Counseling parents for the use of hearing aids

Counseling parents for the use of hearing aids AUTHORS NACHIKETA ROUT ANIKET PANDIT (Under Revision) Kindly Post your Suggestions/ comments which can be incorporated for necessary modification at nachiketa_raut@yahoo.com Thanking you. SPEECH AND HEARING ASSOCIATION OF INDIA WEST BENGAL BRANCH

Counseling parents for the use of hearing aids. Hearing aid is an electronic amplification device which aids the user to utilize his residual hearing. Frequently Asked Questions, before counseling. Q1. What are the different types of hearing aid? A1. Hearing aids are based on different categories and a hearing aid is selected according to the child s need. They are classified as A. Placement based hearing aids a) Body level or pocket level hearing aid b) Behind the ear hearing aid (BTE) c) In the ear hearing aid (ITE) d) In the canal hearing aid (ITC) e) Completely in the canal hearing aid (CIC) B. Based on sides a) Monaural (one ear) b) Binaural (both the ears with two aids) c) Psudobinaural (both ears from one aid) C. Based on amplification a) Mild class b) Moderate class c) Strong class d) Extra strong class

D. Based on processing a) Analogous b) Digital E. Based on programs a) Non programmable b) Programmable F. Based on conduction a) Air Conduction b) Bone Conduction Q2). Is there any other alternative for my child like medicine or operation? A2). Yes there is an alternative in the form of cochlear implant. However it is suitable for children who are NOT benefitted by hearing aids. Cochlear implant is also a hearing assistive device which has to be fitted like a hearing aid but it also requires operation for some of the parts to be fitted to the child directly in the ear. On the other hand there are no medicines or operations which will help your child as the hearing is damaged permanently. A child to undergo cochlear implant has a specific candidacy to be cleared only then can a cochlear implant can be permitted. COCHLEAR IMPLANT

Q3). How much percentage can my child hear now? A3). Your child has a hearing of X percentage. This is calculated based on the following formula. Information about the various types of impairment Category Type of Impairment db Level Word Recognition Score (Speech discrimination) Percentage(%) Impairment of I Mild hearing impairment 26 40 dbhl in better ear 80 to 100% % in better ear Less than 40% II a) Moderate hearing impairment 41 to 60 db in better ear 50 to 80% in better ear 40% to 50% II b) Severe hearing impairment 61 to 70 db in better 40 to 50 % in better ear 71 % to 100% III a)profound Impairment hearing 71 to 90 db Less than 40% in better ear 100% c) Total deafness 91 db and above in better ear Very poor discrimination Note: 50 dbhl does not mean 50% hearing loss Q4). Types of loss my child has A4) There are basically three types of hearing loss Conductive hearing loss (external and middle ear is affected) Sensorineural hearing loss (inner ear and auditory nerve is affected) Mixed hearing loss (outer/middle or inner/nerve are affected) Auditory nerve Can be medically treated

Q5). Will the hearing aid help my child hear and speak like normal children? A5). Yes, your child can acquire adequate speech and language if he uses the hearing aid regularly, and takes auditory training and speech & language therapy regularly. To achieve this goal there is a need of early intervention and rehabilitation. (Especially in the critical age i.e. first 5 years) Q6). Will he be able to stop using the hearing aid and hear normally again? A6). Usually No, Hearing aid is mostly prescribed for a hearing loss which cannot be treated by medicine or surgery e.g. Sensorineural hearing loss which is mostly static. A hearing aid augments oral communication and prevents auditory deprivation. Any child/ adult with hearing will always require a hearing aid as in the case of spectacles for eyes. Q7). If I don t let my child wear the hearing aid, will it affect my child? A7). Yes, if your child is deprived the use of hearing aid there will be deprivation of sound (speech stimulation) to the child. The child will fail to acquire and master the skill to listen to sound. He/she does not develop vivid mental representation of the spoken words thus resulting in poor speech. Poor mental representation of words leads to difficulties in comprehension of words and sentences during communication at sentence level (i.e. day today communication). Each word is spoken relatively at a faster rate. The child requires an adequate mental representation of spoken word to retrieve and correlate the words from the heard stimuli.

More about hearing aid for appropriate usage. Body level hearing aid Any hearing aid which is placed in the pocket or at the level of the chest is called a body level hearing aid. Parts to explain microphone 1) This hearing aid is worn in the pocket. 2) There are two switches a) M/T/O i.e. : Mic / Telecoil /Off b) H/N/L i.e. : High/ Normal / Low 3) There is a volume control on the head of the aid. 4) Keep the volume control between 1 & 3 of the volume control in the hearing aid. 5) The microphone is on the top so now the child hears from the mic and not the ear. 6) When using the telephone place the receiver of phone near the mic 7) You can make a harness for small children to host the hearing aid. 8) There are two types of cord a) S cord b) V cord 9) Do not bend or pull the cords, avoid winding the coil very tightly around the hearing aid.

