Health Society of South Africa

HEARING AIDS
A guide to selection, wear and care

Anyone Can Have a Hearing Loss

Hearing loss is a problem shared by many people. In fact, it is one of the most common health conditions, particularly as people age. Most people over age 65 have some hearing loss, and by age 80, almost everyone does. For millions of people, a hearing aid is the answer to their hearing problems. The hearing aid makes up for much of their lost hearing. This helps them communicate better with other people and stay active in family and community life. A hearing aid may help you, too.

Signs of Hearing Loss
Because hearing loss usually occurs slowly over the years, you may not realise your hearing ability has got worse. It's a good idea to have your hearing checked if you:

Have to strain to hear normal conversation
Have to watch other people's faces very carefully to follow what they're saying
Need to ask people to repeat what they've said
Often misunderstand what people are saying
Turn the volume of the television or radio up so high that others complain
Feel that people are mumbling when they're talking to you
Are having ear infections, dizziness or a ringing in your ears
Find that the effort to hear leaves you feeling tired and irritated
Notice, when using the phone, that you hear better with one ear than the other

Reasons for Hearing Loss
Hearing loss has many different causes. Often these are conditions that may be beyond your control. You may have suffered your loss as a result of one or more of the following:

Physical changes within the ear caused by ageing
An injury or infection that damaged part of the ear
Exposure to loud noise
An inherited condition
Exposure to toxic medicines

How a Hearing Aid Can Help You
Many people have found that a properly selected and fitted hearing aid helps them hear much better. Hearing professionals caution that although a hearing aid can help you overcome your hearing loss, it does not provide the normal hearing you may remember. As useful as hearing aids may be, they have limitations.

A hearing aid can:
Allow you to hear and understand speech better in most situations
Help you hear in certain situations that are difficult or dangerous for you
Help you hear the high-pitched sounds of speech, including the consonants
Increase your ability to participate more fully in group situations and meetings
Make life more pleasant for you and those around you, even if it only partially restores your hearing

A hearing aid may not:
Restore normal hearing or the ability to hear a complete range of sound
Allow you to hear speech clearly when there is a lot of background noise (for example, in a crowd or at a party)
Let you hear only what you want to hear (all sound may be amplified, not just what you want)
Make distorted sound clear and distinct
Enable you to hear extremely soft sounds

How You Hear

The ear is a complex and delicate organ that allows you to detect passing waves of sound energy and thus hear the sounds of the world around you. The ear also contains an organ that helps you to keep your balance. Most of the ear is hidden inside the head, so you are seldom aware of the job your ears are doing until they begin to fail. Fortunately, a hearing aid can often help make up for lost hearing.

Normal Hearing
Your ear has three parts, each with a different purpose. The outer ear collects sound and funnels it to the middle ear. There the sound is amplified (made stronger) and sent to the inner ear, where it is converted into nerve impulses (signals) that go to the brain. The brain compares the loudness of incoming signals from each ear to determine the direction of the sound.

The external ear collects and concentrates sound energy.
The ear canal carries sound to the eardrum, a membrane separating the canal and the middle ear.
The eardrum vibrates in response to changes in sound energy, setting into motion three tiny bones.
The tiny bones of the middle ear vibrate against the fluid-filled cochlea, transmitting the sound energy into the fluid.
Inside the cochlea, special nerve cells pick up the sound waves in the fluid and generate nerve impulses.
The auditory (hearing) nerve carries nerve impulses from the cochlea to the brain, where they are received and heard as sound.

Types of Hearing Loss
You may have one of two basic types of hearing loss, conductive or sensorineural. If you have both types, you have what's called a mixed hearing loss.

Conductive loss occurs if sound waves are disrupted before reaching the inner ear. The canal can be blocked by earwax, infection, a tumour or a foreign object. The eardrum can be damaged by injury or infection. In the middle ear, abnormal bone growth, infection or tumours can block the sound.

Sensorineural loss occurs when sound energy reaching the cochlea is not properly processed or if the nerve signals are disrupted on the way to the brain. Also called "nerve deafness," it usually occurs in both ears. Often it's caused by ageing or loud noise, or by injury, disease, infection, toxic drugs or an inherited condition.

