Modern digital hearing aids incorporate amazing electronic advancements over hearing devices of the past. Manufacturers, in the last decade, have brought hearing aid technology into the 21st century. The circuits are so miniaturized that they can fit into smaller devices and at the same time process sound with space age efficiency. These ear level computers can control feedback, loudness discomfort, and reduce noise more effectively than ever before. In fact, when tested, fitted, and counseled correctly almost all patients will receive significant benefit from amplification. If fitted correctly, Remarkably, the most common errors come from manufacturing or prescription errors made by the Audiologist or Hearing Aid Dispenser. In fact, only 20% of hearing aids fitted today use advanced techniques to select the prescription. Most providers use preset numbers for every loss provided by the manufacturers in a shotgun approach. Furthermore, the ear mold or speaker and dome are frequently ill conceived, poorly manufactured, and frequently misfitted. A high quality provider can correct all these issues.
As a medical device, hearing aid technology has surpassed the hearing loss ear’s ability and are actually attempting to aid in brain processing. This is possible because advancements in technology and hearing science have resulted in devices with options and equalizers that can be adjusted for every hearing loss. This computer technology is available from a number of quality manufacturers.
Although all premium hearing instrument are essentially the same and even with perfect programming, hearing aids cannot restore damaged hearing nerves and consequently, it is realistic to accept some minor degree of residual hearing deficit. Most patient should be able to hear a whisper and have adjustments to reduce the background noise in half. Even with minor deficits, all patients with hearing loss are candidates for some degree of amplification.
Many individuals live very comfortably with their hearing loss. They are good at sharing with their family, friends, and co-workers their needs and rules for best communication, while being respectful of others. This includes learning how to use their hearing aids, adapting to and using special listening devices, and developing good listening skills. These habits help patients to maximize their potential and reduce communication stress.
Unless a special circuit is required, such as a BiCros, results with hearing aids are not dependent solely upon the brand, but the type of hearing loss, the special features incorporated into the hearing instruments, and the person providing the fitting, custom prescription services, and counseling. The manufacturer or brand should be selected for dependability, level of technology, computer programmability, and service policies. A hearing aid is a medical device used in the process of learning or re-learning how to hear. How well the device is manufactured, selected, and adjusted is critical to the results. Hearing aids can be very expensive, but if not correctly fitted or the patient not motivated or correctly counseled they can be rendered ineffective and end up in a dresser drawer. For these reasons, it would be best if every patient could see an Audiologist with a doctorate and master’s degree and 30 years experience, but this is not practical or realistic. However, many qualified Audiologists that are properly trained can provide diagnostic hearing assessment of the ear and brain, determine the correct plan of treatment, and from years of education and experience provide science based solutions. One of these solutions on occasion may include a referral to an Ear, Nose, and Throat (ENT) physician for medical review and hearing loss management. However, in most cases, hearing loss is not treatable or reversible and the ENT physician will not improve the outcome. The prospective hearing aid user should remember that the purpose of consulting these “professionals” is to insure that no medical condition is going untreated and that the hearing aid benefit is maximized.
Hearing Aid Providers
Hearing aid sales have been around since the advent of the first ear trumpets originally sold in pharmacies in the late 1800’s. Since that time, tremendous changes in technology have revolutionized auditory programming, making anyone with a doctorate look twice at the capabilities of modern instruments. Programming hearing aids to change the brain’s sound map or using amplification for children with sound processing problems are a couple of examples of how complex this field has become. In order to keep up with technology and hearing science, the field of Audiology has had to change its minimal education requirement from a Masters to a Doctoral degree. Including university training and internship, a current master’s degree can take 7-8 years and a doctoral degree as many as 10 years. Additionally, continuing education is required annually to maintain licensure and board certification in Audiology. In addition to Audiologists, hearing aid dispensers are separately licensed to provide hearing aids. The current formal education requirement for a dispenser’s license, in most states, is a high school diploma, although a few states have a two year technical training course. Annual continuing education hours are required for dispensers to maintain their license. Dispenser licensees also use terms such as Board Certified in Hearing Instrument Science (BC-HIS).
Hearing aids or ear level amplifiers are being sold as a commodity over the internet and by some retailers without regard for professional patient care that maximizes hearing. Many of these are at wholesale levels without the benefit of appropriate care. Quick gimmicks for self fitted hearing aids or those that are not fitted with real ear testing, will under perform and leave many buyers with their hearing aids in the dresser drawer. The function of an Audiologist is to determine the most appropriate services, utilize the science, and provide the best counseling for each patient, correlate the prescription with the patient needs, select a manufacturer and product, and insuring that brain activity is maximized and memory loss is reduced as much as possible. To maximize hearing, making sound louder over-the-counter is only a small fraction of what is needed. Typically, hours are spent working with patients to correct all the problems associated with fitting and prescriptions. Should you purchase such a device and it does not work within thirty days, it should be returned for a complete refund.
