Hearing, Hearing Loss and Hearing Aids: Issues and Answers
Dr. Douglas L. Beck , Audiologist, Editor-In-Chief, Healthy Hearing Website
Hearing loss occurs to most people as they age. 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. 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.
HOW DO I KNOW IF I HAVE HEARING LOSS?
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.
If you have any of these 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 (or consumer) in a particular direction and may help validate that a hearing problem may indeed exist.
Therefore, we have designed a written hearing screening to provide you with some general guidelines about your hearing ability. It is free and it may offer you insight regarding the likelihood that a hearing loss is present. If you would like to take the written hearing screening.
An audiologist is a person who has a masters or doctoral degree in audiology. Audiology is the science of hearing. In addition, the audiologist must be licensed or registered by their state (in 47 states) to practice audiology.
In the field of audiology, the master’s degree has been the accepted “clinical” degree for almost 50 years. However, the profession is undergoing a transition to a doctorate level degree as the entry-level requirement to practice audiology. In a few years, there will be very few colleges and universities offering a master’s program in audiology. The Au.D. (Doctor of Audiology) is the clinical doctorate degree and is issued exclusively by regionally accredited universities and colleges. There are other doctoral degrees that have been earned and utilized by audiologists to date, such as the Ph.D. (still highly sought today by researchers and academicians), the Sc.D. and the Ed.D.
Audiologists work in a variety of settings including hospitals, schools, clinics, universities, rehabilitation facilities, cochlear implant centers, speech and hearing centers, private audiology practices, hearing aid dispensing offices, hearing aid manufacturing facilities, medical centers, as well as otolaryngology (ENT physician) offices. Although the vast majority of hearing problems do not require medical or surgical intervention, audiologists are clinically and academically trained to determine those that do need medical referral. As a licensed healthcare provider, the audiologist appropriately refers patients to physicians when the history, the physical presentation, or the results of the audiometric evaluation (AE) indicate the possibility of a medical or surgical problem. Many audiologists also dispense (sell and service) hearing aids and related assistive listening devices for the telephone, TV and special listeningsituations.
Otolaryngologists (also called ear-nose-and-throat, or ENT, doctors) are physicians who have advanced training in disorders of the ear, nose, throat and head and neck. Otologists or neurotologists are physicians who in addition to their ENT requirements continue their specialized training for an additional year or more in the diagnosis and treatment of disorders of the ear. Otolaryngologists, neurotologists and otologists are the physicians who typically treat disorders of the ear (or hearing mechanisms) requiring medical or surgical solutions.
HEARING AID SPECIALISTS:
The hearing aid specialist has training in the assessment of patients who specifically seek rehabilitation for hearing loss. The hearing aid specialist is licensed or registered to perform basic hearing tests and can sell and service hearing aids and related products.
DEGREE of HEARING LOSS:
Results of the audiometric evaluation are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. Frequency, from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) and is described in general categories. Hearing loss is not measured in percentages. The general hearing loss categories used by most hearing professionals are as follows:
_____Normal hearing (0 to 25 dB HL)
_____Mild hearing loss (26 to 40 dB HL)
_____Moderate hearing loss (41 to 70 dB HL)
_____Severe hearing loss (71 to 90 dB HL)
_____Profound hearing loss (greater than 91 dB HL)
TYPES OF HEARING LOSS:
The external and the middle ear conduct and transform sound; the inner ear receives it. When there is a problem in the external or middle ear, a conductive hearing impairment occurs. When the problem is in the inner ear, a sensorineural or hair cell loss is the result. Difficulty in both the middle and inner ear results in a mixed hearing impairment (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain than the ear, and will be discussed only briefly.
______Conductive hearing loss occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstructions in the ear canal, perforations (hole) in the eardrum membrane, or disease of any of the three middle ear bones.
A person with a conductive hearing loss may notice that their ears may seem to be full or plugged. This person may speak softly because they hear their own voice quite loudly. Crunchy foods, such as celery or carrots, sound very loud and this person may have to stop chewing to hear what is being said. All conductive hearing losses should be evaluated by an audiologist and a physician to explore medical and surgical options.
______Sensorineural hearing loss is the most common type of hearing loss. More than 90 percent of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. Sensorineural hearing loss is also called “cochlear loss,” an “inner ear loss” and is also commonly called “nerve loss.” Years ago, many professionals said there was nothing that could be done for sensorineural hearing loss that is totally incorrect today. There are many excellent options for the patient with sensorineural hearing loss.
