FREQUENTLY ASKED QUESTIONS

We have provided the answers to some of the most common questions people have regarding hearing aids.  Most of the information these questions were collected from the American Academy of Audiology web site.

  What should users of new Hearing Aids realistically expect?

  How much time is needed to adapt to Hearing Aids?

  Why do Hearing Aids cost so much?

  Why do Hearing Aids amplify so much noise and make sounds too loud, but not clear enough?

  What can I do about the whistling (feedback) produced by Hearing Aids?

  What are Multi-channel (Multiband) Hearing Aids?

  What are Digitally Programmable Hearing Aids?

  What about the new Digital Hearing Aids?

  Why does my voice sound so odd to me when wearing Hearing Aids?

  What determines the style of Hearing Aids I should wear?

  How often must Hearing Aids be replaced?

  How do I determine if I am a candidate for Hearing Aids?

  Is it really necessary to wear two Hearing Aids, or can I get by with one?

  What are Assistive Listening Devices (ALDs) for TV, Telephones and Theaters?

  How are directional and multiple microphones used?

  How do I know if I have a hearing loss?

  I have been told that I have “nerve deafness” and that nothing can help me.  Is that true?

  I am fairly certain that my husband has a hearing loss.  How should I proceed?

  My mother has become very hard of hearing but refuses to admit it or to do anything about it.  How can I encourage her to get tested?

  How is hearing tested?  Does it hurt?

   My aunt’s hearing aid whistles much of the time.  What causes this and what can we do to make it stop?

  Why do hearing aids vary so much in cost?

  Will I become dependent upon my hearing aids?

What should users of new Hearing Aids realistically expect?

When wearing hearing aids:

How much time is needed to adapt to Hearing Aids?

While each person’s experience will vary, hearing aids may allow a person to experience certain sounds they had never heard before (or at least for some time).  Relearning takes place in the central auditory nervous system and not in the ear itself.  Recent experiments suggest that a listener’s ability to comprehend speech may continue to increase over a period of several months when wearing a new amplification system.  This process is termed acclimatization.  Most dispensing audiologists currently allow for a trial or adjustment period with new hearing aids.

Why do Hearing Aids cost so much?

Why do Hearing Aids amplify so much noise and make sounds too loud, but not clear enough?

Among the most frequent complaints voiced by hearing aid users are that noise is amplified too much and that certain sounds become too loud for the user to bear.  Conventional instruments do not have the ability to sort out sounds in the same way that the newer instruments do.  So when sound is made louder, many sounds that do not need to be amplified, do get amplified causing this problem.  When the hearing aids are turned up loud enough to understand speech, the background sound is too loud.  When the hearing aids are turned down to a more comfortable level, there isn’t enough information to understand speech.  Fortunately, many hearing aids now contain computer chips that allow the hearing aid to detect sounds of different pitches and loudness levels, then self-adjust to reduce the amplification (gain) for those sounds.  Unfortunately, because noise is comprised of many of the same frequencies as speech, it is virtually impossible to “shut out” all noise without also adversely affecting the quality of the speech signal.  The good news is that audiologists, using modern technology are able to measure and control the maximum sound intensity reaching your ear, allowing adequate gain for soft sounds while minimally (or not at all) amplifying loud input signals.  Additionally, new techniques using multiple microphones or multiple programs within the same hearing aid aids are improving the listener’s ability to function in noisy environments.  Clarity maybe improved for many people, but even the most sophisticated hearing aid’s ability to clarify speech is limited by the degree of inner ear and/or central auditory nervous system distortion.

What can I do about the whistling (feedback) produced by Hearing Aids?

There are two types of acoustic feedback—that produced internally from the hearing aid, indicating a device in need of repair; and the more common, external feedback produced by a leakage of amplified sound out of the ear canal and back into the microphone of the hearing aid.  Feedback that occurs when the hearing aid is being inserted or removed, or when your had is cupped near the device is common, and does not necessarily signal the need for action.  If however, you experience feedback when you speak, chew, yawn or change position, you need to consult your audiologist.  Feedback is more likely to occur in smaller hearing devices because the microphone is closer to the area at which the sound comes out into the ear.  So, a behind-the-ear style may be less likely to produce feedback than in the in-the-canal device.  Usually, external feedback can be corrected by:

·        Properly reinserting the hearing aid or earmold

·        Remaking the earmold (or in-the-ear shell)

·        Plugging, or reducing the amount of high frequency gain, (typically an unacceptable trade-off because of the resultant loss of high frequency hearing)

·        Altering the sound by means of filters in the hearing aids or changes in the way the devices are programmed

·        Adding a “canal lock” (a piece of plastic) to better hold canal hearing aids in place so they don’t work out of the ear canal as you chew or move your jaw.  Recently some manufacturers have introduced digital feedback reduction. With this technology, feedback is sensed by the hearing aid and canceled by means of a new signal generate4d by the hearing aid itself.

