FAQs

Hearing loss changes our everyday life

Even simple conversations can be very tiring for people with hearing loss. Following a discussion with several participants requires intense effort. Active communication is difficult, which can quickly lead to isolation.

Hearing loss can have many causes. But in most cases, hearing loss can be addressed successfully.

The ear is a very complex sensory organ

It consists of three sections: Outer ear, middle ear and inner ear. (links to causes of hearing loss) Parts of the ear:

1. Pinna
2. Auditory canal
3. Eardrum
4. Malleus
5. Incus
6. Eustachian tube
7. Stapes
8. Semicircular canals
9. Cochlea
10. Auditory nerve

Consequences of hearing loss

Hearing loss often has complex consequences

Many facets of everyday life become increasingly more difficult. Conversations with loved ones, meetings, phone calls and watching TV can be particularly challenging. In many cases, people with hearing loss will withdraw and become socially isolated. Their quality of life diminishes noticeably

Consequences of hearing loss

Studies have shown that people with hearing loss who do not use hearing aids experience more sadness, fear and anxiety than hearing aid users. They reduce their social activities, become emotionally unstable and have trouble concentrating.

On the other hand, studies also show that hearing aid users experience a dramatically increased quality of life as soon as they start using a hearing aid. They maintain better family relationships, have more self-confidence and experience more independence and security.

Physical consequences

If hearing loss is not corrected, it can result in physical issues such as tiredness or fatigue, headaches, vertigo and stress.

The described symptoms are not always caused by untreated hearing loss, but they are observed in many cases. If you experience hearing loss and recognize some of the symptoms described above, you should contact us.

What are the different degrees of hearing loss?

Between “hearing well and “hearing nothing lies a wide range of different degrees of hearing loss. Experts distinguish between mild, moderate, severe and profound hearing loss. Most cases of hearing loss are categorized as mild or moderate.

Mild hearing loss

Soft noises are not heard. Understanding speech is difficult in a loud environment.

Moderate hearing loss

Soft and moderately loud noises are not heard. Understanding speech becomes very difficult if background noise is present.

Svere hearing loss

Conversations have to be conducted loudly. Group conversations are possible only with a lot of effort.

Profound hearing loss

Some very loud noises are heard. Without a hearing aid, communication is no longer possible even with intense effort.

The sound of speech

Human speech consists of vowels and consonants at different loudness and frequency levels. They are recorded on the audiogram as a so-called “speech banana. It is an easy way to check whether the entire spectrum of speech is still audible and how a person’s hearing changes with time.

What does hearing loss sound like?

I can hear, but I don’t understand properly

Hearing loss often affects our ability to understand speech. In particular, the consonants /P/, /K/, /F/, /H/ or all /T/, /Sh/ and /S/ sounds are no longer heard.

Explaining hearing loss

This diagram shows both the loudness and frequency (pitch) of various everyday sounds. Going from top to bottom is increasing in volume and going from left to right is increasing in pitch.

For example, a truck is very loud and also very low in pitch. On the other hand, birdsong is very quiet and very high in pitch. The diagram also indicates the loudness and pitch of different letters within speech.

When hearing ability is measured, the quietest sounds that an individual can hear (hearing threshold) are plotted on such a diagram.

The hearing thresholds’ position on the diagram indicates what level of hearing loss a person has. These different levels of hearing loss can be seen on the right hand side in the diagram above.

Sounds which lie above (quieter than) the hearing threshold cannot be heard by that individual person when not using a hearing aid.

Hearing Loss Simulation Sound Tracks

We can’t hear what other people hear. People with hearing loss are usually unable to explain how the hearing loss affects them or what they hear and what they don’t hear.

The following sound tracks are meant to give you or other people an idea of how hearing loss changes perception.

• Alps
• Announcement
• Beethoven
• Birds
• Ducks
• Frogs
• Piano
• Popmusic

What is an audiogram?

An audiogram is a graphic representation of your hearing ability. During a hearing test, your hearing is checked at different frequencies. The result is recorded as a characteristic audiogram curve.

The frequencies

The horizontal scale at the bottom indicates the different frequencies. The low frequencies (e.g. the hum of an engine) are located on the far left, the high sounds (e.g. the twitter of a bird) on the far right.

The loudness level

The vertical scale indicates the loudness level of the respective frequency, from soft (top) to loud (bottom). Values are given in decibels, abbreviated as dB. The healthy human ear begins to perceive sounds starting at 0 dB and reaches the threshold of pain at 110 dB.

Facts and figures

About 800 million people around the world are affected by hearing loss. It is estimated, that this number will rise to 1.1 billion by 2015 – about 16% of the world’s population.

Several different studies show that approx. 65% of people with hearing loss experience a mild hearing loss, 30% a moderate and 5% a severe or profound hearing loss.

Only about a third of all people with hearing loss are of retirement age. The majority is of school or working age.

Studies also showed that only one in five people who would benefit from a hearing aid actually uses one.

On average, people with hearing loss wait almost 10 years before they do something about it.

At the same time, more and more young people experience hearing loss, which is mainly due to excessive noise levels and listening to music much too loudly.

Discover your child’s hearing

Children’s quality of life and development vitally depend on hearing. Children learn to speak because they hear others and themselves communicate. Hearing helps your child learn to read, appreciate music, and receive warnings of approaching harm. Your child will have difficulty coping with many of life’s challenges and opportunities at home and in school without good hearing.