A person with a sensorineural hearing loss may report that they can hear people talking, but they can’t understand what they are saying. An increase in the loudness of speech may only add to their confusion. This person will usually hear better in quiet places and may have difficulty understanding what is said over the telephone.
______Central hearing impairment occurs when auditory centers of the brain are affected by injury, disease, tumor, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although understanding of speech, also thought of as the “clarity” of speech may be affected. Certainly both loudness and clarity may be affected too.
HEARING AID STYLES:
There are many styles of hearing aids. The degree of the hearing loss, power and options requirements, manual dexterity abilities, cost factors, and cosmetic concerns are some of the factors that will determine the style the patient will use. The most common styles are listed below:
ITE: In-The-Ear units are probably the most comfortable, the least expensive and the easiest to operate. They are also the largest of the custom made styles.
ITC: In-The-Canal units are a little more expensive than ITEs. They require good dexterity to control the volume wheels and other controls on the faceplate, and they are smaller than ITEs.
MC: Mini-Canals are the size between ITC and CIC. A mini canal is a good choice when you desire the smallest possible hearing aid while still having manual control over the volume wheel and possibly other controls.
CIC: Completely-In-the-Canal units are the tiniest hearing aids made. They usually require a “removal string” due to their small size and the fact that they fit so deeply into the canal. CICs can be difficult to remove without the pull string. CICs do not usually have manual controls attached to them because they are too small.
BTEs: Behind-The-Ear hearing aids are the largest hearing aids and they are very reliable. BTEs have the most circuit options and they can typically have much more power than any of the custom made in the ear units. BTEs are the units that “sit” on the back of your ear. They are connected to the ear canal via custom-made plastic tubing. The tubing is part of the earmold. The earmold is custom made from an ear impression to perfectly replicate the size and shape of your ear.
All custom made hearing aids and earmolds are made from a “cast” of the ear. The cast is referred to as an ear impression. The audiologist or hearing aid dispenser makes the ear impression in the office. It takes about 10 to 15 minutes. The audiologist places a special cotton or foam dam in the ear canal to protect the eardrum, and then a waxy material is placed in the ear canal. When the material hardens (about 5 to 10 minutes later) the wax cast, along with the dam are removed from the ear canal. Often, the ear canal will be “oily” after the impression is removed. This is normal. The oil comes from the wax material and prevents the wax material from sticking to the skin.
Tell the audiologist before the ear impression is obtained if you are allergic to plastic or dyes!
Hearing aids work very well when fit and adjusted appropriately. They amplify sound! You might find that you like one hearing aid better than the other. The left and right hearing aids will probably not fit exactly the same and they probably won’t sound exactly the same. Nonetheless, hearing aids should be comfortable with respect to the physical fit and sound quality. Hearing aids do not restore normal hearing and are not as good as normal hearing. You will be aware of the hearing aids in your ears. Until you get used to it, your voice will sound “funny” when you wear hearing aids. Hearing aids should not to be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable, however, hearing aids cannot eliminate background noise.
THREE LEVELS OF HEARING AID TECHNOLOGY:
There are essentially three levels of hearing aid technology. We refer to these as analog, digitally programmable, and digital.
- ANALOG technology is the technology that has been around for many decades. Analog technology is basic technology and offers limited adjustment capability. It is the LEAST expensive.
- DIGITALLY PROGRAMMABLE technology is the “middle grade” technology. Digitally programmable units are analog units digitally controlled by the computer in the office to adjust the sounds of the hearing aid.
- DIGITAL technology is the most sophisticated hearing aid technology. Digital technology gives the audiologist maximum control over sound quality and sound processing characteristics. There are qualitative indications that digital instruments do outperform digitally programmable and analog hearing aids. Digitals are not perfect, but they are very good. Digital hearing aids have been widely available since 1996.
DIGITAL HEARING AIDS:
The term DIGITAL is used so often today, it can be confusing. When the term “digital” is used while referring to hearing aids, it generally means the hearing aid is 100% digital. In other words, the hearing aid is indeed a “complete computer”. 100% digital hearing aids have been commercially available since 1996 and are wonders of modern technology. 100% digital hearing aids can process sound using incredibly fast speeds such as 100 to 200 million calculations per second. Interestingly, most 100% digital hearing aids have analog components, such as the microphone and the receiver. 100% digital hearing aids transform analog information into a digital signal and process the sound to maximize the speech information you want to hear, while minimizing the amplification of sounds you do not want to hear.
