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Progress, Pitfalls and Promises of Hearing Technology: An Expert's View

Not many people can speak as authoritatively about advancements in hearing technology as Dr. Mark Ross. Professor Emeritus of Audiology at University of Connecticut, he is also a consultant with the Rehabilitation Engineering Research Center (RERC) on Hearing Enhancement, a national project focusing on research that promotes technological solutions for the hearing impaired.

When it comes to modern hearing aids, it is not the technological advances that impress me the most, but the actual improvement in aided hearing capabilities, Dr. Ross says. While they are related, they are not the same. Unfortunately, we do not have convincing evidence-based support for many of the new developments.

Dr. Ross assessment is based not only on his extensive professional experience, but also on a personal one: He has been wearing a hearing aid for more than 50 years (and has a cochlear implant as well), which has given him a good insight into how the hearing technology has evolved in the past decades.

Even though, by todays standards, his first hearing aid was large and clunky, Dr. Ross remembers this device first introduced in the United States in the 1920s and improved over the years - fondly. My first body-worn vacuum tube hearing aid helped me (and many others) hear better. Its contributions should be acknowledged and not just dismissed, he says.

Smaller and better

With time, hearing assistive technology (HAT) got smaller in size and better in quality. One of the more important advances, Dr.Ross notes, is miniaturization that made it possible to wear binaural aids. Better control of the electroacoustic product of the hearing aid - such as output, frequency response, extended frequency range, multi-channels and bands - came along and they are also very helpful, though limited to maybe three to five channels. What I particularly like is the availability of various kinds of HAT, such as large and small area assistive listening devices, telephone devices, signaling and warning systems, etc. I have a personal FM, a TV loop, cordless phones with audio output (for use with a neckloop), a vibratory wake-up alarm, and I never attend any large event without ensuring that an assistive listening device is available. I also like the improvement in the hearing aid evaluation tools that we now have, from convenient test boxes to probe microphones.

However, despite the undeniable progress made in the HAT field since the days of the vacuum tube hearing aid, Dr. Ross points out that there is still room for further improvements. For example, he says he is not impressed with the ultimate result of miniaturization (CIC aids) unless functional differences also occur. Sometimes they do, but clearly these are not the impelling force behind the stress on cosmetics, he notes. I like for myself some of the new features available - directional microphones, feedback and noise suppression - but some seem like bells and whistles designed more to make the marketers appear convincing than focus on actual listening performance. These new features, useful or less useful, were only made possible by the advent of digital hearing aids, but their promise was terribly oversold to consumers.

Some things change, others dont

But while the technology progressed exponentially, people with hearing impairment still face many challenges, proving that the more things change, the more they remain the same at least some of the time.

These people face exactly the same problems now as they did 60 years ago, Dr. Ross points out. The public still underestimates the impact of a hearing loss on someone's life. Poor hearing, particularly in the elderly, is still viewed casually or as a subject for crude humor.

What is also still prevalent is the denial mechanism that kicks in when someone is faced with the reality of hearing loss. The I am fine, I dont need a hearing aid argument has not changed much over the years, despite the growing awareness of the available treatment options.

They are not aware of what they don't hear, only of what they do hear, albeit poorly, Dr, Ross notes. In the beginning stages, the progressive nature of the hearing loss is such that projection is common for example, comments like people don't speak as clearly as they did when I was younger, or get the mud out of your mouth. Often, just getting a well-fitted aid on sometime, on trial basis, will make the difference. And maybe lots of pressure, begging, fights, etc. as well. But often, unfortunately, success is not possible; this too is a reality.

Become an informed consumer

Those who do make the wise decision prompted or not to get a hearing aid, are faced with a multitude of HAT options, which may actually make the choice more complicated rather than easier. Many consumers are unduly influenced by sophisticated marketing appeals or look for the best hearing aid, Dr Ross says.

His advice for ensuring the best possible outcome? I would suggest that people first look to secure the services of a licensed and certified audiologist, who will spend the necessary time discussing various hearing aid options, and secondly whose focus is broader than just the hearing aid product itself, he says. People come to the hearing aid dispenser ostensibly for hearing aids, but what they are really implicitly asking for is his or her help with their hearing problem; this is where the focus should be.

Promising developments ahead

If you think the HAT has made impressive strides forward, you are right. And the good news is that more progress is on the way. People with hearing loss can look forward to the future where new technology and medical advances can lead to treatments that just two decades ago were still in the realm of science fiction - such as hair cell regeneration.

I suspect that genetic research will help us identify and treat various hereditary conditions, and that perhaps we will soon see effective hair cell regeneration with adults, Dr. Ross says. In the medium run, however, our society is creating a larger hearing aid market, among younger people, with our love affair with noise and new trends in music - if it doesn't shake your sternum, it's not cool!

In his own life, he adds, the advances in technology have made a tremendous difference. As a cochlear implant user in one ear, and a hearing aid in the other, I shudder to think what my life would have been like without these advances!

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