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Maximizing the Use of Hearing Aids
by Gabrielle H. Saunders
If you are reading this article, you or someone close to you is coping with vision loss. You might not, however, have considered how difficult it might be if you had a hearing loss as well. In the January-February 2009 issue of DIALOGUE, David Goldstein provided an insightful personal account of coping with both hearing and visual impairment. He suggested some simple and practical actions you can take to help yourself and those with whom you are communicating. In this article, I am also going to address hearing loss and vision loss, but I am going to focus on assistive hearing technology and ways to increase the likelihood you'll have a successful visit with your audiologist.
I am a research scientist and my interests include trying to figure out answers to questions like: What makes someone decide to use or reject hearing aids? What can we do to encourage people to use hearing aids? and What features of hearing aids make them usable and appealing, as opposed to frustrating and difficult. In this article, I hope you'll learn that hearing aids, if selected and programmed appropriately, can be effective, usable and easily handled.
Small is not always good when it comes to hearing aid technology. Small hearing aids can seem attractive but when you consider hearing aids have to be inserted into and removed from the ear canal, controls need to be adjusted, the devices must be cleaned and the batteries have to be changed, small hearing aids may be impractical for some people who have dexterity and/or vision concerns.
Hearing aids come in three main styles: Completely-In-The-Canal aids fit deep into the ear and are, therefore, tiny. In-The-Canal and In-The-Ear hearing aids are both larger than completely-in-the-canal models; in-the-canal models are slightly smaller than in-the-ear models, but both fill up much of the visible part of the ear, the pinna. Behind-The-Ear aids are the largest style of hearing aid and consist of the hearing aid part which picks up and amplifies sounds, a plastic (usually transparent) earmold which anchors the hearing aid to the ear, and a narrow tube that the sound travels through which connects the hearing aid to the earmold.
Studies generally show that in-the-ear hearing aids are easiest to handle and see, but that behind-the-ear models are not much more difficult. Traditional behind-the-ear are best for people with more severe hearing losses, completely-in-the-canal models are for much milder losses, with in-the-canal/in-the-ear aids in between. Recently a new model of behind-the-ear has been developed, known as an open-fit hearing aid. It has a small rubber or plastic tip in place of an earmold. These hearing aids are generally smaller than regular behind-the-ear models and are good for people with normal or almost normal hearing in the low pitches, and mild to moderate losses in the higher pitches.
The smaller the hearing aid, the smaller the batteries, the smaller the controls and thus the harder the hearing aid is to see and handle. Behind-the-ear models are easy to clean because the part that collects earwax (the earmold) has no electronic components in it, so it can be washed with soap and water. The earwax that collects on other models of hearing aids must be carefully removed with a brush.
When choosing a style of hearing aid you should consider both how severe your hearing loss is and how easily you can see and handle small objects. Ask your audiologist to let you see and handle examples of each style of hearing aid (if they are all appropriate for your hearing loss) before you decide which to buy.
Choose a hearing aid with only the features you need. Hearing aids come with many optional features. Some of these have, without doubt, been scientifically proven to be useful, while others have not. Some features will be of value to you and your particular lifestyle, while others might not. For instance, if you mostly spend time at home with only one or two other people, then you probably don't need a hearing aid with lots of bells and whistles. On the other hand, if you attend lots of social gatherings, you might well benefit from some extra features. Below I describe four features you'll commonly come across in hearing aids.
Directional microphones are put into hearing aids to help people hear in noisy environments. They work by amplifying sounds from in front more than sounds coming from behind or the sides, on the assumption that people usually face the sounds of interest. There is little doubt that directional microphones help people hear in noise. But, some studies also suggest that directional hearing aids can make it harder to accurately identify the location of sounds. This could be a particular problem if you have a visual impairment. On the other hand, in some circumstances, the advantage of hearing better might outweigh the disadvantage of poorer sound localization. Only experience will tell. The nice thing is that most hearing aids can store two or more programs with different settings. This means your audiologist can activate the directional microphones in some programs, and not activate them in others.
On the face of it, noise reduction sounds like a wonderful feature. It implies that the hearing aid can somehow decrease unwanted noise. Unfortunately, things aren't that simple, in part because the hearing aid doesn't know what you want to hear and what you don't want to hear. Also, noise reduction works by filtering out the sounds the hearing aid calculates to be unwanted noise. If the pitches of the noise are the same as the pitches of the speech, then that part of the speech gets filtered too. So, while noise reduction doesn't tend to improve your hearing, it does make sounds coming through the hearing aids sound more pleasant, and if a pleasant sound means you are more likely to use your hearing aids, then noise reduction is not a bad thing!
Often the first thing people think of when you say hearing aid is that unwanted high-pitched whistling, known as feedback. Feedback occurs when the amplified sound leaks out of the ear and back into the microphone for more amplification. If a hearing aid isn't put into the ear quite right, or if it doesn't fit tightly enough, there will be feedback. Many hearing aids have a special circuit in them that detects and stops feedback as soon as it begins.
Hearing aids have a special setting for picking up magnetic signals such as from a telephone. The hearing aid converts the magnetic signal into sound for you to hear. Until recently people had to manually switch the hearing aid back and forth for using the telephone. Hearing aids these days can automatically switch into telephone/telecoil mode when they pick up a magnetic signal. This is helpful because in general the fewer switches you have to deal with, the better.
Hearing aids are not the only technology available for hearing loss. There are many devices that can be used in addition to, or instead of, a hearing aid. For example, you can purchase vibrating doorbells and alarms that do not rely on hearing or vision, and special (infrared) transmitters that amplify the TV for a person using the device, without amplifying it for others. A system that has repeatedly been shown to be very effective for hearing in noisy places is an FM (frequency modulation) system. A hearing impaired person wears a receiver (e.g. headphones or hearing aid); the person speaking wears a special microphone/transmitter. The microphone/transmitter picks up the speaker's voice and transmits the signal using radio waves to the receiver worn by the hearing impaired person. This system improves hearing in noisy environments because the transmitted signal doesn't get mixed with the background noise. Your audiologist should be able to tell you all about these types of devices and where to buy them.
Finally, make sure your audiologist is aware of the limitation poor sight causes. Audiologists are not generally trained in evaluation of vision, and so might not realize the difficulties you have. During your appointment, tell the audiologist what will help you communicate better. For example, ask for everything to be written down and, if possible, to be printed out in a large font on non-glossy paper. This way you can go home and read the information in a non-stressful environment. Try repeating back what you heard, and have the audiologist confirm or correct it. Make sure you have the time to feel where the switches are located on the hearing aid, and how the battery feels when it is put in correctly.
I hope this brief introduction to hearing aid technology is helpful. Perhaps one day we will have hearing aids that communicate with eyeglasses so that the sound signal can supplement the vision signal and vice versa. Until then, communication and knowledge are the keys.
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