SO YOUR PARENT NEEDS HEARING AIDS (The Adult Child s Guide to Hearing Loss and Hearing Aids) By Patty Earl, Ph.D., CCC-A

Transcription

1 SO YOUR PARENT NEEDS HEARING AIDS (The Adult Child s Guide to Hearing Loss and Hearing Aids) By Patty Earl, Ph.D., CCC-A Welcome to world of hearing loss and hearing aids. Your mother or father may have been struggling for a few years with hearing loss. You and other family members and friends may have noticed Mom s or Dad s hearing problems as well. It is very typical for individuals with hearing loss to take a wait and see approach to this problem and let a few years go by before making an appointment for a hearing test. In our clinic we like for a person to identify his or her stage of acceptance of a hearing problem so that we can properly direct a conversation about hearing loss and hearing aids. We use the following descriptions for this determination: Denial ( It s not my hearing. Everyone around me mumbles. ) Anger ( I have enough on my plate without this! ) Acknowledgement ( I m not hearing as well as others around me. ) Acceptance ( I need help with my hearing. ) If a person selects the denial or anger statements then he or she may agree to a hearing test but would not be ready to proceed with hearing aid selection and hearing aid fitting. If your mother or father accepts that they have a hearing loss and needs hearing help, let me walk you through the process and give you some information about current hearing aid technology so that you will be able to share this experience with them. It is essential to have a thorough test of hearing, a review of hearing/health history and a review of everyday communication difficulties caused by the hearing loss. These three components provide important information from which to proceed. A thorough test of hearing identifies degree of hearing loss (mild, moderate, severe or profound), type of hearing loss (conductive, sensorineural, or mixed), word recognition (word understanding) ability, and measurement of certain transmission characteristics of the ear. Hearing/health history identifies familial patterns of hearing loss, health issues that may impact hearing and environmental situations that may have contributed or are contributing to the hearing loss. A review of everyday communication problems identifies how the hearing loss impacts daily living and how a person is dealing with the hearing loss. After information from these three components is recorded then the audiologist will be able to discuss the findings and provide recommendations. In some cases, a person may need to return to their primary care doctor or another medical specialist because a problem was uncovered that would need to be addressed before proceeding with hearing aid selection. For most people, however, we now have the information needed to begin the hearing aid discussion. Useful information from the Hearing Evaluation:

2 Most people with hearing loss have a permanent type of hearing loss referred to as sensorineural loss. Colloquially, it is called nerve deafness. In sensorineural loss, damage to structures in the inner ear or along the auditory nerve has occurred. It is not yet possible to repair this type of damage. Inner ear damage usually involves the sensory cells (hair cells) located on a structure called the basilar membrane. The audiogram or chart of hearing thresholds provides information about the degree (amount) of hearing loss across a range of frequencies (typically from 250 Hz to 8000 Hz) and type of hearing loss (sensorineural, conductive or mixed hearing loss). Very often people want to know what percent of hearing loss they have. I do not typically run the calculations for percent impairment as this number is not helpful in hearing aid discussions. Percent impairment is used in legal cases when awards are made for injury. Often people with previous audiograms will tell me that they have a certain percent of hearing loss, say 40%. After testing, I will look at the audiogram and see that the hearing thresholds are at about 40 decibels. I think that there was some confusion that 40 decibels was equivalent to 40%. It is not. A hearing threshold level of 40 decibels indicates a hearing loss of a mild degree. Below are two audiograms. The first one identifies the hearing loss as moderate in degree and flat in contour as the hearing thresholds all occur around one level (50 db). It would be reported as a moderate, flat hearing loss. The second audiogram shows thresholds at varying decibel levels getting poorer as frequency increases. This audiogram has a sloping contour and would be described as a mild to severe hearing loss. Note: the red and blue symbols indicate perfect hearing. The range for normal hearing extends to 25 decibels. Degree of hearing loss provides a basis for selecting the power requirements of hearing aids. Generally, hearing aids can be classified into three power categories: standard, power and super power. Most people use standard power hearing aids which cover a fairly wide range of hearing losses. The audiometric contour (amount of hearing loss by frequency) is a factor when selecting hearing aids that provide sufficient gain at various

