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A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one.
A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.
Hearing aids are primarily useful in improving the hearing and speech comprehension of people who have hearing loss that results from damage to the small sensory cells in the inner ear, called hair cells. This type of hearing loss is called sensorineural hearing loss. The damage can occur as a result of disease, aging, or injury from noise or certain medicines.
A hearing aid magnifies sound vibrations entering the ear. Surviving hair cells detect the larger vibrations and convert them into neural signals that are passed along to the brain. The greater the damage to a person’s hair cells, the more severe the hearing loss, and the greater the hearing aid amplification needed to make up the difference. However, there are practical limits to the amount of amplification a hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.
If you think you might have hearing loss and could benefit from a hearing aid, visit your physician, who may refer you to an otolaryngologist or audiologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and will investigate the cause of the hearing loss. An audiologist is a hearing health professional who identifies and measures hearing loss and will perform a hearing test to assess the type and degree of loss.
Hearing aids work differently depending on the electronics used. The two main types of electronics are analog and digital.
Analog aids convert soundwaves into electrical signals, which are amplified. Analog/adjustable hearing aids are custom built to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by your audiologist. Analog/programmable hearing aids have more than one program or setting. An audiologist can program the aid using a computer, and the user can change the program for different listening environments from a small, quiet room to a crowded restaurant to large, open areas, such as a theater or stadium. Analog/programmable circuitry can be used in all types of hearing aids. Analog aids usually are less expensive than digital aids.
Digital aids convert soundwaves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives an audiologist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry can be used in all types of hearing aids.
The hearing aid that will work best for you depends on the kind and severity of your hearing loss. If you have a hearing loss in both of your ears, two hearing aids are generally recommended because two aids provide a more natural signal to the brain. Hearing in both ears also will help you understand speech and locate where the sound is coming from.
You and your audiologist should select a hearing aid that best suits your needs and lifestyle. Price is also a key consideration because hearing aids range from hundreds to several thousand dollars. Similar to other equipment purchases, style and features affect cost. However, don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs.
A hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, options and upgrade opportunities, and the hearing aid company’s reputation for quality and customer service.
Before you buy a hearing aid, ask your audiologist these important questions:
- What features would be most useful to me?
- What is the total cost of the hearing aid?
- Do the benefits of newer technologies outweigh the higher costs?
- Is there a trial period to test the hearing aids? (Most manufacturers allow a 30- to 60-day trial period during which aids can be returned for a refund.)
- What fees are nonrefundable if the aids are returned after the trial period?
- How long is the warranty?
- Can it be extended?
- Does the warranty cover future maintenance and repairs?
- Can the audiologist make adjustments and provide servicing and minor repairs?
- Will loaner aids be provided when repairs are needed?
- What instruction does the audiologist provide?
Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them.
Become familiar with your hearing aid’s features. With your audiologist present, practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries. Ask how to test it in listening environments where you have problems with hearing. Learn to adjust the aid’s volume and to program it for sounds that are too loud or too soft. Work with your audiologist until you are comfortable and satisfied.
You may experience some of the following problems as you adjust to wearing your new aid.
My hearing aid feels uncomfortable. Some individuals may find a hearing aid to be slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while you are adjusting to it.
My voice sounds too loud. The plugged-up sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users. Check with your audiologist to see if a correction is possible. Most individuals get used to this effect over time.
I get feedback from my hearing aid. A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid. See your audiologist for adjustments.
I hear background noise. A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear. Sometimes, however, the hearing aid may need to be adjusted. Talk with your audiologist.
I hear a buzzing sound when I use my cell phone. Some people who wear hearing aids or have implanted hearing devices experience problems with the radio frequency interference caused by digital cell phones. Both hearing aids and cell phones are improving, however, so these problems are occurring less often. When you are being fitted for a new hearing aid, take your cell phone with you to see if it will work well with the aid.
Proper maintenance and care will extend the life of your hearing aid. Make it a habit to:
Keep hearing aids away from heat and moisture.
Clean hearing aids as instructed. Earwax and ear drainage can damage a hearing aid.
