Patient Resources and FAQs

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Valuable FAQ’s

Most first time hearing aid users have common questions and concerns about their performance with hearing aids. At the consultation and fitting, the Audiologist typically counsels each patient about realistic performance expectations and attempts to answer any questions and address concerns. However, often a patient's initial experience with hearing aids will bring about questions and concerns which may not have been addressed in sufficient detail.

The following information is intended to help address some common questions and concerns which many of our patients have had in the past. It is hoped that with a better understanding of what to expect, it will be easier to maximize hearing potential with hearing aids.
A hearing loss typically results from some sort of damage to the hair cells of the cochlea (nerve of hearing). Therefore, no matter how accurately a hearing aid can reproduce sound, it cannot completely make up for the damaged hair cells on the nerve.

To provide a simple, analogy, you can think of the ear as a piano (nerve) with thousands of keys (hair cells). Each key represents a distinct and unique pitch or tone. A Mozart concerto played on a piano with all its keys would sound clear, full, distinctive, and melodic. The striking of each key contributes to the melody as it was intended to sound by the composer. Now imagine that after years of use the piano became damaged and many of the keys were missing. It is likely that the melody would still be recognizable and enjoyable, but it would be lacking some of the original clarity, quality and distinction. Even if the piano is played louder, it does not necessarily improve the sound quality because loudness cannot make up for the missing keys.

The ear has hair cells which could be compared to the piano keys in the above example. Hearing loss typically results from some of the hair cells being damaged. Just as a Mozart concerto would not have the same clarity or quality with keys missing on the piano, speech and other sounds would not have the same clarity and quality with hair cells missing or damaged on the nerve, even if the sound was louder. Therefore, it is not reasonable to expect normal hearing with hearing aids. However, it is reasonable in most cases to expect hearing aids to improve performance in most, if not all listening situations.
If you know someone with hearing aids, you may hear them say "Even with my hearing aids, I still have a lot of trouble in restaurants". As you know, hearing aids do not eliminate background noise. Some of the higher technology hearing aids may help more in noisy situations than traditional conventional hearing aids, but even high technology hearing aids cannot replicate the performance of a normal hearing ear in a noisy situation.

One of the reasons some people with hearing aids might have difficulty in noise was noted in the above section (damaged hair cells which cannot be replaced or repaired). Another reason patients have difficulty in noise is that the brain needs time to "retrain itself" to ignore irrelevant background sounds and focus in on the sounds we want to hear.

After a period of time with hearing loss the brain becomes accustomed to less environmental input. When you use hearing aids for the first time, you might be "startled" by the immediate increase in the input of all sounds (including background). The brain needs practice to relearn how to use the increased input provided by a hearing aid. After a period of time and practice, background noises are not likely to be as bothersome because you will be able to focus more on the sounds you want to hear.

There are some important strategies which can also improve your performance in noise. The most important strategy is "stereo" hearing, meaning optimum hearing from both ears. Studies have demonstrated time and time again that people with similar degrees of hearing loss in both ears need two hearing aids to ensure best possible performance in noise. Another strategy to take advantage of in noise is "preferred listening position". For example, when walking into a noisy restaurant, always ask for a corner booth far away from the kitchen, as this is typically a referable listening position.
Digital hearing aids cannot "block out" background noise although this is often insinuated by company brochures and advertising. Some of the best digital hearing aids are capable of reducing certain types of background noises such as the air conditioning, road noise, and refrigerator. Unfortunately, the most common type of background noise is speech, the very thing that these hearing aids are designed to enhance. In a restaurant, for example, the hearing aid cannot distinguish between the voices you want to hear and those you don't. Despite the fact that "blocking out" unwanted background noise is not possible, good digital hearing aids do provide the best chance for optimal hearing in noise.
A directional hearing aid typically has two microphones. One placed in front and one in the rear of the hearing device. The device compares the input at both microphones and uses advanced signal processing to reduce the noises from behind, thus focusing the hearing forward. This technology has proven particularly helpful in restaurants and large groups. Directional microphones are not available on the smallest hearing aids due to size constraints. However, there are several cosmetically pleasing hearing devices currently available with directional microphones
Patients often report that they have difficulty getting used to the more common noises in their everyday environment. Many patients will return for their follow up appointment and say "I'm hearing much better, but the noise from the refrigerator is bothersome". Others complain about the air conditioning, a fan, traffic, paper crinkling, even crickets among other sounds.

