HEARING AID AND HEARING PROBLEMS - FREQUENTLY ASKED QUESTIONS
Q: My father went to one of those places running the full page hearing aid ads in the paper. Not only did they try to sell him the most expensive hearing aids they had, they also told him if he didn’t wear 2 hearing aids he’d lose his remaining hearing. Is this true?

A: No, it’s not true. You have 2 ears for more reasons than to keep your eyeglasses in place. Most people do hear better with 2 hearing aids. The sound is more natural, speech is clearer, there is less feedback, localization of sound may be improved and you no longer need to put your best (aided) ear forward. Many people we see who wear 2 hearing aids feel severely limited any time they have to be without one of them. However, many people wear one hearing aid with good success. Some people are very comfortable with a hearing aid only on one side. At times it makes your own voice sound better or your head feel less full. Some times it is less confusing for a person to have only one hearing aid to manage. There is some recent research that suggests some people hear better in background noise with only 1 hearing aid. This is contrary to conventional wisdom but the study completed by Walden and Walden at Walter Reed Army Medical Center was well done. However, if there is a compelling reason to use only 1 hearing aid (dexterity, finances, dementia, etc.), that is OK. If you are successful with 2 hearing aids except in noisy situations, try alternating hearing aids to see if things clear up. And as always, if you need more help schedule an appointment to see us.

Q: My new in-the-ear hearing aid has a wax trap that looks like a little white circle on the tip that sticks down into my ear. It seems like it has to be replaced about every month, usually at an inconvenient time. Do I really need this wax trap?

A: Oh, boy, did you ever walk into the hornet’s nest with that question. It’s like asking your dentist if you have to floss. Hearing aids hate ear wax. From the very beginning, the leading cause for repair of custom aids (in-the -ear; in- the canal; completely-in-canal) has been earwax getting into the loudspeaker. Wax loops have always been provided for cleaning the tubing that delivers the sound to the ear but even if you clean faithfully (like flossing your teeth) some wax works its way deep into the hearing aid. Over time enough wax will accumulate to block the sound and the hearing aids will not work. Earwax is not a problem for everyone. We see ears that never have any wax. We see ears that used to be very waxy that aren't any longer. We see ears that used to be dry that now make wax. We want your hearing aids to stay in your ears in good working condition. Everyone hates sending an aid to the factory for repair. Even if it’s covered under warranty and there’s no expense, it is frustrating to be without it. We have been using the “little white circle” wax traps for about 2 years. During that time repairs have been reduced by more than 50%. Our default is to order hearing aids with the wax trap. Now there is more good news. We do not charge for wax traps when they are included with a new order. Furthermore, we do not charge for replacement wax traps. One more thing, if your hearing aid has a wax trap and you don’t like it, you can simply remove the “white circle” and forget it.

Q: Why are hearing aids so expensive?

A: The cost of basic hearing aids has not changed in more than 7 years. The increased cost of hearing aids is based on new digital processing technology. The first digital processing hearing aid to be developed cost over 34 million dollars and took 7 years to create. Because there are less than 1.2 million hearing aids sold in the U.S. to 20% of people with hearing loss, the high cost of research and development cannot be amortized over millions of units, making the cost per unit higher. Hearing aids are a medical product and are strictly regulated by the FDA. Hearing aids are not a one-size-fits-all product but must be custom made and custom fit by professional audiologists. There is a 30 day trial before purchasing a hearing aid and most digital products have a 2 year warranty and a 1 year loss and damage policy. I know of no other medical product or consumer product that offers this protection. Manufacturers continue to develop new technology to improve the listening experience for the client, to decrease size to appeal to the aesthetic aspect and to improve quality so the product withstands heat, moisture and abuse from the user.

Q: My friend just got a new hearing aid that looks like a little bug with a wire running into it. I’ve never seen anything like it. What can you tell me?