10) Cords should not be twisted or knotted 11) A cord is made up two ends one that connects to the receiver and the other that connect to the hearing aid Thick Thin Thick There are two types of pins a) Two pin ( where one pin is thick and the other is thin) b) Three pin ( Two thin and one thick) Behind the ear It is placed behind the pinna 1. Behind the ear hearing aid is more delicate hence requires more safety 2. Right hearing aid has red printing, left hearing aid has blue. 3. Hearing aid should be serviced at least yearly

Battery General instructions A. Body level hearing aid battery 1. Use the correct size of battery or use correct battery 2. For the use of Body level hearing aids use only pencil cells (AA Batteries) 3. Remove the battery when not in use at night. 4. Remember to put the + ve side of the battery in the + ve side of the hearing aid. + Ve - Ve 5. The battery has a life of 100 hours B. Behind the ear hearing aid 1. There are different size batteries for BTE hence use correct battery accordingly Hearing Aid Battery Sizes and Colours Orange Tab Size 13 Brown Tab Size 312 Yellow Tab Size 10 Blue Tab Size 675 2. Remove tab before placing battery in hearing aid. Once the tab has been taken off a battery that hearing aid battery becomes active and will continue to stay active. 3. Remember to put the + ve side of the battery in the + ve side of the hearing aid. 4. Battery door will not close if battery is upside down 5. Opening the battery door when hearing aid is not in use helps batteries last longer

6. Batteries should last x days and possibly longer. Battery Size: Milliamp Hours: 675 600 mah 13 260 mah 312 130 mah 10A 5A 70 mah 35 mah The Calculation Total Hours (TH) = Battery Capacity (BC) / Battery Drain of Hearing Aid (BD) = 130 /.75 = 173.33 Total Hours. Total Days (TD) = Total Hours (TH) / Hours worn per day (HW) = 173.33 / 16 = 10.83 Days What to remember when purchasing new hearing aid batteries 1. Avoid using local or low Quality batteries 2. Do not purchase batteries from an opened packet or check the charge before purchase 3. Do not purchase battery when the tab has been removed Keep the battery safe from the children

Cleaning, Care and Maintains of Hearing Aid 1. Hearing aids should be cleaned every day ( mic, receiver, battery compartment, etc) To clean hearing aids, use dry cloth / tissue or brush 2. Store hearing aids overnight in a clean, dry and safe place. 3. Keep the hearing aid in the box given 4. If possible place the hearing aid with the silicon bag to remove moisture from the hearing aid 5. Try to avoid hearing aid from getting wet in rain, or during washing face 6. Avoid keeping near electronic and hot places or magnetic fields E.g. On electronic equipments like Fridge, TV music systems, computers etc. 7. Try to avoid breakage or falling of hearing aid.. If the hearing aid is not working (Troubleshooting of hearing aid) 1. See if the switch is on/off or on Telecoil 2. Check the hearing aid after changing the battery 3. Check if the battery is not upside down (To check the hearing aid place the receiver near the microphone till you hear a whistle sound in body level hearing aids. In other aids, place the hearing aid in the palm, and slowly close it or place the palm near the ear with the hearing aid worn till you hear a whistle like sound.) 4. Check the volume control 5. Check if the cord is not cut in or has become hard at any place 6. Check if the pins are fixed in hearing aid and receiver properly 7. Check if there is blocking in the mould due to wax recompilations 8. If, after all this, the hearing aid is still not working bring it to the clinic 9. The hearing aid is sealed in a specific way, so do not try opening it your self 10. Do not open the hearing aid by self for repairing the aid or for curiosity. 11. Do not give the hearing aid to local electrician for repairing so as to avoid cost of repair.

Feedback (Whistle like sounds) 1. Check if the mould is broken 2. Check if the mould is not fitting properly or it is small 3. Normally this occurs with hand held against the hearing aid. 4. If the distance between the mic and the receiver of the hearing aid is too close. (Demonstrate the above points to the parents) How and where can I keep my child s hearing aid safe when he is wearing it while playing? A method of retaining a hearing aid in place on a child comprises providing a harness or huggies. Harness is usually made of cloth Fig: harness - it helps to place a hearing aid at a safe distance from the receiver in the ear and to place it firmly. Ear mould Why is it needed? An ear mould is a coupling device used for, helping the receiver remain in place in the ear canal, helping in channeling sound, and helping in varying the required frequency. Some modifications in ear mould (like vent, filter, horn, and damp) help in bringing about required acoustic modification. - Moulds are of two types a) Soft mould b) Hard mould