How a Hearing Aid Helps You Hear
A hearing aid is an electronic device that receives sound, amplifies it and transmits this stronger sound down the ear canal into the ear. Sound may reach the inner ear without a hearing aid. But without enough amplification, the impulses reaching the brain may be weak and distorted. With a hearing aid, sound is amplified to make the weak and distorted signals more audible.

The microphone picks up the sound and sends it to the amplifier.
The receiver inside the aid sends the amplified sound into the ear canal.
The amplifier inside the aid makes the sound louder and helps correct distortion. The volume control adjusts loudness.
The battery inside supplies the power.

Your Hearing Evaluation

The process of choosing a hearing aid usually begins with medical and hearing examinations. The medical examination may be done by your family doctor or you may be referred to an otolaryngologist (a doctor who is an ear, nose and throat specialist). Your hearing will be carefully tested by an audiologist (a health professional who specialises in evaluation and non-medical treatment of hearing loss). The test results, called an audiogram, will show whether your ears are healthy, what type of hearing loss you have and exactly what you can and cannot hear.

Your Medical Examination
A hearing loss can mean you have a medical problem. An examination of your ears, nose and throat is needed to rule out any infection, injury or other problem. Certain ear conditions can be treated or corrected with medicines or surgery. Then there might be no need for a hearing aid. Your doctor will take your medical history, asking you questions about your health and hearing as well as your family's medical history.

Your Hearing Test
The audiologist may use several tests to find which tones, sounds and words you can and cannot hear. These tests are usually given in a soundproof room using electronic equipment. The tests are not painful or difficult to do. You are asked to signal when you hear tones and sounds that come through the earphones. Other tests will show if you can tell the difference between words that sound much alike, such as fin, pin, tin and thin. The tests show which sounds or tones your hearing aid will need to amplify for you.

What the Audiogram Shows
The audiogram is a graph showing the results of your hearing test. Low pitch or frequencies (tones) are shown on the left and high frequencies on the right. Soft sounds are at the top of the graph and loud sounds at the bottom. The loudness where you first hear a tone is marked and these points are connected to form a line. Normal hearing levels start between O and 20 decibels. Normal conversational tones fall within a specific area on the graph.

Other Possible Tests
Other tests may be done, depending on the nature of your hearing loss or the results of your audiogram. Such tests may he used to measure how well the eardrum is working, to check for fluid in the middle ear or to diagnose other conditions not revealed by the usual tests.

Styles of Hearing Aid

After your hearing evaluation, you and your hearing professional are ready to select your hearing aid during a hearing aid consultation. Together you will decide which style of aid is really best for you, which features you need, and whether you need one or two hearing aids. Most of the hearing aids fitted today fall into one of four styles. These range from behind-the-ear models to the smallest units that fit completely within the ear canal.

The Right Hearing Aid for You
Your audiologist or hearing aid specialist will work with you to make the best all-around choice. This choice should reflect your needs, preferences and budget. When deciding, consider the following:

Your lifestyle and level of activity
Your physical characteristics, limitations and dexterity
Any medical condition you may have
Your cosmetic and style preferences
The amount you are willing to pay

One Aid or Two?
For some people, binaural (two) hearing aids may be recommended. The advantages are a better balance of sound (stereo hearing), better location of the sound source and greater ability to pick out sounds against background noise. Talk to your doctor or audiologist about what is best for you.

Behind-the-Ear (BTE)
For mild to profound hearing loss
All components in a small, slim case worn behind the ear
Sound conducted to earmould through a plastic tube
Larger controls, which are easier for some people to adjust
May work best for certain types of hearing loss

In-the-Ear (ITE)
For mild to severe hearing loss
All components contained in a housing that fits in the outer ear and extends into the ear canal
Sound conducted into the ear by the receiver in the canal
Adjustable volume control

In-the-Canal (ITC)
For mild to moderately severe hearing loss
All components in a housing that fits in ear opening and canal
Sound conducted into the ear by the receiver in the canal
Adjustable volume, with smaller controls
Less visible in the ear than ITE models

Completely-in-Canal (CIC)
For mild to moderately severe hearing loss
All components in a moulded housing that fits in the ear canal
Receiver located in the canal
No user-adjustable controls
Almost invisible in the ear
Wearer must have a fairly straight ear canal

Special Features
Today, thanks to electronic technology, many valuable features are available for hearing aids. Some of these may be right for you. Know that special features, especially those using the newest technology, will increase the cost of your hearing aid. Discuss your options with your hearing aid professional.