A: These began appearing a few years ago but in the last several months every major manufacturer has introduced at least one “mini open”. These devices were designed for milder forms of hearing loss. They’re best for people who hear low pitch sounds reasonably well but have some trouble hearing high pitch sounds. They are extremely small and hard to see behind the ear. They have a very fine tube (not a wire) that runs from the hearing aid into the ear canal where they have a “mushroom” shaped tip at the end. They can hardly be felt. One of the major benefits is the ear does not feel plugged and the wearer’s own voice remains very natural. The digital processor within the hearing aid controls feed back that would otherwise be a problem. I’m sure you know from reading this column that we’re not going to tell you these are for everyone. These “mini open” hearing aids do fill an important niche. If you have any more questions, give us a call.

Q: I can’t use my hearing aid on the telephone. Every time I try to answer the phone the hearing aid squeals. Is there anything I can do?


A: It seems like hearing aids and telephones have been feuding with each other forever, like the Hatfields and McCoys. Almost always there is a solution. How we approach the problem depends on the severity of your hearing loss and the type of hearing aids you wear. The real problem is feedback - that squeal, squawk, chirp, twitter, totally annoying sound that you hear when an object approaches your hearing aid. If we get rid of the feedback, the phone is probably not going to be a problem.

Here’s what we might consider in trying to improve your situation: How’s the fit of the hearing aid? If it’s loose, its probably going to feedback on the phone. Again, your audiologist can check to see if it needs attention. Does your hearing aid have an air hole (vent)? If it’s very large, it’s probably going to feedback on the phone. Again, your audiologist can check to see if it needs attention. Does your hearing aid have a telecoil
(T-Coil)? Hearing aids with T-Coils usually have a switch, like a light switch, that you move before you hold the telephone to your ear. This will eliminate the feedback. If the telecoil has adequate strength you will hear well with phones that are compatible. This includes all land phones that have been made in at least the last 15 years. Is an automatic T-coil the answer for you? Some people can’t feel the telecoil switch or find it confusing. If this is you, you may be able to use an automatic T-Coil. These devices have an internal switch that activates when you hold telephone close to the hearing aid. We’ve been very impressed with how easily and reliably they work. Unfortunately, they aren’t available on all hearing aids. Tip your phone a little away from the hearing aid or hold the phone a little higher on your ear. Try a speaker phone. No way will your hearing aid feedback with one of these. (Plus you can have multiple people listen in on the conversation if you want.) Amplified telephones also are great. They come in different strengths for different hearing losses. You can use amplified phones with your hearing aid, turn the volume control down a bit to stop the feedback.

Q: Do all older people have hearing problems?

A: No, it’s not inevitable. We see older adults with very good hearing. (Although, not very many...why would they come see us if they heard well?) In the U.S. it is estimated that 1 in 3 adults beyond retirement age have some hearing difficulty. The numbers increase as age goes up. Hearing loss that is due entirely to aging is called presbycusis. In our society most hearing loss is a combination of aging, other health issues, noise exposure and perhaps even diet and stress. This type of combination hearing loss is called sociocusis. Individuals in less industrialized societies don’t experience the same amount of difficulty. So, like your mother told you years ago: eat a balance diet, exercise, turn that music (or jack hammer) down and take time to enjoy life.

Q: My hearing aids are 6 years old. How long can I expect them to last? If they malfunction, should I repair them or replace them?


A: I wish I had a short and simple answer. Let me walk you through the thought process I take when someone comes in with a broken hearing aid. The mechanical and electronic parts of hearing aids should last more than 5 years. However, like a car, they may need some service from time to time. We don’t do grease and oil changes but we can do very thorough cleaning and minor repairs in the office that solve many problems. More serious malfunctions require service by the manufacturer. I wouldn't hesitate to repair a hearing aid of this age unless you were never really happy with it.
Hearing aids that are 6-8 years old are still good candidates for service when they malfunction if you were hearing well with them. Hearing aids over 8 years old can usually still be repaired but it may not be the best way to spend your money. Chances are really good that after 8 years your hearing requires a different prescription or that better technology is available.

