Hearing Devices: Your expectations and their limitations

It is important to have realistic expectations of hearing devices and to remember that they are aids to hearing. They cannot restore normal hearing, nor can they correct for certain limitations in understanding that are related to ear damage, brain functioning, and poor listening habits. They are electronic devices that amplify, but they are not new ears. Their purpose is to minimize listening fatigue and to improve ease of communication.

There will be some circumstances in which hearing devices do not provide all the benefits that the wearer would like. The most common complaint is that they cannot hear as well as they would like to when background noise is present. While there is technology available to help improve communication and comfort in that situation, no hearing device effectively eliminates all background noise. And indeed, if all background noises were to be removed, some important speech sounds would disappear, too. 

Your own voice will sound different when wearing hearing devices because when you speak, you produce low frequency vibrations in your ear canals. When not wearing a device, your ear canals are open, allowing these vibrations to escape from your ear canals. However, with a hearing device, your ears are at least partially block, trapping these low frequency sounds in your ear canals, changing the way your voice sounds to yourself. This is called "occlusion" and can be minimized by keeping the ear as open as possible (via vents/holes drilled in the earmold or shell), reducing low frequency amplification, and wearing a deeper fitting earmold or shell (which reduces the amount of vibration).

Hearing device users commonly experience external feedback produced by the leakage of amplified sound out of the ear canal and back into the microphone of the hearing aid.  Re-positioning or re-making the ear mold or shell, reducing the vent size (by plugging the hole), or reducing the amount of high frequency amplification (which is not ideal due to the resulting loss in high frequency consonant audibility), can correct this problem. Size of the hearing aid has a large impact on susceptibility to feedback. With smaller hearing aids, the microphone is seated right in the ear, meaning the amplified sound leaking out does not have to travel very far before causing feedback. With behind-the-ear hearing aids, however, amplified sound leaking out must travel farther (to the microphone behind the ear) in order to cause feedback.

Even when wearing hearing devices, it will still be difficult to hear others from a distance. Loudness/intensity decreases as physical distance increases. Unfortunately, most background noise surrounds you and so will not lessen in intensity, while the speech intensity will decrease with distance.  This is why the hearing aid works well when someone is speaking directly in front of you, but at longer distances, reception decreases. 

The benefit derived from amplification may be subtle.  Particularly if only high frequency loss has occurred, then the hearing aids will be primarily amplifying higher frequency sounds (such as /s/, /sh/, /t/, /th/, /f/, and /k/).  A period of initial adjustment and a learning process is required for most new hearing device users.  It may take several weeks or even months before you adjust to the new pattern of sound and learn new "recognition" cues that you probably have not heard for a long time. As a new hearing device user, you need to be gradually oriented back to the world of hearing. This may require a gradual wearing schedule (for example, a few hours the first day, six hours the second, nine hours the third, etc.), or you may be encouraged to wear the hearing aids immediately during all your waking hours. You may also need additional training and counseling related to your hearing loss, your devices, and coping strategies.

Successfully adapting to hearing devices takes time and patience. Honing your ability to understand amplified speech could take three months or longer following your initial fitting. While we will teach you everything you need to know about inserting and removing your hearing devices, checking their batteries, cleaning and maintaining them, and using them with the telephone, it is important to read the instruction manual that comes with your hearing aids.  All the information provided at the initial appointment can be quite daunting, and having the instruction manual to refer to helps make the transition to using the hearing devices easier.  It is important to keep a note of questions or problems that arise so that we can address them at a follow-up appointment. 

Remember that your hearing devices are sophisticated electronic devices that spend most of their time in a rather hostile environment – your ears – where they are exposed to heat, moisture, ear wax, etc. As such, it is common for hearing devices that are worn regularly to require repair. You can minimize the need for repair if you are conscientious about cleaning them daily.

How to Get the Most Out of Your Hearing Devices

Tenacity

Do not get discouraged.  Being fitted with hearing devices can be an overwhelming experience.  It requires time to adjust to the new sounds that you are hearing, the sound of your own voice, and the feel of the devices in your ears.  With your hearing loss, you have been receiving sound patterns that seemed perfectly "normal". Now, with the devices, your brain has to be re-educated to accept different sound patterns as "normal."  It is similar to adjusting to a new accent, like an Australian speaking English for example.

