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Everything you
always wanted to
know about
Hearing Aids
But Were Afraid You Couldn’t Hear
Explained by
AccuQuest Hearing Centers
accuquest.com
Welcome!
Table of Contents
How We Hear ........................................................... 3
Lost Your Keys? ......................................................... 4
Signs of Hearing Loss .............................................. 5
Types of Hearing Loss .............................................. 6
Hearing Loss & Quality of Life ............................... 7
The Hearing Test ...................................................... 8
How Hearing Aids Work ......................................... 9
Hearing Aid Styles .................................................... 10-11
Technology Pyramid ................................................. 12
What to Expect During Adjustment ....................... 13
Helping Others ......................................................... 14
Definition of Terms .................................................. 15
How We Hear
The first step to understanding hearing loss is to
understand how we hear. Sound waves are funneled
through the outer ear and into the ear canal where
they strike the tympanic membrane, or ear drum.
The ear drum and small ear bones make up the
middle ear. As the ear drum vibrates, it moves the
Hammer, which moves the Anvil, which moves the
Stirrup. These are the small bones of the ear.
OUTER EAR
MIDDLE EAR
SMALL BONES
INNER EAR
THE COCHLEA
THE AUDITORY NERVE
Next is the inner ear. The mechanical energy from
the middle ear is transfered into the liquid in the
semicircular tubes, which connect to the cochlea.
Inside the cochlea, microscopic hair cells vibrate
and send impulses to the brain. The hair cells that
pick up high frequencies and soft sounds are near
the opening of the cochlea, and therefore most
susceptible to damage. That is why most people
lose the ability to hear these sounds first. Lower
frequencies travel around the spiral to the hair cells
closer to the center. The impulses from the cochlea
travel along the auditory nerve to the brain, where
they are interpreted. This is how you understand
that your granddaughter said, “I love you.”
THE EAR CANAL
THE EARDRUM
How Loud Is Too Loud? A Chart for Decibels.
OHSA regulations
baby’s cry
jackhammer
Rock concert
Noises
whisper
Loud
)
Prolonged
20dB
1
0
(9
Loud
)
Extremely
db
0
-14
(120
30 dB
85 dB
105 dB
115 dB
140 dB
Noises
This chart displays what noise you may encounter on a daily basis.
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HEALTHY HAIR CELLS
stand erect and are able to move
freely when sound waves pass over
them. They accurately transmit to the
brain a wide range of signals from a
whisper to a jet engine.
DAMAGED HAIR CELLS
are limp and can no longer move freely.
This impairs their ability to transmit
signals to the brain. Usually, damaged
hair cells miss the soft, high-frequency
consonant sounds of speech like “C,”
“H,” and “F.”
Lost Your Keys?
Maybe it’s Your Ears!
Believe it or not, your hearing has a significant impact on the way your brain functions.
A recent study published in the trade
journal Audiology Today shows hearing
loss impairs the signals to your brain
causing the brain to pull cognitive resources
from other functions just to support full
comprehension. Because resources have
been redirected, your brain has a more
difficult time with reasoning, vocabulary
recall, and working memory -- which could
result in something as basic as losing your
keys. These, and similar problems, are often
attributed to dementia or other diseases.
Normal Hearing
Verbal Memory/
Movement Recognition
Visual Process
Memory/Language Skills
Motor Control
4
Reasoning Attention/
Problem Solving
Listening Center of Brain
The solution could be simple. Get an annual
hearing test to catch hearing loss as soon
as possible. You may be able to compensate
for impaired signals by using hearing aids,
and preserve the precious resources of
your brain.
Hearing Loss
Verbal Memory/
Movement Recognition
Visual Process
Reasoning Attention/
Problem Solving
Memory/Language Skills
Motor Control
Listening Center of Brain
draining resources from
other functions
Without a hearing loss, auditory signals are complete.
Your brain can therefore function typically, distributing
resources according to each function’s need. Listening effort
is then minimal.
As hearing deteriorates, the brain struggles to understand
particular sounds. These sounds drop out completely or are
muffled. That’s when it’s necessary for the brain to redirect
resources to try and complete the picture.
With normal hearing you may hear a sentence like this:
With a flat hearing loss at 40 dB, you may hear the same sentence like this:
Please tell Charles and Sharon, thank you
very much for the helping hand.
Please tell Charles and Sharon, thank you
very much for the helping hand.
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Signs of Hearing Loss
While the causes, types, and degrees of hearing loss vary,
the symptoms of hearing loss are essentially the same.
People with hearing loss typically answer “yes” to the
questions below. Please take a moment to ask yourself
the same questions:
If you answered “yes” to any of these questions, you may
have a hearing loss. If you suspect that you or a loved
one has a hearing loss, you should contact a hearing
professional as soon as possible. Untreated hearing loss
only gets worse.