Digital technology is tremendous and it allows the audiologist maximal control over the sound quality and loudness of the hearing aid. Importantly, digital technology allows the audiologist to tailor or customize the sound of your hearing aids to what you need and want to hear. In summary, if you want the best technology— get 100% digital hearing aids.
YOUR OWN VOICE:
When you wear hearing aids for the first time, you will probably notice your voice sounds funny! You will hear your voice amplified through the hearing aid. You may describe this sensation as feeling “plugged up” or hearing your voice echoing. This is normal and will usually go away in a few days after you have given yourself a chance to get accustomed to your new hearing aids and learned to adjust the volume control. There are adjustments that the audiologist can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.
GETTING USED TO HEARING AIDS:
People learn at different rates. Some people need a day or two to learn about and adjust to their hearing aids, most need a few weeks and some may need a few months. There is no perfect way to learn about hearing aids. I usually recommend you wear the hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aid. Eventually you will wear the hearing aids most of your waking hours. It is recommended that you interact with those people you are most familiar with during your first few days. Start off listening with your hearing aids in a favorable listening environment and work towards more difficult listening situations. Let your friends and family know that you are using your new hearing aids.
Helpful Steps to Learning to Use a Hearing Aid:
- Use the aid at first in your own home environment.
- Wear the aid only as long as you are comfortable with it.
- Accustom yourself to the use of the aid by listening to just one other person – husband or wife, neighbor or friend.
- Do not strain to catch every word.
- Do not be discouraged by the interference of background noises.
- Practice locating the source of the sound by listening only.
- Increase your tolerance for loud sounds.
- Practice learning to discriminate different speech sounds.
- Listen to something read aloud.
- Gradually extend the number of persons with whom you talk, still within your own home environment.
- Gradually increase the number of situations in which you use your hearing aid.
- Take part in an organized course of aural rehabilitation, see your audiologist to learn about these courses.
HEARING and VISION and COMMUNICATION:
To maximally communicate, you need to use hearing from both ears (binaural hearing) and you need to use your eyes and ears together. You will not communicate well using your hearing aids alone. To facilitate optimal communication, you will need to pay attention to the speaker’s gestures and facial expressions! To maximize communication remember to watch the person speaking, reduce the distance between the speaker and the listener, reduce or eliminate background noises from the listening environment and use good lighting. If someone is speaking to you from across the room, while the TV is on, while doing the dishes, it will be very difficult to adequately communicate, despite fantastic hearing aids!
BINAURAL HEARING: DO I NEED TWO HEARING AIDS?
Basically, if you have two ears with hearing loss that could benefit from hearing aids, you need two hearing aids. It is important to realize there are no “normal” animals born with only one ear. Simply stated, 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.
Assuming you have two ears that hear about the same, you can do a little experiment at home to better understand how important binaural hearing is:
First, gently close just one ear, by simply pressing the little fleshy part in the front of your ear canal (the tragus) into your ear canal — a little. Do not apply pressure, do not hurt yourself. Just close the ear canal to eliminate sound from entering the ear. The idea is to close that ear for about ten minutes while you watch TV or listen to the radio, or speak with your spouse. Then, after a full ten minutes, remove your finger. What an amazing difference!
There are many advantages associated with binaural (two ear) listening and importantly, there are problems associated with wearing only one hearing aid — if you are indeed a candidate for binaural 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.
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!
People cannot hear well using only one ear. There are studies in the research literature that show that 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 recognition ability more quickly than the ear wearing the hearing aid.
One concern with all new hearing aids is the physical fit. Hearing aids need to be comfortable, not too tight and not too loose, they should fit just right. Do not wear the hearing aids if they cause any discomfort or irritations. Do call your audiologist to schedule an appointment time to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.
Virtually all patients wearing hearing aids complain about background noise at one time or another. There is no way to completely eliminate background noise.