A child’s hearing

Having a hearing loss does not put an end to a child’s ability to enjoy all the sounds of life if amplification and support are provided early. By acting early and selecting the right technological solutions, children will have access to speech and language as well as other important sounds.

If you suspect or know that your child has a hearing loss, you may at first, find it difficult to come to terms with. You may have many questions. In order to find the best possible solutions for your child, this section attempts to provide answers to some of your questions.

Acknowledgements

We acknowledges the permission and assistance of the following organizations for their expertise in this portion of our website:

• The Better Hearing Institute
• The Infant Hearing Guide

Pediatric hearing tests

What types of hearing tests are there?

An audiologic evaluation can help determine if a hearing loss exists in one or both ears at frequencies (pitches) that are critical to normal speech and language development, and if the hearing loss is conductive or sensorineural.

Hearing screening

This is testing which can be carried out at any age. Hearing screening usually shows simply that a child’s hearing is not at a normal level. If a child fails a screening test, he / she will be referred for a more detailed assessment. In recent years the importance of hearing screening for infants has been recognized. There is now legislation in many countries recommending that all newborns are screened for hearing loss. When hearing loss is identified, early appropriate support measures can also begin early.

Comprehensive hearing assessment

An audiologist skilled in working with young children completes a comprehensive hearing assessment. The results of the test are recorded on an audiogram, a graphic chart of audiometric results. Results are used to determine the type of hearing disorder and whether hearing instruments are needed. The physician determines whether medical or surgical treatment is required based on the audiometric findings and otologic examination.

Behavioral hearing tests

Conventional hearing tests usually require that the child respond in some way (verbally, by picture pointing, raising a hand, or through a “game) to soft sounds produced by an audiometer. By the age of three, these types of tests are generally appropriate. For younger children, beginning at about six months of age, other behavioral hearing tests that reinforce a baby’s response to test sounds using an animated toy can be used very accurately.

These tests usually require the child to respond to soft sounds in some way (verbally, by picture pointing, raising the hand or through a “game”). These tests can be fun and for infants and toddlers, a head-turn response to a test signal is usually the best and most reliable testing method.

Auditory Brainstem Response (ABR)

For newborns or infants and children who cannot reliably perform the behavioral test procedures, other more objective tests, such as ABR, can help determine hearing abilities. Clicks or tonal “pips” are sounded in an infant’s ears through earphones. The ABR provides information about the function of the auditory pathway to the level of the brainstem. The response to the clicks or tones are recorded, providing an estimate of hearing sensitivity.

Otoacoustic Emissions (OAEs)

These tests provide a unique way to examine the function of the cochlea. Sounds are sent to the child’s ear with a small loudspeaker. A microphone records the response to the sound from the cochlea (known as an emission). This offers valuable information about the sensory hair cells in the cochlea.

Tympanometry (acoustic immittance testing)

This test helps determine how well the eardrum and middle ear are working. A gentle puff of air is delivered into the child’s ear and the amount the eardrum moves in response to change in air pressure is recorded. If the eardrum does not move, for example, it could mean there is fluid behind the eardrum and otitis media with effusion may be present.

Visual response audiometry (VRA)

This procedure is used for children in the 6-month to 2-year range or hard to test children. With this technique, sounds are presented through headphones or a loudspeaker. Young children are taught to turn toward an animated toy or video as reinforcement for every time they hear a sound. This type of testing gets information about the child’s hearing in both ears plotted on an audiogram.

Conditioned Play Audiometry (CPA)

Young children and pre schoolers are tested with CPA. This uses a game activity every time a sound is heard. One example is having the child drop a block in a bucket when a sound is heard. Sounds are usually presented through earphones and results are graphed on an audiogram. As with VRA, it is possible to get information about the child’s hearing across pitches in both ears.

Pure tone audiometry

This technique is used with older children. Children are asked to push a button or raise their hand when a sound is heard through headphones, earphones placed in the child’s ear or through a loudspeakers (in the case of an ear infection) known as soundfield audiometry.

Speech discrimination tests

When hearing loss is present, it is important to determine how well the child can understand speech under different listening conditions. Speech discrimination tests check the child’s ability to hear words at different listening levels. A variety of tests are available to test children ranging from 3 years onwards.

Communication Milestones

What are my child’s communication milestones?

The cochlea, which is the sensory organ of hearing, attains full adult size and enables the child to hear by the 20th week of pregnancy. This means that children can be exposed to the voice of their mothers, fathers and siblings, as well as other important sounds like music, even before they are born. After birth, a newborn child’s cochlear sensitivity is similar to that of adults, but babies must learn how to use their hearing in order to form the foundations of communication.

Your child’s speech and language developmental milestones

The following milestones are rough “rules of thumb” for the majority of children. If your child is more than 2-3 months delayed compared to the age-groups mentioned below, it might indicate hearing loss or delayed speech-language development.

9 monthsӬ

Demonstrate an understanding of simple words “mommy,” “daddy,” “no,” “bye-bye.”

Ӭ10 months

Babbling should sound “speech like, with single syllables strung together (“da-da-da-da). The first recognizable words emerge at about this time.

Ӭ1 year

One or more real words spoken.

