Everything you always wanted to know about Hearing Aids But Were Afraid You Couldn’t Hear Explained by
AccuQuest Hearing Centers
accuquest.com
Welcome!
Table of Contents How We Hear ........................................................... 3 Lost Your Keys? ......................................................... 4 Signs of Hearing Loss .............................................. 5 Types of Hearing Loss .............................................. 6 Hearing Loss & Quality of Life ............................... 7 The Hearing Test ...................................................... 8 How Hearing Aids Work ......................................... 9 Hearing Aid Styles .................................................... 10-11 Technology Pyramid ................................................. 12 What to Expect During Adjustment ....................... 13 Helping Others ......................................................... 14 Definition of Terms .................................................. 15
How We Hear The first step to understanding hearing loss is to understand how we hear. Sound waves are funneled through the outer ear and into the ear canal where they strike the tympanic membrane, or ear drum. The ear drum and small ear bones make up the middle ear. As the ear drum vibrates, it moves the Hammer, which moves the Anvil, which moves the Stirrup. These are the small bones of the ear.
OUTER EAR
MIDDLE EAR
SMALL BONES
INNER EAR
THE COCHLEA THE AUDITORY NERVE
Next is the inner ear. The mechanical energy from the middle ear is transfered into the liquid in the semicircular tubes, which connect to the cochlea. Inside the cochlea, microscopic hair cells vibrate and send impulses to the brain. The hair cells that pick up high frequencies and soft sounds are near the opening of the cochlea, and therefore most susceptible to damage. That is why most people lose the ability to hear these sounds first. Lower frequencies travel around the spiral to the hair cells closer to the center. The impulses from the cochlea travel along the auditory nerve to the brain, where they are interpreted. This is how you understand that your granddaughter said, “I love you.”
THE EAR CANAL
THE EARDRUM
How Loud Is Too Loud? A Chart for Decibels.
OHSA regulations
baby’s cry
jackhammer
Rock concert
Noises
whisper
Loud ) Prolonged 20dB 1 0 (9
Loud ) Extremely db 0 -14 (120
30 dB
85 dB
105 dB
115 dB
140 dB
Noises
This chart displays what noise you may encounter on a daily basis.
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HEALTHY HAIR CELLS
stand erect and are able to move freely when sound waves pass over them. They accurately transmit to the brain a wide range of signals from a whisper to a jet engine.
DAMAGED HAIR CELLS
are limp and can no longer move freely. This impairs their ability to transmit signals to the brain. Usually, damaged hair cells miss the soft, high-frequency consonant sounds of speech like “C,” “H,” and “F.”
Lost Your Keys? Maybe it’s Your Ears! Believe it or not, your hearing has a significant impact on the way your brain functions. A recent study published in the trade journal Audiology Today shows hearing loss impairs the signals to your brain causing the brain to pull cognitive resources from other functions just to support full comprehension. Because resources have
been redirected, your brain has a more difficult time with reasoning, vocabulary recall, and working memory -- which could result in something as basic as losing your keys. These, and similar problems, are often attributed to dementia or other diseases.
Normal Hearing Verbal Memory/ Movement Recognition
Visual Process
Memory/Language Skills Motor Control
4
Reasoning Attention/ Problem Solving
Listening Center of Brain
The solution could be simple. Get an annual hearing test to catch hearing loss as soon as possible. You may be able to compensate for impaired signals by using hearing aids, and preserve the precious resources of your brain.
Hearing Loss Verbal Memory/ Movement Recognition
Visual Process
Reasoning Attention/ Problem Solving
Memory/Language Skills Motor Control
Listening Center of Brain draining resources from other functions
Without a hearing loss, auditory signals are complete. Your brain can therefore function typically, distributing resources according to each function’s need. Listening effort is then minimal.
As hearing deteriorates, the brain struggles to understand particular sounds. These sounds drop out completely or are muffled. That’s when it’s necessary for the brain to redirect resources to try and complete the picture.
With normal hearing you may hear a sentence like this:
With a flat hearing loss at 40 dB, you may hear the same sentence like this:
Please tell Charles and Sharon, thank you very much for the helping hand.
Please tell Charles and Sharon, thank you very much for the helping hand.
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Signs of Hearing Loss While the causes, types, and degrees of hearing loss vary, the symptoms of hearing loss are essentially the same. People with hearing loss typically answer “yes” to the questions below. Please take a moment to ask yourself the same questions:
If you answered “yes” to any of these questions, you may have a hearing loss. If you suspect that you or a loved one has a hearing loss, you should contact a hearing professional as soon as possible. Untreated hearing loss only gets worse.