Telecoil. This feature prevents feedback (shrill whistling sounds) caused by putting the telephone handset too close to the hearing aid. Available in most BTE and ITE models.

Directional microphones. These are microphones built into the aid to emphasise sounds that you are facing (as in face to-face conversation). Available in many BTE and ITE models.

Digitally programmable hearing aids. These hearing aids allow the wearer to select from several preset listening "channels." These choices are adjusted for the sound quality and loudness of different listening situations such as a concert, noisy restaurant or park. Available in BTE, ITE, ITC and CIC models.

Fully digital hearing aids. These hearing aids use computer technology to produce a clearer sound and to automatically adjust various sounds to levels that are right for you. Available in BTE, ITE, ITC and CIC models.

Getting Your Hearing Aid

Once you and your hearing aid professional have decided which hearing aid is best for you, the fitting process can begin. Your hearing aid will be custom-made for you, using your audiogram as a guide. Your hearing aid should be ready for you about two weeks after your hearing aid consultation. Before you order your hearing aid, however, be sure you understand the features and cost of the aid you're buying; the trial period, instructions, warranty and service provided; and the return policy.

Making the Impression of Your Ear
Your hearing aid must be fitted to your ear if it is to work properly. Without a proper fit, you may have feedback problems and irritation in the ear canal. An impression of your ear canal will be made to provide the exact shape for the hearing aid. This process is painless. The audiologist or hearing aid specialist will probably use a silicone material that firms up in a few minutes and is easily removed. The impression mould is then sent to the manufacturer who will make your hearing aid.

Checking the Fit
When your hearing aid is ready, you will be called in for the fitting session. The audiologist or hearing aid specialist will check to make certain the fit is comfortable and that the aid is working properly. Some additional tests will be done to check the performance of the aid and the improvement in your ability to hear speech sounds. After the hearing aid specialist takes care of any fine-tuning needed, you'll be ready to start wearing and caring for your hearing aid.

Caring for Your Hearing Aid

The audiologist or hearing aid specialist will show you how to use your aid properly and how to care for it. This may take several visits during the trial period. Stay in touch with your audiologist or hearing aid specialist and discuss any problems. Be sure to ask questions if you need more information.

Daily Cleaning
Follow the instructions for regular cleaning provided by the manufacturer of your hearing aid.
Wipe the aid with a soft, dry cloth or tissue.
Never immerse the hearing aid in water or use any cleaning solvents.

Controlling Earwax
Earwax can plug your hearing aid and interfere with sound transmission. Wax that gets inside the aid can also cause the electronic parts to fail and may require expensive repair.
Your hearing aid specialist will show you how to clean the wax out and can suggest several types of wax guards that prevent build-up.
If you have excessive wax production, you may need to have your doctor remove the wax from your ear at least once a year.

Changing Batteries
Your hearing aid specialist will show you how to change the batteries correctly. Don't force the tiny batteries in.
Batteries last from 5 days to a couple of weeks, depending on their size and use.
Keep a small supply of fresh batteries on hand. Some types of hearing aid batteries fail suddenly. Others run down slowly.
Learn how to dispose of used batteries properly. Keep them out of the reach of children and pets. If swallowed or inhaled, they can cause serious injury.

Special Precautions
Your hearing aid is a delicate piece of equipment. Care for it as you would a fine watch or camera.
Do not expose it to water while bathing or swimming or to extreme heat or cold.
Protect the unit from small children who may drop, mishandle or even swallow it.
Do not leave it where it can be found by pets. Dogs find the high-pitched sound attractive and can quickly destroy an aid.
You may wish to ask your hearing aid specialist about insurance to cover any damage or loss that occurs after the warranty expires.

