOsxDLOB+fUGFyogmRVwp23i35PC8SdjU1UoxiTKSn7HuJaQ1RxJQy2JWnUiY0aqfaj1q60txNDioG0eH4WyaUXUXmuU7x2ysfQJX78G8PyvN4a/SaQdt93bLRiNV78d3FPpvh99x5cZeN+Vv5cpj6X34czRLzpdRYVHNZyNTdmHrfwvJXR0ORLvWpT2bCS4IVrCx6lVBwvZ/x/AEzmE7w4O8QiW6C1t4PVZhdffPE5cHGGb337HTTfauOf//QP8Kcf/wug4eH17jaiShXLvILzyUw0WrBNVmmhHbXEinqXjKW8ipdfHqBTqeH73/lVvLf/FvJxiirBL3M7N4apomRWmaW2ydZ+7a6Pb5N+U7HZs6GbhBUR/971/9k61KDSQIUhmBlr1subqZC5lHj3moXY+Y7b+1l3mh3YOBVVN/SzGSrBnK8jZxtMHTFr6WwHv24OwX2bK4NdS2EVsUPECQ775+j4Ee5vtHCvWRcbbTkj2CQYJyOz1EZ2Vb0mYJ1PE+3AcBYzTJeYkJJLsJkasGGA1E3OLJLPXw3BhpbUBpZWOoWKs16IvNnB45cv8dWzp5gvF2uh0ToHj4sFhsdnUqKmj8eSVSRlhFo17D96qNnMTqOLVq2BTqOpbWXOOqhuwMHx5ZkpgE1hq4HnKKOp2FWW/JVb4S6wYXCTzz1y1DmoX6ZIJkN4yxTNiHs/noBGkjMhlZ15rdBriOKl1MBjpWiqGgVF6VxRa8q0dkifJwGC1SNbkFTtJeiMxlPtL02TJapxjFpMH/gmmq0N1Ckr7xktLgYLBjTZaDCgycSNm+umMs45j7TXq6u0eABEULAirroPStfuOvlyFUOBwVcMSHeBDZMh3QMCdZMgyA9RLcWFNAt5vKg0Qkq4OgGRmW9KO4+dhukcQ0oeUY9PtshV2SIzwWGbUGCqNTUrp8L3To0//qdzf+l4ed04oQguZVCg02gxQBcvnuv+7kqwLrHRii3buyqKMtjoHF1DJnDHv/wa1wmqUxcokQrc47nX5B77lcTjL2HRcSvYXNevKx5MnqjUM5kiwYZDabWtRCk1hQgDaoYMXuhjlic4uDjEaD5B2IiwqoforxZ4/uQrfHv3Hv7df/O34SPAf/PRP8D//Hv/C9Co4tHmNppcVPRCZZAvh2PMRjNQ/InPmE8z3Nvdx3ZrG+lwhuRigt36Fn7x3e/im699A4txgmomhNAtoypCrT27wGXLdM0OiwQBm1wqW7PUTyOkad6XThZ3HVnRiW5spBuKYKPL2FJHlV2XBA/ZmmM/vkjFdsdXMv4OQCzLrHjs+XNWSUttRF/OajQns2ZF7oJZXyga8l9qKwkU6dCZztCEh3vtJvbbTdQ9ZsBTpNkcHtue3LVh45uV4XKFZJpgzqE+Nc8Y+Eh1FthMpA8nXSdVXpxVQVpdDJSTOWcyBMiq5guDeYKvzga4mJkZV0zTuO1tRFGI6XCE0fk5wryCcFVBIPae2VOiLtw7H3wD7735Nhqrqjx+uNCp7J3Pz/0eKlWLQW7hm/sVVsPKLdEpg/86YCPZnZrYc6yoKDuTL2ZYzqZa4GzVI2x1Wmrpcd+Gry9glcpslsdIbDOST4zFgjPeIrhLgcE6nhJoZmmq9mPFDyQL1KMnymSKRmcTtXpL3QFVMF6AKKzBC0Jt5UsShQrZKhcME20txsgNdl0/9lorAIaqc1aI9vgVWZrra7RiiD6vXGeFLL0c7K5cwzkVyn0Dtnwuq91FtrL2P1aZ2HyscNjuadRr6DQbkvkR+YPVCrXfUEFvNMLh6RmGJNyEMRDGSlBZeRp3U2KrsTc2yaQ5Dg5sysG6GFzXldw1ZIi7qM9FcCoGagNxZg+lWNmsQaBUTd9UDJSXKsuvtagmUAYjvR6rAFMGo/Lv3gQ2XEy/7cOdfx1fWgzc9MAKkHdUNgkMNZHML2WSDL5rE52V2h2zbAa/GWGYTPDk+DnSSoaoGaOfjPHpyy/xjbdex9/9zd/Ct7uP0EeOv//j/xH/+KPfw3yVoDqdowEPkR9pyEzNZYo58uphyy7yIkxenkoj6v033kOY+Th/cYJ7zV388je/h93WNsJVAJ8VF1d8GPyYFWnL+5J149pXolC7IXuJRmjA87KCYTYWLN02taFYGzlvI/ehrWUhjNXf4s0u7Rc+r1GNYqupWN4WL5YrWbWtcIrnhA/NvyeAOIC54oznRFAtZVUbPJZVpqyeWSn9TBZz1LIc241Yezat2Icn2ZQ5wlqERb7Q0q1IHvSpodfGlGyoFfpJhlEyw4ykiNlMagICWBonqXJYocqAnJt2U2aH6ue9Pp6dnOJ4OEXQaKpa4R6T2kbTKZLJBPlsga1WB6tFImo3ad87e9vYurcrYsh2u4vtoI6IGlfWkVQW3yJHXM6ydMwcv8rND+2GPOVe/qqVjc6PdYoktZq+P6s0AbJE7bNus4nvvv8eRsMh+udnAmT+DatNNwvg1wsGWy7FggGX55TCrglmVNamQ+NyKQ0+BkxWk6xsaLvNeeH27r705FgRcJazTFcIQlr11vTaGGh1fdl2kZGkMfRfI0Vv3r+7z9efrY017R8uEyB7bxRoz3IRvYGeWwy0113jop6rhWh08HhfqIKhMClb3HylFCX1jBVDk3bkcSR6OFulZp5G+Rjas6c46g1w0htgsfIQtdqIGm2MuTphG5d89VVBDkHX3J83efmUweamOBj4tXVVWp75FJP1V46vZaN93TZakfpcfA73b6dVVgST4nvhrLAItNedp+LPy5XNXWBTfK4rfjblvt/PBTbsMVPWgrIz2rW5BBv1Q6sehosxEFcxzMZ4fnqIhPIyXo4XFwc4GRziX/+X/zb+vV/6O+B64++d/zn+1x/+AT7sPcEomyIfTuDNEniLTPLpeRxhFVTN4CtdIqzWsBjM1FprNDvYae6g6TfgJR6qCfDXf/E3xFKrVyN4C92t2kjn5jQPBDNltyKji7EANm6oWlxqexVsWPiw1GfmKH6mMS2zdFtRnBXqTCvHCAMQhC7zgdvAZh2Urmv1eBUFd/69IXuaoKv3UVAk4M8d0Bi6rgm9UmLlMc0yxOkSnbCKnVqEjXqIiGKYy5kWcqkSQZFHCmyyamDWvZgx285wQjtsSvRMaYc9tT7qakzIy4f0bs52FplRIaZj53i+wLPnB/jiOROPQOKRcbMhjbjhbITlbK72W50LiTzvaSbNt729PbXPNra3ELfrYKvt9faWqh+1SDgItlJEDFZimdmhDHfBnEaWo3Hr+mYScsvHFcAvqjysSQVGMZzj6Qq1s9JUQbJRC9FpxPjet7+DUb+Pi/NziSqKBMAKxT4WiSNUaaDBlqRiBNAUMk11bnmMmZ0vVhUpLyTc5dG8gtT3UDMKzib4d6PxRMSNRrONWq0BWgusB/yScjI7U2Zt2LDeWBGZIHwp08KvHVHFtWN1jbpBuF041f3jKsdCYloEn3KQLl7rshcnW1Gmf6ayCQPaY3iivzPnp0tuqxFho91Gmy1eiZmbqouv7eJ8oHuJJIlxkuI5DQl7fQT1Drb2HyClkCaJDJaIIJBhhWz372469WVwKP+ee4+sbFwL1B1rF5yvA+Hi8TBz46szm79sZaN9vRLBpQjy68q0oI12Ja6Tbl9KFq47f3/VNlrx79ZyNTeVUXdVNhy2m4uT1Y2VfrDtKGYNlaCC8TLBvJJhkI1xNLrAMB3hYjLA2eAYG3s1fP+bH+Dv/MJfk/Lw7/zgj/B/Pv4QX1QmmFYSNLIKlqMx8vHUsNrqIRAHpt8q+0cyznwsJwtgmsCvbeLhziO0qnWk4yW+8fBtPNq8j73mJgISW2ZLhGzWSV59pR2N68DGzZxcGVice6yVXe1syumpuQNbZOeYlp3JHJkF8nMxA2I96G7sYobN35N6rlW9LV5A67aebdO5428CggmyxRC6zl4LbTTNexSATICuLYGYZk6+h24tRI12C+yAky5Oujr3aRZG/4xzsmRGy4CFdmS4wW6YdxSSvGzLEGRoQcuW2TTJVAPPU+D8oo8nLw7w8vQUne4WknwlMJOCgiiNRl6F11M2oUuqjyb3U7jk2emgudnF5t4WdjY2sV2toVbxpUHGY82gzw+2XYw2mplpSYCx1EbTt8VWvBltbgcbAgdJJky2mC2z4qad3gp1arSFHjbaHSwXKVKyETWkNtppTpbdXA9G6se5labcbWIL0gP6g5ECKSvCRNeQcV+skS4e10TOIEtymS41x2ES1e5sIAgitSbXjEjaF1BIUz1uy8Si6i91CEnXZqvNttEc+5GfKbpqkhmTxMiQzzIvGewlB3OL3E85aBfjjM5VmqBiq2HD5uNCLKGAoqpUDaaBXA0braa8fci9lyo72YZ5BbPxDJPZQvp6SQWqlr94cYiF56O7cw/b+4/UtvU4G1NZ7+KVSVCKH1eAwHZ0yjOLYpZvovzl+y/e1+5xb32Oa8Cm+HpuqhivvOgC2Fz3Xtz1W47v7r06ht9doPv/Gdi4B1ZGXHLqK74oVaKkE1uNJFkCiDVmynQFWarnBzn66QQXyRC9xRgHF8c47J9iWZnh9Te3sN+o4W88eh+NMMbv/+xD/NGzT/A0SNRuY/srSBKECfc1gDSqIAuIMaYUXtK9jGlzQt1u9iDot13H/uYD7HfuYTVK8cFr7+Hte2+glldRmSQI8irq7PWSscNKxGo9KcOzgceBTTHTIOCoMnAEAS3HXbbB3Al1sUuVQyEbLrcrBApLt5hZIBIUBPokSmlv5vWindOOUpvMnpGC3pW+Y5f29PyFzW+SI9zrp3gp5UA4uK6xCE1mqOUZOlEVjZjBh7YBCzEIGShJxZXx0xKa2Qxmc7XR5pQTl2S6UT+WAh7NnlTo+WJSzWkql69w3p/g+eERLvoD8KHqzaYCZpLMDcWCPRNGHQ6nudhplas5FI7iGAEtFNotbD/cw/72rkRZu3EdrUbTeOFYsKE9hGmXOjkPKl1clYHnYQqWThX6+tvtNrAhuYSimnLR5Mvm17TkJrNKEkVLkRXMWhcDHunrJug5sDGZpyGKSMSVVOZVZijLgY+zXl++QIlstavWS944uua+p8Voyjmx0hzStqIaotZoSTvt9Oxce15auqX7K3d/yOAKqc9nkpyYLSffmLGtP0eR9r1ExbdzL6f1xr9xCROBR4y/a6RaihVMGYzcHEHOsMlcO0n8faO64Fkzv5Ws2lv1GGF1pWqnysVsCrQuprLfyDMe7wjD8VR+SdMsx/lshsPeCD1W2vDw3V/+dZEgOM+SUI21rZC0v469Scuua3PpNirEv3IHQvHRbLWvP8ptpvJVdaVqKGijXXcMb06BLn9yHRus+BxFsCyfEz7KXWBTBs2v1UZz2mhF5Cu+qNvARi+ksBUkujP75+oGmB4sB9iVRoCzWQ9nsz76+QyfH32FF70TNLsROhs+dhohfu3hN7Tg+Cef/AQfHT/Fy2CJPBmZi4G+MmqR5JivmMUwz8uNx3VviojKyUwq+0PIOrO1ia3N++jEXcx7U/ziO9/Ft19/H+1KBIwS1HJfmmx8nzNefBZsXJ7jtvCLB3oNGm5u4/ZdCLA2oKv6cb1xdwFbOQ2nP8XfdRUMgbmaqLYwe0AcYtsX4U5qcYDIAK4bg0GnACIOXHTZ2366W1R0BAcu3roWoMCG7ZRVBQu2XWp1Hd/VbAp/kaBJsInYpgGSZAYvosw6t9iNXTUZTXQmpXzKiMwzKRLTCM5QFXjNSNqGi6906iRTiDsiyxVeHB3jqyfPkGZLtDubmEymCoAMmKKmc96lCsG0SbRaRLVKAgMrrkYLdbbQ2i0BzF6rq7nO9sa2ZPmNTM9Ki7BRYIK7kyfhMXD7XmzzeTkQKEG6mY5WBhu5n1qEFzVXEjOGKSVHTS1ukubF+Q2N0ewsz+5iZanxhnH32GIxJyFNjzm3Qq5sC1GpIqzVcc4l4WSBMT1//ABhvQmP1uFZjhkJBKzwqZY+mWE4HCqohmGMs7MLPH32zAjCssJJ5zo/BBr6ANFimkBRi+qoBaFUKsj04hIxl4ublEmKjMArl48DVkCsOEhCsAwmvmbeg0Wqs06UVYV2wdzMMM1xE3hxr1d0fmDJ5WG6kvq+rrlGFKIe+qDuB6sbLsFKTYGsOrufRKYhv5cuCOY0J1zgdDDEIFloUTj1Ahz1hzg4Ocev//Xf1HEj0DP/cvbyen6dp6sKEGXQMfNHEwmKcdHFAypq8N8SNLWyCqogrUUBH58dGScMqpXf9deWfl7a03HP9fOAjdtzKb+29euz2nploHQAWwSb67pYrg13U2Xj5Gpueq2s1tfFy9/7XSPEWS7ZitnIbT/ndr/h5FMG3ww/ze6KIh+arQbORmeYeSlm0RI/O3yMH3z5E4wqC2w+6GK+mqDTquPhxq4WG+l98vz8BC+mfUy8FKvx0IierWW4KwhWSwSLTAuZy3kG3sDaSqeqMAPTbAk0u9ja2Efdq+N+ex/v7L2O17oP0FyGqExzhMuKbjIOY4uVjTtoLl9xfjzu+8W4xIDu26VA3vBccOUIgHRk4TCDnl/FfDLFKsvUH+cFzpYRgYMMO39u9NsorU+hbPoDLeT+Z7wmFtOZMdqqN1XhTBaJ+vgMzty6JwArINpKhsQHo49mtKFUbQjEzDDUMQSd+mIFkXTtfLZESF/gIq424KWqZeZMtv0mL5s0E+jIyydbYFGhdYCxhZUIp6TvjU0t/y6KmzjvDfDy6AgHxydqCzHT5s2v4aVe96Xku2ZJlgrLso17FIYZRV+fJbwgQr1VR3djA41GC23O6Ta3cG+LWmh1CZKyUiNdXkKNlpDB87G073/JDFnHaKXM3oUbJyNnJPkLag+WGmtyCTtudi1RMd9oDeBJsZlBWU6arHYCGtjpIJrky9KZ18GZraJqBfP5zFpWBBjNpugPR5rFdLa25XR6dHam6pBfc+BNi4HO5gZ6/aHESHuDkaoiLgfzXjw4OMSzZ88kn2SXwczlq+NqliQ1S6RuHLXq4hjNegOthvlvkx5JtKxoNLFBx1aCURhJHNXXzo5dkJTJnUkEzH1h7hoedbe+Ypj95hw7HykeR17b1OVb5lNjN87X73l46+FDvPfaI9HeT14eaGYjB1s7JxJJhRR6zrqyJSazVEoKvfEEp+MRRosUmR+LkVbxQuzfe4BA8k6hIgivPbb+yY7luapyL82earWu2V4mDd2eXwbbSyW1S//BdYLqWKv03iHBo/CZ9xsJCTeZr5l2+y28e7vv5GLPdWAnJqR15izuOblWJ6vTIoCWKygleoWPMg6UFQjWwHHNnKcMSA7Q1snZ1wWbyzLaHDTeuuy1y8QKzIAnQJQjr3k4mV3gJ8eP8WJyipPFAKfDE3T2O3jttYd47f4DDTefvXiOlyfHSNgG6dQwriykQIxkqguQNyxbXHGSoZrmmHEoSvRmzz6ORa0Fs8CwiVp7C9Gqjv32Dr6x/y7e2X4NXTSwGmeIMx+NmLRV4yF+40fJ+e7yxmILDfAzc7IyGrt5OZY+MxlzcynYUV6eNgsEYd/Y8CZZokyfGXWr2lbWQwkdgk3GalCZUa6sebPZ1nvkbguHgUG9pvYKfVzm8yki7nbQNkFLE9yZMeAjJ0FmXKGZGVFUk8FWzDhVOcaV0FuxVWLmFvp9p5Btt861lGpbPFOrecbdBs2fKrTEHiNbJRKh1Pfodcqt94TU3aW0vNgyOzk7x2A4NO/bqveaqsEcqzWYW5aOuym0lOa8ffhLYSghUoqSchDebLaxubGNe1SXqDfQDEMJd6rtwre7fmQDaFKwttqUbAMRbAiwxiKZr8UsNV7J8hg0eE2LTWjOq+gP1IYbTzTM1sIpjesooKqZg9kPUbWvNpphP/EcqYWmOQVnWRMN7TljqfoBJou5JJAI/UGzocqQezbngyECqlkkKcb0+YljgRLnOKRCuwB8dHSE58+fixlIeaP5bKZlTVXUfH9imWkzC5q2M1FrNlFttSVkutluCWg4D2NVs9FqIa4afyAChN6X6PXm3DlDsrUGB/1kCsBjwJaab2ZBk5pxbIaYzbQMi9WEblaIUMVut4X3Xn8D+1sbmPeGePnsqRauZVBHlXHu0NBunTYUcsbNcTEcq+pjktqbTTHMlprfBGENYdTA3tauKj0eX74UKmUTbHLul/OezKzjr71OioDjqMnu6lx3HYr4YLUVXWAtXseKhwUCxXUxJr+DoHKdnwwfxwX2opNmGWxUea4VNMyzl8FkLUh8Dcmg+PvlvysCi/u968Cm+L3K1wUbBTbtohi+tcvkDDtnhSgOMMumyCLgLLnA09ExVhsR0Irw4uIFksUYGxsd1IMIk+EEg34fMy7GVSqyD0jjCgazEZJhH5hNAUrHUHU/NWrF8/HYqC6HMfxGExnbJmxwV0J4YRPtcAObURvv7b6N9++/jW2/Y8Bm6aEZ1+UIWbT2LVTVr5yc8hyZYOHAJq3msjoQ9ogJxQCVI5snqPvGPTPXwh4Dnlx9tLMSVWt6HoKN8XQxwVdaVqwWk9S6bhq5Gg47yUYiw0Yst2xhvU+MunFmnUOZgYqcoDmT5R8RHSscEpuWmifKcHAj2JjYHq41z8Q6jEyGyOqGC7rpco5ZOpVzpPxVVjlmyQLD4VgD66cvDsSSokgkFxX9qCZ9OWZ03N9Ztx2vDJkLdtY6P6Y6IHGgYkVJCTZso3W7m+i2N7BL4gBnN6FRiSbYrNu5LpBooddUamy1V/MVKBB0F9hIS4vcBQs2hCMHNtPhQMoBrFop+smPmEGcoTRNrMwQC1G3uW50z5z/D48hhV0p9soZmpOkYVDNPA+90VREgOcvXxqdOdL/k4UESSlgy99nJcxZDyuZw8NDjM/OVLU0Ox0t27ogpFmLFjXlImfFYEOg1UZnYwPbm5vY7pqqhmBDJ9hYytUEGjtbtGZpYvvZpMVVyQrGzsfK7rPwWOm4LDMr51MVeUPnJmcCRVLJXG6sb7/2AO++9pC73Dg5PMPx8+eS9ZG6guwtuCpwCTaLPMfJWQ/9yRxDKo3ThiFL1diIa0202pvoNNoCm5gVHI34aIBIGn+V1ae3BhsFRZutu5nmTWBzBTRKIq7FJOW6YF8GnKXtjFwHRIoL9poqA8V1YFMM7K56vq69dqVT5ea5BeJSsfqRq3IBiMv/dm3mmzpjjkCi1/91wUbeFryx6fi31uPK1Tvnkhuzl2cvnyLnue5GOFoMkLd9bLx2D6tghdPTAwUGyp8Men3NfMJGDdM8w/H4AqfTISZL+qFMsZzN6MUMSLLd9MvpJqmBDfuy9YYRfeT9lPK5Y+xt7CPOQrzW3scHD97Dg8Y2/KQi7TS2Bhw11h3E28BmfaDtRjW/rqaGVsyKhoGMn6WC7VpSKyBiVpmZ0p8XPPvxXKZksBiOJ6o+OOxNVikWGuJWFJw4QPXmOZqcqXBRDZ6kS7SvYiuQTq1h2FSMcyIJmCw28Iw9MVtbJiOjQrfWGG1LzaoeF8Dmcj/KZK96f2RCUaE7masy4cCZi6gMjtWoivliIuBhJs3/uM1Nv5WL8z6Gkyn6g6HaavLp8avwwpoBLA7J2cL02ZqwP5cjqf3PtbHkFEgKtVE3jhsN7dswMDbrLenidRsdBXy20Kj+3WCAJOtLG2+XVZMUG9jmtLJDbKOFfGg+5Q2VjQlCrDJ59E12brS7THuIlev+7o7anKN+T/RmtsZ4LBfcD2JbjZJEbk9K6gCm4mElSKBgK4NEjWlK/x8zkyOTj/s1z45O0dncxGdffoWz/gBRrQ4GWYINd5lozdCzHkDS37OsNscUW8uV2IpKLSleH/SeD0I0NncQN1vY7G4Y/59WAx1WOa02GnFsXF/1n2X26xozezB8n6zSLw1xtJap64bH024+COC4z0GihGwXeM5ZYeUpajF15Gbotpp4543X8WCni3ye4vTwGMOLc0NztuoKBBqCDtUpuDxM/b3TsyHOhkMMpnPMsNLuF3sVzVYX21v3dD8QbGphzeyUVYA5kz5rNREwdNhl7yLgrBmlhc5GucJRDlRwLyvPe9z9cxOQKCGxXc2bfuemmfltM5lyq8wBlQOZK60wgnnJXqH490pY7b1Y/j33mm8bs1wxT/u6YMNs0zG0HJqyRCbQMO4evHiC8+E5gnaIcKOOg1kP5wScZog8yBGsVtjZ2EDNjzAbjVL7r5kAACAASURBVLGYp2oTMaCdz4f49MUTrGoeKgHlJyiTMkOmCoc+hEtEtIVmpsiWECVOqiHyJWlrHrxliL3WLvzEw47fxTv33sDbW4/QDZoIM2eFcNulcP3PVBUoGJvIpffP/1idWIYeAxhbANxu9zgst20TcDZT9TBezLVT0p8OEbZqAhtWcOOEIp8emvUYse/D5zrReIZlkqEe1dUyanbaAle6ZYZ5FUsu85EGnlcQUG2BQCDHUm5Om3bXJdgY8U7TRjPLuHIqtCV2eVOcFxLdQTm8/vjxZ/izP/9zPH95gFqjrgXL4YQzNZOBEXSmE4qQGvM0vucKLR7YGydYWNqvjh+Xajn8pdwRDyIJAVbDylgxWLSziUS1VpOHT7fdUQuN/1GiZre7iWYQoxZFAhhm4GQa6vxwa9810lxFoxaaqez4wUG0mete30a7Dmx4XVNGhdV7za/gtf19tFodXJyfSvk7z7n/ZSmxogkbarOMA20ngIGaTL3E7dFwh4bCm1ZvbbxYaE5zNhygvbmFz58+Fdj4YSQBUlaRXPqk1fhwNNLCKNtlZJExyXD+Qm5XzBFHeB5YhXE+GtTrqLc2tadDkNFsMKbKeCSgiclK80NVInJL1ZyLdG9jO873kBJs7JxGwXdNureb+jy3DMjLDL5nWGWsVkxnN0G7EciCoV2v4f7eLppxjNmor1hglj0tLVxVDVtgJJ/yWlsoiRmNEx2X09EQ03wpynMliNDpbute4QIyF8Jjgg3N7Ghlz2VqS/RgZXsT2Oh9FQgC64S0EBbKAFP+utzGKkeUu8DmuqG9jrMjqVwzb18nxbcs5K9fhwXTV9pr9hdcG+8mwCkSCG5rownwvi7Y0BiN2QZlKy5LKl5IdDLLcHj4AnEjxtJfopeOcJ5NcJb0cTIbSpyTGWm32UK71lKPOa5GeryT3jmenx3ieHAGrxGi2oxR8ZnVJFgkUy0XYjVHYyNEnrOFU5H0CPOUVe6jklbhL0PUUUO70sB2QMvjPYHNg+4OagiQzY1uVEGL7y+NPBonqK1lAMft47i5FWnW3AngDeqHPhK6UQ4HOO6do5cMUN9twqtXMWMl1z9FfzpSpUOwYZbOmUI2nSMds4ID6nEdm9s72NrZwWZrC5jQVdOYmXH2YthChtJpklgjICrAkXKBCbbG18OBzaV0exFstP/GOY7v6wY9v7jAZ199gY8//QRffPUV+r0LQPpeSnNNBaILnP02Uo4CUZe9INACIq8POk7qhZHqxt9ZsU1mPX5MtLIupcbSoNZsafCtbLvd0a7NhjWQa0Y1NJm1VgMzcKasCV1KadJGkF0wwFlqsZ3TiPG3HmjLIPRWsNGeExtcNOQjQMtGgC/dZPur+RT7O1voNNsYjIcYXPQ0pBcNm4rCdtOds0HXEmEyQPYaJWVmi5U04zST4NyO1esiUbbep9ur6M4hnrI9Np+LhXbS60ll4bR3IakbVsvr2YAdpCurporDktXY5dIr7zHaWXDuFdcbqHixjm+TPkmRIThEvi+gIRW5EZF67Os/Arl7LKOCYJZDbwIb1fycPbIaFFnDqAJoN0m21znaES2/M5E6GvVYCdp8OlH8CJiYsVLjzHCZqauc0sCQKtjpQkC9mOY6TiejIUbsHNTqqLXb0oiLojoW04V5/X6kduWKNH6JiRh2XMBWuK1sWPG5gOmSkXWwvWaOXyQOFAGgCBA3BXEXaO5qoxUDUrlFp3NcmsmUA9hdbOIi006AUBj889/qxtiPm4DvSqV0DY3c/f3XBhuexJRsNO0GkB5ptpZn0yEW8ynGoz46G221wpbBCtWNOr46eYFPDr6CH0e6YHlDhF5gAkqzo0EgLQjoV9Kbj8F5CHdrEHGoyb0eltApsJzAb1CtlsHKl3fHikOTpQ8v81HNAkRpgLe2X8P91h7aqGG31sXDjXvaPk/Gc+0XXLfUt2ajuQyiPLCxWZxah6QNc9/IyoWzqmBlw8BNGwTaAvN5wnqI3nSMJy9foEdV5RjYeNTBrJrieHiO58cHGMxHCOrG4pk33KPtPWzVO5pDzIYTnJ2cq3pgoNhsdPD69mtoBnU0ag21znKKjmaGhSUmjTMytK00Mxy3thAcQ5OGa68GXjQObNbtROpfUSWi6iGq19T+e/byQOZlH3/8sai1vCEdO0gPpZ0S01rNmHRI18yyXtZPRjaUabOqJ2XZUYGl33JJk0H5wd49BUMOq9utllqKpOcymHNoTdaZ9LOsWgADhwb0jHNppkG2gqGe11DLi8dA+xa3VDZFsGEbjYGSQdeBzXLURyMO5HjJQb9UiWk3wAVTS64gI9Dt1QjgaR8hsA0wXixxejE0sxX6NlWrYqT1JhMpBlBd4fj8HF8dHBiV7ekEF8ORgsLo7BjceqxEkR5TzyESDcG8iqpEPo0gKduyblmTx5NUZ0ra+BVaXNR0XOM4QsTjqsqmJsFLtpp5PAlSAnFLdFgvMttMzW3ol03L2EKTmrPmmLw/E7XT+P5ZFXbo7cNBNlvHBDNZYXNhzrDXGFcYT0ivZxuN8xZT2aSyXphPaUWeyRtrwLYlY8jOLvyghvk8sY69huZN9ibjB6/lzN7gnlzqL6no7lpxgfU6i4liKCiqRt8EOLdlsHcRBMqD+Nsqp2K1457zCvW4ILbpgIXX6m1gUgaYMniW93jcMbgOmL4W2LA0j+gpz1LXy7XJ7Ec0bFpg2D/DaDhAGFRQr8fw4yre/e4H2N+9h9/56A/wT//4/8L2/Xt4cXqinjUJAgxOvFkZuNibrrcbePz8S/STCUbpVC2XsBWhElcxz+bAYgD4M11Amhmp2JHJDipZCH9RRavSxC+89W28tf1QlOdaVsX9zg7qbNsNx5JmL3848HFS/Tox14GNdWo0bTRNTI3wB6sBCpOSt1CpSsqFc5hq7ON4cIEvD54h4432oItFOEN/0cdXRy/wxdEztdcoUsrKIxlP1YYj4Lz78E3c39mDzyU2tg3OzzHtTbFX28L+5j72du6hHtWQzUlKIBWXgaK21o9y7/FSC8pWNoX5Uxls3Ftm+4GyPqxumHVrtsDAtlrhxx/9WINpto84q+EyIecQbIcy+2S/nFUvr2nO9pTxc17ArLtCBeeGKhyCCwMg9ztIuWVLh4GPJnIMfgIZzhC4pKHNf2NxbNoyhkLNQTRbWwRqxkDuYqwpuPYEukzOHQdm2CbAXN9Guw1sIm+FGqm4yUyPwfemGRdbpqxRPA+z2eSK0CLH7HwLlKzJq1Wc9Wf48tkLHJ0cqw2maifNVAGT/ryxt4uffPIpPv/yK6x8T6QLHszmzjbGwwGqddoSG3ab2pBiPRJyjeIzKwutIlhGmksm+NpoF9EgazPmXk1dbUqCjJxi2VaLa6o2eDwJOuZxHdvRZSjmOroObPhc3PYnS6/OtmK+QL5I1P7mHlQjqGKTFZRVH2cNqXNJAs3S2Iyz9eiAhrtbZJOxohHFfpljMqYatof+dIr+fI64u4Hd/fvqcpyf99QxIUBKyohEjMCT3JX8rJh+LAzFvzh3cLJBel83LLWv7w2yT29xK72pGrgM8Fepx6/EokKlcd3MxM1UrgMFV5m491akSLvv8R4tAkR5Z8oRBIrVS/HfjNW3zWyuVEr/6f/x0XrPptxzc20x9ybXi1DuJGQ54kqgcp0tMe0mRlWMRgMMBxdKXPd2N8HFtTfffhPfef9tnCLFP/5n/zt+9PnH8Jp1kOTJLIM3Khfw6E1xenqqi7dNW+iH9zXL+NFnPwbSKTrfeANZWMFkeIFqJ8Ry8AxgeuJFqGQ+VqmHSuojzCKEyxBv7b2Bb772AXbjLsbHPVTnOV7fvg8O1qejifj3cvkrXDCuVVAEmFdmGSY1EMiy9UEmkaHMGpthCZLmFdR8H7PpVNVdfzbCh598hMTPce/N15D5GSarHv74h3+MYTpFGgKn/XPRlL1WA/mgB8wS6b55QR0P9+/jndffwc7OjgQ9V7Mljh8fYjXPsbe9hw/e/QA73R1MR1OksyUacV10ctNfN/axkvlxkh0sOIrGcaXKxlGAnYcPP2s2ZbNCEZoqVWmlsa3DKocsNM4QSLmlr41pM5Z80UkUqBh2XXOjo96/Wh1cxCR1OAhEt+V11ajV1uZf66LI0rLNXWKUic0cxZAjtAxq91rMzXuZKbiqzlVuPDb8KJ6/IvVZw3yPbSBm3vScv6xsQgpHpgtUrT6gU1fm3/Am5lyBr8eZ5qnS4SKy6PamvXgxyfDpF1/J4ZXgopY0hRTqNVTDUHOy015f1GdSdqksoOtOYZ8SN4l6gZ6zo7RtNJv2qAp0UjSiPRN8fN8sbkYNcLrHxU621lqqHE3VIwUBP0CzWV9bMjuSg5ISJ02v1Ux7lHUPXd5Lkj6TtlksRib9kbhPo+VXVk0e0KSKgXxpjJuogp3dP2ISOplRjmaqaobtRLI5CbgTWlzIhTMSVXzCY0rL9rguxYCqx+soUveC5IfJeIxWu62qvj+boLvd1WJyhRYkXLy097+SCylNm2uGSZULuAysfH3O3kAq3QWwKQ/mi+BQBBGnoMDj6GY25YDt/rYMdne15cpg5Sob9/jlz8XKpvy3JsR9vT2gKwoMXxdsvNkKNVYzpIOGFYHNcNxT+4waRzSM2r9/D++++zaa3Sa+OHyGP/vxD3FwcYI8DnEwHWJmdyv4GOfcyTg9VeuGg+nN7Q20tzq4GPfxsn+MSs1HXjPD5cZmiMnxY4FNhbSmhYfV3EOQh6h7bTS9Br5x/x086OyjvoowOxsiXHp4uLWLbr2JlBI4srMiDfNSoM/trcjJz6rEKjjYDXmzG2JmAbQyNuxFJ5Ri5E+o12b8fbhNvxDr6nx0gWf9Y0SbDYQbLZyNjvCjH/0JZtkIte0NeJ0afvT4p6AhXXOrq143Z1ij8x5mh+fAdAG/2ZGPy4MHD2WrUF8GGJ0OMeiN0Ixa+MZb7+GNh2+S4YzB2RD1INZ7cK2C9U1l2yE063KZHd/FdW00R4CQ3IsFHBesY58eN0Z3zCySXfqx87lI9NCNQ0FE7g9ZSX+nqGBuBs5DWD0xblJixqjzanlQu0BmA9sEOHPcJYvkfEis54kDGkcd5/NKrsYyqRzQKGO195D8flwr1CYLZt+mEEDtnk0ZbEhuqdE9xYKN+xsCBoU02fYhJZnPxblXGEZqGZqMney8AOO0gsfPXojFxt0ZqhcPadWQGYsBSvuMphO1iozSQqC2Nb/mvIZtKTOiM0mOW+LUTIRVDl1eWUVo18RI0sgZljbkcQPdmJVjTQAT10IBDH9P/5HuLEfOAptOAeiSBsBZk8uMzfs3YCNgUsqYg66z1TzFQsSeRNUSl0VbnBGlqRiB5p4ybDOnPsKFajebkf12xZM+32A0xnROMgUwW9BPaamENWg3UY0bqnRoL8CHJOU5qvrqBrS7HVRCD+P5DM12QxbbvN7MtWQ+ym0rztwc2IjZtzTuwwIlXtcqnS+nN+Xg7BQLio9fDPh3gQ1/96bhvI72HXs82kEs2BUUQc0lQteBTPl43PQ7d+0B/b8GNh61iRKTpZC/nldJZaU8yQCTyUDfp3z9g/09PHr0AEEc4OnhAT599pUykWq3gbMsQT+lrpFpHfQmY5xenIvNRFbWZDLCw9cfypLgpH+O4XwEj8y2TgNekGLaewq/Smqqj+WcV5+HGDVs13ewVdvGWztvIFr6aqHl0xStKunQWwIbVlLOH8qpNBvqMIMd5XHkNKabgDs1ql0uI5cRd+Ram2YgBmzIbZEkR85BPddauO2f42I8wMHgCGmcI97tiCzx9PljnDx5jN/8G9/HN773XQyQ4L/67/9rTOZDVDtt7O3tinK7oLLyRR/TswHvLlRrTexs72FnYwtv7b4Ob+nh4riH86Mz7G/ew6/8wq9it7ODSW+EuFqDLIesdprThGIfnzlkasvo69hojiAgYpd1KNVnqyigoJ26bfLLvnfxgtbcaA1CrKqM6rT2iGzriW2hNXhY0HcgI5KDBRcH9g5sJPvBGaF1ujTZYMGJkzIonqG78m8vae2XwYHBhh+usuGZ/3nAhmw0MtnqFbburGkeB9lZZsgyOkamqlH26BkKLr/vbBjInBwulvji6QtVhQQk2olfDPuixHM+M0tS0df5+gg2fOUMwGRiicguCq+bwdk5IYf8rBIpb+MHqmJIwmH1UrfzGbYr2WZtxk0z/JdDpq0MLYizUjTBwh2vSzuB9UyzJPeyBhudM2OTTZCupAnSRaI5zd72Fh7cv4ftdhNPPv5cs0mjQm0Xb1eOgWbIAcboz1hWTKYL9IfGpI9cQy69JjyolLhpt3Rv8IgYq25WTTEy7n0NemIwhvUIM+4/1ULNfLhnZsRRTfbh2HsuwDuwMVWIsUJwsv1KnnS9meNS/o+PZ3yKLgG5+Du67lhZlRhlxYqouCNlOhOmjeke8y6CwF0zlzsEDG7DIf3sCpiUyAWv/Pw/+yc/0pEoI3K5D8mvX22jAc2KMTKaZDOk1SW8EBjPRphMB4gC7rKESGdjleNbO9vaC/j0yRcCm+buDoaVHKfzMQZz8uSXGC1T9KYjlc/LPEM2nSFuRuhsdlAlm4vinK0Aq9jHcHKK+fQQUWAqiXxawWpWQR1N3GvvY7exjbbfRT6khE2Odhhju7WJDfamI7NVnKamJeHeL8tnqTC7jXqnpOyELa8cfu472EBDkoD+zlvrw5mkZ4lKVMHx4ASHw1MsmitM/QxfnT3H2fEhfu2N1/Fv//a/gc3KQ5xgiP/ov/uPcTA8x3I6RqXbUgrO18qZVoWKCcOpbJnZDqEIYTus4+1H72Crs4n+aR/D0yF2m1v44K0P8Mb+68jnOSq0VuBNYqDQDO+tY2fq/CxuoT5roF4AHLeBz0Phc1Zm2xBOIoM3oeaOrAi8QIHEyXhIyt4uCCojtnsKUjHQnW5gsFzB6OfimRsTMGfFzTmGAxu2CF3rV10ldxNbQoSucyu/41qkDmxE8rCVzSvjuYKCgGujOeozlbJDe5MRaFiRSE3cr6rlRYoy96LYUszIhKN4LJlZDOxBiHG2wmdPnuDi4kLvg+3I6Xyuyoif1QriTkmaKoASuJRNkn4cUW6Ji56XxA6Cq9hlUU3aZt1ORwDTbbXXemdqV5KAwWVNhAgKmXqxzcqsXbMwSy4pxglztHjAXm2jqY1pqxqf9HruHZE1t1yomrm3t4WH+/vYaPv4+MNPLl1LpUxr2oPGYoHCrsaET7tROZeJqUoyUzJKj5+UCSNfBkVD6zV4Uc0sPrNeX+bIZinSeSJTPQq40jIjyY14KX1w8tTMe9etLactaK8dzgGlCmHJFmqj2dYrr3Nzod/s9FkGB3cMXbx1BIFi/C2244pgo8NdAK6fp7Jx4ar8d+t4V9C2vBNZrvmFMpiVK6IrYPSf/9Mf66q5CQHLb9whqR6EqjC5GT5OuFwZVVCtV9AbnOPs9BD5coH7uztipZFGyQxrNJ/i4PhISsH1bhvjfKnFzZPZBFMvx9yvCHQ4iKZkPWmti/kY3XYL9x7swot9Pdd0mWC86GE0eomIqxx5Fdl4hWyUI1rWsBPvYru+DT8NsRwvUFsFuL+1g3sbuxL748XDG3mJQBembir2563tsjMj403pMp7i0qO5aOiHY8poAZbYxQQu83gCaLq0+CsM0iHOsj6O0x4enz3Ds8ExojzDf/iv/Tb+9vv/EsbI8NPll/gv/4f/FtNwhYOjZwBlesKalhkjP4bP2VKaSYCQsxhGgfxiiPbOHt57810B6fnLCwyOenh7/y18/xd/FXVqn5EQxvhkFaYNCBpmlujats103VKnro2iaVzh3/yZ0WIr3wR87/rL9WeJXXKmx2NNKRl6slAlYko7PB5Lo4jAz8YJxxjSZFwItT03E+DM0qwToim7o2qeIMtvK25qnQjNk9jzq/drAE2sPctGM+HTyNUUP4oKAoa2e7lnQ+FSLTxa10oOsdU2CwMpM/cHA/RHZo7FvRgdAQIFRUPjWFbnTw9eSkSTYOPmAuwpuuErg65UtUn9JeikqbJrPsacbp9slZHtaNtlrGBYyXBes72xKRozh/38WoKaBDr7Jv2VqWhEYy7YBwj4pYJqdPUug5YlBFjKuMiGOtWXsxoBfgFsmHTSLoAupmw9ktbfbHCPrIplQpFNKk8YZQNTqdI+PFOVSJUNvn+yz3S+uBqR5UZ4dJpgxDYRNQfjGla0HvEDEQqSeYpFkmB0MVQLmV0WtXUz2j3SO3gFCpJSG5AJkVF4MNUNP0s3jQzJZS7wZqXofqZFXSniZ2LqKYEpgYD7et1uu6a6MXH3VYJAsYJxz3nT57uozde14YqvtayNVsaTm8CkDCo3/V3x7yv/xT/7yaoIKO5NudKuiMzlykbCzhlUgtMQLQ9WWFTmeHb4DE+++hzz6QhvPHyAh/u7EvjjEJSVDb3sa622KIi0cj2ZDHA4GqBXSbGIfGRR1UhKLI04XzqbolWLsb+/K6bWyeAM5+MBqjH7taeo0G5gAcyHGdCnNH2Elt9B1++iG3ZRXQDtqIn727vYbm+KiimGSpUy7jUt0ulDOlaXRmSykbU+H87P3gVJgZHKH0PTVCYlkLkEG34/WyZIqB1WW6G3GuKnx5/jp0ePMamm2KvX8Z/8W/8+vtt4C+Qs/ZPDf4G//4/+J8xrFVwsxsiDKhLK8WgQwuBM+2MjH0Hh04yLnFyGPLkAGh186/3vYCPqYHjcQ2NVw1v7b+K9R+8gXlURUSmArpRyODXig6Jrc7fDbYeXtNHMzVAcrhecSu0hozzOmkhxDWWPVa9pNbjPJfVcqj2vB8uXDqcEbAY5KfW7Ssaq5Zq2jlsatBLx9vUY2TUDNnx/TiiyyJeyJ9v6/hjmmqtseIzdO15nm1ZBgHs2ZbCpUiJfYGgqLHUBmSnb+coFt/sHI/TGQ5nPuZ+rbRWH+NHnn2n47wbPDmy49Mp/E4z5M16HhnlkZj784HPQ3ZQVjph8FNOsc0HTKGJLtbneUCbOdppmJ5bqTSUBHvcqSMwxigBOhNLEAKMM4rQDeY2Y82QH5/Yzkzx9lMCGezUEnLBKAkIVMf9+abxruF8jVexlqtfn3EO5/2UkcHhZG+kj6usli9RU83kFUVhXksjh/sV4jH6yQMCKpdnEMggwz5dahu31BhgPhuif9dGMa+i0Gjg6eomTi3PNTykiS625Rq0rsHGtMR4LN9ciSPP7UkWPayIGOFA3QJTJotqBTTGOuvum6PdzJfCurUcsu7IwmynG3HWlfk2bzrX2yoH+uq//qpXNXWBTnBldiRUl8NU19XXARg682UrgsahS/j/BIB3g4PA5jk+eS5G4XYvx4N6ehnRnZ6fKUDb3dtDpbqolcHFygZNhD08GpzhKxpjEVeRxILUZ0jkpPcJsKJ/PsdFp4t6jffQnAzw7OsAySFCJ51iuUiynOVYEmxH5ljXUq220vTbafgvRKkQrbKBbayAOY4kBig7KGz6oARXjnKibjvsRHKzSUMpuShurZdN+YlYo0GUG7i3hm4GINKsYtTWKt4rD/P6U7ymdIG8BR4sL/MmXH+IouUC018AWfPwHv/qv4jfe+QWcYYLf+Ys/xP/2g/8bA2+BWZAjD6voD4dSvZWMT5UD3FCgOJsmyGYziY8uXxxI6TrYe4Q3772OJmL4SRVxHuDXv/0raAV1NIMGQgbwOWnIyzUVlMZlZbBRINO2+NXL1rXnXaXDn/LGLN5k5kYxS5r8vlGdpTqAsZ1Yl+92J8n04818owhKDmycJLtrnzk7bUPY4P+N/dxaUNBl6FpgvextmzmPqW70/qzJHIklDmxM2+0q2AhwCnI1Dmw4zxPNmlm8+vLGN4iZOa8FVlx8T1y8HE+mGCczLSWSFM05jPaSkOOzp19JfNMxnCZUi+BujFUBYHbOrxX04ppIBi7p4/Xb3dpWhSN2maWHkypO6R5m4DWuFBTOp9mTsYmVkitz7Wt11SoqE3RUGHoUVTXAtvZSsmaJZmJELotx+nyF0cn2MShbVUEzDmQbUK0s5fPDFqRRB6BD6WItFCof0RWJD8u1WCqreLYm5zRIS2k5YCyv+e/BNEEvS+E3GsijEFOuXMxZ8czQ7w8x7I8076TSRKMW48c/+QgHhy/l8jonXV27Wk0xNd3Qn++ZFaBh5tXR4HHlEqxdLiaAE9h5vpgJ0UHWVMn2MJS29ovUZHefuN81yYyZGboPBzTuswvm5SG/gvcdfmM6byXq9ivgcY3QcPn13AZmOg7XtPfK4KbX+7XAhhTP+VKS7xS2my/nmC9nGM/68Lwc2zsbGJyfYeS0m0hP5EIbtbHIu4eHt998B2f9Pp6cHuLF6AITClpGPlJ6qXBmky20tDc4OkQYBfi1X/6eWG6f/OxnOBufINwMMc8SZNMUmNDVi8G+jm64gZbfwqI/R+xF2geiNItHWnLFQ0yJcW0Vx9pN0BKeVzCR4gKbR9mYlgnMBBqbXfrrpcUVosCo+vJ7fFyxqdyg1csxmPZlGrds5vii9xx//OmfYdnysPPWHiqjOb6VtfHW1j300hk+Pn6CRStC3orwcnCOkxdPULu3p8DEdgMBh+U9gysDEB0g88lcW/pSuk5SRI0OHu4+QNtvA9MVfvWDX8ZGvInNeAMRXQXnC6lnE/ypUTZOnHaabXFZi2BdHNY4a30juThVYEPSmVPB21xyFjZMFizVa8faKUr224EsW3iLFS0QiNMqSV7ZYDY3y3pCYAKfR0KIEaLhUuqaqm6tn/k3DFr8LILCK3eLebUCHAVct3Bqx9726/Uwdz2AN+oBTkWAz0tHTm65a/mPtgncUucwWSzEJb58/tzMYJaEFk/zF1Y7F72BKL21bhMzVke0B14uMegNzZJzSGUMVga+huGcbTHItRtm0M//xNbc2tF5NEAU6tpzQMojRGUA6ZBx4dlWM64A5XsX9d9+cLeFqtxszonmDAAAIABJREFUD+m9y4DO2Qa4Ibd1m1UbzTl4mracCTBGRJb/sbqhekYcEfR8qQew5RiomuVukJk/kfbsgI2zKe1wEeMpnEm6MY9bYqqbKs3eopqea5IuccHH8EPtp530e+iPJ5iRdj5fyNoj9ELZSVMd4Y/+6A8xOXwJf38H2ZyrGgoyQJVDX9mXGhdUEiq6XVWHVK2g2kKn3VaFIwBqNFThiCUp80TDzuN5N+xH0x1xnx0hxn12dbm55m8HGxfMbwv4t/2svJT6ymz+dmbzreaZfN7i6yuC6bVgcxdB4K4yKogitbt4wL968jmiyEcym2Bjs4XFYoZOtyW9L81gVpSkT3ExHqI3Gou+ufPgdWxsbitwHJ0cYpTMEHTrGK4SPOkfY4wFgiYXyjxMjg/xzTfewXdfexOf//lHODk7wbThY7CYIZvMQHVKr1pDPagjIHFh5WF0MVarT8sLNK5SS8rwxrhlThFHqiDwYmTWaDJMqy8mr3hqSdVs3zY2298Bt66pxxWgukpEEXVqw2ToyVOHuw/1AE9On2PkzXA4O8OXF89wODlFEqTwmwGaQYCdZYTtZgdePcInT57Ab9YQb7TxxbMnMgsjBZzlurxddGlyf8cADfXQGl5LbpCTaQ9IxqT/oLO5i0bcgZ/VsL/xJv7W935LVd7w8BybcQO11RKLyVDLtgmFRAsl+tr+t9C/fgVsClc3e+qOFm7GuJf9+mIvW4ChcQt9dtwiJaQOYRYsbf5t6CrmGdaU1KvWzc58SmZa3NaX35FgyFYvhdYf82sRHIxIpNx6uMApyDbK3Nct7Lq3WNyJ4I3KrNzMhQwlmxRiJkRsd5HdVGs2pBvHWc3B0aFEMslOI0GAatjjKXdEqJI911yCQOICgAFoI0HiKMg8KgxubJEZWZmGgh+DHn+vVru6lOyILS4BcJntTe+xKKDrKksFTzvzcnsal0y1y9mOggvlaCTMSdA3CQYtAagEQJYZaeykOnNpl8oArkrjfaTugfaOzPf5eNI/I/uOAM4dPOnrmXmQExo1l0YFi1UVz3oTnAyGxiBuQV8b05IkjdwcVw9nZyc4Pj4W48+BmNxvxTtmW5p9VBnvqNqptagm3lW1SK8kMve2uhvS5SPg0N/HqSmYv7ZeRdZ2wnUK+Hi8N3Xd2w6C++yo/9XAAKerZHTebLL687TJlNw4J99rFlBvemz3/TL4lIGr2Ca7DtSK167OS6l9doUg8HXBZjKfIo5D3bRHhy/Uh616VCqOkSzpQljFgrL29GqhjW2a4nTQw/lwhDEtcxsdNBttbNabWM4p4jhFtRFi4Cd43DvEtFbBvLqU/H5tVcE39x5g36/h5Ycf4+nzZ5i1GyIWcABt5DhC4w8zz8wezcLYGHNWIYVn7gVIJt2KaU4zo7DsR5o9MdMT+ySs6et6jRLlISIKF/pmUYxf12oN1GMf7VqA2IPkb2qoSmuJ16zmBWGOw+kFxv4cB5MzfHb8BQ5Hx1hGOfy6L1ror33zFyV2SPFKythIaBA5huMRupubukmWYvJkss+V+jAZSDTt4vZzQv8UHxlmmC+GlKFG0GihVd9CWOmgVd3Fr7z/G7jfuA9vkmOTfWcuQiZj1KNIO6MSzC9kOMUEQ4uIpavskv19KYfjBsKiNGu2YnYsiuZQ/I6CvgUy6pRpKbbALrvcebh8QWSiOTApvhQSCQxYmOcyMGUrLUeWsrbfOcxCpbWGW6sS81gakLz+o3jjl//Nv6CyM48R92TYomHVQgIArxEGy+cHLyz92cjkE3hY8bgqQ5nh0lhCM0lhcGV2rD2Xqo/d3V0j1dNuax6jdhmrmoimd4bicNMHz+N1citXjqEN5MVg58CUn8t7GuWAQs04orUqTAnqEMCNIrsWbpdLk8hRFsomNWot8Yxxh4W257JqVkQ2njWkj2tPKUdAPyZAiuJD6gZ6PhrNuo7h+WSOL457OOobySQ+Lv/OXctUKifLbzyZiIBBQFJwJOONVZ7sfY1UkhcGph1JBYuNLjobXYH8zta21BPYTlP16BmCRaAG7sqoehecS4vtLh6r64Qs3fHne/Wr8XpWVmwxF2fmN55gIdOlarMDnSKAuFabe2x3Df//BTZXXstdYHPrG+V7Dai/lOLs6BDJfKJs//XXH6gX2x+c60Qv/ZVO5jKsSurknAoD05mMn6ZUNU5T7HY20K7VtG2/ijxM/BU+u3iJvreQrw3B5sHOLrY4txglCAZzmUQdYYGMZbjmGYHAhhfvYpJgMUvA4t2BDXWaCDranVGFQ2MWGjuRkqoGp/kebwqyv3wfreaGMkpKyPNGZyapHm6razK26gqtKEDMNtpyJdCp18wFNFyM8NXFAfJmBRf5RJXN6fQcq7iCiqTVU/wr3/+bypQ+f/wlnh0favtZtMygKr+Y6Zw9/FTeKCv6v8gRlZ85YIVaZX6zKdLaPJuI8QM/RLOxjWa4ieqsgXfvvY93772DnaiLBiXVsxTRkpbFHrKM9dKrF6ypE1brhbbidXBJTHb5s/kpQ/kl2NhH0KDf9vQdyKwDJEP/7cFej+tacFZI1M1dNCdAVKBLm9dQBCbZAduqal3ZFAI0s+/bwMaxL4sBeN1ek1R/VQGKWfcXX32JTz/9FC8OX8qOgcGNdH83O2IbRceCbDzOxDwPF2fn60NLkOE1x5kBrzF+ploEJXsoQFqXnplJdlgVqEqgenZJAr6YLNzFVioGqysgVNj9KM8aBOquGrZgQ9JJZZVa0U0jG8RK5/7OjgJuwkpusTAJIYGYzLpksTZZ1MKBBQI+H6nPMgarGsdZVoPcufPp1NqIVUm+OO3jeJbh4Oxcj22sKyj2uhQ4nfd76PV6ZgbEfR2Z9ZkkxtH0uUBGN1jOndmWZAuNFOlGq6n7fm9nV3NJacaxovFokhcg8tiG9wDu6tiysXhduOcpgn0561fSJjasmS0Wj3MZtG6Kw0xgXAJQBht3zbpEongNu/f/81Yud+GA+/ltnbDK1wObFdobbZyeHuOzT36Gvd0dvPv2W/iV730Tn37yGT786C904ugdwYG/CcAzDOdT5UDUgTobj3B8eILtZhMP9/blP0/toklliccXL/FsfIq8Hqq3T1OnZX8Ef5ri/e0HeHl0iKfTPmYKZry4fUmhyw+cNwE7UAtmV1RFXokuTJFKZVIcwtK8rBKoFSB2F+cXC6sxxb49e/ARKaMcFLaMdlTDKObSsIsyHI2wIuVqaphVslwqxK1WE/PFTIrVB/1j1PeamtNcpEP0V2NUalWk1UzGar/0xnvYqLfxgx99hJN+H/WNjix/yUT7iw9/oMHyckkaeILVIlEPXGDjtsUJFs0YQa2KJbWnOPisVFGLN9GKtlGdRtirP8B3Hn0Tb249gD9fwKOGFPlznF9VyQYyl8p1fVbNXNYb+JfWJa4NUL4I3bJm8fsm0zS1j57HfmZVEjBAOaviK9HO9P8VGKxiteDP8GzN9xEgX9X0eV3ZFAe0Mjsr7IG8AnZGHPK2NloRbMrBhF9zUZFJiBiZtAUYjSS5xBba6dkZjk5PbGvI7I1wobN4Q5KlySSJIMLH4ZyAwML/2Crj8WdWzXmNad1dDoYZxKmBVw42xcB1VzBxYHNdMHHvt9yKKQYtyviQ4sFr34EN4Z2zGZIpfvP7v4yLixGODg8V+Pm3fC9k7KndnDHZYHFnzjV3kyhGyiDN+RarE/6uFpApwknDxPlcx7k3T5CEdTw7PlFlydc5mc/0cy7E8vn4uGKaMYFbn38T2HneOWNVm5x+SFx0JaDXayAtmueUrTMtvbIjIPVokh1oWRBpDrVKF4bO71qr68VYq7h+xRTw6j12G9i4c3rX0iaB9Dqgcu+Vf39di+7nrWzuarOVr5sy2Pyl2mi3P5mxF2ZP9OD5U3z7W+/j29/6AO882sIf/smH+P3f/+f44LvfFlCQ186LhTLgEzJzeIKiQJ4uBwcHaIc1vPf6m2jVGtrwPRxc4PHZCzHUVs0I/elYN+RyMkUniPHu7gN8/PljjH2aJZmlRc1hKhz0U1W3KsXXdJ6K8kuwEchkudSAVeGwzTCdq2+smQKHo/b7bApo2UvaUaay4YXYiAk4DbRabbTiGu5ttdFln54sIVY2LMXjGoaTHl6eHOJ81ke81UBlI8TESzCqJFiGOVI/RyVd4o3WFurVGM8OD1CJQh0TOpVSfuOHP/2RFIA57JZnz3J+CTZu1YSmavLZ5VyHLUMeBwpbdtAKNhEu6tj0t/Ct++/j7d2HiBYrVNj65M1GsPHqZqelsNhbPOe6UG8Fm6uUNdciM2DAj8tZjbsw3cwmYJskzyQrv86MLFvMzHG4uGT2PNzXBmxsNgdqZdVJsL18tgLjzCCSURS42my6fL7b2lD6u1LwcAHYvV6ZqNnhOIUemQ2HUaRZGysb6vxxX4SZt+YKqWmVid2Vr9Qqk4xMZOaGzJ7dv9UezTJ9z7HTeA27QGRaXJf7LWXKrHv91wHJ+lxot+n6KTEDh2NT3dRm4x3iwMa10QIqN1iw+f4v/5JoyIcvX2r1gc9FUGVCxGqd4mAM+jxefD8+qwd2BnKKZSSS72Exr9mEVxGxgkmm5jKdNk7mKQ5OT00lSWvoXk9gw8SWn0kPF0iTgMFXKjULu1RLmrMXmllYs6lqhq8tshWksfo2e0iOoSoaeWCESdmRoOab2Kp2MbZ4vdwUiNdJnZJkZ6NdAqKCX81t58/I+xRZl6XVAstYE7haQHTXjzsOtz3+XT8rg0v5WipWdndWNreBDXvunCOenh+hd3GO/b0d3L+3h067jmfPn+L586dob7ZNmcjesFfBOKX20xiThGqtOeqdBqbjIaKVh0d7D9BttNT7/vCTn+IrLoa2Yiwo7rmYoeKH2Gx3cK+ziWqa4yef/Ax5LTJbdsqPlGNoGYSsM37WMiODgVrIrN1ZxWR2dpMDo4n1T5EUgKoh82GX76pk+nB3gS6GLbTr9L031U0jjtCtR+Lac+4iCRMtfK0wGJ7j+OIUk8UUi2CJLMox81P0lhMMaJMdrtAMIuyHbaTjqdw7t+7fx8uzE/zs8WeS7pmvFjKSW1Ypf5IjW3Fwyq1lI/AoB944Mp4ybrtOvGQPsddCs9pGCx3s1+7htc59PGjvocv24CJFQO25KgkIhrJ9XQuA33M95/JFJ2UyAkFBHsbNY4oVjHrGTiRSLbHL+Qj3YQNqTVkVIPXsrbmZ+7erZgzgFCU1+Yp85KtIA/+bPkixNe2969p8ZidmTUi45kGu9JxLsiK82phc6FysKP2TGnkSryLra0rai2VlKcUEHTHlCmujbKcRVByrR0FdM4xLQGSA49duQF7U5lovt5ZaacWA8vOATfk+dwHMVUblFo/7/UD2ERSe5fHNDFPPVjb8d7fReKWNRnDlrUiRTiYavF/YWWDV4tOwrV6XWsJoOsNoQqUAkqJXci49PT/D6XlPALF5fx9/+rOf4XQwEKPPWWOzHR7GsRHU5PXHY2Pba0YZ1liM873RlkM+WkwS7DkjpZwgw+PM78sOwVYznJWprR7F+rtuHCtZLYLNOnGyAb54Lq+0PHk958a6/brjf1eg58+dkKZ7XPc4xYrWAWyxIv15K5u7XsNdYFP8+zvB5rYynMGGI4bD45eYTsZqSbRaDWTpDHWVoiEGwx4SbgPzfNP6mD7h7L/SCAoptu9tolGvicLbDGrYbnfx+PFj/OkPf4hhlmDZrCGvBUA90mYw+e+xH+Ds8FhChWO2YJheSu2X/xlAYS9VX8tnl0s79t/OEVKzG6OC4DaldRGSj8sBL8kAVV9Aw9bGZmcTG7TNbXYENp1WSxVMdZlai1xzwRHVkmSG0XiA6XQk+4NJNsGSc5qWj7P5CM/ODzBdZaqIOnmIeW+Ie9SOazQ0t6ENwWA2AdWfUo9qt5zh0IeDvWfKkxjTNy4f5zHN2WxbjS0jJr4L7kU30Km28LD9AG9svobOqoFG7uNBexMRO4WzOZr1JpKlkdlxH0U206sVweWlY9poFOAkncH8ZhFsNB+xKgFr+LaLfq7lJbIDZWjWYHPpNSPMFH3U/DY/m+9ZqqgG0ob9pMBq50Lm30VutjGNq66YQfOzY8vxxPMxKadzM/+zfBPz8df99BWQzKiOYSoTZtHM5FjB83eodabftbsMTmuuGFjYunWZNx9btF9bvTjAIBg5MGPgcDs5/LkzNC0HBfe67yIIMDMuBqEiSLlseP1+14uIjga90gyDWE+CgE9KuozSloa4weQhSUwQt+0cvn4lMUuqQyRihHH2oWVVDvk5k6rFkvihKC/VFSp+gFmaYjCiBblRTOD30soKf/KTn6A3G5srUAvgbCNXtLDpXrdaTaR/S+LDxAq9ZylOR+sduvU9YG0reD9rVmZnaCRqkJnGzoYDm7rduXNLt+45y9XGtYDD5dXUkImK5BN3Du4K9DeBTTFxLLZA/yqVTRlMyq9pzXYssVevK1K+Nthc9E9xdHyAOAykbbW52cXLly8kL1Nrsje7EklgTFOpysowkCVFsRQGrPwMD+/vYT6cgrThhzv7aqt98vljxBtd7Z9UW0209ndwdHEu75TTswvMDl5i/1vfxIjOnfQmFxWYOyTM8m1XhWXXdGHXP6yLpCxqLStNulwECAM4POFUWdY+Q80MCEmNlpAhPdkbLWmU8eahRTPdFrdaLW1ZM/DSAIo0WFosTGcTLa7Nk7HsF2obDbTvb+AsGeMnTz/DOSV4Gi0E9OOYpbj/2iOZxbGCe/jOW3h5foJPv/ocqWSAPFRiHwjoMmlLNSbzAbXoGSgZONlKqsqOAJMccV7DRtDBtx59gG/svQGMMqyGKV7b3kOUVTDvj9DpbCCltlmJIHC5M0F9w6t7AFfnGyR9Gj+MNdMMVanuumrGXXQM9iIck6FkGUsCtkIXzuzbOJUCM+MRyFAcU9DCnNkwmUwVy68o188mrWGblasrC1WaC/E1EGxIlXaLeMtKeCvYXOk5l9pNfAXtZgPJzAy/ReelQRfFMjNT5TCLFzncUomLWa+CCqnDzLJtBi5qvv19tX7YWrLnwKlFX6oJrDDn3OMabUP3vbsIAneBjXucm6jPBBuvyjG3h6BqSAFFNlpsqwPu/7CtxVaXqjerKLGYThHFAVYVzhxXkvnxoxjDyRRHZ+f48c8+RqPTUZLKFloQ17Cxs43JZIrHL57iycmxklcN+eP4irqCq8qdcZ0SALsr5459M26YBWbbLpVaNttn1pCOho6MB6S4i7RB+wUuzIYkC1B/wVyJRbApz7heOeeuCuWeWcKF8Ms2nAOKu4K8e0ytRhTmrdd1KMoEgWJCcddM767XcRfYXNtGuwlFywhVzHJY2ZxdHKI36ivD5EVD5hTvqygMkC5Nu4csEQaCAYenw6HAhhTigLI0mGGj2zJyKjJjC3Tz9oYjzNhyCHxkodmleXl2po1s7jOoUGGmGhmPC5O52NkNqxaCjjJEZv5LSN6ZaaD1UZEgJHdXVoYdQ7l1ZiyUz1DlUm/qgttsbyhgsD/L10wWirmwAu0WxJZG6aqP8XSEfv+CXGu0GjVMWdllC/z2v/N3JWnzD373H+J5/xQzL1d/eSuso1trSeOKDpikhVebNXR3txF3Gvj0yaeYTYba/Yq22gjqPubp1PS7ZSbnY0HlZoJMWgXmgL8IsB1vYr+5i1//4HvIejN446VEUzfCJhpBjJrHhdZQM7SKzcBdue0keXh82CpQNmpbAk6EUIZ5ZHJ5TuHYAEyRWmwC1Uo0WAagAKnYZ8GKCga22shnJuNUW85u6ciIjqBSBXdQK14Ar1qHV42BCvc1PHmZUAjRDzl0nyGleq7P6yzAkueY5yiIzJ4GAU5EgBTVnAwoswci1YJqfCvY3JZdEiiDankH6PIv+H6cXIneX6G3vm6n2Eyf16NRpzZ/7zJjZzN+0+tggL7t467Kpkh5v+5xigPqcoWj82vZaASbkPmQT7tsc865b+NbFQmCqVQTrNSOmgo0t6ua7/NaZGXIisePa7qWLgZD/PkPfyjB0iiuy8mUIH56cYGXL49w1DuXtBUrSbeno7YZF2p5fWaZqiCBdyGh4nsStZzXfZYbarOrWAgm/E9CvYHa5VqBYNuMlgic4di2KWeebZov2nNQBhnFF+vWWpynOUAQOSM3quRFwCj+21HP139TIvKQrVf8WF839lory+WUK/Xi+S1WY+733OsuA5YD5zLYlBOfK21o+tncerXaH153obEyuegf4/j8SJTn+/fvaflyNB1rsZMDPr4YthN4Y3OTepYkSCW/Ecg1z+MCv8e81EMrrqMR1nF+fo7js3OptzY2usholasN4b4WQtnD1fLXcrUeLGroSkCRJkhqWmlibBnyEjMWim9ygVP9V3vhbG1si9pIsNGiprUlpnmUBrNUSqYnu28lLcRvMkqxXFiTIgHZM1Vgls3RG/cxm48RBz66jVgKCh+8/y7+2ne+jafJGP/wd/4RnvZPVbHxImt4ZihMz5KnBy/0Hv1GiNZGF0EzRNSqoTe+wGgxRTX20GjXQHm0OR0z50OELeMMWcmq8BYBvHkV9bwuoLnf3sO9xgZqmQc/WSHKq9iqbWCvwx2cCFPqTdHp0QZMd0GthTWtmKiIEzyP0tAyrB7NHq6ADSsL1hq+cS21H6omkCLMUwT5HD4S+KRdE3DyKar5CJXV3PjdcIC7ogo3T5mP5Yq01AYqFYol1lEh2CAS+4w3KVmOecjZVorZYiWp+SDuyEBrllUwmkwQ1Zi5Suxf+0lcAvVW3ES3Gl/V2tcGG91ghVbglfupEAx0Mxd+qM4fTcFKLYh1C+wVSVAblApypCV1lFdu5bsy07vAphycrgQPvm7eb5WVHGkpuMlqn2DDNpqWO11lZmdaLnjyPAskqPSAFeKoLqLLlEkilZyXOc4Hpo2m3bN0qQpmQD200RDjyUzCposqb/WrYKOgb9UJ1sfWHhkGSbMnV9N9x6SS97pTZXA6aPyes10w+3tXbRh0XHK2EdnLvhzQu+DrAndRruaVKvnnAJtiMC+26NaAZFu0xfNSBBwHJg4I3QVyXZurDBT82iUHxQurWD3dBTZX/u7v/e4P7wSbVy4wp8tTWeH0nBfDArVapAUsSl1UA8M0OTs/F0VRFzSXocjckLUssw2yQ5ZI8qkAivbMdNQLqqHYJtPJDBtb29rPkff6wgjvDSZjTChQuEjUQuBeDi9gbuqqlZaaBT9J0zBbXKTKzpmZcE+BJlKqXDTgr2GzuyVBToIPLyhVLXbgR0abfGB4gTpJE5sxsOPL4MubjfI7dBw5Hp3iYtQjAsnGgGCT9If4W3/zN3G/Wcfvf/wT/P4P/wzn2Qxn6VTMs3poKK3D8RjPDw/kysjBf9SIZUR37/UHmGVT9Mc9fW51G+hutTUQPT49gB8ZaRGqBVQXIbwkRBNNPOzu41FnD5XZAm162sxSrJIldpvbeHjvkaTlz3s9BJyxUQCxkCEzcIqpYv1mVDVaKwCnDWeCkCEIkCkmcGDGZ9tZvMhM24p6WAmifIZwOUWQTVBdzuAtE4T5EI3VAFWwujHaXMpK2enMONilQJepZiorfuZ/kZR66SaT+VVMIx+rRgy2w6aZh6VfB+IWZhnQGyeoN5u63q+CTarXxY/cr/+VwUbv0d7sRl/t1bTtps6A+02Bjfpsl0NiHQsLNGWAUpCx7EDzGHfojdyVSd6hjXWTOZYLTKt0qZmNA5uIvjIkR1qwYWXDY8AqYy0yynkjPCkosAlIejK7HwQZ7pWB0v+rFXojej69UAttMkvk83PRH5jf4awv9DFeLoxop1UgWB9XyzqTlTVnOFaSSsrYZJNSL433/0ZHVYz5XkP/1j6NFrx9xZViVVFeoiTT1bWd19VqoYLVbLWwQ1MEbzNnfJWNtgYSuw90XTKyrjwsm/DKayxUP2WCRzl5cJVvEUCKoFO0fS5fy8VK6DqMKL4PPeZdYFPu6V1toy0xGJ9jtpho0SquRwKX8XikIMR2GTd3mXkwoHMhMghjZeJUbZ2nc5z3zrC5vYl6q6XrZEI110Ffmc5rb7yuwSEvRmYxzHqU0S8SjLUklqkPrCwmofT+HHlqNsql/eVV1f5itkKNI4nqRVR6raNNI6l6HZXc0BulOWZd71xg5evhRep66s6GwARiO2TMAUr2jPIEh/0jXMyGqNVDbDRqaFSr2G028f7b76qX/Uc/+DN8/PIpKp0WxsEKF/PZ/0PcmzZJkl3Xgcf32HOrrasXAI1uAFzQxEaCpCiSokY2Go3NfBv9pDGNZvR3NKJsaCaT0UQjORQBNAgC3Q10V3VtmZVrrO7hS4yd+96NfPHKI6KAhkZp1h2VERkR7s+f33OXc8+V6I+cfnpyLy9e4pyD45aFDI4jKSDMQvRGNKaV6KxlvUTWq6hyvDh9hKqZiPpBByMgTxDOOugHAzwc3sWD4QkwL5BUNcJljW6Y4sGdh3h45y1kUU8a47LRAEv251jxR0MDN+fN9SPDh6QLWRMLSEbxWu4UM2Za6ixaVzHpNKZVWRtJGgM0nXqGtJograaIyyli/l5OcJQxymHNy6RBy8ZIl3A9mC7LFyXqFdlL1CBjfSWRGzQMMizjDFcE2uO76B3eQ5P2Ma1jzOoEZdQRIGFcJTcY03Y0akyl8VmCJA11/KtHNuamvDX5ykbXR98b1JvYvYfoIIlEkGP0JZ1op5+6kYlGIW66bR91e19k46dhfGzayLm3SBgxjcYtwzSaG9moggBn/ch1XS4FbPhDIy6zaaoaV/lCJmYq07BsGnRsTxElrf7hH39qZGs4F7EoTGaE8jbCKItkLpay/eS+tK7zeo2Z6rRpMEYz0stEVWyqMJDRdniADhs2mdUQRqmMT1xPtlX5pnU6yYx5Wy+TqFs4aTTXwPK83WjEvxavAzY+OOjnq6Gnm+cChQ8IPtj5e7Lt+rp/o3JF0qtwjHUsAAAgAElEQVRk73uNkl4HbDaiOW3q3OYAuWDjo1cTsAGzxk9++qHMkX//a1+VjfDzT3+OKenMZKSx54C505A9CF1x/66vxri4uMJsMZVmqqM7JwImz1jsywthrfHikwnCfhhJkYm4oqnTyFhc0iHpvSytZygWjzSrQIQ6JVWWpLh/cke8GDZnsUmOIMSFowcms2qYYqIIp1O3cKmnMmec5AF709ymmkwqje0gjL7GdY7n4zOMqxk6nRjDLEZWr3DEOo/1rJ6S1vzkEepRH8m9Q3x0+lSaXNnI2esOMM9nOD8/x2Q+kZspjANM8zHeeuchhscDqdUU1cLUuuoC1zenWFBBOu0K2DTzDKtxjE7dx0l6gCMWP/MC9WIhQ6veefg23r7/JfSyA8SSmkowKyZCcJAblcwaQx6XpjXemMtFbmnDt3WxtZAjPVYOLLMMMCUJGH/bGPYMObJ6it5yjLS8Qae8QlZNJcqJmxyHnVTUwc24Bir+GvFVHhOvOwUVaWhsSwbqihI5tMYxiijDZRNhEXXRPbiL0cMvI+jfxbiKkAc9hP0jTJdMXZmBa3RCEtZrhC1lIsIvUrNRsNnWh+QaHhdg9N9CCrCjYvVGVqDRiEb2mwW0dW7fiWcoALurKXUfQcAFuW02YFtmg39PRiEPQAkCrNlI0pzTN23NRu5dew/ryGnWZqZUXXh2imtLGmDNhuBH2jLtyNn5hagxSK3LSkDxWtJA0knjyAaSgyT9aiMZroWmvSS9XVWG8ONI/jCK4XM8Fmo30tFkKl2ApjZ6b3Sw+FlkGrpRt6qUaySq8kqvAEmLxP466tJIxyoI7KrZuIDlA43sETtLyY9M9Lv2gc0rx9QShSlbsi1K2pdG2wAbHZ72y4CNbj6CTZBR/+kXePbsGVgcp27R/TfeQFUv8dlnn+GNhw9lcyRJRwCkKlaiV3RzM5G6S5J1hdpLyu/np8+RDPoYnRyZDbVYSHhecWZ7Yea2i3hhyfnjVEBOpX+GDDGGwKIb1ekJLZmbizNwZAxupyu6UjSgIrFeG8PDcQBUeibY6ELqptX1oOFbGwKrmis3mfD0YyPumUQiHHo2uxCFZ9KBu9RLYxpqUSFrmJPOhKr5w08/xU1Yof/mffz07AlOFzP0jg2dmt/NSJBg07CoTTHPsMG9N+7g7oMTqdVw5PZ4eo28IPBMkFc3yGIOSBuguonQTFJ0qz6GYRdddkdzLPFiiuPhEF/7ytdxfHQfxaJGyREESYrF7EpIHYxWeE5MG3CyIZ0ETnkk3Vvn2WstZ80i4zwcGhWp1VihSyeqIdj0kQvIdJdXyIpL9KsrdJsJuliKpEmWHRnV7YD9J6WZ/7OcoFjODehQ0ZtaWazJFCXqogFFHuiEFEGKZdjH0+s58lWCu1/6Bu5/7QNEBw8xaTqYVBGqsIPaRqw8QgEbS06QmzfIvlAaTejfTmHfv49cIGhLqTGiFIC3IxfkmGwaRGX9XZDxP19aCnckwv9bEwRk+LnVRiMbjVM5GTUq2JD6LD+2QVSN/CJf4nqe46MXp5hSsdwqTBvFqBpX4xt8/uSJOIG83wkuci62XkgRXwISxw9ISs0ZESJqDFYFW/XkmDZnRMPUmQIe93tGMV06m7QBjGhEDsqoC4iCM1PINtJUuSGl5cs12y6rJ6ftG2M3pSacPBJedhAE/Ov9SkrOpl9/1TSaa/c0YnHJDG5E436HgqubhtNjdfe5C8Jr6vOvCjbFaiYK3Z89foS//du/lm7i7//BH2A46uNHH36IBw8eiGdAsOEmKOaVdBKzCkxxy48/+blopD25OMP5bIzu4UiUjzn2lcKcpCay7sJogyGyqMFSgr3LaX8j9GMq4Q6k3iNS4P0Bhj2myYYCMkyxCUWRhUsWt62svKo/Rw3HApjNyuNkSC4LFJpazVqIkE2F1nsSj9Yy0gLWFkiKCCu8XFzi0flTaegcRCHu9vu4lw1wbzDE5ctzEdicJTEmcYPweITPJlf4+8e/wDKxKbl18x9vUNMwe3R8gBoVBgcZjk8OsGQEdcrvuEIQl6ijhagcVLMM1SVpz130ggP0gy6SGugzHVcu0UsTqU91OyPUVSwpKZIe7h8MRDiVUR7Pd3Jzg6uLSzGACjba1W7GG5gfpYtKrlz6X14Fm6zJMQgLZASa/ALd4gyD8grDMMcwLBBGfVSdL6MKewiDGnWTY1lOsMiZl7/CspxJzxYBTQwLUyh5hXxJMkhjWqmaFOPFChfzGqveCR5+47t4+7e+h6Z/F2fTSmo4Qm+WQaE0hJUlUBvKKAkNu/pstt0XBqi4jQ0kbKuccG+53uP6hrSqA9KO7KWnpAnRmSHjg43+zvthH9jsi2wU0H6V+5/v8cHGj2w460fuF5s+o8PJn5vxFC+uxzhdLDG39O+yqTCZTEXclHIzVF9I03itxiBipWyaZSKL47WZXqsZyZj6irBGbU8MWxUIbCfHx2J3CDL8bqaGN3paJKomsHCc+0r0DXmsjNTk/pcJodr/ZSS3jJCS6CbsBRuXTaZr7KbkXgds/FScm8aisoKsr0PLdwFpH0GgrabU9n53f7hRlF/T849l4337ajZt1Ef9QEY2eTOXAUs0jFQqfvTkkRiFwXCIOItNLwdZS7bAfnM9EfkKqrceHh7jyZNnwoaiXtq0zKVz/moyFo0jKkePz6+FRsn+F3bqZ6TtdjOc3LmHu3fu4GR0jEFmxDHXI5y5sem1MDym1pKw0owHuZ41Q++F/TklI5xbcT7h5NMwsTHaARsDREznGTPA+eVKJmgY4MQNTseX+OmjT/D8xecYMW11/x6O0h7evHsXf/mXf4lxnuM3fv+7SE4OMYmBl4sZ/uHxZyLFM5vNZAOTLBHI0BR+/woPHt7HixdPgbjB2+88RJZFePrsES4uzhFzDHfGFEWA/KYBzs2U0iQ9lmFpsWi/BTLAip4mT6yTDXF0eA8Ho7sSEd4dcDxvKAVSKmefnZ3h2ZOnMriOPQaj0aEhV1DGI0ntOGcdLkfqK2/GAFVw2+cSoBJSAOs0R+ECneIc2eKFRDa9eo5BVKGfkTNygFX3XVThgP3hIsdT5NeYzS8xW1yiWE5RV7lowzEdwn2Vy+AxMxqbWdPr8ykGh3dwkwOfX8zQf+Or+J1/+i9x8M5v4DynTmmGZZhSBF85bogDQ4WO2LnebDa17gIX/zUFm7b3aO1A2UgCTq6sCPefnccjKT7bbCg9SjLITBtZVdtNNBushI8Z5SBgQzKYcwAucKoG3RrgWtSttQN913lvS6NphMsIQJiKSYiMqVgJdljnq5Al5vh57jRsBAWCxouzczw7v8AMEWasz60INJO1vA+JFyQCsCbLFL3pwylFZYD3qPa1dDr9NcGHYMJIhun34+NjSZ8LIFLXLLbjrzeiDYYvZhw5Z/M0tFOVdJ3JfCrakEbqMUZxQIYJSCqfLoatq+1Q3eZ3+9Tlda1FygKc/JrYyOZ2oq1AmeROuS+4fkb61gwfNEMGjRDCat3X5To0Lljsoz67170tFdiWhtO0GvfFPrDZ2DukPm+EOt740V0FRvbZFGUuw9N4ocmQuri8lJkSlAcntZlNeXlVGoG8ZSHMEXoi0lVMtkdeoS5LM2CKxoQEgPlcNt5iPhUZ/X43w9HoGCfHhzg5PJHHIY0g02PdnnQvu4gqeU67GcgwW/8olfdWeXId7RgIsXRYtwAozBkt2FaSvtOLzrTP8LArdRUKb677KFaNpOz6gy4eP36Mv//RDzEtC3z5G++jSEP89OlnSEcjfPs730U1LfHpJ58Ki42lCErURN0EcTfFxH7uvFggTiDqDN/64Jv44Q//HleX56IIPJ1wrWYor+asuAIBSRh9AeU0SLBgsyyHZJFGHCZIkw76nYGhekecqROjn5lrwTQVBQ3LsjIU8E4fR0cna8+RtHHxIGPz990A6NYLYfHVaR91RFYei6ulpMpGqzGOq3P081N0i3Mky6lImrBfKco4j6WPXnoi/nFV8fpPUBb8/omk92bzsYAN02mcVUKQWVLWZFnJqGBxmpsAz59fIOqPsIx6mDZdfPBH/wLvfe+f4dOLHMvsEGXcR7miwnWFbhSgy0bYcoF8NpUmwV81shFjYjvw1wbdepj+XCAfbLhHSb+OK9NtT1XzisYtjFCRbCFGiA2hlOMxna4B1TJWBQL2KwWkPlTIbM3GNEkypRdaxj/ZnpsyKDLsyxnFYLQU+H9HrNTL2ft9GK5Xy5Q0NdBUdULEEgg2TElRxzYMZT9pwzQjD1Fwns2kvYG9dHOrIce/438650fHltMWmCWlYTOpdNoOoSr3eqIAwFosAYaZDUYzalsYrfDf7tq7KSK1GVKTlVYGM96bjqkx5hzuZuqJNPpSV2TNiE6nTJ41KdRfFqjXfy9jy0n95o86E5uPCjrtrxPMTOuFnw5zz80/PhcAKA7rXlM/labr56+bfqbPZvO/dwNb9oHNroXkImWdVABEGtjSRJRtH33+OX7wDx/i408+weHdk/Ws9LhjxAZJFaZoIdNa3ShBMZuLMsDkZizT9XSuB/O8xweHUtx/4/59PLh3X9JlMimPHbyc9lkaIT8/n7gLJN1zEp68/dHNI56BfW5dn7Iy4BsFXBa0gxmCsBLF6Pl0hsBOVBSmWxiKlAYVry8XUzy+OMXTmwvkQYOEbLW0hzc6R2Aq7+zqApNihuywjzIBrudjmQPEqPFGBkJVePDgHn7j6+/jyeeP8fizR6KuMx0vjbwJq+gBtdk4BpgzQhpRvK45w4EHLQKjfCWSWldCsdIwxIH0E5mBccICo0o2lYb7dn5Kd2Q8Q47TTjNhvsnap2S9rXCIQggZDTXekq702LCrf7ia4qB5iZPiOQbFKXr5OaJqLvIwQdoDSFKIuhjEfZMeLRdYzG9QCmFhhsV8gvl8LKODSRbIl6zVcLAWB5HVkkqjIWCa43o8A5IuFkgxbVK89+0/wtd+759jnh7iouqgioeo7fhiptFIpo/rhYAYZU++CNj4+8xPibWlN3S/iRNQsX/JCNpSfLWmrIsADgvTmfQWNaJLZCT82ZMUgpkE05yacIy1tXjrUU3Sq0TquJmLY0w1mVoKNrdnLP9SWr89MNewuEVh15CIgXbARl6LTOpJ3sOO/MikoX/x2af42ccfC5hI8+RwIIaais7sLxO5FvZjE3TLSho3eV1ZnxWyjn1df6eCs47AfvPOfQEdGShnO/zNXCqTedBzaQN7sy7m/t+WhtoVmbwO2Pjr50a3a+LHDiO7z47R4dK0ID9Gz9cA6Obk2zbQ8Z0lNyrSaFSPQR/3pdH89dTvDbSpc1d0s20tCDZxEpn6ClayidJOhqfPn+Ov//Zv8IMPfyQbhpuDAMNuf24EyTOKplCA5XQuN5LSFkWPzA6IYp71rYdvCk2ZIMO0DsFKuq2toB43p9KQ3eN0w1X/JnENAkUgXwdstEi46cnQ075BnATIJzNcXlxIRzI3vtSnyNSi95KE4Apd5jM8H1/ibHyFq/lUCvFvj+7h3be/hPObKzy7PMedN++hSgI8u3gBpucm+RSFZYu9+eYbEkEW+Ryf/eJTLG5ugIb5PtFmR8zII0ykeL6cF1gtSDVNjXwPm1xFD04aG6wuzEoAh7369NwMpZuTSTksaiTXoZMN1vI8/G4yCk3zaw+DOMJx1Bhtq84BVmkmhjINSgwxxnFzhcHsEYbLM/SKK2nqlLQAwSYdCNj0op6k+CjKOJtfS2TDOk2+YGOwYcox7bINbBbTGapmheUqxpTpxLCHo3e+gfe++6e4+97v4GWRIg+7aKJMABX1EvVyhqReynHzeH9dYOMDjXvTuffX+qZdkf1k0yThCo2oMTS3x7RKgTATMJHRDQI2jB1LBKGpJUQhIzND717L9bgq2qoe7IAN00TaFxTI+d8aJdfY+PfT2mioIWNtw1UEV1VhG92QsUVjTfFMRvh0QkkOkjHXsmcJSoF0+bObX7r9SZOuKiEF8ZFzcChFw3ky+khqNDXKmNl4ePc+ejJvymRXFGTU0PpNia84B3bt9p13W93kdcDGberUqGH9XTK3jS0D239eB2zWDrFTU3ZleXZ8vDgELhBLVsipIYqw7MZI900dN7cm2HasG2k0Up93IdeuA+Uikaoqi0elW0o5xJGZs359LTWcH/74QyzsfInxbCqpNlNUNnleabLs9WUMq/xHBtToQKIZ0SQbjYy8Nwt7liCw1o+SSt3m4ujCuY/uTeKjbhvYiIfgtWYrxVDlQ8RzAFM71zI0rpgvJKphXYP5YXoMXIc6DqUms1hVWHVT5NEKL24uRQetmM7RR4Ivv/2OrN/LyTWifia9LzfFVNQSrmc36PQ7sim4Pk+efC6ff8X3M8XANJAYImJOgJjFcObAC3qJnCuSIKCxqgM7y2clz5MFJUPjOCNH9OJkcSHqnoxkqAEXU8ZjiE7axag/Wg+PE9Zfd4hRmuCEkjnM8XUGCNKOXP80LDDCBCera3RuPsWgPEO/vBGw4cyhgKNwqQzAOlzcwaoqBUApy1PkY1RljmXOlMp8LXGyBpsl15UkASNJMr0ZI8k6mOYlZmUgoIfhPdx773fw/u/+GYLhQ4zrGPkqBtV8Q1Kr85nI1rBxj/nJXwfYbItothkLc82Ej2dSNwE75ynKKblByzAj9NvIhdeK8QrBhn8TVBJFVg0JEGYKpnjRku65TZ9xiCF/NKq5nWRKFW1Tr1KwUZKMa3zc59z7SCOb9Vhty4rifX0b3ZjjoHNJo0SgIeA8f/4ck9lU7ADT6zLcjFErIxnL/tLeI95P7EOjjaAzK82Yw4EQgLQ3hvp92u3vGnT19Ns87bUR5Jhya6TdKMhdwzYndr1Ge5pit4GUHNu6FvSrg03N3LtN80u92cofiU6fFXD196D7u46V3iA/OVGRP2nUjWr8NdqI2qz9dCO7gNRnH9XdG2cXm0Uo9hE1qW4lTLhxaBgld2o9DU7ZIwONk/MYSrPIJzcAhS/jRP5WRt1aOW927jPCEV0hy0KTTWQXU8Xy1k2HLUKEbZ5kGxCRROD+aMOWgs36c/Rmcjq9CTaza45XeCmNYV979z2ZWU7NsxcvXsiN1BkwZZQIkHzy7HMRDu0ejbBKY8wnU9w8P5NC/ZfeexdhJ8Xn58/RGQ3QZDE+/Nk/omaNYdA1enKdTKaTMrXIvDeNMQMb5UMJQ2xFHg1tkcnzy+hoUkOZ7qeeWGnm+cgmEoEqoXSZyIdgY7RiTOSzYs9DX5pgDzmZlCmQrhEkPBweYJh1cKebSo9C2BkiEhppgCwocBBMcdxcIr76BMPqEv16vI5swigTlhg1zzq8IZoKSxJEpmMsi7nUaZaLORYKNmzelTQamwMbqd+Q+lqVNebTCdJOFzezHDl7rA7uYLbqID5+G1/51j/FN777J7hYhpjxvAL2UtBDKhA1JK1w9MVuIc5dzpb/Wltk09aHoO+rqYIAkiMoxLmQ9GO80sdKZPspgS/5Ul5LFogD0n9JN6/RhCkmJRt+DcNL7inLg3Y9yjVItMjfiLaaBSg1yq7RcI2lvr42ONJiowMl7LAwNVSUQOK8mMzo09H5EhBiQ2ddS12WBACmz5k2Y5RPerOmzZhi58ViwZ/inGREUmWAe42PTKFLc2jJAXKmZsHjNpp9xui2/fjrwqiR71MFAvXsdxnSjc/l6JQddZt9bEDWtnf97ItsVnQObfps3WtkJ77K+sh8q01yykak0jIW3CUA6N+6QLzeT3Z8+bbP53v3go1uKj2JbYvBZSIzQyWyNYQl2OiG5WbjgepwJLmwLI7aUI3cd/WeZLFss6Z28S6LYs080SFV2uHP9ymSu8fsRmp6sV1AdV8nPdpd/F1gI4vqgc1ifIbrizNJ833/d38Pd4+P8NFHn+DDDz+UXoF71IvrdyUfz/TZZ2fPhSxweOdYRs5+/MMfYTqe4Lvf/108+NLbAjCTMkcZB/ibH/xXdAZ98WAZJRLUWS9hMZQ36c3kGqtgKTPUY9ZRKJdO1hWZLhySJsPgAtOoJsPjVmiotFDWUusSsNH5HqJsasFG02yMlcJEZvgccTIpVRe6g/WY4oNuH8fsW+CNz3ELKVOjDXphgYPVGEerKwRXP8ewvMCgniKlVy6K0AlWIenIppAcNASQBRazqahA1CJFtJA+K6E7vwI2jUjN07Cw6ZQgPKPy8ipEdnAHkzLGIjnA8Zd+E3/0r/435PEQy7CLQkYaUCySoFwaiSPWPL6o5EsLfVn347YObe7dGh0UARlTbIScIV3NkKwmSJoFssYAIrva2Tip+1eUxEKmZ1eoghRleAS2zq73t800GCILu/sp9Hg7IVWjGb2n2Vzpg4h7f6gRd22AGmLpWaPWnH1RnM91Ks1ENTx/AzK3Q8x0lsy6qM16KPeq8yh6Y5au7j4SS2UUsu3ar5abIxpcD11bF3YZ7JqpZc8Yt0U1bcZWshx7IpsNw96iwMDJrb8OsHEBR6JJq27dVrNyr68LlG1A67LR2tZAa4LuObStt3z2v/uLH29ENv7i7ItspJ5gc486YZAnSyPB/4RubDv0tXAnktpW5ZZ/o70zPGD9e9nI9ndluHCjqZqrHpequrobxPXM9uUUNbLR815rUvlUVWcmiS5sFNCzvsDk5kLqSb/59W9IuP+Ln/9cZtFfXV/j4M4x25AxPDkSNWcOR/vFk8dI+118+Z13MHt5jsuzU7z79ffxznvv4me/+BQfPfoFzqdTPH7xTPSfmNaa5lQ2rvCVd9+T1BJTEot8ZrivlLWJjYotKW0cea1gEyKROhLBhjRvRjCkERugocY5ZZVNAXoNNgSZ2KQD6VmP7DwfoyfVlxQGU3oHvZEMvWMag2DHpr40LNEhOWBFNto1wstfYFBfo9/MRIxTbgoZQ2B6X+pmIc+QaZSz9kfG4rIUoKH3S4bcsiS4cLhWY5o7JY1m0i7V0sxLkbEVrIFkfSyQYREOgdF9fOdP/hccvvku4oN7mC3NgDORjw9qFHm5TiXtvON3vLiRk3Z6HfR5lftwvUF9TSIbHqdMi5ii09wgq6/RaabIVguk1RKcZipOlhUqrdiPJFqDZK+laOJjUE97bTAtK40s0JqClo15JKiSdMBHrv96oJ20JdwOz/NP1TVMPiiJqoaVuHfPT+owtjjN68hImKlXla/ic7QFzGSIAROBV0YIZmasSNEINZiq44nUNFiz0tcNEdgAMO8F9cRdh1Kf20cQILvRTw35hlM/17Ul+p7X6VPyje+Gc7tHSXVfZMM0mq41/9aNpN3nXUB17aMSBLalDf336R5w94L73MY+cGjmrwU2u05WpsEkZtKcfKFDLRaAEJ76rV5R2z3LkJjaZ6zDrGmTlCexUw9JIdabU0kBcnOyQTOOZLOZcTSbQob+cbuvbyysNxVxW2TjS4aYc6lwdvoI+WIihvnevXvSSEoVAFI7WZ8i7fvk/j2s0kiAhoKirMnQzo+vrvCd97+O8xfPkVF54c2Hovr8V3/3t3h8eoqQHntZ4ODkjpArrscTfPVr7+Pzx08lsgmptpOascmS6yaILG20Io0AoRl1o0PihK5kJ25JzYCv24FSBBumN/k3LPJ3jShhL+nKhNKT0aGp25BuPhgIBZ3gU81Ko4ibhkgjms8C3eZGaM+jeozg+lP0VxN0KbOz4qQo1h4C1CsSd1dYVhNJZ7GHgqkUw0RsBGhmU0Y2LBSvUOQ18sqADR/N8428j41/vKYydoBGNe5iGQ8wT47w9m/9Hr70W7+Lk7e+ipu8xnSei1w9yQEyNpikgS8Q2bSBjftcm5DlOjXFekzYl8J/RrCpqa5wjW59gx614+olVouZcQS0iZHMtXCFmsw1pFhWnAWTmogiMr0kq8hEjk0YowxNn1HFKCrsYBlmBnTsEDpGeIYgsgk4ev+4mQEfbAzCmamiqnq9jnos2AhRxuqZ8TWdhslz0h4fBQT9TjeNQzvg3ssuw0qN63o9nXSYfobrmbtgpP8uShN5ufNo1MDqo0ZL+p61/bAEiF2Oiswz8ujk7pqyOXzXzz6wKUuTqlKKuptK43G29dm0gY2fOtO/cdNwus56DTSz1OZIuTZ7vW4qV7MRWjlo25amWl9cIdY7szecwU8SytmhRMoWk4vk0PNYFyF7jZRHMYgKGlZ1mN8t3rrzo81yfMoVLPQ3iP6uofq2C0oNavfH79bm+2UNIvPIY6WXRiPy7MXn+MXjjxHFbAILxVujUWZqkIaMNSpSwe++8UBUBh49e4LTqwuQAp70OliVS5zEKd55+IaIlSKJRJTw558/wZT9RhV7brpIuj2hit9MZzh9eSEpNR5X0ksRdjnagPpnuZnho9PHpOhPZdMFROcmYHqNoaHWaex5c2AM1zjpIGH9zI5Y6HMOe5LiZHQkTKBRlxHNgaTQRJ497UrUE9ShyaMHlJNfYBDnOIxzdPJzhLPnSGYvkNUTEeOkMAxlQei/koTLJtmymWFZLiTKINDI6GPbU0PQubgaIy8YhdQoOFJiucJcBB1DMa7M97OWwU+Ua0dWXdRFEQ9RJCPEJ+/g3W/+Pr75h/8Ml/MKZxdjHB3fMdRb6eG4lTpxDZnuCTVWbnrGNbqaJvJvLr15d4GNqbGFhqzQjJHWV+hXF+hYsOk1jGwM/ZcpUKpzM6ppQg5jJUCTZUitOGBp5zlxJapVhKIJsVjFSA/uAb0jxIP7qDojXC8j3CxXCJMBesMuAjLDaqONxx+VJ9FsA89rm+PG1yhLJUBne3p80NLIzn9elMVtDUnXru1Rayl6PV6JtGxtSD/fjUJ2GWr9LjoobirMB4adSGBf3KNYs/4I/9h1H7mP/r/5u1/4VyPP5+PYCBvrPvN7btzjd52g9XqqkOwWZ92NzH2HXT/DjR79KKu1ZuNeTPciuf/2N4PZnWYzumipWk9ycLYHhiG3ILAdYiSLSNImi1hWWt58nMkA6yVSTbkAACAASURBVM2t6bT1ze9QlY1xuQWLXRfzVwUbPRbmnBVsaGxpFJ+fPsGHH/0I/YOuMOiYFtDZLwRJzqEv0Qg1fM5eEY6xLhbSXxBmCUbdLo45/iBKpN/g8M4J0m4Pj589E6ApCXRBKBTq8XSOi5sxrsdjFEwdsE8pS7BKayzrJRpqt2hqjI9CdaYV0sjFNiLbMdnqybFvhiDJ9BijFoKMzPTo9tDl8LjhodRkRJjTKuMKfV2G0HEMNSXlI1FujuspBphgGMyQ5i8RTp+jU43RXc3RDSpkUSBgQ0CkqnNVUb37CmVlIxhGNiV7fUwDJ8FmMs5FXn5BmRqZU7/ColhKs3AYMyqWvm5Cl1xiuRGjjjRyFuEQJef6fP3b+Obv/xlmTYKLyQIHx3clmqHXrLpirrfmOi5qbN0UhQs24tXbva1/4z/n7j33fuJMnx4aM3phNUZaUWHhCr1mLEoLrNskdPxKSjQZwUmCDet/JUwhnCU7Xmemg/h7tQrlks+qEPNVinGVIE8G6Nz5Cg7eeh+r3h1cF5yxlyDNujLqgYQJdSrXdRQVttwDNows3fVw2xAEjDhryYmatNl1fa86xq7N+Lo1L/e66PvpBLpGUO9X1x5tu/dNzdm86kZHvj3b9f59kYdr4PfZpzb7qsCi10edgdsIxvTHaT+Qm1Lk3/hNue4ayr/3gE2b/df18B0svQ/cY3ZxZUMbrQ1k9oGN2nr34m70vTg3Iw9CdchkU1iwcEM/gkvbwW674GycdE/IX8w2NHc/a19kw2MTDyI14TAjEKkRlCWevXyKR2ePMDjq487xici60Fsm4460Wkr2cODT+fWlTCmlmjVTfxLFcMpnFOFOl+TnUGoU9994KIyuTz57JEald3CApNuRiObs8koipTkL4XVlW2UaTNmXwoSUFPdtNEOQKdjoSQPMMJ00c0qnmyFQjEp0vO3B8FDOh+DC5jiRYSfoUMgwtv0NHJUbkiFI+oFZb8p7sLs5omIBr2szR1peIxPm2RWSxRnC+TnYatkPK/QSiFKBKPHWtanFLHOMp2coGdnwdws2S4qBsr5SNVjMK4n2ZnOylZT2XArYcILjSqI2duNz6pHJv7NxlKm0Ihpg2b+L0Vtfx2///v+AVe8QN/ManeGRRFZck2rJJslXaxZrY2Y3eFs6SdbBNjG63qaCDZ9rk6vRe4Vgchxw/MIEcX2DlAKl9ZXUbLp1gYQRD/tYBEjMvB/uizKosZQu9hpxYcgeMgXTgk5RrQRsCK7niwYXVYpg9Bbuv/8tWYtF1BeaONNsKdltpBxrP453/2lk594zLnhwJIQLNkr8caX5ZZ3sGou4pQ6uEw3CW2fRvVddQ7bz/rZ9ItvAYtv9L46BBRtRaHB+Xhds1sC2g43mZlZawcY6474B1+PWzIq+140U+BxrNu61850FX0HBB2x3REHbGrj7178Ouv/VyWoDmw2FAR0xsA2h9yF3yGlzNmfrA4IsmAUbd4P6m0pqNgpK3syEDWS22XV3bsguAsM2gPpVwYbHTUOv+k5nV6eYNDP0D000wNeZCiIQ6Qjci6tLYeLIDJ7FXAREh4cHUiy9Ob/EMIrx8N4D6UUYHR5htljIwCiy0O7cuyujcEmh5kz28XwmrCtSyTkPaF7MMVmYfgUhTpT8r5a0i4w3lLHX7IPJ0KN8DhWwe32pwQwHBxLFMD2mAobcmIzIRDHAzgNioVaYgXbSqWwo/iesILJT+2Los5pgc4VseSZRTbI4R1xcoYMcvWRlFbjZWBmJPBHrMYt8gsn0XNJoBBqRoxGgqbFkH01JwGEm0ICNmWdUIhcQ5fCsDIg70n0vZW9RdGakE6GM2MzZR9W7i869r+C3/vB/RPfkLYxpG5OuKEcLk6YohC7sGyX35t51DyjYqOFxUx5687k3qftZ3WqGe6tr9Co2vM4QM7ppmHKcodNUolDN2iSvpwEbE90sVyWKxtCEg6JCIOtm9p2MZWDNqwRmTSRst9MixHXTlZTi3a/8DoYP38UyosxSia51ovxzVIO7D2yYCnUNZRvYyDrYdLWCjX5fQ/vhNobaiafrGpBOQLXsNGWp6eMuz11tSpuR5HNcT6NB96rc1etERuYzdifRXgdsFKx9wHGfb7s+8v0c3tYiMaYOvLs+/vfwd62budGhe+6ukKcClQuaOvbavV/E4bNkBTeNvFYQaAUKh02wzXBrXOGq18rB2jf4B+t+jnh+tiaifS2+SunGZvI2pYvSrwMsbX+zL7Lhe3gTM7LhsbBGoDIYl5MLvJy+xPH9E6njSA9RbqjaLIqyt4jD0Hr9vqS9WL+RZtYklh6D68sr9OIY7375y7LxZVDcisyrCid376A/GAjISIMoNaQo7zGbSc1mNpsj50AqO/5WjA3TSxQSJL3XRiMcHtfLejjoD6VBlkV9ssv6/QG6HBoVcXCcmckuN4allCr1nAKJ6pUyKtV0k6Q3WeSvI8RNJd54p7oWZed4foq0uEDC8Qegzloo+naMmvj+YpGLnls+vxawYRNnsWC9xkQ0RmiTdHkSAEIBWI6w5gwjMtEWTH/x+5MO6qQnxoqGWYaiWbUv0oIX1EoLR+jefxcf/PH/jNHDr2JScuxAisWyllpUWJlRB+7Ntg0ctnnJrjfpg41rJPzvGDQzPCieYlhfIWrmCDGVCDHBUsgUCR0FMskINDUL6qQHm7Rp0SzEuVgtIb1UQhnn6A3qyFV0dgLMmwB50JG+oxfzANdNhjtf/gBf+eD3kAyPcT7OEWVUINjsIvfvUd/QucZNwIbtAPaGlx4vNd6aonLkpEQJQZDZzqFhkd2Ufq3c5PZHmfFkQWKtPq4DD7fMj3GvmWtE2yIb/29fx77s6rHx7c22yOaXARnfuW6aW4kgNxrUc3XZaW7koX/raqO5x6vv3yYkq+fiSgK5zpWCzcb3q+pzWwjrL7a/WNxg9CTbblQVpXTZGFIQtB6Kfh89ZjLR+PcCPnYinB6sHMOuMNUp8K83eUsdZxsY7QMbHg+L/QQbonheLtfHSKHMn332Ed5454FQgSkeOuZYZ3sujILISuMFpcQG+2MYpTx9/kyaMtn0ep/aToOBNGuybsO/IcFgdHgg3iobGIWh3NQCNpRep2gp1Wi5LrMp8+1msJmk+zgwOWYNpodemuLuyV2ZTspohiDTE40zNsdlMnskITBxnoxz0/L4te7G8d7uj3qo5jn2UyWImlIYZwNSdxeniGcvkCwv0MECHdKh40iIBxrSM2U4nRjts9n4JUqKcC5MZGPA5jaNxuwgIxoR4mwY6dQyaE+8tJSpMgpVRkhQSosk1Zx5/GRcLYIeJsEAgze/hu/82f+K3oOvYrwMBaDm5QppEiNYTAVs3JqNembi+Xk1h7YbUt+rKVe9/vyctgKr3i/D+hoP88cYVucIVzmiVSGPYUigMT1BccjGvJUoe4sA5IraYQWKcmHqW0Uo0WyzzLGqcqzs0Dk6SIs6wMvxAkH3CFdlhPNFgN4b7+G9D76PwwdfkiiPta2V1N9uvVE/qtsGNmShmkZTI8ZpdsTtjxgfKRneRg5CYRZqs9m/bFrW2MD9HvcYXDvk/w0dJTWM247Tdx7WhthJo/k2rA0Y2mzIFwUbde7abBef01qN/ttnm8mQB9Wj87TR+B5/rLMfBdE2yb20hSDQBsDueirYuDU/PVYX3OXz3RED/oLrm9wPdy+8go1LCPBH2jKFpF9KQoCqua49ZBY+bRptI/9thS/dC+wrrPKzXOP33wpsaBwZjYgyso1sCKJFOcfj088RpJDIhs8tmO4aUzizEcIAKcpUsibFmx34BIsnT5/KJuhTkmd0IAX/n/70p/IcQUt7EBgdcf1kbkdDr74U4NLQPQwYQdWIQtMTI7UXzvOg/A87/jsZ7hzdEYWCXrcrVGYW88UIkAVFNiCTTt4kUjEanCMfRVJLMtdcKa63DA0mr6hvFlUFeqsxDlY36CxeAOPPzcC0qEQWNma0dsKbwsiW8DNnY6p6j1HMr0QLjTUbMtJqeuklhTY5kZX/NlNZ2XzI5lZ2vOe1ocM2Kem8XWGgkXLNVBoHtvG15YrTOjuYRSMcfvmb+OCP/xVWwwc4mzUIsiGKFWtQAcKckYSRrHf3n7vvfI/QNUQKLC5rzX1O0wht3uuousbbxWc4qM4RIGeIIlI0VKZgfc1ElLGwzZguIdhQPHRJcF7OUAhZgorZQF3MsVrOEXD+z5JAZKjhV5MZ6riLcW3IAnXvBCdvv4c33/1NDB98CVP0RTdOawPK/tJzdplG7jkIODlgs37NAx2t8Wl6TUDGAo7MhInZB2QYrW2g0paG0r+TCN6CjR6nC/R6Di4YuQbQTaO5RngbuLWBjTSi7nCG24y1nqsAtM0kqMF3H/U4fGdm07CbjIQLRuIs2qZOf//5gCyKLw7Q+MDc9pp7Tu73uveJGyysr9c2sNEPdC/OK2jfcNKclRUny8wW++SLtMHI1nT4hdL8yUgkMrxwOVAm5e0G5O/r5y3YuJtNJyK6kxHp0fsg4/6+r6bjs91kYZxdxeMRimxkqM0KNjJ1tCmxqGZ49OQXUmd44603RA356fMnuB5P0e1lWJY1Ol2OPo5lDPZilovRoIQMmWqPT8+kP+Tp08+F/cVUE9Nx2iDLaEmOSTeEXU+jgLvCyegOOmnHTCYdDgVkDg+GOOacnz6Hx7ExLhJSAOswOoNENqSk21YSDfF3V+aDsjM8dxXiI+Nrw9Gw0znJSAurOfqrmagGpPMXaK4/R1ZeYhCx3bC0aSrTT8CObSVR5IsZ6mqBJdNouZlTsyyMsvOyYBqNCs8VCkZtvKN5PGwY5uRWXqWY009NHxYhWejXfKUJQCH+RdDBBD3cefeb+Mbv/wtMoz6eXuUIOodyVIzshlGA1IINKDNPtpwz/VDmIUnToR2wJV3zTFWaMeXS3c7x4Kz7KGVfIqXYzkMyMvRCzxYZIOrPGQXmUfkS71aPMKrPBWhWIHOLcjRGEFWaB5hG4y1CcqFoiJUy1oMKC6xdzXOmZ2sBG4lulgvUxQJlwdEMDYIkw/WswLgApk0o00vD/iG+9tvfwfvf+Se4oQJB3BelCNL6Ceq8Z0RyPwqkAXh97Pa+UBUN47RIg93G3nCBRwDczT44zFVp3owJrXbtWh5JTNHISYrZljKtkZSmeXxqutoNfb0dcDgugKlJ5xra+TEq7b9b4l/3gJGEYr+b/0jWpj7PFChf10edW8O9JG6zHWHgzrGR+4uSdyKUaxiafDTP8z23Wnhuc7xqo+k9uwZ469iLjbY2dhfY6Dq6NtX9t4KK62Dpd7q2V17/P//8h2JbXcRTpNTnXSPE19qKclrQ89HflTNwC4H6d+wW34bq7knJSdvcsMpaGAR/Nd/sAqTvjel36WfTc9bFXgObA5D0ENXrdcNDeT+tdVjj7PIUp2fnQBaiMxiKeObleIKsm8rcHSoXy0jjaim2htaD3fykNL8cc7RzLak61jJEEZdCpdooZ5tO9eaS6KXfB8fcMj329vEDU/zv9yUd1+/2kQnrKxYeWkyRTKO+tV5n9TIluyHNGnY6qbMPXiuNEFTiicdBLnNtsuJaUmjp4hzd8loaE7tUKKbKBPtnRJONYEKvm70hFa5vJvLI1NmyMDcTAaYsSXOupYi9IsiQqsydymmhcSI9JwR4pmV4s8o1pKT9ypCg8ybEPEiA3gm6995BfPwmpkFPRDnFuKZ9YUYOogAdDvVKU0QEFkZgVCnnzJ0oQpbE4gQMmHokzbZeIWT/lwzYS5CLBiq1zfh/M9RMNE2lehRy7oadE8/tUknkFXNmEUoclS9x5/oHOGguQKKNRJP2Quv6y7gIkgwZvVgVCO4VRoc5I90Vm11LVGTyLQtx3rjO3NcC7DI6mYP/Qswb4GaRy6C7N7/0Fbzx9W/jzjf/TMgDeRnK86skE6YeU3fBqkbK6I+rbzXQ5AxlwFsoQJOyjqJlGM/DV/FaN2pQJ1QjESGM0HGgQ+FkPnhtRNyX4xZ4fdkEKiBt1KLVaSUAq8HTz/Q97LZIRdf3Vtlt+zwZNfY6tEzBQEqcIqBunIO2Rzp7bSC0BiU7J0eHpEndtubcHn52hYw1NTtfh79vgp9pEdH11TQuf9fR135k49tnRs0u6PhsNoKWRLEajTr9WOqMutGQ/28FIbG7BBs/tHI3x6se7+2gHh+k/BNxQaTtNYl2HCE6P0Lh6+t0mzObwUVT3qRtx9F2Tu4x6HeJd7VlnoV44s5UQPd7zBqxRl6KisLLq0ucXp5jSRmRiA2LjfTS0As3TLFS6ipkh7E+Qr0yGsUnl1fStE9JdRkeNzeaYOWcnmlllKRp7DiBkHWXwVDqOmyuHGZd3OsfoMPZNMntQDpdM/dCt20IWV/PuL0WyKwRnBpdCxkp0G1yJMXNGmx6OTvhJwjm10ISCKw4IqMXFvvJLisIsgQfUnYZ2VCQkTUb/k4qNJloBbXfOIHGgg0Ht6WUXSFtmakzkwZk5Ed6QNmwML5Cjkjm26RH97CM+7ipElzkDSarBEHvAFFngDiIccSxF0EkaVJSqaNOKgoDHQHtDMNBT1KTB6SEk6Uno96AVKTxE1CQSUZqWbAh+EmvpaUrsGFWVJWFLcdaTIEMOdKmwFF9huObHwnYrB0e0/a83qpU7BavnTUbCpHSSclLFKSCkwwgZIElqBFGsKYTI2BuCRbsv1lwXzEViQAzAlRTY3RwhMHD9/H+n/xrNIfvIG9iTJdAyDHsVBioazM6oloISFLd2cT8MhlH1p+p2A5HKdvoQO4PCzjrlLdSm23dRsYqO9GNgIqXQmvzotvuZ36HmWq6+Zm+8+q+91VHdLNp3LdT/Hv3fnIL3pp6bHNo9Rj8PiH/81XiX22LH4Fs1LxtVOJ+holCN3sTJRK3rNK93y81QcNmVXvrpy7dLJeevzrg7uf766yft16ff/sffrDOGqlx8sHGDVH1S9qihzZA8TdJ28X0N4d78TSKckM997tXlnqoC+K+1/0u/zjWvzt9OnrB3fyviZ6iDeKCHi+BLutE6I/64l2+uDyXIWhPzl4ITTntdfDi7GxNfKDOUzfJZFw1PTPe/BOmRepGpFpECXc6k8flnMO9Kox6fUmP3btzVyZz3jk6NoOien0ZPDcIWaDf3pTGTedvZPfmZiqpDYj2XTfzngaB1GSW6NY5kuUV0tkpssW50J875RTV9Ex6OTjam2mxRV5KtMJH6RciGYAGkAa0XJr+Gm3s5JRrRl6i6xUIQSAksaErM6WlftEsDfuPky0FaGhcmUajNEvcERXoq3yF5+McL6cFyrCDoDsAkkzyun1eW2kQjRBlHQGZ3ogEjSOpw50c3UG/28HxoI8Bm1rDGBk9btkTsYh/SipDAIJpPB0dzOgmxooD/oRFRUWyJbImR5cD55DjqL7A6OYnGNaXpsBu01EmPWUAR5TOpWZDReMGDbXhilIi4QWZeazfyDoq/Z2TTJco8krYfEzRjqkxRzq8RISB7NWA9bP+HXztj/81Hnzje2iSPq7mJQLOJYoSuSZkEC4Xs1fAhmdDjTUec2Yjy/UeagEbcQ7VM/abOF9jRMi2NI8AlwDO5o8LZmo42wyhedevF2x8+7M3je/UtNvqY24a0H9dMy1u5KHnyfveB8M2+xwnRpWb/ylwuZkc7gN3DfV8tL7pp8rabMkrYKMH6QKN/pHLgNCaitwIe+SxfWRrO1m36ccFnVuDfstvcRH29thMLcHdkLtykK7hlX/v4NhrBOWCjbuZCDZMkbGeQQmadNDD4+dP8ed/8f/gxx/9FN0BmT68xxMp0LNZklRk0XWz6rVz1iXoySt1mb0xIdM3pCTHeHj/gUQzJycch31sphGmJsUj9OZqZVSdW7w7Hqt6Rnre7qNcH83PtV2c13hOvCjU6DZzSZ2lizMk0xdI8jOky0s08yuEdY6yWkrnPynH/G9pBSOLyURou1qzodGkN17Ri6dxZTKQgpIy/y1AyHlB3Y4YSzbHTm6uREmAzZ3FKsCMA9TAVFkXVdJDHqTyHJlXHDPAiZ1sZhQQoxYclaC5lmkHCdUTBiMMOKjv6FhSk3dP7pkRC6MBRhweR6o4qdYUk40SmaJpVImp+Eawcfo3bARgpEeZQivQqRdUKUNnNccB5WluPkGvubZsLlv7AOs75t+smfA+qyigKiMiqJ26RL5gZFhiSmCpKxkdIUZDepQM2UIixGaFOVNsXLs04YYwf98AeTxC/93v4bf/yb/E4PgBLuYlws6hADdp9dyvrANJ/xKPx+bKmUZjpU9MNdM49lj9qGY9A4r1QOuVMxrZSHOxV8ibKulmLtQB9lP7kjKyYKP1TLUPaq/46Kb8/b3/6wYb3369jo3UWT9tNSfX3rn3t/s9ruPoAqq7Xrtu44gqHFaBQO21Cy7cU7siu20grs9vaKsxsmkLUdVg+15C2xfvPJk9QnOac3SNeNtFczeKG8U0dPu+ANiwd8EFWB/QtGbjUrJdIGwoc1/mciNT4Zn05f/813+FH/7DhwJkVzeGCq3UZKbFeM9qTjridEtSkAlIHUOP1lHYnJTJaIbKBCofIzePnWzKRw6B1sJ0m8Pg5mz9NKV4RM2mxLkfIe7GG5rWFPGqQm+1QLe8RJafIpk9Qzx9jmhxjrCcYFVx9o7xxEk5ZvTBadVUeqbQJKMToyjAuo4pUkuNQnSrKCrJvL0BG9ZVGIEQbBgZjcfXQJQKeC2aSDrnCTBLjqhO+jifLVFTsZS/s/bTwIyXZq6/gWlezTro9gboDPvoDwxDcDA8EOmgk4MTcRRE8ZpzVESah+rWJto1OXQDNiEjOJFhIpXf1HLkmnAMOCoZHUBQzuopus0Mg+oanckTeY4X0ZAMOIuFYGC6+muyDym/zxoMoxvWsljTKsjSKzEpchPB2MhGo0JZT0oC1SssaZhZj5HZK1KBEX26IhtgnNzFt/74f8LbX/lNLHiUUV9o42QD8l6nOjbTZGZImkmjmbEMxgk06TUbhbXUbMTgWrKQgIglFK3tyB6wUW9bAUkNOD+LqWoZu+SAlQKVRgFuSqh9L//6Ipu2z9+XIVAZLDeb0ga+bjbHtZW+k7kvw/PKMTojwTVakX1nAUiickutdp2ANjBrA54N+/N//N9/v0EQ8A2ve5L6pRq+vU5ks894+VGIbxDbkHszpXYr4OkupP+9/kXX35na0c9rW0ANI9VDcouQTL/wv16fBVZ2ti/RHQ3BmSNnl5cYT8d48uQpZosZxtdjXF1dIp/OwdRfJ0oRpTGOTo5lHgsjFgLN4dDOUidNOY6NHL6dVCrXwjZxyvGvVhLl+GDjrsNGB69DcVyDqgM27pq5XuI2wGE3ThN0Rb+r20zQr67QL84Rzz5HOP4cwewMST1DXcyQF3PxspdNgkW9EoYUe45I1WXtRaVqaFDFftWcQknbFiOIYjGQHP8chCzip5Krp2LvoiysFhiwaGQqDPIwxTLqoQgzLJpQmjiD2EjVs3bGaJRpBhkj3OnLpM/eoC/kjl7/AFm/j053KCDUz/rCECTwk5km0SRWEnUadh/3gMAKopDVDDO1ViZg2ps2CukU5OiscnSrCTocJb4co7u8Qbe4RMYKD4cQknXUkOZt6nUsFLPoLwQdS65gKo2vGbDhpEumYc24hHX6keBTGro4i/0KMCRYrEcVhRHKdICrYIh3P/gDfONbv4vO6C6mdSrgzBTgYlGgwzk0UrNh349U56Veo4V1w1LcTGRtzEjxyEca2azv4RY26f573kTyWrORbWIzFH4E4O9df4/r8LGte3xPzcYHgW12ZqvT5tScXWfRj17aAgJ1wBUENu2iYRX6kZ1/HJx7pBGNps8kknbEPV1SmJvl8m13G9i4zwUEm7YT8Q9c0dYtRqn42y7vdx+yu4vhA40uuIuoblRh/n6Tn6/Hsu3i+BGUTsrbtnA8RwVZ9arWeUvSa2dzHB0diYzK5fhKUjDHd4+EObUo5sjSLsqqwHyWY8qxx1M2ZFZIQ85UJwuK44oNqPA/GjHJVvDGtkrYqhcnPRB2uJwKnGpNxo383Btgr6cj9LjNxjv3910FxiYgFbkn/Tr9Zgo2KfaXZ4jHTxBeP0Y4PUVxc4r5zUuJQHg6UfcAUdqVyIZAMZ9PZH0INlKTEGVE6ueb2exCzKZkPiseDBc4bY1RTVWK+vMNe3aWNaZMn3GYWDJAmY1QBF0s2QDVGYgx5poIa5mMwGaJLvuehgNEWc/WagZIe31kJA50OvJIRhpTdN20I4BDsKGQKKeLcnKk/M5R3DTNZG2RTabD9URQloy5JdKoQj8s0WOqsbpEml8hzC+Q5hNh65nGV7I8qSxeiTCpgC/XZbEQZWWRorHjvDmhlNENU4GL5UrSknm+NDOkNAJiFCSBiMRcsh/N7xEoa0+wyIMYRXaC3v138K3f+2Pcefs9vJzWWKUDZP0hLi+vjZ4dIxvBEwM2AqkCOEYElWwr98dtHXDZUr5Nce9vd/+6dsAFHt+ZfB2CgE9A+v8DbPbZPPc8XOVrP6uiUYUPaLpukpmwUaOus9pnjUxc+9AaeTltuK6dM86OuW+0jODbPzfadK+fb4vW1/NXARu+2VUa3QU2+yIbYwReFePT57gAu8CmTQh018VxL5Qsnj14vXC6oO5n+OGlCzakNjK3T1o289IU2lyUbLwrjYQNiQKkzWamziKq0HYUM9MmZt6EoR5rtCKbzFGjVbkYXQfVm+NxVU5kpjezf+yuB+TfvK4umHuT6793UScJNowgOHOSNOdhfYNh8RLp+Blw9RmCyQs8++mHuDx9ipfPzyRSOTg6wNHJfaS9AaowxMv5lTRpLvOlUa6tSdjm3IpAZtOwZ0bow6x/SJ2LaZxA6NHTosCTly8xXpYCNk08QDi8B/SPUEY9cr5QhzFyfm6zQhKTWkwabYlOGqHT7yHu9hFkXanZxBybwKVxfQAAIABJREFUwNpN1kPW7SFOutLrkjHNJmMVMhFY5bWkzhwVGjKpWXF0Ams4ZBoyQiFpgP9RUHmGLKwwDDkAeop+eY54/hLh7BxBPhFKNVlfHTodMuGWvUUzsAepLJdYzCYmkrGsRhk1wN+ZSiNbj42dS45ZzqWOw9QZe0eqJjRjcLhelsnH1KMMuUsSIQ7MOLm1f4I8GuBbf/CnePv9D6QPKewd4PD4Pp6fvRTtPMOk07lUJqphdCMpLFEQYPy02Z+mNsF11twUvO7Rffe37l23OK5GjhGkOVf2npj/3Pubf+crOPiO1a8zsvHvLd+2tdlJbap0Db1r79oIDm0RzK8KNkIUcRS+12trQcxn4/rr7DPXfGd/Q4jz//qPP5LIpu1iukjrpo80rHIXwv0MXXS+312Ets/bh7zuBmrzwJWN5p+k/q4b3L1AumCy4Z18rx6fW2B0heZcJJf31rb5Tqi3lqRAcLTigvxsvyZFmu567MK6v2VzRIN8j22Ek/d7u9Tta+CIBr1xfZBVp0CP211/vV5pcju8yQUb11j4AK3fUwUR5ux0jxpQVLK/vMGdcIrR8hrjz36M849/hGB8gdPPPsb48goZG2Q5wGwCvPHmIb72rQ/w8eULjMslqsIUwlc0koyAyLJLOsL0mjNltKwQ0lCmHYkiX5yd4/TqEhezAnUco0n7QDpA1TlAk45QJQPUcYYm4RQdU9fi3Jag5liBEgl7I+IIBXtnOMvHA5uUqtdJT/ocUiow9HrmP6bU+ia1RrDpk5lGwkAciuNAwDB7zUQ2TbmQWs1BVOAgmCKbP0dw/QRZeYVeBPSyPuIoRZbGCCMCyRLzOZt/JyiKHIv51PZpcfwCR1nbPiVGNwSMJfXpAuRCvihMPYr59sZMvmRUyGiGdS+ZyKo0WUY7pC10D6XR84Pv/ym+/u0/wPkCmNYx+sNjzAtGZbE0opJNKFwSDtwLIwF9abKMGDFVAuYbzdpWLV3vO+mLcX7aHMI2Y9xGIFrvYws2u6Qw3cjGjThu/31bs3FthH7HPuqwH1msm9KtAW8j6Gw4dXZOlmuT9DjUfrrML+15VBu8z5nftX5iH+zi+TZEf1c23LbIU50F1+a7Drt7TTf6bPw38GDaOnRd4+V7Jn4dx124ts22N6foeCuvAzb+hnW/n//WRVwXED1qcNuG94FWNwGfl/Yyd8qhSrTz3uLNQLFEO0vdPX4CRhCaDgwaJffmk/V1ctB8nzs0To9Riq1btKF2bUK3GEkj6R6X/293T/hgxchkIZz+AFk1Q7oc4wQLjKox8mef4ObRRzj96EME8ymW4xtMLy8xHZfC8B2NMmTHB8i+9BYuiwUW81wK4NLURjFR0pGjTOoyUhsigy+KpU5xOR7j5csLvLyeoumYGsMq7aJO+6jTIepkiCbpoYozrMKOXAeZk8T6FGe31EuETSlOwZzaUDSoHFUQMvRhOrODrDuUFOj9+2/I76ypSdNsv49+vyeRTSdLMKSyhB2LTqBRBQIW0qWgXi9EXPMwmMuo7O7sGYLx5+iX1+hy4nc2QpyY+hzxoKooOjrFfDKROtdiRrAxPVgkULhgwwmm8yXTi4z0StHtE7CxEQ3dFDbAcuSCpM9k2KHtybBgs0z6mDUxfuN7/xTf+M4fiawNRxMkvUPMONWUja4rxkaGdUbwFwOrYBOb6IJhlF/T1ahG9rMjpe9HAG333Dbn0TV60ssT3mqrtX1OW7ThPhdwbeyPCzZ6H+wDGzWs6lT6YKOTMrcZaxMdbt7/vp30wUYjJjca2raGbfZ44/OVxGJra/6xqH3fdvxqU/X1tt/X68s0mu/RuheDKSAXvX3j4yKbGx3pxVIw8Y1pmxe9zdC3gcytMXUzxLef4Btb31Dq8TCtoF6F6wXohVRPwr3AurAu2FiLvSlox+If02a8x9vmVkjnMXfbbQf/to2/9YZ05oPoMep6qVPgXz/Xw3P7bNquiX6mv558njCwTCIZ9El9tGQ5wbBZYNTkwPUpludP8A//5T8jXIxRX19hwcml0xs0y0Z0yeosxVf/6Ps4m08xGc9M1zprAaQos7CNWGoQZJtJQ2JR4GoylSFyVI2elzXS4QGqKMWKwMKphRLR9EQPrCaTLcoktanNg6qMTMChZ86+E8l3yX+RsNa6nO3TP0S328fdO/eFSMBeJ/5HsOn1O6Izx9RXn1k+Gx0T+OVmUykfUcxmb80Co9UUw/Ic3dlTpFMqPRNsAiAdIWQ/UEpZnBXqssBsNsFkwgmlBmwIMtL0KmMETGTDaaYcWTQrzLC0kqMFSCiwpACmuYRxECcQgypgw/SkKm4EKBk1BhnysIuvfecPJbJZRCMBm1U2ELCh5h4JECQ/8FH2kr0+ZJlFAjaGm+Yaa72nSG7hj+on6r3j7sFdYLPtvuV7uP9kgu6OD9j2fr3/QzIVvaZud6/vAxvX2db7bcM+eH18/qH600pd2+vee2rEXcfXB8dd6+iChf6dfJdlo/nfq7/vAxs9xjZQf2Vd/82//68CNi4TS40TH/0Z2r4xdKMFH1Bkk3lCeXoAbcyvLwI27gZx/+1vavcY+e8oSdYpxLZiol5cPx2oN5OmEpnbp8ve9sgIRm7yltdJnWYNZqfn0DLHx82Ru+foR3J6fVzJIX7XOr3odqt7PUf+Mfk3LkG0ihnZhIjqAmE+k+mSfVTIllNEszE++8kP8PxnP8bNs8/RCyogn2Fy+VK6NAZ3TvDl73wLp5MJbq4nRnUhINMsEA+d3vMqSmWkwHiW4/z6RsCGv9OIsuem5pgBofUmBpSirghLMtqpIooUdqSxksduZFhILba9IYx42CCaREiTjtRiut0BBv0ROFSOYNNJOgI2JqLpyr+zTmLkQMIVUsrXkI1m6aGcrMrvkeRnUyMJa3RIc65v0M/P0Js9Rm/xHKP6Bh0qTcRDSeMZWZCVDHObTidCJiFdPJ+zdmObXgvTAEspmqrgKIEQ04IMPw7r5EA1NpSy1hWiEXknhk6kMJg62Ktgk2DGK9E7wld++/t4+ze/jSI5wJh1s2QglGmCSMjzjIyUjjoZUktraTlQKaS1MdehaVvSaLsicN8euPeugs2+yMZ1hvX9rlMcRVmrjdbj2if34jZNux/kGt9dzjyjQt/+ujbH7WvU4/cd/n1g7QPJxn3NPeLJVPn2xAcS93zULvpgqDZm47P2gY1vxN2F2QY0LqK1HYS/uLsWa1/Nxi1L+hdVDIxNw/kbVb9TaZPueboXu81z0c+VzxbhJKPISMeREyxvtciMp25suIUH8XTM85LTt9pn28BGvn/LcCl9zy6wcVNm6oWoYZTPbqE++55dmwe1Xs+QcjGsiXBiZImoNkrPmUizlFhNrvDJh/8vnn/yE0TFGEm1QDOfoBMDhyfHGD14gJc3NwZs2MC4CqXJVUcK0JCScXZ+PcHVdCppNIJM0usJa2y5IheMtQg2VybSsIkwlccqZGqqKyk4khmoUk2Pnw4Gx2HHaYSklyHpJBgMRhj1hwI0g94Qw95Qoo0kSuWx1+WIBCPUSVCgw87bNKKckQUbjjqgoSeRgaksrgnBhj1I7Knpzp+hO32EUX6G0eoaadBgGQ7QxImNvKgHl1slCdZsCiwLU6vJZd4PQcZQnClNw8hmvOCAaBJFViLsKoV7qhbwOGUtuC4WbETPjCQEM2WVkc0UKZKj+3jjq9/E4dvvi0r2tIrRdMjU62CZL5AlIToJHdLbGMLsIWOoRIHBgq07kVNetKrGfmSjDpY71r3NDviM143oic4OxUl3GBC/ruwbbAWbbZGWn4byv8png/p2xo0Q3Pfq5/L41fFzj1XvW03DbXOa3QL9Lju6DXBkj9iftu9Q+73NPrkEEB6zMtjabLxQn3chry6KuyBu0d01Zu7Jul6wbxTdDbPPs9kHNn5Tp28YdQH9FJ8CIpksbq5ZPCbr/fI9uwgC0hBq5V60/Km1FX8srn6fEgl0rfh3bUAo66I0WvvHbarXa5q09U7cyEbPRb9LX3PP93XARo/dj2x4rqbZT/yYdYRIY0ztMKowp6slluMzXD7+CBdPf4Eov8bJIMZBh8OwqVrMxswpxuOJjFrIy0rSNxN2yNcNTs+vMC1LTDmCgMzFJBWiAAGHIMK0l9Qk5BBo0kjQMMBT08gyvUbqdNwFoo4MC8t6Q3T6bNpM0ekn6HYzHEh/0wjDzgAdsswYbVDJgWrZUvwPWf+214oJHKoCrGQ8gRhYGngLNmL8KdC4qhE3SwzipfQgZZPHGEweY1Se4qC+QbhaYgGT7mOBnbNqOCqb2ngUZZWIhmBjqc1UBiCRgkAjCtnVClOqY5tsrYiTUteM48cZ5VFRmQBrXB3zGK6UUBKAY+NmQYbw4C6y47cQHdzHlGCzSgz9eThEVeRIkwBZRokeE8GxNpXa+URUNaYihqTbVPonDK2cTyTOFPeNTxAg2IjzsyfNtGseEO8HTrzdBTauTXKN6S0ImDSaa0z9f+8y4q4tlKhPI2dnvLZvePl3a4fWG9zn202RYnI00dzXNarYdXxt57IBKrYGt+szdkU2ylZTp5x7ln9v9smmjuZegoDmLN1F3fAunMjBBxv+nXomPqiogf2iBIGareZOOO8DmevJtKbJWlbZNf7uxXY3DT9LwaZhM59Sle3QKwUfnw2inpw2t0WS4rgtErrnon+zvhm8dBqfl5vYmRHiAgv/7Ya5bRGKK1fjXiP9967rFzZs5qQSMqVDTBGf0YTMKRFx3hJhs8SoA6wWlzh79BNcPfkIqwXHIC8Qs1fmcoxiNheAocfOEdA306nop7Gv5sXFlVCk65gqAAmiTgdIY/kumvk4GUjPhwuyEnmuZW5iBGkPUXeElA2bg2N0RyfoHxyJKvfBYQ/dTioKAT2qCFCOJiQQGs001pZMU60BDwKCYUAy5beShlYJUiWsjYWuTbAxU7k5nnuBw6TCoL5GOn6E/vgRDuuXGFWXWFWFFOfZQMl1JhON01YZ3Uhdpq6Rzw3YLBfso6HY5q2CQFGvUDQEDVOwV7BhWnAVp1LPIAVaHBzVAGsiATZGNgSbySpDkfYxabqYRT1UvXuYRR1UYUeaW8mQI9h0s1Co41yLJEsMIy/rYtDpI7OzlCS1SEUGCpYyWmMxz44V9wkCEue/Btj496x7u0oad09k46ac/HvD3GvJWgjUvw8FnPeAoRpWzXa4YMP3+tRvvSc1DS8zWrwfdy/rZ7hpfPczXtdZbzt3+ZzXmP62D2wMC9OAIvctH/m7zzQO9lGf3ciiDTDaLpC7WGqsttWEvij1mZInbWDjRmt6YRVENgyTXaT1xXeAS49ZPQsFGz1neZ6RDelVFGQUKrOKKNrfG6bXbms2piDXGCqqZZm1RTY6M8Tdh0YsRLV3zSuSnrBzVPzPcdfAXX83TcgmRe02cv9+DXC2D6rt2hNseitSqGoBG6Zvaoo4rme9VGKgOlGNbrjE5OIZfvg3/wl/91/+E8YXz3Gn10GP81JyaqeZEHyeL3EznWFB1WKeLK08RTNZQLcjAESdWSxfirJh8ZuRjYlQzbVlzEEjSw00IO4O0R0do394F30KawrYHKPTSXF42EE3TUQhgGoMTJuJMoQdXkZwIbnARDWs95gmWF4+Xno2iWqkaCKbWNJoIgmzqlEVUxylDUbNGMn4MXqTRzgozzGsLtCUc8zrCEsCBWWPhABgVcKthzyfLiSKkR4anfnDqEb+NsAylNFvRrpFojoz94drRPArZfyySTMyymGakvUW+ojLIMNVE+OmjPH8ZibjF+KDuyL1UzQhYvYS9UgLD5FlTD2aCK/T62I4OMCg38fR4FAYa6xlMd1IVh1Bh89xQquslakY3c6dss7R6xhzXs9tKSBXQWDbWGmeqDg+lrihj5LE5l7hWsgtzEf2YLEvidp0ofxOx4OP+vvmo3HmXDuhgpZqK/R13SM+2NAhcB1ifZ/79z6AqRP/OpFNW2So9pKPSn127Yx7r7s2xQduBVgfbDTakX4u1lftT/Dv/uLH0mfjs67UIG/LZW5DyldgWr+opXFz29+6zzNvrXLZGn6KkbXI2TYPp81D3/Zduhi+odXf3dddkDJ3kS0425oNe7U34YDdt0xfvPq8+bvNOUJtx6g5W8mHWtYPb5LYGlZSqzcASWe82yd3gzlZRrdNs64X6YLTtrWjOGNIoT7eyALSRpRS5pPYIVHs0UhJD44DLIsFXjx5hB/94O/wN3/9V9LwecB5OM1SGmLFi2SfSsiUlEkLdftDYZOFSWJmzdi5RtLMt0oQdqnWYOjS4jAIi40pSBrbCEGcoTc6wtHxfYyO76J/cIiDwxOMDo8x7Ge4M+zY4W5mTf3aw3pfyAn6zEejzeX/qG4YnY8kqJHVc/SqK/SKFxhOnyOdPRHB0qDMsQyjtdwMVa/FO2TEUpRm1ISd/yNaZ1QVEIKA/a+KUFQ9lCsj7MqmUt7gMteHvf1MrVFeJkxRkjwRpAIiEhEtAQ7EfrlMUCQcnhaiZLMspW8od6MwQWeOESWbWnsDESqlIvbw4EhGjx+NRugxMhwOpQ+Jja9yvwp13SyZ1PRE983aGTY1W6euTUHENYYKNq5Bdv8t94dMZbATMwVczZA1EcF1hq+11T55bGZcPa8Wh7uQTWiGoDFdsW0omjwvjLjtYOiDaZszxzSgf76+sX8dO7ntb/zU4W360Dhmcp86TbESbTqEMe5Btb8u8OsxG7q+UY1Wu+ySwnQUvPy9Tup0D0qN6uuc5D4w0s/4ZQDA/V5XdZTPu5GWGMQWSvG+0NL/fP9iu7/71Ef/s5W6uG2t9h3Lvtf1wrkexkbk6IGN/3n70pR0hN2b1z2PffuAYMOaDx/dv3WPldfPdRY4efTx48f4+OOP8fLppzj96Q9Q52MxrFRd4OdwhHbCSIYjsZmyksFiocis0JDKppfG2RSLmgCXSrGao6eTtIe000OSdkFF295wJOKaBBrOcOlwNIOkzDinJsVBwh6cV8VY9527rpPAjyfXst7zqwZxU4nCc7cZo5efozd7gmz2HGl+gbha4OzqUubiEBw454dKAEt6g6zjRCFms4XMRNI+m3Xkw3pOTcLDENWK+niNBIHGSTAGg0AzW1aoo0ykfPJVgsWKigoBFlWA2SrB9aqPMuG005VIz1RNJcAvDoOM4Y0QM+LrUM5nINpxFCntDQ6ksfVoOECna5te2QjL6IYjNGLT2yS0aXm0jpXX6d821t29/1wHiM/79sZNc/mRvaa4dtkxvV/86EKPYZd9E8eKyhW+AKnj8LXZPfc5go3/N79OsNH1a8t6yH3kHbwfRWpKzG1hURDl+3mdVdpGwUbrN/7aBf/7v/87IQj4/+mF3WcM/c3wOkZ332e6n+EbQn2vpoIYru8CtH3H54JXG+j4+Up/w79GynMnZu/LCbsMFTeM1XVwIxv3GuqX7vt89vj418Nd811gRZBpavahb0oO6Rrxc9RZcAGH83pubm6QT67w6B9/gHx8g6urK1HIns1mZq4Nc/EsIkvTnm16k91sCo+SRqPycjIQkU1SlwkkUkvoD9HpDsBZHaOjY3R7Q/TFQA6FhRbawVKMZLqi1GyK2Luu//Z9vaEEZpNGho8oR16a+TV9NnQW5+hMnooqdlZcIq1zzCdTySow3SWNmfkSsyJHsWxE1ZrpRVKdKfnPdJrUdmQ8NJUCQtTsKwJTf1wj1YAzo9dXYYrr+UJGYM8VaJpYohtOMs2DDmarjjS/yjVjAomfIevMLFwCKilQmTzr9ZF2CSxDdHsjdPpmuNzh0LD2hBJupXBYrxFSRRjJHB8+SrZZxOlMTxlXh3tzW01Gr4ebBnKvj/7bBYu1A+BF9ztvQI/2699Du+yHRN+cUuHN6NlnA937jddyl/16XWd+23fqvaz20v87go1PkJIsik3j6lwcf51VL417xi9BuGDjOutrsHFzhDwgPbh9nvE+Y75rIfdtAt1QPGCt/eiYUn4vN6KCzTYA23d8bXnIbUbHD+Xl+FsKfO557QPWL/o604htzoI+t3ezOjx/PW63xrUPbBjZmFmVm8q7LihraO4K+vHarXj9QGXjhYDMZDoFI59rgs/4BnOKbM5mUo+gB6g9CUwVkb7MFOXo4ESimighNZlGr4uM9YNO18jAUFwzNb8TaEQtQA6W84CAhGOrt4i5vt7+tDp2Gt1Irl82hqmFVaXUq/rNQgbKJeMniCfPEefnSMopmtkU11eXmEymSLMueoOR1Hwurm5weXMjtT2Ox6Zcz5LUcDvGV9Jtq1BqNiRLsHZnakpsIjbD4JoowdnVFMWKU0s5wjqW6IbptCpMpGbDBk6hi8vRcjSCkZ0JY84OimX0QkKR2O4QSaePDtl6nGLa6SFKE4kQOTmV9yGJAjIxVmo2JAnEooLNQXOxVXGQMd70iC2pYx/Y7MsstIHN61w3F5jasjp6/+xq6iTYFDKrfFPI1nVc2s6vDWz22YFf5px8++OXSPTeFNAPLFvRBhw+OEla1lPUlutnB0qSzOLe6/55bJz/v/kPhvrsesCusdlXwN9rzOyZuwfh/nvf+/m3yt3mMfLk1SOSQpRQgV790c/dBzY+GPoerhtZKABvhNysHO/42RtZvOYuaos++FZGNv+9wUbTaO6p6Pq3ea88XllDM2jdGB/SJO3UQqbTmFaj1peADRsWHbCRYWeJYTuF0qxoInN+Fwea8XN4E61/F6VoM1HTGAZDyWQDP2tKBBt3H/rGZ9cl4mcYx9Yl4BqhSv6QGp6Ak0wXMkwumTxHc/0UzfgpwvkVLn/+MS5Pn0mkl3X7OL5zV0YdUKKHtZvryRRF2cgsIMrTEIgMF85Mei1CE/25BkHqNaLIHePTJy9QBASWVOaDirJCZNQWmqiDRUUiBdfHgpUMJOPcoFjSmJzpwzRamjGy6SFjmpL08W5PAF6kgNJEVLANQSARogWlfPjvXkqGWoQk0kjHkAVIl+Y1sHHUhsF2jbcPCtsyHduM9T4jrlGzawfc+2lfUydHl38RsJE08Q77te/495kPWWNvOJref5Iio8qGQ8VWx1C/18cF33Ek2GyzTfo967X9t//xh+s+G99z5+//vcHGRU1jPG6522IUbNPYNmPx6wSbtvXZF9nsiwz3ga1eXHdD63vc89fX9UbZtwn1dQZmbZtFz3XXZteaza7Ipu39t5s7kL4aucaWZio1KqbOhFpei+fMGgKjm3V9jIbLNhKSKixA065aJOCzPhdvdofcDE4ao+1a7D5/CQLsd1vFYVuYpqoBf2TPNgWSOkdWjZEuzlFfPcHi7DHqq6c4/cnfYXH5Ejc3c+RLwy/p9hM8ePgW7j18G6dnL5GLBhojG1OQZiTDrV+ZSQyoApM+U+kRdv4TnPImwEefPpHoh1RmyviIYGnSk/4ksvko2Cm6c0IXXwmdX5aJtTERKU0RScSSIUoYHaYy/6eT9RBmmdDTWV9jGq3b6cigP0r5cKR0FiU4OhjKoDky0+gYUs+A36VgI+w5+9PmkLogqs6emxLynUMfqPYZa9UmUzvjAg2f2xXZ8PWybj/+tvuv7Vh1T/+qzs6++5z7T2sq/H5Ni2mqjGDjps10/TTTxdd0TVxnW+0w2ZpuVsy/NhtpNIKNLnSbR7fPM/9ljbm/GV7n/eq1+sAji+AYGTUqvje074L4nknb7+4aueu0jyCwb/32HZt7sd0bT8/VLbD6a9v2u/99sUe9dF/3PRP/vQo2LtD5e8ntM3j1uoRSbBbxSFJ+WYsQRplhltHwiVySBUTNjRv2kLnwHOgl+8BL4yn4CBvJ5vB1LpALTqKv5TAlf7nzvwUbGY0sLCZTrxEJHW3sq5cCNj2Oha7GqK6e4vLJJyhe/BzV05+huHyB6+trjKcVJmOA9uuNN7t468tfRd0QkFeYsam1NpRqqiGwTZIgQ+b3si7tqAkj/08Av5ktcLMo8Oz8GnXEqaU9rNiTlPWk7whpR0ZpE7zMSAQDNgQPQ6M2TcWSDiSiSvSTIgzYP2FHZqQZ0O1IpCNCpb0+ht2eTJUVsElSnByMBGw0svllwWbDsfLqK/5+9B2tffvXbKBbVqjvYPH9+8CmJvXf+9kWGe8CmzYbzM/5ovZDANH2bGlmSElHUg9jElzHm7QQMPiaAosbAa3XOrjtqdHXXZu1Oanzz81YaHehNYLY5xXwRPaFmXod2rwWvrYPbDS60nSM5PqdDlU3jda2aPsiB//4/A3hGnjXWOq/t4XB+0BEX9+3mfaBjZ9G9M933+cnNnXlFvnkHlQDZJt2t54P2TRM6jhTQN3roAVe1XjacAiCCIviVhWb6S+JBCWlY0fT6qRE1hFs2sX1xBjhuGAnzgfZWApGLERbdha9abmezqwOkgj8Aq+7V3ftT1FQsJGNKCLbVJqZ2xmjFgl8Kn8XiJsSg5jjs3OU189x9ugjzD7/R+D0Z8jPH+PmemzVnYG8BLq9AIdHJ7j7xpsyolkUFAg21D6T84hQScqrQU4KNbXkCAxBJIKlL6/GOL+ZoeSoZ6oopH0DNCRUZFRToHhpLOAiYMMG0FUjtGcZxy3nYtZKO2XMtDTTx0OwQppheOeO1MVIfaYKw0HfgI6CzUG/twE2MvFTUpjmeu6LbPbVbHS/u/ft614/2Tees+UDxV775DSFttkf9/77ZcBm7SDtaSrdZ2dMs7ChJvPeYqpTVVGkllObzIbe7y5g8NwVCzRD45ZYBMzZkmwJNzwWrQ+pDdmIbNyajYtcGhpt/HFLr8zrGnPf+/U3hGvs9Ls13+gCgn/BOFPG937cv5ENrdIYdlH5u4aWZNTs+pG8pk3duUZOL4JPXXQ9lNfxTHQzbrtZXDD3z1OOm8aiZSaPHof/+a+Aq61X+OGvbj56RQokbZEVe2j8c3ZvujaHZfPaGzYPDfcrFFJ7sLIvbRF/DfjOREwadBXO10iX5l56PGxJTZq3SBGmAAAgAElEQVRfLSi60ikmUthed+N3u+ur5ypOQLNaM64UbPi9Ajts7mQUkHaEtrwqC/TjBsO4xmp+hevnn2Hx4mMsPv1bLAg2lzdmjg1legrpYZVR1d/93vdFE+7yZipD0hrm2BmRUAuNUi2WpkxtNM75mS1y3ExziWxmZY2kN7IkAiphZ1hR3odUZ5Il4hgl9c64SGzIXTWiPdeUlHWuDbAkHL1g5+AIHTtBj+ky0abrIsx6MuGUYDMaDjGgYnavj0Gvgy7nAHXMNFOy0dw02lrWiazCHT/77IvuTzeV4zux7v51957YgT0KBNvARo9rm5Cne0quM+8+L8fl1Hxb729P+n/Dsdqi/eg6fvucTfanre8pTxBYv2vX9bG96a+MSGlz0gOCjY9q/1911/4b2ZWUT9ttu+3JTJLZWa0QP+TvRcDfg3gIIZCQUBahsMsuArRKFiUDWTIzmfGMH93uRl+d893+bnWdW9d2dheuZLX79n2cR536qurUg0zST+BjNAcPNvzOZ/aYnU52pCZHqVr8hERgw00zDTqKBpVjQZWczgpkQNRsIkaM591nzybqny62iBhpRvOLiNdGxZv0OagsSQbqF4Ke94ue77NN9qAWhpc4ewRr17UgOgbTWZnhFsGNiG1EdCMzQ5W2m5eXRQyiamer7NleAKZv2WPawqHmwbQ8BBrLSQfX1QRsdMH5BYS2Q0I3UEMBsVowWcAGGsNp9aTc3ZWzxbasFutyfPuubD68KUeXL8vLn/9N+c2vflFev35lAZEIfH375pWZpT777LPy45/8QXn77n15/eZduURQ5w6pcBY1NxrA5PjEPuFQ8fbDVXn/4dbKZV/dLcp6uzCwQfZrlGG4O0J9nzNL/InsAnfYHztBhVPUiECmOtyDYFCW30ZcU5WEkQsNezEAGtNcnjwx89n2bGWgA5C5WJ1X54AV9nSqh9o5AnFt1qq7M4sH3os+JrgdNWfyMK5TpfEIbIwnWG61vetx9JpMs2GJggwwlXfyWgWbaJ0rCHgBjn2KeHJPcI3aGIGNrvtIWNTnPBhsKBGoNKcptHWDSBn41EDrwEb/Z5OZ3T+VyNIDAAHCJOXmSw5mnBGKgrEHG1+PQsdwDthQc9RJ1f8VrKbAxhMm54qaG/usUpYxy6Gy5DgyjdepZqgMQhewtssTP++Pxhh7PvAGs1QzAi5ID2LsqYGQhRg6sKnZCqoGwVqmNr8D6LQ9HWRktvjE2r+ao6v+Bk0KLHBKs9H2ewZp89S0qmPzatsMIAdvsrujo3ILMwVKHOC9iEnafCjL3XU5X2zKk6OrcvXyl+Xlr/6lfPvymxqTgjj2zW25WJ2VF88/sTIDCOz8HvV7bm4LlA6YvpBR4Ob2rtytiwWDXl5+KN+/f19u17tqZjuFyeysbAEycJIAyBzDzbm6OqPf6yOUiDgua3OpOzYPOoA3gkyPkAng9NSyYFsZ7IumsVitnyfl6cWTcgJz3CkcCFBptJabtjxylhutep8ht5z1vXldWZoY7hE0U+cc/tG7JjIz61qY+n3kENF5QY8/cY0elWn+4QUxfQ3BZkqgVPCM1p8CQ0ifyeDSPybiLcSBqUfcC2yQQcAzYbyEDDZC15FkbLm1+kcPGXme8TN4QiQ59tRAXgvVvCs1NAZDxst+EhBoIsuIvae12PmmGUTXcBwzMNO++2t95K4nTJqNeu8nmHqQ4XOg2XBc9BkcM9yv5kNj2OIVyMXoidUTvi4K9nGBUsMzcvb25tfSBSHZjDkQ1JINrJBpC9nApXqJKdjw/Wa2s3xm/RnS1BvaJ1sfcAQw3NoWgA20GzgsWF9N66qJOZEoFPdu1tfl6BZgsy4XJ7vy0fGmnNy9LXfv35T/+vqr8s2vvwRElZ+8+NjKVl++eV3eX76zkgNwAf9wdW1xHSi/8AG1bm635fWrd+UWrtFIZwMT2NHSNI2zc5QIuChXKKYGzzgzm7VM2Q2o14ujco0idmYmQ2475FRblZPzCwvaBJg8f/6irFYXBi4fna+sQikyL1haGrhEry4svZBZQSQ4nIG+nN+a3KXqpUqLvdCFbE0qX1JJ3q8laj4UjpQO54CNrjfPy+yZu2kzYAY26s0aMXztp47JAHayTeB/J1BNjaU4Yx5sR8yZg3uDjUruqrH4PZM5L/fXECx00vQaSh49sPHM1j+f3kb++UpcaqKjaZCSfqYm6oQR6ZUoaHPtMftszHrFl/x9PckDe1aqZXjAzt7PDAIqXHBs8Akz4xTY+A3caB50gXvgIBhMtXNKmLhrqowWrVPPNO4NDEDhXKSt0uMDwQaZnuE6bJoZ0mHuNgY61a+raQlnF+ZVB3PFbrsuy92tgc1pTZ9Ztuvr8vT8tLx7/V359198Ub79+quy3N1YLaCbd9+X5QKZnz+Uy8vL8uHDVbm6ubbM2MiSjT2c91ebqqmIRoIyCsuzlQEM3KCpzZhHWSuDgPFGldIbgAzKA5ydlxOA1JNn5eLZM0tUioDOZ88+MWAB2Fycn1vczBlKDFgFzyMLlkUUuglWkmyzHDeno5aOhSl0lHlWc+c0hWbr09/tgSeyHJAWMEvINziVBcSDjX9+2U4L23PBpiessX9+HAZhUcrCPwRsmK4me39vlh4ENjQXkDGT+SgYKCCw85k3mmomXipPGaFL8R3dn4ENAZP90H2oiIlFYOn3k0hA9sy2wafEoNdnfVTNI5JieprD8NzmIOC1E/7uF9vB4m2Sv5f8ImJWyZ7Xe3CZCzbDdZ3N+SmXdvTNsvca0LT4FvGGq21rAZwuDmtf/wd7NjsLXJw6psxoAJtby/aNPRsASQUby+rdKnbChIW8kwAcbJKvUIIH+zvba0s5c7c4tYBIxOJ8/eV/lM//7q/LF//492Vz+bq8eHpRjnY3ZWtloZH9+dY2tNdb5OQq9rnB/gtMWSdn5eQUsTBVe7GyBRZwedECQGs6eZgjMT7mWHaEjAIL2+RfffSsfPTxJ1Z64dnzH5WPPv5xOYe57OlTM6NdnD2pGs1yaWADz766X7VP5IhxtPVu2n513NmgrzYfzUVdnIyMBqxqan8G5oBNT9DEvT2wMYFqBthEDHy0VijtTBAR+UzUTgW6nkCpwqQHL2reKtAdAOJU20TS6r1/cn205aO8NNIiDTsQZ+MdBAgqkb3dD1i256KDoQPFDniQ03dHDM0DRGZGw/spmZMhR/3tDSjuV3c+dQE0E6ADG09YmTeI35OJAHXqHOqHRMSoxOf/1++MqeuBRE9Tys6rRKZErONjsRzOjOWDM1n3xLevStG2EWJ7HV67q6WQjZfZwXRZQ1taSvnlSS6Z+sXLZwBW1gvk5tuaJlLBBulvqmaDvaBrmLF2SChaSxJYKemyKQVggxiN0+dluz0qZ+WuXF9+V/71i8/L53/7V+Xll/9WTu6uytX335WyuS1beA3BamuOY80N/HhZNqsnZQuXcdT7WcJbrFYjRVkB6FjwhgPe4nbGKyEDg6V9QklkBGo+Qe64T8rTT35Uzj/+1EDn/OmnZkZ79uyZpaFZnZ7bZj96a6lnrHBcrfy5hXtt22gfYjIsz1p1zbbxbxPLIMoKNDUT9BTYZOvH0xbpgGvcg43Sn4FN3XbrHrj+gLa4/4eZ3kzc3J46B2wiRs91OgU22Z5iBtZTiTgjvuEH6l6azVyw4YCpkwBenHlbRXsOyjgIBngugYvaR6QVebChg0AP2dWnnGCjbc6CtjKw8dU0veSRZWDwTNv3T4klIkh4CPlrdI4I9iMmL3FVyxZng9QxyItlSwfpSqzcNSLsEayIWBXbGLHfLX+WuJMrAXri1v75NoAJwt4/yiXWvM3AxOh9VhNMVmnZUr/DcQDZwI5gusIOfPvuEsqyeugIbJrJp75zWzKwIbOJzIxoPzy6cCy31SxGzcbebSpPLXVgWsV2UxZQSVAjB+nsFyflantmprjFdl3OAJx3N+XVy6/Kz3/6D+WXP/tpefvqfyyZ52Z9M0rbhHQ8ePfm9KRsESsy1LJBgtJlWbScaWg/vMxqgoFaEtu8xVYr04JevPhDy+b85NnHVj4AGg5cmZGeZglvsvNzK4h2ijLaUFqgidwhk3M1m62WJ0McB1P6M3bF6sJgT8FoqpbIIG0Oe4Jt/FgSwH+aMNkpi87SAloiAJWI4AWCCqL4BHkA8HDegK+VEuB5K6PdHFJG3o6NDqsmCMCp5cBHn5j/u2mw9PzArxUC3ZRWMQU2fn1RWLd7WkxTH0qrg8yUMOuFvEeDjT7Qo7gHGXaGi+8GEWjt8IMy1Un/m0d/DiIWBQ9lxGwz0iWo6c/vyWjb2HZ9Nxbt1GBnYImgJlUbo7b69ypDzjRDL1X77ybhJ3bv3jwMhF4RZFQXpLf49TyeywwBBHJj4S2zr3oCkV5gCkLcCcYVc2v1glBCYAEGWevgYEyNGaCsMiR2dXmm63P7XIjr6qH5YJzzz4+DydyWWj8/PDMYaMZUJugRDB4dm4s2zYzHPSVqZIwrQvBnTRG3qeEuZVfW19fl8u2b8uH9u/LNf/66vPn+VfnNf39bXr16VUsxtCJriLOxgm3NHIRPpOeBloN8ZdB0MD8nq7Nybpv+F7YPg0+rPXOyKp9+/NxS0JydrwxYrDyDJTo9NbpmehNj1tiPaoXPIHyYo0jLDGe0gNgm1JNhOYFW0G5YE4ESgGdYxVvTgmpNIcu8YDEw1Y1dHN5rTZxmfrOiaKgQa3FatdiZ/6y/94qfIUtFnb9qdt2/id/3Aa61dANd72mmjSw3BBiue087SqcMqlS+QUsK189Biq5mrsTYrTc3lX+Rztq8cG48fxmZp62cTQ0B6B0quHqcsP6hyKAEgHtnrIN0NR69lHF4NVWRE/9vYDiWI1PbfKdYHKynRvo9jYNF31JcewkU39FxlUiV6Q8SwUQ9B73ej9HwXWqhaN+mNJT7jBHf0wOdx4JNJlmlbRUi9/3noiM94ROMEn+YF4CNegtF45dpzqgWyuMQbA6X0AjoHwk2FiQKU1BkxmumFl8pUWmKwEyGgLZR02eBNMw/3J/hkQagqa7Q78vbt2/t3PX7y5raBylmjGHXuj8oDwBzGUDlCDEvp+fl9HxlGZxPz2osDLIzPzm9qC7KKOlsmbTHdePxTDU7k651TpVResFtygxGs56Z2yR4luOiYQYq0CkPyOJcMsnc50ZToGCbpugrskzoeESWidE5VPJ1+1jK4Ck84xrytNFYLeq8Gw3JWrT9tHaPAoyGL1tC1+NpsFElIOJpPwjYcHLpmuyZzkB0LbdOxGj6eLn/Rc1MEeBEcSZKEJCGaYJTzYrn+PyIEeFc5vqnkoEfA5vMR2o2GTNXRhSB5UO1mmFBiFQTjX/WPr4/Elg4T2RYJomh6FcDG2w8eweI+wAHrkX6k6l7vGv9SKo0hU7zDucUO5LuIAnfbS0dDudGmSL+Z4S7byO/K2PhvWT4Rp9NS9S5x/gBcAA8NzdXbU+yVcFsWZuxdwOzJxJolmUFE5QMABBZGV+Ub8a+zaZmYfaOM57hkXH1wMaDTK+/Iz7RaM80FSnHjmcxzQrPE/A8PWZgk1oOXLoaL8krf4p4iGfAfg2l66ftLepz/HtIF9x7psZj2svJ3kEDJm++n56BJhToGtFckjM0GwU5v4Vi6++oZuEnrXrNZrResGcTDZAHm8hmjftQM0SZypRkEC3lCMT0eb2gy2FQj6vZRvd7cD/PEawiQqkN36db8W3X7xEzsfcM3jZxUGS06LTPGTH+rsDmIczCiA2b0WI2wznSCj4PMi6gUFhLgcPsDSqxeeaSSaY12qUe0RzTW1J/GxYvTD/mPTb/GIMNtiKqq3PEIPDUKW9NLmS+XRcq6BZ/MDmSlo25NM2DY1Zd01FUDealui9iR8uwcLOp+ybQcsxkYpagVtIB83O9GVyWlRbJ/NQ6oFKuMbGJvF0cpyn6plZhnnGSdNI0tZbPi8zeWyi4NrN0MRn9MA8fr1PhR9uk9KX/e97p15EXPjyP0RT/pAPds1bNn3RAsLE5QKVMeJRaTruW/btpiXgeXNSH5zrQsfFPzGh0QNB3ax8fDTZ+MElYJBxlDgQbDmIkHc9ZypwUJXL83wMbtgVrSsGG51Xb6RGKnW+ShScC32ZPNHzP5q6muI9Ac8SYgrxyc8bFL9oDpjZnw2HiRZpzLAKcKYaCx2Zgo3NDExEXkBbCI00Zn2ySEsFqapw0KHAKbEgDHujvCzaj+23fewxWng4iBxTPANVMpZI4zoP+MV7M3Duao3Jn5jBdj3WXowargpGCEdnz4aSAQpkt5ZkBF9zObV+kCkoebHAO750yo80Bld780YSLvRkeBGDmLtTiXbxGaWW53O/pRu/JwCbL2t5LBOppLeJ7OjbKIxS0CTbaTgoVuAfChgKtCiQ1eWotKgg3ev5GTQb3ryT348icxlyESfFHDWommLH9tv7vq9ngJm/OiCRBnUy+kJXelFkrUWSSuzIBDxRzJAua0ThZZI4kyMgMpm1i+3vE4vcMDpjJdp+oMhofXUTR/xngZGBDO232nGzB98A2A5vMjIbx0szPeA+l/d5+ndJeZgaJatjrHGX3I9bmPoef/6MEbPT9PUGMwlzPeqCMiqYU5vZbnuy9iVquhBrn0uKMUHTO5rDFM20aX6f0jGqaWhNKGcmwxhv4K5NkmzOBaorZc88GYOM1eAop3pvTC6MZ2GRzq1nbI2EFJksvoCgwZw4CavLic1Q4UP7peSGup8mZIKzjBLBBxm+W5LB3WTqmvfMGrQdqdxmRfAI2qtkoyA+8LHEQGNEH69kQFXVy0Gj1xvJIbSDlrBBzwMUzZQ6ODmhmBhves6iEirb55+BclLV61MZmRvNgyb56sPGL5/e9Z5NJbtli6/W71/+D5yUOAiBWBRfczzmhW7kyUxVUlPH1+jHFCLh4lcl7ZnqULDYvIHiG5MFmkrlK3RCOO8cA9+F/X/Yc+zI8rzFew3o9yBrcXI1bv65uqjOGpaNhTkAzWdX4rDPEGTUPMw+G7OuUZkNmquOkc5KBDZ6NZJje3EpewHWtDF5B77F7NlrPxvMlpdUIiDx/jNYSaJ/A7sHGTJSuLLPSP5/H9eHNaGj71QZgU82QOBDsPJhbYbdpruWjfRvpaMavdR78erTftvvyBGyf8uIDbzQDjcawvSTNrMEKRsrU18g0KJt7ShRs6BTD0xTh7DilN3xqCQBlSsPEWZLGvTcLBlcHKEt0qUFNkeQZga1eV03jDzejZd5W0Z6DX3hzAKV3zQF4ujTjWfugvqvZS2kJ8wf6MfdmxKJgQ1rKfOPZXIykKX//ffoWMYQozkhp+Tgp652BDXy0dSH78VQGQ+ah10DyhKmE64Blz0G3OAdvMo4J18UwJg5ozCQE1/GWgsXe08ovW6xP0yDs/K4GhsK5wQuRur7VjKNMntd4jcSvhQxsMD+3bX8G1+q+FJ4FyR4HaeyQOU7nJksznLQMEuxbjw/26CDTbDiv5Eukgf3+Sp0HT/9sh3oH0mliYOBHi3K7Ww9gg2fAdZzCiQkZQ5HB8UqippOBjadZD/5QNtj+2WCjqKwEkjVG9zwixqCST7TwqKZR6lL0tMGDmu/syaM2tQhlZTT6uy4Qj8z2YC5OkTq5YPipz2BbhgHetSLknQ1qD96eIfbSyUSMMxpfuo1GTC5qv46z9UU2E5XJsJ+6CPl+tSlnZrzIjKS05nPDecCPzGDa18zMp7/rfft5mYYz7w3paQgeQJ4Relr2c6nfTbJfrw0I8C4Kd3Bzxh9S+ftD6RvOARZY3PYe8Vvdh6iusjCbjZkZ8rmJu2xzkFCa1/Xm58OvjUwY4vqOmJY6CPTGKBc2puPkojWvfciKH2b045mv56NZ0Lg3o/n+ejPWiIYXpbx5//3gYWju603YZjuG+k7NWjzc34TKLOjcv9/zPw19idZXqNn8XwIbHfDM9RDeYLo4IibtwWIEXgnY9CZ7IFgRa6N3R5Kfvv+xYEMVugc2OtmRlLlrQZGeibCN3rx6AMR34zirKeYQESP3bXjfATOnd1W7IOrn1DszZtGpCD080oOZfz9Stag0j/+VQUeCmxeGKOVSIsXLGWej9Zb8u4fdJsmgsI+bqqYVFJYb0XtzINg/qz9/ykhVaFIayMAmmnMOLjfnrSZom4i5QtbwDEuEWg8PjDgXCSs6X1MBjbg/oh/fJ9/m3vyHdCpm/Oh30pOa0AZ+tiim2Qzu7BBWNAu/mEc1IS1TQOF9Gdj4seV39jkKHdG5UGHNcqNNTdZIiwhG44fSbLz6ylep+hmBCr3B/CD4737RD1J/S1/SY9bZBhk2aP27xpLndNBrxjyz8UeyrCnpjWYIfc6ofahDLgvdM84oRbvSS7a/7hmrpzU1U0aEnY1Pxiyy9/drdNbW+PH33zeb5m7aGu/BONszpImR91EL4bs9Ax3Pdd2nHKdMqmB3mM2XhpN9GW2LrG8D4BmkgosyD9+/DGw0qPVgTbYm6QpJ6d3xIOSVm+JfCjYhkM3YIO8BmR8jPj8CvRBoAJBTKcfbTQQaZhZQsDlZIR/e3iWe3pkmKKAQHoVJAWO1RqAU+9RBy5Sfl4EOkz3v0fg/FmwYp9IdTGem8RNH5B4GUAK8cC0liy6zFDOWb0NEuH6xmCuok54j4PLt4zUZ2PRcJyPGOoe5+T4itccU2GQ2a8u625Eqcd5XQuT84Z0gJESfzz0iKTfTHFS6juYlc119LNho35R2eH693ozqs+AabgjjMzOj0LVYhRo8wwqRLZeDc4XO8Wi+LYXdXnupaev2YIPnVkGuBogihFPNarVQXUuW6fbrovl6CNgoXaswA5A0RiqDfF+w2e2q40MPcDyzPGCaSR7NjH583zx/6/GWfYOnxR11NyboDH1FFvEnq5ruqQXmGs9sNID/7zZ7M7+CDNMKZWDDoGgVgrj2bW0GoSM6BnBwGdbt7xtslEi4iLykHTGZgQjans0BE54AEF0wWhbVSyY2WYGZSd+lvDaSnLwan0rqrt3ZngTcRkeZdJ2zRmQzH8Z5hwy+Y2L3ixH9n9qTQJLGqSNiBEqMGXPR+5VR8T5z+5yJdr4ttVzx/OO+YIPrIzOOvhG/c3w1ah5gAxPasJHcMRNh7sf9r+DCHGbIIDAGm7aHA5fVY5QpgOv+PoJfmafSv0rxOg6ZZkNmxeeOgBFtd2CTMmc3XYvFPmgx0ig8s6RwSxqcK6z06DgDm2z+M8sQxjfiGRzH5WkN1q0VaBtyqtAgJTZGprSWBRwJ+aasAz1hk5aoXugL2/yD7tnMUQM9E/ZE4aW2kfTTiCti5CZFimA9RRAR08L9BBt9p7bHD/YB8xewi9roCeW+YDPFjE0mTcBGY1nYL92HOZsBFgfSoGSN1gjliG1nDgL+Hn0X/ve5xbxkbFLWTLyI6COrs+j77r9vnduwF4wiydjTImmKYIPfLaVMK4/R694h0ECraXtGd9UJoCYyref1YGJQBAXWRJTVo9LTMJnFQ8HG93XUiECzuS/Y0PU5AhpK4MYn4HknghXXwBywiejGj4eCjrYl02wzBwF1Cec72BcTZpA9nDxSBlfj3w5AZqgma1GZk2DjhW2C9ND/RLMZ0dxjNZvHgo1ODP5XYlcpJJIgcO4Y9dPbEREcJXsFEH0WwMYvNF7LTxJrBEiWqTgBRE5Q9On3LHwfpjSbwTmgZdmduwB08Zx0ipexT378PPPIyvr2BIBorryQge9+T0Pnivzztwk2qZkP0qSzW5PJETSm6NODkTqUmDDU0ax5XzWD7Q+ayxasntkY7FBMTtIzIbU+ygBQs+mBmtKtjj+FgWhtRiB7MA5Wnwe1dw439+eCzlywURdinZ9sz288tq3kt1gfIoBW2n6sZuPHge+jNgwHqWHdS3yyZuPeFwys3qc8zJN1OQ02bH/UDntOsmfz/x5slLgJNh602MlIstcBiMAGqRkJNGpC4gQqsWZmNDIrz1z5/TFgg37YQm0lAiCl1Szo1YZrki/KRMI1lsWz2u+UfBAEFi0onmMcATcnFYSMoUjW5YhZ9ZgO+2/E3NoXfa5vbq0flimg9Us/OQZTjNIzOTJPK0vc0tn37p92fV7U4nmo1tnGEf3CWFEihSmsN/cUrlRIIG2T/tRMpbRIpsOiZOzTXrNpezeStRmBnDZeLUMw3H4XJqztEziqoIVrPX3eF2yivuu5JerxNBf86NOXGPDf94ZQOMpAyt9/ol/IGWcxrUfQFNHX+nst67CvtJvRT09oysAmfW7iIKDCHp810j5b1md11MHvyqvqpB8C5ZzcaKQHtYao8B3FKZIWlX6Mrv/0L39mrYiYNZmqBkoS6XAOf6ipMXVo0JMyab7TIzXP+855qZft1Xo0EWFnex61qlQrlTt4x7SaGdKxat+vF3Ai67cqWXrzA7/TZqy/cwJxHzfodJFrPxSslCnxeZQMe4sSrs1aD0Svs/dPJFNUuvAap2fgPYaqYKPjxPvhp1/rkdSkgPrJ8wB/nOen2qizDczJ/pk31qE3k/Y7G/9IAvd99nOr85+5nkZmLK49vOfDdQ16nHfs+8p6Osn0D+Pj55djlAlTWbuMPyTF0ShM6XUUppB9oLaFoFk/WXemAmx/BaAkw9SR7bmy/ypsjNa3oy/9TdcDz5ORD5qL5I0L2zlT2PMVcI1ztT0zFSCU9lUYIj/mOd5jAstEULuuj8Wf/MU/H7g+a6d0A5NgYQx3JthMbVBHTNozMWUm6hExXJfU0PYL308Y4iQANjbIcIOEHbmBh2kGbbKRyr5KwfVzn9p+GmzoDcO+elBnWeme5OTHz49Z1r/UZvwAsIkWic7biMCSQJY16iW3wwO2p4VQA9jUOBelDRVqMjDN9vwysNHFGTGDiAkpw8kyNETejKrhXN9OC3sZs0/HZyYYeybF7xEYa5uy/kcgN6wlcTDIwLA3DruWLqb3e7Rn6Ok/WpNWtbAAAANkSURBVA+eVj0te5pXUBtpDh1Hp6G9Cdhk48+2d4XhFlpBTziCDe8za8pcsPnjP9/H2fgBwHd1HYzQd+OTo7lZQ0M8g/WSu0d7HQBNZ0MNSxeIepNFBJcxY4CNlTluSG+5klrKB8ua21wHe2Dj7d3R+/TcgZQrViy9TjUX3y9PGFMMJbMZZ8wmWjS+P57h/i7BBqnVPUh5+poaH91ziwA/A5uIvnU8NGhV557XZOPv93A8U2dizV4fM/rPfvdmRD/XKgxFwJvRX/b+KSatGQgisMuA1u6ZATbkR5EZ03vj+Tn2behp+ro3ovScjs8PDDZ+HGmZUs1mBGAwgc8Fmz/6s3/aRZ1TiSyaNA58lu4hIgLPDAbPkKZF8Nn4zLzBFGzmENfBNbCxt5xRVkZLwAZaByXLh4KNJxYSI/tMNVQBlpNHCWcKjLPFnP2eMbuehNZjAl6Sivqvc6DM8iGaDVx8J8Ek0ax+CLAhjR8IEruduS/7NTBH2mSfVNjj+FDKrJ6I03FOGbPK5j/L/eXH3vct62vWvgxscP9Qw+cBjgYZ2HjLBNcpP9WBw9OBB19d1+wXhRVd4zpmmeaX7ZnO5Yk9gdjveev2hmk5x3W/ssfn9P2LDGx0AD1DxPfMdXAO8eGa3gaUTkooRSbpHrLBPkbg3bYWHkLtD/QHgZIGeJLosAc23grVY7YK3sqUqBlywlR6QtujDUKdh8xMli32jNn0Fnt2nr9HZkAVNob6K53ccpGwMhKOErBJ+yfeXI/RbCKgQdu1HtOctRAxb13MXCsEnNI2/Xt0nvU/Y/bRnpb2Iwtazp6f0WdP6DVegL0ec/+th7cAGH9K9jwysMno1wtIkfbqeVhvTLT9fE62p5eBTTb/qjl7sEQbepo523cvsMnMaDaZTfKnpK2mhQxsMmbvB1gZKZktz4ULWsAmkowzYl4iloFlaBvYDM6k2LBuaPJQsDH0d/ELKsXQwUKlHi8B+UWk/UwXU2LzzYgxApWIKeuCygSE0ZyLZP4QzUajpfncERhlyc8eCTZ+bryEGtVjydbE1O9+DShYR/dl85uBgWf2fu41aJPrVNuRvT9bn3PA5rep2VCz03FXwZiaRyRMRvMRaQBKrxwPdcSapJdE2Mo0Iy8sePrSvVDlBQOdJ2Y07e//Ah9l1y8LWSafAAAAAElFTkSuQmCC\")Let’s face it: [today’s world has become increasingly loud](\"https://hearinghealthcenter.com/blog/how-loud-is-too-loud/\"), yet people do not think about their ears when attending concerts. They may say, “I’m paying to hear the music, why would I plug my ears?” Well, there is plenty of research to suggest that loud noises damage your hearing, the most alarming is the fact that the average live concert clocks in at 100 decibels at the back of the venue. If you move closer to the stage, you not only are closer to the speakers but also the fans screaming all around you. Your hearing health is integral to [your overall well-being](\"https://hearinghealthcenter.com/hearing-issues/your-hearing-and-your-health/\"). While you could get away with using disposable foam earplugs that you buy in mass quantities of neon colors, there are earplugs that have been specifically engineered for music-goers. Rather than suffocate all noise reaching your ear, these earplugs use filters with a nearly flat frequency which dials back the volume rather than muting the audio. As you can expect, these plugs cost more than your bargain plugs you get at the drug store, but they are well worth the cost of hearing music without sacrificing your long term hearing health. National Public Radio’s (NPR) Tiny Desk is an intimate concert series where artists play for an audience in a small, office-sized studio. The trick to these performances is that no musician plays louder than the singer can project their voice without amplification, ensuring a clear and balanced sound. Sound engineers are able to create this because the studio is a small space. However, when sound engineers need to balance a venue bigger than a typical office that balance goes out the window. As we know, the louder the sound is, distortion also increases. If you prefer to be close to the performance, being closer to the speakers inevitably can lead to hearing loss. Hearing loss is an extremely common condition, especially as we age. The National Institute on Deafness and Other Communication Disorders states that prolonged exposure to sounds can damage the cells in the inner ear and cause noise-induced hearing loss (NIHL) and tinnitus. Any extended contact with noise of 85 decibels (sounds of heavy city traffic) can and will damage your hearing. Makes sense right? If you or a loved one have experienced hearing loss, [schedule a completely free appointment today.](\"https://hearinghealthcenter.com/make-an-appointment/\") To read full story, click [here](\"https://www.npr.org/sections/allsongs/2019/03/12/692852104/tiny-tech-tips-why-you-need-earplugs-at-concerts\"). ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health, Hearing Protection --- ### [Every Voice is Too Precious to Miss: Going Above and Beyond A Patient Care Story](https://hearinghealthcenter.com/testimonial/every-voice-is-too-precious-to-miss-going-above-and-beyond-a-patient-care-story/) **Published:** June 8, 2019 **Author:** Ronna Fisher **Content:** # Every Voice is Too Precious to Miss: Going Above and Beyond ### A Patient Care Story ![\"\"](\"http://new.hearinghealthcenter.com/wp-content/uploads/2018/08/Robert-Risley-June-2017-e1498141271555.jpg\")At Hearing Health Center, going the extra mile is part of our mission statement. We strive to bring our patients the best care in every way we can; it’s written into our foundation. That’s why Dr. Robert Risley made a home visit recently after he had seen all of his patients for the day. Let’s say this patient’s name is Sarah. Sarah is homebound in an apartment and lives with a care giver. Since her hearing aids are no longer strong enough for her hearing needs, Sarah relies on written notes for her caregiver and subtitles on the television to stay engaged with what is happening around her. Her daughter does not live locally, making assisting her mother a near-impossible task. The circumstances surrounding our health do not define us. That’s why Dr. Risley brought his portable audiometer in hopes of being able to improve Sarah’s quality of living. We do not realize the divide hearing loss wedges between us and our loved ones. Old hobbies become a challenge, routine life feels much more fast-paced and confusing. Hearing loss is gradual; the average American waits seven years before seeking help. Do yourself and your loved ones the biggest favor and stop in for a hearing check-up. You’ll be glad you did. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Testimonial --- ### [How To Protect Your Hearing At Lollapalooza](https://hearinghealthcenter.com/ask-the-audiologist/how-to-protect-your-hearing-at-lollapalooza/) **Published:** August 1, 2019 **Author:** Ronna Fisher **Content:** Over 100,000 people will descend on Chicago’s Grant Park for Lollapalooza this year. The annual festival is already wreaking havoc on traffic, and is sure to kill millions of tiny hair cells in the ears that respond to sound. Many attendees will go home with permanent hearing damage. In previous years, the level of the music was measured anywhere from 115 to 135 decibels. “At that level,” said Dr. Ronna Fisher, AuD audiologist, “permanent damage can occur in two minutes.” “Once it’s gone…it’s gone,” says Fisher. “You will never hear the music, or anything else, clearly again.” Do not be a martyr…or stupid. #### **The music is too loud if:** 1. You experience any buzzing/ringing/noises (tinnitus) in your ears 2. Sounds, voices, hearing, is muffled when you leave 3. If you have to yell to be heard, it is too loud. #### **Tips to Protect Whatever Hearing You Have Left** 1. Try to position yourself away from the speakers (where the sound is loudest) 2. Wear earplugs. Almost any kind will protect your ears if you get them in correctly. For frequent concertgoers, get custom, high fidelity earplugs (available at any Audiology office). They will fit your ears perfectly and let you hear the music and the singer while decreasing harmful sounds. 3. Take a break. Ears that get a break have time to recover and do not suffer as much damage. 4. Drinking and smoking make you less sensitive to sound (ever get into your car in the morning and the radio is blasting from the night before?). Pay attention. If you still have ringing/buzzing,etc, and voices still sound muffled and unclear, after 48 hours, you need professional help. Now. Call your local Doctor of Audiology, Primary Physician, or ENT specialist. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Protection --- ### [Summer Activities That Can Permanently Cause Hearing Damage](https://hearinghealthcenter.com/ask-the-audiologist/summer-activities-that-can-permanently-cause-hearing-damage/) **Published:** June 14, 2021 **Author:** Ronna Fisher **Content:** # 5 Summer Activities That Can Permanently Cause Damage and Alter Your Life ### **Fireworks** From Memorial Day to Labor Day, elaborate firework displays reign supreme. Most fireworks have sound upwards of 125 dB, (think diesel engines or the level of sound which actually causes pain), easily causing permanent hearing damage. ### **Outdoor Concerts** Summer festivals, outdoor concerts and music festivals are great summer activities for the entire family. However, since outdoor venues cause the sound to disperse, bands turn the music up even louder. In addition to permanent hearing damage, oftentimes, the results of listening for too long and too loud, is tinnitus (ringing in the ears). Sometimes it goes away…and sometimes it doesn’t. Always try to sit away from the speakers. ### **Parades** Marching bands, sirens, motorcycles, and revving engines are loud…louder than you think. Loud enough to cause hearing damage in just a few minutes. ### **Yard Work** Any noise measuring in excess of 80 dB (decibels)has the potential to be harmful to hearing. Heavy traffic, window air conditioner, noisy restaurants fall into this category. Most equipment used for yard work measures in excess of 95dB. ### **Air & Water Shows** The sights and sounds and aerial stunts of air and water shows are exciting and breathtaking. But the noise of the jet engines can be ear-splitting, especially when pilots venture close to the ground. A jet engine at takeoff is 140 decibels. At that level, and depending on how close you are, damage can happen within minutes. ### **PROTECT YOUR EARS AND YOUR HEARING** Wear ear plugs. Custom-made (made from an impression of your ears for an exact fit) are best. But over-the-counter, foam plugs will do the job. Children are especially prone to hearing damage from loud noise. Their ear canals are smaller, and it takes less noise to cause irreversible damage. Protect yourself and your kids by wearing earplugs. Baby Banz makes lightweight foam-filled ear cups for youngsters. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Protection --- ### [I’ve fallen and I can’t get up - Hearing and balance with Dr. Sarah Schwartzer](https://hearinghealthcenter.com/hearing-issues/ive-fallen-and-i-cant-get-up-hearing-and-balance-with-dr-sarah-schwartzer/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Hearing Health Center’s Dr. Sarah Schwartzer, an audiologist and balance specialist, offers this informative video that explains the link between […](https://hearinghealthcenter.com/hhc-video-library-hearing-health/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Hearing Health, Hearing Issues, Symptoms --- ### [5 Ways to Protect Your Hearing Health This Summer](https://hearinghealthcenter.com/hearing-protection/5-ways-to-protect-your-hearing-health-this-summer/) **Published:** May 22, 2025 **Author:** Ronna Fisher **Content:** Don’t let ear pain or hearing loss bring you down this summer. Concerts, yard equipment, and swimming all have the potential for life-changing hearing loss if you don’t take the proper precautions ahead of time. That’s why we believe that enjoying the sounds of summer shouldn’t come at the cost of your long-term hearing well-being. That’s why we’ve put together this guide on five essential ways to protect your sense of hearing throughout the sunny months. ## 5 Ways to Protect Your Hearing Health This Summer ![](https://hearinghealthcenter.com/wp-content/uploads/2025/05/2-events.png)If you plan to enjoy your summer thoroughly, consider these tips when protecting your hearing health. ### 1. Be Smart about Loud Noises at Summer Events Summer is synonymous with outdoor concerts, festivals, and fireworks displays. While enjoyable, these events often involve prolonged exposure to high decibel levels. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), [prolonged exposure to noise above 85 decibels can cause permanent hearing loss](https://www.nidcd.nih.gov/health/noise-induced-hearing-loss). To put this into perspective, concerts can reach 100-110 decibels, with fireworks peaking at nearly 150 decibels. #### How to Protect Your Hearing: Earplugs are the best protection against hearing loss in the summer. While not trendy, they do wonders for protecting the long-term health of your hearing. Opt for high-fidelity earplugs designed for music, which reduce the volume evenly across frequencies, preserving the sound quality while lowering the intensity. You can get away with foam earplugs, but they might muffle sounds more. Also, keep a safe distance from loud noises. That means avoiding being right in front of the speakers or the fireworks’ launch area. You might even want to take listening breaks. Find a quieter area to allow your ears to recover from the loud noises. ### 2. Guard Your Ears During Water Activities While swimming and boating are quintessential summer pastimes, they can also lead to hearing damage if not taken seriously. Water introduces moisture and other irritants into your ear canals, leading to swimmers’ ear. Symptoms of swimmer’s ear include pain, hearing loss, and more. #### How to Protect Your Hearing: Did you know they make swimming earplugs? Custom-molded or over-the-counter swim earplugs can create a watertight seal, preventing water from entering the ear canal. Get a pair if you’re prone to ear infections or spend much time in the water during the summer. Your hearing health will be much happier for it. When you’re done in the water, dry your ears. After swimming, gently tilt your head to each side to allow water to drain out. You can also use a soft towel to pat your outer ear dry. Avoid inserting cotton swabs deep into the ear canal, as this can push debris further in and potentially damage the eardrum. ### 3. Protect Your Ears from Extreme Heat and Sun Extreme heat does not directly cause hearing loss; other heat-related illnesses could lead to hearing loss. For example, sun exposure causes dehydration, affecting the inner ear’s fluids. Heatstroke may also decrease blood circulation to the ears. These conditions might not directly relate to hearing loss, but protecting yourself limits the chances of something unfortunate. #### How to Protect Your Hearing: This advice is just helpful in general: stay hydrated. The last thing you want ruining your summer is a case of dehydration or heatstroke. Proper hydration supports all bodily functions, including those of the inner ear. ### 4. Be Mindful of Loud Yard Work and Power Tools Yard work can be loud, especially if you’re mowing the lawn, using leaf blowers, and operating power tools. Lawn mowers, for example, can produce noise levels between 90 and 105 decibels, while leaf blowers can reach up to 110 decibels. Even just a few minutes exposed to this high-level noise could cause hearing health damage in the short and long term. #### How to Protect Your Hearing: We suggest investing in a good pair of earmuffs or industrial-grade earplugs designed to reduce noise from power tools. You want a snug fit while providing substantial noise reduction. It also doesn’t hurt to break up your yard work into shorter sessions to reduce the overall duration of noise exposure. ### 5. Pay Attention to Ear Discomfort or Changes in Hearing This summer, don’t ignore minor ear discomfort or temporary changes in hearing. Many exciting events might come your way this summer, but ignoring persistent pain, pressure, drainage, or a sudden change in your hearing could lead to more serious issues if left untreated. Call Hearing Health Center immediately to schedule an appointment if your hearing or pain changes. #### What to Do: If you experience persistent ear pain, drainage, sudden hearing loss, or tinnitus that doesn’t subside, consult a hearing healthcare professional immediately. Early diagnosis and treatment often prevent long-term complications. Also, don’t try to self-diagnose or treat ear problems with over-the-counter remedies without consulting a professional, especially if symptoms are severe or persistent. ## Struggling with Ear Pain? Having Trouble Hearing? At Hearing Health Center, our team is ready to help you with any ear problems you might be experiencing. Our team of expert audiologists can help you with temporary hearing loss, hearing aid fittings, and so much more. Call us today or [book an appointment](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) online to get your hearing health where it needs to be this summer. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Protection --- ### [Is it the Laser or the Ophthalmologist That Saved Your Vision?](https://hearinghealthcenter.com/ask-the-audiologist/is-it-the-laser-or-the-ophthalmologist-that-saved-your-vision/) **Published:** August 15, 2025 **Author:** Ronna Fisher **Content:** **Is it the laser, or is it the Ophthalmologist that saved your vision?** **Is it the artificial heart, or is it the surgeon that saved your life?** All hearing aids are a piece of plastic. Granted, some pieces of plastic are more expensive than others depending on the electronic components and computerized technology inside the plastic. But essentially, hearing aids are plastic devices. **So, is it the piece of plastic, or is it the provider you see that’s behind successful use and adaptation to hearing aids?** Purchasing hearing aids online and at retail establishments might be tempting to save money, but they lack the critical elements for successful hearing aid use and satisfaction: - Lack of professional evaluation may not accurately reflect your true hearing ability and may miss a medical or surgical problem. - Without professional and personalized fitting, the hearing aids may not sit correctly in your ears causing pain, discomfort, and slippage. - Inadequate programming can lead to over or under amplification. - You may be on your own for troubleshooting issues or adjustments. - Lack of regular maintenance can cause more breakdowns and repairs. While online and retail purchased hearing aids might offer a lower upfront cost, the potential for poor fit, improper programming, and lack of support and ongoing care can render the hearing aids ineffective. You’ve wasted your money. ![](https://hearinghealthcenter.com/wp-content/uploads/2025/08/2-So-is-it-the-piece-of-plastic.png "- Hearing Health Center")**In a recent study by the National Institutes of Health, the number one reason for success and satisfaction with hearing aids is the hearing care provider.** Hearing aids are medical devices regulated by the FDA and are only available through licensed hearing care providers. Hearing care providers, specifically doctors of audiology, are exceptionally trained and educated to diagnose the cause of hearing and balance problems, including tumors, growths, and infections. If the problem is not medically or surgically treatable, doctors of audiology have a comprehensive understanding of the software and algorithms of the different hearing aid manufacturers. You are unique. Your brain, lifestyle, needs, and sound preferences are different from your best friend or neighbor. Audiologists assess all the above before determining which hearing aids would be best for you. The fitting, programming and adjustments of the hearing aids are personalized for your brain’s processing ability and your listening preferences to ensure optimal performance and comfort. Ongoing support and continuity of care are essential for optimal results and long-term hearing health. Hearing aids are not a one-shot deal. They are a lifetime. Just like teeth, hearing aids need regular checkups and maintenance. Just like your vital statistics, your prescription can change. Yearly hearing evaluations are crucial so adjustments can be made to accommodate any changes to your hearing and brain processing ability. **Bottom line: See an audiologist for the best outcome and satisfaction with your hearing aids.** ![](https://hearinghealthcenter.com/wp-content/uploads/2025/08/3-bottom-line.png "Stephen Miller- Former Berkley University Professor - Hearing Health Center") ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [Can I Clean My Own Ears?](https://hearinghealthcenter.com/ask-the-audiologist/ewwww-earwax-disgusting/) **Published:** September 11, 2025 **Author:** Ronna Fisher **Excerpt:** It’s pretty standard for patients to think they can clean their own ears, but unfortunately, it often leads to a pretty bad experience. **Content:** You get out of the shower or start getting ready for the day, and you see a Q-tip on your counter. Next thing you know, it’s swirling around in your ear, only to make things muffled or hard to hear. It’s pretty standard for patients to think they can clean their own ears, but unfortunately, it often leads to a pretty bad experience. Let’s take a look at some of the most common earwax cleaning myths and why you should work with an audiologist the next time you think you might have too much earwax. ## Why Do I Have Earwax? EWWW…EARWAX! DISGUSTING! Why is everyone so grossed out by earwax? Well, for one, it looks gross. It’s brown, greenish, gunky and sometimes gooey and sticky. Just seeing it can make you feel unclean and in need of hygiene. But get over it! Everyone has earwax. And, it’s a good thing you do, or you’d be in a lot of trouble. There’s a reason you have earwax. It creates a waterproof lining in your ears that keeps them dry, which prevents germs and bacteria from causing constant infections. Earwax traps dirt and dust, and little pieces of cotton (from those nasty Q-tips), and all the stuff that gets stuck in the hairspray you accidentally sprayed in your ears. Wax keeps your ears lubricated and repels fungi, insects, and water. Earwax has a purpose. It protects your ears. ## Are There Different Kinds of Earwax? Having too little earwax or over-cleaning your ears can cause dry, flaky, and itching ears and trigger infections. Some wax is dry and flaky, and some wax is gooey and sticky. What kind you have is basically genetic. In general, Asians have dry earwax while European and African populations produce “wet” earwax. ## Should I Clean My Own Ears? ![](https://hearinghealthcenter.com/wp-content/uploads/2017/02/2-should-i-clean-my-own-ears.png "2 should i clean my own ears - Hearing Health Center") GET THAT Q-TIP, BOBBY PIN, PEN KNIFE, SAMURAI SWORD OUT OF YOUR EAR! Most ears are self-cleaning. Every time you chew or talk, the movement of your jaw causes the dusty, germ-laden wax to be pushed toward the opening of your ear, where it usually flakes and falls out. Meanwhile, the glands in your ear canals are producing new, protective, fresh wax. When you stick objects in your ear, you’re really not helping. You’re pushing all the wax deeper into the canal and causing it to keep building up. Then the wax gets impacted. - You get hearing loss - You get an earache - You get tinnitus (ringing in your ear) - Your ears itch - Your ears smell bad - You puncture your eardrum ## 5 Things That Can Cause Excessive Earwax Build-Up There are five main reasons why you might have excessive earwax. Some of these are things you can control, whereas others are just part of our genetics. 1. The number one cause of excessive wax buildup is self-cleaning attempts. 2. Genetics – some people just produce too much. It runs in the family 3. Headphones\* 4. Hearing aids\* 5. Age – the ears produce less moisture, and the ear canals can narrow, causing the dry wax to get stuck. \*Your ears need to breathe and get air. Wearing headphones and using hearing aids can block the ears from performing their natural self-processing. ## Common Earwax Cleaning Myths We get patients every day who tell us about something they’ve heard online, or from a friend about cleaning their ears. Next thing you know, they tried something, and it made everything worse. Here are some of the most common earwax cleaning myths we’ve heard: ### Myth: Ear candling is a safe and effective way to remove earwax and toxins. ![](https://hearinghealthcenter.com/wp-content/uploads/2017/02/3-ear-candle.png "3 ear candle - Hearing Health Center") Ear candling, or ear coning, involves placing a lit, hollow candle into the ear canal, with the belief that it creates suction to draw out earwax and impurities. Medical experts and scientific studies have consistently debunked this practice as both ineffective and highly dangerous. It does not remove earwax; instead, it can lead to severe burns, introduce candle wax into the ear canal, cause ear infections, or even puncture the eardrum. The residue found in candles after use is typically just candle wax and soot, not earwax. ### Myth: You should clean your ears daily to maintain good hygiene. ![](https://hearinghealthcenter.com/wp-content/uploads/2017/02/4-daily-cleaning.png "4 daily cleaning - Hearing Health Center") While it’s important to keep the outer ear clean, the inner ear canal is remarkably self-cleaning. Your ears are designed with a natural “conveyor belt” system, where old earwax is gradually moved out of the ear canal through jaw movements (like chewing and talking). Attempting to clean your ears daily, especially by inserting objects, can disrupt this natural process, push wax deeper, and cause more problems than it solves. For most people, simply wiping the outer ear with a damp cloth is sufficient. ### Myth/Fact: Over-the-counter ear drops are a universal solution for all earwax problems. ![](https://hearinghealthcenter.com/wp-content/uploads/2017/02/5-ear-drops.png "5 ear drops - Hearing Health Center") Ear drops can help soften earwax, which can aid in its natural expulsion or make professional removal easier. Many over-the-counter drops contain ingredients like hydrogen peroxide or carbamide peroxide that work to break down earwax. However, they are not a universal solution. Ear drops should be used with caution and often under the guidance of a healthcare professional, especially if you suspect you have a perforated eardrum, an ear infection, or ear tubes. For significant or impacted earwax, drops alone are usually not enough, and professional removal by an audiologist or doctor remains the safest and most effective method. ## Cleaning Your Ears Isn’t a DIY Project. Call Hearing Health Center Today to Get Your Ears Cleaned Today. Cleaning your ears isn’t a do-it-yourself project. Even if you use an over-the-counter remedy, how do you know if it worked? You can’t see what you’re doing in there. If you think you have earwax buildup, do NOT try to fix it yourself. Your audiologist or doctor can remove it quickly, easily, comfortably, and professionally. [Schedule an appointment](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) with one of our audiologists at Hearing Health Center for a comprehensive hearing exam and be on your way to better hearing. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Earwax, Hearing Health Center Services --- ### [How to insert your own Lyric hearing aid](https://hearinghealthcenter.com/hearing-aids/how-to-insert-your-own-lyric-hearing-aid/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Dr. Ronna Fisher, Founder of the Hearing Health Centers in Chicago, demonstrates how to insert and remove a Lyric Hearing Aid. To learn more about […](https://hearinghealthcenter.com/hhc-video-library-you-can-do-it/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Hearing Aids, How To --- ### [Lyric hearing aid insertion](https://hearinghealthcenter.com/hearing-aids/lyric-hearing-aid-insertion/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** A visual guide on how to self insert your Lyric hearing aids. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To --- ### [How to Remove and Replace Your Domes](https://hearinghealthcenter.com/hearing-aids/how-to-remove-and-replace-your-domes-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To --- ### [How to Read an Audiogram](https://hearinghealthcenter.com/how-to/how-to-read-an-audiogram/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Audiology Assistant Megan Foy explains how to read an audiogram. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** How To --- ### [Cleaning Your Hearing Aid Microphone](https://hearinghealthcenter.com/hearing-aids/cleaning-your-hearing-aid-microphone/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To --- ### [How to pair your iPhone to your hearing aids](https://hearinghealthcenter.com/hearing-aids/how-to-pair-your-iphone-to-your-hearing-aids/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To --- ### [How to clean your hearing aids!](https://hearinghealthcenter.com/hearing-aids/how-to-clean-your-hearing-aids/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Hearing Health Center’s Audiology Assistant Michelle Cruitt explains how to take care of your investment in hearing aids. Manufacturers […](https://hearinghealthcenter.com/hhc-video-library-you-can-do-it/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To --- ### [Check out this tutorial on a Clean and Check for Oticon Hearing Aids!](https://hearinghealthcenter.com/hearing-aids/check-out-this-tutorial-on-a-clean-and-check-for-oticon-hearing-aids/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Join our Chicago office team member, Brandon, as he guides you through the essential steps for cleaning and checking your Oticon Hearing Aids. The […](https://hearinghealthcenter.com/hhc-video-library-you-can-do-it/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [5 Reasons to Get Your Hearing Checked](https://hearinghealthcenter.com/ask-the-audiologist/5-reasons-to-get-your-hearing-checked-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** The quality of our life is greatly influenced by the strength of our hearing. From our ability to communicate to simply being able to balance […](https://hearinghealthcenter.com/hhc-video-library-hearing-health/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health, Hearing Health Center Services --- ### [It’s all about blood flow!](https://hearinghealthcenter.com/hearing-health/its-all-about-blood-flow/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Your ears are the gateway to your heart. Researchers believe that early cardiovascular problems can be detected by testing your hearing […](https://hearinghealthcenter.com/hhc-video-library-hearing-health/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health --- ### [What Untreated Hearing Loss Costs You](https://hearinghealthcenter.com/hearing-issues/what-untreated-hearing-loss-costs-you/) **Published:** December 19, 2025 **Author:** Ronna Fisher **Excerpt:** Hearing loss costs a lot more than just your hearing. Every single day, patients walk into our practice not realizing how much they’ve lost financially, physically, and emotionally due to ignored hearing healthcare. **Content:** Hearing loss costs a lot more than just your hearing. Every single day, patients walk into our practice not realizing how much they’ve lost financially, physically, and emotionally due to ignored hearing healthcare. To help patients better understand what untreated hearing loss costs them, we put together this guide that explains how hearing loss impacts every single aspect of your life. If you’ve ignored your hearing health, or want a check up, [schedule a free comprehensive hearing exam with Hearing Health Center today](https://hearinghealthcenter.com/book-my-hearing-test-appointment/). ## How Common is Hearing Loss? Hearing loss is remarkably common amongst adults. Approximately [15% of adults aged 18 and over in the United States report some hearing difficulty](https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing). That’s a little over 37 million people. Age is the strongest predictor of hearing loss, with the highest percentage occurring between the ages of 60 and 69. Another key factor in hearing loss is exposure to loud workplace noise. 18% of adults have hearing loss at speech frequencies in both ears if they report loud workplace noise, while only 5% have hearing loss if they don’t. Tinnitus is a concern as well. Around 10% of the adult population in the United States has experienced tinnitus, rising to 14% when worldwide totals are included. ![](https://hearinghealthcenter.com/wp-content/uploads/2025/12/2.png "2 - Hearing Health Center") One of the trickiest parts of dealing with hearing loss is that it’s often gradual. That means over time, you slowly lose your hearing until one day, poof, you recognize you can’t hear as well as you once did. Subconsciously, your brain might do more lip-reading, or strain so you don’t have as much of an idea how much you’re being affected until it’s too late. Some physicians do not routinely perform hearing exams during physicals, which means gradual hearing loss could be occurring without you even realizing it. The best and most effective way to gain a better understanding of your hearing health is to schedule an exam with a trained audiologist. At Hearing Health Center, our team performs a comprehensive hearing exam that gives you a clearer picture of your hearing health and the steps you can take to prevent hearing loss and reduce long-term costs. ## The Monetary Costs of Hearing Loss The 83% of people on Earth suffering from untreated hearing loss account for [costs of nearly $980 billion per year](https://www.valueinhealthjournal.com/article/S1098-3015%2823%2903805-6/fulltext). That total is around 6 % of GDP per capita. According to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health, “older adults with [untreated hearing loss generated an average of 46 percent more in total health care costs](https://publichealth.jhu.edu/2018/patients-with-untreated-hearing-loss-incur-higher-health-care-costs-over-time) over 10 years versus those who don’t have hearing loss.” In dollars, that’s a little over $22,000 over 10 years. Broken down further, people with hearing loss incurred nearly 26 percent more total health care costs over two years than those treated. But what is most costly is the hospital stay data. After 10 years, patients with untreated hearing loss were hospitalized 50% more often; 44% of those people were at higher risk of hospital readmission within 30 days, and had about 52 more outpatient visits than those without hearing loss. Another study calculated the extent to which untreated hearing loss affected household income. They found that people with the highest level of hearing loss earned $12,000 less per year than those with minimal to no hearing loss. Simply put, the data shows that untreated hearing loss means you’ll earn less and spend more on healthcare costs in the future. Don’t let untreated hearing loss cost you your hard-earned money; schedule your hearing exam today. ## The Health Costs of Hearing Loss The most obvious cost of hearing loss is, of course, the inability to hear. But what most patients do not realize is that their hearing health affects the entire body, including brain function, balance, and overall well-being. When someone loses their hearing, they become much more at risk of dementia. A 2020 report lists hearing loss as one of the significant contributors to dementia, as hearing loss requires your brain to work extra hard to understand and fill in missing gaps. The more your brain works on these tasks, the more energy is taken away from thinking memory systems. Another possibility is that hearing loss causes an aging brain to shrink faster, thus leading to dementia. As of today, hearing loss is attributed to around 8% of all new dementia cases, or around 800,000 every year. ![](https://hearinghealthcenter.com/wp-content/uploads/2025/12/3.png "3 - Hearing Health Center") Another danger of hearing loss is its effect on someone’s balance. The vestibular system in your ear helps detect the head’s positioning and the space around you. Hearing loss can negatively affect these neurons and sensors, thereby increasing the risk of falling. There are two additional factors to consider. The first is that auditory input is lowered with hearing loss, which then affects the brain’s ability to understand spatial information. Without being able to comprehend the area around you fully, you end up more likely to slip or fall. Another aspect to consider is that, because your brain is working harder to understand sounds, it leaves less space to understand your surroundings. Your brain is focusing too much on one thing, leaving you more likely to ignore the space around you. Your hearing health is more than just that: proactive action to protect yourself can help prevent serious, long-term issues. ## The Social and Emotional Costs of Hearing Loss Loss of hearing comes at a price for your mental health as well. Nearly 33% of adults 70 or older suffer from hearing loss that impacts their daily communication, which, as a result, leads to further isolation. This isolation then leads to depression and an overall decrease in your well-being. ![](https://hearinghealthcenter.com/wp-content/uploads/2025/12/4.png "4 - Hearing Health Center") People who are hard of hearing become embarrassed by constantly asking others to repeat themselves, or frustrated when talking with family members, when they can’t understand them. Studies have shown that once these incidents occur frequently, people isolate themselves, leading to less-happy lives and even shorter lifespans. There’s also the lesser-known effect of hearing loss: missing nuance in meetings and how that impacts work promotions. Between isolation and the negative emotional impacts, it’s an easy solution to start focusing on your hearing health as soon as possible. ## How Can Early Treatment of Hearing Loss Help You? [Early interventions for hearing loss](https://hearinghealthcenter.com/ask-the-audiologist/how-to-keep-a-little-hearing-loss-from-becoming-a-big-deal/ "Early interventions for hearing loss") limit many of the short- and long-term negative health and financial effects that cost people thousands of dollars each year. Financially, you are not only more likely to make money with early hearing loss interventions, but you’re also less likely to spend money on hospital visits due to injuries sustained as a result. There’s also the financial savings that come with being less likely to fall and injure yourself, and lowering the risk of dementia or other brain-related diseases. Hearing aids are statistically more likely to lessen the likelihood of social isolation, thus reducing the chances of dementia. While treatment has not been proven to to prevent dementia, early research is promising. Early interventions and treatment give people back the life they deserve, so don’t wait any longer and get your hearing checked today. ## Need a Hearing Test? Contact Hearing Health Center Today! Struggling with your hearing lately? Want to get checked early before something goes wrong? Call Hearing Health Center today and schedule a free comprehensive hearing exam to get you started on your hearing health journey. Don’t let hearing loss cost you your life, [schedule your appointment today](https://hearinghealthcenter.com/book-my-hearing-test-appointment/). ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health, Hearing Issues, Hearing Protection --- ### [How to Keep a Little Hearing Loss from Becoming a Big Deal](https://hearinghealthcenter.com/ask-the-audiologist/how-to-keep-a-little-hearing-loss-from-becoming-a-big-deal/) **Published:** January 20, 2026 **Author:** Ronna Fisher **Excerpt:** Hearing loss refers to a reduced or diminished ability to pick up on sounds or even understand them. Its severity can range from minor to extreme, depending on the underlying reasons. **Content:** Hearing ability is a precious gift that enriches us and helps us connect to the world. Unfortunately, due to hectic lifestyles and impractical choices, hearing loss has become increasingly common, affecting all ages. But the good news is that many of these cases of hearing loss are preventable. By practicing healthy choices and taking proactive steps, you can safeguard your hearing health for ages to come. ## What Is Hearing Loss? Hearing loss refers to a reduced or diminished ability to pick up on sounds or even understand them. Its severity can range from minor to extreme, depending on the underlying reasons. This includes ear infections, prolonged exposure to loud sounds, hereditary predisposition, head injury, side effects of a medicine, and aging. The key to preventing or slowing hearing loss is to understand what is “loud” and to limit exposure. Understand that the louder the volume, the less time you can listen to it before it harms your hearing. ## Why Is Hearing Loss Affecting People at Younger Ages? There are myriad reasons why hearing loss appears to affect people now at earlier ages. ![](https://hearinghealthcenter.com/wp-content/uploads/2026/01/2-Why-is-hearing-loss-affecting-people-at-younger-ages-1-1024x896.png "2 Why is hearing loss affecting people at younger ages - Hearing Health Center") Loud environments and prolonged exposure to extreme volumes, such as recreational activities, concerts, and the constant use of personal audio devices at high volumes, are contributing significantly to hearing damage among young people. With headphones becoming an everyday staple, constant exposure to loud music is slowly affecting people’s hearing. Add in how some occupations (construction sites, manufacturing facilities, aviation, transportation, and entertainment) regularly expose people to high levels of noise, and young people are more likely than ever to experience hearing loss. Some medical conditions, such as genetic disorders, infections, and autoimmune diseases, can also lead to hearing loss, especially in younger individuals. Genetic predisposition can make individuals more prone to hearing issues. Thanks to cutting-edge diagnostic tools, more and more people are now aware of the importance of hearing health. This includes improved identification and early detection of hearing loss. You can schedule a [free comprehensive hearing exam](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) at Hearing Health Center today. ## What Are The Early Signs of Hearing Loss? It is essential to note the early signs, although they vary by individual or specific type of hearing loss. If you notice any of these signs or have concerns, connect with the Hearing Health Center team to avoid more serious, long-term damage. ### Difficulty Deciphering Conversations ![](https://hearinghealthcenter.com/wp-content/uploads/2026/01/3-What-are-the-early-signs-of-hearing-loss-1-1024x502.png "3 What are the early signs of hearing loss - Hearing Health Center") One of the early signs of hearing loss is trouble following conversations, especially in noisy environments. You may find it challenging to understand what others are saying, leading to repeated questions or requests for clarification. ### Increasing Volume Turning the volume up or asking others to repeat themselves if you find it too loud or extremely loud indicates the onset of hearing loss. Gradually increasing the volume is a major early sign that most people do not recognize. ### Withdrawal from Social Events Individuals with hearing loss often withdraw from social gatherings or group conversations. This is the result of difficulties understanding conversations, which then leads to feeling frustrated, embarrassed, and even isolated. Eventually, individuals will avoid situations that demand extensive communication. ### [Tinnitus](https://hearinghealthcenter.com/hearing-services-chicago/#tinnitus-consultation) The perception of ringing, buzzing, or other ghost sounds in the ears is associated with hearing loss. If you often experience tinnitus, especially with other symptoms such as difficulty hearing, it is advised to have your hearing checked. ## 6 Ways To Protect Yourself From Hearing Loss ### 1. Protect Your Ears Against Noise Wear earplugs or muffs to reduce the impact of excessive sound at concerts or sporting events. When at home, keep the volume at a normal level, especially when listening to music or watching TV, and use headphones. ### 2. Take Breaks from Noise Taking regular breaks from noise is advised, especially in loud environments or when wearing headphones. If you work at a loud site or in a noisy setting, take proper breaks in quieter areas to allow your ears to recover. ![](https://hearinghealthcenter.com/wp-content/uploads/2026/01/4-Ways-to-protect-yourself-from-hearing-loss-1.png "4 Ways to protect yourself from hearing loss - Hearing Health Center") ### 3. Be Cautious with Headphones While earbuds and headphones entertain with convenience, don’t forget that they can be harmful, especially when misused. Limit your use of headphones or earbuds, and when you do use them, keep the volume at a reasonable level. Consider using noise-canceling headphones, which block external noise, so you can enjoy music without turning up the volume. ### 4. Follow a Healthy Lifestyle Lifestyle factors influence your hearing health. Avoid smoking; it can contribute to hearing loss. Manage chronic conditions like hypertension and diabetes – they affect your auditory system. Stay physically active and practice a balanced diet to promote overall well-being, including your ears’ health. ### 5. Be Cautious with Medicines Certain medications, also known as ototoxic drugs, [damage your hearing](https://hearinghealthcenter.com/hearing-health/summer-activities-that-can-permanently-cause-hearing-damage/). This means if you are prescribed medication, consult your healthcare professionals about potential side effects on your hearing. Be vigilant and report any effects or changes in your hearing during or post medication. ### 6. Schedule Regular Hearing Tests Like any other routine medical check-up, regular hearing evaluations play a key role in detecting potential hearing loss early. [Schedule an appointment with a trusted audiologist](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) or hearing healthcare expert to monitor your hearing health and address your concerns. ## Ready To Protect Your Hearing? Schedule Your Free Hearing Exam Today. Hearing loss can happen at any age and for many reasons, but fear not. You can avoid noise-related hearing loss by getting annual hearing health testing, avoiding ear-damaging loud sounds, wearing ear protection muffs around loud noises, and practicing safe headphone usage. [Schedule your free hearing health exam ](https://hearinghealthcenter.com/book-my-hearing-test-appointment/)at Hearing Health Center today. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Communication Issues, Hearing Health, Hearing Issues, Hearing Protection --- ### [What is Looping?](https://hearinghealthcenter.com/ask-the-audiologist/what-is-looping/) **Published:** April 17, 2015 **Author:** Ronna Fisher **Content:** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/hearing-loop-logo.jpg "hearing-loop-logo - Hearing Health Center") Americans spend an average of 5 hours per day watching TV. And, if you have any hearing issues, you spend even more time listening to television since you’re not going out and socializing as much…it’s not fun when you don’t know what people are talking about and it can be embarrassing. Besides, even when you go to the movies or theater, you really don’t enjoy it. And everyone is annoyed when you keep saying, “What?” “What did she say?” So you stay home watching TV, but you can’t understand what they’re saying half the time and turning up the volume doesn’t help. Especially with Downton Abbey. Who can understand those foreign accents? Then, your spouse and kids complain the TV’s too loud and turn it down! Imagine clearly hearing and understanding every word on your favorite TV show. Imagine going to a movie, play or drive-thru Starbucks and hearing everything clearly? Imagine going to church or synagogue and actually enjoying the sermon? With hearing loops, you can! Ever since composer Richard Einhorn, wrote about his experience at Kennedy Center, looping has been taking the country by storm. “There I was at ‘Wicked’ weeping uncontrollably – and I don’t even like musicals,” he said. “For the first time since I lost most of my hearing, live music was perfectly clear, perfectly clean and incredibly rich.” Looping is basically just a copper wire placed around a room that’s hooked up to a transmitter that’s connected to the sound source (a microphone, the TV). The wire emits a magnetic signal. Most hearing devices have a tiny coil inside that also emits a magnetic symbol. When the little coil is turned on, the transmitter sends the signal (voice) directly into your hearing devices and voila! You hear everything right into your ears. It’s like magic. The best part is, besides finally knowing what’s going on, is you don’t have to wear a big bulky headset that announces to the world you can’t hear. And, it’s not isolating. You can hear everything that’s going on and still talk to the person next to you. When you see this symbol to the left, just touch the button on your hearing devices (or remote control) to activate the coil. Now, sit back and enjoy! P.S. Even if you don’t have hearing devices, can still enjoy hearing through looping. Just ask to borrow a headset. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [Batman Delivers the Gift of Hearing to a 6 Year Old Cancer Patient](https://hearinghealthcenter.com/fisher-foundation/batman-delivers-the-gift-of-hearing-to-a-6-year-old-cancer-patient/) **Published:** September 2, 2015 **Author:** Ronna Fisher **Content:**  **[Click here](http://www.dailyherald.com/article/20150914/entlife/150919423/)** to see the original article on the Daily Herald website from 9/2/15: ***Batman delivers hearing aids for 6-year-old*** A superhero shared his super hearing with a 6-year-old in need of hearing aids at a Naperville hearing health center. Riley Buckholz, 6, of Burlington, got new hearing aids recently from Batman, his favorite among all superheroes. Riley’s partial hearing loss was caused by pineal blastoma, a childhood brain tumor about the size of a sunflower seed, said his mother, Adena Buckholz. The tumors and the radiation and chemotherapy used to treat them are caused Riley to lose the ability to hear several sounds, said Kara Houston, his doctor at Hearing Health Center in Naperville. “The hearing loss that Riley has is in the high frequency ranges, like the sounds of F, H, TH and CH. Those high-frequency sounds give us clarity of speech,” said Houston, who programmed and installed Riley’s new hearing aids. “If he’s not hearing those sounds, everything is going to sound muddled and not very clear.” Riley is receiving free treatment at the Hearing Health Center through support of the Fisher Foundation for Hearing Health Care. Phonak, LLC, donated his special hearing aids, which were decorated with the Batman logo to continue the super hearing theme. The aids will help Riley hear teachers and peers more clearly so he can perform better in first grade. “He needs to be able to hear those sounds in order to distinguish between words like show, how and feel, with all those consonant sounds which are very similar,” Houston said. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [Hearing Health Center in the News: Combating Hearing Loss](https://hearinghealthcenter.com/media-press/west-suburban-living-article-combating-hearing-loss/) **Published:** March 2, 2016 **Author:** Ronna Fisher **Content:** Dr. Fisher was featured in this February 2016 article from the West Suburban Living publication titled “Combating Hearing Loss”: [ http://www.westsuburbanliving.net/February-2016/Combatting-Hearing-Loss/](http://www.westsuburbanliving.net/February-2016/Combatting-Hearing-Loss/) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Roger Daltrey Gets New Hearing Aids at HHC](https://hearinghealthcenter.com/hearing-aids/roger-daltrey-gets-new-hearing-aids-hearing-health-center/) **Published:** April 1, 2016 **Author:** Ronna Fisher **Content:** “I got my new hearing aids when I was in town for our concert. All I can say is WOW! I didn’t know I could hear like this. It makes me so sad that Brian Johnson (lead singer of AC/DC) has to quit doing what he loves because of his hearing. It’s time I speak out.” ![IMG_1566](http://www.theloopdemo.com/hearinghealthcenter/wp-content/uploads/2016/04/IMG_1566-768x1024.jpg "- Hearing Health Center") ![IMG_1567](http://www.theloopdemo.com/hearinghealthcenter/wp-content/uploads/2016/04/IMG_15671-768x1024.jpg "- Hearing Health Center") ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, HHC News, Roger Daltrey --- ### [Roger Daltrey and Hearing Health Center](https://hearinghealthcenter.com/news-press/roger-daltrey-hearing-health-center/) **Published:** May 1, 2016 **Author:** Ronna Fisher **Content:** When Roger Daltrey realized he had a hearing problem, the Who’s lead singer could have gone to any audiologist in the world. He chose Dr. Ronna Fisher, audiologist and founder of Hearing Health Center in Chicago. This video illustrates both why – and how – nearly invisible hearing aids have kept him young, connected….and as cool as ever!  ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News, Roger Daltrey --- ### [Roger Daltrey and HHC](https://hearinghealthcenter.com/roger-daltrey/roger-daltrey-and-hhc/) **Published:** May 31, 2016 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Roger Daltrey --- ### [How often should I change my hearing aid batteries?](https://hearinghealthcenter.com/ask-the-audiologist/hearing-aid-battery-life/) **Published:** November 1, 2016 **Author:** Ronna Fisher **Content:** “How often should I change my hearing aid batteries?” is one of the most common questions that we get from hearing aid users. Battery manufacturers use an equation to give an estimate; however, there are several factors that determine the battery life of a hearing device. **Battery Types:** *Zinc Air* is the most common battery type. Zinc air batteries have a tab. When the tab is pulled off, oxygen mixes with zinc oxide and the battery is activated. For best results, it is recommended to wait up to 5 minutes, after pulling the tab off the battery, before inserting the battery into the hearing device. *Rechargeable* is another popular option. Though rechargeable batteries are not available with all hearing aids, more manufacturers are starting to offer them as an alternative to zinc air. Rechargeable devices are placed in a charger overnight. **Battery Life:** All hearing aids have an indicator to let you know when your battery life is low and needs to be changed. There are a number of factors that can determine the life of the battery. Here are just a few: *![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/clock.png "clock - Hearing Health Center")*Length of wearing time: The longer the device is being worn, the faster the battery will drain. *![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/phone.png "phone - Hearing Health Center")*Streaming and remote usage: The ability to stream phone calls or music is a very popular feature; however, it can drain your battery more quickly. *![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/open-zephyr.png "open-zephyr - Hearing Health Center")*Moisture: Yes, moisture can drain your battery faster as well! You may not sweat and there might not be any humidity in the air, but your hearing aid can still accumulate moisture. It is recommended that hearing devices using zinc air batteries be kept in a hearing aid de-humidifier, such as the Zephyr, overnight to prevent moisture build up and keep your hearing device working in tip top shape! If you feel as though you are going through batteries faster than you should be, give us a call! -contributed by Marnie Belfor, Audiology Technician ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Everything you wanted to know about batteries!](https://hearinghealthcenter.com/ask-the-audiologist/hearing-aid-batteries-faq/) **Published:** December 9, 2016 **Author:** Ronna Fisher **Content:** #### ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Batteries-Rayovac-150x150.png "Batteries-Rayovac - Hearing Health Center")In order for your hearing aid to work properly, you need- you guessed it!- a quality hearing aid battery. Many of our patients have asked to learn more about batteries; below are our informational tidbits and FAQs. **Throw away dead batteries. They do not spontaneously regenerate!** **Are there different types of batteries?** - There are two different types of [hearing aid batteries](https://hearinghealthcenter.com/product-category/batteries/): zinc-air (disposable) and rechargeable batteries. Most hearing aids still utilize zinc-air disposable hearing aid batteries as rechargeable batteries are just starting to gain popularity. - Helpful tip: Zinc-air batteries are activated when the factory seal sticker is removed. Wait at least one minute after you remove the sticker to place the battery in your hearing aid- this will allow the battery to fully activate. **How will I know when to change my batteries?** - Most hearing aids have a beeping signal to tell you when your battery is about to die. However, if you notice that the sounds you are hearing are distorted or if you need to raise the volume more than normal, that could also be a good indication that it’s time to change your batteries. - Always try to carry an additional battery with you if you are out and about! **How long should my batteries last?** - Every hearing aid user has a different lifestyle and experience, so there is no hard and fast rule of how long your batteries will last. A good rule of thumb is the following: - Size 10 (yellow label): 3-5 days - Size 312 (brown label): 5-7 days - Size 13 (orange label): 6-14 days - Size 675 (blue label): 9-20 days - If you feel like you are running through batteries more quickly than you should be, there are several factors that can lead to battery drain; chief among them are moisture, wearing time, and remote usage. You can read more **[here](https://hearinghealthcenter.com/hearing-aid-battery-life/)**. **Can I do anything to extend my battery life?** - When not in use at night, open your hearing aid battery door (pro-tip: also use a [**drying unit**](https://hearinghealthcenter.com/product-category/dehumidifiers/) overnight to cut down on moisture found in your hearing aids!) - Make sure to store your batteries at room temperature (heat and humidity can cut down on battery life!) #### Have a question about your hearing aid batteries that we didn’t address? Leave us a comment- we’re here to help! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [An Amazing Experience - Featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/an-amazing-experience-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents An Amazing Experience featuring Walter Jacobson **Content:** Hearing Health Center presents An Amazing Experience featuring Walter Jacobson ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [4 Common Myths About AI in Hearing Aids](https://hearinghealthcenter.com/hearing-aids/4-common-myths-about-ai-in-hearing-aids/) **Published:** March 17, 2026 **Author:** Ronna Fisher **Excerpt:** As hearing technology improves, so do the buzzwords. Recently, there's been a lot of noise about AI in hearing aids, and it’s important to understand what it means, how it affects your hearing aids, and why you may (or may not) need it. **Content:** Your hearing health matters, and the choices you make about [hearing aids](https://hearinghealthcenter.com/hearing-aids-chicago/ "hearing aids") affect not only your day-to-day living but also your long-term cognitive health. As hearing technology improves, so do the buzzwords. Recently, there’s been a lot of noise about AI in hearing aids, and it’s important to understand what it means, how it affects your hearing aids, and why you may (or may not) need it. Despite AI hearing aids being around for a few years, we wanted to help you separate fact from fiction so you and your audiologist can make the most informed decision possible. ## How Does AI Work in Hearing Aids? At this point, it’s impossible to avoid AI in nearly every aspect of our lives. From live chats with our phones to customized shopping lists at the grocery store, if there’s a way to include artificial intelligence in a product, you’re going to see it. But did you know that hearing aids have been advertising AI for years? For hearing aids, AI should be broken into two categories: machine learning and deep neural networks. About two decades ago, the first hearing aids with AI were introduced to the public. For years, your hearing aids have identified audio patterns in restaurants, conversations, and music to build an internal memory system. Then, when the wearer’s environment matches the learned memory system, your hearing aids automatically apply the right settings for the situation. In 2021, the first hearing aid with embedded deep neural networks hit the market. DNN’s are trained on massive datasets of real-world sounds to mimic the human brain, eventually separating sound from [speech to provide a clearer hearing](https://hearinghealthcenter.com/hearing-issues/the-connection-between-hearing-loss-and-speech/) experience. ![Illustration of an AI robotic hand fitting a hearing aid on a woman, representing artificial intelligence in hearing aid technology](https://hearinghealthcenter.com/wp-content/uploads/2026/03/How-does-AI-in-hearing-aids-work-1-1024x762.png "How does AI in hearing aids work 1 - Hearing Health Center") We are at the point where these hearing aids are being trained on tens of millions of sound samples and spoken sentences, creating a better-than-ever sound experience. At this point, hearing aids with AI intelligently separate what you want to hear versus what you don’t. The AI continuously analyzes your environment to adapt in real time to patients’ needs. A March 2024 study found that DNN-powered noise reduction outperformed traditional noise reduction techniques, and a 2025 follow-up field research study found that DNN improved interference control. For patients with cognitive load and mental fatigue that lead to conditions like Alzheimer’s, DNN-powered hearing aids are a welcome relief. Some AI-powered hearing aids also allow audiologists to make remote adjustments to your devices based on patient feedback or data collected on the device. If you’re travelling or live far away from your audiologist, this ensures you get the essential fine-tuning you need for the best experience with hearing aids. That being said, not all AI hearing aids are the same. Only a few products on the market offer real-time AI processing, which means it’s even more important to work with your audiologist to identify the best hearing aids for your situation. ## 4 Common Myths About AI in Hearing Aids With “AI-powered” marketing language all around us, it’s harder than ever to understand what’s real and what’s fake when it comes to your hearing aids. Here are some of the most commonly believed myths and what the evidence actually proves. ### Myth: All AI hearing aids think and adapt in real-time while you wear them. The reality is that most hearing aids use AI during the development and training phase (i.e., before you purchase them), not while you wear them. There are a few products that offer real-time AI processing, but for the majority of hearing aids on the market, all of the AI tools are developed before your purchase. But that isn’t a bad thing, as the AI algorithms are genuinely effective in providing an excellent hearing aid experience. ### Myth: AI hearing aids automatically fix my hearing without the need for an audiologist. The diagnostic experience and fine-tuning that comes from working with an experienced audiologist is the difference between a good and a bad experience with your hearing aids. Audiologists ensure everything fits correctly and that the hearing aid is programmed correctly for your specific hearing loss. ### Myth: More AI features mean better hearing. Studies and tests show that while AI features work well, they aren’t universally better in every situation. Those with quieter daily routines probably don’t need adaptive technologies, unlike folks working in more chaotic sound environments. As with any hearing aid, work with a trusted audiologist to ensure you get the right hearing aid for your sound environment. ### Myth (mostly: AI hearing aids are always listening to my private conversations. AI-powered devices use strict security measures to protect your personal information, with many newer hearing aids processing data on the chips themselves rather than sending audio to the cloud. But one study revealed that hearing aids were broadcasting patients’ names over Bluetooth without users’ ability to change them. There are also some inconsistencies in how data is governed. Our recommendation is to ask your audiologist about how your data is stored, processed, and shared. ## Do You Need AI In Your Hearing Aids? When surrounded by AI marketing, the question becomes, “Do you need AI for your hearing aids too?” The answer, unfortunately, isn’t as simple as yes or no; the truth lies in what environments you spend your time and what sort of hearing problems you have. Almost all research universally agrees that AI in hearing aids helps with noise reduction, specifically in situations where you need to understand what someone is saying over competing background sounds. A 2025 study published in Frontiers in Audiology and Otology evaluated DNN-based processing across seven real-world acoustic environments, including bars, restaurants, shopping malls, and construction sites, finding measurable improvements in both speech recognition and listener preference when AI-based noise reduction was active. ![Dr. Donna Fisher, audiologist, explaining that well-fitted hearing aids can match AI hearing aid outcomes for mild hearing loss](https://hearinghealthcenter.com/wp-content/uploads/2026/03/Do-you-need-AI-in-your-hearing-aids-1024x576.png "Do you need AI in your hearing aids - Hearing Health Center") If these hearing aids reduce cognitive load, there’s a good chance they will positively affect brain health outcomes. When a hearing aid reduces the strain of processing sound in noise, it potentially frees up cognitive resources. Modern AI-powered hearing aids provide an effortless listening experience, reducing the strain often associated with hearing in complex environments. For anyone at risk, these new AI-powered hearing aids can help reduce the risk of cognitive decline. For people [dealing with mild hearing](https://hearinghealthcenter.com/ask-the-audiologist/early-stage-hearing-loss-can-be-reversed-in-your-brain/) loss or who spend most of their time in quiet environments, the most advanced AI isn’t as important. A well-fitted and adjusted hearing aid will deliver just as good outcomes. ## Fit and Adjustments Are The Most Important Factors More than any new technology, the most important factor in your [hearing aid experience comes from the tuning, fitting, and adjustments your audiologist makes](https://hearinghealthcenter.com/hearing-services-chicago/#hearing-aid "hearing aid experience comes from the tuning, fitting, and adjustments your audiologist makes"). At Hearing Health Center, our audiologists have decades of experience working with patients of all ages, helping them get the most out of their hearing aids. When your hearing aids fit correctly and volumes are just right, you’re much more likely to continue wearing your hearing aids. That’s why we always recommend coming to any of our five locations for fittings, adjustments, and to get any questions you might have about your hearing aids answered. ## Having Trouble Hearing? Schedule Your Appointment at Hearing Health Center Today. Having trouble hearing during conversations? Feel like social gatherings are getting harder and harder? Book your appointment online with Hearing Health Center for a free comprehensive hearing exam. An audiologist on staff performs a full exam and provides you with the information you need to get your hearing back on track. [Schedule your appointment today!](https://hearinghealthcenter.com/book-my-hearing-test-appointment/ "Schedule your appointment today!") ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Changing Wax Filters - Custom Hearing Aids](https://hearinghealthcenter.com/hearing-aids/changing-wax-filters-custom-hearing-aids/) **Published:** April 29, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [Signia Active Hearing Aid Earbuds at Hearing Health Center](https://hearinghealthcenter.com/services/signia-active-hearing-aid-earbuds-at-hearing-health-center/) **Published:** April 6, 2021 **Author:** Ronna Fisher **Excerpt:** Finally, a hearing aid smartly designed to look and function like an earbud. Unlike traditional earbuds, Signia Active's proven hearing technology is laser focused and tailored to the wearer's unique needs, making hearing in any situation precise and personalized. Whether filtering out specific, distracting background noise or focusing in on a conversation, Signia Active optimizes one's human performance through enhanced hearing in any situation. Visit the audiologists at Hearing Health Center to customize your Signia Active hearing experience. **Content:** Finally, a hearing aid smartly designed to look and function like an earbud. Unlike traditional earbuds, Signia Active’s proven hearing technology is laser focused and tailored to the wearer’s unique needs, making hearing in any situation precise and personalized. Whether filtering out specific, distracting background noise or focusing in on a conversation, Signia Active optimizes one’s human performance through enhanced hearing in any situation. Visit the audiologists at Hearing Health Center to customize your Signia Active hearing experience. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, Hearing Health Center Services --- ### [Earwax Removal](https://hearinghealthcenter.com/services/ear-wax-removal/) **Published:** August 28, 2022 **Author:** Ronna Fisher **Content:** All ears have wax. A little wax is good. It keeps your ears moist, repels bugs, and prevents infections from bacteria and germs. Some ears produce too much wax. It builds up and blocks your hearing ability. Removing earwax is not a do-it-yourself project. Q-tips usually just push the wax deeper inside your ear making it even harder to remove. Never, ever try ear candling. Burns are all too common and the wax you see is from the candle, not your ears. In addition, even over-the-counter earwax removal kits are a problem. How do you know if it worked? You can’t see what you’re doing down there. There are different kinds of earwax. Some wax is soft and gooey, some hard and impacted, some flaky and loose. Moreover, there are different methods to remove earwax: suction, curettes, flushing, and more. The audiologists at Hearing Health Center are expertly trained in every method, utilize the best one for the type and amount of earwax, and the one most gentle for your comfort. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Earwax, Hearing Health Center Services --- ### [Diagnostic Hearing Testing](https://hearinghealthcenter.com/ask-the-audiologist/diagnostic-hearing-testing/) **Published:** August 28, 2022 **Author:** Ronna Fisher **Content:** There are different types of hearing problems and many causes of hearing loss. Identifying the type, severity, and cause of the hearing problem is critical in determining the next steps as well as the treatment options available. Doctors of Audiology spend four years of intensive study in the anatomy and physiology of the ear and brain to accurately diagnose and correctly treat hearing and cognitive impairments. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health Center Services --- ### [Is Earwax a Problem for You?](https://hearinghealthcenter.com/ask-the-audiologist/is-ear-wax-a-problem-for-you/) **Published:** March 3, 2025 **Author:** Ronna Fisher **Content:** Are you having trouble hearing? You might just have a problem with wax buildup. The best way to find out if you have wax buildup is to come in and have us examine your ears with our video otoscope. Every one of us secretes wax in our ears. Wax not only serves to protect the skin in our ear canal but also provides lubrication and can protect our ears from bacteria, insects, and fungi. Most of us barely notice the presence of our wax, but for others, it can build up without actually removing itself, causing a blockage in our ear canal. ## What is Ear Wax? Nobody likes ear wax, but it’s essential to protecting your ears. Ear wax, medically known as cerumen, is a naturally occurring substance produced within the ear canal. While it’s called ear wax, it’s a mixture of ear secretions, shed skin cells, and trapped debris. Ear wax is the first line of defense for your ears. It traps dust, dirt, and other small particles that could otherwise penetrate deeper into the ear and potentially damage your eardrum. Additionally, ear wax provides lubrication, preventing the ear canal from becoming dry and itchy. You may have found that ear wax can be in many colors, including off-white, yellow, and brown. If your ear wax is green, it’s time to see a doctor, as you might be fighting off an infection. ## The Complications of Ear Wax Ear wax is generally beneficial, but if it accumulates too much and becomes impacted, it can threaten the health and well-being of your hearing. Impacted ear wax occurs when the cerumen becomes lodged deep within the ear canal, often blocking it entirely. If that happens, you’ll typically experience the following symptoms: #### Hearing Loss The most common symptom of too much ear wax is when the blockage prevents sound waves from reaching the eardrum effectively, resulting in muffled or diminished hearing. #### Ear Ache Another common symptom of impacted ear wax is ear pain because of the pressure exerted by the ear wax against the eardrum or the ear canal walls. #### Tinnitus You may have tinnitus if you’ve ever experienced ringing, buzzing, or other noises in the ears. There are different causes for tinnitus, but impacted ear wax is one of the more common ones. #### Vertigo Impacted ear wax sometimes causes balance problems because the ear plays a vital role in maintaining equilibrium. If you feel dizzy or have vertigo, it might be from too much ear wax. #### Ear Infection Because areas in the ear canal are blocked, they become breeding grounds for bacteria growth. If that happens, you will end up with a lot of ear pain and an ear infection. If you experience any of these issues, reaching out to your audiologist before attempting to clean your ears yourself is important. ## How Do You Clean Your Ears? ![](http://new.hearinghealthcenter.com/wp-content/uploads/2017/11/2-clean-300x258.png)One of the biggest misconceptions is that you should clean your own ears. Most common at-home ear cleaning attempts end in serious, long-term damage to your hearing. Sometimes, the damage is even permanent. While seen on TV and in movies, the cotton swab is one of the last things you want to stick in your ear. Using them oftentimes pushes the ear wax further into the ear canal, causing more impact on the ear drum. If you’re not careful, cotton swabs can scratch or puncture your ear drum. Another common at-home solution is an ear candle. There is no medical proof that ear candles work, but there is evidence that usage causes burns, additional blockages, and perforation. There is no best home solution for cleaning your ears. Sticking anything in your ear is a recipe for serious and long-term damage, which is why you should always go to a doctor or an audiologist if you are experiencing symptoms of impacted ear wax. ## How Do You Prevent Ear Wax Buildup? ![](http://new.hearinghealthcenter.com/wp-content/uploads/2017/11/3-prevent-300x273.png)While being proactive about protecting your ears might make sense, many at-home remedies are dangerous. The ear canal is self-cleaning, and overdoing it disrupts this process, leading to excess ear wax. Two methods to prevent impacted ear wax are gentle cleaning after showers and using a humidifier. After showering or bathing, gently wipe the outer ear with a soft cloth. This helps remove any excess wax that naturally migrated outward. Dry air sometimes causes dryer ear wax, which can be more prone to impaction. Using a humidifier helps maintain adequate moisture levels. Of course, the best prevention is scheduling regular appointments with an audiologist who can check and clean your ears. The audiologists at Hearing Health Center are trained in all forms of ear wax removal, including suction, curettes, flushing, and more. ## Ear Wax and Hearing Aids For all of the good ear wax does, its existence complicates things for people wearing hearing aids. One of the biggest concerns is that wearing hearing aids prompts the glands in the ear canal to produce more wax, preventing it from moving out because of the barrier created by the hearing aid. Ear wax can accumulate on the hearing aid’s receiver (speaker), blocking sound transmission and causing muffled or distorted sound. This is a common issue, especially with in-the-ear (ITE) and receiver-in-canal (RIC) hearing aids. ## When Ear Wax Becomes a Problem, We Have a Solution: Ear Wax Removal! As audiologists, we are trained in our academic coursework and through specialized wax removal courses. Wax removal can take many forms, depending on the wax type, the wax buildup, and what is necessary for the most uncomplicated removal. Come in, find out if it’s just wax, and [get it taken care of at Hearing Health Center](https://hearinghealthcenter.com/hearing-services-chicago/#earwax-removal) with our specialized audiology team! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Earwax, Hearing Health Center Services, Hearing Issues --- ### [Dr. Ronna Fisher on CEO IntroNet TV.flv](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-on-ceo-intronet-tv-flv-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Dr. Ronna Fisher, CEO of Hearing Health Center, with CEO IntroNet TV host, John Page, talking about her personal story that lead to the founding of […](https://hearinghealthcenter.com/hhc-video-library-media/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Dr. Ronna Fisher discusses Competition on CEO IntroNet TV.flv](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-discusses-competition-on-ceo-intronet-tv-flv-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Dr. Ronna Fisher, CEO of Hearing Health Center, Chicagoland, with Murrel Karsh, Founder of Windy City Field House and WCF Corporate Events, Chicago […](https://hearinghealthcenter.com/hhc-video-library-media/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Roger Daltrey and HHC](https://hearinghealthcenter.com/roger-daltrey/roger-daltrey-and-hhc-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press, Roger Daltrey --- ### [Roger Daltrey & Dr. Ronna Fisher: “You’ve Let Me Keep Doing What I Love.”](https://hearinghealthcenter.com/roger-daltrey/roger-daltrey-dr-ronna-fisher-youve-let-me-keep-doing-what-i-love/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Roger Daltrey, lead singer of the iconic rock group, The Who, said, “Dr. Ronna Fisher, at Hearing Health Center, is the only person I trust with my […](https://hearinghealthcenter.com/hhc-video-library-media/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press, Roger Daltrey --- ### [Dr. Ronna Fisher on Fox Morning News](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-on-fox-morning-news-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Dr. Ronna Fisher discusses hearing difficulties on Fox Chicago Morning News, aired 8/14/07 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Experience the "TeleCare" Breakthrough featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/experience-the-telecare-breakthrough-featuring-walter-jacobson-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Hearing Health Center presents Experience the “TeleCare” Breakthrough featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [A Wonderful Thanksgiving featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/a-wonderful-thanksgiving-featuring-walter-jacobson-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Hearing Health Center presents An Amazing Experience featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [My Invisible Hearing Aids featuring Walter Jacobson](https://hearinghealthcenter.com/walter-jacobson/my-invisible-hearing-aids-featuring-walter-jacobson/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Hearing Health Center presents My Invisible Hearing Aids featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [Walter Jacobson endorses Hearing Health Center](https://hearinghealthcenter.com/walter-jacobson/walter-jacobson-endorses-hearing-health-center/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Hearing Health Center presents People Are Listening featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [Walter Jacobson and Dr. Ronna Fisher: Hearing is the Foundation of Communication](https://hearinghealthcenter.com/walter-jacobson/walter-jacobson-and-dr-ronna-fisher-hearing-is-the-foundation-of-communication/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Walter Jacobson interviews Dr. Ronna Fisher. She discusses hearing as the foundation of communication. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Walter Jacobson --- ### [Hearing Loss & Cancer Treatment: Walter Jacobson interviews Dr. Ronna Fisher](https://hearinghealthcenter.com/hearing-health/hearing-loss-cancer-treatment-walter-jacobson-interviews-dr-ronna-fisher-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Walter Jacobson interview Dr. Ronna Fisher, founder of the Hearing Health Centers in Chicago and the Fisher Foundation for Hearing on hearing loss […](https://hearinghealthcenter.com/hhc-video-library-walter-jacobson/#) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health, Walter Jacobson --- ### [All About the Fisher Foundation for Hearing](https://hearinghealthcenter.com/fisher-foundation/all-about-the-fisher-foundation-for-hearing/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** Legendary newsman Walter Jacobson talks to Fisher Foundation for Hearing founder Dr. Ronna Fisher about the purpose of the foundation. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [We Bring Hearing Back The Fisher Foundation for Hearing Health](https://hearinghealthcenter.com/fisher-foundation/we-bring-hearing-back-the-fisher-foundation-for-hearing-health-2/) **Published:** April 11, 2025 **Author:** Ronna Fisher **Content:** We Bring Hearing Back ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [The Connection Between Hearing Loss and Speech](https://hearinghealthcenter.com/hearing-issues/the-connection-between-hearing-loss-and-speech/) **Published:** April 22, 2025 **Author:** Ronna Fisher **Content:** Nearly 20% of the world’s population struggles with hearing loss daily. The latest data shows [that 1 to 3 of every 1,000 children have hearing loss](https://www.cdc.gov/hearing-loss-children/research/index.html) (other studies have it as high as 2 to 5 in 1,000), and a large portion struggle with speech development as a result. From the earliest days of our lives, how we hear the world affects how we communicate with it. Muffled sounds, limited feedback, and obstructed ear canals lead to future speech development issues if not addressed quickly. Hearing is essential to a child’s ability to develop speech and language skills from the earliest stages of life. This includes how they understand sounds, learn languages, and communicate with others. At Hearing Health Center, your hearing matters no matter your age. This guide helps you better understand the importance of early interventions for young people with hearing loss and how it affects their communication skills. ## Early Childhood Language Acquisition [Infants listen to speech patterns and tones almost immediately after birth](https://www.scientificamerican.com/article/how-babies-learn-language/), which allows them to begin developing their language abilities. Hearing allows infants to recognize and imitate the sounds they hear, laying the groundwork for speech and communication. However, this process is disrupted when a child experiences hearing loss. [Limited access to sound can delay language milestones](https://pmc.ncbi.nlm.nih.gov/articles/PMC10775292), including babbling, first words, and simple sentences. Without early intervention, these delays can worsen, impacting vocabulary growth and the ability to form complete sentences. ## Ongoing Speech and Language Skills It isn’t just what the people around them say, but what the children say themselves. Auditory feedback, or the ability to hear one’s voice, helps children learn how to pronounce words. The loss of hearing impairs this feedback loop, making it challenging for children to correct speech errors and develop clear articulation. ## The Importance of Early Detection and Intervention ![](https://hearinghealthcenter.com/wp-content/uploads/2025/04/2-early-detection.png "- Hearing Health Center") That’s why it is so important to test early and often for signs of hearing loss. [Newborn hearing screenings and regular hearing tests](https://www.audiology.org/consumers-and-patients/children-and-hearing-loss/newborn-hearing-screening/) help detect hearing issues early in a child’s life. When identified early, interventions such as hearing aids and speech therapy can be implemented to support language development. The goal is to give children early access to sound to naturally gain language skills and speech. ## Types of Hearing Loss and Their Impact on Speech Hearing loss can be categorized into three primary types: [conductive, sensorineural, and mixed](https://www.hopkinsmedicine.org/health/conditions-and-diseases/hearing-loss/types-of-hearing-loss). The different types affect your speech perception differently. **Conductive hearing loss** occurs when sound waves are obstructed from traveling through the outer or middle ear to the inner ear. This could be caused by something as simple as earwax buildup, fluid in the middle ear from infections, perforated eardrums, or abnormalities in the ear’s structure. ​ As an adult, if you’ve ever had too much earwax or fluid in your ear, you understand how difficult it is to hear sounds and conversations. Certain noises or speech frequencies might even be completely impossible to hear, as the low volume makes them difficult to understand. Children with this conductive hearing loss might exhibit [speech and language development delays due to inconsistent auditory input](https://www.childrenshospital.org/conditions/hearing-loss). ​ **Sensorineural hearing loss** results from damage to the inner ear (cochlea) or the auditory nerve pathways. This damage can be due to [aging, exposure to loud noises, head trauma, or genetic factors](https://www.cincinnatichildrens.org/health/s/sensorineural-hearing-loss). Individuals may struggle to distinguish between certain consonant sounds, leading to misunderstandings. High-frequency hearing loss, a common form of sensorineural loss, can make it particularly [challenging to hear sounds like “s,” “f,” and “th,”](https://www.sciencedirect.com/topics/medicine-and-dentistry/high-frequency-hearing-loss) which are crucial for speech comprehension. **Mixed hearing loss** is a combination of both conductive and sensorineural hearing loss. This indicates issues in the outer or middle ear and the inner ear or auditory nerve. For instance, a person might have age-related inner ear damage (sensorineural) and a middle ear infection (conductive). ​ The dual nature of mixed hearing loss means individuals may face compounded challenges: reduced sound volume from the conductive component and diminished sound clarity from the sensorineural aspect, leading to difficulties in both hearing and understanding speech. Depending on your age, mixed hearing loss could affect your ability to understand and participate in conversations. ## How is Speech Affected by Hearing Loss? ![](https://hearinghealthcenter.com/wp-content/uploads/2025/04/3-effects.png "- Hearing Health Center") The effects of hearing loss depend on factors such as the severity of the hearing impairment, the age at which it occurs, and whether intervention measures are in place. A few speech characteristics associated with hearing loss include: ### Delayed Speech Development in Children Children with hearing loss may experience delays in reaching speech and language milestones. You may notice a limited vocabulary, difficulty forming sentences, and challenges with grammatical structures. This includes struggles with plural forms, past tense, and possessives because they cannot hear the subtle differences in sound. ### Pronunciation Difficulties Hearing-impaired individuals often face challenges in articulating certain speech sounds, particularly high-frequency consonants like “s,” “sh,” “f,” “t,” and “k.” These sounds are typically softer and more complex to hear, leading to omissions or mispronunciations in speech. ​ ### Voice Volume Individuals with hearing loss have difficulty controlling their voice pitch and volume without the ability to hear feedback. This commonly results in monotone speech or a lack of natural variations in intonation, creating an unusual or less expressive speech pattern. ### Simplified Sentence Structures Individuals with hearing loss might use simpler sentence constructions, often relying heavily on nouns and producing shorter sentences. This simplification can stem from difficulties in acquiring and using complex grammatical forms. ### Challenges with Grammatical Elements Using grammatical markers such as verb inflections, adverbs, prepositions, and pronouns may cause noticeable difficulties. These challenges can lead to speech that sounds less fluid and more fragmented. ​ ## Strategies for Mitigating Speech Challenges Early intervention is the most crucial strategy for mitigating speech challenges among young people. From an early age, assistive technology, specialized therapies, and alternative communication methods significantly improve communication abilities and the quality of life for individuals with hearing impairments. The younger you are, the more significant timeliness is. The Centers for Disease Control and Prevention (CDC) emphasizes that [infants diagnosed with hearing loss should receive intervention services as soon as possible](https://www.cdc.gov/ncbddd/hearingloss/treatment.html), ideally before 6 months. These services often involve therapists working closely with families to teach communication strategies and integrate learning into daily routines. ​ On the audiologist’s end, properly-fitting hearing aids improve audio input and speech comprehension. Because every person is different, working with a trusted audiologist allows for personalized care and treatment to ensure optimum results. Consistent use of well-fitted equipment is a foundational step in developing normal auditory, speech, and language skills. ​ [Speech-language pathologists (SLPs)](https://www.alicepeckday.org/news/how-speech-language-therapy-can-help-with-hearing-loss) provide tailored interventions to help individuals with hearing loss build, sustain, or improve their communication abilities. Therapies might focus on articulation, language growth, and auditory training. Implementing specific strategies in school settings can support students with hearing loss. These range from systematic vocabulary instruction to the use of visual aids. Depending on the need, techniques such as semantic mapping and providing context for new vocabulary words may be used to reinforce language skills. ## Is Your Child Struggling with Hearing Loss? Call Hearing Health Center Today. Early interventions protect long-term hearing health and assist in developing language skills. The trained audiologists at Hearing Health Center are prepared to help you and your family with regular hearing exams, hearing aid fittings, and more. To get started, [schedule an appointment at any of our five locations today](/book-my-hearing-test-appointment/)![](javascript:;) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Communication Issues, Hearing Issues --- ### [United Healthcare Investigation | Medicare Advantage Plan Fraud](https://hearinghealthcenter.com/news-press/united-healthcare-investigation-medicare-advantage-plan-fraud/) **Published:** May 15, 2025 **Author:** Ronna Fisher **Content:** United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costsUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costsUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost betweenUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 00-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, (United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up toUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 4,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost betweenUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costsUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost betweenUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 00-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, (United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up toUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 4,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 00-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, (United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costsUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost betweenUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 00-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, (United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: ### 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. ### 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. ### 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. ### 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. ### 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. ## Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up toUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 4,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up toUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costsUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost betweenUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 00-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, (United Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 85/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up toUnited Healthcare is the nation’s largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older. The allegations United Healthcare include: 1. Claim Denials and Prior Authorization: - **High Denial Rates:** UHC, like other large insurers, faces criticism for denying claims and requiring prior authorizations, leading to delays and difficulties in accessing necessary medical care. - **Algorithms and AI:** UHC has been accused of using algorithms and AI-driven tools to deny claims, sometimes leading to wrongful denials. - **Retroactive Denials:** UHC has been criticized for retroactively denying claims, leaving patients responsible for bills they thought were covered. 2. Impact on Patients: - **Unexpected Bills:** Claim denials and coverage disputes can leave patients with large, unexpected medical bills. - **Difficulty Accessing Care:** Prior authorization requirements and network limitations can make it challenging for patients to see specialists or receive timely treatment. - **Stress and Anxiety:** Dealing with claim denials and appeals can be a stressful and time-consuming process for patients. 3. Provider Concerns: - **Contract Disputes:** UHC has faced criticism for its contracting practices with healthcare providers, including disputes over reimbursement rates and network participation. - **Administrative Burden:** Prior authorization requirements and claim denials can create administrative burdens for providers. 4. Profit Motives and Corporate Practices: - **Prioritizing Profits:** Critics argue that UHC, like other for-profit insurers, prioritizes profits over patient care. - **Anti-competitive Practices:** UHC has been accused of engaging in anti-competitive practices that limit patient choice and increase costs. - **Lack of Transparency:** Concerns have been raised about UHC’s lack of transparency in its claims processing and decision-making. 5. Legal and Regulatory Scrutiny: - **Lawsuits and Investigations:** UHC has faced lawsuits and investigations related to claim denials, billing practices, and the use of AI in healthcare. - **Government Oversight:** Government agencies, like the [Centers for Medicare & Medicaid Services (CMS)](https://www.cms.gov/nosurprises/policies-and-resources/providers-submit-a-billing-complaint), have scrutinized UHC’s practices. Understanding Traditional Medicare vs. Advantage Plans **Traditional Medicare** is operated by the government. Most people receive Medicare Part A (hospital insurance) for free. Part B (medical insurance) typically costs $185 per month (may be higher depending upon your income), and covers 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. Generally, they pay 80% of your health care costs. To cover the remaining 20%, you must buy a Medigap or supplemental policy. In general, most supplemental G plans (the most popular), cost between $100-$200/month. **The good news:** - **Out-of-pocket costs.** Are generally limited to the annual Part B deductible, which is $257 in 2025. - **Widest access to health providers.