Yes No
Do I hear sounds, but have trouble distinguishing words? Do I frequently have to ask people to repeat themselves? Do I struggle to follow a conversation when two or more people are talking at once? Do I feel tired or irritable after a long conversation? Do I misunderstand others sometimes and respond inappropriately? Do others complain that I turn up the volume too loud on the TV or radio? Do I have a difficult time determining where an object (like a cell phone) is by its sound? Do I have particular trouble hearing the voices of women and children? Do I have trouble hearing at movies, concerts, church, and group conversations? Am I embarrassed by my hearing difficulties?
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Hearing aids? I put that off for several years, as I equated that with old age. I’m 76. Then one day I received in the mail a promotional brochure. That same day I made an appointment to have my hearing tested. I knew my hearing was bad, but after receiving a thorough hearing exam, I realized it was worse than I thought…I purchased the hearing aids, I was encouraged to continue having my hearing monitored. The best part was there was no additional cost. My only regret – I waited so long to buy them. - Bertram D., Placerville, CA
Types of Hearing Loss Hearing loss is hearing loss, right? Well, not exactly. Generally speaking, there are two basic types of hearing loss: Conductive and Sensorineural. They both have to do with a failure to transfer sound along the path from the outer ear to the brain’s hearing centers, but they differ in the location of the failure. Conductive Hearing Loss In the case of conductive hearing loss, sound is obstructed in the outer and/or middle ear. For example, there may be wax in the ear canal or the small bones in the middle ear don’t work properly. This usually results in reduced sound levels and the loss of the ability to hear faint sounds. Common causes may include ear infections, earwax, fluid in the middle ear from a cold, among other diseases and disorders. The most common treatments are medical and surgical for this type of loss. However, hearing aids may help in some cases. Sensorineural Hearing Loss When there is damage in the inner ear or along the neural pathways to the brain that results in the loss of the ability to hear certain frequencies, this is called Sesorineural Loss. According to the Center for Disease Control (CDC), 75% of Americans with hearing loss have this type of loss. Usually the cause of this loss is damage to the hair cells or other interior workings of the cochlea. You see, in the cochlea microscopic hair cells vibrate with sound, transmitting neuro-electrical signals along the auditory nerve to the brain. Healthy hair cells stand up straight and can move freely. When these hair cells are damaged, they become limp and cannot vibrate correctly. This means the signals to the brain are incomplete, making it difficult or impossible to understand the sounds for which those hair cells are responsible. While damaged hair cells are irreparable, compensation is possible and highly recommended without delay. Causes of Sensorineural hearing loss can be congenital (present at birth) or acquired (after birth). Congenital causes might include: infections, prematurity, hereditary factors, or birth trauma. Acquired causes include: overexposure
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to noise, ear infections, head injury, disease (like meningitis or encephalitis), or a negative side effect of some drugs. No matter the cause, hearing aids are usually the best way to compensate for sensorineural hearing loss. Mixed Hearing Loss Sometimes someone will have one type of hearing loss—like conductive—and then something will happen to damage another part of the ear and cause sensorineural damage. When both types of loss are present at the same time, it is called mixed hearing loss. Treatments for this type of hearing loss usually include medical and surgical procedures. However, in some cases hearing aids can be effective as well. Consulting with a hearing care professional is the best way to determine the right solution for you. Tinnitus Some people have a constant ringing or buzzing in their ears. This constant sound is called “tinnitus” (pronounced either ti-NIGHT-is or TIN-i-tus. Both pronunciations are correct). Tinnitus does not always occur with hearing loss, but they are often associated. If the ringing is in the same frequency range as the hearing loss, hearing aids help bring in the ambient sounds that naturally cover the constant ringing. The exact cause of this condition is unknown at this time, but there are many known ways to either mask or manage this constant sound. To learn more about tinnitus, visit the American Tinnitus Association at www.ata.org.
