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Listen Up! A Consumers Guide to Hearing Aids and Assistive Listening Devices 2003 Update

There are an estimated 27.2 million Americans with hearing loss. Most do not investigate or obtain hearing aids. What is it that makes the idea of hearing aids so daunting? Why do so many people with hearing loss choose not to use hearing aids?

It''s no secret that psychosocial issues do play a major role in a persons decision to purchase or not to purchase hearing aids. Are psychosocial issues so over-bearing that they overpower a persons desire to communicate with greater ease?

People with hearing impairment tell their audiologists all too often ''only old people wear hearing aids'' or ''my hearing is not bad enough to warrant hearing aids.'' These excuses may not be the only obstacles audiologists and hearing-impaired individuals have to overcome.

Some audiologists refer to the people in their office as ''patients,'' others use the term ''clients.'' However, when the time comes to invest in hearing aids - the patient/client takes on an additional role, ''consumer.'' As consumers, people look to audiologists and other hearing healthcare professionals to provide them with a service and a product that will best fit their needs, while giving them the ''biggest bang for their buck. Consumers need to feel comfortable and confident in their decisions to pursue and choose appropriate amplification. For many people, hearing aids appear foreign and too complicated.

By simply knowing what to expect through appropriate education and counseling, the consumer can gain confidence, and enjoy the experiences involved, rather than feeling anxious or unnecessarily frustrated. Patients should be aware that obtaining hearing aids involves a significant time investment and it is a multi-step process.

First and foremost, a comprehensive audiometric evaluation should be performed by a hearing healthcare professional. Audiologists are licensed specialists with a masters degree or a doctorate (some may have both) in audiology or hearing sciences and they are the professionals who typically perform these comprehensive evaluations. An audiologist will also interpret the results, diagnose the type and degree of hearing loss (ASHA, 1996) counsel their patients, and refer appropriate patients to physicians for medical treatment. Most audiologists also fit, dispense and sell hearing aids. Hearing instrument specialists are licensed to test hearing for the purposes of fitting hearing instruments. Although they do not have the same educational and academic training as audiologists, they too, fit, dispense, and sell hearing aids.

Although all hearing healthcare professionals take a case history and obtain an initial hearing evaluation, each patient is different! Each patient has their own unique history, presentation, hearing loss, and their own needs and desires. An important issue to consider is that even if your hearing loss is similar to someone elses --- we hear with our BRAIN! The brain is where the tiny electrical impulses are changed into meaningful sound and of course, every brain is different! Although two people may have identical audiograms (hearing tests) they may possess very different degrees of difficulty in understanding speech! Again, although the ears gather and transfer the energy of sound, our brains make sense of these sounds!

Interestingly, the way in which hearing loss affects speech understanding is often a good indicator of how well the patient may do with hearing aids. Differences in speech understanding lead to different levels of benefit from hearing aids. Some people will likely experience improved sound awareness, but may still have difficulty understanding speech. Others are likely to see significant gains in speech understanding. The result of wearing hearing aids varies tremendously, based on the hearing loss, the brain, the acoustic environment, the abilities and desires of the patient, and of course the hearing aids themselves!

If we measure hearing aid "success" by the degree of improvement between ''unaided'' and ''aided'' results, we will find success is not only obtainable, but almost a certainty! It is reasonable to expect improved hearing while using hearing aids. However, it is not reasonable to expect "normal" hearing! That is an important concept. Hearing aids make sounds louder, and by making them loud enough to hear, the brain can attempt to make sense of the sounds. The brain cannot make sense of the sounds it doesnt hear, but making sounds louder does not mean they will all be crystal clear.

Therefore, what works well for one person may not work at all for another. If two people have identical hearing loss (a rare occurrence indeed) the chances that they will both be fit with the same hearing aids, programmed the same way, and receive the same benefit is very, very small.

Since every individual is unique in regards to their hearing loss, many audiologists use a rehabilitative model of service, rather than a medical model (Erdman et al., 1994). Audiologists are concerned with treating the ''patient'' by developing rapport and involving them (the patient) as a participant in the process. In other words, the audiologist tends to work with the patient and their situation, and does not simply "treat" the hearing loss.