Remember, when you had normal hearing there were still times when background noise was a problem. It is no different now, even with properly fit hearing aids! The good news is there are circuits and features that help to reduce (or minimize) background noise and other unwanted sounds. In fact, there are research findings that demonstrate digital hearing aids with particular circuit and microphone options can effectively reduce background noises. Please speak with your audiologist about this.
Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter, however, not only was the background noise made quieter, but so too, was the signal (the speech sound).
Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.
The best and most efficient way to eliminate or reduce background noise is through the use of FM technology. Please speak with your audiologist about this.
More than 75 percent of all hearing aid repairs are due to moisture and earwax accumulating in the hearing aid. The vast majority of these repairs are 100 percent preventable. It is extremely important to clean the entire hearing aid every time it is removed from your ear by wiping and brushing it. To better protect your investment, use a DRY-AID kit every night! Electronic dry-aid kits are the best. They include a germicidal light that kills most bacteria and other germs. They also have desiccants to absorb moisture and fans to circulate air around the internal components of the hearing aid. Get in the habit of cleaning the hearing aid after each use and keeping the hearing aid in the dry-aid kit at night. The hearing aid is electronic and moisture is the enemy! Preventive maintenance is the key to trouble free, long life from a hearing aid. A well maintained hearing aid can easily last 5 to 7 years, maybe longer.
HEARNG AID BATTERIES:
All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery it is a medical emergency and the individual needs to see a physician immediately.
One question often asked is “How long does the battery last?” Typically they last 7-14 days based on a 16 hour per day use cycle. Batteries are very inexpensive, costing less than a dollar each. Generally, the smaller the battery size, the shorter the battery life. The sizes of hearing aid batteries are listed below along with their standard number and color codes.
- Size 5: RED
- Size 10 (or 230): YELLOW
- Size 13: ORANGE
- Size 312: BROWN
- Size 675: BLUE
Today’s hearing aid batteries are “zinc-air.” Because the batteries are air-activated, a factory-sealed sticker keeps them “inactive” until you remove the sticker. Once the sticker is removed from the back of the battery, oxygen in the air contacts the zinc within the battery, and the battery is “turned-on”. Placing the sticker back on the battery will not prolong its life. Since many of today’s automatic hearing aids do no have “off” switches, removing the battery at night assures that the device is turned off. Zinc-air batteries have a “shelf life” of up to three years when stored in a cool, dry environment. Storing zinc-air hearing aids in the refrigerator has no beneficial effect on their shelf life, in fact, quite the opposite may happen. The cold air may actually form little water particles under the sticker. Water is made of oxygen and hydrogen. If the water vapor creeps under the sticker, the oxygen may contact the zinc, and the battery could be totally discharged by the time you peel off the sticker! Therefore, the best place to store batteries is in a cool dry place, like the back of your sock drawer, not the fridge!
WHAT ARE ASSISTIVE LITSENING DEVICES (ALDs)?
You may have certain communication needs that cannot be solved by the use of hearing aids alone. These situations may involve the use of the telephone, radio, television, and the inability to hear the door chime, telephone bell, and alarm clock. Special devices have been developed to solve these problems. Like hearing aids, assistive listening devices make sounds louder. Typically, a hearing aid makes all sounds in the environment louder. Assistive listening devices can increase the loudness of a desired sound (a radio or television, a public speaker, an actor, someone talking in a noisy place) without increasing the loudness of the background noises. This is because the microphone of the assistive listening device is placed close to the speaker, while the microphone of the hearing aid is always close to the listener.
ARE ALDs ONLY FOR PEOPLE USING HEARING AIDS?
No. People with all degrees and types of hearing loss — even people with normal hearing can benefit from assistive listening devices. Some assistive listening devices are used with hearing aids; some are used without hearing aids.
WHAT TYPES OF ALDs EXIST?
There are many assistive listening devices available today, from sophisticated systems used in theaters and auditoriums to small personal systems.
Various kinds of assistive listening devices are listed below:
Personal Listening Systems: There are several types of personal listening systems available. All are designed to carry sound from the speaker (or other source) directly to the listener and to minimize or eliminate environmental noises. Some of these systems, such as auditory trainers, are designed for classroom or small group use. Others, such as personal FM systems and personal amplifiers, are especially helpful for one-to-one conversations in places such as automobiles, meeting rooms, and restaurants.
