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Dr. Ross on Hearing Loss

Helpful Hints to the New Hearing Aid User

by Mark Ross, Ph.D.
This article first appeared in the
Hearing Rehab Quarterly (1994)

If you are an adult and have just received your first hearing aid, the chances are that its need has been apparent to most everyone, except perhaps yourself, for years. The average adult receives his or her first hearing aid some five to seven years after the problems caused by a hearing loss are first noticeable. Up to that point, because the usual onset of an adult hearing loss is so gradual, you may not have been aware of having hearing problems, or else blamed your conversational partners for any difficulty you were having ("If people would only get the mud out of their mouths and stop mumbling, maybe I wouldn't have so much trouble hearing them"). You have finally come to the realization--perhaps through a nagging spouse or children, an irritated boss or co-worker, or, hopefully, on your own--that the problem resides not in other people's mouths but in your ears.

Now you've done something about it. You've succumbed to all the internal and external pressure and agreed to try a hearing aid. It is important to say at the outset of this paper that you have not thereby solved all your hearing problems. Do not expect to suddenly hear normally and experience no difficulty in understanding speech. Do expect a reduction in the degree of hearing difficulty that you have been having, more so in some situations that in others.

Most hearing aids are not very "smart" in that they do not do a very good job of discriminating between desirable and undesirable sounds, between, in other words, the sounds you want to hear (speech) and those you want to ignore (background noise). For normal-hearing individuals in all but the most difficult of acoustical situations, this is a task made easy and effortlessly by their two good ears. While this situation is slowly changing with the development of more sophisticated electronics (and as hearing aid engineers get "smarter"!), no hearing aid yet developed can completely compensate for a hearing loss. However, and it is important to emphasize this point, the overwhelming majority of hearing-impaired adults can function better and are much better off with a hearing aid than without one. Because an aid cannot eliminate all f your hearing problems is no reason to reject the assistance that it can offer.

The amount of help you can get with a hearing aid depends on many factors. These include the kind of hearing loss you have, how well the hearing aids have been adjusted to your particular hearing loss, the kinds of communication situations you find yourself in, and your willingness to work through, in cooperation with your audiologist, any problems that may come up. I will have more to say about these factors later on.

Up to this point, I have referred to a hearing aid in the singular and not the plural. Most hearing-impaired people would be better off with two hearing aids, one for each ear, than just one. If a binaural fitting has been recommended to you, this does not mean that your hearing loss is twice as bad as if only one hearing aid (a monaural fitting) was recommended. What it does mean is you have the kind of hearing loss in which it would be advantageous to stimulate both ears with sound. Most older people who need a hearing aid also need eyeglasses: when was the last time somebody recommended a monocle for you to wear? It does not make much sense to respond to a binaural recommendation by saying "I can get along all right with just one aid." You can probably get along with just one eye too, but why bother when you can see out of both? It's the same with two hearing aids: if you can hear better with two, why limit yourself to just one? It is true that there are times, for audiological, physical, or financial reasons, when just one hearing aid is going to be used. Whether you wear one or two hearing aids, however, the assistance you receive is going to depend in large part upon your understanding of what a hearing aid can and what it cannot do for you. If you expect too much, you're going to be disappointed. If you expect too little, you may be limiting yourself unnecessarily. The comments I've outlined below are designed to assist you to get the most possible benefit out of your hearing aid.

Helpful Hints

First, and most important, do not get discouraged. It may take some time to realize the potential benefit of a hearing aid. Remember, you have heard abnormally for a number of years; but for you, what you have been hearing is "normal." Now you are suddenly being exposed not only to louder sounds, but to a different pattern of sounds. Your ears (and your brain) are going to have to be re-educated to accept these different sound patterns as "normal." What you are now perceiving with a hearing aid can be likened to a slightly different dialect of your native language. Just as it takes some time to get used to someone's speech who comes from a different section of the country, it will take some time for you to adjust to the amplified speech "dialect" coming through the hearing aid.