Yes No
Do I hear sounds, but have trouble distinguishing words?
Do I frequently have to ask people to repeat themselves?
Do I struggle to follow a conversation when two or more people are talking at once?
Do I feel tired or irritable after a long conversation?
Do I misunderstand others sometimes and
respond inappropriately?
Do others complain that I turn up the volume too loud
on the TV or radio?
Do I have a difficult time determining where an object (like a cell phone) is by its sound?
Do I have particular trouble hearing the voices of women and children?
Do I have trouble hearing at movies, concerts, church,
and group conversations?
Am I embarrassed by my hearing difficulties?
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Hearing aids? I put that off for several years,
as I equated that with old age. I’m 76. Then one
day I received in the mail a promotional brochure.
That same day I made an appointment to have my
hearing tested. I knew my hearing was bad, but
after receiving a thorough hearing exam, I realized it
was worse than I thought…I purchased the hearing
aids, I was encouraged to continue having my
hearing monitored. The best part was there was
no additional cost. My only regret – I waited so
long to buy them.
- Bertram D., Placerville, CA
Types of Hearing Loss
Hearing loss is hearing loss, right? Well, not exactly. Generally speaking, there are two
basic types of hearing loss: Conductive and Sensorineural. They both have to do with
a failure to transfer sound along the path from the outer ear to the brain’s hearing
centers, but they differ in the location of the failure.
Conductive Hearing Loss
In the case of conductive hearing loss, sound is
obstructed in the outer and/or middle ear. For
example, there may be wax in the ear canal or the
small bones in the middle ear don’t work properly.
This usually results in reduced sound levels and the
loss of the ability to hear faint sounds. Common
causes may include ear infections, earwax, fluid in
the middle ear from a cold, among other diseases
and disorders. The most common treatments are
medical and surgical for this type of loss. However,
hearing aids may help in some cases.
Sensorineural Hearing Loss
When there is damage in the inner ear or along
the neural pathways to the brain that results in the
loss of the ability to hear certain frequencies, this is
called Sesorineural Loss. According to the Center
for Disease Control (CDC), 75% of Americans
with hearing loss have this type of loss. Usually the
cause of this loss is damage to the hair cells or other
interior workings of the cochlea.
You see, in the cochlea microscopic hair cells vibrate
with sound, transmitting neuro-electrical signals
along the auditory nerve to the brain. Healthy
hair cells stand up straight and can move freely.
When these hair cells are damaged, they become
limp and cannot vibrate correctly. This means
the signals to the brain are incomplete, making it
difficult or impossible to understand the sounds
for which those hair cells are responsible. While
damaged hair cells are irreparable, compensation is
possible and highly recommended without delay.
Causes of Sensorineural hearing loss can be
congenital (present at birth) or acquired (after
birth). Congenital causes might include:
infections, prematurity, hereditary factors, or birth
trauma. Acquired causes include: overexposure
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to noise, ear infections, head injury, disease (like
meningitis or encephalitis), or a negative side
effect of some drugs. No matter the cause, hearing
aids are usually the best way to compensate for
sensorineural hearing loss.
Mixed Hearing Loss
Sometimes someone will have one type of hearing
loss—like conductive—and then something will
happen to damage another part of the ear and
cause sensorineural damage. When both types
of loss are present at the same time, it is called
mixed hearing loss. Treatments for this type of
hearing loss usually include medical and surgical
procedures. However, in some cases hearing aids
can be effective as well. Consulting with a hearing
care professional is the best way to determine the
right solution for you.
Tinnitus
Some people have a constant ringing or buzzing in
their ears. This constant sound is called “tinnitus”
(pronounced either ti-NIGHT-is or TIN-i-tus.
Both pronunciations are correct). Tinnitus does
not always occur with hearing loss, but they are
often associated. If the ringing is in the same
frequency range as the hearing loss, hearing aids
help bring in the ambient sounds that naturally
cover the constant ringing. The exact cause of this
condition is unknown at this time, but there are
many known ways to either mask or manage this
constant sound. To learn more about tinnitus,
visit the American Tinnitus Association at
www.ata.org.
You can’t imagine the thrill of being able to
hear my own voice. I didn’t realize what I had
been missing. My son calls me every morning
to ask if I can hear the birds. I CAN! My daughter
says it has changed my outlook on life…I am truly
lucky and delighted that I made that phone call.
- Mariann S., Fort Collins, CO
Hearing Loss & Quality of Life
Studies show, people with progressive hearing loss wait an average
of 5-15 years before seeking treatment (1). During those years,
there are negative physical and lifestyle effects on the person with
the loss and those with whom they interact. Here are just a few
of the big ones.