What are Multi-channel (Multiband) Hearing Aids?

As a result of these enhanced procedures, it has become abundantly clear that significant differences exist not only among individuals with nearly identical audiograms but also among the loudness growth of specific frequencies for a given individual.  A patient can demonstrate loudness tolerance problems for certain frequencies, but not for others.  Therefore, the electroacoustic characteristics programmed into the hearing aid should differ for the various frequencies.  Through the use of multiple compression channels, a completely unique set of signal processing instructions can be utilized.  With multi-band compression, the reduction in gain is limited to those frequencies containing the offending signal.  This may be the most important advantage of all.

What are Digitally Programmable Hearing Aids?

Some of the characteristics of the sound produced by hearing aids can be modified using computers or other devices.  Hearing aids that have this capability are called “digitally programmable.”  They have several advantages over non-programmable instruments but should not be confused with fully Digital Hearing Aids.

What about the new Digital Hearing Aids?

The future of hearing aid technology has arrived!  Advancements in research have led to the ability to manufacture hearing aids that process sound digitally.  This offers the potential for dramatic improvements over previously available instruments.  Hearing aid researchers haven investigating the use of true digital technology for over a decade and we are now able to provide these digital hearing instruments to our patients.  More patients than ever are receiving benefit from this technology.  We have more control over the way the sound is processed thus able to program the hearing aids to most closely accommodate each patient’s individual needs.  This ability greatly enhances hearing ability for many patients who previously had difficulty wearing them.

Why does my voice sound so odd to me when wearing Hearing Aids?

Some hearing aid users report that they feel as if they are in a barrel or experiencing an echo when talking.  This is called the “the occlusion effect.”  Normally, when your ear is unblocked and you are speaking, you hear yourself both through the air traveling through your ear canal, (air conduction) and through vibrations that you create in your skull and ear canal (bone conduction).  When your ear is occluded or blocked, however, air conduction transmission is reduced and bone conduction perception enhanced.  Try this experiment.  Hum aloud and then alternately plug and unplug one ear while humming.  Notice how the sound changes pitch and loudness in your plugged ear.  This happens because the vibrations are blocked from their usual escape route.  Most new users adapt to this effect and it isn’t a problem.  However for some, the following steps may help:

What determines the style of Hearing Aids I should wear?

There are four primary styles of modern hearing aids.  They are:  Behind-The-Ear (BTE); In-The-Ear (ITE); In-The-Canal (ITC), and Completely-In-The-Canal (CIC).  While many people choose styles based on appearance, decisions regarding which style of hearing aids are most appropriate for you may need to be based on a variety of factors. 

Physical factors include:

Hearing related factors include:

BTE aids have a clear advantage over the smaller ITE or ITC aids because feedback is less likely to occur.  While you may feel that you will only wear an inconspicuous device, check the appearance of a small or mini-BTE aid coupled to the ear with an open earmold.  A mini-BTE aid connected to the ear with an open earmold may be less conspicuous than most ITE and many ITC aids.  Most importantly, discuss the pros and cons of different styles with your Doctor of Audiology.

How often must Hearing Aids be replaced?

Generally speaking, hearing aids should last from 3 to 5 years.  The need for new hearing aids may occur if a patient’s hearing significantly changes, but with the availability of programmable and digital hearing aids, changes can often be made in the audiologist’s office and should reduce the need to order new hearing aids merely because of changes in hearing.

How do I determine if I am a candidate for Hearing Aids?

You are a candidate for hearing aids if you experience difficulty communicating because you are unable to hear sufficiently enough, to understand what people say.  You also may be at risk for safety because you cannot hear appropriate warning sounds.  Amplification may relieve the strain of concentrating in listening situations, relieving some stress.  Often hearing loss interferes with relationships with other family members.  It is very difficult to try to communicate when one cannot hear.  Often, those with hearing losses withdraw from everyday activities and become more isolated.  Hearing aids are not a mark of infirmary; rather they are a wonderful choice you have to enhance your relationships, communication and safety.  They may allow you to perform more efficiently at work, and be more comfortable in social or family situations.  If you are experiencing withdrawal from previous interactions because it is too difficult to understand, you should consult an audiologist to determine presence of a hearing loss and investigate your options for improvement.  It is often advisable to arrange to try hearing aids within your own unique environments to determine the benefit of hearing aid use.