You can’t imagine the thrill of being able to hear my own voice. I didn’t realize what I had been missing. My son calls me every morning to ask if I can hear the birds. I CAN! My daughter says it has changed my outlook on life…I am truly lucky and delighted that I made that phone call. - Mariann S., Fort Collins, CO
Hearing Loss & Quality of Life Studies show, people with progressive hearing loss wait an average of 5-15 years before seeking treatment (1). During those years, there are negative physical and lifestyle effects on the person with the loss and those with whom they interact. Here are just a few of the big ones. Physical Effects Auditory Deprivation When your brain does not receive stimulation for certain frequencies or sounds, it is called Auditory Deprivation. Usually, this occurs when the hair cells in the cochlea are damaged so they are unable to properly transmit those sounds to the brain. Much like an unused muscle becomes weak over time, prolonged auditory deprivation causes your brain to forget how to interpret those lost frequencies. Even if hearing aids are able to stimulate the damaged hair cells, your brain will need time to get used to interpreting these sounds again. If damaged hair cells are not ever stimulated they will eventually die off, creating dead regions in the cochlea. It is currently impossible to even compensate for these dead regions, so the ability to hear these frequencies is permanently lost. In other words, “use it or lose it” applies to hearing too. Fortunately, recent advances in digital hearing technology make it possible to detect damaged and dead regions within the inner ear, and compensate for damaged hair cells. This targeted stimulation of neurons can help maintain speech comprehension and keep your brain stimulated.
Dementia Auditory deprivation is also mentioned in a recent Johns Hopkins study that shows a link between hearing loss and the development of dementia (2). The study was published in the February 2011 Archives of Neurology. It used data from the Baltimore Longitudinal Study on Aging (BLSA), which has tracked various health factors of thousands of men, women, and children over decades. About a quarter of the over 600 volunteers the study focused on
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had hearing loss at the start of the study, but none had dementia. Participants were closely followed for nearly 20 years. Afterward, almost 10% of them had developed dementia. Compared to those with normal hearing, participants with mild hearing loss were twice as likely to develop dementia over time. Those with moderate hearing loss were three times as likely. And those with severe hearing loss were five times as likely. In fact, the study showed that for every 10 decibels of hearing loss, the extra risk increased by 20 percent. While further research is required to determine the exact reason why hearing loss and dementia are connected, auditory deprivation and the isolation inherent in hearing loss are two possible contributors proposed by the study.
Lifestyle Effects
Hearing loss is not just a physical problem, it also effects your lifestyle. Individuals with hearing loss are more likely to experience: • Tension, irritation, or frustration at communication difficulties • Feelings of inadequacy in everyday interactions • Fear of being ridiculed, pitied, or appearing less intelligent • Feelings of being prematurely old, handicapped, or abnormal • Tendency to avoid social gatherings, outdoor activities, even personal interactions • Physical fatigue from straining to hear • Personal safety risks • Depression
The effects of hearing loss on the friends, family, and coworkers of an individual with loss might include: • Misunderstandings when someone with hearing loss answers a question inappropriately or not at all. • Significant others may be required to interpret for the individual with hearing loss causing stressful logistical and conversational difficulties • Feelings of rejection or misunderstanding because someone with hearing loss withdraws after a difficult listening situation • Feelings of guilt arising from not including an individual with hearing loss in conversation or activities • Feelings of resentment at not being able to enjoy certain activities because of the reclusive behavior of an individual with hearing loss • Constant concern or anxiety about the safety of an individual with hearing loss
Benefits of Treatment
The good news is many of these negative physical and lifestyle effects can be greatly diminished or even eliminated through proper treatment. Hearing aids can compensate for loss in targeted frequency ranges, providing auditory stimulation so your brain maintains its ability to comprehend speech and you can interact with loved ones again. This stimulation may also contribute to delaying or even preventing diseases like dementia. Many people are afraid that hearing aids are too noticeable and scream to the whole world “something is wrong with me.” However, what is more noticeable, a hearing aid tucked behind your ear, or constantly asking people to repeat themselves? The benefits of treating hearing loss keep expanding every time you don’t have to ask, “What?” and can instead enjoy a worry-free conversation. 1) Rawool V.: Effectiveness of Informal Counseling on Acceptance of Hearing Loss Among Older Adults, The Hearing Review. 2009;16(6):22 2) Johns Hopkins University School of Medicine. (2011). Hearing loss and dementia linked in study. [Press release]. Retrieved from http://www.hopkinsmedicine.org/news/ media/releases/hearing_loss_and_dementia_linked_in_study
The Hearing Test The hearing test is the primary tool your hearing care provider will use to determine if you have a hearing loss, how severe it is, and at what frequencies. The standard test is what is called a Pure Tone Test, where you hear a buzz or beep about 1 second long at varying volumes and pitches. The volume of the sound is measured in decibels (dB) and the pitch of the sound is measured in hertz (Hz). Your hearing care provider will change the dB level at certain frequencies until they find the lowest level you can hear the sound 50% of the time. This level is called your threshold.
