Should I Get a Hearing Aid?
(3/16/11)- Updated by the editors:
In a recent study that was performed on the hearing ability of 715 elderly people, nearly 63% of those 70 and older were found to be suffering from hearing impairment that affects their ability to hear human speech as defined by the World Health Organization.
The study was part of the National Health and Nutritional Examination Survey in 2005-6. The results of the study were published in a recent edition of The Journal o f Gerontology: Medical Sciences.
Hearing loss was more common in men than women, and was significantly less common in black adults. Dr. Franklin R. Lin, an assistant professor of otoloty at Johns Hopkins University School of Medicine was the lead author of the study.According to Dr. Lin only a minority of older people with these hearing impairments use hearing aids.
Mark Ross, Ph.D.
(11/7/99)- 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
yougot 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.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
Mark Ross, Ph.D.
November 7, 1999
updated March 16/ 2011
http://www.therubins.com
Acknowledgments
This article was supported, in part, by Grant #RH133E30015 from
the
U.S. Department of Education, National Institute on Disability
Rehabilitation Research, to the Lexington Center, Jackson
Heights, NY
To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com