Physical Effects
Auditory Deprivation
When your brain does not receive stimulation
for certain frequencies or sounds, it is called
Auditory Deprivation. Usually, this occurs
when the hair cells in the cochlea are damaged
so they are unable to properly transmit those
sounds to the brain. Much like an unused
muscle becomes weak over time, prolonged
auditory deprivation causes your brain to
forget how to interpret those lost frequencies.
Even if hearing aids are able to stimulate the
damaged hair cells, your brain will need time
to get used to interpreting these sounds again.
If damaged hair cells are not ever stimulated
they will eventually die off, creating dead
regions in the cochlea. It is currently
impossible to even compensate for
these dead regions, so the ability to hear
these frequencies is permanently lost. In
other words, “use it or lose it” applies to
hearing too.
Fortunately, recent advances in digital
hearing technology make it possible to detect
damaged and dead regions within the inner
ear, and compensate for damaged hair cells.
This targeted stimulation of neurons can help
maintain speech comprehension and keep
your brain stimulated.
Dementia
Auditory deprivation is also mentioned in a
recent Johns Hopkins study that shows a link
between hearing loss and the development of
dementia (2). The study was published in the
February 2011 Archives of Neurology. It used
data from the Baltimore Longitudinal Study
on Aging (BLSA), which has tracked various
health factors of thousands of men, women,
and children over decades. About a quarter of
the over 600 volunteers the study focused on
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had hearing loss at the start of the study, but
none had dementia.
Participants were closely followed for nearly
20 years. Afterward, almost 10% of them
had developed dementia. Compared to those
with normal hearing, participants with mild
hearing loss were twice as likely to develop
dementia over time. Those with moderate
hearing loss were three times as likely. And
those with severe hearing loss were five times
as likely. In fact, the study showed that for
every 10 decibels of hearing loss, the extra risk
increased by 20 percent.
While further research is required to determine
the exact reason why hearing loss and dementia
are connected, auditory deprivation and the
isolation inherent in hearing loss are two
possible contributors proposed by the study.
Lifestyle Effects
Hearing loss is not just a physical problem,
it also effects your lifestyle. Individuals with
hearing loss are more likely to experience:
• Tension, irritation, or frustration at
communication difficulties
• Feelings of inadequacy in everyday
interactions
• Fear of being ridiculed, pitied, or
appearing less intelligent
• Feelings of being prematurely old,
handicapped, or abnormal
• Tendency to avoid social gatherings,
outdoor activities, even personal
interactions
• Physical fatigue from straining to hear
• Personal safety risks
• Depression
The effects of hearing loss on the friends,
family, and coworkers of an individual with
loss might include:
• Misunderstandings when someone
with hearing loss answers a question
inappropriately or not at all.
• Significant others may be required to
interpret for the individual with hearing
loss causing stressful logistical and
conversational difficulties
• Feelings of rejection or misunderstanding
because someone with hearing loss
withdraws after a difficult listening
situation
• Feelings of guilt arising from not
including an individual with hearing loss
in conversation or activities
• Feelings of resentment at not being
able to enjoy certain activities because
of the reclusive behavior of an individual
with hearing loss
• Constant concern or anxiety about the
safety of an individual with hearing loss
Benefits of Treatment
The good news is many of these negative
physical and lifestyle effects can be greatly
diminished or even eliminated through proper
treatment. Hearing aids can compensate for
loss in targeted frequency ranges, providing
auditory stimulation so your brain maintains
its ability to comprehend speech and you
can interact with loved ones again. This
stimulation may also contribute to delaying
or even preventing diseases like dementia.
Many people are afraid that hearing aids are
too noticeable and scream to the whole world
“something is wrong with me.” However,
what is more noticeable, a hearing aid tucked
behind your ear, or constantly asking people
to repeat themselves? The benefits of treating
hearing loss keep expanding every time you
don’t have to ask, “What?” and can instead
enjoy a worry-free conversation.
1) Rawool V.: Effectiveness of Informal Counseling on
Acceptance of Hearing Loss Among Older Adults, The
Hearing Review. 2009;16(6):22
2) Johns Hopkins University School of Medicine. (2011).
Hearing loss and dementia linked in study. [Press release].
Retrieved from http://www.hopkinsmedicine.org/news/
media/releases/hearing_loss_and_dementia_linked_in_study
The Hearing Test
The hearing test is the primary tool your hearing care
provider will use to determine if you have a hearing
loss, how severe it is, and at what frequencies. The
standard test is what is called a Pure Tone Test,
where you hear a buzz or beep about 1 second long
at varying volumes and pitches. The volume of the
sound is measured in decibels (dB) and the pitch of
the sound is measured in hertz (Hz). Your hearing
care provider will change the dB level at certain
frequencies until they find the lowest level you can
hear the sound 50% of the time. This level is called
your threshold.
