Frequently Asked Questions about Hearing Aids

Knowing if you are experiencing difficulty hearing or are having increased stress and strain in your daily life may include asking people to repeat things, having difficulty with hearing in background noise, difficulty hearing women and children, if others seem to be mumbling and if the TV needs to be louder are a few potential indicators. Amplification not only may help with hearing better in the situations that are important to you such as being with family and friends, but may also simply relieve the strain of hearing and the often resulting fatigue. You may want to ask yourself whether you find you are becoming stressed or fatigued after a day of straining to listen and whether the ability to hear, but not understand, is adequate for your needs. Sometimes it is difficult to ask ourselves whether we are becoming a burden to our family and friends, even if we do not personally recognize difficulty hearing. Hearing loss is often a gradual process. Wearing a hearing aid is not a mark of infirmity, but may be a mark of courtesy to others. Consult your audiologist for a full Audiological evaluation and discuss the difficulties you are having with communication.

Research shows that there are negative social, psychological, cognitive and health effects of untreated hearing loss . . . with far-reaching implications that go well beyond hearing alone. In fact, those who have difficulty hearing can experience such distorted, fragmented, and stressful communication that it seriously impacts their professional and personal lives, at times leading to withdrawal and isolation.

Studies have linked untreated hearing loss to:

• irritability, negativism and anger
• fatigue, tension, stress and depression
• avoidance or withdrawal from
• social situations social rejection and loneliness
• reduced alertness and increased risk to personal safety
• impaired memory and ability to learn new tasks
• reduced job performance and earning power
• diminished psychological and overall health

Hearing aids have been shown time and time again by research, clinical experience, and common sense to greatly improve quality of life in many ways, for many hearing impaired people. Research by the National Council on the Aging on more than 2,000 people with hearing loss and their significant others showed that hearing aids are clearly associated with impressive improvements in the social, emotional, psychological, and physical well-being of people with hearing loss. This is true of all hearing loss categories from mild to severe. Specifically, hearing aid usage is positively related to the following quality of life issues. Hearing loss treatment was shown to increase or improve:

• Earning power
• Communication in relationships
• Intimacy and warmth in family relationships
• Ease in communication
• Emotional stability
• Sense of control over life events
• Perception of mental functioning
• Physical health
• Group social participation

Hearing with two ears is the natural way that our ears were designed to work. Just as our eyes naturally work in a pair, our ears and hearing are at their best when both ears are working together. If hearing loss occurs in both ears, hearing aids should be worn in both ears for the best possible hearing. There are four main reasons why binaural (two eared) listening is superior to monaural (one eared) listening. They are:

1. Better Hearing in Noise: An individual's ability to hear in noise can be improved if the signal reaching each ear arrives at a slightly different moment in time. This is technically referred to as phase. When the brain receives slightly different, yet still audible signals at the two ears, it has the ability to cross-correlate and process the primary signal (usually speech) better than if the signal is received monaurally.
2. Improved Signal versus Noise Level from Optimizing Position: Sound loses intensity (loudness) when it travels across the head. This occurs mostly for the high frequencies which are the most important for understanding of consonants, such as /s/, /t/, /f/, and /sh/. If you have a hearing aid on only one ear, say the left one, and the person you wish to hear is speaking to you from the right side, the consonants may be decreased by nearly 20 decibels by the time it gets to your aided ear. Unfortunately, noise in the room may occur from any or all directions, so while the noise level is not decreased, the speech level is. Wearing two hearing aids ensures that the speech sounds will not be diminished any more than necessary because of your position in the room.
3. Improved Localization Ability: We determine where a sound is coming from on the basis of 1) the relative time in which the sound arrives at each ear, 2) the relative difference in loudness at the two ears, and 3) the relative difference in the pitch of the sound at the two ears. When there is a large difference in hearing between two ears (as might occur when a person with similar hearing in both ears only wears one hearing aid) the brain cannot make use of these subtle relative differences and their ability to locate sounds may suffer.
4. Possible Deterioration of the Unaided Ear: We hear in our brain, not in our ears. The ultimate goal of hearing aids is not just to send sound into the ear. It is also essential to retrain the central auditory system in the brain. While it is uncertain whether hearing sensitivity (ability to hear soft sounds) will decrease if your ear is not stimulated adequately, research now suggests that there can be changes in the way in which your brain processes sound when it is "starved." Thus, providing stimulation may be important in preserving your auditory potential.

