Hearing Loss Help  

by Neil Bauman, Ph.D.

Some people have been longing for a completely implantable hearing aid. Besides the (dubious) advantage of being completely invisible (people won’t be able to tell if you are hard of hearing so won’t make allowances when you don’t hear them), there are a few real advantages to a totally implantable hearing aid.

For example, if you spend time in the water swimming or splashing around, you’ll still be able to hear. Ditto when you are in the shower. Furthermore, you can leave it on all night as you sleep so if you are a mother with young children, you’ll be able to hear them if they cry during the night (assuming you don’t roll over and sleep on the implant side so the microphone is buried in the pillow). Also, if you live in a humid location, or sweat profusely, or work in a dirty environment, all that extra moisture and dirt won’t “gum up the gearworks”. Furthermore, if wearing hearing aids/ear molds causes problems in your ear canals, with an implanted hearing aid, your ear canals will be totally free of any apparatus.

The good news is that if you are so inclined, you now can get such a hearing aid. Otologics of Boulder, CO has introduced their new fully-implantable hearing aid called the Carina.

Here’s how it works. The microphone, which is implanted under the skin, sends the sound signals to the amplifier which is surgically embedded in the mastoid bone behind your ear (much like the internal parts of a cochlear implant are embedded). The output of the amplifier is sent down a wire to a transducer (vibrator), the point of which touches, and thus pushes on, the incus (anvil), the second of the three bones in your middle ear. This mechanical motion amplifies the normal sound signal that is then sent in the usual fashion to the incus (stirrup) and from there to the inner ear.

Incidentally, the amount of movement the transducer imparts to the incus is very small—only 1 to 2 micrometers. That is only 1 to 2 thousandths of a millimeter, (or about one 25 thousandths of an inch) an imperceptible movement even under a microscope.

Since it is all internal, you need a remote control to adjust the volume and turn the hearing aid on or off. Unlike the remotes in typical hearing aids where you just hold the remote in your hand in front of you and press a button, the Carina remote has to be placed right over the implant behind your ear before you press any buttons.

The implant is programmed according to your specific hearing needs just like any regular digital hearing aid. The Carina is designed for adults with moderate to severe hearing losses.

Since the battery is also internal, the folks at Otologics had to come up with a way to recharge the internal battery. The charger system consists of the base station, a charging coil, and the charger body. To recharge the implant, you remove the charger body from the base station and place the coil on your skin over the implant. The charger body contains a clip so you can attach the charger to your belt during charging. Typically, charging time is about 1 hour. You must recharge the Carina daily. While recharging, you can go about your normal daily activities, turn the implant on and off, and adjust the volume.

One cool thing about the Carina is if the battery dies or the implant quits working for any reason you won’t be left totally deaf—you can still use your residual hearing. You see, the implant does not affect your residual hearing. Thus you could even temporarily wear a backup hearing aid in your implanted ear.

There are some downsides to implantable hearing aids. For one thing, upgrading your “hearing aid” as new technology comes along is going to be a real problem. Second, you will need surgery to replace the battery when it finally dies. This won’t happen often as the battery has a projected 20 year life span. Third, you cannot have any MRIs unless you have the whole implant surgically removed. Fourth, if you like diving or scuba diving, you will have to limit yourself to a depth of 10 feet or less. And fifth, it is pretty expensive—$12,000.00 and $15,000.00 each, and that does not include the surgery and related costs.

However, if having a fully-implantable hearing aid turns your crank, the Carina may be the hearing aid for you.

To learn more about the Carina, point your browser to the Otologics web site.

by Neil Bauman, Ph.D.

A man asked:

Is it possible for hearing aids to be programmed to deal with “recruitment”, the loud “bursty” elements of sound?

This seems to be quite a common problem for those of us with more severe hearing losses. Few audiologists seem to take the time to properly test for recruitment, and then specifically adjust our aids so they don’t cause recruitment.

The proper way to test for recruitment is to check the uncomfortable loudness levels (UCL) where sounds go from being too loud to hurting for each test frequency.

Typically, audiologists just do a “broadband” check of the UCL, rather than frequency by frequency. In fact, only one time in my life has an audiologist ever done a proper frequency by frequency recruitment check, and that was because I specifically asked her to do it.

After testing for the UCL frequency by frequency, your audiologist then needs to set the compression on your hearing aids for each frequency to limit the maximum sound level for those frequencies such that they always remain below your recruitment level.

