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The Future of Hearing is Here

FAQ

Get answers to frequently asked questions

How do I know if I have hearing loss?
What are the different degrees/types of hearing loss?
What is digital hearing aid technology?
What types of hearing aid technology are available?
What types/styles of hearing aids are available?
What are realistic expectations for the hearing aid user?
How do hearing aids work in the presence of background noise?
How are ear impressions made?
What is a middle ear implant?
What should I know about hearing aid batteries?

How do I know if I have hearing loss?

Hearing loss occurs to most people as they age. Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. In 2009, there were some 35 million people in the USA with hearing loss. Hearing loss is the single most common birth “defect” in America. Hearing loss in adults is common—30-40% of people over age 65 have it.
You may have hearing loss if…
  • You hear people speaking but you have to strain to understand their words.
  • You frequently ask people to repeat what they said.
  • You don’t laugh at jokes because you miss too much of the story or the punch line.
  • You frequently complain that people mumble.
  • You need to ask others about the details of a meeting you just attended.
  • You play the TV or radio louder than your friends, spouse and relatives.
  • You cannot hear the doorbell or the telephone.
  • You find that looking at people when they speak to you makes it easier to understand.
If you have any of these symptoms, you should see a hearing care professional to get an “audiometric evaluation.” An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed hearing care professional. An AE is not just pressing the button when you hear a “beep.” Rather, an audiometric evaluation allows the hearing care professional to determine the type and degree of your hearing loss, and it tells the professional how well or how poorly you understand speech. After all, speech is the single most important sound, and the ability to understand speech is extremely important. The AE also includes a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. The results of the AE are useful to the physician should the hearing aid consultant conclude that your hearing problem may be treated with medical or surgical alternatives.

What are the different degrees/types of hearing loss?
Results of the audiometric evaluation are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. Frequency (pitch), from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) (intensity) and is described in general categories. Hearing loss is not measured in percentages. The general hearing loss categories used by most hearing professionals are as follows:
  • Normal hearing (0 to 25 dB HL)
  • Mild hearing loss (26 to 40 dB HL)
  • Moderate hearing loss (41 to 60 dB HL)
  • Severe hearing loss (61 to 80 dB HL)
  • Profound hearing loss (greater than 81 dB HL)
Types of Hearing Loss
The external and the middle ear conduct and transform sound; the inner ear receives it. When there is a problem in the external or middle ear, a conductive hearing impairment occurs. When the problem is in the inner ear, a sensorineural or hair cell loss is the result. Difficulty in both the middle and inner ear results in a mixed hearing impairment (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain than the ear, and will be discussed only briefly.
Conductive hearing loss occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from earwax blocking the ear canal, fluid in the middle ear, middle ear infection, obstructions in the ear canal, perforations (hole) in the eardrum membrane, or disease of any of the three middle ear bones.
A person with a conductive hearing loss may notice that their ears may seem to be full or plugged. This person may speak softly because they hear their own voice quite loudly. Crunchy foods, such as celery or carrots, sound very loud and this person may have to stop chewing to hear what is being said. All conductive hearing losses should be evaluated by a physician to explore medical and surgical options. Conductive hearing loss represents approximately 10% of all hearing losses.
Sensorineural hearing loss is the most common type of hearing loss. More than 90 percent of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes to hearing and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. Sensorineural hearing loss is also called “cochlear loss,” an “inner ear loss” and is also commonly called “nerve loss.” Years ago, many professionals said there was nothing that could be done for sensorineural hearing loss – that is totally incorrect today. There are many excellent options for the patient with sensorineural hearing loss.
A person with a sensorineural hearing loss may report that they can hear people talking, but they can’t understand what they are saying. An increase in the loudness of speech may only add to their confusion. This person will usually hear better in quiet places and may have difficulty understanding what is said over the telephone.
Central hearing impairment occurs when auditory centers of the brain are affected by injury, disease, tumor, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although understanding of speech, also thought of as the “clarity” of speech may be affected. Certainly both loudness and clarity may be affected too.

