Hearing is a gift that helps us to learn, share ideas and enjoy pleasures such as music, nature and conversations with friends and loved ones. Untreated hearing loss can result in negative social, psychological, and cognitive health effects, which is why individuals with a suspected hearing or balance disorder should be evaluated by an audiologist as soon as possible to determine the type, degree, and root cause of the problem and to find the appropriate treatment.
- How do I know if I have a hearing loss?
- If I have or suspect I have a hearing loss, what do I do?
- What can I expect from an audiological evaluation?
- How do I know if I need a hearing aid(s)?
- What kinds of hearing aids are available?
- Why do hearing aids cost so much?
- What can I expect as I adjust to my new hearing aids?
- What can I do if my hearing aid stops working?
- What devices, other than hearing aids, are available to help me?
Hearing loss often occurs so gradually that the individual may not be aware of a problem. In fact, it is not uncommon for a hearing loss to be first detected by a family member, who is having to speak louder or repeat themselves. Early signs of hearing loss include:
- Turning the TV or radio volume louder than other family members prefer.
- Difficulty understanding speech in a background of noise, for instance in restaurants.
- More difficulty hearing children and women than men.
- Difficulty hearing in meetings.
- Difficulty hearing at public speaking events.
- Ringing in the ear(s) when no external sound is present.
- Having things repeated frequently.
- Difficulty hearing people "with low voices."
If you suspect that you have a hearing loss, consult with an audiologist. An audiologist is trained to identify whether a hearing loss requires medical or non-medical treatment and will refer you to the appropriate medical specialist when necessary. The audiologist will identify, diagnose, treat and manage your hearing loss.
The audiologist will perform a thorough assessment of the hearing mechanism, beginning with a history interview. History questions will focus on the following areas:
- Conditions at birth or during adolescence that may have an impact on hearing.
- Exposure to workplace, military, or recreational noise.
- Medications prescribed for medical conditions.
- Past surgeries.
- Family traits and hereditary anomalies that may be associated with hearing loss.
Visual Inspection of Outer Ear and Ear Drum
Following the history, the audiologist will examine the outer ear with an otoscope or video otoscope. The audiologist can observe any damage caused by the use of cotton applicators ("Q-tips"), trauma, or chronic infection. The audiologist can also observe the condition of the ear drum and determine whether the ear canal may have a buildup of earwax causing a hearing loss.
After considering a patient's history and performing a visual inspection of the outer ear, the audiologist will perform an audiological evaluation composed of a series of tests. These test may include but are not limited to:
- Tympanometry to assess the status of the middle ear.
- Pure tone thresholds by air conduction and often by bone conduction to determine the degree and type of hearing loss.
- Tests of speech threshold and speech recognition to asses comprehension of complex signals.
- Special tests of auditory function, such as otoacoustic emissions, brainstem auditory evoked response (BAER), or balance testing.
The results of the audiological evaluation are a critical factor in helping to determine the need for hearing aid(s), the type of hearing aid(s) and whether one or two aids are needed. The audiologist will review the results of your evaluation and provide various options and recommendations for remediation, if needed.
Personal Preference and Physical Health
Although the audiological evaluation is necessary to determine a course of action, it does not tell the entire story. Audiologists also consider and weigh the patient's personal preferences as well as their overall health. Patients may not be ready to try hearing aids initially, but they will be asked to truthfully assess their degree of communicative difficulty.
Hearing aids are available in a variety of sizes and shapes, from instruments that fit behind the ear to instruments that totally fit within the ear canal and are minimally visible. Electronic circuitry has advanced significantly in the recent past, allowing patients greater sound comfort and improved speech recognition in noisy situations, to name a few. Digital and programmable hearing aids, which are adjusted via a computer connection, provide the most flexibility, allowing the audiologist to custom fit the response of the device to a specific hearing loss. Digital hearing aids can be modified if hearing changes or as your listening needs change. Your audiologist will help you choose the best instrument according to your needs and your budget.
Professional Services Required for Maximum Benefit
In order to receive maximum benefit from hearing aids, a professionally trained audiologist is involved in the fitting process which typically involves an average of five direct contact hours during the first year. In many cases, audiologists will provide unlimited service during the warranty period (from one to three years) or beyond, for no additional charge. This follow-up care may be "bundled" into the upfront cost of the hearing aid. In other words, when a hearing aid is dispensed, it is typically part of a package that routinely includes certain required professional services such as verification of the hearing aid fitting including, but not limited to, real ear (or probe tube) measurements and aided sound field testing. This package may also include ear impressions, selecting/ fitting/adjusting/reprogramming the hearing aid, patient and family counseling regarding hearing aid use, maintenance and realistic expectations and follow-up appointments.
