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Dr. Ross on Hearing Loss

Should I Get a Hearing Aid?

by Mark Ross, Ph.D.
1999

If you've been asking yourself this question, then the answer is probably "yes". You wouldn't be asking it if you were not having some hearing difficulty and if you did not already suspect that this was going to be the answer. And if you're typical of the many people who ask this question of themselves, your family and friends have been giving you this unsolicited answer for some time now. Of course, you don't like the prospect of wearing hearing aids, nobody does. But think of the reasons you've reached this point, the experiences you've had (or did not have), and the impact hearing difficulties have been having on your life. Remember too, while you may be the one with the hearing loss, your family, friends, all of your associates have a hearing problem - and that's you. Consider communication as a two-way street: if your half is impaired or uncertain, it will also affect everyone else you talk to.

Typically, you've been going through a long period of gradually increasing hearing difficulty, perhaps beginning with the observation "that people don't talk as clearly and loudly as they used to". Since you may be having little trouble understanding speech in some situations and with some people, but do in other situations and with other people, it's hard to accept the notion that the cause lies primarily in your ears and not in their mouths. Maybe some people do talk like they have "mud in their mouths", but your spouse, adult children, friends, etc. don't seem to be having any trouble "wading" through it.

What's been happening is that your tolerance to withstand any form of distortion in the speech signal has been reduced. Understanding someone in the presence of noise is probably the worst condition, but you may also be noticing additional difficulty in trying to comprehend people talking too rapidly, speaking English with an unfamiliar foreign accent, or even understanding your own grandchildren (a particularly poignant example). Ordinarily, in an normal conversation, there's lots of redundancy in the conversational exchange, a lot of extra acoustic and linguistic cues you can call upon to comprehend the meaning of an utterance. A hearing loss, even a mild- to-moderate hearing loss concentrated at the higher frequencies, eliminates some of the acoustic cues normally contained in a speech signal. With little redundancy to fall back upon, you are holding on to comprehension by your fingertips; any additional distortion that masks even a few remaining speech cues can push you right off the edge. And since in real life, these additional distortions occur erratically and unpredictably, so may your understanding of speech vary in an apparently inconsistent fashion. As a result, sometimes you do fine, other times you have to strain but do get the message, and sometimes you're completely lost. It can be quite disheartening and quite confusing.

To be fair to yourself, it's likely that it's because the onset of a hearing has been so gradual, with such variable and unpredictable effects, that you've delayed as long as you have in considering the assistance of hearing aids. You yourself may not have realized just how much trouble you were having, until repeated instances of misunderstandings, feelings of anxiety in social situations, or increased personal isolation brought the issue clearly to the surface (not to mention the repeated nagging of your friends and family). If you're reading this, then you've taken the first step in doing something about your problems, and that is the simple acknowledgment that you may, and probably do, have a hearing loss. Don't underestimate this step. We know that almost eighty percent of the people with significant hearing losses in our society do not take it, and consequently lead lives so much more constricted and unsatisfying than they might be. Indeed, denial of a hearing loss, an unwillingness to accept its reality (for whatever reason, and they are legion) is the single biggest obstacle preventing professionals from bringing the blessings of better hearing to literally millions of people.

When you acknowledge the reality of a hearing loss, you're not confessing to a shameful condition, some sort of social disease that you are being pressured to reveal to the world. No one will think the less of you if you accept the need for a hearing aid, as long as you take the lead in accepting it and accepting yourself. You have no reason to be embarrassed of the fact that some sensory cells in the auditory system have been damaged or obliterated by one of a myriad of possible conditions. It can happen to anyone (including presidents and perhaps 26 million other people in our society). Sure, you'd rather not have a hearing loss, and certainly you should take steps to prevent further damage (consult with your audiologist), but think positively - you can minimize its impact upon your life.

Before you actually go out and purchase hearing aids, it is always a good idea to first determine whether your hearing condition can be improved through medical or surgical intervention. My suggestion would be to see an ear doctor (an otologist) who is the professional most qualified to care for hearing problems that may be amenable to treatment. But, and with apologies to my physician colleagues, this person would not be the most qualified to judge whether or not you are a hearing aid candidate. That decision can best be made by an audiologist, a non-medical specialist broadly trained to deal with the communication implications of a hearing loss, and this includes the recommendation and fitting of hearing aids. Actually, finding and working with a trusted audiologist is undoubtedly the most important step you can take to ensure that appropriate hearing aids are being selected and that you are being helped to make the most of them.

This is a point that bears emphasis. Not a week goes by that I don't inquiries from, or read about, people asking about the "best" hearing aid. Some potential hearing aid users do an awesome amount of research into the types and features of available hearing aids. Maybe they know someone who loves his newly purchased hearing aid, someone else who swears by a different aid, and then a third person who hates all the hearing aids she has ever worn. It's easy for potential users (or anybody) to get confused as they read the commercial literature, and the various claims and testimonials made about different hearing aids. Every hearing aid seems to be touted as the "best" and the answer to a consumer's prayers.