3 frequencies. If an audiometric contour was flat, then gain requirements of the hearing loss would be fairly constant across the frequency range. If the audiometric contour was sloping, then gain requirements would vary across frequencies. A feature in hearing aids that should be examined is the number of frequency channels or bands that can be manipulated so that adequate gain is delivered at various frequencies. Irregular or complex audiometric contours require a greater number of frequency bands. Another important piece of information to know is the word recognition or word understanding score. One would expect that good word recognition would be seen in cases of mild hearing loss and that word recognition would become poorer with increasing amounts of hearing loss. That trend is generally true; however, exceptions are seen rather routinely. Word recognition scores can be recorded in many ways. Sometimes word recognition is measured when presenting a list of words at average conversation level. Listening at average conversation level can be difficult with hearing loss so word recognition is often measured at a patient s most comfortable listening level. People with hearing loss usually select a comfortable listening level that is higher than average conversation level so that they can hear more clearly. Word recognition while listening to lists of words recorded in background noise may also be measured. A person can have good word recognition score while listening in quiet but much poorer word recognition when listening in noise. That fact should be discussed in terms of how much help to expect from hearing aids and how various hearing aid technologies can help to hear and understand better when listening in noise. At this point I must say that it is important to use the visual channel (the eyes) to supplement the number of auditory cues that hearing aids will make audible. Even when using the most sophisticated hearing aids, the combination of visual cues and auditory cues will provide the highest level of speech perception. Looking at the person who is speaking is helpful for two reasons. First, you are positioning yourself to receive the auditory cues in the most direct and acoustically cleanest way. Secondly, visual cues from the face and lips of the person speaking will supplement the auditory cues making speech perception quicker and more precise. People with hearing loss often mention that they read lips and they should be encouraged to continue this practice along with the use of their hearing aids. Useful information from the Hearing History: Hearing histories provide information about medical problems and genetic factors that may affect hearing. For example, hearing loss is more commonly seen in individuals with diabetes as compared with other groups. A general overview of health problems is very helpful to the audiologist and may uncover important information like the presence of progressive hearing loss. In cases of progressive hearing loss, hearing aids that can be adjusted for increasing hearing loss will need to be used. Medications taken for the treatment of a health problem should be reviewed to see if any of them are possibly harmful to hearing. Identifying hereditary hearing loss may or may not have a direct effect on hearing aid selection but it is important information for the family.

4 Tinnitus (a ringing or roaring in the ears) is most often identified during a hearing history review. It often occurs with hearing loss and is usually benign. Questionnaires can be used to determine the degree of perceived handicap that tinnitus causes. Degree of perceived handicap can vary from slight to severe. Sometimes the use of hearing aids will lessen the severity of benign tinnitus. A few hearing aids are available with additional programs that produce sounds to compete with the tinnitus. There may be instances where a medical referral will be made to determine the etiology of the tinnitus. Most of the time this involves metabolic studies (blood work) and possibly MRI. Everyday Communication Problems: There are a number of good questionnaires used to identify the most important communication problems caused by the hearing loss. Sometimes these communication problems will be identified by the patient during a conversation about the effects of the hearing loss. Many hearing aid manufacturers build questionnaires and scales into the software used for hearing aid selection and fitting and these can be used as well. Identifying communication difficulties will help the audiologist select hearing aid technologies to discuss with the patient. For example, if it is very important for a person to hear a table conversation because they dine out frequently then the use of hearing aids with focused pick up areas and good noise reduction may be discussed. The use of peripheral connectors would be discussed with a patient who needs help with listening to phone conversation or TV audio output. A list of communication difficulties can also be used as an assessment tool for quantifying hearing aid benefit during a trial period. Hearing Aid Styles: Today s hearing aids are smaller than ever. Power models are larger than standard models but only slightly so. Cosmetics are important to many people but so is ease of handling. If a person has physical limitations he may not be able to use very small instruments which require a certain level of dexterity. A slightly larger instrument may be very easy to handle and still be cosmetically pleasing. Hearing aid styles can be broadly divided into behind-the-ear and in-the-ear (also called custom) models. Behind-the-ear designs include the hearing aid plus an earmold which is a traditional model and the receiver-in-canal which has the hearing aid body behind the ear and the speaker (receiver) inside the ear canal. The receiver-in-canal devices are tiny. In-the-ear styles include full shell model which fills the outer ear, half shell model which is half the size of the full shell design, in-the-canal model which can be seen slightly protruding from the ear canal and the completely-in-canal model which is barely visible at the entrance of the ear canal. There is a relatively new in-the-ear style which is a very deeply seated completely-in-canal style. It requires a very deep ear impression of the ear canal so that the hearing aid is seated very close to the ear drum. Hearing aid style selection may be dictated by previous experience with hearing aids, the amount of hearing loss, configuration of hearing loss (shape or contour of the