Quiet
125
250
500
1000
2000
High Frequency
4000
8000
0 Normal Hearing
10
20
z 30
40 Decibels (dB)
For example, the hearing care professional may play a 250 Hz tone at 40db, 30db, 20db, 25dB, 30dB, 20dB, 25dB, 30dB, 35dB, 25db, 30dB. You have 4 chances to hear the tone at 30dB. If you hear that tone 2 or more times, then 30dB is your threshold at 250 Hz. The normal hearing range is from 0dB to 20dB at every frequency. Any threshold above 20dB at any frequency means you have a hearing loss.
AUDIOGRAM
Low Frequency
50
60
J
p
v mdb i
a r o
e
ch
k h g
f
s
th
Mild Hearing Loss
sh Moderate Hearing Loss
u Moderately Severe Hearing Loss
70
80
Severe Hearing Loss
90
Each threshold is marked on a chart called an Audiogram. Each ear is tested separately and the results charted on the same audiogram. To keep the left and right ear tests separate, the left ear results are recorded with blue Xs and the right ear results are recorded with red circles. The easy way to remember this is to think of the 3 Rs: Red, Right, and Round. If there is a small arrow on the X or the circle, that means a frequency was tested to the maximum dB level and there was still no response to it. Audiograms can get pretty complicated with Air Conduction Tests, Bone Conduction Tests, Masked Tests, and Unmasked tests. However, audiograms come with a key, and if you remember these basic principles you should be able to get a pretty good idea of what frequencies you have a hard time hearing and how much of a loss you have.
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Loud
100 110
120
Profound Hearing Loss
How Hearing Aids Work While the specifics of this process will vary depending on the particular hearing aid, here is a general idea of how modern digital hearing aids work: 1. Sound: Sound waves enter your ear and travel down your ear
canal to the hearing aid.
If you have been tested and told you have a bilateral loss (hearing loss in both ears), it may be tempting to only get one hearing aid and wear it in the ear with the most loss. Fight this temptation! The advantages of binaural hearing (having two hearing aids with a bilateral loss) are well worth it. Here are just a few of them. • Better Sound Quality • Wearing two hearing aids increases your range of hearing from 180 degrees to 360 degrees, allowing you to0hear 01 the world around you more accurately.
110 10 110 001 000 0100 1011 1 1 0 01 11 Better Localization 10 011 000 0001 1100 1 1ears0allows 001 1000 from 10 two 10 0 1 1 Information your brain to pinpoint the direction and location of a 0 0 0 0 1 1 0 01 1001 110 1 0 0 0 0 0 1 0 0 1 1 you 00 sound. 01 01like 11 11Much 100your depth perception when you cover up one eye, you lose 010 0lose 0 010 0110 1 0 0 1 1 0 1 0 1 0 01 110 10 1011 01 the direction of sound with only one good ear. 000 000 1110your 0 001to1track 01 ability 100 011 0 0 00 110 101 000 1001 0001 1100 0110 00011 1 1 1 0 0 1 1 00 010 1 1 0 0 1 1 0 1 0 1 1 1 1 0 00 10 010 001 1100 0110 1011 0Better Ability to Hear in Noise 001 000 111 0 0 01 00 00 011 0100 0101 1011 1101 00010 A report available through the Better Hearing Institute says that when a desired sound and 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 0 1 0 0 1 0 0 1 0 11 10 01 01 undesired sound are presented to both ears simultaneously instead of just one, the ability 00 11 100 001 1010 0110 0011 00101 100 111 0 01 00 01 to pick out the desired sound is enhanced (1). This is called Masking Level Difference 011 1010 1100 1010 0100 10110 0 1 0 0 0 1 000 110 100 011 000 110 (MLD) and allows you to pick out a conversation in a noisy restaurant. 011 0010 1100 1010 1101 00110 10 0 0 101 31011 0001 0001 1001 11100 0 1 100 0100 0110 1001 1010 1 0 Wider Hearing Range 100 0100 1000 0110 1 011 0100 1001 The same report says that “the loudness of a sound is greater when it is presented to two 0 0 1 1 1 1 0 0 ears simultaneously than to just one ear alone (1).” This is called Binaural Loudness 110
2. Microphone: The hearing aid’s microphone picks up the
sound and transfers it to the digital converter.
