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Are Hearing Aids for Me?

The critical variable is whether you experience difficulty hearing or are having increased stress and strain in your daily function. Amplification may relieve the strain of hearing, as opposed to making sounds louder or even improving your understanding of speech. This alone can be a very significant benefit. You must ask yourself whether you find you are becoming stressed or fatigued after a day of straining to listen. Ask yourself whether the ability to hear, but not understand, is adequate for your needs. Unselfishly examine whether you are becoming a burden to your family and friends, even if you do not personally recognize difficulty hearing. Remember that wearing a hearing aid is not necessarily a mark of infirmary, rather it is a mark of courtesy to others. Thus, sometimes it is advisable to arrange to try hearing aids within your own unique environments to determine whether the benefit warrants the expense.

About Audiograms

Get a hearing test and find out. Here is how you do it!

What's a audiogram? An audiogram is the test results you receive when you take a hearing test. A very highly calibrated machine that produces sound at the pitches associated with human speech, called an audiometer, is hooked up to a pair of headphones that you wear. The person giving the test will chart the volume level at which you detect each pitch or tone across the frequency range where human speech takes place. After the hearing test the person giving the test will usually go over it with and show you how your hearing compares with what is considered normal hearing. It is a very simple test much like the way we get our eyes tested - no studying required!

Where can I get a hearing test??

You can get your hearing tested free or for very little cost at any hearing aid dispenser or audiologist. Check the yellow pages under Hearing Aids. Make sure you ask for a copy of the hearing test results, your audiogram, when setting up the appointment. At Advanced Hearing we will be glad to give you a second opinion on your hearing for free. We will tell you if you need hearing aids, which type of hearing aids will help you, and the cost of those hearing aids. There is no charge for our consultation.

You can get a free hearing test online as well. While this is no substitute for the evaluation of a trained professional, the information may be useful to you.

The links below will give you the information you need to evaluate your audiogram.

Is it 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:

  1. Better Hearing in Noise: An individual's hearing in noise can be improved if the signal reaching each ear arrives at a slightly different moment in time. This is technically referred to as phase. When the brain receives slightly different, yet still audible signals at the two ears, it has the ability to cross-correlate and process the primary signal (usually speech) better than if the signal is received monaurally.

  2. Improved Signal versus Noise Level from Optimizing Position: Sound loses intensity (loudness) when it travels across the head. This occurs mostly for the high frequencies which are the most important for understanding of consonants, such as /s/, /t/, /f/, and /sh/. If you have a hearing aid on only one ear, say the left one; and the person you wish to hear is speaking to you from the right side, the consonants may be decreased by nearly 20 decibels by the time it gets to your aided ear. Unfortunately, noise in the room may occur from any or all directions, so while the noise level is not decreased, the speech level is. Wearing two hearing aids ensures that the speech sounds will not be diminished any more than necessary because of your position in the room.

  3. Improved Localization Ability: We determine where a sound is coming from on the basis of 1) the relative time in which the sound arrives at each ear, 2) the relative difference in loudness at the two ears, and 3) the relative difference in the pitch of the sound at the two ears. When there is a large difference in hearing between two ears (as might occur when a person with similar hearing in both ears only wears one hearing aid) the brain cannot make use of these subtle relative differences and their ability to locate sounds may suffer.

  4. Possible Deterioration of the Unaided Ear: We hear in our brain, not in our ears. The ultimate goal of hearing aids is not just to send sound into the ear. It is also essential to retrain the central auditory system in the brain. While it is uncertain whether hearing sensitivity (ability to hear soft sounds) will decrease if your ear is not stimulated adequately, research now suggests that there can be changes in the way in which your brain processes sound when it is "starved." Thus, providing stimulation may be important in preserving your auditory potential.


What Style of Hearing Aid Should I Wear?

There are four primary styles of modern hearing aids. They are: CIC (Completely-In-Canal), ITC (In-The-Canal), ITE (In-The-Ear), and BTE (Behind-The-Ear)

While many people choose style based on vanity, 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:

  1. The shape of your outer ear: deformed outer ears may not allow for wearing of BTE styles.

  2. The depth of the depression near the ear canal (technically called the concha): if your ears are very shallow there may not be adequate space for certain ITE model aids.