There are four primary styles of modern hearing aids. They are: Open-fit Behind-The-Ear (O-BTE); Behind-The- Ear (BTE); In-The-Ear (ITE), In-The-Canal (ITC), and Completely-In-The-Canal (CIC). While many people choose style based on vanity, decisions regarding which style of hearing aids are most appropriate for you may need to be based on a variety of factors.



Physical factors include:

1. The shape of your outer ear: deformed outer ears may not allow for wearing of BTE styles.
2. The depth of the depression near the ear canal (technically called the concha): if your ears are very shallow there may not be adequate space for certain ITE model aids.
3. The ear canal size and shape: certain ear canals may be too narrow or shaped in a manner such that ITC or CIC hearing aids will either not go in easily, or may fall out too easily.
4. Manual dexterity: not only is the removal and insertion of canal style hearing aids difficult for some people, but some individuals are unable to insert the battery or manipulate the volume control.
5. Wax in the ear: some people build up large amounts of earwax, or may have extremely moist ear canals that require adequate ventilation. For these people ITC, or even certain full size ITE aids may not be appropriate.
6. Draining ears or ears otherwise having medical problems may not be able to safely utilize hearing aids that completely block the ear canal. For these ears, it is vital to allow ventilation so hearing aids that do not fully block the ear may be required. Sometimes, BTEs that are connected to earmolds that have large vents (openings to let air pass through) are useful.

Hearing related factors include:

1. The shape of the audiogram (hearing test); individuals who have hearing loss for certain pitches (frequencies) but not others (for example those who hear the low frequencies fine, but have a high frequency hearing loss), may be better served by systems that do not fully block the ear canal.
2. Degree of loss; currently, severe and profound hearing losses are best served by BTE style aids. This style may also minimize the likelihood of feedback (whistling).
3. The need for special features such as directional or multiple microphones and/or the use of a telecoil (a small magnetic loop contained in the hearing aid that allows for better use with telephones or assistive listening devices), may dictate the preferred style.
4. Acoustic feedback (whistling) occurs when the microphone is close to the loudspeaker. BTE aids have a clear advantage over the smaller ITE or ITC aids because feedback is less likely to occur. While you may feel that you will only wear an inconspicuous device, check the appearance of a small or mini-BTE aid coupled to the ear with an open earmold. A mini-BTE aid connected to the ear with an open earmold may be less conspicuous than most ITE and many ITC aids. Most importantly, discuss the pros and cons of different styles with your audiologist.
   

Some hearing aid users report that they feel as if they are in a barrel or experiencing an echo when talking. This is called "the occlusion effect." Normally, when your ear is unblocked and you are speaking, you hear yourself both through the air traveling through your ear canal (air conduction), and through vibrations that you create in your skull and ear canal (bone conduction). When your ear is occluded or blocked, however, air conduction transmission is reduced and bone conduction perception enhanced. Try this experiment. Hum aloud and then alternately plug and unplug one ear while humming. Notice how the sound changes pitch and loudness in your plugged ear? This happens because the vibrations are blocked from their usual escape route. Most new users adapt to this effect and it isn't a problem. However for some, the following steps might help:

1. keeping the ear as open as possible.
2. reducing the amount of gain (amplified volume) in the low frequencies.
3. using an earmold that fits very deeply into the ear canal so that it contacts with the bony rather than the soft cartilaginous portion (to reduce vibration).