TV Listening Systems: These are designed for listening to TV, radio, or stereos without interference from surrounding noise or the need to use very high volume. Models are available for use with or without hearing aids. TV listening systems allow the family to set the volume of the TV, while the user adjusts only the volume of his or her own listening system.
Direct Audio Input Hearing Aids: These are hearing aids with direct audio input connections (usually wires) which can be connected to the TV, stereo, tape, and/or radio as well as to microphones, auditory trainers, personal FM systems and other assistive devices.
Telephone Amplifying Devices: Most, but not all, standard telephone receivers are useful with hearing aids. These phones are called “ hearing aid compatible.” The option on the hearing aid is called the T-Coil. The T-coil is automatically activated on some hearing aids and manually activated on others. Basically, the telephone and the hearing aids T-coil communicate with each other electromagnetically, allowing the hearing aid to be used at a comfortable volume without feedback and with minimal background noise. You should be able to get hearing-aid-compatible phones from your telephone company or almost any retail store that sells telephones. Not all hearing aids have a “T” switch. Make sure your hearing aids have a T switch before purchasing a new hearing aid compatible phone! There are literally dozens of T-coil and telephone coupling systems. Speak with your audiologist to get the most appropriate system for your needs.
Cell Phones:Most hearing aids can be used with most cell phones. Importantly, digital hearing aids and digital phones may create constant noise or distortion. There may be significant problems for some hearing aids when used with particular cell phones! The best person to address this problem is your audiologist speak with your audiologist BEFORE you buy a cell phone or hearing aids!!!!
Regarding “hands free” systems, there are many to choose from and hearing impaired users usually benefit maximally by using binaural hands free systems.
WHAT IS TINNITUS?
Tinnitus is the term for the perception of sound when no external sound is present. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus can be intermittent or constant, with single or multiple tones. Its’ perceived volume can range from very soft to extremely loud.
HOW MANY PEOPLE HAVE TINNITUS?
50 million Americans experience tinnitus to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, they cannot function on a “normal,” day-to-day basis.
WHAT CAUSES TINNITUS?
The exact cause (or causes) of tinnitus is not known in every case. There are, however, several likely factors which may cause tinnitus or make existing tinnitus worse: noise-induced hearing loss, wax build-up in the ear canal, certain medications, ear or sinus infections, age-related hearing loss, ear diseases and disorders, jaw misalignment, cardiovascular disease, certain types of tumors, thyroid disorders, head and neck trauma and many others. Of these factors, exposure to loud noises and hearing loss are the most probable causes of tinnitus. I strongly recommend that an audiologist and a physician should evaluate all presentations of tinnitus.
TINNITUS MANAGEMENT and TREATMENT?
There are many options for people who experience tinnitus. Some wear hearing aids to help cover up their tinnitus, some wear tinnitus maskers. Additionally, there are combined tinnitus maskers and hearing aids all in one unit! Some patients require counseling to help them develop strategies to manage their tinnitus. If you’ve been told “learn to live with it,” there are many additional options to explore. Your audiologist is an excellent resource for issues and answers related to tinnitus. Additionally, I recommend that all people with tinnitus visit the American Tinnitus Association website for more information, ideas and strategies concerning tinnitus. http://www.ata.org/
MIDDLE EAR IMPLANTS:
Middle ear implants are surgically implanted devices. The FDA has approved specific middle ear implants and the FDA is still reviewing others. The middle ear implant is a useful hearing instrument and is quite different from traditional hearing aids. Generally speaking, hearing aids reproduce sounds and make them louder than the original sound. When a hearing aid is placed in the ear canal, the loud sound is perceived by the hearing impaired ear. Middle ear implants work by vibrating the middle ear bones, rather than by producing audible sound.
Therefore, middle ear implants are less likely to produce feedback, and they do not occlude, or “plug up” the ear canal. Additionally, for most people wearing middle ear implants, their hair tends to cover up the external device.
In summary, the reported benefits of middle ear implants are elimination of the occlusion effect, elimination/reduction of feedback, reduction in distortion, improved clarity, as well as some cosmetic advantages.
Middle ear implants are an excellent alternative for people with moderate to severe sensorineural hearing loss, after they have tried traditional hearing aids for a few months and after they have determined that traditional hearing aids are not able to provide the desired benefit.
If you are considering a middle ear implant, speak with your audiologist. Your audiologist can direct you to an otolaryngologist, otologist or neurotologist with experience and expertise in implanting these devices.