I would always consider the cost of repair versus the cost of replacement. If you have a basic hearing aid it could be replaced for about $800 as compared to repairing it at a cost of about $200. However, if you have a more sophisticated hearing aid that cost $2500, a repair bill of $250 seems a lot more tolerable. You should also think about your insurance benefits. Many of you have insurance that will pay for all or part of the cost of new hearing aids. Almost none of them will pay for a repair. So, are you better off to spend $200 for a repair or nothing for new aids?
One final thought. If you have been extremely happy with your hearing aids you may want to lean more in the direction of repair. There is a lot to be said for the familiarity and consistency of the sound and feel after several years with the same instrument.

Q: My friend just had surgery that corrected her hearing problem. Could this work for
me too?

A. This is a very common question. The most common type of hearing loss is sensorineural. This type usually is the result of damaged or deteriorated hair cells in the inner ear. Sensorineural hearing loss can be caused by intense sound, trauma, disease, medications, heredity or many other factors. Most people who acquire hearing loss with increasing age have sensorineural hearing loss. The other common type of hearing loss is conductive. This type results from problems affecting the ear canal, ear drum or middle ear bones. It can result from trauma, disease, infection, heredity or other factors. Of these 2 types of hearing loss, the conductive type is more often treatable surgically.

Q: I’ve had my hearing aids for about 2 months and like them very much. I hear so much more clearly and the sound quality is excellent. However, my own voice sounds different. It sounds loud to me so I speak softer. Sometimes it sounds like I have a head cold or like my “head is in a barrel”. Is this normal? Can you make it better?

A. No, it’s not normal but it’s common. Let me explain. When you put your hearing aids on, two things happen that cause your problem. First, your ear canal is totally or partially blocked. Try talking with your hand pressed tightly against your ear without your hearing aid and you’ll get a similar sound. Anytime you block the ear canal self-generated sounds, such as talking or chewing (you’ll want to give up that potato chip habit), are loud. The second thing to happen is your own voice is being amplified. Without a hearing aid, you hear your voice mostly as it travels through the bones of your skull to you ear. With a hearing aid, your voice is also picked up by the microphone and amplified. Did you ever hear yourself from a tape recorder? Almost everyone says, “Do I really sound like that?
Now that you know what causes the problem, let’s get to the ”can you make it better” part. The simple answer is usually. Mother Nature is a great help to us here. Often over a period of time the odd sound quality of your voice becomes natural. Sometimes the voice is just too loud and it does not correct itself. In these cases, we modify the earmold or hearing aid to increase the amount of air flow through a vent hole or we adjust the internal settings of the hearing aid. In extreme cases it may be necessary to change hearing aid styles to a model that will allow us to leave the ear canal almost entirely open. These adjustments solve the problem in most cases.

Q: My husband recently got new hearing aids. He hears much better but still doesn't hear me from the another room. What's wrong.


A. Hmmmm. Does he hear you better if you're telling him the ball game is about to come on TV or when you ask him to clean the gutters? Seriously, this is a very commen concern for the spouse. Why don't the new hearing aids entirely correct the problem? As usual the answer is perhaps a bit more complex than you were expecting.
First, let's not overlook the obvious. There really could be something wrong with the hearing aids. I'm assuming these are new instruments and you are still in the process of having them fit. Talk with your audiologist about your concern and find out if there is any adjustment that will improve the situation.
Next, let me tell you about a major limitation of hearing aids. Distance. The farther you are away from the hearing aid wearer the more difficulty they will have hearing you. This is true even if your hearing is perfect. Hearing aids are at there best when you're in the same room as the wearer.
Finally, and this is really the important part of the answer, you need to change your communication patterns. Hearing loss affects the entire family, not just the person with the hearing loss. Hearing aids or not, people hear better when they are in the same room, looking at one another, without a lot of distracting sound. Who knows, you might find that you really like spending time close together. So, give your spouse (and yourself) a break. Come into the same room and get his attention before you start talking.