Living with Your New Hearing Aid

A hearing aid is an aid to better hearing, not a cure for hearing loss. People often have unrealistic hopes about their hearing aid and are disappointed when it fails to provide perfect hearing. Getting the most out of your new hearing aid means acquiring two new skills: learning how to use the hearing aid and learning new ways to hear. It takes effort to learn these new skills, but once mastered, they can help you overcome a hearing loss and open your way to a more active, enjoyable and rewarding life.

Adjusting to a New World of Sound
In the first week with your hearing aid, you'll be listening to the many strange, often loud, new sounds around you, including your own voice.
Start with quiet one-to-one chats with friends and family. Gradually move to more difficult situations, such as talking with more than one person.
Realise that making adjustments to the noise in restaurants, auditoriums and parties will take time.
Hearing loss often occurs slowly. Adjusting to your new hearing aid also takes time. It may take up to six months for you to achieve the full benefits offered by your hearing aid.

Tips for Better Listening
Start the conversation. Don't wait for others to speak to you first.
Move closer and position yourself so that the speaker's face is well lighted and you can easily see it clearly.
Watch the speaker's face, lips and gestures for clues to what's being said.
Relax. Don't strain to hear every word. People with normal hearing miss words and "fill in" from surrounding sentences.
Enlist the support of your family and friends during your adjustment period.
Install a telephone amplifier at home.
Wear your hearing aid. The more you use it, the better your results will be.

Learning New Ways to Hear
It's not easy to concentrate on a conversation in the midst of distracting background noise. Getting the most from your hearing aid means learning new ways to listen - and not always with your ears. Your audiologist or hearing aid specialist can recommend classes in auditory or aural rehabilitation (training to improve your hearing by learning new listening techniques). For example, you'll learn to pick out speech against background noise by watching the speaker's moving lips, facial gestures and body motions.

Better Communication Skills
An aural rehabilitation class provides an opportunity to resolve any remaining problems you may have with your hearing aid. These classes also offer counselling and support to help you and your family cope with the psychological and emotional aspects of hearing loss.

Hints for Your Family and Friends
Speak at a normal level. The hearing aid will amplify voices
Talk naturally and distinctly
Don't chew or smoke when speaking
Don't let your hands hide your mouth and face
Turn off the radio or TV. Background noise is distracting
Get the listener's attention before speaking. You may not be heard when speaking from another room or if the listener is near a source of noise.
Talk face to face. Lip movement, facial expression, and gestures are an important part of conversation.
If you're misunderstood, rephrase your comments. Don't repeat the same words.

Assistive Listening Devices (ALDs)

Designed to be used alone or in addition to a hearing aid, assistive listening devices (ALDs) amplify specific sounds you hear during your day-to-day activities. Whether you are talking on the telephone, visiting with a friend, watching TV or attending a concert, an ALD may help make your listening experience easier and more rewarding.

Telephone Amplifiers and Text Telephones
Your telephone can be equipped with an amplifier. Simply adjust the amplifier built into the phone handle to a sound level that's comfortable for you. Portable amplifiers, which slip over most telephone receivers, are also available. With a text telephone (called a TTY or TDD), you can "talk" to another TTY by typing your conversation. Messages from both parties are shown in writing on the lighted display screen. These devices may be available to you through your local telephone service provider.

Alerting Devices
If you have difficulty hearing certain sounds in your home, alerting devices - flashing lights, loud bells or vibrators - can be installed. These devices are activated by the sound of a telephone, doorbell, alarm clock, smoke alarm or crying baby.

Group Listening Devices
Many theatres, concert halls and meeting rooms are equipped with group listening systems. These systems can deliver quality sound to individual listeners in a large group setting.

Personal Communicators
Listening can be difficult in a noisy place, such as a restaurant or car. With a one-tone personal communicator, your companion's voice can be amplified well above the background noise level.

Television Listening Devices
A TV listening device enables you to amplify the sound coming from the television without disturbing the listening comfort of those around you.

Enjoying Your New Hearing

You can overcome many of the problems a hearing loss brings by using a hearing aid and assistive listening devices, and by learning new communication skills. Your improved hearing will make it easier to participate in the world around you and can open the way to a more active and rewarding life.