5 audiogram), ease of handling of the device or batteries, cosmetic appeal or any combination of those factors. Time should always be taken to discuss these factors. Receiver-in-ear design Custom in-the-canal design Levels of Processing: Communication demands on hearing/listening need to be considered when selecting processing features in hearing aids. More sophisticated signal processing should provide better separation of the speech signal from backgrounds of noise. The noise may be environmental noise or background conversation. If a person has the need to hear and understand speech in various noisy backgrounds, then a higher level of hearing aid signal processing technology should be selected. Hearing aid manufactures provide product guides which categorize models according to the number of situations where the hearing aids can be used effectively. Sometimes, people state that they only have a need to hear in background noise once or twice a month and decide to use a lesser technology to keep costs down. Later, they may find that those occasional listening experiences are in fact important to them and frustrating because the speech signals are lost in the background noise. There are two choices. They can either be resigned to the fact that the hearing aids are effective in fewer situations or they can try advanced levels of hearing aid processing in another hearing aid model. For people with poor word recognition, hearing aids with advanced processing may be the best choice to provide the most separation of the speech signal from background noise. In addition to the consideration of hearing/listening demands, many hearing aids provide features such as automatic program switching and/or wireless connections to cell phone or audio from the TV. In automatic program switching, the hearing aid changes how sound is picked up and processed depending on what is in the acoustic environment. Automatic program switching may even include a program for telephone listening. People who want instruments without volume control wheels or program buttons but need to hear in a variety of listening situations would benefit from these forms of automation. Automatic features are generally found in mid level to upper level hearing aids. Wireless connections to cell phone, landline phone, TV, etc. are available in many hearing aids and are quite helpful, especially for people who have struggled to hear over the phone or listen to TV with other devices or hearing aids. Components used to

6 connect cell phone and TV outputs to hearing aids are an additional cost. Generally, these components can be used with higher or lower level hearing aids. Trial Use of Hearing Aids: Sometimes a person will be offered the chance to use a demo set of hearing aids to see if that model is appropriate or to see if they are ready to use hearing aids. Demo hearing aids are typically offered if a person is a candidate for a behind the ear style instrument and can use an in stock ear piece. If a person needs an in the ear style hearing aid or has the need for power or super power devices, then it is not likely that a demo set of hearing aids would be available for trial use. The use of demo hearing aids does not constitute a hearing aid trial period. A hearing aid trial period occurs for a certain period of time after a hearing aid fitting and purchase. A trial period is part of the hearing aid fitting and allows the wearer to try the hearing aids in everyday listening environments. A person returns to the audiologist during the trial period for progress checks and adjustments. If a person rejects the hearing aids, they must be returned by the end of the trial period so that a refund can be processed. Trial periods are at least for 30 days. A trail period is very important and requires true participation on the part of the wearer. Someone on a trial period should try using the hearing aids in as many situations as possible. They should determine if the hearing aids are physically comfortable and provide adequate amplification. Any problems with physical fit or sound quality and aided listening performance should be discussed with the audiologist. A person should not feel uncomfortable returning hearing aids if they do not prove to be helpful. Hearing aids do not provide 100% success but should make a noticeable difference and be helpful enough to justify keeping them. You may have seen hearing aids advertised for purchase on ebay or other sites on the internet. I do not think that this practice is in a patient s best interest. Without good audiometric data, evaluation of communication needs and thorough product knowledge, it is very likely that the wrong instruments will be selected. It may be difficult to find an audiologist in your area who works with the instruments you purchased. You may think that you have saved some money but you may have actually given yourself one big headache. From Beginning to End: The following outline of services is a typical one and describes the process from identification of hearing loss through the purchase and trial use of hearing aids. Understanding the process is helpful when determining if the time is right for an individual to pursue hearing aids. First visit consists of the recording of health history with emphasis on factors pertaining to hearing health, a review of hearing needs and communication problems, completion of

7 a diagnostic hearing evaluation, discussion of results/recommendations, and possibly hearing aid selection. Hearing aid selection may occur at a subsequent visit. Please note that sometimes hearing aids may be available for immediate fitting. If a patient is ready to try hearing aids, then the first visit may include a hearing aid fitting as well! Visit two consists of the fitting and orientation of the hearing aids previously selected. During hearing aid fitting a computer software program is used by the audiologist to set an initial prescription in the hearing aids. During orientation the patient is taught how to use and care for the hearing aids. Payment for the instruments is collected and the trial period begins. Visit three is usually scheduled a week or two into the trial period to check on progress. At that time adjustments may be made to hearing aid output to improve a problem listening situation. Time may be taken to review previous instruction regarding care and use of the hearing aids. Testing would be performed to assess hearing aid benefit. Additional visits are scheduled as needed. Outcome at the end of the hearing aid trial period is documented during an office visit or by telephone contact. If hearing aids have not been satisfactory even with modifications by the audiologist, then they must be returned at this time. Usually, however, a successful outcome has occurred. In Conclusion: I hope that this booklet has given you useful information regarding hearing loss and hearing aids. It is difficult to participate in a discussion about these topics without background information. Familiarity with the vocabulary and concepts related to hearing loss and hearing aids will allow you to more fully share this experience with your mother or father. About the author: I am an audiologist with over 30 years experience in hearing testing and hearing aid fitting. I received a M.A. degree in Audiology from the University of Tennessee in 1979 and a Ph.D. degree from the same university in Hearing and Speech Science in I am state licensed in Audiology and have certification in Audiology from the American Speech-Language-Hearing Association. I am a Fellow of the American Academy of Audiology. I have worked in hospital Audiology clinics, ENT practices and now enjoy a private practice in Audiology. I believe that patient (and family) education contributes to peace of mind and successful outcomes. For that reason this booklet was written.