Quiet
125
250
500
1000
2000
High Frequency
4000
8000
0
Normal
Hearing
10
20
z
30
40
Decibels (dB)
For example, the hearing care professional may
play a 250 Hz tone at 40db, 30db, 20db, 25dB,
30dB, 20dB, 25dB, 30dB, 35dB, 25db, 30dB. You
have 4 chances to hear the tone at 30dB. If you
hear that tone 2 or more times, then 30dB is your
threshold at 250 Hz. The normal hearing range is
from 0dB to 20dB at every frequency. Any threshold
above 20dB at any frequency means you have a
hearing loss.
AUDIOGRAM
Low Frequency
50
60
J
p
v
mdb i
a
r
o
e
ch
k
h
g
f
s
th
Mild
Hearing Loss
sh
Moderate
Hearing Loss
u
Moderately Severe
Hearing Loss
70
80
Severe
Hearing Loss
90
Each threshold is marked on a chart called an
Audiogram. Each ear is tested separately and the
results charted on the same audiogram. To keep the
left and right ear tests separate, the left ear results are
recorded with blue Xs and the right ear results are
recorded with red circles. The easy way to remember
this is to think of the 3 Rs: Red, Right, and Round.
If there is a small arrow on the X or the circle, that
means a frequency was tested to the maximum dB
level and there was still no response to it.
Audiograms can get pretty complicated with Air
Conduction Tests, Bone Conduction Tests, Masked
Tests, and Unmasked tests. However, audiograms
come with a key, and if you remember these basic
principles you should be able to get a pretty good
idea of what frequencies you have a hard time hearing
and how much of a loss you have.
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Loud
100
110
120
Profound
Hearing Loss
How Hearing Aids Work
While the specifics of this process will vary depending
on the particular hearing aid, here is a general idea of
how modern digital hearing aids work:
1. Sound: Sound waves enter your ear and travel down your ear
canal to the hearing aid.
If you have been tested and told you have a bilateral loss
(hearing loss in both ears), it may be tempting to only get
one hearing aid and wear it in the ear with the most loss.
Fight this temptation! The advantages of binaural hearing
(having two hearing aids with a bilateral loss) are well worth
it. Here are just a few of them.
• Better Sound Quality
• Wearing two hearing aids increases your range of hearing from 180 degrees to 360 degrees, allowing you to0hear
01 the world around you more accurately.
110 10
110 001
000 0100 1011
1
1
0
01
11
Better Localization
10
011 000 0001 1100 1
1ears0allows
001 1000 from
10 two
10
0
1
1
Information
your brain to pinpoint the direction and location of a 0
0
0
0
1
1
0
01 1001 110
1
0
0
0
0
0
1
0
0
1
1 you
00 sound.
01 01like
11 11Much
100your depth perception when you cover up one eye, you lose 010 0lose
0
010 0110
1
0
0
1
1
0
1
0
1
0
01 110
10 1011
01
the direction of sound with only one good ear.
000 000 1110your
0
001to1track
01 ability
100 011
0 0
00
110
101
000 1001 0001 1100 0110 00011
1
1
1
0
0
1
1
00 010
1
1
0
0
1
1
0
1
0
1
1
1
1
0
00
10
010 001 1100 0110 1011 0Better
Ability to Hear in Noise
001
000 111
0 0
01
00
00
011 0100 0101 1011 1101 00010
A
report available through the Better Hearing Institute says that when a desired sound and
1
0
0
0
0
1
0
1
1
0
0
0
1
1
1
0
1
0
0
1
0
0
1
0
11
10
01
01
undesired sound are presented to both ears simultaneously instead of just one, the ability 00
11
100 001 1010 0110 0011 00101
100 111
0
01
00
01
to pick out the desired sound is enhanced (1). This is called Masking Level Difference 011 1010 1100 1010 0100 10110
0
1
0
0
0
1
000 110
100
011 000
110
(MLD) and allows you to pick out a conversation in a noisy restaurant.
011 0010 1100 1010 1101 00110 10
0
0
101 31011 0001 0001 1001 11100
0
1
100 0100 0110 1001 1010
1
0
Wider Hearing Range
100 0100 1000 0110
1
011 0100 1001
The same report says that “the loudness of a sound is greater when it is presented to two 0
0
1
1
1
1
0
0
ears simultaneously than to just one ear alone (1).” This is called Binaural Loudness 110
2. Microphone: The hearing aid’s microphone picks up the
sound and transfers it to the digital converter.
