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Dan's New Hearing Aid

Dan was born 23 years ago with profound deafness. He had worn hearing aids since he was two years old. But even when he wore his powerful behind-the-ear hearing aids, Dan's limited hearing ability only allowed him to tell when people began to speak and when they stopped speaking. The poor quality of his speech consisted mostly of loud vowel sounds and only a few consonants. Dan became an excellent speech reader by watching the movements of the mouth, and he learned sign language in school. His vocabulary and reading skills were low compared to his high intelligence and abilities. When he came to my office for hearing aid repairs and earmolds, I used American Sign Language (ASL) to communicate with him.

Understanding speech is much like the game ''Wheel of Fortune.'' When only the vowels are seen, it is much more difficult to solve the puzzle. As consonants are added, our ability to solve the puzzle increases. Listening to speech with a severely impaired hearing system is the same. Trying to guess what someone says by listening to the vowels with just a few consonants thrown in, is amazingly difficult to do.

As in ''Wheel of Fortune,'' some consonants are more valuable than others, like the /s/ or /t/ because they have a greater occurrence in written and spoken language, and they add so much more meaning to English. Dan's limited hearing ability did not allow him to hear most speech sounds. He had what audiologists call, ''a corner audiogram.''

As an audiologist, I am constantly on the alert for new hearing aid technology to help people with different types and degrees of hearing loss. I knew that if I could deliver more high pitched speech sounds, such as the consonants, to Dan's ears, he would understand speech better. Unfortunately, Dan had no measurable hearing in the high frequencies -- where most speech sounds are located.

When I discovered a new computer programmable hearing aid at a hearing industry trade convention, I immediately thought of Dan. This new technology actually ''moved'' high frequency speech sounds, like the s, k, t, sh, ch, which occur in Dan's inaudible range, to lower frequency areas, where Dan had hearing and could perceive them. Moving the speech sounds is called ''frequency compression transposition.'' You might think of this technology as a song being played on the piano. Imagine that speech is usually played in a higher key, or higher octave, where many people with severe and profound high frequency hearing losses cannot perceive them. However, this technology actually moves the song to a lower key, or a lower octave, where it is discernable. The song is the same, it's just lower in pitch and more audible for people who have hearing only in the low frequencies.

Hearing these important speech sounds for the first time, Dan heard a presence of sound where previously there was an absence of sound. Remember the ''Wheel of Fortune'' game? Dan was receiving additional letters appearing in the puzzle, which allowed him to move one step closer to solving the spoken message.

Dan's first reaction to these new hearing aids was amazement at how ''quiet'' they sounded. He had been used to very ''loud'' sounds with his power hearing aids. He discovered that most speech is quiet, not thunderous, and has a rich, variable, and pleasant sound.

Now, Dan's listening task consisted of learning a ''foreign'' language --oral English. He had to remember and use new sounds when he heard them. Dan came to see me once a week for listening exercises, called auditory habilitation. Sometimes, he found it difficult to trust the sounds his hearing aids were providing him. Dan often closed his eyes and repeated what I said accurately, but thought he said something different. We both discovered how oral English often does not make sense, nor does it follow common sense rules.

One afternoon, Dan was practicing listening for the /sh/ sound, when I said the word: ''Russian.'' He looked at me and said, ''Is that the word Southerners use when they mean to go fast, ''Rushin?'' When I showed him the word Russian, he hadn't realized the word had a /sh/ sound in it. So, I showed him some more words: ''pressure, concussion, session, Russian.'' He was amazed that the /sh/ sound was in the middle of these words too. He learned that the flower's name, ''rose,'' had a /z/ sound instead of an /s/ sound.

Dan soon discovered puns, an auditory play on words. One afternoon, he came into my office for his weekly learning to listen lesson - with a sneaky grin on his face.

''Margie,'' he said. ''Do you know what the little fish said when he swam into a
concrete wall''? ''No, what''? I answered, happy to hear Dan's first joke. ''Dam!'' , he said grinning.