  3. The ear canal size and shape: certain ear canals may be too narrow or shaped in a manner such that ITC or CIC hearing aids will either not go in easily, or may fall out too easily.

  4. Manual dexterity: not only is the removal and insertion of canal style hearing aids difficult for some people, but some individuals are unable to insert the battery or manipulate the volume control.

  5. Wax in the ear: some people build up large amounts of earwax, or may have extremely moist ear canals that require adequate ventilation. For these people ITC, or even certain full size ITE aids may not be appropriate.

  6. Draining ears or ears otherwise having medical problems may not be able to safely utilize hearing aids that completely block the ear canal. For these ears, it is vital to allow ventilation so hearing aids that do not fully block the ear may be required. Sometimes, BTEs that are connected to earmolds that have large vents (openings to let air pass through) are useful.

Hearing related factors include:

  1. The shape of the audiogram (hearing test); individuals who have hearing loss for certain pitches (frequencies) but not others, (for example those who hear the low frequencies fine, but have a high frequency hearing loss) may be better served by systems that do not fully block the ear canal.

  2. Degree of loss; currently, severe and profound hearing losses are best served by BTE style aids. This style may also minimize the likelihood of feedback (whistling).

  3. The need for special features such as directional or multiple microphones and/or the use of a telecoil (a small magnetic loop contained in the hearing aid that allows for better use with telephones or assistive listening devices), may dictate the preferred style.

  4. Acoustic feedback (whistling) occurs when the microphone is close to the loudspeaker. 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 audiologist.


Why does my voice sound so odd?

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 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 might help:

  1. keeping the ear as open as possible.
  2. reducing the amount of gain (amplified volume) in the low frequencies.
  3. using an earmold that fits very deeply into the ear canal so that it contacts with the bony rather than the soft cartilaginous portion (to reduce vibration).

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 hand 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 in-the-canal style device. Usually, external feedback can be corrected by:

  1. properly reinserting the hearing aid or earmold

  2. remaking the earmold (or in-the-ear shell)

  3. plugging, or reducing the diameter of any vents (holes)

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

  5. altering the sound by means of filters in the hearing aids or changes in the way the devices are programmed

  6. adding a "canal lock" (a piece of plastic) to better hold canal hearing aids in place so they don't work their way out of the ear canal as you chew

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 generated by the hearing aid itself.


Facts for Consumers from the Federal Trade Commission

Produced in Cooperation with the
American Association of Retired People
November 1992

More than 21 million Americans suffer from some type of hearing impairment. Fortunately, many of these people can benefit from the use of a hearing aid. However, hearing aids cannot work for everyone. Those who can be helped need to be carefully fitted. This on-line brochure provides information about hearing loss and things to look for when shopping for a hearing aid. It stresses the importance of a medical exam and the value of a trial period.

Types of Hearing Loss

The two basic types of hearing loss are conductive and sensorineural. Conductive hearing loss involves the outer and middle ear. It can result from a blockage of wax, a punctured eardrum, birth defects, ear infections, or heredity. Usually, conductive hearing loss can be corrected medically or surgically. Sensorineural, or "nerve" hearing loss involves damage to the inner ear. It can be caused by aging, prenatal and birth-related problems, viral and bacterial infections, heredity, trauma [such as a severe blow to the head], exposure to loud noises, the use of certain drugs, fluid buildup in the inner ear, or a benign tumor in the inner ear.

Only in rare cases can sensorineural hearing loss be medically or surgically corrected. It is the type of hearing loss that is most commonly managed with a hearing aid. Sensorineural hearing loss can affect selective portions of a person's range of hearing. Therefore, the degree of hearing loss and the specific levels of pitch [frequencies] affected will vary from person to person. Even in instances where the pattern of the loss is the same, the degree of sound clarity may vary from person to person or may differ between ears for one individual. As a result, individuals suffering from sensorineural hearing loss often require a hearing aid tailored to the specific sensitivity and the pattern of hearing loss.

