Listen Up! A Consumer's Guide to a Successful Hearing Aid Experience

Editor's Note: This paper was the winning paper for the 2nd Annual Rayovac and Audiology Online writing contest. Although this paper is written for consumers, you are welcome to download and print it as desired, and you may distribute it to your patients for educational purposes. This paper will be featured on our consumer website (www.healthyhearing.com) on June 9th. Congratulations to Ms. Prout from all of us at Rayovac and Audiology Online! ---Editor

There are an estimated 28 million Americans with hearing loss. Many of these individuals do not investigate or obtain hearing aids. What is it that makes the idea of hearing aids so daunting? Why do so many people with hearing loss choose not to use hearing aids?

It's no secret that psychosocial issues do play a major role in a person's decision to purchase or not purchase hearing aids. Are psychosocial issues so over-bearing that they take precedence over a person's desire to communicate with greater ease?

Many people with hearing impairment tell their audiologists, ''Only old people wear hearing aids,'' or ''My hearing is not bad enough to warrant hearing aids.'' However, almost 25 percent of all people aged 65 to 74 years of age, and almost a third of people aged 75 years or older have significant hearing loss. Yet, hearing loss affects people of all ages. Many young people have hearing loss too. Some are born with it and others acquire hearing loss due to ear disease, noise induced hearing loss, head trauma, ototoxic medications, and many other causes too.

Some audiologists refer to the people in their office as ''patients,'' others use the term ''clients.'' However, when the time comes to invest in hearing aids - the patient/client takes on an additional role - ''consumer.'' As consumers, people look to hearing healthcare professionals to provide them with a service and a product that will best fit their needs, while giving them the ''biggest bang for their buck''. Consumers need to feel comfortable and confident in their decision to pursue and choose appropriate amplification.

For many people, hearing aids appear foreign and too complicated.

By simply knowing what to expect through appropriate education and counseling, the consumer can gain confidence and enjoy the experiences involved, rather than feeling anxious or unnecessarily frustrated. Patients should be aware that obtaining hearing aids involves an investment in time, and that it is a multi-step process.

First and foremost, a comprehensive audiometric evaluation should be performed by a hearing healthcare professional. Audiologists are licensed professionals with a master's degree or a doctorate (some have both) in audiology or hearing sciences, and they are the professionals who typically perform comprehensive audiometric evaluations. Audiologists will also interpret the results, diagnose the type and degree of hearing loss (ASHA, 1996) counsel patients, and refer appropriate patients to physicians for medical treatment. Most audiologists fit, dispense, and sell hearing aids. Hearing instrument specialists are also licensed to test hearing for the purposes of fitting hearing instruments. Audiologists and hearing instrument specialists are both licensed by the states in which they practice and their responsibilities may vary state-by-state.

All hearing healthcare professionals take a case history during the initial hearing evaluation. Each patient is different! Each patient has their own unique history, presentation, hearing loss, and their own needs and desires. An important issue to consider is that even if your hearing loss is similar to someone else's - you actually hear with your BRAIN! The brain is where the tiny electrical impulses are changed into meaningful sound - and of course, every brain is different! Although two people may have identical audiograms (hearing tests) they may possess very different degrees of difficulty in understanding speech! Again, although the ears gather and transfer the energy of sound, our brains make sense of these sounds!

Interestingly, the way in which hearing loss affects speech understanding is often a good indicator of how well the patient may do with hearing aids. Differences in speech understanding ability leads to different levels of benefit from hearing aids. With hearing aids, some people will likely experience improved sound awareness, but may still have difficulty understanding speech, while others will see significant gains in speech understanding. The result of wearing hearing aids varies tremendously, based on the type and degree of hearing loss, the brain, the acoustic environment, the abilities and desires of the patient, and of course - the hearing aids themselves!


Since each individual is unique with regard to their hearing loss, many hearing professionals use a rehabilitative model of service, rather than a medical model (Erdman et al., 1994). Hearing professionals are concerned with treating the ''patient'' by developing rapport and involving them (the patient) as a participant in the process. In other words, hearing professionals tend to work with the patient and their situation, and do not simply ''treat'' the hearing loss.

During the initial meeting, patients are encouraged to discuss their personal difficulties and their perceptions related to their hearing loss with the professional. After their opinions, desires and thoughts have been discussed, the hearing test is obtained and test results are reviewed with the patient, typically within the context of a rehabilitative model.

Although we do our best to explain things, patients should feel free to ask for clarification as needed.