It is important to understand that every new hearing aid user has been living in a world muted by some degree of hearing loss. Not only is speech much softer and more difficult to hear, but so is the everyday annoying sounds around us. This muted background can often be quite pleasant. Those with hearing loss do not hear some the annoying sounds in the environment that people with normal hearing readily perceive.

As noted in the above section on listening in background noise, the brain is initially "startled" by the immediate improvement in the detection of all sounds including the ones we wish we didn't have to hear. In the beginning it is difficult to simply ignore annoying background noise, however, your brain will soon "tune out" the background noise to allow you to focus on the sounds you want to hear. It should be remembered that people with normal hearing hear all audible background sound, but have become so accustomed that it is as if the sounds are not even there. The fact that you may hear sounds like the refrigerator or air conditioning when you put on your hearing aids should be considered positive, as that is further proof that your hearing is closer to normal.
Feedback ("whistle") is a normal phenomenon with all hearing aids to some extent. Most hearing aids will whistle when you put your hand over the ear or if the hearing aid is turned on when inserted. Some patients with greater degrees of hearing loss are more prone to feedback. One of the most common reasons for feedback is improper placement of the hearing aid in the ear. If you set the hearing aid to a comfortable volume level and feedback occurs when you turn your head or open your mouth, this is not normal (assuming the aid is inserted properly). If you ensure the hearing aid is inserted correctly and feedback continues, please inform the audiologist at your follow up appointment so that necessary adjustments can be made.
You can expect your voice to sound different with a hearing aid. Patients sometimes ask "Am I talking too loud?" or "Does my voice sound louder too you?" Your voice with hearing aids is never louder than without. However, you may perceive your voice to be louder with hearing aids.

Hearing impaired people tend to adapt to their vocal loudness and quality with a hearing loss. They may even be unaware that there was any change in the perception of their own voice, because hearing loss typically occurs very gradually. In contrast to the gradual loss of hearing, a hearing aid immediately replaces much of your lost hearing range with amplified sound. It will take the brain some time to adapt because the change is immediate. With time, most patients learn to monitor their voice and eventually their voice with the hearing aid becomes normal.

