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Patient Education

A Patient's Guide to Hearing Instruments

Great Expectations

"Hearing instruments changed my life."

"Hearing instruments don't work -- period."

No matter what you've heard about hearing instruments, none of it matters until your own ears are in question. Then, nothing is more interesting than learning all there is to know about these emotionally and electronically loaded little devices: the aesthetics, the size, the microchips, the bells, the whistles, the possibilities, the costs, and the success stories

In this section, we'll try to give you the reality: the information you need to consider and what you can really expect if you choose to wear hearing instruments.

Developing realistic expectations

Some people put on a hearing instrument and hear better right away. For most, there is more of an adjustment period. The single most important factor in the process is the attitude and commitment of the wearer and the development of realistic expectations.

Just as if you had a knee replacement or other medical procedure, you can expect to go through a period of rehabilitation, followed by adjustment to your new circumstances. You can also expect that this will take some time. You'll need both a willingness to go through that process, as well as the patience to re-learn a new way of hearing.

Part of that re-learning is recognizing that hearing instruments won't replicate the way you used to hear, nor will they restore or prevent further loss. Most people gain significant improvement in their sense of hearing with hearing instruments, though it is a gradual process that can and will take some time.

Re-learning to Hear

When you put on hearing instruments for the first time, you'll begin hearing sounds you haven't heard in some time. Your brain actually has to re-learn how to hear these sounds, particularly the complex range of frequencies in human speech.

Don't worry if you can't immediately understand all speech. A low, comfortable volume setting is preferable as you adapt to the new sound quality provided by hearing instruments, even if you miss occasional soft sounds or conversation.

Remember too that communicating with others combines listening with attention, concentration and visual cues. Use these cues to help your understanding by observing others' facial expressions and gestures.

Your own voice may also sound funny to you when you first begin wearing hearing instruments. Practice speaking and listening with someone facing you whose voice is familiar and understands your needs.

Adjusting to Different Sound Environments

Once you feel comfortable with your hearing instruments in familiar surroundings, practice wearing them in a wider variety of sound environments. Practice selecting specific sounds and voices, focusing your attention on them as you do so. Let visual cues like facial expressions and gestures enhance your understanding.

When conversing with others, try to face the person you're speaking with. Family members may need to know that with a hearing instrument on, loud voices can actually be irritating. Ask them to speak in a comfortable voice and minimize distractions such as covering the mouth with hands, eating or listening to a radio or TV while talking.

In public places like a meeting or church, try to sit reasonably close to the speaker and within easy visual distance. Since every space has its own sound characteristics, you may need to try different locations for best results.

Why is Digital Technology Better?

Digital technology's superiority over traditional analog hearing instruments isn't just what it can do with sounds, but how much better it does it.

By converting the incoming signals into computerized "bits" they can be processed, or manipulated extremely fast and efficiently in many complex ways using mathematical formulas known as algorithms. This gives digital signal processors (DSP) tremendous speed and agility to recognize sound's key ingredients.

Like a graphic equalizer in high-end audio systems, algorithms can continually divide sounds into frequency channels. These help preserve and emphasize the higher frequencies containing vital consonant sounds in speech -- the "c" and "t" sounds in "cat" -- over the distracting rumble of low frequency noise.

Algorithms also manage noise by its duration. While speech sounds' intensity can change radically in a millisecond, noise is more acoustically stable over a comparatively longer time. Using time, DSP precisely reduces the levels of continuous sounds like traffic noise and household appliances. And it instantaneously readjusts when changes occur, restoring amplification when shorter duration sounds are detected.

That same sensitivity is also useful in quiet surroundings. Utilizing an audio technique called expansion, the digital algorithm senses the consistency of softer environmental sounds from ventilation systems and appliances.

It automatically reduces amplification in the appropriate frequency range, immediately restoring proper levels when the sound pattern changes.

Digital algorithms can also minimize and eliminate the onset of feedback, a common nemesis to hearing instrument use. Within its elaborate frequency channel network, the algorithm detects the elements of feedback before they become audible. It then reduces levels in just those discreet channels, with no noticeable effect on perceived volume levels.

The precision and flexibility of digital technology also gives your hearing professional the ability to more accurately tailor your amplification for the best possible match to your listening and lifestyle needs. This process may include subsequent visits to ensure that you are receiving maximum benefit from your instruments.

The Value Equation

Improving your hearing and adding to your quality of life is hard to put a price tag on. While it might seem odd, it's not really what's inside the piece of plastic that you're paying for -- it's how well the hearing instrument improves your quality of life. The real value is what it's worth to be able to fully engage in your relationships, work and the activities you enjoy.

You may also want to think about what you value most in terms of a hearing instrument's features and benefits. How important is vanity? How important is the latest technology? The equation of price will depend somewhat on your priorities -- and it's different for everyone.