Ӭ18 months

Understand simple phrases, retrieve familiar objects on command (without gestures) and point to body parts. Also should have a spoken vocabulary between 20 and 50 words and use short phrases (“no more,” “go out,” “mommy up”).

Ӭ24 months

Spoken vocabulary should be at least 150 words, coupled with the emergence of simple two word sentences. Most speech should be understandable to adults who are not with the child daily. Toddlers also should be able to sit and listen to read-aloud picture books.

Ӭ3 to 5 years

Spoken language should be used constantly to express wants, reflect emotions, convey information and ask questions. A pre-schooler should understand nearly all that is said. Vocabulary grows from 1000 to 2000 words, which are linked in complex and meaningful sentences. All speech sounds should be clear and understandable by the end of the preschool period.

Transforming Education for Children with Autism

Autism Spectrum Disorder (ASD) has a huge impact on the lives of the children it affects, especially their learning. Studies have found that children with ASD particularly struggle in noisy environments (1) like classrooms. They are often unresponsive and struggle to pay attention to auditory stimuli, such as the teacher’s voice, which are the most significant predictor of educational performance (2).

1. Ornitz et al. 1989, Alcantara et al. 2004
2. Ashburner et al., 2008

However scientific studies have also proven the positive effects of wireless microphone systems technology on the classroom performance of children with ASD.

These systems comprise of a microphone, worn by the teacher, and one or two discrete in-ear receiver options, worn by the child. These systems pick up the teacher’s voice, clean this voice signal and transmit these speech sounds directly into the child’s ear (via their receivers). The result? The child is better able to hear, concentrate on, and respond to the words they hear.

What is APD?

APD stands for Auditory Processing Disorder. It also referred to as (Central) Auditory Processing Disorder or (C)APD. APD covers a variety of disorders that affect the way the brain processes auditory (audio) information.

Individuals with APD usually have normal hearing ability. It is not a sensory hearing impairment as such, although it is not yet known how many people with hearing loss also have APD.

How common is APD?

It is estimated that 3-5% of all children have APD. It is found twice as often in boys than in girls.

What causes APD?

Auditory processing disorder can be congenital (sufferers have it from birth) or acquired. It may result from prolonged middle ear infections and head injuries that cause difficulties with the central nervous system, affecting the processing of auditory information. The underlying causes of APD however remain unknown.

What are the characteristics of people with APD?

People with APD struggle with one or more of the following:

1. Sound localization: it may be difficult for an APD sufferer to say whether a sound is coming from the left, the right, or the centre.
2. Sound discrimination: it may be difficult for them to hear the difference between pat / bat / fat / hat.
3. Pattern recognition: it may be difficult for them to hear the different emphasis between sentences like these:ӬI want to drive to New York tomorrow (i.e. the speaker really prefers to drive rather than fly)ӬI want to drive to New York tomorrow (i.e. the speaker really does not want to travel today)
4. Temporal aspects of listening: it may be difficult for APD sufferers to hear the difference between lemonade and menolade, star and tsar, reserve and reverse etc.
5. Speech understanding in the presence of background noise: although in quiet situations APD sufferers usually have no problems, background noise can pose a real challenge. This problem can, for example, hinder learning in school, and/or cause sufferers difficulties in social and/or group situations.

People with APD have trouble paying attention to and remembering information that is presented orally (spoken); instead they cope better with visually acquired information. They often have problems following spoken, multi-step directions, as they prefer to hear only one command at a time.

People with APD have trouble paying attention to and remembering information that is presented orally (spoken); instead they cope better with visually acquired information. They often have problems following spoken, multi-step directions, as they prefer to hear only one command at a time.

Causes of Tinnitus

There are many different theories to explain what causes tinnitus – however it is still considered one of the big mysteries of the human ear.

High exposure to noise increases the risk of developing tinnitus. For example loud environments like concerts, music festivals and night clubs, or listening to personal music players at high volume.

Anxiety, fast pace of living or stress can also cause tinnitus problems.

“Ear noise itself is not a disease, but can be a symptom of other health problems of both psychological or physical background.

It is generally accepted that tinnitus is a side effect of damage to a person’s auditory (hearing) system. 80% of people with tinnitus also have a hearing loss.

Hyperacusis

Hyperacusis is defined as an over-sensitivity to sound and is often associated with tinnitus.

Everyday sounds that are considered normal to most people would be unpleasant to a person with hyperacusis.

Treatment of hyperacusis is focused on rebuilding sound`s tolerance, through listening to soft sounds and increasing the volume overtime.

Miniature Miracles

Treating hearing loss involves fitting discreet modern hearing aids. Once set-up by a qualified hearing expert, these devices boost and clarify real-world sounds such as speech. This often reduces the perceived loudness of tinnitus, while at the same time helping you to hear and understand more.

In one survey of hearing care professionals, 60% said their tinnitus patients had gained tinnitus relief after using hearing aids. Another study of sufferers themselves found that 75% who wore hearing aids gained relief either ‘frequently’, ‘most’ or ‘all of the time’.

Tinnitus Management

The diagnosis of tinnitus requires a comprehensive medical examination, covering a review of medical history, physical check-up and audiological evaluation, including tinnitus assessment tests.

The first step towards relief from tinnitus is visiting a General Practitioner (GP). An ENT (Ear, Nose and Throat Specialist) consultation may also be required.

Currently there is no approved drug specifically to cure tinnitus. Most of treatment options concentrate on relieving the symptoms and making the tinnitus less distressing.