  1. When you first put the aid on, you are suddenly going to hear many sounds you were previously unaware of. Many of them will jog familiar memories. For others you are going to have to consciously determine the source of the sound, either by asking someone or seeking it out yourself. For example, while you probably will immediately recognize the sound of footsteps in a hallway, even after not being aware of them for years, you may not know what is causing that clicking noise in your car (check the turn indicator).
  2. All at once, you are going to be exposed to a world of sound you forgot existed, such as the thumping of the compressor on the refrigerator, the whine of an electric can opener, the blare of the street noises in a city, the tumult in your favorite restaurant, and the screeching coming from your grandchildren's stereo (it's called music). It's true that it is a noisy world we live in, and it seems to be getting noisier all the time, but it is the world we live in, and it's the one you're going to connect to better when you hear more of it.
  3. At first wear the hearing aid for as many hours during the day as you feel comfortable (but see item 4).
  4. Eventually, you will want to get to the point where you put it on in the morning and then forget about it until you go to bed (but please take it off before you take a shower!). There are exceptions to full-time use, and you should check these out with your audiologist. For some people, mainly those with mild losses, the aid may be extremely helpful in some situations, as in a business meeting or while working as a cashier or a bank teller, but not really helpful in other situations, such as in a noisy restaurant or party. In such instances, it's all right to take it off and not feel guilty. The hearing aid is designed to assist you, and you have to be the judge when it is doing the job. But you won't know this for sure until you do give it a good try in all situations where you are having hearing difficulty.
  5. If you feel a little overwhelmed by the new sound experience, you may want to first use it in certain restricted situations, such as while talking to your family or friends or while watching TV. (Incidentally, you may now find everybody in your family very happy about the reduced sound level to which you can now turn the TV. ) News broadcasts and commercials are great for practice. At home, have someone talk in a normal loudness and turn the volume control of the hearing aid until her or her speech is comfortably loud. (It may be difficult at first for people to reduce the loudness of speech they have been using with you.) This will be your basic volume control adjustment. After you have used the aid at home for a while, then it is time to try it in other places. While you don't want to rush into different hearing situations until you feel comfortable with the hearing aid, you don't want to hesitate either in attempting to expand your hearing horizons.
  6. In certain situations, such as in a movie or in a meeting when the speaker is talking in a soft voice, it is all right to turn the volume control up. In very noisy places, on the other hand, you may want to turn the volume down (some hearing aids will do this automatically for you). While you don't want to continually fiddle with the volume control, still if a volume control adjustment can help you, by all means do it. It's your hearing aid and your ears, and you're the boss.
  7. A major reason why people discard their hearing aids is the fact that some intense sounds produce an uncomfortably loud hearing sensation. In protecting oneself from these intense sounds, the tendency is to reduce the volume control. Often when one does this, the resulting sounds are not loud enough. So the person is continually turning the volume control up and down and either hearing sounds too loudly or too softly, until finally he or she gives up in disgust and places the aid in the dresser drawer. (At last count, there may be more hearing aids in drawers than on ears!) Don't give up. There is an easy way to take care of this problem.
  8. Everyone who receives a new hearing aid should be, and usually is, scheduled for a follow-up appointment with the examining audiologist or the hearing aid dispenser. Tell this person about your experience with loud sounds. He or she will make a relatively simple adjustment in the hearing aid which will protect you from overly loud auditory sensations, but which will not affect your ability to hear faint speech. As a matter of fact, much as we would like it to be, fitting hearing aids is not yet an exact science. Everyone is different, and everyone responds to their first hearing aid just a little differently. You want to make sure to keep all of your follow-up appointments, whether you think you need them or not, and relate to the audiologist any problems or unusual experiences you may have had with the hearing aid. Actually, audiologists cannot do their job effectively unless they have several opportunities to meet with you after the hearing aid fitting.
  9. When you first put the hearing aid on, your own voice may sound strange to you. Remember you are not only hearing other people through your hearing aid, but you are also hearing yourself. If your voice has a hollow, booming quality, like you were talking from the bottom of a barrel, don't worry. This will mainly apply to those people whose ear canal is completely filled by an earmold. This can easily be corrected by a small vent hole inserted through the earmold. This vent may also help relieve a feeling of pressure which sometimes occurs after an earmold is placed in the ear.
  10. After three or four weeks, the sound you are receiving through the hearing aid should be sounding "natural," even though all speech signals are still not understood. Remember, though, that while "hearing" is occurring whether you pay attention or not, "listening" takes effort. It is not just the ears, which are involved in active listening, but the mind as well. Work at it, and it will get easier over time.
  11. As you get used to the sound quality of the hearing aid, you may find yourself ready to tolerate a slightly different pattern of amplification. Many hearing-impaired people at first prefer "natural"-sounding louder sounds to those which appear to be sharper, crisper, or "tinny." This is understandable, but it is these qualities which may also make many of the consonants of speech easier to understand. After you get used to the sound quality you are currently experiencing, ask the audiologist if it is possible for him or her to slightly increase the high-frequency response of the hearing aid. It is desirable to keep doing this until both you and the audiologist agree that your hearing aid is optimally adjusted for understanding speech.
  12. Above all, keep in mind that a hearing loss is not a personal disgrace or that wearing a hearing aid a personal stigma. Many people in our society seem to go to absurd lengths in denying, evading, or attempting to ignore the presence of a hearing loss. But it doesn't go away if the hearing-impaired person attempts to ignore its presence. The most important feature of a hearing aid is its ability to lessen the impact of the hearing loss, and not if it is tiny enough to fit all the way into your ear canal. In other words, the significant question is how well the hearing aid works, and not how well it can be disguised. Don't worry about people seeing your hearing aid--if you accept its presence so will they--but do worry about using and benefiting from it to the fullest extent possible.
  13. Finally, and to emphasize several points made a number of times earlier, give yourself time to adjust to the aid and be sure to take advantages of the informed services of your audiologist and hearing aid dispenser if there ever are any problems. They really do want to help.

Acknowledgments

The preparation of this paper was supported in part by Grant #H133E30015 from the National Institute on Disability and Rehabilitation Research and the Office of Education to the Lexington Center.

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