If we measure hearing aid ''success'' by the degree of improvement between ''unaided'' and ''aided'' results, we will find success is not only obtainable, but is almost a certainty. It is reasonable to expect improved hearing while using hearing aids. However, it is not reasonable to expect ''normal'' hearing! This is an important concept.... hearing aids make sounds louder, and by making particular sounds loud enough to hear, the brain can make better sense of the sounds. Audibility is the first step in solving the problem, since the brain cannot make sense of sounds that it doesn't hear!

Simply pumping up the volume does not translate into perfect hearing. Therefore, what works well for one person may not work well for another. If two people have identical hearing loss, the chance they will both be fit with the same hearing aids, programmed the same way, and receive the same benefit - is very, very small.

In addition to the tremendous variation in types and degree of hearing loss, individuals have different needs with regards to amplification systems due to different social, home, and work issues. They may have different desires regarding the physical appearance of their hearing aids and of course, financial constraints may impact their choices too.

To some extent, buying hearing aids is like car shopping. In other ways, the comparison leaves much to be desired!

Just as all cars get you from point A to point B, all hearing aids amplify sound. The decision between different technologies is analogous to choosing between different cars, such as Yugo versus Mercedes. Big difference!

When automotive terms and ''buzzwords'' are not understood, consumers sometimes find it embarrassing to ask questions. The same is true of hearing aids. There are many terms; ''directional microphones,'' ''compression,'' ''noise reduction,'' ''digital circuits,'' and ''multiple channels,'' which can be overwhelming. For this reason, I recommend patients bring a spouse or a loved one to the appointment. An extra set of ears (no pun intended) is helpful when trying to gather information and understand it all.

Cars are quite expensive, often requiring a loan to purchase them. Digital technology has caused the price of hearing aids to rise as well, but thankfully not as high as car prices! Nonetheless, amplification can put a bigger dent in a person's pocket than expected. For those of you who feel the price tag is extremely high, you may want to think in terms of amortizing the price of hearing aids over the ''life'' of the investment. In other words, if a pair of hearing aids cost $4800, and they're expected to last 6 years, the cost per unit is 33 dollars per month. You may be interested to know the price of digital hearing aids has recently dropped - due to the popularity of these hearing aids. More manufacturers produce digital hearing aids than ever before and just like any other product, as the supply increases, the price drops! One final note on finances, hearing aids can usually be leased. You may want to speak with your hearing professional about this option.

In addition to the cost of hearing aids, patients often ask about battery cost. I recommend you purchase high quality, long lasting batteries to get the most battery for your dollar. Battery and hearing aid manufacturers have worked together to increase the life of high quality zinc air batteries, which means less money spent. In addition, it's worth considering that when you buy a high quality hearing aid, you need a high quality battery to power it for the best possible performance. Same with cars. If you have a fantastic new sports car, you probably should not use an off brand, low priced gasoline!

People may go shopping for a car wanting something sporty and fun. However, sometimes reality rears its ugly head, and something larger and more reliable is purchased, like a mini-van!

The same analogy can be made for hearing aids. A person with profound hearing loss may desire nearly invisible completely-in-the-canal (CIC) hearing aids, but sometimes a larger style would be more appropriate.

As I said earlier, all hearing aids do indeed amplify sound, but not all hearing aids are created equal!

Re-visiting the car analogy, sometimes just ''getting from point A to point B'' is not enough. Dr. Purdy (2001) best stated this idea when she simply wrote; ''I cannot win the Daytona 500 in a Yugo.''

If you seek the best, you will likely be surprised at how good hearing aids can be, and you will probably be very pleased. Yes, they are expensive, but you may be surprised at what they have to offer. For example:

Many digital (computerized) hearing aids have directional ability, meaning they can ''focus'' on sounds in front of you, or the location of the most prominent sounds. They also have noise reduction ability, to reduce, although not eliminate, background noise. Digital hearing aids can be reprogrammed with sophisticated software packages, meaning the sound can be changed if your preferences or hearing loss changes, and most digital hearing aids have multiple programs for different listening situations. For example, one program might be desirable for a quiet library-like environment, while a very different program might be desirable for a wedding reception. Some digital hearing aids have additional features too, such as ''direct audio input'' allowing the patient to ''plug into'' the TV, the radio or the telephone. Some digital hearing aids have ''FM'' options, which create a mini radio station between the microphone and the receiver, and they have amazing quality and clarity of sound.

Telecoils, often referred to as ''T-coils,'' are an important option on most in-the-ear (ITE) and behind-the-ear (BTE) hearing aids. The telecoil allows the hearing aid to be used with most assistive listening devices and of course, the telephone! To activate the T-coil, one simply flips a switch on the hearing aid(s). The T-coil essentially ''turns off'' the hearing aid microphone to all sounds, except for the information being transmitted electromagnetically, thereby eliminating background noises and providing an easier listening situation and avoiding feedback (also known as whistling). Unfortunately, T-coils can pick up electromagnetic interference from other electrical equipment including computer monitors and digital cellular phones.

