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Consumers and Hearing Aids: An Introduction to Amplification.


Introduction:
Many first time hearing aid wearers want to know what hearing aids are capable of, that is - their limitations and benefits. This article aims to inform the consumer, their families and friends, about issues relating to what a hearing impaired person might expect from hearing aids. However, each hearing loss is unique and your personal hearing healthcare professional will be able to give additional information specific to your individual needs. I encourage you to seek personal, professional guidance, and to use this article as an overview only.

Adjusting To New Experiences With Sound and Hearing Aids:

When you first wear hearing aids, the world will sound different. You will hear many sounds you are not used to. Although you will notice many immediate improvements, it will take time to gain maximum benefit. Some new hearing aid users find it very easy, and some find it difficult to adjust to the increased volume and the altered sound quality (Miller, 1988). For many patients, the transition to hearing aid use is made easier by building up their listening experience gradually, beginning with quiet situations and wearing their hearing aids for only a short time each day. Patience is essential.

Gradually, youll find your hearing aids will help you communicate with your family and friends and will help you enjoy the sounds of life. It may take several weeks to a few months to obtain a good result. Research suggests that aided speech discrimination ability can grow as much as 3 months after the use of a new hearing aid (Gatehouse and Killion, 1993).

You may notice a change in your own voice. Because hearing aids and ear molds block the ear canal, their presence alters the natural resonance of the ear canal and changes the sound you hear. New hearing aid users sometimes comment that their own voice sounds like talking in a barrel, or it echoes. Generally, we can adjust the hearing aids to minimize peculiarities in your own voice, and of course, you will get accustomed to the new sounds over time.

Hearing aids will also affect the background sounds you hear. You will notice differences in the sounds of your car, refrigerator, air-conditioner, wind, and highways. Every sound is different because of your hearing aids unique sound pattern.

Further, hearing aids will allow you to hear sounds you probably havent heard for years. These include your own breathing and your footsteps. Those sounds disappeared so gradually from your awareness that you probably never noticed their absence. If hearing aids could return them to you very gradually their presence would be acceptable. However, since hearing aids bring those sounds back with the flick of a switch, new hearing aid users may have a difficult time getting re-oriented to these sounds, and must learn again to ignore them. People with normal hearing can hear these sounds, and they ignore them too. It takes time for our brains to become accustomed to new sound levels and to tune out new background sound patterns. We need to hear them even when no one is around, so that we can stop listening to them (Pascoe, 1991).

Types of Hearing Loss:

Described below are 3 categories of hearing loss. I will give my analysis of what a patient in each category might typically expect with and without hearing aids.

Type 1: Mild to Moderate. Without amplification, hearing soft or distant speech in ideal listening situations would be difficult. Hearing high-pitched voices would also be difficult. Understanding conversational speech in background noise would be very challenging. An individual with a Type 1 loss doesnt need loud sounds to be made louder, what is needed is amplification for soft sounds - to make soft sounds audible and clear. Hearing aids will be of significant help in most listening situations.

Type 2: Moderately-Severe. Without amplification, people in this category have difficulty understanding conversational speech most of the time, and it is even more difficult in the presence of background noise. Not only is there a loss of loudness or sensitivity to quiet sounds, but also a deficit regarding the clarity of speech, especially in noise. The clarity of speech heard may be significantly affected due to the hearing loss, and this negatively impacts on the usefulness of hearing aids. If the listening environment is not too noisy hearing aids will typically allow conversational speech to be heard.

Type 3: Profound. With this category of hearing loss, hearing impaired people have limited useable hearing. Even in ideal listening conditions, poor speech discrimination is likely, with and without amplification. In order to understand, speech must be presented at close to discomfort loudness to maximize intelligibility, but sufficiently below discomfort to keep sounds tolerably loud. Some profoundly deaf people can understand clear speech in quiet conditions using listening alone when wearing hearing aids, while others find it almost impossible even with hearing aids. Hearing aid users with this type of loss often experience repeated volume control adjustment, regular discomfort, or loss of communication (Killion, 1995).

