Posted on Thursday, 12th June 2014 by

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If you think you have a hearing loss and are now pondering whether or not you should buy hearing aids, take a few moments to read this article so that you are empowered with the information you need to obtain competent hearing health care. 

Finding a Competent Professional

The first thing you need to do is find a hearing health care professional who can do a comprehensive audiological evaluation (hearing test).   An audiologist is a healthcare professional specializing in identifying, diagnosing, treating and monitoring disorders of the auditory and vestibular system portions of the ear.  Audiologists also dispense hearing aids.  The other professional who can sell hearing aids is a hearing instrument specialist.  Both audiologists and hearing instrument specialists may work in private practice or work for big box stores like Costco.  Audiologists also may work for physicians specializing in the ear.  Audiologists should hold an AuD (Doctor of Audiology) Degree, which is a professional 4-year degree earned following an undergraduate degree.  Some audiologists may also hold a Ph.D.  In order to practice audiology in each state, audiologists must be licensed.

The Hearing Test

An audiological evaluation should include a battery of tests to determine the degree, configuration (shape) and type of hearing loss you have and whether or not you need to be referred to a physician for medical treatment.  There are many causes of hearing loss and it is important that serious medical issues be ruled out.  For more information on symptoms and causes of hearing loss, consult the Hearing Loss Association of America’s fact sheet.  Be sure that the office tests you in a calibrated sound booth for reliable testing.

In order to determine how much difficulty you experience listening in noise, an adaptive speech-in-noise test should be performed.  The QuickSin™ is fast and can also inform decisions on what type of technologies will best meet your needs.  For example, a good score on this test may indicate that hearing aids alone will help you in most situations.  A poor score may indicate that you need to be pairing hearing aids with wireless technologies in many of your day-to-day listening situations.  Inclusion of this test is considered a “best practice” and I would search for a profession who includes it in his or her battery of diagnostic tests.




Counseling/Needs Assessment

Once a medical condition is ruled out, then it’s time to talk about your hearing loss and what to do about it.  If the first thing you hear out of the professional’s mouth is “How much do you want to pay for hearing aids?”, then you should stand up, turn around, and head quickly for the nearest exit.  Why?  Because the first question that should be asked is “So are you having any hearing difficulties?  Tell me about them.”  Your hearing health care professional should focus on you as a whole person, not as a potential hearing aid buyer.   Thus, a comprehensive receptive communication needs assessment should be done that examines four universal receptive communication needs:

1.      FACE-TO-FACE:  We must be able to engage in face-to-face communication, whether in one-to-one situations or in groups.

2.      MEDIA:  We must be able to receive media on all platforms:  TV, radio, tablets, phablets, phones, movie theaters, etc.

3.      TELECOMMUNICATIONS:  We must be able to communication on the phone. This includes landline and mobile as well as teleconferences using phones and computer devices.

4.      ALERTING SIGNALS:  We also need to be aware of alerting signals such as the alarm clock, smoke alarm, baby cry, appliance signals, etc. 

All four needs may occur at home, at work and while out and about.  The role of the hearing health care professional is to ensure that you hear and comprehend in as many listening environments as possible.  Depending on your particular hearing loss and lifestyle, hearing aids alone may or may not meet all four needs in all situations.  Oftentimes hearing aids can be used along with hardwired and wireless accessories (known as assistive listening devices (ALDs) or hearing assistance technologies (HAT).  By combining these technologies, every single communication situation in your life can be made accessible.  To read more about HAT, you can read some tutorials I wrote for a website called SoundStrategy.

You might be wondering why hearing aids may need to be used with accessories.  Hearing aids are designed to make speech audible (and thus understandable), but they do this best at close distances.  In order to hear better in noise and amidst reverberation in larger rooms, the signal of interest (whatever it is that you want to hear) must be louder than the noise and/or reverberation.  So, you have two choices.  Move closer (which you cannot always do) or place a wireless microphone next to the talker, or plug a wireless transmitter into a TV, etc.  These wireless devices function like binoculars for the ears, picking up the signal of interest and broadcasting it across the room directly into your hearing aids. 