This sounds simple in theory—but may be harder to do in practice depending on the number of compression bands your hearing aids have. Because of the placement of my recruitment along the frequency spectrum, and since by hearing aids only have four compression bands, my audiologist has to “detune” half of my channels in order to fix the recruitment problem. The result is that my comprehension goes down significantly. This is not good.

Thus I have two choices: either fix most recruitment problems, but don’t understand as much of what I hear, or understand more of what I hear, but yank my hearing aids out of my ears when sounds start recruiting. Either way, I don’t hear as much as I should. The next time I get hearing aids, I’m going to look for hearing aids where the compression can be set for each frequency—not just by broader bands.

Totally eliminating recruitment isn’t easy. There is a fine line you have to walk when adjusting the hearing aids to get the best of both worlds at the same time. It won’t be perfect, but with patience, your audiologist should be able to get pretty close.

by Neil Bauman, Ph.D.

Distance and noise are two enemies of hearing aids. That is why hard of hearing people often need to use assistive devices coupled with their hearing aids in order to hear beautiful, clear sound.

There are many “generic” assistive listening devices that couple with hearing aids via their built-in t-coils. This is the industry “standard”.

However, each hearing aid manufacturer wants people to purchase their hearing aids (understandable—that is why they are in the business) so they come up with proprietary innovative ways to connect to various audio sources such as TVs, iPods, computers, etc.

This means when one of their customers (that’s you and me) buy their hearing aids, we are locked into their line of assistive devices (and they are not cheap). Then, if in the future we want to buy new hearing aids from a different manufacturer, we lose all our investment in the assistive devices we have purchased for our previous hearing aids.

This may be good business for the hearing aid manufacturers, but it is definitely bad for our pocketbooks! We now have to shell out big bucks, not only for new hearing aids, but for new assistive devices as well.

This should not be. Connectivity to assistive devices should be “open source” so all manufacturers can use the same modes of connectivity.

I’m all for innovative designs and advances in technology. I’m just against all the mutually incompatible proprietary devices we have to purchase in order to use the latest technology with our hearing aids.

What brought on the above diatribe is GN ReSounds new Alera hearing aid with yet another proprietary set of assistive devices.

The press releases are long on hype and short on hard facts, but from what I can gather, the Alera has a built-in (presumably FM) receiver operating at 2.4 GHz. Then, the customer purchases various proprietary transmitters that connect to the audio devices he wants to listen to. So you buy one so you can listen to your TV and another to listen to your computer, etc.

It sounds like cool technology. The FM receiver is built into the hearing aid so there is no need for using boots, neckloops or remotes. This makes for a “cleaner” design.

You hook up the appropriate transmitter to the audio device you want to listen to—and voila, you hear beautiful, clear sound. With the Alera, you can be 21 feet away, which is about the same distance as the effective range of the Bluetooth technology that is already out there.

If the “hypewriters” are correct, this new technology will deliver “unique sound quality” by employing ReSound’s “revolutionary” Surround Sound technology which delivers a rich and crisp 360-degree sound.

The Alera and its assistive devices will be available in June, 2010. If any of you try them, I’d love to hear how they work for you. Just be sure that the Alera comes with a standard t-coil, or, when you go to places that use loop technology, you’ll be left “out of the loop” and thus your fancy new hearing aids will be essentially useless.

Learn more about the Alera here.

by Neil Bauman, Ph.D.

A lady wrote:

I was diagnosed with Meniere’s disease. I have horrible tinnitus and can tell my hearing has gone horribly downhill. My question is, can a hearing aid help with the tinnitus to shut it out or anything? When I’m in a room with stuff going on I don’t usually hear it AS well as I do in a quiet room, but it’s still enough to really bug me.

Excellent question. Hearing aids in and of themselves do not affect the loudness of your tinnitus as such. Rather, they amplify sounds so you hear more (and louder) sounds. The good news is that this partially masks your tinnitus so you don’t notice it as much.

It is basically the same effect as you have already found when in a noisy room—your tinnitus doesn’t appear to be as loud because your brain has lots of real sounds on which to concentrate. Furthermore, in a noisy situation, the contrast between the background sound level and your tinnitus is much less than if you were in a quiet room.

However, when you are in a quiet location there is nothing to mask your tinnitus sounds. Thus, you perceive them as louder and more intrusive. Wearing a hearing aid in a quiet room will pick up the softer sounds you can no longer hear and thus help mask your tinnitus.