•
•
3. Digital Conversion: The organic sound is then converted
to a digital signal, or a binary code series of 0s and 1s, and passed on to the processor.
•
•
2
•
•
Summation, and it allows you to hear softer sounds that may be inaudible with only one good ear. In other words, what one ear can hear at 10 feet, two ears can hear at 40 feet.
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1
5
4
4. Processor: This is where the real power of your hearing aid
is demonstrated. Your hearing professional has programmed your hearing aid to compensate for your particular hearing loss. Depending on the sophistication of the processor, it will manipulate the digital signal accordingly. It will amplify certain frequencies, filter out background noise, cancel feedback, or a number of other operations. It all depends on the hearing aid and the programming.
5. Sound Conversion: Once the sound has been appropriately
manipulated, the digital signal is then converted back to a sound wave and projected from the hearing aid’s receiver into your ear.
6. Hearing: The personalized sound then continues through
your middle and inner ear. In the inner ear these new sound waves stimulate your hair cells, including damaged hair cells, and send more complete and accurate signals to your brain. Your brain then has the information it needs, so you can interact with family and friends once again!
• Less Effort • Because one ear is not trying to do the work of two, binaural hearing results in less
straining to listen. This means less effort, less fatigue, and more enjoyment from listening.
• Better Tolerance of Loud Sounds • Another result of Binaural Loudness Summation is that less gain is required to maintain a comfortable hearing level. Less gain requires a lower volume setting for your hearing aids. With the volume lower, loud sounds are amplified less, which means you can hear louder sounds more comfortably.
• Reduced Feedback • Because each hearing aid requires less gain to reach a comfortable hearing level, the chances of feedback are greatly reduced.
• Keeps Both Ears Active • If your ears are not active you can suffer from auditory deprivation. Prolonged auditory
deprivation can result in further deterioration of hearing loss and eventually permanent loss of the ability to hear certain frequencies. Maintaining active ears may prevent these and other negative effects, including dementia (see Hearing Loss & Quality of Life on page 6).
• Better Speech Understanding • MLD and Binaural Loudness Summation both contribute to the
ability to better hear and understand someone speaking to you. And after all, isn’t that one of the primary reasons for getting hearing aids—to understand your friends and family better?
• Greater Satisfaction • Wearing two hearing aids, you will find greater satisfaction with the performance of your hearing aids because your hearing aids will be able to perform as they were designed.
During your visit to your hearing care provider, ask him or her to demonstrate the difference between one and two hearing aids either in the office or during your trial period. Then you can hear for yourself the binaural advantage. 1(http://www.betterhearing.org/pdfs/Binaural_hearing_aid_complete_review.pdf)
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Hearing Aid Styles All hearing aids have the same basic parts, but they differ in style. Some styles fit partially in your ear while others are small enough to fit deep within the ear canal, making them practically invisible. As a general rule, the smaller the hearing aid, the less powerful it is, the shorter the battery life, and the more it will cost. There are, of course, exceptions to every rule. There are two categories of styles: custom shells and open fit. Custom shell styles are made from a custom mold of your ear, so the hearing aids fit comfortably in your particular ear. They fill up the entire ear canal so the only sound that gets through is the sound that has been processed for your particular hearing loss. Open Fit hearing aids have a flexible tip that fits deep within the ear canal and does not require a custom molding process. The tip is usually vented to allow natural sound to enter the ear canal and prevent the “head in the barrel” sensation that can occur when the canal is plugged with a custom shell. Here is a quick run down of the different styles of hearing aids: Behind-the-Ear This style of hearing aid is the most powerful. The hearing device is housed in a curved shell that sits behind your ear while a clear tube hooks over your ear. Traditionally, this tube connected to a custom mold that filled the ear. But the most recent advances in technology are making BTE both cosmetically appealing and available in open fit. These hearing aids are large enough for users with dexterity issues to handle with ease. This style typically uses size 675 or 13 batteries, which are larger and easier to handle. These hearing aids are helpful for those with mild to profound hearing loss. RIC (Receiver-In-Canal) This style of hearing aid is also housed in a curved shell that sits behind the ear. The receiver, or part of the hearing aid that sends sound into your ear, is small enough it sits deep inside the ear canal making it nearly
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undetectable. This style comes with many different features, including directional microphones and manually adjustable volume. This style only comes as an open fit hearing aid. These hearing aids typically use size 312 batteries. This style is helpful for those with mild to severe hearing loss.
to the smaller size, some features may be more difficult to adjust. These hearing aids may not fit well in smaller ears. This style of hearing aid typically uses size 312 batteries, which are smaller than the ITE batteries, and is helpful for those with mild to moderate hearing loss.