Purchase Suggestions

A hearing aid is an electronic device that picks up sound waves with a tiny microphone. The microphone makes weaker sounds louder and sends them to the ear through a tiny speaker. Because a hearing aid is an amplification device, a person must have some hearing to benefit from its use. In addition, because hearing loss has a variety of patterns and degrees of severity and affects people in different ways, no single hearing aid is right for everyone.

The Federal Trade Commission [FTC] offers the following suggestions if you are considering the purchase of a hearing aid.

Consider Getting an Ear Examination

The Food and Drug Administration [FDA] recommends that you have your ears examined by a licensed physician. Ear examinations are universally recommended by the medical community to ensure there are no underlying diseases or medical problems causing the hearing loss. A hearing loss may be a symptom of another medical problem that needs a doctor's attention. Also, the cause and severity of a hearing loss vary widely from person to person.

Be wary of any advertisements for hearing aids that play down the need for a medical examination and a hearing test. Dispensers or providers that encourage you to sign a waiver for a medical examination may be selling products that do not meet industry standards.

Get a hearing evaluation from a dispenser or an audiologist. Have your hearing tested to assess your ability to hear with and without a hearing aid. This test will enable a dispenser or audiologist to select and fit a hearing aid to your individual needs. [The term "dispenser" refers to anyone selling hearing aids, whether the person is a hearing aid dealer or an audiologist.]

Check Out the Dispenser

Before you buy, check the reliability of local hearing aid dispensers with your local Better Business Bureau [BBB], consumer protection agency, or state attorney general. You also may want to verify the reliability of dispensers and physicians with their licensing boards in your state capital. Ask if there are any complaints on file, and how the company or professional has responded to the complaint.

Ask the Dispenser or Audiologist about a Trial Period

Many manufacturers, hearing specialists, and consumer groups recommend, and some state laws require, that consumers be given at least a 30-day trial period with only a small service fee [varying from five to 20% of the purchase price] if the consumer returns the product. In fact, manufacturers routinely make adjustments and permit hearing aid returns within 60 to 90 days at no charge to the dispenser. A trial period is strong protection for such an important purchase, so ask before you buy.

Remember, if you purchase a hearing aid from a door-to-door salesperson you have the right under the FTC's Door-to-Door Sales Rule to cancel within three business days of any sale for $25 or more. The sale may take place in your home, or at a location that is not the seller's regular place of business.

If you are thinking of buying a hearing aid through the mail, consider the difficulty of getting the right hearing aid for your needs and a proper fit. Although there is no federal law against the mail order sale of hearing aids, several states have banned hearing aid sales by mail. In states that do allow the sale of aids by mail, the transaction is subject to the FTC's Mail Order Rule. This rule requires companies to ship purchases made by mail when promised or give consumers the option to cancel their order for a refund.

Be Aware of Sales Practices

Avoid being pressured into buying a hearing aid. As with any other medical decision, you should be given the opportunity to seek additional information or a second opinion. Sales personnel using high-pressure approaches demonstrate little concern for your well being.

Purchase Agreements

The hearing aid purchase agreement, or contract, should contain all terms of the transaction in writing, including an explanation of all verbal promises. In reviewing your agreement, remember to consider the following:

  • Is there a written warranty?
  • Is the warranty honored by the manufacturer or by the dispenser? [In some cases warranties by the manufacturer may not be recognized unless the hearing aid is purchased from a seller authorized by the manufacturer.]
  • What services, if any, will be provided free of charge, and how long will they be provided?
  • Will you receive a "loaner" if your hearing aid needs to be repaired?

Do business with a dispenser who will clarify these details and put all verbal commitments into the written contract.

Federal Standards for Sales

The FTC is responsible for monitoring the business practices of hearing aid dispensers and vendors. Under the Federal Trade Commission Act, the FTC can take action against a company that misleads or deceives consumers. Such a company may use misleading sales and advertising practices --- giving inaccurate information about hearing loss, performance of a hearing aid, refund policies, or warranty coverage. The Magnuson-Moss Warranty Act, which the FTC enforces, provides consumers with certain protections relating to warranties. This act requires a company offering a warranty to fully disclose all its terms and conditions.