Mail order or budget clubs may sell hearing aids at lower prices because they are often placed on the user with minimal or no instructions and/or adjustments. (Their components may be less expensive, too.) The user may be charged for return visits including minor tubing changes and adjustments. In the long run, the patient may pay as much or even more than they would from a full-service audiology practice.
The minimum training required for a dispensing audiologist has been a master's degree, which is now transitioning to a doctoral degree (Au.D.). Mail order discount centers, by contrast, are often staffed by sales people with minimal technical training. Why does it matter? Audiologists know that the most important consideration in hearing aid selection is not the hearing itself; rather, it is the skill and knowledge of the professional dispensing the hearing aid. The audiologist's responsibility is to ensure that a suitable instrument is selected and to provide an understandable explanation of its merits and limitations.
High Tech/Low Volume
Hearing aids are sold in relatively low volume when compared with other electronic devices. For example, approximately 1.7 million hearing aids are sold in the U.S. per year as compared to several million stereos; yet, the amount of time and resources manufacturer's spend on development and research is considerable. One manufacturer reports spending more than twenty million dollars developing a single model.
Return for Credit Policy
"Return for Credit" policies are standard among hearing aid manufacturers and required by state and federal hearing aid guidelines, allowing new hearing aids to be returned within an established evaluation period. The costs associated with these policies are considerable, especially for custom products, and naturally must be absorbed in the overall pricing structure.
Weighting the Costs
Communication is vital to human existence. According to a groundbreaking study published by the National Council on Aging (1999), "Untreated hearing loss has serious emotional and social consequences for older persons." The benefits hearing aid users reported in their lives ranged from improved relationships at home and sense of independence to improved social and sex life. According to the study, the families of hearing-aid users noticed improvements in every dimension the survey measured. An additional "Beyond Fifty" survey conducted by the AARP and Harris Interactive (2003) found that the ability to stay connected to family and friends contributed to quality of life more than overall health. So if wearing hearing aids allows you to resume activities you enjoy, improve relationships with friends and family, retain your independence, etc. the cost becomes a lot more justifiable.
Besides helping you to hear and understand voices better, properly adjusted hearing aids will allow you to hear sounds that previously may not have been audible. You may notice that your own voice is louder, too. Your entire auditory system will adjust to the to new sounds that have not been heard for a long time. The sound of wrinkling newspaper or water running may be annoying at first. However, after about 2-3 weeks, you will notice an adjustment to these environmental sounds. Gradually increasing the amount of time you wear the hearing aids and following the schedule provided by your audiologist will result in an easier transition to amplified sound. During the initial adjustment period, you may be asked to visit the audiologist several times so that he/she may monitor your progress and adjust the controls of your hearing aid(s), if needed. These follow-up visits are crucial to your success with amplification.
The number one cause of hearing aid failure is ear wax debris in the speaker opening of the hearing aid, the small hole in the hearing aid that goes into your ear. If your hearing aid stops working, first check this part of the hearing aid to be sure that it is free of any ear wax or other debris. Use the brush or the pick that came with your hearing aid to carefully remove the blockage. Hearing aids should be inspected and cleaned daily to prevent problems. If you have a chronic problem with wax build-up, your audiologist may offer other solutions.
Weak or Dead Battery
The second most common cause of hearing aid failure is a depleted or weak battery. Test your battery or replace it with a fresh battery
If you have cleaned the hearing aid and replaced the battery and your hearing and continues to malfunction, contact your audiologist. If you do not have an audiologist or would like to locate an audiologist in your area, use the "Audiologist Directory" tool.
A wide range of products, often refereed to as assistive listening devices (ALDs), are available to help people hear better in specific situations. For example, assistive listening devices are available to improve hearing while watching television or for group-listening situations such as movies, lectures or religious services. Specific devices are also available for individuals who have difficulty hearing the doorbell, car signal, or emergency alarms. Telephone amplifiers are available for individuals who are experiencing difficulty understanding speech while using the telephone.
Speak with your audiologist concerning other ALDs that may be beneficial for your specific situation.