When your tinnitus is bothering you and you are in a quiet place, you need to enrich your environment with real sounds—turn on the TV, listen to a radio, stereo, iPod or MP3 player, and/or wear hearing aids.

This is especially important at night when the room is quiet. Some people find that just having a fan running, or a clock radio playing music really helps take their focus off their tinnitus. Use whatever works to give your brain real sounds to listen to so you don’t focus on your tinnitus.

You see, if you focus on your tinnitus, you will perceive your tinnitus as becoming louder and louder and more and more intrusive as the days go by. Therefore, you want to focus on the loves of your life, and the things you are doing, rather than on your tinnitus. When you do this, you’ll notice, if you stop at that point and think about it, that your tinnitus now appears softer and much less intrusive. This should be your goal.

If you want to learn more about tinnitus and the things you can do to help bring it under control, see the book, “When Your Ears Ring—Cope with Your Tinnitus—Here’s How“.

by Neil Bauman, Ph.D.

A man explained:

I am deaf on my left side due to four acoustic neuroma surgeries. I now have a TransEar hearing aid but it doesn’t work like I expected. How about a CROS aid? Also, what else is new on the market?

There are a number of solutions for single-sided deafness.

1. If you have normal hearing on your good side, just be deaf on one side and practice good coping strategies to help overcome it such as sitting with your good ear “into the room” when in church, in meetings, etc. When chatting, have the person you are talking to either sit opposite you or sit on your good side—this kind of thing.

2. Get a bone-conduction hearing aid that was designed for single-sided deafness. There are three “kinds” out there of which I’m aware. All use the principle of bone conduction to transfer the sound from your deaf side to the good side.

A. Bone Anchored Hearing Aid (BAHA). This involves having a titanium screw (post) drilled into your skull and the sound processor sits on this post. This is an invasive procedure and by far the most expensive.

C. TransEar. Which you already have. This is a BTE hearing aid that has a special transducer (vibrator) that vibrates a special ear mold that fits deep in your ear canal. Note: a new model is coming out shortly that might give you better results.

D. SoundBite. This is the “new kid on the block” and is still in trials. It vibrates your back molars to conduct the sound to your other ear. I wrote about the SoundBite here.

3. Get a CROS hearing aid. Cross aids are basically one hearing aid in two pieces. You wear the part that contains the microphone and transmitter on your bad side, and the part that contains the receiver and amplifier on your good side. It feeds the sounds from your deaf side to your good side. Because you wear a loose-fitting ear mold, you still hear all the sounds from your good side as well.

4. Get certain high-end regular hearing aids that “talk” to each other. You can set them such that any sounds picked up by the bad ear side are automatically transmitted to the good ear (crossover) so you can hear them.

CROS aids don’t seem to be very popular any more. Maybe because regular hearing aids that can do crossover (talk to each other) can do much the same thing.

I think the darling of the industry at the moment is the BAHA. It is worth investigating if you don’t mind the surgery and risks and expense involved.

However, you might also want to investigate the SoundBite. Perhaps it will be a good aid for you. Maybe you could get in the trials. Check out their web site.

Do your homework on all of the above, then talk to your audiologist about these various options and decide on what seems the best course of action for you.

by Neil Bauman, Ph.D.

Many people have asked me,

Where can I find an affordable hearing aid? They all cost so much, and I’m on a limited income. Can you help me?

Typically hearing aids are expensive, ranging from around $800.00 at the low end, and on up to $3,000 or $4,000 each for high-end models. Such aids are out of the reach of those with severely limited incomes.

I’ve written about sources of help for purchasing hearing aids before, but even some sources of help require the person to put up hundreds of dollars as their “share” of the cost, and even this may be too much for some people to handle.

Fortunately, a new outfit, MDHearingAid, is now producing low-end hearing aids at a price many people can afford, no matter what their income. Marketed under the Acoustitone brand name, these hearing aids were made to the specifications of ENT Dr. Cherukuri, the founder of MDHearingAid.

At present, there are just two models available-the Acoustitone MAX which normally sells for $129.99 (currently on sale on the MDHearingAid web site for $89.99), and the more advanced Acoustitone PRO which normally sells for $259.99 (currently on sale for $149.99). These prices are hard to beat!

The Acoustitone MAX is a very basic unit. Dr. Cherukuri designed it primarily for “home-bound seniors that need help hearing the television and family members.” Its only control is the volume control. Actually, it is somewhat reminiscent of the first behind- the-ear hearing aids that came out in the mid 1950s in that it has a button receiver to which snaps a generic ear tip. (There are 3 ear tips of various sizes.)