•
•
3. Digital Conversion: The organic sound is then converted
to a digital signal, or a binary code series of 0s and 1s, and
passed on to the processor.
•
•
2
•
•
Summation, and it allows you to hear softer sounds that may be inaudible with only one good ear. In other words, what one ear can hear at 10 feet, two ears can hear at 40 feet.
6
1
5
4
4. Processor: This is where the real power of your hearing aid
is demonstrated. Your hearing professional has programmed
your hearing aid to compensate for your particular hearing
loss. Depending on the sophistication of the processor, it will
manipulate the digital signal accordingly. It will amplify certain
frequencies, filter out background noise, cancel feedback, or a
number of other operations. It all depends on the hearing aid
and the programming.
5. Sound Conversion: Once the sound has been appropriately
manipulated, the digital signal is then converted back to a
sound wave and projected from the hearing aid’s receiver into
your ear.
6. Hearing: The personalized sound then continues through
your middle and inner ear. In the inner ear these new sound
waves stimulate your hair cells, including damaged hair cells,
and send more complete and accurate signals to your brain.
Your brain then has the information it needs, so you can
interact with family and friends once again!
• Less Effort
• Because one ear is not trying to do the work of two, binaural hearing results in less straining to listen. This means less effort, less fatigue, and more enjoyment from listening.
• Better Tolerance of Loud Sounds
• Another result of Binaural Loudness Summation is that less gain is required to maintain a comfortable hearing level. Less gain requires a lower volume setting for your hearing aids. With the volume lower, loud sounds are amplified less, which means you can hear louder sounds more comfortably.
• Reduced Feedback
• Because each hearing aid requires less gain to reach a comfortable hearing level, the chances of feedback are greatly reduced.
• Keeps Both Ears Active
• If your ears are not active you can suffer from auditory deprivation. Prolonged auditory deprivation can result in further deterioration of hearing loss and eventually permanent loss of the ability to hear certain frequencies. Maintaining active ears may prevent these and other negative effects, including dementia (see Hearing Loss & Quality of Life
on page 6).
• Better Speech Understanding
• MLD and Binaural Loudness Summation both contribute to the ability to better hear and understand someone speaking to you. And after all, isn’t that one of the primary reasons for getting hearing aids—to understand your
friends and family better?
• Greater Satisfaction
• Wearing two hearing aids, you will find greater satisfaction with the performance of your hearing aids because your hearing aids will be able to perform as they were designed.
During your visit to your hearing care provider, ask him or her to demonstrate
the difference between one and two hearing aids either in the office or during
your trial period. Then you can hear for yourself the binaural advantage.
1(http://www.betterhearing.org/pdfs/Binaural_hearing_aid_complete_review.pdf)
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Hearing Aid Styles
All hearing aids have the same basic parts, but they differ
in style. Some styles fit partially in your ear while others
are small enough to fit deep within the ear canal, making
them practically invisible. As a general rule, the smaller the
hearing aid, the less powerful it is, the shorter the battery life,
and the more it will cost. There are, of course, exceptions to
every rule.
There are two categories of styles: custom shells and open fit.
Custom shell styles are made from a custom mold of your
ear, so the hearing aids fit comfortably in your particular
ear. They fill up the entire ear canal so the only sound that
gets through is the sound that has been processed for your
particular hearing loss.
Open Fit hearing aids have a flexible tip that fits deep within
the ear canal and does not require a custom molding process.
The tip is usually vented to allow natural sound to enter
the ear canal and prevent the “head in the barrel” sensation
that can occur when the canal is plugged with a custom
shell. Here is a quick run down of the different styles of
hearing aids:
Behind-the-Ear
This style of hearing aid is the most
powerful. The hearing device is
housed in a curved shell that sits
behind your ear while a clear tube hooks over your ear.
Traditionally, this tube connected to a custom mold that
filled the ear. But the most recent advances in technology
are making BTE both cosmetically appealing and available
in open fit. These hearing aids are large enough for users
with dexterity issues to handle with ease. This style typically
uses size 675 or 13 batteries, which are larger and easier to
handle. These hearing aids are helpful for those with mild to
profound hearing loss.
RIC (Receiver-In-Canal)
This style of hearing aid is also
housed in a curved shell that sits
behind the ear. The receiver, or part
of the hearing aid that sends sound into your ear, is small
enough it sits deep inside the ear canal making it nearly
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undetectable. This style comes with many different features,
including directional microphones and manually adjustable
volume. This style only comes as an open fit hearing aid.
These hearing aids typically use size 312 batteries. This style
is helpful for those with mild to severe hearing loss.
to the smaller size, some features may be more difficult to
adjust. These hearing aids may not fit well in smaller ears.