Hearing instruments generally run from several hundred to a few thousand dollars. Typically, costs reflect the amount of research and development that has gone into the product as well as quality of the components, with the smallest, most technologically advanced instruments at the higher end of the pricing spectrum. However, you can also get hearing instruments that provide a good benefit in a modest price range. In addition, most hearing instruments come with a warranty and return policy.

Common Myths and Facts

A lot of what passes for knowledge about hearing loss and hearing instruments today is based on outdated, or simply erroneous, information. Before you make any big decisions about hearing loss, check out the real story behind these common myths:

Myth: Only a few people are truly hearing impaired; the statistics don't apply to me or those close to me.
Fact:   With 28 million reporting hearing loss in this country alone, or one in 10 people, odds are good that you or someone you know is indeed affected by hearing loss -- especially if you're age 60.
Myth:   If I did have a hearing impairment, I'd certainly know about it.
Fact:   The truth is, hearing loss happens gradually and the signs are subtle at first. Our own built-in defenses and ability to adapt make it difficult to self-diagnose. A simple Q & A hearing test can help you gain insight, while professional screening can provide a more definitive answer.
Myth:   Most hearing problems can't be helped.
Fact:   30 or 40 years ago, that was true. Today, 90% of hearing loss, the kind that's brought on by age or exposure to noise, is very responsive to treatment in the form of technically advanced hearing instruments.
Myth:   If you're hearing impaired, it just means sounds aren't loud enough.
Fact:   Hearing isn't only about loudness or decibel level. Typically, hearing loss has more to do with the frequency of the sound, that is, its pitch, than its loudness. When hearing loss occurs, it's harder to hear higher pitches --especially when there is background noise to complicate the picture, such as conversation in a noisy restaurant. That's why amplifying incoming sounds alone isn't as effective in treating hearing loss as amplifying selectively.
Myth:   Living with hearing loss is not a big deal.
Fact:   There are many psychological effects to hearing loss, including frustration, withdrawal, and depression. Trouble communicating with others creates a strain on relationships and a loss of esteem. It's far better to deal with hearing loss than to pretend it isn't happening or to ignore the effect it is having on those around you.
Myth:   Hearing instruments are obvious and unattractive.
Fact:   While it's true that hearing instruments don't enjoy the fashion status of a pair of glasses, new technology has made these devices remarkably discreet. Many people can wear instruments that are either tucked well inside the ear or almost completely hidden in the ear canal. Behind-the-ear styles are often disguised by hairstyles.
Myth:   Hearing loss and hearing instruments are a sign of old age.
Fact:   Things are changing. Just as hearing loss is itself no longer the province of the elderly (there are more hearing-impaired people in the 45-64 year-old age category than there are in the over-65 age group), neither is wearing a hearing instrument. Many of the baby boomers now experiencing hearing loss will undoubtedly invest in better hearing sooner than later. And, as a culture, we're increasingly showing our preference for treatment over doing nothing, witness the popularity of such investments in life as laser eye surgery and hormone replacement therapy, to name a few. Indeed, doing nothing to help yourself may be seen as a more obvious sign of old age than the problem itself.
Myth:   Really good hearing instruments are prohibitively expensive.
Fact:   Better hearing through technology is within the reach of most people. The real issue is quality of life, and what it's worth to you. While good hearing instruments are seen as expensive, putting a price on a better life experience is hard to do. You have to weigh the benefits and make your own decision. However you choose to look at it, treating hearing loss and enjoying the benefits is still relatively inexpensive compared to treating most health problems.
Myth:   Hearing instruments don't work.
Fact:   Hearing instruments won't restore lost hearing or stop the progression of age- or noise-related hearing loss. And because hearing is as much a function of the brain as it is the inner ear, hearing aids aren't the whole story in hearing better. But smart new technologies, including the ability to amplify sound selectively, do help most people to hear better in most situations. Even so, it needs to be said that no hearing instrument, no matter how sophisticated, will work unless you are willing to wear and adapt to it.

Types of Hearing Instruments

CIC -- Fitting completely in the canal, it is the least visible hearing aid available. This style requires that the patient have good dexterity in order to manipulate the small device and battery. The CIC is best suited for hearing losses in the mid to moderate range.


ITC -- Still having a cosmetically appealing look, this device fills the outer portion of the ear canal. The in the canal aid has a larger battery, which allows for more power and longer battery life. The ITC fits mild to moderate hearing losses.

ITE -- Filling the entire bowl of the outer ear, this style of hearing aid uses a larger battery generating even more power and battery life. The ITE is best suited for mild to severe hearing impairments.

BTE -- The behind the ear device is connected to a custom made ear mold that fits in the canal through a clear tube. This style of hearing device can be used for mild to profound hearing losses and can allow for the most amplification and longest battery life possible.
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