There are two types of acoustic feedback: that produced internally from the hearing aid - indicating a device in need of repair; and the more common external feedback produced by a leakage of amplified sound out of the ear canal and back into the microphone of the hearing aid. Feedback that occurs when the hearing aid is being inserted or removed or when your hand is cupped near the device is common, and does not necessarily signal the need for action. If however, you experience feedback when you speak, chew, yawn or change position, you need to consult your audiologist. Feedback is more likely to occur in smaller hearing devices because the microphone is closer to the area at which the sound comes out into the ear. So, a behind-the-ear style may be less likely to produce feedback than an in-the-canal style device. Usually, external feedback can be corrected by:

1. properly reinserting the hearing aid or earmold
2. remaking the earmold (or in-the-ear shell)
3. plugging, or reducing the diameter of any vents (holes)
4. reducing the amount of high frequency gain, (typically an unacceptable trade-off because of the resultant loss of high frequency hearing)
5. altering the sound by means of filters in the hearing aids or changes in the way the devices are programmed
6. adding a "canal lock" (a piece of plastic) to better hold canal hearing aids in place so they don't work their way out of the ear canal as you chew

Recently some manufacturers have introduced digital feedback reduction. With this technology, feedback is sensed by the hearing aid and canceled by means of a new signal generated by the hearing aid itself.

Most of the time, listeners are facing the person they are speaking to. Noise, however, is often located in front of, behind, and/or to the sides of the listener. Some hearing aids now contain directional or multiple microphones which "communicate" with each other in a manner such that sounds originating from the front of the hearing aid receive maximum amplification and sounds originating to the sides or behind the hearing aid receive considerably less amplification. This effectively suppresses some of the annoying background noise that creates so much difficulty for hearing impaired listeners. The technology using these types of microphone arrangements is very promising. They can be found in several different hearing aids but are generally limited to behind-the-ear or full shell in-the-ear hearing aids due to size restrictions.

Among the most frequent complaints voiced by hearing aid users are that noise is amplified too much and that certain sounds become too loud for the user to bear. Some modern hearing aids contain sensors that allow the hearing aid to detect sounds exceeding a certain loudness level, and then self-adjust to reduce the amplification (gain) for those sounds. Unfortunately, because noise is comprised of many of the same frequencies as speech, it is virtually impossible to "shut out" noise without also adversely affecting the quality of the speech signal. The good news is that audiologists have learned to utilize modern technology to measure and control the maximum sound intensity reaching your ear. If sounds (speech or noise) exceed either the saturation level (maximum level the hearing aid can amplify without distortion) or your personal loudness discomfort level, distortion or discomfort will be the result. Modern hearing aids utilize technology that allows for adequate gain for soft sounds while minimally (or not at all) amplifying loud input signals. Concerning background noise, new techniques using multiple microphones within the same hearing aid are improving the listener's ability to function in noisy environments. With regard to clarity, even the most sophisticated hearing aids' ability to clarify speech is limited by the degree of inner ear and/or central auditory nervous system distortion.

While each person's experience will vary, hearing aids may allow a person to experience certain sounds they have never heard before (or at least for some time). Relearning takes place in the central auditory nervous system and not in the ear itself. Recent experiments suggest that a listener's ability to comprehend speech may continue to increase over a period of several months when wearing a new amplification system. This process is termed acclimatization. Your audiologist will discuss the 75-day adjustment period on your new hearing aids.

The reasons hearing aids cost so much are:

1. They are sold in relatively low volume (i.e. approximately 1.7 million hearing aids for some 30 million hearing impaired) are sold per year, as compared to several million stereos.
2. The amount of time and money spent by manufacturers on research and development is considerable. One manufacturer claims to have spent over twenty million dollars developing a single model.
3. The amount of time spent by an audiologist with a patient is very significant. Data indicate that an average of five direct contact hours is spent during the first year a patient receives hearing aids. This time is critical for new users, particularly to assist during the acclimatization process. Mail order or budget clubs can afford to sell hearing aids at lower prices because the electronic components often are inexpensive and the hearing aids themselves are often placed on the user with minimal or (in the case of mail order) no instructions or fine tuning adjustments. Furthermore, the patient may be charged for every return visit, including minor tubing change and adjustments. Thus, in the long run the patient is likely to pay as much or even more. Additionally, the minimum amount of training required for a dispensing audiologist is a master's degree while mail order or discount centers are often staffed by sales people having minimal technical training. Audiologists, like consumers, are concerned about keeping the cost of hearing aids affordable. The reality is, communication is one of the most important skills humans have. So if wearing hearing aids allows you to resume normal activities and communicate with loved ones, the cost becomes a lot more justifiable.

