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Hearing Aid Guide Table of Contents:

Section One

Hearing is a Vital Part of Life

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It connects you to the world around you and to the lives of those you love. The most important part of life is arguably your connection with people. Hearing allows you to build relationships and bring vibrancy to life. With this in mind, keeping your auditory nerve active and your brain stimulated should be a high priority. When you begin missing sounds with your ears, remember that your brain is also affected, specifically your speech and memory centers. Rather than allowing feelings of isolation and disconnect to seep in, there are steps you can take today to keep these centers strong and active and step back into the conversation. The first step is to see if hearing aids are right for you. Our Doctors of Audiology are experts in hearing solutions.

They are current on new technology, and make it a priority that you are fit with hearing aids that are right for you. The decision to improve your hearing by purchasing hearing aids is a big decision. Before you invest, it is important to know what hearing aids can and can’t do. It is also important to know what to listen for in your selection process. To help you get started in your research, here is the ultimate guide to understanding hearing aids.

You’re Not Alone In This Endeavor

First of all, take comfort in knowing that you are not alone. Recent studies show that 15% of American adults report having some trouble hearing, and 28.8 million Americans could benefit from using hearing aids*. With technology improving and becoming increasingly effective, more and more people are turning to hearing aids to keep their brain active. The shrinking size of technology makes solutions more discreet than ever. Those that try hearing aids feel more engaged in their surroundings and report a greater sense of purpose.

Your Ears Hear and Your Brain Listens

Before you can understand why hearing aids are necessary, you first need to better grasp how your auditory system is supposed to work. Your auditory system is comprised of your outer, middle and inner ear, your auditory nerve and your brain (auditory cortex). Each of these components play a different role in making hearing possible.

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The Different Parts of the Ear

The Outer Ear

The outer ear, also known as the pinna, is everything that you can see on the surface of the ear and the ear canal. The pinna is specifically designed to focus sound into the ear canal where those sound waves are then transferred to the middle ear.

The Middle Ear

The middle ear begins at the very end of the ear canal where the eardrum is located. It is in the middle ear that you will find the three smallest bones within the human body. These three bones, referred to as the ossicles, are the malleus, incus, and stapes. The eardrum is connected to the ossicles, so that when waves of sound penetrate the eardrum, it vibrates in response. This vibration then allows the ossicles to move which then penetrates the cochlea.

The Inner Ear

The inner ear is the most complicated portion of the entire ear. It is comprised of the cochlea which has two functions – hearing and balance. The cochlea is a boney structure similar to a snail’s shell that contains thousands of hair cells and three chambers of fluid.

The inner ear is the most complicated portion of the entire ear. It is comprised of the cochlea which has two functions – hearing and balance. The cochlea is a boney structure similar to a snail’s shell that contains thousands of hair cells and three chambers of fluid.
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Section Two

Hearing Loss

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Now that you have a basic understanding of how hearing should work, you will be better able to understand how hearing can go wrong and result in a hearing loss. There are three types of hearing loss and learning about each may help you diagnose which type of hearing loss is affecting you.

Types of Hearing Loss

Conductive Hearing Loss

When sound cannot pass through the middle ear, this is known as conductive hearing loss. Common causes for these obstructions are wax compaction, outer ear obstructions, middle ear fluid, ear drum perforations, or ear infections, to name a few. A reduction in the level of sound or the capability to register quiet sounds is typical in this case. Conductive hearing loss can usually be completely or partially repaired medically without the use of hearing aids. Our Doctors of Audiology will always look for this type of loss first.

Sensorineural Hearing Loss

Sensorineural hearing loss occurs when the tiny hair cells that alter the motion of sound into electrical signals are damaged. Everyone loses these hair cells throughout their lifetime, which is why your hearing gets worse as you get older. These hair cells are also damaged by loud noise, lack of blood flow, inner ear infections, exposure to secondhand smoke, or as a side effect of some medications. They can also be damaged by many health conditions such as diabetes. This type of hearing loss is the most prevalent.

When hair cells are damaged, there is currently no way to repair them. Sensorineural hearing loss is permanent. People with this type of loss find the most value in hearing aids. Understanding the extent of the damage and how this change is affecting the way your brain processes sound is important in determining treatment options.

Mixed Hearing Loss

A mixed hearing loss is a combination of both a conductive hearing loss and a sensorineural hearing loss. Essentially, this means that there is damage in the middle ear as well as the inner ear. People who suffer from a mixed hearing loss often complain about sounds being too soft and difficult to understand.

