Hearing Loss Help  

by Neil Bauman, Ph.D.

One lady wrote:

Your article on loop systems (http://www.hearinglosshelp.com/articles/loopsystems.htm) just about convinced me that I should install a loop system in my office. What’s the next step?

I warned her that before she purchases any kind of loop system, she first needs to make sure that her office is reasonably free from electromagnetic interference.

Such interference is commonly produced by the 60 Hz. alternating current that flows through all the wires in the electrical system. Devices that cause interference include older fluorescent light fixtures, TVs, computer monitors (CRT monitors, not LCD monitors), electrical panels in the walls and sometimes the electrical wiring throughout the office.

You typically hear this interference as a loud buzzing sound when you have your hearing aids set to the “T” position.

The easiest way to tell if your office is reasonably interference-free is to turn your hearing aids to the “T” (t-coil) position, turn your volume way up, then move around your office and listen. If you hear a loud buzzing sound all over, then the office is too full of interference to effectively use your t-coils with a loop system.

If you only hear loud interference in one or two places, then as long as you place your desk (working area) in an interference-free spot, the interference shouldn’t bother you. However, since your computer and/or monitor may produce interference, you may have to lean away from the monitor to get away from the interference when using your t-coils.

Here’s a trick that will help keep the interference to as low a level as possible. Turn the gain on the loop system up so it produces a much stronger magnetic signal than the existing interference. Now you can turn the volume down on your hearing aids, thus making them less sensitive to the interference while still clearly hearing the signal off the loop.

by Neil Bauman, Ph.D.

August 26, 2005. (Stewartstown, PA) Since the successful release last month of a visor card designed specifically for hard of hearing people, deaf people have clamored for a similar card designed specifically to meet their unique communication needs. Today, the Center for Hearing Loss Help released the deaf version of their visor card for those whose communication preference is American Sign Language (ASL) rather than spoken English.

Used correctly, visor cards can effectively help bridge the communications gap whenever hard of hearing or deaf people are stopped by the police, especially at night.

To learn all about how and why to use visor cards, and to obtain your free visor cards (both hard of hearing and deaf versions available), point your browser to http://www.hearinglosshelp.com/articles/visorcards.htm.

by Neil Bauman, Ph.D.

A hard of hearing college student was having trouble hearing certain students in classroom discussions. Since the college did not have real-time captioning available, she wrote:

The only option I can think of is to use a hand signal to indicate when I’m having trouble understanding a student and need the instructor to paraphrase their comments. This way she doesn’t have to paraphrase every single comment.

I suggested a more novel, yet free and effective, strategy–that the student make up some “paddles” with the exact message she needed printed in bold letters. Then when she needed the instructor to repeat something, she could just hold the paddle up just enough to catch the teacher’s eye.

(Of course, you arrange this ahead of time with the instructor.)

There are three advantages to using these paddles rather than using hand signals.

First, you can tell the teacher exactly what you need her to do. Hand signals are not as intuitive as plainly lettered English–especially if the instructor is busy thinking about what she is saying, and thus forgets what a given hand signal means.

Paddles make it easy for the teacher to know what to do. For example, you might have one paddle that says “Speak louder.” Another paddle might say, “Repeat question.” A third paddle could say, “Speak slower.”

There is no end to what you could put on a paddle to fit your unique communication needs, without overloading the teacher with the need to memorize myriads of hand signals.

Second, with clearly-printed messages, you don’t have to interrupt the instructor and cause her to lose her train of thought in order to tell her what you need. Just hold up the paddle with the appropriate message.

Third, you can influence the teacher to want to cooperate with you by showing your appreciation each time she does what you ask. How? On the back of each of your paddles, you have a big “Thank You” printed.

When you hold up a paddle that says, “Repeat question” and the instructor does so, you just flip it around so she can see the big “Thank You.”

I made up a set of 3 paddles out of yellow-colored card stock. Next, I glued them together with a paint “stir stick” sandwiched between them for a handle. (I cut the stir sticks down to about 8.5 inches in length.)