Mini RIC (Receiver-In-Canal) This style provides the power of a traditional RIC, but it’s housed in a smaller curved shell. With the clear tube that hooks over your ear and the diminished size of the shell, these hearing aids are virtually invisible. Patients with dexterity issues may have difficulty operating this smaller size. These hearing aids typically use size 10 batteries, and are helpful for those with mild to severe hearing loss.
CIC (Completely-In-The-Canal) This style of hearing aid is housed in a tiny shell that fits comfortably and completely into your ear canal. The device is removed by pulling a tiny cord. This style is much less noticeable and the ear naturally protects the device from wind. Some features, though, such as manual volume control, are not available. This style may be difficult to operate especially if the user has poor dexterity. These hearing aids typically use size 10 batteries, and are helpful for those with mild to moderate hearing loss.
ITE (In-The-Ear) This style of hearing aid is housed in a custom shell, so it fits comfortably in the bowl shape of your outer ear. It is more visible and may pick up wind. Due to the larger size, though, these hearing aids are easily operated even if the user has poor dexterity. Adjustable volume control and other features are also available. These hearing aids typically use size 13 batteries. This style is helpful for those with mild to severe hearing loss. ITC (In-The-Canal) This style is also housed in a custom shell that fits comfortably inside the beginning of the ear canal and delivers sound directly to the inner ear. Due
IIC (Invisible-In-Canal) This style is called “invisible” for a reason. It rests comfortably in the second bend of your ear canal, where most other hearing aids end. This allows it to use the ear’s natural acoustics and anatomy to deliver more precise, natural sound—AND it is completely undetectable to the outside world. Unlike extended wear deep insertion aids, like LyricTM or WowTM, IIC hearing aids can be removed and reinserted daily to promote better hearing health. The compact size means that some features, like directional microphones, are not available. They are also difficult to operate for users with poor dexterity, and are usually one of the most expensive styles. These hearing aids typically
use size 10 batteries, and are helpful for those with mild to moderate hearing loss. You now know a little more about your hearing aid options. Selecting the hearing aid style that is right for you is a critical step on the path to better hearing, but it is just one step. Your hearing care professional will provide you with a thorough evaluation and consultation to help you determine the best solution for getting you back to better hearing.
Hearing Aid Battery Basics Battery Size
10
312
Battery Life
up to 5 days
Typically used in...
CIC, Mini, BTE
13
675
up to 10 days
up to 2 weeks
up to 3 weeks
ITC, ITE, Mini BTE
ITE or BTE
BTE
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Technology Pyramid
Designed for those who are budget conscious and just need basic amplification in quiet environments. This type of technology is usually from $1500 - $3500 a pair.
Basic digital technology designed to help people that aren’t very active or spend the majority of time in quiet environments only. Typically ranges $ 2500 - $5000 a pair.
Technology designed to be used in relatively easy listening situations with some noise. Typically ranges from $3500 - $7500 a pair.
Best
Advanced
Basic
Economy
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Designed for active people that are in a variety of listening environments. Typically range in price from $5000 - $12,000 a pair.