The Gold Standard of Care
The Hearing Guy has created a Gold Standard of Care from his experience and information taken from the field of Audiology (American Academy of Audiology) and other specialists. The following services, hearing aid options, and protocols are recommended as part of the hearing aid process. Requesting these services along with your motivation and readiness to wear hearing aids will greatly improve your chances of achieving success. Take these suggestions to your Audiologist and he or she will be able to take you through each of the steps.
1. Hearing Assessment – The purpose of the assessment is to obtain sufficient diagnostic information to determine the type, location, and magnitude of the hearing loss and associated processing disorders, determine candidacy for amplification, identify medical conditions requiring an ENT specialist, counsel patients and family members on the test results, and provide recommendations. At a minimum, the assessment should include an examination of the ears, a medical history, hearing questionnaire, and diagnostic hearing testing.
2. Needs Assessment – The purpose of this assessment is to set a treatment plan that takes into consideration a variety of factors necessary to meet the patient’s hearing needs. This includes a discussion on the benefits, limitations, and costs associated with obtaining amplification.
3. Selection and Special Features – The selection of hearing aids should be based on the degree of hearing loss, power needed to meet the prescription, the shape and size of the ear, jaw movement, wax development, and the patient’s ability to operate the hearing aid. Furthermore, special features needed to control soft sounds, loudness, background noise, and clarity is available from most quality manufacturers and should be discussed. When properly selected, the features listed below (A-J) can enhance hearing. However, in some hearing loss cases, the addition of special features may not be beneficial depending upon how the ear and brain function. A qualified Audiologist can assess the efficiency of each feature based on the patient’s actual needs.
A. Do I need a digital hearing aid? The entire industry is moving all hearing aids to digital status. HearingGuy.com recommends that you purchase digital technology. Older analogue technology is being phased-out and within a few years will not be available.
B. Do I need feedback cancellation? A new feature in feedback control (feedback is a loud squealing sound) is digital cancellation. This is a great improvement in technology as it allows the hearing aid to give a wider range of sound power resulting in better understanding. The feedback control is especially important if you have small ear canals or have a moderate to severe hearing loss requiring power.
The most remarkable change in hearing aid technology is in the area of noise reduction. These special microphones change the emphasis of sound allowed into the hearing aids. Dr. Colucci recommends that patients purchase directional microphones that are rated at 6 dB or greater. However, if word understanding without hearing aids is poor then directional microphones will be less effective in some noises, but still useful for reducing noise confusion and discomfort.
D. Do I need a t-coil? A t-coil or more appropriately the telephone coil is a magnetic device that picks up sound from a speaker of a telephone earpiece, a classroom sound system (loop or FM), a t-coil booster, neck loop, or other device connected to Bluetooth. If it makes sound, the t-coil can be used to attach your hearing aids to the world. This product is highly recommended by the Hearing Loss Association of America (HLAA) and professionals in Deaf Education, Otolaryngology, and Audiology. For public areas, the American Academy of Audiology and HLAA have joined together to promote the Loop America initiative to help groups with understanding and implementing the technology (picture from http://www.hearingloop.org/).
E. Do I need direct audio input (DAI) connections? In moderate to profound hearing loss, for patients using behind-the-ear (BTE) hearing aids, a special connection can be used to input sound signals from a variety of devices. This is accomplished by using a boot that slips onto the bottom of the BTE hearing aid so that other devices can be plugged into that and heard. In children, direct audio input (DAI) is a necessity.
F. Do I need two hearing aids? If you have hearing loss in both ears The Hearing Guy recommends a hearing aid for each. Remember that hearing is a learned function and the purpose of using two hearing aids is to map and remap the brain from the best possible information. Among other things, the ears work together to enhance the understanding of speech, locate sound, and decrease noise interference. There are two exceptions and these are seniors with an ear that sends distorted sound or those who have auditory processing disorders (APD). In these cases, a single hearing aid may outperform fitting both ears.
G. Does the size of the hearing aid matter? Our fondest dream is that we can all use the smallest hearing aids that fit discretely into the ear and are practically invisible, last forever, and have superior performance. Unfortunately, the smallest hearing aids can service not all ears and degrees of hearing loss nor do they last forever. The smallest hearing aids are called completely-in-the-canal (CIC) and can be an excellent device when fitted to the right patient. However, CIC hearing aids are not recommended for severe to profound hearing loss or for ears that develop considerable wax. In most cases, the size and shape of the hearing aid does matter as the fit and power requirements needed to match every hearing loss, ear shape, or medical problem will be different for each patient.