Common methods are based on enriching the sound environment, via hearing aid fitting or providing additional sound sources (noise generators, sound libraries), that direct attention away from tinnitus. These are typically complemented by some form of counselling.

Therapies may also incorporate educational elements like relaxation techniques and psychological therapy, or alternative treatment such as acupuncture.

Turn down ringing ears

Are you frustrated by tinnitus? If so, the good news is that real relief is available through a combined treatment approach.

It is estimated that 10-15% of the population experience tinnitus – a ringing, roaring, whooshing or chirping sound in the ears. However, while there is no cure, scientific research has proven that real tinnitus relief is possible.

The key? Treating the most common underlying cause – hearing loss, which 80% of people with tinnitus have to some degree – alongside one-on-one coaching to help you better understand and cope with the noise in your head.

Are you frustrated by tinnitus? If so, the good news is that real relief is available through a combined treatment approach.

Understanding Tinnitus

Tinnitus is increasingly common in our society. It can be an occasional annoyance for some but a constant frustration for others. Although each person experiences and reacts to it individually, the underlying causes and links to hearing loss are common to the majority of people.

• Learn more about tinnitus
• Learn more about the causes of tinnitus and the link to hearing loss
• Learn more about hyperacusis

The key to effective tinnitus management

Tinnitus is a very personal condition.

The key to its effective management is to work with a hearing care professional to develop an individualized treatment plan. This may include the use of hearing aid technology along with expert guidance to help you better understand and cope with the noise in your head.

The eventual goal is that you are able to enjoy life again without the annoyance of “ringing ears.

Practical tips for communicating with hearing aid users

How do you communicate with people who use a hearing aid?

Addressing this question is particularly important, because hearing loss always comes with a social dimension. Some people avoid all contact. They feel insecure and don’t know how to communicate with a person who uses a hearing aid. However this can be overcome by following these small simple steps.

Speak clearly and naturally

You don’t have to shout. This does not help with understanding speech. Don’t speak more loudly, but more clearly and slowly.

Shorten the distance

In loud environments, you should shorten the distance between you and the listener.

Maintain eye contact

People with hearing loss gain important information from facial expressions and lip movements. The more clearly you speak, the better for your partner.

Get attention

Call the hearing aid user by his or her name. Make sure that the person can see you or lightly tap his or her shoulder.

Be aware of the surroundings

Avoid having conversations from one room to another or in a place with intense background noise. Vacuum cleaner, washing machine or loud music can make a conversation frustrating for both sides.

Respect the limitations

Please be aware that using a hearing aid can be very exhausting at first. When talking to a hearing aid user, look for signs of tiredness. Do not force or prolong the conversation unnecessarily.

Be patient

Especially during the learning phase, the concentration of the hearing aid user may lessen quickly. Hearing and understanding take a lot of energy. Never force a conversation.

Tips for getting used to the hearing aid

The first encounter with your hearing aid

Your first experiences are essential for the successful adjustment of your hearing aid. We have put together a few tips and tricks for you, so that you will be able to fully enjoy your hearing aid. Make use of all the possibilities your modern hearing solution has to offer!

In addition, please follow the instructions you received with your hearing aid. If you have any questions or problems, please contact your hearing care professional.

Adjusting the volume to the situation

Modern hearing aids automatically select the appropriate volume when they are switched on. No other adjustments are necessary. If you adjust the volume manually, do not make it too loud. This rarely helps with understanding. Please do not try to understand someone speaking softly at a great distance. Even a healthy ear cannot do that.

The hearing aid – a part of your life

Just like spectacles or contact lenses, a hearing aid can feel strange at first. After a brief period of adjustment, this will change. Give yourself a little time to get used to it. However, if you experience any problems or pain, please contact your hearing care professional.

Being an active participant in discussions

Even people without hearing loss find it difficult to follow discussions sometimes, especially if several people talk at once. Move closer to the person you would like to hear and focus on him or her. As you gain experience with your hearing aid, you will be able to master these situations with more ease and confidence. Additional listening devices can also be helpful in these situations. You can find out more and discuss this with your hearing care professional. They will be able to provide information on which additional devices are most appropriate for your needs.

Visits to public places

Theatres, places of worship, conference halls and similar places can present an acoustic challenge for hearing aid users. Ideally, you should find a seat in the section with the best acoustics. It is usually located in the front and centre of the room. Do not sit too closely to the speaker, but close enough to see his or her face. Some public places have special technical equipment to make hearing and understanding easier. Just ask in advance or when you get there.

Follow television and radio programmes

Sometimes it is not possible to understand every single word. In those cases, try to concentrate on the overall context. In these situations, an appropriate additional listening device can also be helpful.

Use your hearing aid with the phone

As a hearing aid user, you have many options to improve your hearing and understanding of phone calls. Your hearing aid specialist can advise you, which solution is best for you.

Two ears hear better than one

In case of bilateral hearing loss, both ears are fitted with a hearing aid. As a hearing aid user, this will introduce you to a completely new level of hearing. Humans have two ears for a reason and it makes sense to wear two hearing aids, if you have a hearing loss in both ears.

How to train your hearing

Beginning something new is never easy

During the adjustment period, the multitude of new sounds you experience can be tiring. Take your time to get used to your hearing aid. Your positive attitude and determination to hear and understand better are crucial for your success.