Care and Maintenance of Ear Moulds 1. Before using hearing aid appropriate mould is required. 2. One should make maximum use of ear mould with the hearing aid. 3. The hearing aid is also required to be kept safe 4. Keep the moulds clean and free of dirt or ear wax. Blocked moulds result in poor sound reception. Dirt may lead to infection in the ear. 5. Changing the hearing aid a) The ear size changes every 6 months in children hence require new mould till 12 years of age. b) Repair or change the tube whenever the tube breaks or leaks 6. The ear mould should be cleaned every fortnight. a) Wash the mould in Luke warm water or soapy water so that the wax gets dissolved. b) One can use a clean cloth to wipe it clean or clean the dirt with a wire or tooth brush. c) Blow from one side to the other so that any remaining water, dust particle is cleared from the tube. 7. The mould should not be removed very often from the receiver as the spring loses its tension. 8. Do not press the mould hard over the receiver (in pocket model aids) as this can damage the receiver. 9. Use the mould only after drying it properly. 10. Avoid breaking or bending the moulds 11. If the child shows any skin reaction after using the mould consult the ENT specialist. Solar charger 1. In this rechargeable pencil cell batteries are used, 2. The charger is required to be placed facing the sun for at least 2 days to charge the battery. 3. It is important that one avoid contact of water and rain with the charger. 4. After charging remove the battery from the charger Solar plate facing the sun Battery fit properly

GENERAL POINTS 1. Encourage the child to wear the hearing aid at least 6 to 8 hours a day The child is to wear the hearing aid for 15 to 20 min twice a day in the start and then gradually the time should be increased so that the child will get accustomed to the hearing aid. Adapt the child slowly to wear the aid. If he resists, first adapt him with ear moulds 2. The volume control should be placed as per the instructions given by the dispenser and adjust volume only if the child feels uncomfortable with the existing volume. 3. Make the child aware of different sounds in the environment. 4. Try to talk with the child as much as you can 5. The child is required to undergo auditory training or auditory verbal therapy (professionals discretion) A) Auditory training a) Awareness or Detection of signal (at this level the child is made aware of different sounds including speech sounds and enviournment sounds) Activities: the child is conditioned to place toys in the basket when they hear a banging noise. This is carried out first with visual cues and later from behind, i.e. without visual cues. The distance is gradually increased from 3 feet to 10 feet. b) Discrimination of signal. (at this level the child is required to differentiate whether one sound pattern is the same or different from the other.) Activities: place two pegs one high and one low and ask the child to put rings when high pitch and low pitch sound is heard. c) Identification of signal. (Once the child can discriminate the sound stimuli he has to recognize them and identify which sound he has heard.) Activities: the child is provided with different animal sounds and he has to identify the correct picture of the animal d) Comprehension.(at this level, the child is required to indicate that he understands what he has heard, by making a suitable oral response or by following a command.) Activities: The child is asked to carry out a simple command without visual clues to help. B) Auditory verbal approach This approach helps children with hearing impairment to use their hearing and listening potentials to communicate through spoken language. It helps them use the residual hearing to process verbal language and to speak. The goal of auditory- verbal therapy is that children who are deaf or hard of hearing grow up in regular learning and living environments enabling them to become independent, and contributing citizens.

6. It is more beneficial to wear hearing aid in both ears than only one ear. It helps in a) Binaural summation of sound b) Helps in lateralization and localization of the sound source c) Better hearing in noisy environment 7. Remember to remove hearing aid when going for bath During trial period 1. Read over the information provided by the audiologist 2. Pay close attention to what you do/do not like about the hearing aid so that the hearing aid may be adequately adjusted 3. Try to wear the hearing aid most of the day every day; it s OK to take the hearing aid out from time to time during the day or if otherwise instructed by audiologist 4. Observe the changes (if any) of auditory behavior in aided condition. Do expect 1. Listening to be easier 2. To hear better in many situations most of the time 3. Own voice may seem louder 4. May take several months to get used to Do not expect 1. Hearing aid to be painful 2. To hear speech better in noise 3. To hear better in all situations

SOME OTHER QUERRIES. Q1). Where can I get new battery, cord and other accessories of the hearing aid? A1). You can get the accessories from a hearing aid dispensing clinic. Q2). How many years will the hearing aid work? A2). The life of a hearing aid is at the most 5 years to 7 years. Q3). How will I know if my child is benefiting with the hearing aid? A3). a) The child will enjoy variety of sounds. b) The child will ask for hearing aid himself. Q4).How long will I require him to come for therapy? A4). The time may vary according to the child s needs. Q5).Where should go to change the mould? A5). You go to an authorized audiological clinic. Q6).What will happen if the loss increases? A6). A re-evaluation is required, and then, if required the hearing aid needs to be changed. Q7). Will the hearing aid affect his personality? A7). There is less chance that the hearing aid will affect his personality if the family members are supportive. Q8).Will my child needs to wear the aid when going to play, and how do we keep it safe during playing? A8). The child is required to wear a hearing aid when going to play, but one must be careful when he is playing outdoor games. Q9).Will my child is able to marry? A9). Yes, your child will not have any problem in marrying. Q10).Will my child is able to talk using telephone? A10). After training your child will be able to use the phone. Q11).Is there any hearing aid that will not be visible? A11). Yes there are other types of hearing aids available also some are worn behind the ear while others inside the ear. But they are selected according to the need and loss of the child