What to Expect During Adjustment Once you purchase hearing aids, there will be a period of adjustment while your brain gets used to hearing theses sounds again. The average person has had hearing loss for 5-15 before they finally get treatment. Anything you don’t do for over a decade will require a bit of time to relearn. One key to a successful transition to your new hearing is having realistic expectations. Below are some tips to give you an idea of what typically happens during adjustment. Adjustment Differs for Everyone Some people can wear their hearing aids all day right off the bat. Others have to gradually build up to that kind of use. One way is not better than another, it is all a matter of personal preference. The important thing is that you are wearing them regularly to train your brain how to hear again. Starting off in quieter environments, like around your house, is better than heading out to a restaurant right away. Wear Your Hearing Aids Whether or not you can wear your hearing aids all day right away, you should wear them as much as possible. Even when you are alone at home, it is a good idea to wear them. This will allow your brain to get used to hearing this way, and it won’t be bombarded suddenly in a social setting. Also, if you are comfortable wearing them alone, you will be comfortable wearing them in social settings as well. Like any other instrument, hearing aids take practice to adjust to them. Something in Your Ear It is normal to feel like something is in your ear because it is. You will adjust to that feeling and not even notice it in time. If your hearing aid is causing sores or irritation, let your hearing care provider know immediately. These are signs that something is wrong, and professional assistance is recommended. Hearing Your Own Voice While you have lived with decreasing hearing, you have grown accustomed to hearing your own voice inside your head. Now that you have hearing aids, your brain must process your own voice through your ears as well. This is similar to listening to your own voice on a voice mail recording or some other outside source. It will be strange at first, but you will adjust to it. Suddenly There is Background Noise Sounds like your air conditioner or refrigerator running may sound very loud. Your auditory system is not used to hearing these softer sounds. It’s all part of hearing better. While these sounds may be annoying, these frequencies are an important
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part of understanding speech better. As you acclimate to your hearing aids, your brain will relearn how to filter them out. Improvement Not Perfection It is important to remember that you will never hear like you did before the hearing loss. Today’s hearing aids are incredibly sophisticated and powerful, and they can make it possible to enjoy sounds better than ever before. They are trying to imitate an incredibly complex system—the human ear. No matter how good an imitation is, it is still an imitation. As you work with your hearing care provider to fine tune your hearing aids, work toward better hearing and not perfect hearing. Expect Improvement Perfection may not be attainable, but dramatic improvement most certainly is. On average, it takes about 45 days for your brain to adjust to the new way of hearing, but you should notice a difference before that. If you do not notice a difference, talk with your hearing care provider. Something needs to be adjusted. A Team Effort Hearing is subjective and so sounds that are annoying to some people will not annoy others. As you begin to hear some of the lost frequencies again, you will come across some unpleasant sounds as well. Especially during the adjustment period, you should visit your hearing care provider often. He or she will help fine tune your hearing aids to your personal needs. Working together you can hear better. Knowing what to expect ahead of time means you can recognize the success you’re having and enjoy it.
Helping Others You may be reading this guide because you have a loved one with hearing loss and you’re not sure how to help them. Studies show that people with progressive hearing loss may wait 5-15 years before getting treatment (1). The two biggest reasons for this delay are denial and being unaware of the loss or its severity. Either way, you can help your loved one understand the impact of hearing loss on his or her life. Why Refuse Help?
How to Help
Denial Denial is a natural response that helps minimize the effect of stressful situations. As it relates to hearing loss, a patient in denial often shifts ownership of his or her hearing loss to other people, like the speaker, the environment, or competing noise. In not acknowledging the hearing problem, those in denial chose to continue asking people to repeat themselves, withdrawing form social situations, and relying on you or others to interpret for them. This is taxing on everyone involved and will only get worse.
Whether a loved one is in denial or simply concerned about being seen with a hearing aid, your goal is to help them perceive their situation more accurately. Once they understand their loss and the benefits of better hearing (as well as the remarkably discreet options in today’s hearing aids), they will be more likely to get treatment. Here are a few ideas of how to help your loved one gain an accurate perception:
Unaware of Loss or Severity People with hearing loss often report “my hearing loss is not severe enough” among the top reasons for not getting treatment (2). Because hearing loss typically occurs gradually over time, those with a loss may not fully realize what they are missing for quite some time. The unfortunate consequence of this form of denial is that the patients gradually alter their lifestyles as the loss progresses until they become isolated, lonely, and disengaged. Vanity Inaction is frequently a result of stigmas attached to hearing aids and hearing loss, and feeling that hearing aids advertise a handicap. The anticipated embarrassment of a visible assistive device outweighs the possible benefits of better hearing. But consider this question, “which is more visible: a hearing aid, or constantly misunderstanding conversations and asking others to repeat themselves?”
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•
The Better Hearing Institute suggests declaring a “Hearing Help Quest.” Then whenever you need to help your loved one, preface what you are repeating with something like, “Hearing Help.” This will help them recognize how often you are helping them (4). Stop carrying messages between your loved one and the rest of the family when they can get the information from the source.
• Stop raising your voice. It is not good for your vocal chords, and talking in a normal tone will help your loved one recognize their loss better.
• Set an example. Get your hearing checked regularly, and then discuss
your positive experience. A study by Professor Vishakha W. Rawool at West Virginia University shows that “50% of participants who were in denial or unaware of their loss accepted their hearing loss after an informational consultation with a relatively inexperienced clinician (1).” Sharing your experience can put you in the role of the “relatively inexperienced clinician” and the information you know can have a great impact.
This may all take some time, so have patience. It will be hard, but let your loved one struggle a bit. In the end, it will be worth it when your loved one can hear independent of you and enjoy the benefits of better hearing.