To learn more about how hearing loss and room acoustics impact communication and why hearing aids may or may not be enough, go to this link.

Hearing Aid Features

 When selecting hearing aids you have the choice of various models, but it is very important to be sure that the model you chose contains some key features.

 Directional Microphone

Directional microphones can improve your ability to understand in noise by reducing what you hear to the sides and behind you.  They work best when you are close to the sound source (“near-field” listening).  However, their effectiveness is reduced or eliminated if you get too far from the sound source (“far-field” listening) and/or are listening in a very reverberant room.   In these situations the hearing assistance technology (HAT) described above can be used along with your hearing aids.  There are other factors affecting directional microphone benefit.  To learn more, read this excellent blog by Jason Galster, Ph.D. 

Telecoil

Another helpful feature is a telecoil.  As shown in the illustration, a telecoil is a small sensor that is placed inside of the hearing aid (or implant) and used to pick up electromagnetic energy from hearing aid hearing aid compatible phones.  They also provide wireless access to large rooms that are equipped with loops, FM or infrared wireless listening devices.  These systems are mandated by the Americans with Disabilities Act (ADA) and can provide access to movie theaters, concerts, plays, meetings and even your own TV.  If your hearing aids do not have telecoils, then the only way to access large area wireless listening systems is to remove your hearing aids and use the receiver and earphones provided by the movie theater or other venue.  This may or may not be ideal.  To learn more, click here. 

Wireless Hearing Aids

Newer hearing aids contain wireless receivers that can be paired with wireless accessories from the same manufacturer.  For example, one brand of hearing aid can be ordered with a TV transmitter that allows you to hear a stereo TV signal in your hearing aids when you enter the room.  This same system can be ordered with a “spouse mic” that your significant other can clip to his or her lapel so that you can hear better in a car, restaurant, etc.  Multiple mics also can be used in meetings.  Some hearing aids can also be used with the iPhone, allowing phone calls and music to be sent to the hearing aids directly. 

Because of the existence of old and new technology side-by-side, it makes sense to include telecoils in your new hearing aids, even if they are wireless.  This way you can be guaranteed to have access to all existing technologies. 

Verification Is Key!

When fitting hearing aids, the hearing health care professional should ensure that the hearing aids chosen for you are working properly and are meeting well-researched fitting targets for audibility and comfort. 

When the audiologist or hearing aid dispenser purchases hearing aids from a manufacturer, the first thing he or she should do upon receiving the hearing aids is to measure their performance  in a hearing aid analyzer to verify that the hearing aids meet the manufacturer’s specifications. 

This is quality control, folks.

The next step is the programming of the hearing aids.  Each hearing aid is programmed using software provided by the manufacturer.  The hearing aid will be programmed according to your needs as determined by your hearing loss and certain fitting targets established by a large body of audiological research.  To determine if each hearing aid is meeting target, verification must be done.  This means that a small flexible microphone will be placed in your ear, first without the hearing aid inserted and then with it inserted.  This is the ONLY – I repeat – ONLY way to objectively determine what Sound Pressure Level (SPL) the hearing aid is delivering to your eardrum.  Without this Probe-Microphone Test (also called Real Ear), it’s anyone’s guess as to whether or not the hearing aid is adjusted properly.  Probe-microphone testing also provides a baseline for comparison when you return for adjustments and is also used to compare performance if your hearing aid malfunctions.  Before you make an appointment to be fitted with hearing aids, always ask if the hearing health care professional uses probe-mic (or real ear) testing to verify a hearing aid fitting.  If the answer is “no”, find another professional.  There is no excuse for not providing probe-mic measurement.  Period. 