What is digital hearing aid technology?
The term digital is used for most of today's current technology, from televisions to cell phones. Hearing aids today are also digital, meaning incoming sound is converted into a series of numbers, which is then processed using mathematical equations. Digital processing enables very complex manipulation of sound, for example, to separate speech from noise.
The digital technology within hearing aids also allows to separate sound into different frequency regions and amplify each region selectively, depending on the hearing aid wearer’s hearing loss. The processing within hearing aids also enables different amounts of amplification for soft, moderate, and loud sounds, so sounds are audible, but loud sounds are not uncomfortable or over amplified. And, digital processing enables a natural sound quaity with minimal distortion, resulting in excellent sound quality.
Digital hearing aids are programmable, meaning the hearing aid settings can be precisely fine tuned and special features can be adjusted for each wearer by a hearing aid professional, using special hearing aid software on a computer. Hearing aids are programmed and customized for both the hearing loss and the preferences of the person who wears them.
Advanced Technology
In addition to basic digital hearing aid technology, many hearing aid manufacturers offer several levels of advanced features made possible with digital processing technology. Digital hearing aids continue to advance and have become much more automatic and are equipped with sophisticated features for people who regularly encounter dynamic listening situations. Examples of of some of these advanced features, what they do and how they benefit the hearing aid wearer are:
  • Directional Microphones - Applies preference to sounds in front of the wearer and reduced sound from behind the wearer. This technology has been proven in studies to improve speech understanding in background noise.
  • Noise Reduction - Determines if signal contains unwanted background noise and reduced level of background niose if present. Background noise is less annoying and hearing aid wearer's listening comfort is improved in noisy situations.
  • Feedback Management - Reduces or eliminates whistling that can often occur with hearing aid use. Hearing aid wearer's comfort is improved from annoying whistling.
  • Wind Noise Reduction - Reduces the noise created from wind blowing across the hearing aid's microphone(s). Designed to improve comfort for persons who spend a lot of time outdoors.
  • Data Logging/Learning - The ability of the hearing aid to track and learn the hearing aid wearer's preferences in various listening environments. This information can assist the hearing professional in making future programming adjustments and allows the hearing aid to adapt to the wearer's preferences.
  • Bluetooth Interface - Establishes a wireless connection between hearing aids and Bluetooth compatible devices. Designed to improve wearer convenience and use with devices such as cell phones, Mp3 players, computers, TV, etc.

What types of hearing aid technology are available?
There are essentially three levels of hearing aid technology. We refer to these as analog, digitally programmable, and digital. At Future Hearing of San Leandro we dispense only the highest level of technology, which is digital hearing instruments.
ANALOG technology is the technology that has been around for many decades. Analog technology is basic technology and offers limited adjustment capacity. It is rarely used today and is becoming obsolete.
DIGITAL technology is the most sophisticated hearing aid technology. Digital technology provides maximum control over sound quality and sound processing characteristics. There are qualitative indications that digital instruments do outperform digitally programmable and analog hearing aids. The digital technology ranges from basic to advanced devices. A person's lifestyle is the determining factor to decide which will be most beneficial.

What types/styles of hearing aids are available?
There are many types of hearing aids today and the type of hearing aid is dependent upon both the style chosen and technology chosen.
Styles of Hearing Aids
Hearing aids are available in many different sizes and styles thanks to advancements in digital technology, miniaturization of digital electronic part and fresh focus on design among the hearing aid manufacturers. Many of today's hearing aids are considered sleek, compact and innovative - offering solutions to a wide range of hearing aid wearers.
When selecting style the following is considered:
  • The degree of the hearing loss (power requirements)
  • Manual dexterity abilities
  • Patient budget