This style of hearing aid typically uses size 312 batteries,
which are smaller than the ITE batteries, and is helpful for
those with mild to moderate hearing loss.
Mini RIC (Receiver-In-Canal)
This style provides the power of a
traditional RIC, but it’s housed in a
smaller curved shell. With the clear
tube that hooks over your ear and
the diminished size of the shell, these hearing aids
are virtually invisible. Patients with dexterity
issues may have difficulty operating
this smaller size. These hearing aids
typically use size 10 batteries, and
are helpful for those with mild to
severe hearing loss.
CIC (Completely-In-The-Canal)
This style of hearing aid is housed in a
tiny shell that fits comfortably and
completely into your ear canal. The
device is removed by pulling a tiny cord. This style is much
less noticeable and the ear naturally protects the
device from wind. Some features, though,
such as manual volume control, are
not available. This style may be
difficult to operate especially if
the user has poor dexterity.
These hearing aids typically
use size 10 batteries, and
are helpful for those
with mild to moderate
hearing loss.
ITE (In-The-Ear)
This style of hearing aid is
housed in a custom shell,
so it fits comfortably in the
bowl shape of your outer
ear. It is more visible and may
pick up wind. Due to the larger
size, though, these hearing aids
are easily operated even if the user
has poor dexterity. Adjustable volume
control and other features are also available.
These hearing aids typically use size 13 batteries.
This style is helpful for those with mild to severe
hearing loss.
ITC (In-The-Canal)
This style is also housed in a custom
shell that fits comfortably inside the
beginning of the ear canal and delivers
sound directly to the inner ear. Due
IIC (Invisible-In-Canal)
This style is called
“invisible” for a reason. It
rests comfortably in the second
bend of your ear canal, where
most other hearing aids end. This
allows it to use the ear’s natural acoustics
and anatomy to deliver more precise, natural
sound—AND it is completely undetectable to the
outside world. Unlike extended wear deep insertion aids,
like LyricTM or WowTM, IIC hearing aids can be removed
and reinserted daily to promote better hearing health. The
compact size means that some features, like directional
microphones, are not available. They are also difficult to
operate for users with poor dexterity, and are usually one
of the most expensive styles. These hearing aids typically
use size 10 batteries, and are helpful for those with mild to
moderate hearing loss.
You now know a little more about your hearing aid options.
Selecting the hearing aid style that is right for you is a critical
step on the path to better hearing, but it is just one step. Your
hearing care professional will provide you with a thorough
evaluation and consultation to help you determine the best
solution for getting you back to better hearing.
Hearing Aid Battery Basics
Battery Size
10
312
Battery Life
up to 5 days
Typically used in...
CIC, Mini, BTE
13
675
up to 10 days
up to 2 weeks
up to 3 weeks
ITC, ITE,
Mini BTE
ITE or BTE
BTE
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Technology Pyramid
Designed for those who are budget conscious
and just need basic amplification in quiet
environments. This type of technology is
usually from $1500 - $3500 a pair.
Basic digital technology designed to help people
that aren’t very active or spend the majority of
time in quiet environments only. Typically ranges
$
2500 - $5000 a pair.
Technology designed to be used in relatively easy
listening situations with some noise. Typically
ranges from $3500 - $7500 a pair.
Best
Advanced
Basic
Economy
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Designed for active people that are in a variety
of listening environments. Typically range in price
from $5000 - $12,000 a pair.
What to Expect During Adjustment
Once you purchase hearing aids, there will be a period of adjustment while your brain gets used to hearing
theses sounds again. The average person has had hearing loss for 5-15 before they finally get treatment.
Anything you don’t do for over a decade will require a bit of time to relearn. One key to a successful transition
to your new hearing is having realistic expectations. Below are some tips to give you an idea of what typically
happens during adjustment.
Adjustment Differs for Everyone
Some people can wear their hearing aids all day right off the
bat. Others have to gradually build up to that kind of use. One
way is not better than another, it is all a matter of personal
preference. The important thing is that you are wearing them
regularly to train your brain how to hear again. Starting off in
quieter environments, like around your house, is better than
heading out to a restaurant right away.
Wear Your Hearing Aids
Whether or not you can wear your hearing aids all day right
away, you should wear them as much as possible. Even when
you are alone at home, it is a good idea to wear them. This
will allow your brain to get used to hearing this way, and it
won’t be bombarded suddenly in a social setting. Also, if you
are comfortable wearing them alone, you will be comfortable
wearing them in social settings as well. Like any other
instrument, hearing aids take practice to adjust to them.
Something in Your Ear
It is normal to feel like something is in your ear because it is.