Avoid using hairspray or other hair care products while wearing hearing aids.
Turn off hearing aids when they are not in use.
Replace dead batteries immediately.
- Keep replacement batteries and small aids away from children and pets.
Although they work differently than the hearing aids described above, implantable hearing aids are designed to help increase the transmission of sound vibrations entering the inner ear. A middle ear implant (MEI) is a small device attached to one of the bones of the middle ear. Rather than amplifying the sound traveling to the eardrum, an MEI moves these bones directly. Both techniques have the net result of strengthening sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss.
A bone-anchored hearing aid (BAHA) is a small device that attaches to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are generally used by individuals with middle ear problems or deafness in one ear. Because surgery is required to implant either of these devices, many hearing specialists feel that the benefits may not outweigh the risks.
Hearing aids are generally not covered by health insurance, although some companies do. Financing is usually available. For eligible children and young adults ages 21 and under, Medicaid will pay for the diagnosis and treatment of hearing loss, including hearing aids, under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service. Also, children may be covered by their state’s early intervention program or State Children’s Health Insurance Program (SCHIP).
Medicare does not cover hearing aids for adults. However, diagnostic evaluations are covered if they are ordered by a physician for the purpose of assisting the physician in developing a treatment plan. Since Medicare has declared the BAHA a prosthetic device and not a hearing aid, Medicare will cover the BAHA if other coverage policies are met.
Researchers are looking at ways to apply new signal processing strategies to the design of hearing aids. Signal processing is the method used to modify normal sound waves into amplified sound that is the best possible match to the remaining hearing for a hearing aid user. NIDCD-funded researchers also are studying how hearing aids can enhance speech signals to improve understanding.
In addition, researchers are investigating the use of computer-aided technology to design and manufacture better hearing aids. Researchers also are seeking ways to improve sound transmission and to reduce noise interference, feedback, and the occlusion effect. Additional studies focus on the best ways to select and fit hearing aids in children and other groups whose hearing ability is hard to test.
Another promising research focus is to use lessons learned from animal models to design better microphones for hearing aids. NIDCD-supported scientists are studying the tiny fly Ormia ochracea because its ear structure allows the fly to determine the source of a sound easily. Scientists are using the fly’s ear structure as a model for designing miniature directional microphones for hearing aids. These microphones amplify the sound coming from a particular direction (usually the direction a person is facing), but not the sounds that arrive from other directions. Directional microphones hold great promise for making it easier for people to hear a single conversation, even when surrounded by other noises and voices.
An audiologist is a licensed professional who has a masters or doctoral degree in audiology. Audiologists are clinically, academically and professionally trained to determine which hearing losses require medical referral and/or assistive listening devices. The audiologist appropriately refers patients to physicians when the history, physical presentation, or the results of the audiometric evaluation indicate the possibility of a medical or surgical problem. Audiologists also dispense (sell and service) hearing aids and related assistive listening devices for the telephone, TV and special listening situations.
Audiologists are not the only people allowed by law to dispense hearing aids. The hearing aid specialist (also know as a hearing aid dispenser) is licensed to perform basic hearing tests for the purpose of
selling and servicing hearing aids and related products. This individual has a minimum of an associate’s degree (in whichever major they chose) that includes four hearing-related classes.
Another point to remember is the law does not allow hearing aid dispensers to bill insurance for the basic hearing test. This is because the dispenser is doing the hearing test ONLY for the purpose of selling a hearing aid (not to rule out medical conditions before fitting a hearing aid). When our audiologist sees you, you can be sure that we do a complete hearing evaluation to rule out any medical problems before considering hearing aids.
The most common complaint a hearing impaired person will say is “I hear you, but I don’t understand you.”
You may have hearing loss if…
- You hear people speaking but you have to strain to understand their words.
- You frequently ask people to repeat what they said.
- You don’t laugh at jokes because you miss too much of the story or the punch line.
- You frequently complain that people mumble.
- You need to ask others about the details of a meeting you just attended.
- You play the TV or radio louder than your friends, spouse and relatives.
