Hearing Care
 Hearing Loss
A loss of hearing is often interpreted as a loss of mental acuity inattention of those experiencing it. Younger people who are trying to communicate with victims of hearing loss can often become impatient and demonstrate their annoyance. To avoid this unfortunate misunderstanding, it is very important to recognize signs of hearing loss and to have a strategy to bridge the communication gap.
Sufferers also need to understand and accept the realities of hearing loss, or else they will feel left out, isolated and less inclined to socialize in groups. Trying to follow the thread of a conversation can be frustrating, even exhausting if others don’t know how to speak in a manner that compensates for hearing loss.
The following reviews different characteristics of hearing change, three types of hearing loss and the reasons behind them and finally, communication strategies that will facilitate clear understanding and enjoyable dialogue for all parties.
One third of those who are 60+ years old and half of those who are 85+ years old
27.8% of people with hearing problems said it began at or after age 65
Ranked as first in the overall stress of aging
Linked to depression, reduced functional health, social withdrawal
Many seniors who appear confused, antisocial, or demented may simply suffer from a hearing disorder
What causes hearing loss?
When we hear properly, our outer ear captures a sound wave and funnels it down the ear canal to the eardrum in the middle ear. The eardrum vibrates, and the sound is amplified and transmitted to the cochlea, or inner ear. In this tube filled with fluid, thousands of sensory cells that look like tiny hairs flex and bend in response to the vibrations. These sensory cells are made of unique proteins not found anywhere else in the body. They generate electrical impulses that travel along the auditory nerve to the brain, which then translates them into sound information. A glitch anywhere along the route can cause hearing problems.
If sound can’t pass through your middle ear, you have what is called a conductive hearing loss. It can result from a wide variety of diseases and conditions such as wax buildup or bacterial infection and it usually doesn’t last. Treatments are normally successful, and only occasionally will scarring cause permanent damage.
Most hearing loss is related to the inner ear, specifically the cochlea and is called sensorineural hearing loss. Hearing problems may result from aging, infections, heredity or noise damage. Noise damage can occur when loud and/or continuous noise assaults the ears. The hair cells in the cochlea stand up when they are healthy, but if they become damaged by too much vibration, they will flop down and eventually disappear.
Common Types of Hearing Problems
- Changes can occur in the following hearing characteristics:
- Volume
- Frequency
- Discrimination
- Processing
Possible auditory Problems:
Prescycusis
Conductive hearing loss
Central auditory impairment
Tinnitus
Dizziness/vertigo
Auditory – 3 Types of Loss
- Conductive hearing loss
- Sensorineural hearing loss
- Central auditory impairment
Tell Your Friends and Family These Communication Strategies
- Be patient
- Don’t yell. Increased volume doesn’t translate into clarity and you will look angry even if you don’t mean to
- Speak from your diaphragm and lower your tone.
- Talk face-to-face so they can clearly see you
- Pronounce your words and slow your pace down.
- Eliminate background noises by turning off the TV, radio, or shutting the window.
- Repeat your message and choose different words to get your point across
- Have them repeat the message back to you.
Hearing instruments
Hearing Aids
How do hearing aids perform with background noise?
Background noise is present in everyone's life. Unconsciously, the brain filters out most background noise. During hearing loss, the brain becomes lazy in this process because all sounds are reduced or inaudible. When an individual begins using the hearing aid all sounds are once again heard and it is necessary to retrain the brain in selective listening skills. It is critical that the hearing aid consumer participate in follow-up and counseling sessions during this period of adjustment.
Behind the ear aids (BTE)
BTE aids have a small plastic case that fits behind the ear and conducts sound to the ear canal, usually through an earmold that is custom made. BTEs can be used for mild to profound hearing losses. Recent innovations in BTEs include miniature "invisible" BTEs with thin hair-like sound tubes. These are often less visible than In-The-Ear (ITEs) and some keep the ear canal more open so listeners may still utilise their residual natural hearing which is helpful for those with normal hearing in the lower frequencies.