The Food and Drug Administration [FDA] enforces regulations that deal specifically with the manufacture and sale of hearing aids, because these products are recognized as medical devices. FDA regulations have the force of federal law. According to the FDA, the following conditions must be met by all dispensers before selling a hearing aid:

  • Dispensers must obtain a written statement from the patient signed by a licensed physician. It must be dated within the previous six months, state that the patient's ears have been medically evaluated, and state that the patient is cleared for fitting with a hearing aid.
  • A patient, age 18 or older, can sign a waiver for a medical examination, but dispensers must advise the patient that waiving the examination is not in the patient's best health interest.
  • Dispensers must avoid encouraging the patient to waive the medical evaluation requirement.
  • Dispensers must advise patients who appear to have a hearing problem to consult promptly with a physician.
  • The FDA regulations require that an instruction brochure be provided with the hearing aid that illustrates and describes its operation, use, and care. The brochure also must list sources for repair and maintenance and include a statement that the use of a hearing aid may be only part of a rehabilitative program.

State Standards for Sales

In addition to federal regulation, many states have laws that apply to the sale of hearing aids. Most states license hearing aid dispensers, and several states prohibit the sale of hearing aids through the mail. Purchasers also may be protected by implied warranties, created by state law. Your state Attorney General's Office can provide you with particular information about state laws that apply to the sale of hearing aids.

The state Attorney General's Office also will have information on whether hearing aid dispensers must be licensed or certified by the state. Some hearing professionals, such as physicians and audiologists, may be licensed by a state regulatory agency. These agencies may provide helpful information for individuals considering a hearing aid purchase.

Where to Complain

If you have questions or complaints concerning the sales practices of a hearing aid dispenser, contact your state Attorney General's Office, local consumer protection agency, the Better Business Bureau, and write:

Correspondence Branch
Federal Trade Commission
Washington, DC 20580

Although the FTC usually does not resolve individual disputes, the agency may take action against a company if there is evidence of a pattern of deceptive or unfair practices.

The National Fraud Information Center [NFIC] maintains a toll-free Consumer Assistance Service, 1-800-876-7060, to provide consumers with answers to questions about telephone or mail solicitations, information about how and where to report fraud, referral services, and help in filing complaints.

The NFIC Consumer Assistance Service is available from 9:00am to 5:30pm EST, Monday through Friday. The toll-free number is in service in the United States, Puerto Rico, and Canada. Spanish-language service is available.

The consumer complaint information is instantly available to assist law enforcement agencies through a database operated by the Federal Trade Commission and the National Association of Attorneys General.

Protecting Your Hearing

Hearing loss can occur as part of the natural aging process. Other hearing losses are the result of exposure to factors at both work and home. Some types of hearing loss can be prevented.

Second only to aging, exposure to loud noise is the most common cause of hearing loss. Loud sounds, such as gunshots, firecrackers or jet engines, may cause permanent hearing loss. Moderate noise levels over time can also cause hearing loss. The noise may be quieter but, if it lasts longer, it will still damage the ear. Common items, such as power tools or a vacuum cleaner, have this capability.

Ear muffs or foam earplugs can help reduce or prevent hearing loss. The law requires employers to provide hearing protection for employees in noisy work areas. Hunters and target shooters are trained to wear ear protection when firing guns. Teens can enjoy a loud concert without hearing loss by wearing earplugs.

Pregnant women can reduce the chance of congenital hearing loss by:

  • getting prenatal care and
  • avoiding viral infections that may result in fetal deafness in the first three months of pregnancy

Children should have routine hearing screenings, starting at birth. This is essential in reducing the effect of a hearing loss on speech and language, as well as, social and emotional development. Treatment can often significantly improve a child's hearing loss.

Remember, an ounce of prevention is worth a pound of cure. It is never too early, or too late, to protect the hearing you have. If you suspect a hearing loss, contact your healthcare provider. He or she may perform a hearing exam, or may refer you to an audiologist for a more comprehensive exam.

Excerpt from uihealthcare.com/topics/hearing/hear4689.html


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