** Only a small group of medical services require prior authorization. **The bad news:** - Premium for supplemental policy is more than for Advantage Plans - You still have to buy a separate drug plan (Part D). In 2025 it is estimated to be approximately $46.50 per month. **Advantage Plans** are operated by private insurance companies that contract with Medicare. They may offer additional benefits (dental, vision, hearing) that traditional Medicare does not cover. **The good news:** Although you still must pay your monthly cost for traditional Medicare, ($185/month), the Advantage plan premiums are much lower, and sometimes, free. They usually include drug coverage (Part D) which is extra in Traditional Medicare. **The bad news:** - **Limited provider networks:** Typically enrollees must use doctors, hospitals, and other healthcare providers within a specific network. Going out-of-network can mean higher costs or no coverage at all. - **Prior authorization:** required for many services, which can delay or even prevent needed care. - **Travel limitations:** May not offer coverage outside their service area. - **Higher costs:** Although they may have lower premiums, they also have higher co-payment, deductibles, and out of pocket maximums (In 2025, the out-of-pocket maximum for Medicare Advantage is plans is $9,350 for in-network services. Some plans may have lower out-of-pocket limits, and those that allow out-of-network coverage may have a higher out-of-pocket maximum. For combined in-network and out-of-network services, the maximum can be up to $14,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 4,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** 4,000 in 2025. - **Denial of service:** Some Medicare Advantage plans have been reported to delay or deny coverage for medically necessary care. While Medicare Advantage plans may have lower premiums, they can also have higher copayments, deductibles, and out-of-pocket maximums, especially if you use out-of-network providers. **The bottom line: Be careful what you wish for and read the fine print** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [Purchasing Hearing Aids Online vs. Seeing a Professional](https://hearinghealthcenter.com/ask-the-audiologist/purchasing-hearing-aids-online-vs-seeing-a-professional/) **Published:** July 9, 2025 **Author:** Ronna Fisher **Content:** We live in a digital age. With a click of a button, you can download your favorite movies. You can order the latest clothing trends. You can even have your groceries delivered right to your door. So what about having your hearing aids delivered to you? Sure, the convenience and relative ease might be convincing. But how do you know you’re really getting the hearing help you need? ## The Convenience of Online vs. The Value of Professional Hearing Care The hearing industry has experienced tremendous growth over the last 25 years. We no longer see the “big beige bananas” earphones that plagued those with hearing problems in the past. Now, hearing aids are small, discrete, and more technologically advanced than ever. But you wouldn’t buy a pair of glasses without knowing your prescription, would you? The same principle should apply if you’re purchasing hearing aids. The difference maker between online purchases and in-office ones is the trained Doctor of Audiology, who fits and sets up the hearing aids. Unless your hearing aid is programmed directly for your needs—your physical ear, your lifestyle, your audiometric hearing loss—you won’t be getting the hearing help you need. Instead, you’ll be left to figure it out yourself, leading to a lackluster hearing experience. ## Why Professional Diagnosis is Non-Negotiable for Your Hearing Health ![](https://hearinghealthcenter.com/wp-content/uploads/2017/10/3-non-negotiable.png "- Hearing Health Center") When it comes to your hearing, a professional diagnosis isn’t just a recommendation—it’s non-negotiable. Why? Before we even think about hearing aids, our Doctors of Audiology perform extensive testing to pinpoint the exact cause of your hearing problems. Hearing loss isn’t always as straightforward as needing a volume boost. Sometimes, hearing loss can be something easily treatable, such as a simple buildup of earwax. Other times, it’s a sign of a more serious medical issue. You don’t and can’t know on your own. Plus, without a medical diagnosis, you could end up spending a significant amount of money on a hearing aid you don’t even need. We don’t want our patients to fall for the trap of an online solution when what they truly need is a precise and professional diagnosis. ## The Role of Your Audiologist There are four key roles your audiologist takes on when you come in with hearing problems: diagnosis, programming, fitting, and repairs. At one of your first appointments, and before ever discussing hearing aids with you, Doctors of Audiology perform extensive testing to determine the root cause of your hearing problems. These simple tests are comprehensive and enable you to gain a thorough understanding of your current hearing health. Without a doctor’s diagnosis, you could be scammed into paying for a hearing aid online that you do not need. Once we’ve discussed your hearing aids, your audiologist will take the time to assist you in programming them. Remember, hearing aids are not just volume controls. Hearing aids have to be specifically programmed to help you hear the sounds you are missing. Without a comprehensive test, even the best hearing aids can’t help you because they won’t be programmed to your needs. Of course, you also want the right fit for your hearing aids. These must always be customized to the specific user. If you purchase hearing aids online, there is no guarantee that they will fit your ears properly. And in the unlikely event that something breaks, like any piece of equipment, your audiologist has the capabilities to repair and assist with any issues you might encounter. Rather than having to fill out online forms or mail your hearing aids, Hearing Health Center can help you right away. ## A Personalized Approach to Hearing Health ![](https://hearinghealthcenter.com/wp-content/uploads/2017/10/4-audiologist-role.png "- Hearing Health Center") Your ears are as unique as your fingerprints, and your hearing loss pattern is entirely individual. This is precisely why a personalized approach to hearing aid fitting and programming is a crucial step in your hearing health journey. Without custom programming based on a comprehensive audiometric test, even the most advanced hearing aid technology will fall short. It would be like trying to navigate a complex city with a generic map when you need a detailed GPS. A personalized approach means your hearing aids are an extension of you, not a one-size-fits-all solution. ## Is an Online Bargain Truly a Better Value? While a pair of online, over-the-counter hearing aids might retail for anywhere from $300 to $2,000, professionally fitted prescription hearing aids, which often include comprehensive services, are a bit more expensive. At first glance, that price difference feels substantial. But remember, that online “bargain” often doesn’t account for crucial elements like a professional diagnosis, custom programming tailored to your unique hearing loss, or personalized fitting for optimal comfort and effectiveness. These aren’t just “add-ons”; they are the foundational pillars of successful hearing aid use. Without a proper diagnosis, you may purchase an unnecessary device or one that fails to address the root cause of your hearing issues, resulting in wasted money. If the fit is poor, you’ll experience discomfort and likely won’t wear them consistently, rendering your investment useless. Is it really a bargain if you’re not hearing your best? ## Ready to Improve Your Hearing? Call Hearing Health Center Today! Want to experience the difference by working with Hearing Health Center? Our team delivers comprehensive, high-quality exams to ensure your hearing aids are the right match, fit, and sound for you. [Schedule your free examination](https://hearinghealthcenter.com/book-my-hearing-test-appointment/) to start hearing better today! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [HHC Lee Freedman, MD](https://hearinghealthcenter.com/news-press/hhc-lee-freedman-md/) **Published:** June 20, 2011 **Author:** Ronna Fisher **Excerpt:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com **Content:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [HHC James Cunnar, MD](https://hearinghealthcenter.com/news-press/hhc-james-cunnar-md/) **Published:** June 15, 2011 **Author:** Ronna Fisher **Excerpt:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com **Content:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [HHC David Edelberg, MD](https://hearinghealthcenter.com/news-press/hhc-david-edelberg-md/) **Published:** June 20, 2011 **Author:** Ronna Fisher **Excerpt:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com **Content:** The Doctors You Trust, Trust Hearing Health Center www.hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [Dr. Ronna Fisher on CEO IntroNet TV.flv](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-on-ceo-intronet-tv-flv/) **Published:** December 29, 2011 **Author:** Ronna Fisher **Excerpt:** Dr. Ronna Fisher, CEO of Hearing Health Center, with CEO IntroNet TV host, John Page, talking about her personal story that lead to the founding of Hearing Health Center. **Content:** Dr. Ronna Fisher, CEO of Hearing Health Center, with CEO IntroNet TV host, John Page, talking about her personal story that lead to the founding of Hearing Health Center. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Dr. Ronna Fisher discusses Competition on CEO IntroNet TV.flv](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-discusses-competition-on-ceo-intronet-tv-flv/) **Published:** December 29, 2011 **Author:** Ronna Fisher **Excerpt:** Dr. Ronna Fisher, CEO of Hearing Health Center, Chicagoland, with Murrel Karsh, Founder of Windy City Field House and WCF Corporate Events, Chicago talking about staying ahead of the competition with CEO IntroNet TV host, John Page. **Content:** Dr. Ronna Fisher, CEO of Hearing Health Center, Chicagoland, with Murrel Karsh, Founder of Windy City Field House and WCF Corporate Events, Chicago talking about staying ahead of the competition with CEO IntroNet TV host, John Page. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Hearing Health Center Patient Testimonials](https://hearinghealthcenter.com/testimonial/hearing-health-center-patient-testimonials/) **Published:** January 7, 2013 **Author:** Ronna Fisher **Excerpt:** See what our patients are saying! Recorded 11/9/12 **Content:** See what our patients are saying! Recorded 11/9/12 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Testimonial --- ### [HHC on "American Health Front"](https://hearinghealthcenter.com/media-press/hhc-on-american-health-front/) **Published:** January 7, 2013 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center's segment on "American Health Front," which aired 12/15/12 on CBS. **Content:** Hearing Health Center’s segment on “American Health Front,” which aired 12/15/12 on CBS. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [The Sounds of Life](https://hearinghealthcenter.com/hearing-health/the-sounds-of-life/) **Published:** March 7, 2014 **Author:** Ronna Fisher **Excerpt:** Chicago's Hearing Health Center is proud to share with you the Sounds of Life. Hearing loss affects nearly 28 million Americans. What most people don't realize is that hearing loss is a condition that can be treated with hearing aids. There are a variety of different hearing aid styles to cover a wide array of hearing losses and lifestyles. Let the Hearing Health Center help you like we've helped so many that suffered from hearing loss. And don't just take our word for it- hear what some of our patients have to say. We've helped them to again hear the Sounds of Life. **Content:** Chicago’s Hearing Health Center is proud to share with you the Sounds of Life. Hearing loss affects nearly 28 million Americans. What most people don’t realize is that hearing loss is a condition that can be treated with hearing aids. There are a variety of different hearing aid styles to cover a wide array of hearing losses and lifestyles. Let the Hearing Health Center help you like we’ve helped so many that suffered from hearing loss. And don’t just take our word for it- hear what some of our patients have to say. We’ve helped them to again hear the Sounds of Life. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health --- ### [Dr. Ronna Fisher on Fox Morning News](https://hearinghealthcenter.com/media-press/dr-ronna-fisher-on-fox-morning-news/) **Published:** January 5, 2015 **Author:** Ronna Fisher **Excerpt:** Dr. Ronna Fisher discusses hearing difficulties on Fox Chicago Morning News, aired 8/14/07 **Content:** Dr. Ronna Fisher discusses hearing difficulties on Fox Chicago Morning News, aired 8/14/07 ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Media & Press --- ### [Free Baseline Hearing Checkups](https://hearinghealthcenter.com/services/free-baseline-hearing-checkups/) **Published:** August 28, 2022 **Author:** Ronna Fisher **Content:** Most people haven’t had their hearing checked since grade school. It is rarely included in annual physicals and people just don’t think to get it tested. That’s why Hearing Health Center is committed to making sure that everyone in the community, over 50 years old, has a baseline hearing test. If you haven’t had your hearing tested, now is your chance. Make an appointment for a free baseline hearing checkup at any of our five locations ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health Center Services --- ### [Hearing Health Center in Naperville Magazine: Fisher Foundation for Hearing Health Care](https://hearinghealthcenter.com/fisher-foundation/hearing-health-center-naperville-magazine-fisher-foundation-hearing-health-care/) **Published:** January 4, 2018 **Author:** Ronna Fisher **Content:** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/NMAG0118_Humanitarian_800px.jpg "- Hearing Health Center")Tell me again you love me, Momma, I can hear you now.” The simple phrase from a seven-year-old boy who had lost his hearing after recovering from brain cancer meant everything to Dr. Ronna Fisher. “It was one of the most gratifying moments of my life. Everyone in the room was crying,” she recalls. “I knew then I had found the purpose for my foundation; these children with brain cancer have a need no one is filling.” Fisher started her Fisher Foundation for Hearing Health Care nonprofit in 2005; it provides hearing aids to anyone who cannot afford them, as the costs are not usually covered. [Read the full article.](http://napervillemagazine.com/2018/01/sound-advice/) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [What is The Fisher Foundation?](https://hearinghealthcenter.com/fisher-foundation/fisher-foundation-and-batman/) **Published:** August 19, 2018 **Author:** Ronna Fisher **Content:** **Na na na na na na na na BATMAN!** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/batman.png "batman - Hearing Health Center")*(Above: Our patient, Riley, who is battling cancer was gifted with hearing aids from his favorite superhero, Batman, due to the donations from the Fisher Foundation).* In 2005, the Fisher Foundation was established by Dr. Ronna Fisher to provide hearing services and treatment to those in need. Dr. Fisher and the Hearing Health Center team provide education to the community, ear protection to our troops and hearing aids to children and adults. The most popular event The Fisher Foundation hosts is an annual Hike 4 Better Hearing in which the community comes together to spread awareness for hearing health and raise donations for this great cause. With the combined efforts of the HHC team, patients, sponsors and community, we are able to provide the gift of hearing to many special individuals. Take this opportunity to find your inner superhero and spread the joy of hearing. With Batman’s help we are unstoppable! We want to help even more people this year and educate the public about our most precious sense…hearing. Website: [fisherfoundationforhearing.org](http://fisherfoundationforhearing.org) **Melissa Mandra, Au.D.** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [Patient Testimonials](https://hearinghealthcenter.com/testimonial/patient-testimonials/) **Published:** April 11, 2025 **Author:** muneeb **Content:** We love our patients! Thank you for the kind words! ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Tom Wykle - Roofing Business Owner](https://hearinghealthcenter.com/testimonial/tom-wykle-roofing-business-owner/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Tom Weinberg - Television Producer](https://hearinghealthcenter.com/testimonial/tom-weinberg-television-producer/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Mark Levy - Head NFL Coach for 17 Seasons](https://hearinghealthcenter.com/testimonial/mark-levy-head-nfl-coach-for-17-seasons/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Glenn Jones - Retired Construction E.V.P.](https://hearinghealthcenter.com/testimonial/glenn-jones-retired-construction-e-v-p/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Dr. David Edelberg - Internist](https://hearinghealthcenter.com/testimonial/dr-david-edelberg-internist/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Stephen Miller- Former Berkley University Professor](https://hearinghealthcenter.com/testimonial/stephen-miller-former-berkley-university-professor/) **Published:** April 11, 2025 **Author:** muneeb **Content:** ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Check out this Patient Testimonial!](https://hearinghealthcenter.com/testimonial/check-out-this-patient-testimonial/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Listen to this inspiring story of our long time patient Gio he has been wearing hearing aids since he was a young child. ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Testimonial --- ### [Tour Highland Park - Hearing Health Center](https://hearinghealthcenter.com/virtual-tours/tour-highland-park-hearing-health-center/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Take a virtual tour of our state-of-the-art audiology practice in Highland Park. Hearing Health Center (HHC) in Highland Park was founded in […](https://hearinghealthcenter.com/hhc-video-library-virtual-tours/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Virtual Tours --- ### [Hearing Health Center Naperville Grand Opening](https://hearinghealthcenter.com/virtual-tours/hearing-health-center-naperville-grand-opening-2/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Join us as we celebrate the Grand Opening of the new Hearing Health Center Naperville location with the mayor and legendary Chicago Newsman Walter […](https://hearinghealthcenter.com/hhc-video-library-virtual-tours/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Virtual Tours --- ### [Tour Chicago - Hearing Health Center](https://hearinghealthcenter.com/virtual-tours/tour-chicago-hearing-health-center/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Take a virtual tour of our state-of-the-art audiology practice in Chicago. Hearing Health Center (HHC) in Oak Brook was founded in 1984 by […](https://hearinghealthcenter.com/hhc-video-library-virtual-tours/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Virtual Tours --- ### [Tour Naperville - Hearing Health Center](https://hearinghealthcenter.com/virtual-tours/tour-naperville-hearing-health-center/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Take a virtual tour of our state-of-the-art audiology practice in Naperville. Hearing Health Center (HHC) in Naperville was founded in 1984 […](https://hearinghealthcenter.com/hhc-video-library-virtual-tours/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Virtual Tours --- ### [Tour Oak Brook - Hearing Health Center](https://hearinghealthcenter.com/virtual-tours/tour-oak-brook-hearing-health-center/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Take a virtual tour of our state-of-the-art audiology practice in Oak Brook. Hearing Health Center (HHC) in Oak Brook was founded in 1984 by […](https://hearinghealthcenter.com/hhc-video-library-virtual-tours/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Virtual Tours --- ### [Doctor Hilary MacCrae- Tinnitus](https://hearinghealthcenter.com/tinnitus/doctor-hilary-maccrae-tinnitus/) **Published:** April 11, 2025 **Author:** muneeb **Content:** Dr. Hilary MacCrae, an Audiologist at Hearing Health Center, discusses the causes of and treatments for Tinnitus. Over 20 million Americans […](https://hearinghealthcenter.com/hhc-video-library-tinnitus/#) ![author avatar](https://secure.gravatar.com/avatar/bcec9046c85e0bb3f44c2c1e1f51b6e4408e76ef9d2803b9e54d9e1a56088d27?s=300&d=mm&r=g) muneeb [See Full Bio](https://hearinghealthcenter.com/author/muneeb/) [ ](https://hearinghealthcenter.com/author/muneeb/) **Categories:** Tinnitus --- ### [Tips for Understanding Better in Noise](https://hearinghealthcenter.com/ask-the-audiologist/tips-for-understanding-better-in-noise/) **Published:** November 14, 2017 **Author:** Ronna Fisher **Excerpt:** Walking into a busy restaurant, a work meeting, or even a family gathering, you may feel overwhelmed and frustrated with all the sounds your hearing instruments are picking up.  This is normal!  **Content:** ![Tips for Understanding Hearing in Noise](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/graphicstock-busy-hipster-businessman-holding-a-smartphone-making-a-phone-call-standing-at-the-crowded-station_Sdr8HTGSG-.jpg "- Hearing Health Center") *Author: Dr. Jaclyn Riel* Walking into a busy restaurant, a work meeting, or even a family gathering, you may feel overwhelmed and frustrated with all the sounds your hearing instruments are picking up. This is normal! Even people with normal hearing have difficulty in these situations. Here are some tips to help you hear your best: 1\. Always sit facing the person that you are trying to hear, and put your back to the crowd/noise! **Do not sit with your back to a wall and face the crowd.** 2\. Make sure there is adequate **lighting**. A dark restaurant makes it difficult to read facial expressions and lips. 3\. If you are in a large meeting, ask if the room is **looped** or if they have assistance for the hearing impaired. 4\. Use a **remote microphone** to hear the speaker (if your hearing aids are compatible). 5\. **Turn down** the noise if possible (turn off the television, turn down the radio). 6\. Do not be afraid to tell people when you didn’t hear them! If you do not understand something, ask that the speaker **repeat or rephrase**. You would be surprised by how many other people also missed what was said! 7\. Find a **quiet place to talk**. Stay away from speaker systems and music while talking with others. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Communication Issues, Hearing Issues --- ### [A Wonderful Thanksgiving featuring Walter Jacobson](https://hearinghealthcenter.com/news-press/a-wonderful-thanksgiving-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents An Amazing Experience featuring Walter Jacobsen **Content:** Hearing Health Center presents An Amazing Experience featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [Experience the "TeleCare" Breakthrough featuring Walter Jacobson](https://hearinghealthcenter.com/ask-the-audiologist/experience-the-telecare-breakthrough-featuring-walter-jacobson/) **Published:** December 30, 2016 **Author:** Ronna Fisher **Excerpt:** Hearing Health Center presents Experience the "TeleCare" Breakthrough featuring Walter Jacobsen **Content:** Hearing Health Center presents Experience the “TeleCare” Breakthrough featuring Walter Jacobsen ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [How do I change my wax guard?](https://hearinghealthcenter.com/ask-the-audiologist/how-do-i-change-my-wax-guard/) **Published:** March 22, 2017 **Author:** Ronna Fisher **Content:** Has your hearing aid ever suddenly stopped working? Most often, you might try changing the battery and then wind up coming in to the [audiology office](https://hearinghealthcenter.com/why-hearing-health-center-audiologist/) for an appointment. During that appointment, have you been told that your hearing aid was just plugged with wax? Well, I know that I have told many patients this in the past. The great news is that you have the ability to unclog your hearing aid at home by changing the [wax guard](https://hearinghealthcenter.com/product-category/wax-guards/). **What is a wax guard and why is it important?** Depending on the type and style of hearing aid you have, there is a wax guard located at the sound outlet or at the receiver. The wax guard acts as a protective cover to stop ear wax from going deep into the hearing aid. Typically it is a white circle that is located on the portion of the hearing aid that you insert into your ear. **When should I change my wax guard?** The amount of earwax produced by each individual can vary. It is recommended that we check the wax guard daily. If your hearing aid starts to sound weak/silent or wax is visible, it’s time to change the wax guard. **How do I change my wax guard?** First, wipe off any visible wax from the hearing aid, and make sure you have the necessary wax removal sticks to change it at home. ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/widex-wax-guards.jpg "widex-wax-guards - Hearing Health Center") Next, insert the open ended portion of the removal stick into the sound outlet (usually encompassed into a stainless steel bushing), twist, and pull it straight out. *![hearing health center](https://hearinghealthcenter.com/wp-content/uploads/2018/09/3-Old-wax-guard-removed-225x300.jpg "3-Old-wax-guard-removed - Hearing Health Center")![hearing health center](https://hearinghealthcenter.com/wp-content/uploads/2018/09/4-Putting-in-new-wax-guard-225x300.jpg "4-Putting-in-new-wax-guard - Hearing Health Center")* Now, turn the removal stick to the other side (that has the new white end on it) and insert the new white end into the sound outlet and remove. Make sure the wax guard is sitting flat against the stainless steel bushing of the sound outlet. All that’s left to do is throw out your old wax guard and removal stick, which can’t be reused. And you’re done! Are you hearing better now? ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [Patient Testimonial](https://hearinghealthcenter.com/testimonial/patient-testimonial/) **Published:** April 4, 2017 **Author:** Ronna Fisher **Excerpt:** We love our patients! Thank you for the kind words! Website: www.hearinghealthcenter.com **Content:** We love our patients! Thank you for the kind words! Website: www.hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Testimonial --- ### [Can Wearing Earbuds Hurt Your Ears?](https://hearinghealthcenter.com/ask-the-audiologist/can-earbuds-hurt-your-ears/) **Published:** May 24, 2017 **Author:** Ronna Fisher **Content:** Earbuds are tiny, lightweight, inexpensive portable speakers. They are by far the most popular choice for private listening. ##### **Harmless, Right?** ##### **Wrong!** Twenty percent of teenagers have a moderate to severe, permanent and irreversible hearing deficit usually seen in 70-year-olds. Why? Earbuds! ##### **How Can Earbuds Damage Hearing?** Any sustained sound that exceeds a certain volume level (measured in decibels, dB) will cause hearing damage. Anything over 85 decibels (traffic noise, vacuum cleaner, noisy restaurants) is harmful. It doesn’t matter if the sound is pleasant (music, sporting events) or irritating and cacophonous (sirens, chain saws, lawn mowers). Any loud sound for a long time kills the tiny hair cells that respond to auditory stimulation and damages the nerve fibers that send those sounds to your brain. ##### **Earbuds makes the problem worse because:** 1. They are nestled inside your ear canals very close to your eardrum and inner ear. 2. The sound is concentrated. Close proximity in an enclosed environment increases power of the sound about 10 times. And it’s aimed right at the organ of hearing. 3. Unlike the old Walkman, whose battery died after a few hours, listening devices today (iPods, MP3 players) can remain powered for 24 hours. You can listen for long periods of time without taking a break. The ears don’t have a chance to recover from the onslaught of harmful sound. ##### **Which are Worse: Earbuds or Headphones?** ![Photo of Hearing Health Center headphones](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/headphones-1837146_640-300x184.jpg "headphones-1837146_640 - Hearing Health Center")The short answer is earbuds, because of the deep insertion into the ear canal sending stronger waves that quickly damage the nerve fibers. But headphones today, like Beats by Dre, which are made to fit snugly over the ears and boost the base, can be just as damaging depending on the volume and duration of exposure. Most MP3 players can produce volumes up to 120 decibels. Listening at that level can cause irreparable hearing loss in less than 15 minutes. And if you ever have ringing in your ears after loud exposure to sound – it’s too late. Your hearing may recover, but the dead hair cells and nerve damage never will. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [Walter Jacobson with Dr. Ronna Fisher On Why She Chose to Be an Audiologist](https://hearinghealthcenter.com/ask-the-audiologist/walter-jacobson-with-dr-ronna-fisher-on-why-she-chose-to-be-an-audiologist/) **Published:** August 9, 2017 **Author:** Ronna Fisher **Excerpt:** Walter Jacobson sits down with Dr. Ronna Fisher of Hearing Health Center. Visit our website: hearinghealthcenter.com **Content:** Walter Jacobson sits down with Dr. Ronna Fisher of Hearing Health Center. Visit our website: hearinghealthcenter.com ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, HHC News --- ### [How can I care for my hearing aids in the summer?](https://hearinghealthcenter.com/ask-the-audiologist/how-to-care-for-your-hearing-aids-in-the-summer/) **Published:** August 17, 2017 **Author:** Ronna Fisher **Content:** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/pier-569314_640.jpg "pier-569314_640 - Hearing Health Center")Technology requires special care during the summer months, and your hearing aid is no exception. You need to maintain your hearing aids as you normally would, but because of the added humidity in the air and the heat of June, July, and August, you’ll need to take extra care when you’re having summer fun. Take care of your investment and your health with these four tips. ##### Tip 1: Remove your hearing aids before swimming. Anytime you’re around water, it’s best to leave your hearing aids behind. You do need to consider your own safety though. If you won’t be able to hear warnings, it might be safer to leave them in. If they do get wet, use a lint-free towel to dry them off, remove the battery, and place the aid itself in a hearing aid dryer or desiccant jar. ##### Tip 2: Protect them against sweat and humidity. After a workout, remove your hearing aids and wipe them off. Even water-resistant sets are vulnerable to the bacteria which grows faster when it’s hot and humid. Use disinfectant towelettes and a [dry and store solution](https://hearinghealthcenter.com/product-category/dehumidifiers/) designed to keep your aids clean and dry. Ask your audiologist about getting your set of hearing aids professionally cleaned more often in the summer. ##### Tip 3: Keep your hearing aids secure. Summer activities are often much more risky than those you undertake the rest of the year. Use special clips to keep your hearing aids attached to your clothing or your glasses. If something does come out of place, it won’t go too far. ##### Tip 4: Get hearing aids suited to your lifestyle. Talk to your audiologist about the style of hearing aid that fits your needs. Hearing aids that reduce wind noise because they sit completely in the ear canal are ideal for golfers. If you wear a helmet that reduces the effectiveness of your aid, your audiologist has solutions. Take care of your expensive equipment by following proper care and use. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, How To --- ### [When should I change my domes or mold?](https://hearinghealthcenter.com/ask-the-audiologist/change-domes-mold/) **Published:** September 26, 2017 **Author:** Ronna Fisher **Content:** Anyone that has a behind-the-ear hearing aid will use either a dome or a custom mold- this is the piece of rubber or plastic that goes directly into the ear. These pieces of your hearing aid live in a wet, humid environment- so it’s important to know when to change them out! Additionally, sometimes the dome or ear mold just doesn’t fit right, which will not only affect the quality of your hearing, but it will also affect your experience with the hearing aids themselves. #### DOMES ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/HI-with-Dome.jpg "HI-with-Dome - Hearing Health Center")The dome is the rubber tip that sits inside the individual’s ear canal. Domes are usually clear or black, and can range in a wide variety of sizes- one for every possible ear canal! As the dome is the first point of contact with your ear canal, it can very easily become blocked with wax or debris, and prevent sound from coming out of the hearing aid. We see a lot of patients whose hearing aids have “stopped working”- when upon closer inspection, they just need a clean dome! When the dome becomes plugged, you can use a cleaning tool with a brush on the end to brush off any debris or wax. So, when should you change your dome with a new one? You should change your dome if it is ripped or yellow. If you see that your dome is ripped or has turned a yellow color, it is time to visit your audiologist and change your dome- or, [change it at home](https://hearinghealthcenter.com/product-category/domes/)! #### CUSTOM EAR MOLDS Many patients with behind-the-ear hearing aids have custom molds that fit into their ear. ![Photo of Hearing Health Center Earmold with BTE](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/BTE-with-Earmold.jpg "BTE-with-Earmold - Hearing Health Center")You may need to get a new ear mold if: - Your ear mold is not fitting right or coming out of your ear. - Your ear mold is ripping or very discolored. - You are getting feedback or whistling from your hearing aid. If your ear mold is not fitting in your ear correctly, sound may be leaking out of your ear and getting picked up by the microphones of your hearing aid. In any of these cases, call your audiologist to see if it’s time for a new ear impression! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Purchasing Hearing Aids Online vs. Seeing a Professional](https://hearinghealthcenter.com/ask-the-audiologist/purchasing-hearing-aids-online-vs-seeing-professional/) **Published:** October 9, 2017 **Author:** Ronna Fisher **Content:** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/female-medical-doctor-consultation-woman-patient-sitting-in-office_rKsH3HTVo-268x300.jpg "female-medical-doctor-consultation-woman-patient-sitting-in-office_rKsH3HTVo - Hearing Health Center") *Author: Dr. Alissa Nickerson* We live in a digital age. With a click of a button, you can download your favorite movies. You can order the latest clothing trends. You can even have your groceries delivered right to your door. So what about having your hearing aids delivered to you? Sure, the convenience and relative ease might be convincing. But how do you know you’re really getting the hearing help you need? The hearing industry has grown tremendously in the last 25 years. We no longer see the “big beige bananas” that plagued those with hearing problems in the past. Now, hearing aids are small, discrete and more technologically advanced than ever. But, it’s not just the hearing aids that help the user. It’s the trained Doctor of Audiology fitting the hearing aids. This is true in not just the hearing industry but many health-related fields. Consider a doctor performing a knee surgery: sure, the prostheses helps the patient, but it will only work well if the doctor performs the surgery appropriately. The same is true for your hearing! Unless your hearing aid is programmed directly for your needs—your physical ear, your lifestyle, your audiometric hearing loss—you won’t be getting the hearing help you need. In addition to the knowledge the Doctor of Audiology can provide in a professional appointment, there are so many other aspects of hearing health that need to be addressed when you get hearing aids: - Diagnosis: Before ever discussing hearing aids with you, Doctors of Audiology perform extensive testing to determine the root cause of your hearing problems. In some instances, hearing problems can be easily fixed, such as removing a build-up of earwax from the ear. Without a doctor’s diagnosis, you could be scammed into paying for a hearing aid online that you do not need. - Programming: Hearing aids are not just volume controls. Hearing aids have to be specifically programmed to help you hear the sounds you are missing. Without a comprehensive test, even the best hearing aids can’t help you because they won’t be programmed to your needs. - Fit: The fit of the hearing aids has to be customized to you. If you buy online, there is no guarantee that the hearing aids will fit your ears. - Repairs: Hearing aids can, and do break, just like any piece of technology. When this happens, it’s important to have a professional nearby to help you with issues. So are you really getting a bargain online? Is it really convenient if you aren’t hearing your best? I’ll let you be the judge. The Doctors of Audiology at the Hearing Health Center are here for you— we look forward to evaluating your hearing and balance problems. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Untreated Hearing Loss and Dementia](https://hearinghealthcenter.com/hearing-issues/untreated-hearing-loss-and-dementia/) **Published:** October 15, 2017 **Author:** Ronna Fisher **Content:** ## The following article appeared on betterhearing.org on October 11, 2013. Read on to get more information on how hearing loss and dementia are related. ## Dementia-Hearing Loss Link Warrants Routine Hearing Checks, BHI Stresses for National Alzheimer’s Disease Awareness Month Washington, DC, October 10, 2013 – As research showing a link between hearing loss and cognitive function mounts, the Better Hearing Institute is urging people to pay close attention to their hearing and take a confidential online hearing check at www.hearingcheck.org in recognition of National Alzheimer’s Disease Awareness Month in November. BHI is raising awareness of the relationship between hearing loss and dementia, and is underscoring the importance of addressing hearing loss for the benefit of overall cognitive function. Today, nearly 40 million people in the United States have some degree of hearing loss. While the causality requires further investigation, the increasingly evident link between hearing loss and dementia elevates the urgency of diagnosing and treating hearing loss as soon as possible. A study published earlier this year found that hearing loss is associated with accelerated cognitive decline in older adults. Conducted by Johns Hopkins otologist and epidemiologist Frank Lin, M.D., Ph.D. and other hearing experts, the study found that older adults with hearing loss are more likely to develop problems thinking and remembering than older adults whose hearing is normal. According to a Johns Hopkins press release, volunteers with hearing loss, undergoing repeated cognition tests over six years, had cognitive abilities that declined some 30 to 40 percent faster than in those whose hearing was normal. The researchers also found that the greater the hearing loss, the greater the levels of declining brain function. In a 2011 study, Lin found that seniors with hearing loss are significantly more likely to develop dementia over time than those who retain their hearing. The study also found that the more hearing loss they had, the higher their likelihood of developing dementia. ### Exploring the hearing loss-cognition connection Other studies have shown related findings, including several involving Brandeis University Professor of Neuroscience, Dr. Arthur Wingfield. For many years, Wingfield has been studying cognitive aging and the relationship between memory and hearing acuity. Wingfield and his co-investigators have found that older adults with mild-to-moderate hearing loss performed poorer on cognitive tests than those of the same age who had good hearing. These findings have included a significant interaction between hearing acuity and the level of difficulty listeners experience in cognitively processing linguistic information–which is a higher-level brain activity than simply interpreting the sound. These findings, Wingfield says, suggest that the listener’s hearing ability not only affects their sensory processing of auditory information, but that it also affects higher level linguistic processing. The study participants with hearing loss expended so much cognitive effort on trying to hear accurately, Wingfield concluded, that it diminished their ability to comprehend rapid speech and remember what had been heard. More recently, Wingfield, along with colleagues at the University of Pennsylvania and Washington University in St. Louis, used MRI to look at the effect that hearing loss has on both brain activity and structure. Their study found that people with poorer hearing had less gray matter in the auditory cortex, a region of the brain that is necessary to support speech comprehension. Wingfield believes that the participants’ hearing loss had a causal role. He and his co-investigators hypothesize that when the sensory stimulation is reduced due to hearing loss, corresponding areas of the brain reorganize their activity as a result. “The sharpness of an individual’s hearing has cascading consequences for various aspects of cognitive function,” said Wingfield. “We are only just beginning to understand how far-reaching these consequences are.” “Even if you have just a mild hearing loss that is not being treated, you have to put in so much effort just to perceive and understand what is being said that you divert resources away from what you would ordinarily use to store what you have heard in your memory,” Wingfield continued. “Cognitive load increases significantly.” As people move through middle age and their later years, Wingfield suggested, it is reasonable for them to get their hearing tested annually. If there is a hearing loss, it is best to take it seriously and treat it. For more information on Alzheimer’s disease and National Alzheimer’s Disease Awareness Month, visit the Alzheimer’s Association at [www.alz.org](http://www.alz.org/). ### Hearing aids can benefit people with Alzheimer’s disease and hearing loss–and their caregivers BHI reminds people with Alzheimer’s disease and their caregivers that hearing health is an important factor in their quality of life. The ability to communicate with the help of hearing aids can help enhance quality of life for individuals with Alzheimer’s and their caregivers. BHI advocates that hearing checks, hearing healthcare, and hearing aids when appropriate be included in the regimen of care for people with Alzheimer’s disease. Identification and remediation of hearing loss prior to the evaluation of dementia also can help ensure a more accurate medical evaluation. BHI advocates that a comprehensive hearing examination and hearing healthcare be part of the diagnostic process. For information about the 10 Early Signs and Symptoms of Alzheimer’s, visit [www.alz.org/10signs](https://alz.org/10-signs-symptoms-alzheimers-dementia.asp "www.alz.org/10signs"). Click here to read the full article at [betterhearing.org](http://betterhearing.org/press/news/National_Alzheimer's_Disease_Awareness_Month_2013_pr101013.cfm "Alzheimers Disease Awareness Month")! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues --- ### [How Hearing Loss Affects Your Family](https://hearinghealthcenter.com/hearing-issues/how-hearing-loss-affects-your-family/) **Published:** March 12, 2018 **Author:** Ronna Fisher **Content:** The hearing loss of one family member affects the whole family. I not only see how it affects my patients and their families, but I also lived it when my grandfather moved in with us. Here is my story. The day my grandfather moved in with us was the day my grandmother unexpectedly died. We were all grieving and going through some terrible days. One thing we as a family did not realize when taking in our grandfather was his hearing loss. Our grandmother was his hearing aid. She would repeat, spell, write, and go right up to him to converse. We had watched this for years but none of us really understood the enormous impact it would make on us. She lived like this for years, with us drifting from conversing with him to just conversing with her and never even saw it happening. Talking to him was difficult and frustrating. Repeating ourselves was a constant and sometimes we would just stop talking all together. We could not have a normal dinner. We would talk around him then have to yell at him to catch him up with what he missed. He would interject with off the topic remarks or just ignore us completely. Our family had two televisions in the family room; one for him with headphones that he would crank all the way up and the other one for us at a normal volume. My grandfather would wake up before us in the morning and not realize how loud he was in the kitchen, banging pans and cupboards, which would frustrate the whole family. He could not answer the phone at a comfortable volume, which would then blow our ears out if we picked up the phone after him because he adjusted the volume all the way up. These are just some of the little things that affected not only him, but the whole family. After he got hearing instruments, our daily life changed completely. He heard little sounds and knew when people were coming up behind him. He wasn’t as loud in the morning. He could answer the phone and make phone calls, which he rarely did before! At dinner, he actually participated and we all enjoyed conversation and dinner. Our relationship went from frustrating and annoying to comfortable and enjoyable! Life became what it should have been all along…happy! This is just one story. There are many other stories just like this out there that have gotten the help they need to change their whole family dynamic around. Don’t waste precious time being frustrated not being able to talk comfortably to your loved one. Stop repeating to each other. We only had a little less than two years with my grandpa living with us before he passed away. But it was two beautiful years finally getting to know him without the frustration of his hearing loss. It was well worth it! *– story shared by [Dr. Kara Houston](https://hearinghealthcenter.com/audiologist-chicago-hearing-health-centers/ "Dr. Kara Houston, Au.D., CCC-A")* ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Communication Issues, Hearing Issues --- ### [Paying it Forward](https://hearinghealthcenter.com/fisher-foundation/paying-forward-video/) **Published:** February 21, 2018 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [Hearing Loss & Cancer Treatment: Walter Jacobson interviews Dr. Ronna Fisher](https://hearinghealthcenter.com/ask-the-audiologist/hearing-loss-cancer-treatment-walter-jacobson-interviews-dr-ronna-fisher/) **Published:** March 22, 2018 **Author:** Ronna Fisher **Excerpt:** Walter Jacobson interview Dr. Ronna Fisher, founder of the Hearing Health Centers in Chicago and the Fisher Foundation for Hearing on hearing loss and cancer treatment. Visit www.fisherfoundationforhearing.org to learn more. **Content:** Walter Jacobson interview Dr. Ronna Fisher, founder of the Hearing Health Centers in Chicago and the Fisher Foundation for Hearing on hearing loss and cancer treatment. Visit www.fisherfoundationforhearing.org to learn more. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [Can Eating Certain Foods Help Improve Your Hearing?](https://hearinghealthcenter.com/ask-the-audiologist/can-eating-certain-foods-help-improve-your-hearing/) **Published:** April 6, 2018 **Author:** Ronna Fisher **Content:** #### Have you ever wondered if there are foods you can eat to help improve your hearing? Read on! *by Ali Marquess, Audiology Technician* Recent studies have shown the correlation of magnesium intake along with antioxidants may prevent hearing loss due to noise exposure and even genetics. At the University of Michigan Kresge Hearing Research Center, two studies focused on just this. A drug cocktail of Vitamins A, C, and E mixed with magnesium, slowed down hereditary deafness in mice with a specific genetic mutation (connexin 26 gene deletion) that is known to cause genetic hearing loss in humans. A very similar cocktail was given to guinea pigs prior to noise exposure and they found the combination of the four micronutrients blocked about 80 percent of the noise-induced hearing impairment. This has since been brought to human trials on military bases in Spain and Sweden. Specifically given to a military population because statistics show that one-third of returning soldiers fighting in Afghanistan and Iraq cannot be redeployed specifically because of hearing impairment, likely caused by noise exposure. These studies are still ongoing in human populations. **As for right now, [Audiologists](https://hearinghealthcenter.com), researchers, and other medical professionals suggest eating a well-balanced diet with Vitamins, minerals and antioxidants specifically in mind to keep your hearing and overall health in good standing.** --- **![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Egg-150x150-1.jpg "- Hearing Health Center")Vitamin A** is a fat-soluble vitamin that is important for normal vision, immune system, proper organ function and reproduction. There is a lot of research showing a link between lack of Vitamin A and hearing loss, and a correlation between high levels of Vitamin A and better hearing. **Foods:** Beef liver, carrots, sweet potatoes, kale, spinach, apricots, broccoli, butter, eggs and squash. [Click here for a list of correlation.](http://knowledgeofhealth.com/lack-of-vitamin-a-may-be-overlooked-root-of-tinnitus-and-hearing-loss/) --- **Vitamin B-12** keeps the nerve and blood cells healthy, and also assist in making DNA. B-12 deficient people are more at risk for tinnitus (ringing in the ears), noise-induced [hearing loss](https://hearinghealthcenter.com), and possibly presbycusis (age-related hearing loss) especially combined with low folate levels. **Foods:** meat, poultry, dairy. Beef liver, salmon, sardines and clams are specifically high in B12. Animal products are the only source to get B12 naturally. If you are vegetarian/vegan, try a supplement. --- **![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Oranges-150x150-1.jpg "- Hearing Health Center")** **Vitamin C** is an antioxidant found in most fruits and vegetables. It is helpful in providing a strong immune system, fighting off infections (like those of the middle ear) and preventing damage to the hair cells within the cochlea (inner ear). **Foods:** oranges, strawberries, pineapple, mango, Brussels sprouts, bell peppers, kiwi, and broccoli. --- **Vitamin D** is primarily responsible for bone health. A vitamin D deficiency can cause osteopenia (bone loss) and otosclerosis (abnormal bone growth/calcification) in the bones of the middle ear, which can lead to hearing loss and deafness. **Foods:** fatty fish like tuna, mackerel and salmon, dairy products, fortified foods, beef liver, cheese, and egg yolks. --- **![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Avocado-640x405-1.jpeg "- Hearing Health Center")** **Vitamin E** has antioxidant properties and improves circulation. This is said to be beneficial for the hair cells in the inner ear (cochlea). Also- your entire body! **Foods:** Almonds, spinach, sweet potato, avocado, wheat germ, sunflower seeds --- **Magnesium** regulates muscle and nerve function, blood sugar levels, and blood pressure. It also makes protein, bone and DNA. Magnesium also regulates glutamate, which is a neurotransmitter produced in the inner ear/hair cells. Those who are magnesium are more likely to develop tinnitus. **Foods:** Dark chocolate, nuts, avocados, tofu, seeds, whole grains and some fatty fish. --- **![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Banana-640x405-1.jpeg "- Hearing Health Center")Potassium** is an electrolyte that conducts electricity in the body in conjunction with sodium, chloride, calcium and magnesium. Potassium is one of the fluids present in the inner ear. Regulating this electrolyte can help keep potassium levels high in the inner ear, which tends to drop off with age. This is one of the leading causes in presbycusis (Age related hearing loss) **Foods:** potatoes, spinach, lima beans, tomatoes, raisins, apricots, bananas, melons, oranges, yogurt and low-fat milk. --- Sources: Bill Sardithe Vitamin Supplement Answer Man.” Knowledge of Health RSS, knowledgeofhealth.com/lack-of-vitamin-a-may-be-overlooked-root-of-tinnitus-and-hearing-loss/. “Can Vitamins and Minerals Prevent Hearing Loss?” Can Vitamins and Minerals Prevent Hearing Loss? | Michigan Medicine, 10 Nov. 2008, www.uofmhealth.org/news/824vitamins-and-minerals-prevent-hearing-loss. 1. Windsor, Amie. “Foods That Boost Hearing Health: The Power of Vitamins.” Healthy Hearing, 14 Mar. 2016, [www.healthyhearing.com/report/51182-Foods-that-boost-hearing-health-the-power-of-vitamins.](http://www.healthyhearing.com/report/51182-Foods-that-boost-hearing-health-the-power-of-vitamins) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [The Fisher Foundation featured on The Jam](https://hearinghealthcenter.com/fisher-foundation/the-fisher-foundation-featured-on-the-jam/) **Published:** May 4, 2018 **Author:** Ronna Fisher **Content:** ##### We are proud to partner with the **[Fisher Foundation for Hearing Health Care](http://fisherfoundationforhearing.org/)** to provide hearing aids to those in need. Click below to see the recent coverage on WCIU’s The Jam! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation --- ### [Dexterity and Hearing Aids](https://hearinghealthcenter.com/hearing-aids/dexterity-and-hearing-aids/) **Published:** May 16, 2018 **Author:** Ronna Fisher **Content:** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/side-view-portrait-of-a-senior-woman-inserting-a-hearing-aid-in-her-ear-against-grey-background-modern-hearing-aid-for-old-people_rTet1v84tl-300x300-1.jpg "- Hearing Health Center") It can be frustrating to physically handle and manipulate hearing aids for someone who has poor dexterity. Fortunately, recent technology in hearing aids has made this much easier! First, there is the [Lyric hearing aid](https://hearinghealthcenter.com/hearing-aids-chicago/). The audiologist inserts the Lyric hearing aid in the office; there is absolutely NO maintenance required by the patient. The user does not have to remove the Lyric, put it in the ear, clean the hearing aid, or change batteries! For someone with limited dexterity, the Lyric can be the perfect solution! There are many [styles of hearing aids](https://hearinghealthcenter.com/hearing-aids-chicago/), some of which are easier to insert in the ear than others. [Custom in-the-ear hearing aids](https://hearinghealthcenter.com/hearing-aids-chicago/) tend to be easier for many patients to insert. They can come with a large battery, making it easier to handle. Changing batteries in a hearing aid can be time-consuming and inconvenient. In the past, there was no way around changing a battery when using a hearing aid. Now, almost all manufacturers have a rechargeable option that eliminates the need to change batteries. There are many solutions to help make wearing a hearing aid easier for individuals with limited dexterity. It is important that you discuss these options with your hearing care professional. If you would like more information, please contact us! *-Dr. Jaclyn Riel, Au.D., CCC-A* ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids --- ### [Dr. Ronna Fisher selected as a Highland Park "Heart-Led Leader"](https://hearinghealthcenter.com/news-press/dr-ronna-fisher-selected-as-a-highland-park-heart-led-leader/) **Published:** May 29, 2018 **Author:** Ronna Fisher **Content:** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/Heart-Led-Leaders-Photo-806x360-1.png "- Hearing Health Center") #### *GROUP HONORED FOR “LEADING WITH THEIR HEART”* Chamber of Commerce honors Highland Park business and community leaders for “building communal values and taking time to kindle a collective optimism in the lives of their neighbors.” Story appears in the Highland Park Chamber’s 2018 [Community Guide.](https://www.yumpu.com/en/document/view/60001042/hpcg-2018proof) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [Hearing Loss: How Loud is Too Loud?](https://hearinghealthcenter.com/ask-the-audiologist/how-loud-is-too-loud/) **Published:** July 1, 2018 **Author:** Ronna Fisher **Content:** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/chicago-815470_640-300x201-1.jpg "chicago-815470_640-300x201 - Hearing Health Center")Our world has become increasingly loud in the past 20 years; think *cars, trains, subways, and the general hum of the city life.* Our exposure to these sounds alone is most likely not enough to be considered a hazard to our hearing, but they do influence how we listen to other mediums which may be a danger to our hearing. Since the turn of the century, our access to sound has increased; *personal music players and blue tooth headsets.* We have really taken our access to sound “on-the-go” into what could be a 24/7 experience. The ability to listen to music on your walk to work or during a workout is fun and exciting, and the ability to make a phone call while grocery shopping or multi-tasking is surely convenient- but I have to wonder…where is your volume set? Most personal headsets are offered of a generic fit of “one size fits all”. The problem with this non-custom fit model is that it allows room for acoustic leakage, which means that sound is able to leak in and out through the cracks. If ambient sound is leaking in, the result is an increase in volume so that we can hear our phone call or music over the background noise. **This is where we go from loud to TOO LOUD.** The best thing that you can do to avoid hearing loss due to exposure to loud sound from your headphones is to purchase custom-fit sleeves for your ear-buds. A mold of your ear canal, taken by an Audiologist, will be used to create a soft custom piece that will fit right over your ear-bud, giving you the isolation from the ambient sound that you need in order to **turn the volume down**. ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/music-791631_640-300x200-1.jpg "music-791631_640-300x200 - Hearing Health Center")A good rule of thumb is the 80% rule; always keep the volume at no more than 80% of full on volume. In addition to keeping your ears safe, you always want to be able to hear other things going on around you, and never want someone from the other end of the bus to be able to know exactly what song you’re listening to. And when in doubt, consult your Audiologist!! We are here to help! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [“You’ve Let Me Keep Doing What I Love.”](https://hearinghealthcenter.com/testimonial/youve-let-me-keep-doing-what-i-love/) **Published:** July 17, 2018 **Author:** Ronna Fisher **Excerpt:** Roger Daltrey, lead singer of the iconic rock group, The Who, said, “Dr. Ronna Fisher, at Hearing Health Center, is the only person I trust with my hearing.” Near the end of Monday night’s performance of the rock opera, Tommy, at Ravinia Festival, Daltrey talked about the struggles with his hearing. “Do yourself a favor, he told the standing ovation crowd, go get your hearing checked. It’s more important than you know.” **Content:**  Roger Daltrey, lead singer of the iconic rock group, The Who, said, “Dr. Ronna Fisher, at Hearing Health Center, is the only person I trust with my hearing.” Near the end of Monday night’s performance of the rock opera, Tommy, at Ravinia Festival, Daltrey talked about the struggles with his hearing. “Do yourself a favor, he told the standing ovation crowd, go get your hearing checked. It’s more important than you know.” ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Testimonial, Video --- ### [Hearing Health and Rheumatoid Arthritis](https://hearinghealthcenter.com/hearing-issues/hearing-health-and-rheumatoid-arthritis/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** **Rheumatoid Arthritis** is a chromic autoimmune disease that causes the immune system to attack healthy tissues. The result is inflammation, pain, deformity of the affected areas and stiffness in the joints. Astudy conducted by the Arthritis Foundation found an overwhelming connection between rheumatoid arthritis and hearing loss, with a 42.7% correlation. Hearing loss is the most common health-related issue, with up to 72% prevalence in rheumatoid arthritis (*The Open Rheumatology Journal, Jan. 2016*) **THE LINK** Rheumatoid Arthritis is associated with many other diseases that are also known to adversely affect hearing such as cardiovascular disease, osteoporosis and kidney dysfunction. Another link between rheumatoid arthritis and hearing loss is medications. Many medications are known to cause hearing loss. Ibuprofen and acetaminophen, which is often used to manage the pain of R.A., can cause hearing problems. A 2012 study, published in the American Journal of Epidemiology, showed that taking these pain medications six or seven times a week increased the risk of hearing loss by 24%. These painkillers, such as Advil, Motrin or Tylenol restrict blood flow to the inner ear. Blood carries oxygen and other nutrients throughout the body, so when less blood reaches the ear, the cells become damaged, resulting in loss of hearing. **What you can do** Get a baseline hearing test now. If you have rheumatoid arthritis, your medications should be reviewed and your hearing monitored regularly for any associative changes. ![RONNA-2017-HEADSHOT](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg) Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues --- ### [Hearing Health and Its Impacts on Heart Health](https://hearinghealthcenter.com/hearing-issues/hearing-health-and-its-impacts-on-heart-health/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** **A study conducted by Harvard University found an overwhelming relation between heart disease and hearing loss.** “Hearing loss has occurred 54% more often in people with heart disease than in the general population.” Heart disease can be caused by problems with blood flow and blood vessels. It often results from plaque build-up on the arteries (atherosclerosis) which makes it difficult for blood to flow through the veins, arteries, vessels and bodily organs – especially the inner ear. Hearing loss is not only the consequence of ineadequate blood flow to the auditory system. Recent research (*Hull RH, Kerschen SR, The influence of cardiovascular health on peripheral and central auditory function in adults: a research review. AmerJournAud 2010;19(1):9-6.* shows corresponding damage to the brainstem and auditory pathways resulting in difficulties processing, decoding and understanding speech. **THE LINK** The inner ear is extremely sensitive to blood flow. Inadequate blood flow and blood vessel trauma damages the nerves of the inner ear. Hearing loss could be an early, in fact the first, warning sign of an impending heart attack or stroke. The nerves of the inner ear are so sensitive and fragile that Harvard researchers concluded the ear might be the first organ to feel the effects of **[cardiovascular disease](https://hearinghealthcenter.com/blog/the-link-between-heart-issues-and-hearing-loss/).** They stated that if blow flow is inadequate. The nerves of the inner ear are so sensitive that hearing loss can be an early warning sign of impending cardiovascular disease. **WHAT YOU CAN DO** [**Get a baseline hearing test now.**](https://hearinghealthcenter.com/make-an-appointment/) If you are receiving treatment for cardiovascular disease, monitor your hearing regularly for any changes. ![RONNA-2017-HEADSHOT](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg) Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Issues --- ### [Your Hearing Health and Medical Care](https://hearinghealthcenter.com/hearing-health/your-hearing-health-and-medical-care/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** #### **Falls and Balance** **Hospitals and doctors’ offices nationwide might have avoided nearly 2000 patient deaths and thousands more emergency room visits if medical staff and patients communicated better.** Those with hearing loss misunderstand over 50% of instructions given by physicians and health providers. According to a recent report published in the journal JAMA, there is a significant breakdown in communication with patients over 60. Patients describe not understanding therapeutic instructions, medication dosages or side effects which can lead to a myriad of other **[health issues](\"https://hearinghealthcenter.com/blog/the-link-between-heart-issues-and-hearing-loss/\")** and **[risks](\"https://hearinghealthcenter.com/blog/untreated-hearing-loss-and-dementia/\").** **THE LINK** **In hospitals and many medical care settings there is often competing noise in the background.** Patients are often nervous and already stressed about their medical condition and the content is often extremely technical and unfamiliar. Those with hearing loss rely on lip-reading, facial expressions and visual cues when communicating. Hospitals and physician offices now require electronic medical records. Doctors and medical staff spend the majority of time typing notes into a computer thereby eliminating face-to-face doctor-patient communication. **WHAT YOU CAN DO** **[Get a hearing test now](\"https://hearinghealthcenter.com/make-an-appointment/\").** If your hearing is even slightly diminished, get treatment immediately to improve your clarity and ability to understand and communicate. Ask for as many repetitions as needed to comprehend physician instructions. Ask your doctors and care providers to stop typing and look at you when they speak. Your health and life are of paramount importance, protect yourself by being your own best advocate. **Your hearing, processing, clarity and ability to understand speech are vital to your happiness, your relationships and your enjoyment of life.** **[Your hearing ability and your hearing health are a direct link to your overall health and wellness.](\"https://hearinghealthcenter.com/blog/cognitive-function-and-hearing-2/\")** **Do not wait until you have a problem.** By the time you realize you have a problem with your hearing, irreversible damage to your brain has already occurred and may be too late to reverse or repair[. ](\"https://hearinghealthcenter.com/make-an-appointment/\")**[Get your hearing checked regularly](\"https://hearinghealthcenter.com/make-an-appointment/\").** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg "RONNA-2017-HEADSHOT") Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health --- ### [Your Hearing and Medications](https://hearinghealthcenter.com/hearing-health/your-hearing-and-medications/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** #### **Medications** According to the Government Accountability Office, only 1 to 10% of all adverse side effects are reported to the FDA. **In a case of notable regulatory short-sightedness,** drug companies are only required to report adverse effects they deem “statistically significant.” Many medications cause hearing loss, tinnitus (ringing in the ears), cognitive disorders and memory loss. These adverse reactions are not listed in the manufacturer’s “warnings of adverse side effects.” **THE LINK** **It is well known that drugs and treatment that save the lives of patients with cancer cause permanent and irreversible hearing loss.** It is also known that many antibiotics and pain relieving, anti-inflammatory drugs (aspirin, Motrin, NSAIDs) damage the auditory system. It is less well known and rarely acknowledged, that drugs such as Viagra and other erectile dysfunction drugs directly affect hearing. In addition, diuretics used to treat high blood pressure and heart failure, statin medications to lower cholesterol and even many over-the-counter and herbal medications can cause hearing loss, balance disorders and severe tinnitus. **WHAT YOU CAN DO** [**Get a baseline hearing test now**](\"https://hearinghealthcenter.com/make-an-appointment/\")**. Bring a comprehensive list of the medications that you are taking. If you are associated with hearing, balance, tinnitus or dizziness, your audiologist will contact your doctor to discuss alternative medications that are not ototoxic.** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg "RONNA-2017-HEADSHOT") Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health --- ### [Your Hearing and Your Health](https://hearinghealthcenter.com/hearing-health/your-hearing-and-your-health/) **Published:** February 14, 2019 **Author:** Ronna Fisher **Content:** Helen Keller said, “Blindness cuts us off from things, but the loss of the most vital stimulus – the sound of the voice – is much worse.” Remaining healthy has become a focus, even an obsession with Americans, particularly with baby boomers. Health issues do not happen in a vacuum; your body needs every sense for it to properly operate. Hearing health is of paramount importance to long term brain and heart health. **Prevention and early detection** with regular heart, blood pressure, cholesterol, colon, liver, skin and every type of screening has become near-mandatory in today’s age. We want to live longer and make the most of our lives through remaining active which allows us to stay engaged with friends and loved ones, travel and partake in our favorite pastimes. **Yet we totally disregard** our number one form of communication, engagement and way of maintaining relationships. We ignore our hearing. Doctors rarely screen for hearing disorders or even think to ask about a patient’s hearing health. Difficultly with hearing and understanding are rarely a problem, or evident, in quiet environments or when communicating face-to-face. “It’s not that bad” is what every audiologist has heard countless times. **All over the world, the one common element** that brings happiness and joy is being with the people you care about and love. All over the world, sharing, laughing, telling stories and relating memories brings the greatest pleasure, warmth and feelings of love. **When your ability to hear and understand** the spoken word diminishes, so do yours enjoyment of the things you love doing, the people you love being with and **[your ability to achieve happiness.](\"https://hearinghealthcenter.com/blog/youve-let-me-keep-doing-what-i-love/\")** **If that is not enough reason to get a hearing checkup** immediately, the **[findings of every study](\"https://hearinghealthcenter.com/blog/the-link-between-heart-issues-and-hearing-loss/\")** in the last fifteen years should motivate you to run to your nearest audiologist. ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2018/09/RONNA-2017-HEADSHOT.jpg "RONNA-2017-HEADSHOT") Dr. Ronna Fisher, Au.D. Founder & President Hearing Health Center, Inc. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health --- ### [Hearing-Impaired Workers Find a Home at Starbucks](https://hearinghealthcenter.com/news-press/hearing-impaired-workers-find-a-home-at-starbucks/) **Published:** March 1, 2019 **Author:** Ronna Fisher **Content:** Everyone feels happier and more comfortable when they are recognized by their environment for their individuality, which is why Starbucks’ new location is so important. This location is not just another coffee shop in Washington D.C. It may be another Starbucks, but the sign is spelled S-T-A-R-B-U-C-K-S in the hand symbols for American Sign Language (ASL). The stores is run by 24 deaf, hard-of-hearing and hearing employees and the store is designed towards accessibility and generating employment prospects for the deaf community. In addition to the workers, the store has been specifically modeled to celebrate deaf culture. One wall is covered by a mural by Tiqiao Wang, a deaf artist who is a prominent member of the Gallaudet University faculty, which is just blocks away. While exclusively employing staff who are all conversant in ASL, their focus on accessibility of technology and service is unparalleled. The store was modeled to maximize natural lighting and lines of sight, keeping in mind the needs of the hard-of-hearing. Adam Novsam, a Starbucks utility analyst, was given a tour two nights before the store was set to open. As he walked down H Street to see the vibrant colors of the mural which celebrates deaf culture, he said, “The vibrancy moved me. It made me stop in my tracks. And it gave me tears.” For the full story, click [here](\"https://www.washingtonpost.com/business/2018/10/23/starbucks-opens-first-us-sign-language-store-with-murals-tech-pads-fingerspelling/?noredirect=on&utm_term=.f003297ee632\"). ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2019/03/Picture1.jpg "Picture1")Employees take an order at Starbucks first U.S. signing in D.C. (Joshua Trujillo/Starbucks) ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** HHC News --- ### [Rechargeable Hearing Aids. Should You or Shouldn’t You?](https://hearinghealthcenter.com/ask-the-audiologist/rechargeable-hearing-aids-should-you-or-shouldnt-you/) **Published:** March 4, 2019 **Author:** Ronna Fisher **Content:** JUST AS TECHNOLOGY IN HEARING AIDS CHANGE, HEARING AID BATTERY TECHNOLOGY IS ALSO CHANGING. HERE IS WHAT IS AVAILABLE AND SOME THINGS TO CONSIDER ### TYPES OF BATTERIES REGULAR, DISPOSABLE ZINC-AIR BATTERIES Zinc-air hearing aid batteries are the traditional, pull-tab disposable batteries most frequently used in hearing aids. When the tab is pulled, the oxygen from the air oxidizes with the zinc in the battery and creates a charge. #### **ZINC-AIR BATTERIES** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2019/03/Picture1-500x360.png "Picture1") 1. Batteries are color-coded. Regardless of the manufacturer (Ray o vac, Duracell, Energizer, etc.), the color corresponding to the battery size is the same. 2. All size 10 batteries (the smallest hearing aid battery) are yellow and last between 3-5 days. 3. All size 312 batteries are brown and last between 5-8 days. 4. All size 13 batteries are orange and last between 10-14 days. 5. All size 675 batteries (rarely used today) are blue. 6. After pulling the tab, you should wait 2-5 minutes before putting the battery in the hearing aid to allow time for oxygen to react with the zinc for the fullest charge and longest battery life. #### **RECHARGEABLE HEARING AID BATTERIES** Rechargeable hearing aids have been around for over 30 years, but they were never very popular because the charge did not last all day. Two new battery technologies in the last 18 months fixed that problem and rechargeable hearing aids are now all the rage. Every major manufacturer offers rechargeable hearing aid options. **LITHIUM- ION BATTERY TECHNOLOGY** – all lithium-ion batteries (also used in computers, cell phones, even Tesla’s) are totally sealed (encased) in any device for safety reasons. They can be a fire hazard if mishandled or damaged. **PROS OF LITHIUM-ION RECHARGEABLE HEARING AIDS** 1. Eliminates expense of disposable batteries. 2. No hassle of changing batteries every 3-7 days. 3. Last battery life. Lasts 4 to 5 years. 4. Gets the longest usage with one charge – 30 hours per charge and/or 24 hours of continuous use with 5 hours of streaming. 5. Better moisture protection- water and perspiration problems are greatly reduced. **CONS OF LITHIUM-ION RECHARGEABLE HEARING AIDS** 1. The hearing aids are slightly larger and heavier 2. No access to the battery compartment. You cannot use regular, disposable, batteries in an emergency. 3. You must take the charger with you on trips and vacations 4. Power limitations – if you stream phone calls and music a lot, the charge may not last all day. Streaming uses a lot of power. 5. Your hearing aids are “out of commission” when they are being charged, and any problems with the battery require manufacturer repair. #### **SILVER ZINC RECHARGEABLE HEARING AIDS** **PROS OF SILVER ZINC RECHARGEABLE HEARING AIDS** 1. Eliminates expense of disposable batteries. However, the cost of the hearing aid is slightly more expensive (They pretty much cancel each other out). 2. No hassle of changing batteries every 3-7 days. 3. 24 hours of continuous use with up to 5 hours of streaming. 4. Flexibility – Because they are removable, the rechargeable battery can be replaced with regular, disposable hearing aid batteries in an emergency, you do not want to carry your charger with you and/or forget your charger at home. 5. Silver-zinc is no- flammable, non- toxic and 100% recyclable. 6. Silver-zinc is smaller than lithium-ion. Hearing aids are slightly smaller and lighter. 7. Backwards Compatibility – Many manufacturer’s hearing aids can be changed or retrofit since the rechargeable component is in the battery door. **CONS OF SILVER-ZINC RECHARGEABLE HEARING AIDS** 1. Battery must be replaced once a year (replacement cost of rechargeable battery is about the same as purchasing disposable batteries) 2. Power limitations – if you stream a lot of phone calls and music, the batteries may not last the full 24-hour day. There is a lot to think about when it comes to rechargeable hearing aids. Both systems has its pros and cons. Just like with the style, technology, features and benefits of hearing aids, it is about what is right for you. **Your hearing care provider should be knowledgeable and familiar with every type of hearing aid available and know *your* lifestyle, hearing needs and *you*.** ![hearing health center](http://new.hearinghealthcenter.com/wp-content/uploads/2019/03/Picture2.png "Picture2") ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [Hearing Aids Are Not a One-Shot Deal](https://hearinghealthcenter.com/ask-the-audiologist/hearing-aids-are-not-a-one-shot-deal/) **Published:** April 23, 2019 **Author:** Ronna Fisher **Content:** Most hearing aid users know that their hearing health, treatment, and their hearing aids are crucial. In fact, they probably see their doctor of Audiology more often than any other health care provider. They understand that their hearing capacity and their ability to understand and process speech is critical for effective communication and enjoyment. First time hearing aid wearers do not realize that hearing aids can require multiple adjustments to obtain the best settings and the right sound for them. Custom hearing aids, especially the tiny, invisible ones, are often re-made several times for fit and comfort. Hearing aids require maintenance, [regular cleaning](https://hearinghealthcenter.com/blog/how-to-care-for-your-hearing-aids-in-the-summer/) and sometimes repairs. Hearing aids reside in a wax- filled, sweaty, oily and moist environment all day and expected to perform optimally all the time. Hearing levels, processing ability, and prescriptions change. Yearly monitoring, reprogramming, and fine- tuning of your hearing aids are critical to your ability to communicate. You are not “done” after you get your hearing aids. Just like with your internist, dentist, and ophthalmologist, your hearing care is ongoing and forever. #### **BENEFITS vs. DISCOUNTS** - **Benefit** (definition) – An advantage or profit gained. A payment or gift. - **Discount** (definition) – A deduction from the usual cost of something. “Benefits are far more reliable than perks or discounts and cover more basic needs. Perks are like bonuses that companies offer to make their offer seem better than the competition.” Many insurance Companies and Medicare supplement policies lure new members by offering “hearing aid benefits.” Are they really offering you a “benefit?” NO! The insurance Company is actually offering a perk that doesn’t cost them a penny. You, the member, get a discount on hearing aids if you call the 800-number to a 3rd party broker. The 3rd party broker rakes in a fortune from the referrals. #### **PROS AND CONS OF BUYING YOUR HEARING AIDS FROM A BROKER** **PROS** 1. You get a discount on the purchase of your hearing aids. 2. You can sometimes get them from your provider of choice. 3. You can save money upfront on the purchase of your hearing aids. **CONS** 1. You are not purchasing your hearing aids or hearing treatment from your provider. 2. The broker pays your provider a set fee for your initial consultation, delivery and fitting your hearing aids, and one or two follow up visits, even one year. 3. Restrictions and limitations – Number of visits or specified time are included in your purchase. Thereafter, you pay the provider every time you walk in the door for an office visit. Every 6-month cleaning, annual monitoring, in-office repair, fed-ex shipping and handling to the manufacturer, adjustment, reprogramming, and fine-tuning. 4. All of the restrictions and limitations are included with your hearing aid purchase from your provider. One or two re-programming charges alone may exceed your initial savings. #### **PROS AND CONS OF BUYING YOUR HEARING AIDS FROM A BROKER** Your insurance policy or supplement may have an agreement with any one of the numbers of 3rd party brokers of hearing aids. They all have different prices and limitations in the fine print. We know them all. **Before calling the 800 number and saying “yes,” *call* us** and let us help you on your journey to better hearing. Click here to schedule an [appointment](https://hearinghealthcenter.com/make-an-appointment/). ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids, Hearing Issues --- ### [If we seem a little smarter about new hearing technologies next time you come in, here’s why.](https://hearinghealthcenter.com/ask-the-audiologist/new-hearing-technologies-continuing-education/) **Published:** September 3, 2019 **Author:** Ronna Fisher **Content:** ![HHC-FamilyPhoto](http://new.hearinghealthcenter.com/wp-content/uploads/2019/09/HHC-FamilyPhoto-1.jpg) # **If we seem a little smarter about new hearing technologies next time you come in, here’s why.** ### Hearing Health Center audiologists learn about new hearing technologies through committed continuing education Several times a year, we close all five offices and everyone gets together for an intense, idea-filled day of **Continuing Education**. Friday, August 23, was one of those days—with a full program of expert speakers, demonstrations and hands-on experience with the newest of the new in Audiology. “We’re in an industry with technical and treatment advances happening continuously and our patients depend on us to be on the cutting-edge of progress at all times,” said Director of Operations Marsela Kole, who was the Event Chairperson. The “next generation” hearing aids from the world’s leading manufacturers garnered profound interest. They provide benefits to wearers that go far beyond hearing quality and clarity that have exceeded all expectations. Patients who have worn hearing aids for years will discover processing power far beyond anything they’ve experienced, letting them understand speech effortlessly in noisy settings—with unwanted sounds suppressed. Features of this new hearing technology include many vital functions for health, safety and information never before associated with hearing aids. The revolutionary devices include ones that monitor brain and body activity, can actually sense if the wearer has fallen and automatically send out alerts to three pre-selected contacts. Others can be serviced via an app, avoiding an office visit, and stream telephone, TV, music and messages directly into the patients’ ears. Marsela Kole said “These days are always a good chance for the teams from each of the offices to get together, compare notes and participate together in group activities. There’s always some fun to be had.” ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist --- ### [Ewww...I Hate My Own Voice](https://hearinghealthcenter.com/ask-the-audiologist/ewwwi-hate-my-own-voice/) **Published:** November 6, 2019 **Author:** Ronna Fisher **Content:** ### Your Voice on a Tape Recorder (or through a Hearing Aid) Did you ever hear your voice on a recording or through a [hearing aid](https://hearinghealthcenter.com/hearing-aids-chicago/)? Bet you didn’t like it. You most likely thought it didn’t sound anything like you. In fact, in a study of subjects listening to recordings of their own voice, along with recordings of 19 unfamiliar voice recordings, only 38% of subjects recognized their own voice. Whether you liked or hated the sound of your voice on a recording that is the “real” sound of your voice. That is the voice others hear when you speak. It is not however, the voice you hear. The sound waves, created when we talk, create vibrations in our vocal cords, the vibrations of our vocal cords, soft tissue, and bones in our head. This makes us sound richer and deeper to ourselves. ### WHAT’S NORMAL? How Your Voice Sounds With a Hearing Aid Nearly everyone that puts on a hearing aid for the first time hates the sound of their voice. After putting on the hearing aids, every audiologist hears, “Ewww, I hate my own voice.” “I sound hollow and like an echo.” “I sound like I’m in a tunnel.” “I sound so raspy.” The response of every audiologist is, “Don’t worry, you’ll get used to it.” That is true. The majority of hearing aid users do quickly get used to, and accept, the sound of their own voice. “Normal” is what you’re used to. You’re used to hearing yourself with a hearing deficit at many of the pitches of speech. Your hearing changed gradually over 15 to 20 years. You didn’t notice that, little by little, your voice changed subtly along with it. Suddenly, in one minute, you’re hearing all of the pitches that took 20 years to lose. It’s shocking. You don’t like it. No one likes it. But really, you do get used to the sound of your voice through [hearing aids](https://hearinghealthcenter.com/hearing-aids-chicago/). Your “new” voice becomes your “new” normal. Unfortunately, it doesn’t happen overnight ### THE GOOD NEWS. Hearing Aids Deliver Faster Adaptation and more immediate relief are on their way. By understanding, and then manipulating, the intricacies and dynamics of sound, hearing aid manufacturers have gone to great lengths to reduce the shock of hearing a new you. Technology really is amazing (when your computer works). ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Aids --- ### [How to Insert or Remove a Lyric Hearing Aid by Dr Ronna Fisher](https://hearinghealthcenter.com/hearing-aids/how-to-insert-or-remove-a-lyric-hearing-aid-by-dr-ronna-fisher/) **Published:** March 24, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [How to Pair Made-for-iPhone Hearing Aids to Your iPhone](https://hearinghealthcenter.com/hearing-aids/how-to-pair-made-for-iphone-hearing-aids-to-your-iphone/) **Published:** March 27, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [Phonak Marvel - How to Change Your Wax Filters](https://hearinghealthcenter.com/hearing-aids/phonak-marvel-how-to-change-your-wax-filters/) **Published:** March 31, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [How to Remove and Replace Your Domes](https://hearinghealthcenter.com/hearing-aids/how-to-remove-and-replace-your-domes/) **Published:** March 31, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [Cleaning Your Hearing Aid Microphone - ITC](https://hearinghealthcenter.com/hearing-aids/cleaning-your-hearing-aid-microphone-itc/) **Published:** April 2, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [We Bring Hearing Back The Fisher Foundation for Hearing Health](https://hearinghealthcenter.com/fisher-foundation/we-bring-hearing-back-the-fisher-foundation-for-hearing-health/) **Published:** April 2, 2020 **Author:** Ronna Fisher **Excerpt:** We Bring Hearing Back **Content:** We Bring Hearing Back ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Fisher Foundation, HHC News, Video --- ### [Quick Tip for Changing Waxguards On Phonak Marvel Hearing Aids](https://hearinghealthcenter.com/hearing-aids/quick-tip-for-changing-waxguards-on-phonak-marvel-hearing-aids/) **Published:** April 9, 2020 **Author:** Ronna Fisher **Content:** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Aids, How To, Video --- ### [“We’re mad as hell and we’re not going to take it anymore.”](https://hearinghealthcenter.com/hearing-issues/boomers-need-hearing-tests/) **Published:** August 16, 2023 **Author:** Ronna Fisher **Content:** ### ![](http://new.hearinghealthcenter.com/wp-content/uploads/2023/08/Baby-boomers-hearing-aid-blog-300x252.jpg)This is the rallying cry from baby boomers all over the country that ruined their hearing going to concerts and listening to loud music. Millions of baby boomers are experiencing the foibles of their youth and suffering the consequences. “My average patient used to be in their late seventies,” said Dr. Ronna Fisher, AuD. Of Hearing Health Center. “Today my average patient is in their early sixties.” Fifty percent of people over the age of sixty have a significant hearing deficit that interferes with their everyday life. Yet, at the same time, some of these baby boomers still perceive hearing problems as an old person’s issue. “They still think, “hearing = old,” and refuse to recognize and admit they have difficulty hearing and understanding,” said Dr. Fisher. “Hearing loss runs in my family,” proclaimed Dr. Fisher, who has been wearing hearing aids since she was fifty. “At first, I used to think, ‘I’m too young to wear hearing aids. Then I realized, I’m too young not to wear hearing aids.” Baby boomers are all about living longer, being more active and communicating their vast knowledge…to their employees, to their children, and anyone else willing to listen to their wisdom. Astute baby boomers understand that communicating is a two-way street. making the rest of their lives the best of their lives. And they’re realizing that it’s all about communicating. ### **Age doesn’t matter. [Book a FREE hearing test today.](https://hearinghealthcenter.com/book-my-hearing-test-appointment/)** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health, Hearing Issues --- ### [It's Not All About You](https://hearinghealthcenter.com/hearing-issues/untreated-hearing-loss-and-your-family/) **Published:** July 17, 2023 **Author:** Ronna Fisher **Content:** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2023/07/Tips-for-Talking-to-Partner-300x188.jpg)You might think your hearing problem only affects you, but your spouse, family, friends, and co-workers might have already had it up to *here*. Untreated hearing problems are a major cause of stress in relationships, especially with those closest to us. Researchers who conducted a qualitative study of couples, where one partner had hearing loss, found that hearing loss produces feelings of frustration, embarrassment, and distress…**especially for the partner without hearing loss.** Day-to-day communication, whether about important matters or trivial, is the cornerstone of a healthy relationship. When communication breaks down, frustration creeps in. Frustration leads to resentment, then to further breakdown in intimacy. Both partners in the study bemoaned the loss of spontaneity, small talk, and sharing small, unexpected incidents. Those small asides, including jokes and humor, bring about shared companionship and reflection. And relationships, especially marriages, experience a significant loss in the absence of that communication. And both partners agreed there had been a meaningful change in the nature and content of their communication because of hearing problems. **EMOTIONS CONNECTED WITH DECREASED HEARING ABILITY** - Frustration - Resentment - Loneliness - Curtailing social activities - Decrease in intimacy, joking, interacting with friends and family. - Decrease in shared activities (even watching TV) - Loss of companionship - Less communication (words are kept to a minimum) ### **TIPS FOR TALKING TO YOUR PARTNER ABOUT THEIR HEARING** - **Tell them it is affecting your relationship.** Your partner might be concerned about the stigma of wearing hearing aids, but saying, “what,” “huh,” “pardon me,” all the time is often irritating to others and frustrating to have to repeat everything. - **Tell them you are concerned for their health**. When hearing loss is left untreated, the speech and language areas of the brain can atrophy, leading to [auditory deprivation ](https://www.healthyhearing.com/report/46306-Hearing-loss-auditory-deprivation)and putting a person at increased risk of [cognitive decline](https://www.healthyhearing.com/report/52904-The-connection-between-hearing-loss-and-cognitive-decline). Early detection and treatment of hearing problems is the number one factor under your control to prevent and delay dementia. - **Tell them you are concerned about your own health**. The additional stress of worrying about your other half’s health and safety can take a physical and emotional toll on your own health. Plus, it is no fun to listen to the TV or stereo when it is cranked up too high, and could be damaging your own hearing, or having to shout or constantly repeat yourself. - **Make an appointment to have your own hearing evaluated** and ask them to go with you. First, it is something you should do anyway. The Alzheimer’s Association recommends everyone over fifty get a baseline hearing evaluation. Secondly, it’s always good to have another set of ears to hear what the [hearing care provider](https://www.healthyhearing.com/hearing-aids) has to say, no matter who that patient is. ### **HOW HEARING AIDS IMPROVE RELATIONSHIPS** ![](http://new.hearinghealthcenter.com/wp-content/uploads/2023/07/Friends-Talking-300x188.jpg)Wearing hearing aids not only improves your hearing, but it also improves your intimate relationships. Opening that extra channel of communication can stimulate conversation and reduce frustration, providing better understanding of one another. #### **They reduce miscommunication.** What was that? Did you say, “answer the phone” or “Sarah is home?” Hearing loss can result in a lot of confusion for the person experiencing it. Mistakes made from mishearing your partner could result in fighting and a decline in overall happiness. Relationships are enough work as it is without factoring in the added burden of hearing loss. A hearing aid is a simple solution to reducing miscommunication and maximizing your hearing potential. #### **They lower frustration and tension** Living with hearing loss requires extra effort. But it requires a lot less effort if you take the available options to improve your hearing. Doing so will not only relieve the stress you experience every day but reduce the stress it places on your loved one. Constant communication is necessary in a relationship, and communication comes much easier when you can hear one another. #### **Hearing aids make it easier to have a real conversation** People with hearing loss tend to withdraw into themselves because conversation becomes embarrassing and difficult. You may not realize it at first, but you are putting distance between yourself and your loved one by avoiding conversation, whether that be in person or on the phone. Hearing aids, which take some getting used to, allow you to engage in conversation and maintain your connection with your partner much better than if you did not wear them. #### **They allow you to tune in to each other** All the extra communication opportunities hearing aids provide you allow you to become better tuned to your partner’s needs. Cohabitation becomes much easier when a couple’s understanding of each other improves. Plus, when your partner sees you trying to improve your hearing condition, they are more likely to put in an effort also. ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Communication Issues, Hearing Issues --- ### [Diabetes & Hearing Loss: What is the link?](https://hearinghealthcenter.com/ask-the-audiologist/diabetes-and-hearing-loss/) **Published:** December 6, 2021 **Author:** Ronna Fisher **Content:** Did you know that 1 in 10 people in the US have diabetes? That’s 34.2 million Americans! Diabetes causes a partial or absolute deficiency of insulin. Insulin is responsible for creating enzymes that break down fat, starches, and sugar in the blood. An increase in blood sugar damages the inner lining of arteries. The body responds by creating plaque on the artery walls which restricts blood flow. ### How does diabetes affect your hearing? This thickening of artery walls affects an area of the inner ear called the stria vascularis, causing it to atrophy and prevent it from doing its job efficiently. The stria vascularis is responsible for controlling the chemical makeup of the inner ear, which allows the hair cells to change mechanical information into electrical information– a key part of how we hear! Some studies show that an abnormal stria vascularis can even cause hair cell death, permanently damaging your hearing. A 2008 study by the National Institutes of Health showed that people with diabetes are twice as likely to have hearing problems. In fact, even the 88 million people in the US with prediabetes have a 30% higher likelihood of having hearing problems. That’s 1 in 3 Americans at an increased risk! ### Get a baseline hearing test if you have diabetes If you or a loved one have diabetes or prediabetes, it is important to have a baseline hearing test. Monitoring your hearing is vital to your overall health. Like diabetes, hearing problems can develop gradually, and early detection is critical. In honor of Diabetes Awareness, Hearing Health Center offers complimentary hearing check-ups at all five locations. **[Click here to book an appointment](https://hearinghealthcenter.com/book-my-hearing-test-appointment/)** ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Ask the Audiologist, Hearing Health --- ### [Dr. Katrina Lapham on Hearing Loss and Dementia](https://hearinghealthcenter.com/video/dr-katrina-lapham-on-hearing-loss-and-dementia/) **Published:** March 11, 2021 **Author:** Ronna Fisher **Excerpt:** Untreated hearing problems are the number one modifiable risk factor for dementia. Even mild levels of hearing loss can double your risk. Dr. Katrina Lapham, an audiologist from Chicago's Hearing Health Center discusses how to join the fight to battle dementia by getting your hearing tested free of charge. Plus, Hearing Health Center will donate $20 to the Alzheimer's Association in your name. It's our way of helping to protect your hearing and preserve your brain. Visit our website to make your appointment today at https://hearinghealthcenter.com/hearing-and-alzheimers/ **Content:** Untreated hearing problems are the number one modifiable risk factor for dementia. Even mild levels of hearing loss can double your risk. Dr. Katrina Lapham, an audiologist from Chicago’s Hearing Health Center discusses how to join the fight to battle dementia by getting your hearing tested free of charge. Plus, Hearing Health Center will donate $20 to the Alzheimer’s Association in your name. It’s our way of helping to protect your hearing and preserve your brain. Visit our website to make your appointment today at https://hearinghealthcenter.com/hearing-and-alzheimers/ ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. [See Full Bio](https://hearinghealthcenter.com/author/ronna/) [ ](https://hearinghealthcenter.com/author/ronna/) **Categories:** Hearing Health, Video --- ### [How to Survive (and enjoy) the Holidays When You Have Trouble Hearing and Understanding](https://hearinghealthcenter.com/ask-the-audiologist/how-to-survive-and-enjoy-holidays-when-you-have-problems-hearing-and-understanding/) **Published:** November 11, 2020 **Author:** Ronna Fisher **Content:** ![Happy Hearing this Holiday Season](http://new.hearinghealthcenter.com/wp-content/uploads/2020/11/happy-holidays-300x300.jpg)It’s been a difficult, trying year – but now the Holidays are here. Hopefully it will be a joyous time to share with your family, and it might be the only time all year you get together with your whole family. Of course, you want to talk to everyone, get to know new additions (spouses, grandkids, and friends), share stories and memories, and laugh. When you have hearing loss, the holidays can be stressful and worrisome. Large dining room tables make conversation difficult. Everyone is talking at once and the football game and music in the background makes it almost impossible for you to participate. You can do several things so you don’t feel left out, and not enjoy yourself. 1. Limit background noise. Ask the host to turn down the TV or music. 2. Try to sit in the middle of the table. 3. Take breaks. Listening and concentrating so intently is exhausting. Go outside, find a quiet spot, and give your ears and your brain a rest. Then you will be ready for more socializing. 4. Bring your humor. Forget being embarrassed. So what if you say the wrong thing or answer incorrectly. Laugh at the mis-hearings. They can be hilarious. 5. Wear your hearing aids and make the most of them. You have two computers in your ears. They are smart, really smart, with special settings for different situations and environments. 6. Hearing aids have special gadgets and accessories to make hard situations easier – tiny microphones to put on the table to pick up voices and deliver them to your ears, chair loops that connect directly to your hearing aids. Don’t be afraid of technology. It’s easier than you think. Experiment. 7. Cupping your hand to your ear is a signal for others to talk louder 8. Have reasonable expectations. You are not going to hear everything everyone says. That’s ok. With visual cues (facial expressions, lip reading), and context, you can usually get the gist of, and participate in the conversation. 9. Don’t fake it. Don’t just nod and pretend you hear or laugh just because everyone else is laughing. It can end up being embarrassing for you or insulting to someone else. Be honest. Be brave. Ask them to repeat. Tell them you have difficulty hearing/understanding. Enjoy the holidays. Have fun with your family. Every moment is precious, don’t miss it! ![author avatar](https://secure.gravatar.com/avatar/b133bf615221a4356c14a748f94ee86e38589d8f564f9496aa0919fe6b7de152?s=300&d=mm&r=g) Ronna Fisher Dr. Ronna Fisher, AuD, CCC-A, FAAA is the founder and president of Hearing Health Center, which she established in 1984 in memory of her father, who suffered from untreated hearing loss and died at 53. That personal loss has shaped her entire career. Under her leadership, Hearing Health Center has been voted the best hearing practice in Illinois three years in a row by Hearing Review. In 2005, she expanded her mission by founding the Fisher Foundation for Hearing Health Care, a nonprofit dedicated to making auditory care more accessible. Dr. Fisher earned her doctorate in audiology from the Pennsylvania College of Optometry and holds a Certificate of Clinical Competence in Audiology (CCC-A) from the American Speech-Language-Hearing Association. She is a Fellow of the American Academy of Audiology and a member of the Academy of Dispensing Audiologists. 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The charge will not be processed unless you fail to cancel at least 24 hours prior to or do not show up for your appointment.* **Product categories:** Deposits --- ## locations ### [Park Ridge](https://hearinghealthcenter.com/locations/audiologists-park-ridge/) **Published:** February 28, 2025 **Author:** muneeb --- ### [Oak Brook](https://hearinghealthcenter.com/locations/oak-brook-audiologists/) **Published:** February 28, 2025 **Author:** muneeb --- ### [Highland Park](https://hearinghealthcenter.com/locations/highland-park-audiologists/) **Published:** February 28, 2025 **Author:** muneeb --- ### [Downtown Chicago](https://hearinghealthcenter.com/locations/downtown-chicago-audiologists/) **Published:** February 27, 2025 **Author:** muneeb --- ### [Naperville](https://hearinghealthcenter.com/locations/naperville-audiologists/) **Published:** February 28, 2025 **Author:** muneeb --- ## Categories ### [Ask the Audiologist](https://hearinghealthcenter.com/category/ask-the-audiologist/) --- ### [Hearing Issues](https://hearinghealthcenter.com/category/hearing-issues/) --- ### [Hearing Health Center Services](https://hearinghealthcenter.com/category/services/) --- ### [Hearing Aids](https://hearinghealthcenter.com/category/hearing-aids/) --- ### [How To](https://hearinghealthcenter.com/category/how-to/) --- ### [Fisher Foundation](https://hearinghealthcenter.com/category/fisher-foundation/) --- ### [HHC News](https://hearinghealthcenter.com/category/news-press/) --- ### [Communication Issues](https://hearinghealthcenter.com/category/communication/) --- ### [Roger Daltrey](https://hearinghealthcenter.com/category/roger-daltrey/) --- ### [Testimonial](https://hearinghealthcenter.com/category/testimonial/) --- ### [Video](https://hearinghealthcenter.com/category/video/) --- ### [Hearing Health](https://hearinghealthcenter.com/category/hearing-health/) --- ### [Virtual Tours](https://hearinghealthcenter.com/category/virtual-tours/) --- ### [Tinnitus](https://hearinghealthcenter.com/category/tinnitus/) --- ### [Media & Press](https://hearinghealthcenter.com/category/media-press/) --- ### [Walter Jacobson](https://hearinghealthcenter.com/category/walter-jacobson/) --- ### [Earwax](https://hearinghealthcenter.com/category/earwax/) --- ### [Hearing Protection](https://hearinghealthcenter.com/category/hearing-protection/) --- ### [Healthcare Coverage](https://hearinghealthcenter.com/category/healthcare-coverage/) --- ### [Symptoms](https://hearinghealthcenter.com/category/symptoms/) --- ## Tags ### [Lyric Hearing Aids](https://hearinghealthcenter.com/tag/lyric-hearing-aids/) --- ## Product categories ### [Deposits](https://hearinghealthcenter.com/product-category/deposits/) ---