In the ear aids (ITE)
These devices fit in the outer ear bowl (called the concha); they are sometimes visible when standing face to face with someone. ITE hearing aids are custom made to fit each individual's ear and can be used in mild to some severe hearing losses. Feedback, a squealing/whistling caused by sound leaking out of the aid and being amplified again, may be a problem for severe hearing losses. Some modern circuits are able to provide feedback regulation or cancellation to assist with this.
In the canal (ITC), mini canal (MIC) and completely in the canal aids (CIC)
ITC aids are smaller, filling only the bottom half of the external ear. You usually cannot see very much of this hearing aid when you are face to face with someone. MIC and CIC aids are even smaller and often not visible unless you look directly into the wearer's ear. These aids can be used for mild to moderately-severe losses. CICs are usually not recommended if you have good low frequency hearing.
Open-fit devices
Recently a new device has come on the market, the "Open-fit" or "Over-the-Ear" OTE Hearing Aid. Usually quite discrete, these are small Behind-the-ear type devices, with a much finer clear tube that runs down into the ear canal. Inside the ear canal, there is a small soft silicone dome or a molded, highly vented acrylic tip that holds the tube in place. There are also devices available which have an external speaker, placed inside the ear canal, and connected to the hearing system itself by a thin wire. The external speaker allows the device behind the ear to be even smaller. These devices are designed to reduce the "occlusion effect", which is the amplification of your own voice. If you stick your fingers in your ears and speak, you will closely simulate this effect. However, they also increase the possiblity of feedback and for that reason are limited to moderate high frequency losses.
Bone Anchored Hearing Aids (BAHA)
The BAHA is a surgically implanted auditory prosthetic that uses the skull as a pathway for sound to travel to the inner ear. It is very effective for people with conductive losses because the BAHA bypasses the external auditory canal and middle ear, stimulating the functioning cochlea. For people with single sided deafness, the BAHA uses the skull to conduct the sound from the deaf side to the side with the functioning cochlea.
Hearing aid technology
Wireless
FM listening systems are now emerging with wireless receivers that are integrated with hearing aids. A separate wireless microphone can be given to a partner to wear in a restaurant, in the car or in another room. The voice is transmitted wirelessly to the hearing aids reducing the effects of distance and background noise.
Many theatres and lecture halls are now equipped with assistive listening systems that transmit the sound directly from the stage; audience members can borrow receivers and hear the program without background noise. And that is a fantastic feature for the listener because background noise makes listening a tiring strain.
Directional microphones
Many hearing aids now have directional microphones, which can be a major improvement in crowded places such as restaurants and open-plan offices, because the directional microphone allows the user to focus on whoever is directly in front with reduced interference from conversations behind and to the sides. Directional microphones are currently the best way to improve the signal to noise ratio, and thus, improve speech clarity in noise for the wearer.
Adaptive directional microphones are a recent improvement. The hearing aid processor is able to distinguish between noise and speech and can automatically reduce the particular noise source from a certain angle. The limitations are at the identification level, where a noise that behaves like a speech signal is difficult to identify. In severe background noise, the directional microphone is less efficient.
The recently introduced eyeglass aid by the Dutch company Varibel uses four microphones on each side of the frame of a pair of glasses that, together, work as two directional microphones. Technology inside the frame is able to discern between sounds coming from the front and sounds coming from the sides or back, amplifying the sound from the direction the wearer is looking and suppressing sounds from the side.
Telecoil
Telecoils (T-coils) allow different sound sources to be directly connected to the hearing aid which improves sound quality and allows the hearing aid wearer to easily perceive the intended signal dispite background noise. They can be used with telephones, FM systems, induction loop systems and public address systems. An unfortunate problem with T-coils is that they can pick up lot of buzz from sources of electromagnetic fields, such as computers, electric cables, cellphones etc.