Not all patients are surgical candidates, and each candidate does not receive the same benefit. Nonetheless, middle ear implants are an option, and are worthy of further consideration for appropriate patients. Again, the best source for initial information on this topic is your audiologist.
Generally speaking, cochlear implants are for patients with severe-to-profound, sensorineural hearing loss. There are approximately 500,000 patients in the USA with severe-to-profound hearing loss. Cochlear implants are only recommended after the patient has tried the most powerful and most appropriately fit hearing aids, and has not shown sufficient benefit from hearing aids. Cochlear implants are devices that are “permanently” surgically implanted into the inner ear.
Cochlear implantation is a surgical procedure performed by otolaryngology surgeons. Cochlear implants have been FDA approved for almost two decades and the advances and improvements in the technology have been amazing. The Food and Drug Association (FDA) and the American Medical Association (AMA) recognize cochlear implants as safe and effective treatment for severe-to-profound sensorineural hearing loss. Most insurance programs pay (at least partly) for cochlear implantation. Your audiologist, your otolaryngology surgeon and their appropriate office staff are experienced at managing insurance issues.
Appropriately identified adults as well as profoundly deaf children (starting at age 12 months) can be implanted. Research demonstrates that the earlier a deaf child is implanted, the better the long term result will be with respect to speech and language development. Following surgery, rehabilitation is necessary, as the child must learn to associate the sound signals with normal sounds. Regarding deaf adults, research suggests that adults who receive cochlear implants are less lonely, have less social anxiety, are more independent, have increased social and interpersonal skills, and of course, they hear better with the cochlear implant!
Cochlear implants are utilized in the patient who cannot benefit from hearing aids. The cochlear implant is a device used to bypass the nonfunctional inner ear and converts sound into electrical impulses that directly stimulate the cochlear nerve. The implant consists of an external portion comprised of a microphone, sound processor, and external coil and an internal portion that must be surgically implanted. The surgical procedure involves the placement of an internal receiver beneath the skin behind the ear, and stimulating electrode array, which is inserted into the cochlea or inner ear. The electrical signals are manipulated and controlled by the audiologist to maximize speech perception. The brain interprets these electrical impulses as sound. Again, not all patients are surgical candidates, and not all cochlear implant recipients receive the same benefit.
It is important to remember that the vast majority of the patients who receive cochlear implants are actually “deaf” prior to implantation, and they have not been successful with traditional hearing aids. Your audiologist is a very knowledgeable resource in regards to cochlear implants and will be happy to discuss them with you.
RECOMMENDTAIONS and WARNINGS:
Please review this information with your spouse or loved ones and please feel free to discuss all of these issues with your audiologist and/or your physician.
Federal regulation prohibits any hearing aid sale unless the buyer has first received a medical evaluation from a licensed physician. However, if you are at least 18 years old, you can sign a form (waiver) that says you are fully aware of your rights but choose not to have the medical evaluation. Then, you can purchase hearing aids without seeing a physician. For people under 18 years of age, waiver of the medical evaluation is not permitted. These rules and regulations may vary state-by-state and you certainly need to check with your state rules, regulations and laws. I do not recommend using waivers.
I believe your best health interest is served by seeing a licensed audiologist for a complete audiometric evaluation and seeing an otolaryngologist for the medical and/or surgical diagnosis and treatment of all ear and hearing disorders and diseases.
The opinions throughout this article are those of the author. Other audiologists and otolaryngologists may have different opinions and recommendations. Additionally, each patient and each hearing problem is unique. “Self-diagnosis” and treatment is unwise, is not recommended and may indeed lead to a worsening situation.
Some state associations, national associations and indeed many state and federal rules and regulations vary from location-to-location and they change over time. Therefore, it is very important for you to check with your local licensed health care professionals to verify and confirm the information in this pamphlet, and to best determine how it applies to you and your situation, if at all.
This article may be downloaded and photocopied in its entirety (only) for personal and educational purposes.
If you have questions, or would like to contact the author, you can contact Dr. Beck at email address: email@example.com.
Dr. Beck wishes to thank: Aimee LaCalle Au.D., at HearLab Inc. in San Antonio, Texas, and Barbara Beck, Au.D Candidate, from Audiology Online in San Antonio, Texas for their kind, thoughtful and helpful review of this manuscript.