You will adjust to that feeling and not even notice it in time. If
your hearing aid is causing sores or irritation, let your hearing
care provider know immediately. These are signs that something
is wrong, and professional assistance
is recommended.
Hearing Your Own Voice
While you have lived with decreasing hearing, you have grown
accustomed to hearing your own voice inside your head. Now
that you have hearing aids, your brain must process your own
voice through your ears as well. This is similar to listening to
your own voice on a voice mail recording or some other outside
source. It will be strange at first, but you will adjust to it.
Suddenly There is Background Noise
Sounds like your air conditioner or refrigerator running may
sound very loud. Your auditory system is not used to hearing
these softer sounds. It’s all part of hearing better. While these
sounds may be annoying, these frequencies are an important
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part of understanding speech better. As you acclimate to your
hearing aids, your brain will relearn how to filter them out.
Improvement Not Perfection
It is important to remember that you will never hear like you
did before the hearing loss. Today’s hearing aids are incredibly
sophisticated and powerful, and they can make it possible to
enjoy sounds better than ever before. They are trying to imitate
an incredibly complex system—the human ear. No matter how
good an imitation is, it is still an imitation. As you work with
your hearing care provider to fine tune your hearing aids, work
toward better hearing and not perfect hearing.
Expect Improvement
Perfection may not be attainable, but dramatic improvement
most certainly is. On average, it takes about 45 days for your
brain to adjust to the new way of hearing, but you should
notice a difference before that. If you do not notice a difference,
talk with your hearing care provider. Something needs to be
adjusted.
A Team Effort
Hearing is subjective and so sounds that are annoying to some
people will not annoy others. As you begin to hear some of the
lost frequencies again, you will come across some unpleasant
sounds as well. Especially during the adjustment period, you
should visit your hearing care provider often. He or she will help
fine tune your hearing aids to your personal needs. Working
together you can hear better. Knowing what to expect ahead
of time means you can recognize the success you’re having and
enjoy it.
Helping Others
You may be reading this guide because you have a loved one with hearing loss and you’re not
sure how to help them. Studies show that people with progressive hearing loss may wait 5-15
years before getting treatment (1). The two biggest reasons for this delay are denial and being
unaware of the loss or its severity. Either way, you can help your loved one understand the
impact of hearing loss on his or her life.
Why Refuse Help?
How to Help
Denial
Denial is a natural response that helps minimize the effect
of stressful situations. As it relates to hearing loss, a patient
in denial often shifts ownership of his or her hearing loss to
other people, like the speaker, the environment, or competing
noise. In not acknowledging the hearing problem, those in
denial chose to continue asking people to repeat themselves,
withdrawing form social situations, and relying on you
or others to interpret for them. This is taxing on everyone
involved and will only get worse.
Whether a loved one is in denial or simply concerned about
being seen with a hearing aid, your goal is to help them
perceive their situation more accurately. Once they understand
their loss and the benefits of better hearing (as well as the
remarkably discreet options in today’s hearing aids), they will
be more likely to get treatment. Here are a few ideas of how to
help your loved one gain an accurate perception:
Unaware of Loss or Severity
People with hearing loss often report “my hearing loss is
not severe enough” among the top reasons for not getting
treatment (2). Because hearing loss typically occurs gradually
over time, those with a loss may not fully realize what they
are missing for quite some time. The unfortunate consequence
of this form of denial is that the patients gradually alter their
lifestyles as the loss progresses until they become isolated,
lonely, and disengaged.
Vanity
Inaction is frequently a result of stigmas attached to hearing
aids and hearing loss, and feeling that hearing aids advertise a
handicap. The anticipated embarrassment of a visible assistive
device outweighs the possible benefits of better hearing. But
consider this question, “which is more visible: a hearing aid, or
constantly misunderstanding conversations and asking others
to repeat themselves?”
•
•
The Better Hearing Institute suggests declaring a “Hearing Help Quest.”
Then whenever you need to help your loved one, preface what you
are repeating with something like, “Hearing Help.” This will help them
recognize how often you are helping them (4).
Stop carrying messages between your loved one and the rest of the
family when they can get the information from the source.
• Stop raising your voice. It is not good for your vocal chords, and talking
in a normal tone will help your loved one recognize their loss better.
• Set an example. Get your hearing checked regularly, and then discuss
your positive experience. A study by Professor Vishakha W. Rawool at
West Virginia University shows that “50% of participants who were
in denial or unaware of their loss accepted their hearing loss after an
informational consultation with a relatively inexperienced clinician
(1).” Sharing your experience can put you in the role of the “relatively
inexperienced clinician” and the information you know can have a
great impact.
This may all take some time, so have patience. It will be hard,
but let your loved one struggle a bit. In the end, it will be worth
it when your loved one can hear independent of you and enjoy
the benefits of better hearing.