DAI
Direct Audio Input (DAI) allows the hearing aid to be connected to an external audio source like a CD player or an assistive listening device (ALD). This is preferred by many users, as opposed to using a T-coil with a standard set of headphones because there is less buzzing interference.
What to do if hearing loss is suspected?
The first step is to visit a hearing professional, also called an audiologist, who will test your hearing. Unlike most medical tests, the tests to measure hearing ability are quick and painless. An audiologist or hearing instrument specialist will probably perform three or four simple exams, which may include:
Audiologists near you
These tests are performed at a hearing professional’s office and usually take less than an hour to complete. With the information your hearing professional gathers from these tests, an accurate assessment of your hearing capabilities will be mapped out and you will be advised of all your treatment options. In most cases a hearing instrument will be recommended. If a medical problem is found, your hearing professional will refer you to a physician for next steps.
Hearing and Sound Level Testing
If you are curious or concerned about your hearing, try visiting www1.freehearingtest.ca to take a fun and informal test in the comfort of your home. This is by no means a professional test and shouldn’t be used as anything but a cursory trial. If you or your loved ones are concerned about your or a family member’s hearing, book an appointment to take a hearing test.
The Audiologist
The audiologist will most likely test your hearing in a number of different ways, to determine where the hearing problem is located. At the end of your hearing test, ask the audiologist to explain the tests he or she performed and tell you what the results mean. He or she will conduct a number of tests that can include:
- Otoscopy, or looking into the ears with a lighted scope;
- An audiogram, a sound check that produces a mapping or graphical representation of hearing ability;
- A tympanogram, which measures the pressure of the inner ear and assesses the ear drum’s mobility.
Your History
Your audiologist will first ask you a few questions about your medical history, noise that you have been exposed to at or outside of work and if any physical damage has ever occurred to your ears. This helps the audiologist decide the best way to assist you with your hearing loss.
Looking into your ear
The audiologist will use an otoscope to see into your ear better and determine if there are any abnormalities in the ear canal or eardrum.
The sound booth / room
Next, you will be seated in a quiet sound room. It looks the same as the booth they mix soundtracks in, but you won’t be recording hit songs here. Rather, it is to makes sure outside noises will not interfere with test results.
The pure tone tests
You will be asked to place, either a set of headphones over your ears or, to insert a small set of earplugs into your ears. The headphones will deliver a series tones into your ears. An audiometer electronically generates these "pure tones" which vary in tone and volume. This test helps the audiologist to determine the threshold at which a patient hears different frequencies. Each ear is tested individually. You will indicate when you hear a tone by raising your hand or pushing a button.
Test of the Middle ear
The audiologist may also check the middle ear with an impedance test. A probe is placed in your ear and air pressure is increased and then decreased while a tone is presented. A graph will be generated with the results of the test.
Test Results
Depending on the test results, there may be other hearing tests performed. The audiologist will then take the whole pile of graphs, papers and reports and explain what they mean with a graph called an audiogram
An audiologist should take the time to explain your test results. Remember, there are no stupid questions. If you have any questions, or don't understand something, just ask. It is your hearing and you have a right to know.
There is Help
If you do have a hearing problem, there is a lot of help out there, although not everyone is taking advantage of it. According to the Canadian Hearing Society, one in five people with hearing loss would rather struggle along with their condition rather than get a hearing aid. Some are embarrassed or feel they risk losing their sense of pride. Many others have tried older hearing aids, which were very difficult to use because they amplified all sounds – speaker and background alike. Newer, digital hearing aids ranging between $1000 and $4000 have built in smarts that allow them to do a much better job selecting the sounds you want amplified.
Audiologists as Entry Point to Health Care, 1995, AmericanAcademy of Audiologist Conference.
Self Help for Hard of Hearing People Journal, May/June 1997.
www1.freehearingtest.ca
www.hearingcenteronline.com Daniel Allen, B.Sc., M.A.I.S., CCC-A, Audiologist
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