For example, I don't envy any potential hearing aid user trying to make sense of the presumed advantages of various digital hearing aids, analog programmable aids, those that fit completely in the ear canal, the new generation of behind the ear FM hearing aids, those with and without FM "boots", or trying to determine the personal relevance of such electro-acoustic features as "multi- band", "multi-memory", multi-microphones", "k-amp", "wide dynamic range compression", "directional microphones", etc. and etc. And I do mean "etc. and etc.!" Professional audiologists have a dickens of a time keeping up with the flood of new developments, and that's their profession and their job. While I'm not advising that people abdicate personal responsibility in selecting hearing aids, I do think that finding and working with a compassionate and competent audiologist is ultimately the best way to ensure that you are getting the most hearing help.

At an absolute minimum, be certain that the audiologist you are seeing is professionally certified and licensed by the state to practice Audiology. You can get this information through two professional organizations: the American Academy of Audiology, and the American Speech- Language-Hearing Association. Then get personal recommendations from friends and families, from other professionals, from the administrators at senior citizen centers, or from local chapters of Self Help for Hard of Hearing People (a national consumer organization). Once you see this person, the rest is up to you; the chemistry has to be right and you have to feel comfortable. Don't hesitate to ask questions about any aspect of the hearing aid selection process; you do have to understand the significance of the various steps that take place.

During your first visit to the audiologist, he/she will interview you and then administer a comprehensive battery of audiological and other tests. This is a prerequisite step for establishing hearing aid candidacy and to help determine what kind of features would likely be helpful. You will then have ear impressions made and be scheduled for follow-up appointments. Unless there are cogent personal or audiological reasons, I strongly advise that you acquire a hearing aid for each ear. This does not mean that your hearing loss is twice as bad as you expected, only that people normally hear better with two ears than one (and I often wonder why people are so surprised by this obvious fact). It's at the conclusion of the testing stage, that the audiologist will discuss your hearing aid options with you.

It is the responsibility of the audiologist to explain, in understandable language, the various hearing aid options thought desirable for you. It is your responsibility to question these explanations, if you need more information, and not passively accept any recommendation. The hearing aid selection process should be viewed as a partnership arrangement, with the necessity for some "give" on both sides. While you may have to temper unrealistic expectations with a heavy dose of reality, you do have a right to expect that you are receiving the best that technology has to offer you at this time. If compromises are necessary, for financial or other reasons, then you should know and be informed of the options. Essentially what you are trying to do is balance your expectations of hearing aid benefit with the inherent limitations imposed by your hearing loss; it's not easy, and lots of trial and error may be involved. Trust, having confidence in your audiologist, is the key ingredient in this balancing process.

At a minimum, your new hearing aids must provide you with significant hearing assistance, in at least some communicative situations very important to you, or else they do you no good. Reaching this point may require frequent hearing aid "tune ups" by the audiologist - this is very common - or occasional remakes when a specific model is found not to be appropriate. Your responsibilities include returning for scheduled follow-ups and attending to the inevitable admonition by the audiologist to "call if there are any problems." They really do mean it (and if you feel that one doesn't, then this is where you should find yourself another audiologist). And, yes, do have the audiologist repeat the explanations of the specific electro-acoustic features that he/she selected to include in your hearing aids - and why. You'll get no answers by remaining passive.

During the hearing aid fitting and verification stage, I'd like to see audiologists do "real-ear" tests. This is where they insert a very narrow tube in the ear canal alongside the hearing aid, and measure the actual sound pressure in the ear canal produced by the hearing aid. This can help determine whether the pattern of amplification produced by the hearing aid is appropriate for your type of hearing loss. I also think it necessary for them to administer, both before and after you receive your hearing aids, one of a number of standardized scales on which you rate the impact the hearing loss has had upon your life.

In an ideal situation, one that I hope will eventually be routine, your audiologist should also offer you (and a significant other) an opportunity to participate in a group hearing aid orientation program at no extra cost to you. During the weekly sessions, extending about four weeks, the audiologist presents information about hearing loss, hearing aids, and other assistive devices, while you get to share experiences with others in a similar situation and generally learn how to be a more effective communicator.

It often take time to realize the full benefits of hearing aid amplification. Remember, that you've haven't heard well in years; you've learned to adapt (not necessarily happily but inevitably) to imperfect hearing. The sound sensations you had been experiencing were "normal" for you. Now you have to relearn what "normal" is - only this experience of normal should help you function more "normally". You have at least a 30 day money-back guarantee (minus, perhaps, the cost of earmolds and a small fee), and you should give the hearing aids an intensive and careful trial during this period. There are many different procedures you can follow, and you can work out the specific ones with your audiologist. One common theme will be found in all the suggested procedures: you do have the wear the hearing aids a significant number of hours each day in different types of situations if you are to judge whether or not the cost is worth the benefit. Don't only ask yourself, however, check with the people who routinely talk to you. For example, you may notice little difference in how you can understand your wife (husband), but that was because before you got the aids, she/he spoke very loudly to you. Now she/he is speaking at a normal conversational level. Not only is this better for your spouse's vocal folds, but not having to act as your "hearing aid" may reduce much of the stress in the household. Nobody has to go around shouting at one another all the time!

Remember also, hearing aids are only part of the "hearing solution". In recent years, we have seen a proliferation of other kinds of hearing assistive devices, all of which are designed to compensate somewhat for a hearing loss. You can also improve your communication skills (and really this is what we've been talking about) through non-technical solutions, by employing various types of "hearing tactics". Watch this space for future essays on these topics.

Acknowledgments

This article was supported, in part, by Grant #RH133E30015 from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research.

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