Is it really necessary to wear two Hearing Aids, or can I get by with one?

There are four main reasons why binaural (two eared) listening is superior to monaural (one eared) listening.  They are:

What are Assistive Listening Devices (ALDs) for TV, Telephones and Theaters?

One of the major goals of signal processing schemes is to enhance the signal to noise ratio perceived by the listener.  The use of aids with automatic low frequency reduction represents an attempt at this goal.  Unfortunately, despite all the new technological advances, a basic problem remains for which wearable amplification falls woefully short.  That problem related to the physical distance between the microphone of the hearing aid and the source of the sound desired to be heard.  Intensity (loudness) decreases as physical distance increases.  Unfortunately most background noise surrounds the listener, so while the intensity of the speech decreases with distance, the intensity of the noise may not.  This is one reason why hearing aids transmit sound so well if the speaker talks directly into the microphone, but at longer, more realistic distances reception diminishes. 

It would be ideal to have the sound produced at the source transferred directly to the listener without losing any intensity.  It is usually impractical to ask the speaker to move closer to the listener’s ear.  One way of achieving this effect is with direct audio input, in which the speaker holds a microphone that is hard wired to the hearing aid itself near his mouth.  Many hearing aid wearers are reluctant to ask the speaker to do this.  An alternative approach is available through infrared transmission, FM transmission, or inductance loop transmission.  These systems are currently used in many theaters, concert halls, houses of worship and households.  One of the best uses is for television listening.  The portable transmitter (usually smaller than most cable boxes) and microphone are located near the TV loudspeaker.  The sound picked up by the microphone is then transmitted in the same intensity to a receiver worn by the listener.  These devices can transmit with minimal distortion over a considerable distance (up to 50 feet).  ALDs are becoming increasingly common in public places, due to the legislative enactment of the Americans with Disabilities Act.  Other non-wearable devices that assist the hearing impaired listener include telephone amplifiers, vibrating alarm clocks, TV closed caption decoders, inexpensive personal hand held or body borne amplifiers, visual alarm systems, and TDDs (telephone devices for the deaf).

How are directional and multiple microphones used?

Most of the time, listeners are facing the person they are speaking to.  Noise, however, is often located in front of, behind, and/or to the sides of the listener.  Some hearing aids now contain directional or multiple microphones that “communicate” with each other in a manner such that sounds originating from the front of the hearing aid receive maximum amplification and sounds originating to the sides or behind the hearing aid receive considerably less amplification.  This effectively suppresses some of the annoying background noise that creates so much difficulty for hearing impaired listeners.  The technology using these types of microphone arrangements is very promising.  They can be found in several different hearing aids but are generally limited to behind-the-ear or full shell in-the-ear hearing aids due to size restrictions.

How do I know if I have a hearing loss?

Do you have difficulty understanding conversation in a group of people or in a noisy place like a restaurant?  Do you find yourself asking others to repeat themselves?  Does it seem to you that some people mumble?  Do you turn the TV up too loud for the comfort of your family members?  Do you have trouble understanding whispers from those next to you or do you have trouble understanding voices from across the room?  Do you have difficulty understanding women or children?  If you answer “yes” to any of these questions, then you likely have a hearing loss.  You should have a Doctor of Audiology test your hearing. 

I have been told that I have “nerve deafness” and that nothing can help me.  Is this true?

Nothing could be further from the truth.  First of all, “nerve deafness” is a misnomer.  Hearing loss that occurs with increasing age or from hereditary factors is rarely caused by a deterioration of the hearing nerve, but is caused by damage to the tiny hair cells in the inner ear or cochlea.  The vast majority of successful hearing aid users have been told they had “nerve deafness” at one time or another.  “Nerve deafness” is simply a term that has been used to label any type of hearing loss that cannot be treated by medicine or surgery. 

I am fairly certain that my husband has a hearing loss.  How should I proceed?