Easy hearing step by step

Don’t take your hearing aid to a concert right away. Be patient – your hearing needs to gain necessary experience first, especially in difficult hearing situations.

Practice every day

You will feel it: Every day you will enjoy life more. In the beginning, wear your hearing aid for only a few hours per day. Increase the duration of your practice time gradually every day. Please familiarize yourself with the exercises listed here and always practice them in the correct order.

Exercise 1: Listen

On the first day, start by reading something aloud to yourself. Your own voice may sound strange at first. This impression will go away after a short time. Listen to the sounds of your steps and your breath. Deliberately make soft noises, such as rustling paper, flipping a light switch, jingling your keys, etc. Write down all sounds you can hear in the house. Describe these sounds with adjectives (e.g. clear, dark, clinking, …) and judge them (pleasant, strange, funny, familiar, …).

Exercise 2: Follow a conversation

You should practice this exercise on the next day – and only if you were satisfied with the first exercise. Otherwise you should repeat exercise 1.

Call the speaking clock. If you were able to understand it well, make a brief phone call to an acquaintance. Next, have a conversation with a friend or relative in calm, quiet surroundings. Do not talk too long, take your time and pace yourself. Finally, watch a television show or listen to a radio programme in quiet surroundings.

Exercise 3: Learn to tolerate loud noises

Please note that this exercise is recommended only after you have completed the first two successfully. Don’t take on too much at first. Repeat the first two exercises until you feel confident and secure.

Have a conversation in a loud environment. You can turn on the television in the background or go to a moderately busy street café. The first rule for such a difficult hearing situation is: Be patient! Your success will come, it may take a few days or maybe it will take a few weeks. Just keep practicing.

Have you mastered this exercise as well? Increase the challenge and have a conversation with several partners in a loud environment.

Exercise 4: Learn how to focus your hearing

Now you are able to hear better with your hearing aid and can communicate well in many difficult situations. The next step is to remain a focused and alert listener. Because in loud hearing situations, even people without hearing loss need to make an effort in order to hear what they need to hear and ignore the rest.

Practice focusing on sounds you want to hear and ignore unwanted or disruptive noises. Try to identify unfamiliar sounds in a loud environment and make a conscious effort to ignore unimportant noises. Soon you will be able to focus your attention from one sound to another.

Roger – Bridging the understanding gap

Roger is the new digital standard that bridges the understanding gap, in noise and over distance, by wirelessly transmitting the speaker’s voice directly to the listener.

All about Roger technology

Consequences of hearing loss

Hearing loss often has complex consequences. Simple conversations become very challenging, misunderstandings happen often and lead to social isolation. Quality of life diminishes.

How to increase your quality of life

Hearing aids bring joy back into your life

Studies show that hearing loss affects everyday life: More than half of people questioned who do not wear a hearing aid claim that they feel somewhat lonely and experience a considerable loss in quality of life.

Well adjusted hearing aids are proven to have a positive influence on your quality of life. Wearing a hearing aid every day can bring joy back into your life.

Convincing arguments

• Hearing aids enable you to participate in everyday life.
• Thanks to the latest technology, modern hearing aids are small and comfortable to wear.
• With a hearing aid, you regain your independence. Repeated questions and misunderstandings are things of the past. A well fitting hearing aid that is adjusted to your needs will never let you down in any situation.
• Quality hearing aids are available for all budgets. Ask your hearing care professional or your health insurance provider about your options.

Modern hearing aids are true miracles of technology

Modern hearing aids offer a wide range of functions and variety. Your hearing care professional will help you make the choice that is perfect for you. They will consider your hearing needs, your budget, your lifestyle and your individual hearing preferences.

There are two basic types of hearing aids

Custom models (ITE or ITC and CIC models)

These models are made specifically to fit the shape of your ear canal for maximum benefit and the best possible comfort. They are available in many skin tones, are unobtrusive and very effective. The smallest versions sit in your ear canal and are virtually invisible. These models are suitable for mild to severe hearing loss.

Behind-the-ear models (CRT and BTE models)

BTE models are available for all degrees of hearing loss and, as the name suggests, can be worn comfortably behind the ear. Incoming signals are amplified and transmitted into the ear via very small, unobtrusive tubes. These models are available in many different colors, styles and designs.

Hearing aids through the ages

From the ear trumpet to modern hearing aid. A journey through the history of hearing aids.

A hearing aid is customized in several phases

Recognition of hearing loss

If you experience hearing loss, one of the first steps is the decision to try a modern hearing aid. The earlier you recognize the hearing loss and take action, the earlier you are able to recover your hearing ability and increase your quality of life.

A hearing aid is personal

The adjustment of a hearing aid is done in several steps. In the course of this individual process, the device is customized to fit your hearing loss, the shape of your ear and your hearing habits. This ensures the best possible adjustment that will satisfy you completely.

Phase 1: Consultation with a Hearing care professional or ENT doctor

First, a hearing care professional or ENT doctor will do a hearing test to determine whether you have a hearing loss. He or she will determine the type and degree of hearing loss individually for each ear from the information provided by the hearing test. The professional will then discuss and explain to you which technological options are best suited to your needs.

What is an audiogram?