My paddles are oval shaped–about 7.5 inches wide and 5 inches high. The handle sticks down about 4.5 inches below the bottom of the oval.

Incidentally, I got this idea from Dr. Sam Trychin a few years ago. Thanks for the idea Sam.

by Neil Bauman, Ph.D.

One lady asked:

I have a sensorineural hearing loss, severe in the upper registers and moderate in the lower. I’ve worn hearing aids for about 20 years. My hearing aid dispenser tells me that I must wear my hearing aids all the time, except for sleep or bathing–if I don’t, my ability to discriminate speech will deteriorate. No one ever told me this before. Is it true?

Theoretically it is true, but in actual practice, it is pure baloney. That is a hearing person talking, not a hard of hearing person who has had years of experience with this. Some people, by choice, put their hearing aids on when they get up and refuse to take them off until they go to bed. My younger daughter is one of these. I am exactly the opposite. I’ve worn hearing aids for 50 years now. Most of the time, I don’t wear them. (I enjoy the silence.) In fact, I wear my hearing aids only when I really need to–and that is often less than 2 hours a week.

By your dispenser’s reckoning, my discrimination should be close to 0% by now–yet my discrimination is still 80% after more than 50 years of never wearing my hearing aids all day. (With a severe loss, you are not going to have perfect discrimination by any means–so 80% is good in my case.) How does your dispenser explain that my daughter’s discrimination is similar to mine, even though we have such different hearing aid habits?

The lady continues,

I always wear my hearing aids at work, and when I’m with other people, but once I get home I take them out and enjoy the peace and quiet (and relief for my itchy ears). If I want to watch TV or listen to the radio/music I use headphones. If I’m truly damaging my comprehension I’ll wear the hearing aids more, but I’d prefer not to.

If you lived in silence most of the time, theoretically your auditory circuits would begin to atrophy. However, you get plenty of auditory stimulation in all the hours you wear your hearing aids, and then even more hours wearing headphones. You are getting way more auditory stimulation than you need to keep all your auditory circuits working properly.

I sure wouldn’t worry about the discrimination thing. Besides your ears need the down time to make up for all the amplified sounds they endure. They get tired of all that noise and need the rest in order to remain healthy.

Thus, as long as you get adequate auditory stimulation–and you do–you don’t need to worry about wrecking your discrimination from not wearing your hearing aids.

You are doing the right thing for your ears. Don’t let any hearing person scare you into thinking otherwise! Hearing health care professionals can give the “stupidest” advice at times.

by Neil Bauman, Ph.D.

A recent study confirmed what I have known for decades, namely, that hard of hearing people often strain so hard to catch the words in instructions that they don’t accurately retain the instructions themselves. So never blame a hard of hearing person for not following your instructions or directions unless you have written them down and given them to the hard of hearing person.

Dr. Arthur Wingfield at Brandeis University in Waltham, Massachusetts in a recent article in Current Directions in Psychological Science concluded that older adults with mild-to-moderate hearing loss may expend so much cognitive energy on hearing accurately that their ability to remember spoken language suffers as a result.

This is also true of younger people, and those with more severe hearing losses too. I know this well. It has been my experience all my life. (I was born with a severe hearing loss.) I ask a person for directions, but in the process of straining to hear (and understand) them, I spend so much mental effort trying to get the directions straight, that the message itself doesn’t stick in my brain. I may be sure I understand the directions or instructions, but when I go to follow the instructions, I realize I don’t have a clue what I am really supposed to do. This is embarrassing to say the least–so much so that I don’t want to go back and ask for the directions all over again.

Therefore, whenever you are giving instructions or directions to hard of hearing people, you are far better off writing them down at the outset, rather than verbally telling them (likely over and over until you are both frustrated), because hard of hearing people very likely will have garbled your carefully explained directions before they even get out the door!

by Neil Bauman, Ph.D.