How To Treat Hearing Loss

Cochlear Implants

A cochlear implant is “a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely
hard-of-hearing.”* This small device is made up of the following parts:

  • Microphone – This picks up the sound around you.
  • Speech Processor – This is able to differentiate between speech sounds and other noises.
  • Transmitter – Converts the sound collected by the speech processor into electrical impulses.
  • Electrode array – Collects the electrical impulses by using a group of electrodes and then sends them to the auditory nerve where they are processed by the brainstem.

Although cochlear implants are unable to restore normal hearing, they are able to create an accurate representation of sounds so that a deaf person, or someone with profound hearing loss, will be able to understand speech. Where hearing aids amplify the sound around you so that the damaged part of your ear can detect what is being said, cochlear implants skip over the damaged portion and directly stimulate the auditory nerve.

Assistive Devices

An “assistive device” includes any type of technology that is able to help someone with a hearing loss, or any other communicative disorder, be able to communicate more effectively. There are three main types of assistive devices and they include the following:

  • Altering Devices – Anything within your home that projects sound, such as a telephone, doorbell, or alarm, can be altered to give off a blinking light or a loud sound to inform the person with a hearing loss that their attention is needed.
  • Augmentative and Alternative Communication Devices (AAC) – This includes anything that can be used to help someone with a communication disorder express themselves.
  • Assistive Listening Devices (ALDS) – ALDS can be used with your hearing aid or cochlear implant to amplify the sound that you want to hear.

Hearing Aids

Hearing aids are small electronic devices that are designed to be worn behind, or in your ear. Hearing aids amplify sound so that someone suffering from mild to severely-profound hearing loss can listen and communicate more effectively with those around them. Hearing aids make it possible to be able to fully participate in the daily activities the wearer once enjoyed before their hearing loss. These devices make it possible to hear both in noisy and quiet settings.

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Section Three

How Hearing Aids Work, Testing, and If You Need One

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How Hearing Aids Work

A hearing aid is relatively simple in terms of how it works, it is made up of four parts:

  • Microphone – Receives sound waves and then converts it into electrical signals.
  • Amplifier – The amplifier picks up the electrical signals and then increases their power.
  • Digital Signal Processor – Allows for more dynamic and specific improvements
  • Speaker – The speaker receives the amplified signal making speech sound more clearly.

New technology is affording many benefits to hearing aid wearers. New processors are able to offer solutions much more specific to individual hearing needs. Your Doctor of Audiology will know the differences in each of the major hearing aids offered. Selecting the correct hearing aid for your specific loss and listening environments coupled with correct programing are arguably the most important success factors. Doctors of Audiology offer the most comprehensive background and education to people looking for hearing health care.

How a Hearing Test Works

Hearing tests are extremely non-invasive and should be done thoroughly. Before your Doctor of Audiology can prescribe you a hearing aid, they must first understand your listening environments and how your hearing loss is affecting you. To accomplish this, you should expect a thorough case history and seven to nine tests. These tests help create a picture of how your ears and brain are working together. They are covered by most insurances. These tests include otoscopy, tympanometry, acoustic reflex threshold testing (ipsilateral and/or contralateral), speech recognition threshold, speech discrimination, speech in noise, pure tone audiometry (air & bone), most comfortable level, and uncomfortable loudness level testing.

Types of Hearing Tests

Pure Tone Audiometry (PTA)

PTA is a hearing test of both ears. This is accomplished by the patient wearing a set of headphones and when they hear a sound that is produced by an audiometer, they simply raise their hand or push a button. The audiometer will produce various sounds of different volumes and pitches.

Bone Conduction Test

To help your audiologist understand what type of hearing loss you have, he will also do a bone conduction test. This is accomplished by putting a vibrating probe against the bone behind your ear, known as the mastoid. This will test how well you are able to hear sounds that are transmitted through the bone. This may sound like a strange test, but it is able to measure how effectively your inner ear and its hearing nerves are functioning.

Speech Discrimination

This test includes listening to random words and then repeating those words back to your audiologist. This may be done through headphones, or over a speaker system, but without the help of visual cues. You may also be asked to listen and repeat these random words with a level of background noise.

Speech Recognition

This test determines the quietest level at which speech can be heard. It entails blocking sound from one of your ears and repeating back the quiet word that you hear, and then repeating the process with the other ear.

Tympanometry

Tympanometry measures your eardrum movement as well as the pressure behind your eardrum. This is done by placing a small machine over your ear and allowing it to change the pressure within your ear canal. This will allow your doctor to see if your Eustachian tube is functioning properly and will determine if there is any fluid behind your eardrum.