Dan turned off the captions on his television to help him practice listening and understanding. He told me that ''English sounds like a foreign language.'' He is getting better at ''picking out words'' in a constant stream of spoken English. Dan used to watch me carefully when I spoke to him without simultaneously using Sign Language. But as he became more proficient in listening, he'd gradually look away, using his hearing instead of his eyes to receive language.

Sitting around a family campfire one evening, Dan laughed and talked with his family. Previously he would just go inside, because it was too dark for him to lip read or see the sign language clues to the conversations, which his family provided.

Dan heard other new sounds, too. One afternoon, he stopped by my office and asked me to drive with him to Wal-Mart, a short distance away. ''There is some new sound in my car which is driving me crazy.'' He said, ''I need you to tell me what I am hearing.'' I hopped into his car and when we drove over a bump in the road, I heard something rattle in the trunk. ''There,'' he said, looking over at me. ''did you hear it''?

I told him he had something loose in the truck which was banging around when he drove. He stopped the car and moved the tire jack.

Another time when his brother was visiting, Dan heard a strange sound repeated in the bathroom. He stood by the door trying to determine what the peculiar noise was. Later, when his brother came out, Dan asked him. His brother had to think for a few minutes and then began to laugh, ''I was blowing my nose.'' he told Dan.

Dan was delighted to hear birds singing, wind rattling the leaves, the pesky, loud insects called Cicadas, and even his dog whining to be let out.

One of Dan's goals with his new hearing was to use the telephone ''like other people do'' by talking and listening to the person speaking. In the past, he had to use a ''text'' telephone, called a ''TDD'' or ''TTY'' and apply a relay system of telephone operators to make his phone calls for him. Telephone usage was clumsy, inefficient, and intimidating. One recent Friday, when he arrived at the office, I told Dan we were going to practice utilizing the telephone. He was reluctant, but agreed to try.

We sat down by a regular telephone with a speaker attached. I told him I would call from the other room and say, ''Hi Dan'' and ''How are you.'' I told him I would ask him some other basic questions, too of which he had no previous knowledge. He would not be able to see me, but would have to rely completely on his new hearing aids.

''Hi, Dan.'' I spoke into a portable phone from a back office.
''Hi, Margie.'' He answered.
''How are you''? I asked.
''I am fine.'' He answered again with his voice quaking a little. He knew the unknown English questions would be coming up.
''Is it raining''? I asked with my fingers crossed.
''Yes, it's raining!'' He answered giggling slightly.
''Are you hungry''? I asked with joy bubbling up in my voice.
''Yes, I am hungry. I haven't had lunch yet!'' He replied with happiness radiating in his voice. By this time, I was leaping around the back office yelling with joy. Dan heard me clearly on the phone, said, ''I hear you celebrating, Margie!'' Then, he quietly requested, ''Can we call my dad?''

I told him we could try, but I cautioned him, it might not work on long distance calls as well as the inter-office call. He dialed his father's work number in Wisconsin. His step-mother answered the phone. I explained to her what we were going to attempt. She replied, ''Hi Dan. I'll get your father.'' Dan looked and me and grinned. ''I heard her say she was going to get my dad!'' Dan's father came on the line. ''Hi, son, this is your dad.''

Dan's eyes filled with tears when he heard his father's voice. ''Dad, I can hear you. I am talking to you on the phone just like other people do. Margie is not telling me what you are saying.''

There was a long silence, and then Dan and I heard his father's choked voice replying, ''Sorry, Dan, but I am crying and it is hard to talk. I can't believe it. For the first time in my life, my son is talking to me on the telephone.''

Dan and his father and his step-mother talked a long time. Occasionally, when the topic shifted, Dan would get lost and look to me for help. But I would simply tell his parents to say it again or to speak a bit more slowly and Dan picked up the flow of the conversation again. I just sat there and watched, so happy for, and so proud of, Dan.

Hearing technology changes quickly. In the last 36 months, some truly amazing circuits have been introduced. I urge all people with hearing loss to see their hearing healthcare provider for a current evaluation, and to try new and improved digital, direct audio input and FM technologies.

The tools we have in 2003 didn't exist in 2001, and many of them are quite remarkable. Even if your hearing loss is not as bad as Dan's, you will likely be surprised to hear all the sounds you're missing!

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