During the initial meeting, patients are encouraged to discuss their personal difficulties and their perceptions related to their hearing loss to their audiologist. Once the hearing evaluation is completed, and after their opinions, desires and thoughts have been discussed, the test results are reviewed with the patient within the context of a rehabilitative model. Although we do our best to explain things, patients should feel free to ask for clarification as needed.

In addition to the great diversity in hearing ability, individuals have different needs with regards to amplification systems and they may have different desires regarding the physical appearance of their hearing aids, the financial constraints that may impact their choices and other preferences too. There are many decisions that must be made.

To some extent, buying hearing aids is like car shopping. In other ways, the comparison leaves much to be desired!

Just as all cars get you from point A to point B, all hearing aids amplify sound. The decision between different technologies is analogous to choosing between different cars, such as Yugo versus Mercedes. Big difference!

When automotive terms and ''buzzwords'' are not understood,consumers sometimes find it embarrassing to ask questions. The same is true of hearing aids. There are many terms; ''directional microphones,'' ''compression,'' ''noise reduction,'' ''digital circuits,"and ''multiple channels,"which can overwhelm people. For this reason, I recommend patients bring a spouse or a loved one along to the appointment. An extra set of ears (no pun intended) is helpful when trying to gather information and digest it all.

Cars are quite expensive, often requiring a loan to purchase them! Increased technology has caused the price of hearing aids to rise as well, but thankfully not as high as car prices! Nonetheless, amplification can put a bigger dent in a persons pocket than expected. For those of you who feel the price tag is extremely high, you may want to think in terms of amortizing the price of hearing aids over the ''life'' of the investment. In other words, if a pair of hearing aids cost $4800, and theyre expected to last 6 years, the cost per unit is 33 dollars per month. You may be interested to know the price of digital hearing aids has recently dropped due to the popularity of these hearing aids. There are more manufacturers producing them and there are more options and packages available. Just like any other product, as the supply increases, the price drops!

People may go shopping for a car wanting something sporty and fun. However, sometimes reality rears its ugly head, and something larger and more reliable is purchased, like a mini-van!

The same analogy can be made for hearing aids. A person with profound hearing loss may desire nearly invisible completely-in-the-canal (CIC) hearing aid, but usually a larger style would be more appropriate for someone with a hearing loss of that degree.

As I said earlier, all hearing aids do indeed amplify sound, but not all hearing aids are created equal!

Re-visiting the car analogy, sometimes just ''getting from point A to point B'' is not enough. Dr. J. Purdy (2001) best stated this idea when she simply wrote; ''I cannot win the Daytona 500 in a Yugo.''

If you seek the best, you will likely be surprised at how good hearing aids can be, and you will probably be very pleased. Yes, they are expensive, but you may be surprised at what they have to offer, for instance;

Most digital (computerized) hearing aids have directional ability, meaning they can "focus" on sounds in front of you, or the location of the most prominent sounds. They also have noise reduction ability, to reduce, although not eliminate, background noise. Digital hearing aids can be reprogrammed with sophisticated software packages, meaning the sound can be changed if your preferences or hearing loss changes, and most digital hearing aids have multiple programs for different listening situations. For example, one program might be desirable for a quiet library-like environment, while a very different program might be desirable for a wedding reception. Some digital hearing aids have additional features too, such as "direct audio input" allowing the patient to "plug into" the TV, the radio or the telephone. Some digital hearing aids have "FM" options, which create a mini radio station between the microphone and the receiver, and they have amazing quality and clarity of sound.

Lets talk briefly about some of the options I just mentioned. Telecoils (often referred to as the "T-coil") are an important option on most in-the-ear (ITE) and behind-the-ear (BTE) hearing aids. It is the telecoil that allows the hearing aid to be used in conjunction with most assistive listening devices. To activate the T-coil, one simply flips a switch on the hearing aid(s). The T-coil essentially "turns off" the hearing aid to all sounds outside except for the information being transmitted electromagnetically, thereby eliminating background noises and providing an easier listening situation and avoiding feedback (also known as whistling). Unfortunately, T-coils can pick up electromagnetic interference from other electrical equipment including computer monitors and digital cellular phones.