H. Do I need additional devices to augment the use of my hearing aids? Most hearing impaired listeners can use two to four products that make life easier. These are telephone amplifiers or t-coil booster, Bluetooth and FM connections, a TV amplifier system, and a hearing aid dryer to remove moisture. The Hearing Guy recommends these products because they have exceptional acceptance among users and professional organizations. Many of these products can be seen in the products section of this site.
I. Do I need an open mold hearing aid fitting? You do if your hearing in the low tones is normal and you only have a high tone hearing loss as seen in the attached audiogram. If your hearing ability in the low pitches (the pitch range you hear when saying “eeee” and “rrrrr”) is near normal, then an open mold fitting is just what the doctor will order. This “eeee” to “rrrrrr” range in a man’s voice is a low tone sound (125-750 Hertz). When this range is normal, filling the ears with hearing aids will close off the head’s normal low tone exit (ear canal) and a clogged sensation occurs. This makes the voice sound hollow, muffled, or reverberating as if your head was in a barrel. This is called occlusion. The only way to relieve this pressure is to use an open mold fitting. Rarely can anyone become accustomed to occlusion and a change in hearing aids to an open mold strategy is almost universally inevitable.
J. Do I need wireless communication between my hearing aids? This feature is found in a variety of premium hearing aids and can be very helpful in adjusting programs for noise reduction and volume. The latest technology in hearing aid communication couples both right and left hearing aids so that the user can make a change in function on one side that will change in both hearing aids. Additionally, the use of remote controls including one version, just like a TV channel changer, that can be used to adjust the hearing aids, control a remote microphone, and hear a Bluetooth cell phone.
4. Verification – This stage of the hearing aid fitting process is ultimately more important than the choice of hearing aid manufacturer. Verification starts with an evaluation of physical fit and comfort to insure that the hearing aid is secure, but not too tight to cause pressure or discomfort in the ear canal. Following physical fit, the purpose of verification is to guarantee that the hearing aid prescription actually fits the hearing loss. This is done by performing a remarkable set of tests called real ear probe or sound mapping. During these procedures, a tiny microphone tube is inserted into the ear canal along with the hearing aid. When the hearing aid amplifies sound, it can be measured at the eardrum and adjusted via computer to maximize power and performance. For very young children, special testing called real ear to coupler difference (RECD) are routinely used to determine fitting accuracy in place of real ear tests that require cooperation. After fitting services typically result in some minor changes to the original prescription to accommodate loudness, voice, and noise preferences. Computer automated fittings without real
5. Orientation and Counseling – After the physical and acoustic fit of the hearing aids have insertion and removal of the instruments and batteries, operating the different sound and comfort programs, turning the device on and off, as well as how to use the telephone and other compatible devices. Maintenance of the hearing aids, including cleaning and removal of wax and moisture, should also be reviewed. Listening skills instruction that help patients to function in common hearing situations are also typically provided. In some cases, auditory therapy will be necessary to improve hearing performance. This may include enrollment in a speech reading class and in-office receptive language training for those with severe communication problems.
6. Validation – How do you know that the hearing aid you purchased work correctly for your hearing loss? One way is to compare the aided results of your hearing questionnaire against the questionnaire you took prior to using hearing aids. Another way to measure performance is to determine the improvement based on a set of goals. Based on the realistic expectations provided by your Audiologist, the results of your hearing performance should demonstrate improvement hearing in quiet surroundings and better performance either tolerating or understanding in background noise for most. Validation is a measure of the results obtained with amplification. The degree of improvement or the outcome is what professionals like to measure to prove benefit.
– During this final training, your Audiologist will help you to understand how the brain and its connections learn to channel sound from the ears to a map in the cortex. You will learn that over time, the consistent use of hearing aids can help the hearing brain to function better, especially if auditory therapy is added. The typical time it initially takes to adapt to hearing aids is between 30 and 60 days for adults. However, after this initial adjustment period, it takes a number of months before the adaptation process is completed. For very young children this process is often occurring along with a maturing hearing system and new sounds are integrated as part of the development. For seniors, it may take even longer as health problems and aging may play a role in reducing performance and learning.
When hearing aids are fitted correctly and the services connect with the seven steps presented above are used, the patient should have maximum hearing aid performance. Most patients recognize that hearing aids are of great importance in their daily lives and without them there is a lack of communication and social engagement. However, this does not mean normal communication in all listening situations and some degree of residual deficit is to be expected. Finally, when making a decision on the person that is going to be responsible for your hearing analysis and treatment, it is wise to review their experience, education, product choices, and reputation. In fact, returning a hearing aid for credit or not using the device should be almost non-existent when seeing an experienced and qualified Audiologist. Modern hearing aids work for almost all hearing losses and when fitted properly can make an important contribution to our quality of life and health.