Patients with memory difficulties may want to avoid T-coils because they might have difficulty remembering to switch the T-coil on and off. If the hearing aid is accidentally left in the T-coil setting for situations other than talking on the phone or using FM systems, the listener will not receive regular hearing aid amplification!

If the benefits of T-coils sound exciting to you, but you are not thrilled about the possible problems associated with electronic interference, all is not lost! Some hearing aids have a feature called ''Direct Audio Input'' (DAI). DAI sound quality is said to be superior to that typically heard through T-coils, but it requires an electronic boot (this is an accessory to the hearing aid) and usually a wire to connect it. Patients who are around computers or other electrical machinery may greatly benefit from DAI, as it is not susceptible to the electromagnetic interference that T-coils are susceptible to. Usually, a behind-the-ear (BTE) style hearing aid is required for DAI capability.

Remember my comparison to buying a car? I have one final car analogy... Many people buying new automobiles are interested in a test drive. It makes good sense. The good news about hearing aids is that most professionals offer a ''test drive' for new hearing aids, usually about 30 days. These ''trial periods'' are not mandated nation-wide and different rules apply in different states. Please note, the trial period does not constitute the time period in which a person fully adjusts to new hearing aids! Often, it takes several months to achieve maximal performance with new hearing aids.

The relationship between you and the professional does not stop when you acquire hearing aids. There are follow-up visits and future services that will be necessary. All of these factors need to be assessed when evaluating hearing aid costs versus benefits.

The consumer should be aware the hearing aid price usually includes in-the-office service (cleaning and adjusting) and the time of the professional, during the warranty period of the hearing aid. Check with your hearing professional to see exactly what the warranty covers, and to find out if it's a one year, two year or longer warranty.

It has been said that the high price placed on some top end hearing aids often allows a very important benefit - more time spent with the audiologist (Ross and Beck, 2001). Of course, this too varies, and the consumer should feel free to ask the professional which services are included and which are not.

As mentioned earlier, it is important for the consumer to know that hearing aids DO NOT restore normal hearing and things will not suddenly be crystal clear. Better hearing takes time. Adjusting the hearing aids and adjusting to the hearing aids takes time.

Often, your hearing professional will recommend group or individual hearing aid orientation sessions, sometimes called ''Aural Rehabilitation'' classes. I highly recommend these classes. They offer further instruction on hearing aid use as well as strategies for listening in noisy environments. These groups not only give you more time with your hearing professional, but they can bring you together with other new hearing aid users, with whom you can share your concerns as well as your successes. Professionals are aware of the benefits of these courses and sometimes they offer incentives for attending, such as some free hearing aid batteries.

You may be asking yourself if hearing aids are the only answer to hearing loss. The answer is NO! For some people with hearing loss, there may be a medical or surgical alternative, which is why it is always recommended that each patient see their physician before acquiring hearing aids. There are also alternatives to hearing aids that work well for certain clients in certain situations. Some devices cater to specific listening situations, such as watching television, talking on the telephone, and watching a play or movie. These devices are collectively called ''assistive listening devices'' (ALDs). ALDs are not only stand-alone devices, but some can be used in conjunction with hearing aids to offer maximal benefit in less than optimal listening conditions.

There are many different amplification devices for you to consider and evaluate - but the only way to find out what may work best for you and your needs is to make an appointment with a hearing healthcare professional.

CONCLUSION:

The more educated the consumer, the greater the likelihood of a successful hearing aid experience.

Hopefully this article has given you a sense of comfort or a better understanding of what services and devices are available.

Knowledge is power. Consumers should be aware of the products and services hearing health care professionals have to offer. By staying informed, consumers and professionals can work together to establish reasonable expectations in order to achieve the common goal of enhanced communication through better hearing.

REFERENCES:

ASHA - American Speech-Language-Hearing Association, Scope of Practice Statement. 1996
https://professional.asha.org/resources/deskref/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=11887

Erdman, S.A., Wark, D.J., & Montano, J.J. (1994). Implications of service delivery models in audiology. JARA, 27, 45-60.

Kochkin, S. (1999). MarkeTrakV: ''Baby boomers'' spur growth in potential market, but penetration rate declines. The Hearing Journal, 52(1), 33-48.

Purdy, J.K. (2001). Roles in successful hearing aid fitting: consumers, audiologists, and manufacturers. Audiology Online, April, 2001.

Ross, M., & Beck, D.L. (2001). Expensive hearing aids: investing in technology and the audiologist's time. Audiology Online, March 2001.

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