After the hearing aids have been verified, you should be instructed in the care and use of the hearing aids.  This process should involve your significant other(s) as well.  The ultimate success of the hearing aid fitting may depend upon how much information you are able to recall from the orientation process so feel free to ask questions and take notes and call the office if you have any questions.  Remember, it’s all about YOU and your happiness.  A good service provider will be more than happy to help you through the process.   You should also ask for a formal report showing objective benefit achieved in quiet and in noise after the fitting.

Validation

Validation is where you and your audiologist or hearing aid dispenser judge whether or not the treatment goals have been achieved.  Oftentimes a questionnaire is given before and after the hearing aid fitting to see how many communication difficulties have been resolved and what else needs to be done, if anything, to improve your ability to hear in all situations of your life.   It is also the time to decide if you want to keep the hearing aids.  A popular questionnaire is called the COSI and you can read more about it here:  http://www.nal.gov.au/outcome-measures_tab_cosi.shtml

Make sure you understand the return and refund policy if you are not totally satisfied with your improved hearing/comprehension.  Beware of professionals who brush off your complaints with “Your brain will get used to the hearing aid…give it time.”  Yes, there may be an adjustment period, but if you feel something isn’t right, then it probably isn’t.  Have faith in your judgment and be assertive!  State laws require trial periods with hearing aids and money back guarantees.  However, if best practices are followed – i.e., your provider takes the time to listen to your concerns, verifies and validates, then most likely you will keep the hearing aids and may end up using them along with additional hearing assistance technologies to meet all four of your receptive communication needs. 

Training

Depending on the nature of your hearing loss, you may need additional training (called aural rehabilitation) to help you hear better with your new technology.  Some providers offer this training in a group or individually.  You may also want to inquire about LACE (Listening and Communication Enhancement) Auditory Training programs that retrain the brain to better comprehend speech in difficult listening situation such as noisy restaurants, rapid speakers, and competing speakers.  To learn more, visit this site:  http://www.neurotone.com/

Support: Hearing Loss Association of America (HLAA)

HLAA is the nation’s leading organization representing people with hearing loss.  HLAA provides assistance and resources that can help you and your family learn to adjust to living with a hearing loss.   HLAA has a major impact on communication access, public policy, public awareness, and service delivery related to hearing loss.  Their national office is located in Bethesda, Maryland and they also have state chapters around the country.  They are a great organization and I have volunteered for them for many years.  I currently consult for them on technology and training.  Check out their website and consider coming to their convention in Austin this June!  It’s always great fun.

Final Thoughts

We all deserve to have FULL receptive communication access – for a lifetime.  By employing a holistic systems-engineering approach that uses best practices to carefully assess your communication needs, only then can your hearing health care professional move forward to select, verify and validate appropriate technology.   Remember, need informs technology, not the other way around.  Finally, you want a professional who can also provide you with behavioral and environmental strategies that can be used along with your technology to help you achieve the full communication access you deserve.

Cynthia Compton-Conley Ph. D. is a Board Certified Doctor of Audiology, Professor of Audiology, Hearing Industry Consultant and Host of the Hearing Loss Help Forum. Dr.  Cynthia is a retired Professor of Audiology who taught in the graduate school at federally-funded Gallaudet University for 32 years and retired in the CSRS system.  In 2013 she founded Compton-Conley Consulting.

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We do not provide medical advice. This website and the information provided on this site are intended solely for consumer education. This website and its information services do not constitute the practice of medicine, nursing, or other professional health care practice and nothing contained in this website is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment. Do not disregard, avoid or delay obtaining medical advice from your physician or other qualified health care provider because of something you have read on this website.  While the publisher and author have used their best efforts in providing information on hearing loss and associated hearing enhancement or hearing protection technology, they make no representations or warranties with respect to the accuracy or completeness of the content of this forum and Website, replies to site visitor questions, or prepared articles, and they specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. The advice and strategies contained herein may not be suitable for your situation. You should consult with a physician or audiologist where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

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