Generally speaking, hearing aids should last for at least five years. The need for new hearing aids may occur if a patient's hearing levels change, if the hearing aids are not cared for properly or if new technology better meets a patient's needs.

Hearing aids do quite well in the majority of environments but they are not perfect. A basic problem remains for which personal hearing aid fall short. That problem relates to the physical distance between the microphone of the hearing aid and the source of the sound desired to be heard. Intensity (loudness) decreases as physical distance increases. Unfortunately most background noise surrounds the listener, so while the intensity of the speech decreases with distance, the intensity of the noise may not. This is one reason why hearing aids amplify sound so well if the speaker is closer to the hearing aid wearer. At longer, more realistic distances reception diminishes. It would be ideal to have the sound directed to the listener without losing any intensity. It is usually impractical to ask the speaker to move closer to the listener's ear. One way of achieving this effect is through infrared transmission, FM transmission, or inductance loop transmission. These systems are currently used in many theaters, concert halls, houses of worship and households. One of the best uses is for television listening. The portable transmitter (usually smaller than most cable boxes) and microphone are located near the TV speaker. The sound picked up by the microphone is then transmitted at the same intensity to a receiver worn by the listener. These devices can transmit with minimal distortion over a considerable distance (up to 50 feet). These Assistive Listening Devices (ALDs) are becoming increasingly common in public places, due to the legislative enactment of the Americans with Disabilities Act. Other non-wearable devices that assist the hearing impaired listener include telephone amplifiers, vibrating alarm clocks, TV closed caption, inexpensive personal handheld or body borne amplifiers, visual alerting systems, and TDDs (telephone devices for the deaf).

When wearing hearing aids:

1. Your hearing in quiet environments (one to one communication, watching TV, etc.) should be improved.
2. Your hearing in moderate background noise should be improved.
3. Your hearing in background noise is NOT going to be as good as your hearing in quiet.
4. Your hearing in loud background noise should be NO WORSE than without the hearing aids.
5. Soft speech should be audible, average speech should be comfortable; loud speech should be loud, but never uncomfortable.
6. Your earmolds should be comfortable.
7. Your own voice should be "acceptable" to you.
8. There should be no feedback when the hearing aids are properly inserted in your ears.
9. You may hear sounds you have not heard for a while (like footsteps or the refrigerator humming). This is not abnormal.

Be patient. It requires time to adjust to hearing aids. Your listening skills should improve gradually as you become accustomed to amplification. Ask your audiologist about the Listening and Auditory Communication Enhancement (LACE) CD that is available to assist you in learning to listen again with your new hearing aids.

Hearing aids WILL NOT restore your hearing capabilities to "normal" or to pre-existing levels.

An audiologist is a professional who diagnoses, treats, and manages individuals with hearing loss or balance problems. Audiologists have received a master's or doctoral degree from an accredited university graduate program. Their academic and clinical training provides the foundation for patient management from birth through adulthood. Audiologists determine appropriate patient treatment of hearing and balance problems by combining a complete history with a variety of specialized auditory and vestibular assessments. Based upon the diagnosis, the audiologist presents a variety of treatment options to patients with hearing impairment or balance problems. Audiologists dispense and fit hearing aids as part of a comprehensive habilitative program. Audiologists may be found working in medical centers and hospitals, private practice settings, schools, government health facilities and agencies, as well as colleges and universities. As a primary hearing health provider, audiologists refer patients to physicians when the hearing or balance problem requires medical or surgical evaluation or treatment.

Audiologists hold master's or doctoral degrees from accredited universities with special training in the prevention, identification, assessment and non-medical treatment of hearing disorders. Audiologists are required to complete a full-time internship and pass a demanding national competency examination. By virtue of their graduate education and licensure, audiologists are the most qualified professionals to perform hearing tests, refer patients for medical treatment and provide hearing rehabilitation services.