Limitations Of Hearing Aids:

Hearing aids only solve some problems. Unlike spectacles, which often restore normal sight, hearing aids do not restore normal hearing. Hearing aids can make sounds louder but the message may be distorted because of the nature of the hearing loss not the hearing aids!

Factors such as cochlear distortions, central auditory nervous system deficiencies, deficits in cognitive processing, type and degree of hearing loss, noisy environments, large rooms, poor signal-to-noise ratio, reverberation and certain talkers will create serious obstacles that even the most suitable and sophisticated amplification system may not overcome (Sweetow, 1996 and Lambert, 1996).

Some people with hearing loss have recruitment and are very sensitive to relatively small increases in loudness. This is one reason why people with hearing loss, especially when they are wearing hearing aids, seem so sensitive to raised voices and other loud noises.

How Hearing Aids Can Help You:

Hearing aids essentially make sounds louder, but may also improve the clarity of words in a quiet environment, by making previously "unheard" sounds, loud enough to be heard. Hearing aids can amplify some sounds more than others. In general, hearing loss is greater for higher-pitched sounds. Consequently, hearing aids usually amplify high-pitched sounds more than low-pitched sounds, to help you hear the high frequency sounds more clearly. In this way, a hearing aids frequency response is fitted to your hearing loss.

All hearing aids have a "maximum output level," that limits the level of the strongest sounds that each hearing aid can deliver. Furthermore, for many years now, most hearing aids have included "compression" systems that amplify weaker sounds more than stronger ones.

Hearing loss is an invisible handicap, but hearing aids are not really invisible. However, you can expect them to be cosmetically acceptable. How many hearing aids have you seen lately? Hearing aids are usually only visible when you look for them. Of course, most people are not looking at your ears, they usually look at your eyes when speaking with you. You can feel confident that your hearing aid is not drawing attention to itself. In fact, there is a wise saying that is popular in some circles which states "your hearing loss is more obvious than your hearing aid."

It is a simple concept that reading with two eyes is easier and better than using only one eye. Hearing is very similar. When fitted with two hearing aids, the brain has more information available to it while trying to make sense of speech. Not only does using two ears make speech relatively clearer, but it also helps ease the strain of listening in difficult communication settings. Furthermore, it provides a balance of sound and allows you to take advantage of the side with the best listening conditions at any particular time. Wearing two hearing aids also allows a person to locate where sound is coming from more easily (Carhart, 1958).

Apart from helping you to hear, hearing aids have also been known to help reduce the effect of internal ringing or buzzing noises from your ears or head, referred to as tinnitus.

How You Can Help Yourself:

Hearing aids cannot help you on their own; you must use them to help yourself. Wearing hearing aids is a process where success depends a great deal on your effort.

The better the user is able to manage the aids the more benefit they can expect to gain. Research has shown, that those who are able to manage their hearing aids well, are more satisfied and successful hearing aid users (Hickson, et al., 1986).

Some may consider hearing aids as the end process in coping with hearing loss. However it is just the beginning. You can expect to improve the way you hear with a combination of hearing aids and listening tactics listed below (Dillon, 2000)

1. Tell the speaker to slow down and dont shout please. Also ask the talker to gain your attention before they speak.

2. Move closer.

3. With proper lighting, seeing the talkers lips, face and body gives us visual information (Binnie, et al., 1974).

4. Avoid or reduce noise, if you can.

5. Try to improve the sound you hear; by carpeting the floors, hanging thicker curtains on the windows to reduce excessive reverberation.

6. Do not be afraid to let people know that you have a hearing problem. Most people are willing to help when they are aware.

7. When you find it difficult to follow a conversation:
-Ask specific questions
-Ask people to rephrase the idea
-Find out the topic
-Avoid bluffing
-Dont do all the talking

8. Obtain good seating.

9. Keep alert for key words.

10. Fill in the gaps: It is O.K. to miss words and to guess at meaning based on all the evidence available.

11. Try to relax, avoid tension and maintain a sense of humour.

People who have received even a brief instruction in hearing tactics report less disability and handicap than those who have not (Ward and Gowers, 1981).