When selecting your future hearing aids and their technology, the expert will consider the degree of hearing loss, the shape of your ear canals, your personal needs, your taste and your budget. You can choose between custom models and behind-the-ear models, digitally programmable or analogue devices with or without remote control or FM receiver etc. The hearing aid specialist will take a cast of each ear to ensure that your device will fit you with the best possible comfort later on.

A journey through the history of hearing aids

From the ear trumpet to modern hearing aids

Deafness and hearing loss have always been around. For a long time, it was believed that people who could not hear well also had additional disabilities. A misunderstanding that lasted, unfortunately, until the 16th century. Society discriminated against people with hearing loss for a very long time.

A Spanish monk named Pedro Ponce proved in the 16th century that there is no connection between people’s hearing ability and their intellectual capacity. Around 1530, he taught Pedro and Francisco, the deaf sons of the nobleman Juan Fernández de Velasco y Tovar, how to read, write, do math and speak.

The first ear trumpets in the 17th century

The first hearing aids were ear trumpets. They were created in many different shapes and sizes. They were made from sheet iron, silver, wood, snail shells or animal horns.

Some people did not want to admit to their hearing loss. Many attempts were made to conceal it. Some ear trumpets were hidden in fans, others were integrated into walking sticks. Some ear trumpets were even camouflaged as diamond-encrusted pieces of jewelry.

Milestones in communication technology

Alexander Graham Bell, the inventor of the telephone, taught deaf students, was married to a deaf woman and had a deaf mother. So his original goal was to transform spoken words into electric signals in order to make them visible to deaf people. When he realized that this technology could also be used to transmit speech over long distances, the telephone was born.

The first hearing aids in the 20th century

The first electric amplifiers were available at around the beginning of the 20th century. The first hearing aids were invented. By the 1920s, they became small enough to carry in a handbag.

Big steps towards the modern hearing aid

As the miniaturization of technology progressed, hearing aids, became ever smaller. In the 1940’s, the first pocket devices were introduced. In the early 1960’s, a design entered the market that is still available today: The behind-the-ear device (BTE). Since that time, hearing aid technology has undergone rapid development thanks to the progress of microelectronics.

Today’s hearing aids work with digital technology and are equipped with powerful computer chips. Many functions ensuring better sound quality, wireless connectivity and ever smaller dimensions are the defining characteristics of modern hearing solutions.

Along with the technology, the acceptance of hearing aids changed as well. Smaller devices, new designs and stylish colours help users to wear their hearing aids with ease and confidence.

How a hearing aid works

Innovative technology on a very small scale

Modern hearing aids are small, comfortable and nearly invisible. They improve hearing ability, speech recognition and hearing comfort. The powerful high-tech devices help you regain your ability to relax and listen.

Inside a hearing aid

A hearing aid consists of a microphone, an amplifier or processor and a loudspeaker that transmits the optimized sounds into your ear. A small battery provides the necessary energy. Modern devices are customized to fit the shape of your ear, the degree of your hearing loss, your lifestyle and your hearing habits.

What is FM?

Understanding wireless technology

FM technology refers to a type of wireless system that helps people better understand speech in noisy situations. FM systems commonly work together with a user’s hearing aids, although systems are also available for those with otherwise normal hearing (such as people who suffer from APD, ADHD etc.).

An FM system works like this:

• The person speaking wears or holds a transmitter microphone, or the transmitter is placed in the middle of the group (picking up speech from all around).
• Using harmless radio waves, the FM system sends speech signal(s) to the listener, who wears a tiny FM receiver behind the ear.

About FM systems

• FM systems can transmit through objects
• Unlike infrared systems, FM systems operate as effectively in sunlight as they do indoors
• FM systems do not require any installation

Checking the hearing instrument performance

Since your baby cannot tell you whether the hearing instruments are working properly or not, you have to take an active role in checking their performance. It is ideal to check the instruments at the end of each day so that they are ready for action when your baby wakes up the next morning. This checklist will help you to carry out these examinations easily and effectively.

Earmolds

• Make sure that the opening to the ear canal portion of the earmold is free of wax. Should you find wax there, simply wipe it with a damp cloth or use a wax loop or brush to remove it. If the earmolds are visibly soiled, wipe them with a damp cloth. Be sure not to get the hearing instruments wet.
• Check that the earmold tubing is free of moisture, as a drop of water blocking the tube can prevent sound getting to the ear. If you see moisture, detach the earmold from the hearing instrument and use an earmold blower to dry it. If the earmold has a vent, blow the air through that opening too.
• Look closely to see that the earmold and tubing do not have any cracks or tears that could lead to feedback (whistling or squealing). The audiologist can replace any damaged tubing easily. A torn earmold will need replacing.

Hearing Instruments

• Use a battery tester to see that the battery is fully charged, and always replace low batteries.
• With the earmold connected to the hearing instrument, use a listening tube or listening stethoscope to listen to each device and each combination of devices your baby uses. For example, if your baby uses more than one program/memory or an FM system, listen to each of these to check there is a clear and undistorted signal. If you are using an FM system at home, set the FM microphone/transmitter close to radio or television. Listen to the signal as you move to different areas of the house to check for interference. As your child gets older and begins to use the telephone, you will want to test that signal as well.
  Note: If your child has severe or profound hearing loss, consider lowering the volume setting prior to your listening check.
• The volume control on our instruments can be deactivated or covered to avoid it being adjusted by accident. If for some reason it has not been deactivated you should check that the volume control is set correctly based on the recommendation of your audiologist.