Q: Does anyone like their hearing aids? It seems that everyone I know with hearing aids complains about them. My wife doesn't even hear me when she's in the next room.

A: Hmmmm......sounds to me like you're the one complaining. Do you hear your wife when she talks to you from the other room? I'll bet she comes into the room before she talks to you. I'll even bet you believe the full page ads that say, "You'll never say 'huh' again"! Hearing aids do not give super-normal hearing. However, carefully chosen and fit instruments provide tremendous improvement. Enough tongue lashing for now. Yes, lots of people like their hearing aids. Many could not get along without them. Hearing aids do not restore hearing. They certainly have limitations. As you probably remember, any new hearing aid purchased in this office has a trial period during which it can be returned for a full refund if the patient is not satisfied. Historically we have about 2% returns and last year it was less than 0.5%. We recognize that not returning your hearing aid is not the same as saying you love them. So, last year we began asking our patients to complete satisfaction surveys about 3 months after getting new hearing aids. We ask ask 18 questions about how the hearing aids help in a variety of situations. We believe the most important question is, "Do your hearing aids improve your quality of life?" 100% of our patients responded positively (80% strongly agreed; 15% definitely agreed; 5 agreed). Nearly everyone found their hearing aids comfortable to wear with pleasant sound quality and good clarity as long as there wasn't too much background noise. The situations that produce the least positive responses involve background noise. We know there is a long way to go before you get "bionic ears". but there have been definite improvements in hearing aid technology with more on the way. Meanwhile, pretend like you're newlyweds and get together in the same room to talk with your wife.

Q: I have an acquaintance who just got 2 hearing aids in your office. When I got my hearing aid you said I should only have it in one ear.


A: Sometimes I do have trouble making up my mind, like do I want the tiramisu or chocolate decadence for dessert. I'm usually pretty confident in recommending 1or 2 hearing aids. In your case, I'm thinking 3 o4 would be better! Before I tell you some things I consider in making a recommendation, I want to tell you some things that are true and some things that are false:

TRUE: - 2 hearing aids allows the ears to continue working together as a team sending important information to the brain that is necessary for "stereo" imaging, loudness perception, localization and suppressing background noise.

FALSE: - You can't benefit from 1 hearing aid. You will lose hearing the unaided ear if you don't wear two. These are sales gimmicks. If a salesperson tells you this, run away!
There are several considerations in choosing to be monaural ( 1aid) or binaural (2 aids).

1. Hearing loss - if both ears have hearing loss and both have enough hearing that they will be able to benefit from a hearing aid - fit 2 aids.
2. Physical or cognitive limitations - if a patient is likely to have trouble handling a hearing aid or remembering how to use it - fit 1 aid. If all goes well, a second can be added later.
3. Finances - if 2 hearing aids is cost prohibitive, by all means get one. While two hearing aids are more beneficial for the majority of people, one hearing aid is far better than no hearing aids.
4.Benefit is demonstrated with 2 hearing aids - the majority of people will do better with 2 hearing aids than 1. This means that there is a minority that does not do better with 2 hearing aids. Who are these people? Can I predict them with certainty? A recent study by Robyn M. Cox, Ph.D. and associates at the University of Memphis (Dr. Cox, taught me all about hearing aids about 100 years ago when I was in graduate school in Memphis) failed to find any means of predicting with a high level of confidence who these people are. We have always relied on trial periods to help us with this question. If I believe you will do better with 2 hearing aids and we discover it doesn't work as well as expected, we return 1 of the hearing aids and the full purchase price is refunded.
So, if you are wondering if you would be better off with two hearing aids ask yourself the following questions. Do you feel disadvantaged when someone speaks to you from your unaided side? Does sound seem unbalanced? Is sound too soft or not full enough? Answering yes to these questions suggests a second hearing aid should be considered.