In-the-Ear-Styles
Completely-In-the-Canal (CIC) - The smallest custom hearing aids made, CICs sit deeply and entirely inside the ear canal. They usually require a “removal string” due to their small size and the fact that they fit so deeply into the canal. They fit mild to moderate hearing loss and offer high cosmetic appeal.
In-The-Canal (ITC) sit in the lower portion of the outer ear's bowl and are slightly larger than a CIC hearing aid. Because of their slightly larger size, the often have a longer battery life than CICs and come available with more options depending upon the size of ear. They fit mild to moderate hearing losses.
Half-Shell - The half shell model fills half of the bowl of the outer ear and like ITC hearing aids, the alow more options and longer battery life due to the larger size. This size is ideal for persons seeking a smaller hearing aid that may have potential dexterity concerns.
Full Shell or In-The-Ear (ITE) - The largest of the custom hearing aids made, full shell hearing aids fill up the entire bowl of the outer ear. This size of this style allows the maximum number of controls and features, and is able to fit mild to severe hearing losses.
Behind-the-Ear (BTE) Styles
Mini-BTE with slim tubes - This type of BTE is often referred to as an "open fit" hearing aid. The small miniature hearing aid sits behind the ear and transmits sound into the ear canal via a thin plastic tube. The tubing connects to a soft tip that sits in the ear canal but doesn’t occlude it. The result is a natural, open feeling as airf and sound enter the ear naturally around the tip, while amplified sound enters through the tip. This style of BTE is recommended for mild to moderate high frequency losses and offers cosmetic appeal to the small size of the hearing aid.
Receiver-in-the-Ear (RITE) - RITE hearing aids, also known as Receiver-in-canal (RIC) models, are similar to the mini BTE however instead the speaker of the hearing aid sits inside the ear canal versus the main body of the hearing aid behind the ear. Although it looks like a mini BTE when worn on the ear, the RITE style fits a higher degree of hearing loss (mild to severe), while still providing the "open" fitting.
BTE with custom earmold - BTEs with custom earmolds fit the widest range of hearing loss, from mild to profound. They are slightly longer in shape and are contoured to sit nicely behind the ear for a sleek, compact look. This style of hearing aid typically offers a wide array of features and options, as well as more control and power than custom models. BTEs are connected to the ear canal via custom-made plastic tubing and earmold. The earmold color and style, as well as the wearer's hairstyle will determine how this style looks on each person.
Hearing Aid Technology
A wide range of technology and a whole host of features are available in each hearing aid style. The cost of hearing aids generally depends on the technology and the number of features the instrument has, and not necessarily on the style selected.
Today's digital hearing aids are typically offered in various levels such as basic or entry-level to advanced or premium-level. Within each level, different technology and features are available.
Basic digital hearing aids generally require the wearer to make some manual adjustments in certain listening environments such as turning a volume control up or down, or pushing a button to change listening programs. In contrast, a premium or more advanced hearing aid responds automatically to changes in the listener's environment, making changes based on the signals being detected by the hearing aid. The hearing aid wearer is not required to make any manual changes.
As the level of the technology increases in hearing aids, so do the availability of advanced features. Examples of some of the advanced features found in today's digital hearing aids are shown below.
  • Directional Microphones - Applies preference to sounds in front of the wearer and reduced sound from behind the wearer. This technology has been proven in studies to improve speech understanding in background noise.
  • Noise Reduction -Determines if signal contains unwanted background noise and reduced level of background niose if present. Background noise is less annoying and hearing aid wearer's listening comfort is improved in noisy situations.
  • Feedback Management - Reduces or eliminates whistling that can often occur with hearing aid use. Hearing aid wearer's comfort is improved from annoying whistling.
  • Wind Noise Reduction - Reduces the noise created from wind blowing across the hearing aid's microphone(s). Designed to improve comfort for persons who spend a lot of time outdoors.
  • Data Logging/Learning - The ability of the hearing aid to track and learn the hearing aid wearer's preferences in various listening environments. This information can assist the hearing professional in making future programming adjustments and allows the hearing aid to adapt to the wearer's preferences.
  • Telecoil/Auto-telecoil - This feature picks up a signal from a compatible telephone and hearing aid wearers can listen to the telephone without whistling. Some hearing aids this requires a push of a button to activate, other manufactuers offer an auto-telecoil where the hearing aid switches automatically when a telephone signal is detected.
  • Bluetooth Interface - Establishes a wireless connection between hearing aids and Bluetooth compatible devices. Designed to improve wearer convenience and use with devices such as cell phones, Mp3 players, computers, etc.

What are realistic expectations for the hearing aid user?
Hearing aids work very well when fit and adjusted appropriately. They amplify when you have hearing loss to provide clarity of speech. You might find that you like one hearing aid better than the another. Hearing aids should be comfortable with respect to the physical fit and sound quality. Hearing aids do not restore normal hearing and are not as good as normal hearing. You will be aware of the hearing aids in your ears. Until you get used to them, your voice will sound louder. Hearing aids should not to be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable, however, hearing aids cannot eliminate background noise. Hearing aids can reduce background noise with use of directional microphones that can improve speech understanding up to 40% than hearing aids without directional mics.
Your Own Voice:
When you wear hearing aids for the first time, you will probably notice your voice sounds louder. You will hear your voice amplified through the hearing aid. You may describe this sensation as feeling “plugged up” or hearing your voice echoing. This is normal and will usually go away in a few days after you have given yourself a chance to get accustomed to your new hearing aids and learned to adjust the volume control. There are adjustments that the practitioner can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.
Getting Used to Hearing Aids:
People learn at different rates. Some people need a day or two to learn about and adjust to their hearing aids, most need a few weeks and some may need a few months. We usually recommend you wear traditional hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Over a period of time you will lengthen the amount of time that you wear the aid. Eventually you will wear the hearing aids most of your waking hours. It is recommended that you interact with those people you are most familiar with during your first few days. Start off listening with your hearing aids in a favorable listening environment and work towards more difficult listening situations. Let your friends and family know that you are using your new hearing aids. You will hear sounds that you may not have heard for years. Your brain will adapt to these sounds quickly, but this process may last up to one year.
Helpful Steps to Learning to Use a Hearing Aid:
  • Use the aid at first in your own home environment.
  • Wear the aid only as long as you are comfortable with it.
  • Accustom yourself to the use of the aid by listening to just one other person – husband or wife, neighbor or friend.
  • Do not strain to catch every word.
  • Do not be discouraged by the interference of background noises.
  • Practice locating the source of the sound by listening only.
  • Practice learning to discriminate different speech sounds.
  • Listen to something read aloud.
  • Gradually extend the number of persons with whom you talk, still within your own home environment.
  • Gradually increase the number of situations in which you use your hearing aid.