The only professional trained in the measurement of hearing is an audiologist.  An audiologist has earned, at minimum, a Masters degree in Audiology from an accredited University and he or she should be licensed by the State Board of Examiners.  The highest degree attainable in the field of Audiology is the Doctor of Audiology.  Both of our audiologists are licensed Doctors of Audiology.  A Doctor of Audiology will measure your husband’s hearing and will do all appropriate testing to determine if hearing aids might be of benefit.  With today’s advanced technologies, the vast majority of hearing losses can be corrected with hearing aids.  Only 20% of hearing losses in adults are caused by medical problems, but if indicated, an appropriate referral will be made for medical treatment.

My mother has become very hard of hearing but refuses to admit it or to do anything about it.  How can I encourage her to get tested?

Hearing loss often occurs very gradually and is a problem only in certain listening conditions.  It is easy for the listener to blame background noise, room acoustics or the speaking characteristics of others for inability to hear clearly.  It is hard for many to accept that the problem is theirs and not the speaker’s.  It may by useful to sit down with your mother and share with her how frustrating her hearing loss is for you.  You have to get her attention before you can speak to her.  You cannot talk to her from another room.  She is always asking you to repeat what you say.  It is just plain hard work to communicate with her and that makes visiting a chore.  Many people don’t realize what an imposition their hearing losses are for friends and family members and end up socially isolated as a result.  Approach your mother’s hearing loss from the standpoint that you would like to be able to visit with her more freely, and that might persuade her to seek help.  Offer to make her an appointment with an audiologist and then go with her.  Your audiologist is trained to counsel those with hearing loss and help them deal with their feelings of denial.

Many people still feel that the use of hearing aids creates a stigma associated with aging and/or disability.  It sometimes helps to point out that the stigma of appearing inattentive, self centered or just plain dumb is much worse than the “stigma” of hearing loss.  The successful use of hearing aids is very common.  Patients usually find that the benefits of better hearing outweigh their concerns that someone will see their hearing aids.

How is hearing tested?  Does it hurt?

Many methods have been developed to assess hearing ability, but the most common and the most reliable test has been the pure tone audiogram.  Earphones will be placed on your ears and you will be asked to listen for a series of beeping tones that sound rather like notes on a piano.  You will be asked to respond when you hear these sounds by pushing a button or raising your hand.  Your audiologist will determine the softest volume that you can hear for a variety of tones from very low to very high pitched, and the results may be compared to what is normal for human beings.  You will also be asked to repeat a series of one-syllable words to determine how well you understand what you hear.  In addition you will be tested for your threshold for understanding speech with spondaic words.  Sometimes the test is repeated in the presence of background noise.  The test will be conducted in a sound treated suite.

The entire evaluation takes about an hour and there is no pain or discomfort involved.  It simply requires some concentration on your part.  The test results are used to determine which, if any, hearing instruments will be most effective in correcting your hearing loss. 

My aunt’s hearing aid whistles much of the time.  What causes this and what can be done to make it stop?

Whistling, or feedback, is a very common symptom of a poorly fit hearing aid.  The hearing aid’s job is to amplify sounds not heard well by the user.  If the amplified sound coming out of a hearing aid gets picked up by its microphone rather than going down the ear canal, feedback will occur.  It is necessary to isolate the microphone from the ear canal with a custom fitted earmold.  A whistling hearing aid is caused either by an earmold that does not fit the ear snugly or by an earmold that is not properly seated in the ear canal.

If a significant hearing loss exists, the hearing aid user will not hear that feedback but it is annoying to anyone nearby.  A visit to your audiologist is in order to take new ear impressions or to get instruction on proper insertion of the hearing aid into the ear canal.

Why do hearing aids vary so much in cost?

As with automobiles, it’s what’s “under the hood” that determines cost.  The most expensive hearing aid circuitry is digital or programmable, while the simplest conventional hearing aid is fairly inexpensive.  Generally you get what you pay for.  Digital circuits contain a computer that allows the audiologist to program literally hundreds of adjustments into your hearing aids.  Digital hearing aids produce the best sound quality available today and are upgradeable should your hearing change. 

Will I become dependent upon my hearing aids?

If properly fitted, hearing aids will not make your hearing any worse, nor will they prevent your hearing from deteriorating naturally.  Once accustomed to listening with hearing aids, most people do find they are somewhat “lost” without them and put them on along with eyeglasses each morning.  You will probably find that you will be less fatigued by social gatherings and long conversations than you were before acquiring your hearing aids.  A “dependence” upon hearing aids is no different than a “dependence” on eyeglasses.  If you need them to hear and to see, then wear them and enjoy hearing and seeing better!!!

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