Background Noise:

Each listening situation is different! Hearing aids provide much more benefit in some situations (eg. listening to a softly spoken person in a quiet place) than in others (eg. listening to a loud person in a noisy, reverberant place) (Cox and Alexander, 1991; Dillon, et al., 1999; May, et al., 1990)

The hardest test for a new hearing aid user will be listening to speech when there is a lot of background noise. Readjusting to noise can be difficult. Background noise might be many people talking at the same time - such as at a large party or gathering. This background noise can be further complicated by music and other sounds.

Success with hearing aids in noise, is often dependent on learning to ignore the background noise and forgetting that you have the hearing aids on (Pascoe, 1991). It might help to turn down the volume control to reduce background noise. Despite marketing claims, no hearing aids completely eliminate background noise (Sweetow, 1996), although some sophisticated digital hearing aids do a very nice job reducing and managing noise. All hearing aid users should remember that noise adversely affects everyone, even those with normal hearing.

Final Comment:

Some of the truths and myths of hearing aids have been explored. Dramatic improvements have been made in digital hearing aid technology, and you may expect to find many situations in which the hearing aids will make speech easier to understand. However hearing aids remain imperfect devices.

If you know what hearing aids can and cannot do and if you are willing to spend time and effort, you will improve your contact with the world around you. Most hearing impaired people succeed when they try amplification, and they wish they had tried them earlier.

To family members, your support, patience, understanding and encouragement will make a difference towards an active, meaningful lifestyle for someone you care about while they undergo adjustment.

For those of you considering hearing aids, stay positive, stay in touch with your hearing healthcare professional, and allow yourself the time to do this right. If you remain committed you may be pleasantly surprised at what you and your hearing aids can achieve.

You CAN overcome hearing loss.

References:

Binnie CA, Montogomery AA, and Jackson PL. (1974) "Auditory and visual contributions to the perception of consonants" in Journal of Speech and Hearing Research, Vol 17, p619-630.

Carhart, R., (1958) "The usefulness of binaural hearing aids" in Journal of Speech and Hearing Disorders Vol 23, p42-51

Cox, R. and Alexander, G. (1991) "Acoustic versus electronic modifications of hearing aid low-frequency output" in Ear and Hearing Vol 4, No. 4, p190-196

Dillon, H. (2000) "Hearing Aids" Boomerang Press Thieme

Dillon, H., Birtles, G., and Lovegrove, R., (1999) "Measuring the outcomes of a national rehabilitation program: normative data for the Client Oriented Scale of Improvement (COSI) and the Hearing Aid Users Questionnaire (HAUQ)" in Journal of American Academy of Audiology Vol 10, No.20, p67-79

Gatehouse S, and Killion M. (1993) "HABBRAT: Hearing Aid Brain Rewiring Accommodation Time" In Hear. Instrum. 1993;Vol 44, p29-32.

Hickson, L, Hamilton, L and Pat, S, (1986) "Factors associated with hearing aid use" in Australian Journal of Audiology Vol 8, No.2 p37 41

Killion, M. (1995) "Talking Hair cells: What they have to say about hearing aids" in Berlin, C (Ed) Hair cells and hearing aids Singular Pub. Group

Lambert, K. (1996) "The Problem Patient" in Goldenberg, R (Ed) Hearing Aids: A Manual For Clinicians Philadelphia : Lippincott-Raven

May, A., Upfold, L., and Battaglia J., (1990) "The advantages and disadvantages of ITC, ITE and BTE hearing aids: diary and interview reports from elderly users" in British Journal of Audiology Vol 24, No. 5 p301-309

Miller, A. (1988) "A Practical Guide To Hearing Aid Usage" Thomas

Pascoe, D. (1991) "Hearing Aids: Who Needs Them? : What They Can Do For You, Where To Buy Them, How To Use Them" Big Bend Books

Sweetow, R. (1996) "Advising A New Hearing Aid Candidate" in Goldenberg, R (Ed) Hearing Aids: A Manual for clinicians Philadelphia : Lippincott-Raven

Ward P, Gowers J. (1981). "Hearing tactics: the long-term effects of instruction" in British Journal of Audiology, Vol 15, No. 4, p261-262.

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