One lady wrote: “I thought that people with normal hearing had 0 dB (decibel) hearing loss. Was I mistaken?”

Yes and no. How’s that for an answer?

Zero dB is the theoretical “normal.” In truth, some people have better hearing than this and others worse–mostly worse. Audiologists classify anything between -10 dB (10 dB above the 0 dB line) and 25 dB as “normal.” (Notice that your audiogram goes to -10 dB, not just to 0 dB.)

Within this “normal” range, hearing still varies enormously. For example a person hearing “normally” at -10 dB hears 1,000 times better than a person hearing “normally” at 20 dB, yet all this variation is considered “normal.”

In actual fact, few people hear at the theoretical 0 dB because they have damaged their ears from loud sounds, from ear infections, from taking ototoxic drugs to fight ear infections and other illnesses, from having tubes put in their ears–and a number of other causes.

Another misconception is that at 0 dB, there is no sound–that it is totally quiet. One person asked, “Is there such a thing as 0 dB? There can’t be, can there? Wouldn’t that be silence?”

Surprise! Zero dB isn’t the absence of sound like you might think, but is the result of the ratio (expressed in logs) between a measured level of sound (that you hear) and a published standard. (That standard happens to be 10 to the minus 12 watts per square meter in case you are interested. This standard is set at the volume of the faintest sound the average person with “perfect” hearing can just barely hear.)

If you really want to know how it works, if the faintest sound you can hear is the same as the above sound standard, then the ratio between them is 1:1 and since the log of 1 is 0, you are hearing at a level of 0 dB. (See how simple it is–grin!)

by Neil Bauman, Ph.D.

A lady recently asked me, “What is speech discrimination? How does it relate to hearing loss?”

Hearing loss is the result of damage to your ears. As a result, a person with a hearing loss needs more volume in order to hear the sounds that people with normal hearing can hear.

In contrast, speech discrimination is a measure of how well you understand what you hear when speech is loud enough to hear comfortably.

Audiologists measure speech discrimination in percent. If your discrimination scores are 100%, you understand everything you hear. At the other end of the spectrum, 0% discrimination means you can’t understand a single word that is spoken, no matter how loud it is.

Unfortunately, speech discrimination and hearing loss generally go hand in hand. For example, the last time I had my hearing tested, my hearing loss stands at 75 dB (a severe loss). Fortunately my speech discrimination is still relatively good at 80%. This means that, on the average, I understand 4 of every 5 words that are spoken if the volume is loud enough. That fifth word, however, just sounds like so much gibberish. This is one of the reasons I don’t depend on my hearing alone, but speechread the person at the same time. As a result, I have more difficulty understanding a person on the phone because I can’t speechread them.

If you have a hearing loss and your discrimination is good (80% or higher), typically you will find hearing aids very useful. However, if your discrimination is poor (below 40%), hearing aids will just make louder gibberish and thus are basically a waste of money.

by Neil Bauman, Ph.D.

Doctors often give the wrong advice regarding hearing aids for people with sensorineural hearing loss (often called nerve deafness). Here is a recent email I received.

I’m writing to you about a friend who has been diagnosed with Sudden Hearing Loss in his right ear. His hearing test showed a 65 dB loss. The doctor said that hearing aids would only amplify the mumbling sounds that he already hears in that ear, and thus he would not recommend a hearing aid. However, recently my friend walked into an Audiology Center and they assured him a hearing aid would help him tremendously. Should my friend look into this, or is this a scam?

Typically (and unfortunately) doctors don’t know much about hearing loss, so they generally give this erroneous advice–hearing aids don’t help in cases of nerve deafness–but this is total rubbish. In contrast, audiologists are the professionals that are specifically trained to evaluate hearing loss and determine whether hearing aids will help. I’d listen to them.

The truth is, hearing aids are designed for people with nerve deafness. In fact, 90% of all adults with hearing loss have sensorineural hearing losses (nerve deafness). Thus, your friend should be able to hear much better with a properly-fitted hearing aid.