1)Rawool, V. (2009). Effectiveness of informational counseling on acceptance of hearing loss among older adults. The Hearing Review, 16 (6), 14-24. 2) Kochkin, S. (2007). MarkeTrak VII: Obstacles to adult non-user adoption of hearing aids. Hearing Journal, 60(4), 24-51. 3) Mulrow, C., Lichtenstein M. (1991). Screening for hearing impairment in the elderly:rationale and strategy. J Gen Intern Med, 6(3), 249-258. 4)Better Hearing Institute (2005). When a loved one resists help. Your Guide to Better Hearing, 13.
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Definition of Terms Adaptive Feedback Cancellation - is a common method of cancelling audio feedback in a variety of electro-acoustic systems such as digital hearing aids. The time varying acoustic feedback leakage paths can only be eliminated with adaptive feedback cancellation. When an electro-acoustic system with an adaptive feedback canceller is presented with a correlated input signal, a recurrent distortion artifact, entrainment is generated. There is a difference between the system identification and feedback cancellation.
Cochlea - snail-shaped structure in the inner ear that contains the organ of hearing.
Automatic Gain Control—Output (AGCo) - is an adaptive system found in many electronic devices. The average output signal level is fed back to adjust the gain to an appropriate level for a range of input signal levels. For example, without AGC the sound emitted from an AM radio receiver would vary to an extreme extent from a weak to a strong signal; the AGC effectively reduces the volume if the signal is strong and raises it when it is weaker.
Automatic Gain Control - (AGC) is an adaptive system found in many electronic devices. The average output signal level is fed back to adjust the gain to an appropriate level for a range of input signal levels. For example, without AGC the sound emitted from an AM radio receiver would vary to an extreme extent from a weak to a strong signal; the AGC effectively reduces the volume if the signal is strong and raises it when it is weaker.
Digital Noise Reduction - is the process of removing noise from a signal. All recording devices, both analogue or digital, have traits which make them susceptible to noise. Noise can be random or white noise with no coherence, or coherent noise introduced by the device’s mechanism or processing algorithms.
Gain Reduction - Diminution of the output of an amplifier, usually achieved by reducing the drive from feed lines by use of equalizer pads or reducing amplification by a volume control.
Feedback - is the whistling sound that occurs when sound from a speaker loops back to the microphone. It is best described as a highpitched screeching. Gain - the volume added to a sound after amplification.
Open Fit - a hearing aid designed to fit over the ear with a thin tube or wire running into the ear, and a small, soft plastic tip. The tip has Audiogram - A chart used to plot an individual’s scores from a holes to keep from blocking the ear canal so that the user does not feel plugged or occluded. Open ear hearing aids are primarily used for hearing test. high frequency hearing loss. Adaptive Directional Microphones - A directional microphone system capable of activating automatically when it senses the presence Video Otoscope - an instrument with lighting and magnifying systems used for visual examination of the tympanic membrane and of background noise. the canal connecting it to the exterior of the body Inner Ear - part of the ear that contains both the organ of hearing (the Telecoils - You may have heard the telecoil in your hearing aid cochlea) and the organ of balance (the labyrinth). referred to as a telephone switch, a T-switch, or a Tcoil. Whatever you Middle Ear - is the portion of the ear internal to the eardrum, and call it, it’s one of the most important features of a hearing aid. It makes external to the oval window of the cochlea. The mammalian middle talking on the telephone much easier; but it also opens up the world ear contains three ossicles, which couple vibration of the eardrum of assistive listening devices, including the induction loop technology into waves in the fluid and membranes of the inner ear. The hollow that is so widespread in Europe (and becoming more so in the US). space of the middle ear has also been called the tympanic cavity, or cavum tympani. The eustachian tube joins the tympanic cavity with the nasal cavity (nasopharynx), allowing pressure to equalize between the middle ear and throat. The primary function of the middle ear is to efficiently transfer acoustic energy from compression waves in air to fluid–membrane waves within the cochlea. Outer Ear - is the external portion of the ear, which consists of the pinna, concha, and external auditory meatus. It gathers sound energy and focuses it on the eardrum (tympanic membrane). One consequence of the configuration of the external ear is to selectively boost the sound pressure 30- to 100-fold for frequencies around 3 kHz. This amplification makes humans most sensitive to frequencies in this range - and also explains why they are particularly prone to acoustical injury and hearing loss near this frequency. Most human speech sounds are also distributed in the bandwidth around 3 kHz.[1]
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