The Adjustment Process

When you first put on your hearing devices, you are suddenly going to hear many sounds of which you were previously unaware –frying food, the whirl of dishwasher, the whine of an electric can opener, birds singing, a microwave beeping.  Some sounds will require conscious effort to identify while others, like the sound of traffic, street and restaurant noises, may initially even be a little disturbing.  However, as you hear more of those sounds around you and adapt to what you are hearing, you will become more familiar and comfortable with those new sounds – and eventually will even tune some of them out!

Expectations

Not everyone receives the same degree of benefit from hearing devices.  No matter how advanced the hearing devices or how well they are fitted, the level of improvement they bring to your hearing will ultimately be determined by the nature of your hearing loss. Nonetheless, nearly everyone can obtain at least some degree of benefit from hearing devices. Your satisfaction with your hearing devices will depend greatly on your expectations, which should be neither too high nor too low.

Be In Control

It is important to work closely with us, your hearing health care professionals.  For new hearing device users in particular, the initial period after acquiring the devices is crucial.  Many problems can be resolved or at least lessened if we are made aware of them.  Initially you should wear the hearing devices for as long each day as you feel comfortable, with the goal of wearing them all day, every day.

Keys to Success

• Practice, practice, practice!

• Patience, patience, patience!

• Remember your hearing devices are an "aid" and will not cure your hearing loss. With hearing devices, sounds are amplified and you will hear better, but they will not restore normal hearing. Hearing devices cannot correct hair cell damage, which changes the ear's ability to process sound, and as such problems with clarity of speech are not always resolved with hearing devices.

• Your brain needs time to adjust to hearing. Most people have had hearing loss for a long time before seeking help and their brain has adapted to their hearing loss. Your brain will not instantly adapt to the new sounds from the hearing devices. The more you wear the hearing devices, the better your brain will become at interpreting the sounds.

• Do not be discouraged by the interference of background noise. As you learn to discriminate between noise and speech and to identify various background sounds, you will also be able to learn to ignore irrelevant noises - like the fridge or furnace running – just as people with normal hearing do.

Tips

1. Use the hearing aid first in your home environment. Initially you may be disturbed by background noise. It is easier to adapt to noise in the home environment before moving into noisier settings.

2. Build up the length of time you wear your hearing devices. If you are tired, give yourself a break and do not get frustrated. Then continue your efforts to increase the amount of time you are wearing the devices until you are able to wear them for all waking hours.

3. If you have hearing loss in both ears, consider using hearing devices in both ears. For the same reasons that we have two ears, we can generally hear better if we hear through both ears. Our brain relies on balanced input from both ears to localize sound sources, focus on specific sounds, and discriminate speech from background noise. We also generally hear fuller, smoother, richer sound quality when hearing from both ears. We can hear louder if we hear through both ears so, generally, the hearing devices do not need to be set as high if worn in both ears.

4. Practice locating the source of sound by listening only. Identifying the direction a sound comes from is difficult for hearing device users.

5. Increase your tolerance for loud sounds. Initially hearing devices are usually set lower than needed for efficient listening in order to allow the user to adjust to the new sounds that they are hearing. Over time, however, the volume should be increased in order to further improve hearing.

6. Listen to someone read aloud and gradually increase the number of people with whom you talk. Also gradually increase the number of situations in which you use your hearing devices.  After you have adjusted to wearing the hearing devices at home, wear them out to public places including the supermarket, church and theatre.

7. Use other communication cues in combination with hearing in order hear and understand others.  For example, use context, lip-reading, and speech reading cues.

8. Consider positioning.  Many hearing devices now have directional microphones, which attempt to focus more on incoming sound from the front so it is important to try to position yourself facing those that you want to hear, while putting other noises behind you (when possible), in order to maximize the effectiveness of the directional microphones in noisy situations.

9. When you mishear, do not just say "what?" but rather request specific clarification.  For example, "please rephrase that," "please speak slower," "please spell that," "please face me when you are speaking," etc.

10. Be assertive about your needs.  It is important to control the listening situation when possible (i.e. ensure good lighting, reduce background noise when possible, etc.).  It is also important to ensure that you are assertive about your needs and to educate others about how best to communicate effectively with you.

11. Consider Assistive Listening Devices (ALD) in situations where hearing devices alone are not sufficient.