However, hearing loss is only one part of the equation. If all a hearing loss entailed was a lack of volume, then hearing aids would amplify sounds to give us normal hearing again.

The truth is, there are other factors to consider. A big one is called discrimination. Discrimination is how well you understand speech when it is at a comfortable listening level. A score of 100% means you understand everything when it is at your comfortable level, while a score of 0% means that all you would hear is loud gibberish, not intelligent speech, no matter how loud the sound is.

Unfortunately, most people with hearing loss also have some accompanying loss of discrimination. This makes it harder to understand speech than formerly (Why do you think they call us “hard of hearing” and not “soft of hearing”?)

If your friend’s discrimination score is 80% or higher, then a hearing aid should definitely help him. However, if it is 40% or less, then getting a hearing aid would be a waste of money. In fact, he would have more trouble understanding speech with a hearing aid, than he would just using his ears because the gibberish in his bad ear would interfere with his brain’s processing of the clear speech from his good ear.

by Neil Bauman, Ph.D.

People are often uncomfortable around those that are different from them. Thus, it should be no surprise that hearing people are often uncomfortable when trying to talk with hard of hearing people.

Hearing people are not mindreaders. They don’t know what they should do to “fix” the communication problem. Should they just pretend that there is no problem? Should they yell at the person and hope they will hear, or should they take the easy way out and ignore the hard of hearing person?

When communication difficulties arise, we hard of hearing people need to take the initiative and set hearing people at ease. The quickest way we can do this is simply to explain what we need them to do so we can effectively communicate with them. This is a two-step process.

First, we need to let them know what the problem is. I often just say, “I am hard of hearing and am not hearing you.” Now the hearing person is aware of the problem, but this just makes him even more uncomfortable. That is why it is vitally important at this point to take the second step, and immediately propose effective solutions that are easy for the hearing person to implement.

For example, I might say, “There is too much background noise here for me to hear you. Let’s move over there where it is quieter.” In another situation, I might say, “I’m hard of hearing and speechread you. Please look at me when you talk so I can read your lips.” With another person, I may say, “I need you to speak slower and more clearly so my ears can understand you.” Or I may say, “I can’t hear you from over there, I need to get closer to you because I am hard of hearing. Hang on a second while I get closer.” If the light is wrong for speechreading, I may say, “Would you trade places with me, so the light from the window falls on your face and not in my eyes, which interferes with my speechreading you?”.

Often implementing one or two of these simple little things is all that it takes to establish effective communication. Go for it!

by Neil Bauman, Ph.D.

When a person describes hearing phantom sounds, how can you tell whether these sounds are non-psychiatric or psychiatric in nature? In other words, is the person hearing them sane or psychotic?

Following is an excerpt from an email I recently received.

My mother is 88 years old and has been hard of hearing for a number of years now. She told me that she heard a man and woman singing. She felt certain that they were her upstairs neighbors. Later, she spoke about the same man and woman speaking directly to her, swearing and saying unkind things to her. She also told me that she was trying to stay very quiet because if she rattled her dishes getting them out of the cupboard, they would comment.

Is this woman experiencing the “normal” phantom Musical Ear Syndrome sounds that many elderly hard of hearing people experience, or is she experiencing psychiatric auditory hallucinations that should be treated by a psychiatrist, and why?

Answer: This person is experiencing psychiatric auditory hallucinations and should be treated by a psychiatrist. The key is that the auditory hallucinations are personal in nature. The voices are either speaking to her (swearing at her and saying unkind things), or about her (commenting when she rattles the dishes).

In contrast, people experiencing Musical Ear Syndrome might have heard the same music and singing and similarily thought it was coming from the upstairs neighbors, but it would be completely impersonal in nature–as though it were coming from a radio, TV or stereo. They would not be interacting with the voices in any way.

For more on this fascinating (and at times disturbing) subject, point your browser to Phantom Voices, Ethereal Music & Other Spooky Sounds.