Physical Fit:
One concern with all new hearing aids is the physical fit. Hearing aids need to be comfortable, not too tight and not too loose, they should fit just right. Do not wear the hearing aids if they cause any discomfort or irritations. Do call your practitioner to schedule an appointment time to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.

How do hearing aids work in the presence of background noise?
Background noise exists and is important to hear in order for the hearing aid user to be involved in their environment. There is no way to completely eliminate background noise, however, technology exists today to reduce distracting noise and allows you to focus better on the person you want to hear. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.
Remember, when you had normal hearing there were still times when background noise was a problem. It is no different now, even with properly fit hearing aids! The good news is there are circuits and features that help to reduce (or minimize) background noise and other unwanted sounds. In fact, there are research findings that demonstrate digital hearing aids with particular circuit and microphone options can effectively reduce background noises.
Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter, however, not only was the background noise made quieter, but so too, was the signal (the speech sound).
Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect.
The best and most efficient way to eliminate or reduce background noise is through the use of FM technology.

How are ear impressions made?
All custom made hearing aids and earmolds are made from a “cast” of the ear known as an ear impression. An ear impression is made in the office in just 10 to 15 minutes. First, a special foam or cotton dam is placed in the ear canal to protect the eardrum, followed by a waxy material that hardens into a cast of the ear canal. Both the wax cast and the dam are then removed.
The ear canal is often “oily” after the impression is removed. This is normal, as the oil helps prevent the cast from sticking to the skin.
If you are allergic to plastic or dyes, please tell your practitioner before the procedure begins.

What is a middle ear implant?
In order to be fit with a Middle Ear Implant (MEI), one requires a purely sensori-neural hearing loss. Since MEIs are better at generating mid- and high-frequency gain than low-frequency gain, the optimal hearing loss should be sloping. Many MEIs can be digitally programmed or are in fact digital. With the extra control that these technologies afford, other sensori-neural configurations can be fit. Although the various surgeries are not complicated, they can be lengthy (up to 3 hours) and like any surgery, can be traumatic. A MEI candidate is therefore one who has tried conventional hearing aids and was unsuccessful either because (i) they were not able to obtain as much high-freuency amplification as required, or because (ii) the occlusion effect (Vagal response) could not be resolved to the satisfaction of the patient. While the cosmetic issue is important, I am not convinced that this should be the primary deciding factor, given that CIC hearing aids can be made quite small with newer technology. There are several companies working on new MEIs that are in the experimental phase.

What should I know about hearing aid batteries?
Hearing Aid Batteries
All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery it is a medical emergency and the individual needs to see a physician immediately.
One question often asked is “How long does the battery last?” Typically they last 7-14 days based on a 16 hour per day use cycle. Batteries are very inexpensive, costing less than a dollar each. Generally, the smaller the battery size, the shorter the battery life. The sizes of hearing aid batteries are listed below along with their standard number and color codes.
Color, size, approx. number of days:
  • Yellow, #10, 3-4 days
  • Brown, #312, 8-10 days
  • Orange, #13, 12-14 days
  • Blue, #675, 25-30 days
Today’s hearing aid batteries are “zinc-air.” Because the batteries are air-activated, a factory-sealed sticker keeps them “inactive” until you remove the sticker. Once the sticker is removed from the back of the battery, oxygen in the air contacts the zinc within the battery, and the battery is “turned-on”. Placing the sticker back on the battery will not prolong its life. Since many of today’s automatic hearing aids do not have “off” switches, opening the battery door at night assures that the device is turned off. Zinc-air batteries have a “shelf life” of up to three years when stored in a cool, dry environment. Storing zinc-air hearing aids in the refrigerator has no beneficial effect on their shelf life, in fact, quite the opposite may happen. The cold air may actually form little water particles under the sticker. Water is made of oxygen and hydrogen. If the water vapor creeps under the sticker, the oxygen may contact the zinc, and the battery could be totally discharged by the time you peel off the sticker! Therefore, the best place to store batteries is in a cool dry place, like the back of your sock drawer, not the fridge!