1)Rawool, V. (2009). Effectiveness of informational counseling on acceptance
of hearing loss among older adults. The Hearing Review, 16 (6), 14-24.
2) Kochkin, S. (2007). MarkeTrak VII: Obstacles to adult non-user adoption
of hearing aids. Hearing Journal,
60(4), 24-51.
3) Mulrow, C., Lichtenstein M. (1991). Screening for hearing impairment in
the elderly:rationale and strategy. J Gen Intern Med, 6(3), 249-258.
4)Better Hearing Institute (2005). When a loved one resists help. Your Guide
to Better Hearing, 13.
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Definition of Terms
Adaptive Feedback Cancellation - is a common method of
cancelling audio feedback in a variety of electro-acoustic systems such
as digital hearing aids. The time varying acoustic feedback leakage
paths can only be eliminated with adaptive feedback cancellation.
When an electro-acoustic system with an adaptive feedback canceller
is presented with a correlated input signal, a recurrent distortion
artifact, entrainment is generated. There is a difference between the
system identification and feedback cancellation.
Cochlea - snail-shaped structure in the inner ear that contains the
organ of hearing.
Automatic Gain Control—Output (AGCo) - is an adaptive system
found in many electronic devices. The average output signal level is
fed back to adjust the gain to an appropriate level for a range of input
signal levels. For example, without AGC the sound emitted from an
AM radio receiver would vary to an extreme extent from a weak to a
strong signal; the AGC effectively reduces the volume if the signal is
strong and raises it when it is weaker.
Automatic Gain Control - (AGC) is an adaptive system found in
many electronic devices. The average output signal level is fed back
to adjust the gain to an appropriate level for a range of input signal
levels. For example, without AGC the sound emitted from an AM
radio receiver would vary to an extreme extent from a weak to a strong
signal; the AGC effectively reduces the volume if the signal is strong
and raises it when it is weaker.
Digital Noise Reduction - is the process of removing noise from
a signal. All recording devices, both analogue or digital, have traits
which make them susceptible to noise. Noise can be random or white
noise with no coherence, or coherent noise introduced by the device’s
mechanism or processing algorithms.
Gain Reduction - Diminution of the output of an amplifier, usually
achieved by reducing the drive from feed lines by use of equalizer pads
or reducing amplification by a volume control.
Feedback - is the whistling sound that occurs when sound from a
speaker loops back to the microphone. It is best described as a highpitched screeching.
Gain - the volume added to a sound after amplification.
Open Fit - a hearing aid designed to fit over the ear with a thin tube
or wire running into the ear, and a small, soft plastic tip. The tip has
Audiogram - A chart used to plot an individual’s scores from a holes to keep from blocking the ear canal so that the user does not
feel plugged or occluded. Open ear hearing aids are primarily used for
hearing test.
high frequency hearing loss.
Adaptive Directional Microphones - A directional microphone
system capable of activating automatically when it senses the presence Video Otoscope - an instrument with lighting and magnifying
systems used for visual examination of the tympanic membrane and
of background noise.
the canal connecting it to the exterior of the body
Inner Ear - part of the ear that contains both the organ of hearing (the
Telecoils - You may have heard the telecoil in your hearing aid
cochlea) and the organ of balance (the labyrinth).
referred to as a telephone switch, a T-switch, or a Tcoil. Whatever you
Middle Ear - is the portion of the ear internal to the eardrum, and call it, it’s one of the most important features of a hearing aid. It makes
external to the oval window of the cochlea. The mammalian middle talking on the telephone much easier; but it also opens up the world
ear contains three ossicles, which couple vibration of the eardrum of assistive listening devices, including the induction loop technology
into waves in the fluid and membranes of the inner ear. The hollow that is so widespread in Europe (and becoming more so in the US).
space of the middle ear has also been called the tympanic cavity, or
cavum tympani. The eustachian tube joins the tympanic cavity with
the nasal cavity (nasopharynx), allowing pressure to equalize between
the middle ear and throat. The primary function of the middle ear is
to efficiently transfer acoustic energy from compression waves in air to
fluid–membrane waves within the cochlea.
Outer Ear - is the external portion of the ear, which consists of
the pinna, concha, and external auditory meatus. It gathers sound
energy and focuses it on the eardrum (tympanic membrane). One
consequence of the configuration of the external ear is to selectively
boost the sound pressure 30- to 100-fold for frequencies around 3
kHz. This amplification makes humans most sensitive to frequencies
in this range - and also explains why they are particularly prone to
acoustical injury and hearing loss near this frequency. Most human
speech sounds are also distributed in the bandwidth around 3 kHz.[1]
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