- You cannot hear the doorbell or the telephone.
- You find that looking at people when they speak to you makes it easier to understand.
There are many causes of hearing loss. Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. Most commonly, hearing loss occurs as we age, gradually and very slowly. In the year 2001, there are some 28 million people in the USA with hearing loss. Hearing loss is the single most common birth “defect” in America. Hearing loss in adults, particularly in seniors, is common.
If you have any of the above symptoms, you should see an audiologist to get an “audiometric evaluation.” An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed audiologist. An AE is not just pressing the button when you hear a “beep.” Rather, an audiometric evaluation allows the audiologist to determine the type and degree of your hearing loss, and it tells the audiologist how well or how poorly you understand speech. After all, speech is the single most important sound, and the ability to understand speech is extremely important. The AE also includes a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. The results of the AE are useful to the physician should the audiologist conclude that your hearing problem may be treated with medical or surgical alternatives.
Written hearing tests, “dial a hearing test” and other online hearing tests are not particularly accurate and are certainly not diagnostic tests, but may be utilized as screening tools. These screenings are usually free and can be scored within a few seconds. Written hearing screenings may point the patient in a particular direction and may help validate that a hearing problem may indeed exist. You can always get a free hearing screening by a licensed Audiologist at Geneva Hearing Services.
If you have hearing loss in both ears and you are a hearing aid candidate in both ears, you should wear two hearing aids. You have two ears because you need two ears. If we try to amplify sound in only one ear, you cannot expect to do very well. Even the best hearing aid will sound “flat” or “dull” when worn in only one ear.
There are many advantages when using two ears (binaural) to listen. In addition there are problems associated with wearing only one hearing aid — if you are indeed a candidate for binaural (two) amplification.
Localization (knowing where the sound came from) is only possible with two ears, and just about impossible with one ear. Localization is not just a sound quality issue; it may also be a safety issue. Think about how important it is to know where warning and safety sounds (sirens, screams, babies crying, etc) are coming from. Using both ears together also impacts how well you hear in noise because binaural hearing permits you to selectively attend to the desired signal, while “squelching” or paying less attention to undesired sounds such as background noise.
People cannot hear well using only one ear. There are studies in the research literature which show children with one normal ear and one “deaf” ear are ten times more likely to repeat a grade as compared to children with two normally hearing ears. Additionally, we know that if you have two ears with hearing impairment, and you wear only one hearing aid, the unaided ear is likely to lose word understanding ability more quickly than the ear wearing the hearing aid.
Binaural hearing allows a quality of “spaciousness” or “high fidelity” to sounds, which cannot occur with monaural (one ear) listening. Understanding speech clearly, particularly in challenging and noisy situations, is easier while using both ears. Additionally, using two hearing aids allows people to speak with you from either side of your head – not just your “good” side!
TRT stands for Tinnitus Retraining Therapy because that is what we do, we retrain the brain.
People suffer from tinnitus not because they hear tinnitus, but because of the way their body reacts to it. We hear thousands of sounds on a day to day basis; our refrigerator fan running, our cell phone ringing or a truck passing by. These sounds do not elicit the same reaction that tinnitus does. The goal of TRT is to retrain the patient’s brain so they treat tinnitus similar to the way they treat the sound of a refrigerator: Normally they are not aware of it and when they do hear the sound it is not bothersome.
TRT, uses a combination of low level, broadband noise and counseling to achieve the habituation of tinnitus, that is the patient is no longer aware of their tinnitus, except when they focus their attention on it, and even then tinnitus is not annoying or bothersome.
Not every audiologist is appropriately trained to provide TRT. Luckily, our audiologist, Maria Morrison, is clinically trained and able to provide TRT to all eligible patients.
There are two parts to the TRT program: 1) Evaluation and 2) Treatment. Typically your insurance will cover the evaluation portion of TRT, however the treatment portion is a self-pay item. If you need, Geneva Hearing Services can work out a financial payment play to fit your budget.
If you are interested in TRT, please call us at 630-232-9153 and we will send you an informational packet.