Do I Need a Hearing Aid?

If you’re unsure about when you should make an appointment with a Doctor of Audiology to check your hearing, look for some
of the following warning signs to help give you an idea:

  • You tend to avoid social interaction or family gatherings where the environment is noisy.
  • You have a difficult time understanding when people speak softly.
  • You have to strain to understand conversation.
  • You’ve become more withdrawn, frustrated, irritable, or impatient.
  • You have trouble following group conversations.
  • You prefer listening to the radio or TV louder than others.
  • You have to frequently ask others to repeat what they’ve said.
  • You have difficulty understanding what is being said at church, the movies or other public places.
  • You have trouble hearing someone when they’re speaking to you from a different room.
  • You have difficulty understanding someone when you can’t see their face.
  • You rarely start conversations.
  • It’s difficult for you to hear over the telephone.
  • You often complain that others are mumbling.

If even a few of these warning signs occur in your life, it is time to get your hearing checked so that you can be on your way to hearing again.
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Section Four

Types of Hearing Aids

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Learning about the various types of hearing aids, will help you to be more informed when you speak with your Doctor of Audiology about possible treatment options. You may want to have a hearing aid the hides inside your ear canal (CIC – Completely in the Canal) or one that sits behind your ear (BTE – behind the ear). Each of these have different pros and cons. Ultimately, your Doctor of Audiology should work with you to determine the style that will work best for you. Selection is critical for success. There are five major factors that should be analyzed carefully to ensure correct selection. These factors include ear canal anatomy, wax count, severity and slope of hearing loss, speech understanding and sound perception. Special considerations should also be taken into account for dexterity, vision impairment, skin type, neurologic sensitivity, cosmetics, and outer ear irregularities.

Behind-the-Ear

Behind-the-ear hearing aids, often referred to as BTE hearing aids, are hearing aids that sit comfortably behind your ear which then connect
to a custom ear piece (or earmold) by a thick tube.

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  • This type of hearing aid is appropriate for all ages.
  • It can benefit almost every type of hearing loss.
  • It is capable of a greater amplification than other types of hearing aids.
  • It is bluetooth compatible.
  • Prevents a feeling of your ears being plugged-up.

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  • Although there are some mini-designs that make a BTE hearing aid less visible, this type of hearing aid is the largest kind.
  • It tends to pick up more wind noise than other types of hearing aids. Although new technology is designed to slightly reduce wind noise.
  • The moisture and wax within your ear canal can limit the life of the receiver.

Receiver in Canal (RIC) or Receiver in the Ear (RITE)

The RIC or RITE are similar to the BTE hearing aids in that they have the hearing aid behind the ear and a receiver or speaker inside the ear canal, however rather than tubing connecting the two, with RIC and RITE hearing aids, a small wire connects the pieces instead. This type of hearing aid is perfect for people with mild to severe hearing loss because this type of hearing aid provides amplification across a wide range of frequencies.

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  • Is less visible than BTE hearing aids.
  • The controls are easily manipulated on the larger models.
  • The custom-fit ear mold is easy to clean.
  • Has larger batteries making it easier to manage.

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  • Earwax can clog the speaker but this can be prevented with regular care.
  • Unless there is ventilation, you can get a plugged-up feeling.
  • The custom-fit ear mold is visible.
  • Susceptible to sweat and wax buildup.

Completely in the Canal (CIC) Invisible in the Canal (IIC)

Behind-the-ear hearing aids, often referred to as BTE hearing aids, are hearing aids that sit comfortably behind your ear which then connect to a custom ear piece (or earmold) by a thick tube.

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  • Least visible of all hearing aids.
  • Easily inserted or removed.
  • Unaffected by wind noise.
  • It does not need telecoil.

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  • Because it is so small, it also comes with small batteries that are difficult to handle and have a shorter life.
  • Doesn’t have a directional microphone, volume control, or any other features.
  • Being completely in the ear canal, it is vulnerable to wax and moisture buildup.

In the Canal Hearing Aid (ITC)

Behind-the-ear hearing aids, often referred to as BTE hearing aids, are hearing aids that sit comfortably behind your ear which then connect
to a custom ear piece (or earmold) by a thick tube.

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  • Barely visible
  • Includes features such as volume control and directional microphones in the larger units
  • Easy to insert

 

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  • Vulnerable to earwax blocking the speaker.
  • The battery is smaller, so it has a relatively short lifespan.
  • The features can be difficult to manipulate because it’s a smaller hearing aid.