Patients with memory difficulties may want to avoid T-coils, because they might have difficulty remembering to switch the T-coil on and off. If the aid is accidentally left in the T-coil setting for situations other than talking on the phone or using FM systems, the listener will not receive regular hearing aid amplification!

If the benefits of T-coils sound exciting to you, but you are not thrilled about the possible problems associated with electronic interference, all is not lost! As noted earlier, some hearing aids have a feature called "Direct Audio Input" (DAI). DAI sound quality is said to be superior to that typically heard through T-coils, but it requires an electronic boot (this is an accessory to the hearing aid) and usually a wire to form its direct connection. Patients who are around computers or other electrical machinery may greatly benefit from DAI as it is not susceptible to the electromagnetic interference that T-coils are susceptible to. Usually, a behind-the-ear (BTE) style hearing aid is required for DAI capability.

Remember my comparison to buying a car? I have one final car analogy Many people buying a new automobile are interested in a test drive. It makes good sense. The good news about hearing aids is that most professionals offer a ''test drive for new hearing aids, usually about 30 days. These ''trial periods'' are not mandated nation-wide and different rules apply in different states. Please note, the trial period does not constitute the time period in which a person fully adjusts to new hearing aids. Often, it can take many months to achieve maximal performance with new hearing aids.

The relationship to the professional and their office does not stop when you acquire hearing aids. There are follow-up visits and future services that will be necessary. All of these factors need to be assessed when looking at costs versus benefits. The consumer should be aware that the hearing aid price tag usually includes in-the-office service (cleaning and adjusting) and the time of the professional, across the lifetime of the hearing aid. It has already been said that the high price tag placed on some higher end hearing aids often offers a very important benefit, specifically more time spent with the audiologist (Ross and Beck, 2001). Of course, this too varies, and the consumer should feel free to ask the professional which services are included and which are not.

As mentioned earlier, it is important for the consumer to know that hearing aids DO NOT restore normal hearing, and things will not suddenly be crystal clear. Better hearing takes time. Adjusting the hearing aids and adjusting to the hearing aids takes time.

You may be asking yourself if hearing aids are the "end all, be all" answer to hearing loss. The answer is NO! There are alternatives to hearing aids that work well for certain clients in certain situations. There are devices that cater to specific listening situations, such as watching T.V. or talking on the telephone and these devices are collectively called "assistive listening devices" (ALDs).

More often than not, ALDs used in conjunction with hearing aids offer maximal benefit in less than optimal listening conditions.

There are many different amplification devices for you to consider and evaluate - but the only way to find out what may work best for you and your needs is to make an appointment with a hearing healthcare professional.

CONCLUSION:

The more educated the consumer, the greater the likelihood of a successful hearing aid experience. Hopefully this article has given you a sense of comfort or a better understanding of what services and devices are available.

Knowledge is power. Consumers should be aware of the products and services hearing health care professionals have to offer. By staying informed, consumers and professionals can work together to establish reasonable expectations in order to achieve the common goal of enhanced communication through better hearing.


REFERENCES:

ASHA - American Speech-Language-Hearing Association, Scope of Practice Statement. 1996
http://professional.asha.org/resources/deskref/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=11887

Erdman, S.A., Wark, D.J., & Montano, J.J. (1994). Implications of service delivery models in audiology. JARA, 27, 45-60.

Kochkin, S. (1999). MarkeTrakV: ''Baby boomers'' spur growth in potential market, but penetration rate declines. The Hearing Journal, 52(1), 33-48.

Purdy, J.K. (2001). Roles in successful hearing aid fitting: consumers, audiologists, and manufacturers. Audiology Online, April, 2001.

Ross, M., & Beck, D.L. (2001). Expensive hearing aids: investing in technology and the audiologists time. Audiology Online, March 2001.

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