Inserting a hearing aid

For optimal performance, the hearing instrument must be in the correct position. To insert the hearing instrument into the child’s ear, just follow these simple steps:

• Either turn the instrument off or select the minimum volume setting to avoid whistling.
• Grasp the tubing near the earmold between your thumb and index finger.
• Bring the instrument to the child’s ear, tilting it forward slightly and carefully place the canal portion of the earmold inside the ear canal.
• Once the canal portion is in place, twist the earmold back so that it fits into the concha and tuck the instrument behind the ear taking care not to twist the tubing. You can check that the instrument is in the correct position by tracing the contour of the ear with your finger to see that it is sitting snugly.
• Now you can switch on the instrument and adjust the volume to the desired level. In some cases, the volume control may be disabled by the audiologist.
  Note: When removing the instrument, be sure to grasp the earmold to ease it out, and do not pull on the tubing.
• For optimal fit and safety, use Stick’n Stay, the Oliver Clip or use one of the solutions from the Practical tips section.

Getting use to new sounds

Every day brings a new constellation of different sounds and voices to your baby. In the home environment, the hearing instruments will enable your baby to hear all that is going on in this relatively quiet environment. When you are spending time with your baby in these circumstances, it is important to reduce distracting background noise as much as possible, for example by switching off the TV and radio and staying close to your baby when you are talking.

FM systems

As you complete household tasks, like vacuuming or doing the dishes, it is not possible to stay so close to your baby that your voice is within an optimal distance from the hearing instruments microphone. Additionally, you or your baby’s caregiver will want to go out and about and in these situations, such as a visit to the zoo, family gatherings, going out for a walk in the stroller or a supermarket visit, an FM system can be a huge help. These wireless systems transfer speech directly to the hearing instrument so there is no loss of quality in noisy places.

Noise exposure

One of the most common and yet completely preventable causes of permanent sensorineural hearing loss is exposure to sound levels that are excessively loud. High noise levels first cause temporary and then permanent damage to the sensory hair cells within the cochlea. Even young children may be exposed to sounds that could be damaging to their hearing. Noise produced by various modes of transportation (subways, trains, airplanes, snowmobiles, etc.) and home appliances (stereo music equipment, power tools, lawn maintenance equipment, hair dryers, etc.) may be damaging to hearing depending upon the closeness to the noise source and the exposure time. Moreover, some toys may actually produce intense sound, and certainly sound levels at some music concerts can damage hearing.

Monitor the level of noise your child is exposed to. If speech must be raised (shouted) to communicate, it is very likely that the noise is excessive and possibly damaging. Ringing in the ears (tinnitus) after noise exposure also indicates excessive sound levels. Children should be told about the dangers of noise exposure and the use of ear protection (ear plugs, ear muff s, etc.). When ear protection is unavailable, simply block the ear canal opening with your fingers. This serves to reduce the level of sound going to the eardrum. Obviously children should be protected from excessive noise exposure whenever possible.

As a parent, you can set examples for your child. When mowing the lawn or using noisy tools or appliances, use hearing protection, and insist that your child playing nearby does the same. Such habits will save both your hearing and that of your child.

Handling and care of hearing aids

Hearing aid care and use are discussed during the hearing aid fitting appointment. You may be asked to come back in a week or two to see how the hearing aids are working and to see if you have any questions. Many audiologists order a “hearing aid care kit for your child along with the hearing aids. Common items in a hearing aid care kit include:

• Battery tester
• Bulb syringe to dry tubing
• Wax loop for the earmold
• Listening tube so you can listen to the hearing aids
• A container to absorb moisture out of the hearing aids

Moisture

Hearing aids are very sensitive to moisture. They should be kept in your child’s ears or in the drying container. This container has silica crystals in it that absorb the moisture out of the hearing aids aid at night. Moisture causes serious problems with hearing aids. Your child will be wearing hearing aids continuously during all waking hours. Some children even prefer to wear their hearing aids while they are sleeping. You will need to place them back in your child’s ears when this happens. It is important that your child learns to keep the hearing aids in their ears so that they get the most benefit from them.

• How to insert a hearing aid
• How to check the hearing instrument performance
• How to maintain and care for hearing instruments and earmolds
• How to get used to the sounds of hearing aids

Maintaining what counts – Daily equipment care

Each part of the amplification system needs to be cared for and properly maintained. Hearing aid care and maintenance should be discussed during the fitting appointment. Usually the audiologist will provide a hearing aid care kit for your child along with the hearing aids. These kits consist of accessories which can extend a hearing aid’s life expectancy and provide for long-term trouble-free functioning.

Earmolds

During the first two years babies will need many new earmolds to keep up with their rapid growth. Later, a three or four year-old might keep the same earmolds for as long as one year. Earmolds may become loose over time and cause feedback, so it is important to check regularly that the earmold has a snug fit and to have new earmolds made, if they are loose.

Lubricants

These products are specially made for use with hearing instruments and are a great help when earmolds are either loose or too tight. Please note that petroleum jelly is not a suitable substitute since it has a tendency to grow bacteria.

Batteries

Button batteries power the hearing instruments. The estimated battery life for a button battery varies with each device and its power needs. Estimated battery life is available from your audiologist for each hearing instrument but the use of a battery tester will enable you to check that the batteries are working every day. Despite your best efforts, batteries may lose their charge during the course of the day. Remember to keep extra batteries with you when you are away from home.