In the Ear Hearing Aid (ITE)

Behind-the-ear hearing aids, often referred to as BTE hearing aids, are hearing aids that sit comfortably behind your ear which then connect
to a custom ear piece (or earmold) by a thick tube.

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  • Offers more features that can’t fit on smaller types of hearing aids such as telecoil, volume control and directional microphone.
  • When ventilated, there is less of a plugged-up feeling.
  • Has a larger battery which also means a longer battery life.
  • Easier to handle

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  • Tends to pick up more wind noise than some of the smaller styles.
  • More visible.
  • Susceptible to sweat and earwax buildup.
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Section Five

Hearing Aid Features

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When you’re familiar with the various hearing aid features that are available to you, you will be able talk with your
Doctor of Audiology about features that are important to you, and those you can live without.

Main Features

Telecoil

This is a feature that many wearers really appreciate. The telecoil feature is simply a switch that allows you to change from a normal microphone setting to a “T” setting which allows you to hear better while talking on the telephone. Those who don’t have the telecoil feature often complain about hearing a “whistling” sound when they talk on the phone because their microphone is off. This telecoil wire is also compatible with other assistive listening devices, so simply by having this feature and turning it to the “T” setting, you will be able to hear better at church, movie theaters, auditoriums, and other large public settings.

Directional Microphone

The directional microphone feature is a switch that when activated picks up sound coming from a certain direction. This is extremely beneficial when you are in a noisy room because the directional microphone will amplify the sound that is right in front of you. This of course is helpful for one on-one conversations as well. When you wish to switch back to the omnidirectional setting, your hearing aid will respond to all sounds equally again.

Feedback Suppression

With older hearing aids, when the microphone and speaker were too close to each other, there would often result in a loud squeal or whistle. Modern hearing aids now come with feedback cancellation that automatically adjusts itself based on surrounding sounds, and can identify and remove feedback so that you don’t have to hear a loud whistle

Miscellaneous Features

  • Manual volume control– this allows you to adjust the sound to suit you best in various noise settings. Some hearing aids come with a self-learning feature that will adjust itself after it has learned your preferred settings.
  • Vents– These are tiny tunnels within the ear models that prevent that plugged-up feeling from occurring.
    Automatic volume control– This prevents high sound levels from being too loud and hurting your ears.
  • Wax Guard– this keeps wax from clogging up and causing your hearing aid to malfunction.
  • Low Battery Indicator– This lets you know that you need to change your battery soon.
  • Digital Noise Reduction– This improves the sound quality and comfort in noisy environments.

Features for New Wireless Technologies

  • Bluetooth capabilities
  • Direct connect to smart phones
  • Direct connect to TV, radio and many MP3 players

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Section Six

Selecting a Hearing Aid with Hearing & Balance Doctors

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Your Initial Visit

We can’t wait to meet you! At Hearing & Balance Doctors we know all about hearing health care, but what makes us great is the people that work here. At your initial visit you will meet our staff members and get to know our office. Our Audiology Assistant will bring you back and begin a taking a case history. One of our Doctors of Audiology will then talk with you before beginning a thorough examination. Knowing how you live and what situations you are struggling in will help them better recommend a treatment tailor fit for you. During your initial visit we’ll also verify your insurance, so we can give you the accurate financial information concerning your treatment plan.

Determining Treatment

Once we’ve finished testing and understand your listening needs, we will review your test results together. After reviewing the results, we will recommend treatment and talk through options we believe will work best for you. Our office is constantly studying new technology from each of the major hearing aid manufacturers and will be able to talk through what type of technology we believe is best suited for you. We will review style, price, comfort, usability, and any other questions you may have.

Delivering/Fitting Your Hearing Aid

This is an excited day! At this appointment you will receive your new hearing aids. We will teach you all the important details you’ll need to know and review what we call our ‘New Fit Check List’. This list includes checking the physical fit of your hearing aids, testing them to ensure they are programmed properly, teaching you how to put them in your ears correctly, daily maintenance and how to replace the batteries. We also want to make sure you know what to expect while listening through your new ears.

Follow-up Visits

Our doctors are dedicated to your long-term success. Because of this each of our hearing aid patients receive free lifetime service. Lifetime service includes seeing you once a month for the first few months and then every six months after that. We believe this is key to ensuring continued success with hearing aids. At these appointments we will make any necessary adjustments, thoroughly clean your ears and hearing aids, and most importantly spend time reviewing the progress you are making in your listening situations. These steps ensure each of our patients the opportunity to jump back into the conversation and to begin enjoying the sounds of life again.