In some cases, particularly with custom in ear devices, patients perceive an "echo" or "talking in a barrel" sensation when first using hearing aids. This sensation can result from the hearing aid blocking the exit of sound through the ear canal as it would normally travel. Depending on the degree and type of hearing loss the sensation may be intolerable to some and not even noticeable to others. If the problem continues there may be modifications which can improve the "echo" sensation. The sensation often becomes less noticeable after a few days of hearing aid use. The Audiologist may prefer that you wear the hearing aids for a week or two prior to attempting any major modifications, as this could result in adverse effects such as increased feedback ("whistle"). If you are unable to adapt, the Audiologist may decide to attempt to reduce the sensation of echo by modifying or adjusting the hearing aid. Today's popular "open style" hearing aids have greatly reduced our patient's own voice complaints by leaving the ear canal completely open thereby allowing both internal and external sounds to enter and exit without blockage.
Your complaint may be caused by high frequency (treble) drop off in your hearing. The drop off results in a reduced perception of the soft consonants in speech making people sound as if they are mumbling. Those with high frequency hearing loss may notice that similar words such as "hat", "sat", and "fat" are confusing, particularly in the presence of noise. High frequency hearing loss is very common. In most instances, properly fit hearing aids can improve clarity by replacing much of the lost high frequency information.
The smallest hearing aid is called the completely in the Canal (CIC) and we find it to be an appropriate hearing aid for many of our patients. However, miniaturization often requires manufacturers to remove some potentially beneficial features to fit the smaller size device. For example, a CIC cannot have a dual directional microphone to reduce the noises behind the patient and focus the hearing forward. The good news is that manufacturers have worked hard to make larger hearing aids more cosmetically pleasing. In fact, the ultra-small open over the ear hearing aid has become our most popular device due to the lower price, higher reliability, flexible options, less echo/occlusion and ability to blend in cosmetically.
Most hearing losses cannot be corrected surgically. Hearing aids are often the only viable option to improve hearing. Don't worry about "looking older" with hearing aids because people are more likely to associate hearing loss with old age than hearing aids. In fact, our patients often report feeling and looking younger because they can communicate more effectively without saying "What", "Huh", and "Pardon Me". In addition, today's hearing aids look and perform better than ever. Technological advances and styling improvements have gradually reduced the stigma attached to hearing aids. Now, more people are beginning to realize that hearing loss is much more noticeable than hearing aids.
Nerve deafness is more commonly known in our profession as sensorineural hearing loss. The loss results from damage to the inner ear hair cells or neural pathways to the brain caused by many factors including genetics, aging, noise exposure and some medications. Sensorineural hearing loss is the most common type of hearing loss and is typically permanent and irreversible. Once the hair cells are damaged they cannot be repaired or regenerated. There is currently research being done to determine if functional hair cells can be regenerated, however, a cure does not appear to be on the immediate horizon. For now, the most successful treatment for people with sensorineural hearing loss is properly fit hearing devices.
In most instances, two hearing aids are recommended for patients with bilateral hearing loss, except in special circumstances. Studies have consistently shown the advantages of binaural (two) hearing aids including improved understanding in noise, better sound localization, improved "stereo" sound quality, and better sound balance. Not all patients require two hearing aids. In fact, some patients with very low listening demands (i.e. one on one communication) do fairly well with one hearing aid. However, for those patients who hope to hear better in groups and noise, two hearing aids are critical.
All people who dispense hearing aids are required to have a state issued dispensing license. The license can be obtained by passing both a written and practical exam mandated by the state. Formal education is not required to become a hearing aid dispenser.

Currently, to become a dispensing audiologist one must obtain a Doctoral degree in Audiology from an accredited university, complete a clinical fellowship, and pass both the state audiology and dispensing exams. Until 2006 a Master’s degree was the minimum requirement to become an audiologist and many of those currently practicing have or are pursuing a transitional Doctoral degree. An audiologist's scope of practice includes the evaluation and treatment of those with balance problems and/or tinnitus in addition to hearing loss and hearing aids.
The three most important determinants of hearing aid success are:

1. Patience
2. Positive Attitude
3. Realistic Expectations

1. Patience: It may take some time and practice to become adept at inserting and adjusting hearing aids. Try not to let yourself get frustrated if it initially takes you several attempts to insert or adjust your hearing aids. Invariably, you will develop your own techniques within a short period of time, and insertion and adjustment of the hearing aids will become easy as putting on your shoes in the morning. In particular, people with physical disabilities such as arthritis in the fingers must have a lot of patience. Your Audiologist is more than willing to take as much time as necessary to help you with the insertion and adjustment of the hearing aids.

It is also important to have patience with regard to your performance using hearing aids. You will not perform as well at 2 weeks of use as you will at 1 month. You will also not perform as well at 1 month of use as you will at 3 months, as so on. "Retraining the brain" takes time, therefore you will not reach your full potential with hearing aids until you have worn them consistently for several months.

2. Positive attitude: Probably the most important determinant of success with hearing aids is attitude. Those patients who understand and accept their hearing loss, and sincerely desire to improve their communication ability, have a very high probability of success. On the other hand, those patients who get a hearing aid to please a family member, but don't believe they have any significant communication difficulties, have a very low probability of success (i.e. "It's not that I have a hearing problem, it's simply that some people mumble").

To ensure the best chance of success, your primary reason for purchasing hearing aids must be to "help yourself" hear and communicate better.

3. Realistic Expectations: Each individual patient has a hearing loss and listening demands which are as unique as their finger prints. Your Audiologist can give you an idea of what you might expect based on your audiological profile and the type of device you chose to purchase.