All batteries should be stored in a dry place and away from children. FM transmitters and receivers may use rechargeable batteries. The manufacturer has recommendations for charging each device. Follow local environmental guidelines for the safe, responsible disposal of batteries.

Hearing instruments and FM devices

FM devices and hearing instruments are cared for in the same manner as other sensitive electronic devices. They should not be exposed to extreme temperatures or extreme moisture or humidity. In humid climates, or when worn by babies who perspire easily, the use of a hearing instrument drying unit can be very beneficial. These drying units are either passive storage compartments or electrical driers specifically designed for hearing instruments. For best results the drying unit should be used every day. Regardless of the type of drying unit used, the hearing instrument batteries should be removed during the drying process. If the hearing instrument goes for an unexpected swim, the best course of action is to remove the battery and place it in the drying unit immediately. In some cases, it may work again when dry.

In rare instances, if the hearing instruments are exposed to exceptionally dusty conditions, they may have to be sent in for reconditioning.

Warranties often are available for hearing instruments and FM systems. The length of the warranty varies with each make and model of hearing instrument. Check with your audiologist to find out more.

Practical tips

How can I help my child adjust to wearing hearing aids?

For some parents, keeping the hearing aids in the ears is a huge challenge! Most children pull the hearing aids out because the sound is different from what they are used to. It is usually not because the hearing aids hurt or aren’t fitting properly. Below are practical tips that parents can use to encourage wearing of the hearing aids.

My child pulls his hearing aid out of his ear all of the time. What can I do?

Infants spend a majority of their waking hours exploring their environment and that environment includes their ears and hearing aids. It is important to first rule out that there are not other causes for your child’s behavior, such as a poorly fitting earmold or hearing aid settings that are either too loud or not loud enough. Your pediatric audiologist can help determine if rejection is due to physical discomfort or hearing aid concerns.

Some parents find it useful to have their child wear a cap or headband to minimize the likelihood of removal by their child. It is important to ensure that these devices do not affect the response of the hearing aid microphone.

I am constantly afraid that my child will lose her hearing aid at daycare or when we are at the store or at a park. Any suggestions on how to prevent this?

Hearing aids are very expensive and parents often worry about losing such small devices. The following information should be helpful:

• Loss and Damage Warranty
  Some manufacturers offer a renewable loss and damage warranty when hearing aids are purchased. If the manufacturer of your child’s hearing aids does not offer this option, there are companies that do provide hearing aid insurance. It is important to read the details of these policies thoroughly. Some homeowner policies will also cover loss of hearing aids – ask your insurance agent.
• Hearing Aid Clips”¨
• Dental Floss and Fishing Line
  While not as attractive as the above option, dental floss or fishing line and a safety pin can provide the same security. It is important to make sure that the length of the string is kept short.

My daughter’s hearing aid whistles all of the time. The only thing that prevents it is for me to turn the volume down below the recommended setting. What causes this and what should I do?

Whistling or feedback is caused when sound leaks out of the ear and travels back into the hearing aid microphone. Turning down the volume of the hearing aid is not a good long-term solution, because important speech sounds will be less audible. The following options can be tried:

• New earmold”¨
  Unfortunately, frequent earmold replacement is often necessary for infants and young children because of rapid ear canal growth. This can be costly, but it is not uncommon for young children to need new earmolds as often as every 2 months in the first year of life and 2-3 times per year until they are preschool age. Earmolds made of a soft material provide a better seal and are safer for children than hard molds.
• Special Ointments & Creams”¨
  Water-based lubricants or Silicone-based creams are made to help with earmold fit. OtofermT is a silicone-based cream that can be used to help with feedback until new earmolds are made. The silicone material makes a seal between the earmolds and ear canal. This can control feedback for some babies and children.
• Remote Microphone
  In special cases where feedback is very difficult to control, a remote microphone can be used if the hearing aid has a Direct Audio Input (DAI) option. Feedback can be reduced this way because the distance between the hearing aid microphone and hearing aid receiver (speaker) can be increased. The microphone can be clipped to the child’s hair or attached to a hat or bonnet.

Troubleshooting

Each part of the amplification system needs to be cared for and properly maintained. Hearing aid care and maintenance should be discussed during the fitting appointment. Usually the audiologist will provide a “hearing aid care kit for your child along with the hearing aids. These kits consist of accessories which can extend a hearing aid’s life expectancy and provide for long-term trouble-free functioning.

If you notice that your child’s hearing aid does not sound like it should, there are several steps you can take to figure out the problem.

• Check the battery or replace it.
• Remove the earmold tubing from the earhook. Listen to the hearing aid and see if it works. If it does, the problem is in the earmold or tubing. If it still doesn’t work, the problem is in the hearing aid.
• Soak the earmold and tube in soapy water and blow out the tubing using the bulb syringe. Make sure the tubing is completely dry before putting it back together.
• Put the hearing aid in the drying container for a day. If it still doesn’t work, may have to be sent for repair. Contact your audiologist for repair services and the possibility of a loaner.

Hearing aids are very sensitive electronic devices. Even the humidity in the air is enough to cause hearing aid problems over time. It is not uncommon for hearing aids to be repaired two or three times a year. Taking care of the hearing aids properly can help reduce the number of times that the hearing aid has to be repaired.