The more advanced Acoustitone PRO is a much better value (in my opinion) since it has a directional microphone, and a two-channel tone control which decreases background noise and customizes the output for people with either a predominantly flat “curve” (hearing loss about the same at all frequencies) or the much more typical ski-slope curve (high frequency hearing loss). It also can use a custom-fitted ear mold, although it comes with 3 generic ear tips of various sizes.

Both of these hearing aids amplify the critical speech frequencies between 1,000 Hz and 4,000 Hz.

Note: neither of these hearing aids have t-coils which are so important for coupling hearing aids to the many assistive listening devices that help us hear ever so much better under poor listening conditions when hearing aids by themselves are not that helpful.

The good news is that MDHearingAid will soon be introducing a third hearing aid that will indeed have a t-coil. It might be well worth waiting for this new model whenever it comes out.

To learn more about these very affordable hearing aids, point your browser to the MDHearingaid website.

by Neil Bauman, Ph.D.

You’ve all heard of sound bytes (short pithy chunks of speech), but this interesting hearing aid literally puts the bite on sound. That’s why they named it the SoundBite.

According to their web site, “Sonitus Medical^TM is pioneering the development of the world’s first non-surgical, removable hearing and communication solution that is designed to imperceptibly transmit sound via the teeth.”

Well, I’ve got news for their “hype writers”. Far from being the first, they are actually a “Johnny come lately”—489 years late to be exact. You see, hearing through your teeth is nothing new. Some of the earliest “hearing aids” were held in the teeth and thus transmitted sounds to the inner ear via bone conduction. There are published reports of such devices as early as A.D. 1521, although “dental hearing aids” did not become popular until Richard Rhodes of Chicago, IL patented and began selling his Audiphone in 1879. (That’s still 131 years ago!) Surprisingly, this Audiphone produced up to 35 dB of amplification.

Actually, using the teeth to transmit sound vibrations to the cochlea is not as strange as it might seem at first glance. The late Dr. Berger explained, “It may surprise some to learn that sound conducted through the teeth is a more efficient bone conduction route than that through the skull, particularly for low-frequency sounds.” So maybe the SoundBite’s time has come.

With the advent of the SoundBite, we have yet another acronym to add to the already prolific “alphabet soup” of hearing aids. Thus, in addition to BTE, ITE, ITC, and CIC hearing aids, we now have to add—ITM (in-the-mouth) hearing aids.

The Sonitus SoundBite is currently in clinical trials in the USA. It is being touted as a solution for people with single-sided deafness, and for those with conductive hearing losses. As such it would be another alternative to Cochlear’s Bone- Anchored Hearing Aid (BAHA) and Ear Technology’s TransEar bone conduction hearing aid.

The SoundBite consists of two parts. First, there is what looks like a traditional BTE hearing aid. The BTE portion contains the microphone and a tiny transmitter that wirelessly transmits the sounds it receives to what looks like an overgrown dental retainer that fits beside the upper molars. The in-the-mouth piece is custom fitted from tooth impressions made by your dentist (much as ear molds are custom made by your audiologist to fit your ears).

One side of the ITM piece houses the amplifier and tooth conduction vibrator while the other side contains the rechargeable battery. The SoundBite is custom fitted for either the left and right side of your mouth, depending whether your left or right ear has the hearing loss.

I don’t know whether I’d want to wear an in-the-mouth hearing aid, but you will shortly have that option.

Learn more about the SoundBite hearing aid here, and see a good set of pictures of this new hearing aid here.

by Neil Bauman, Ph.D.

Ear Technology Inc. has done it again! “Done what?” you ask. They’ve come up with another cool product. You probably first knew them for their Cadillac of hearing aid drying and disinfecting systems—the Dry & Store. Then about 3 or 4 years ago they designed their unique TransEar BTE bone conduction hearing aid for people with single-sided deafness. The TransEar uses a special ear mold as the bone conductor.

Now they’ve come up with a new concept in hearing aid programming and design—what they call the Clik system—where all the programming is done with the click of a button on the hearing aid itself. There is no need for computers, programming interface boxes, etc.

What this means is that instead of programming this hearing aid in the sterile, quiet environment of your audiologist’s office, you can both step out into the street and program it right there for those exact noisy listening conditions.

What’s even cooler, is that if you are a savvy hearing aid wearer, you can program this hearing aid yourself. (Your audiologist will have to show you the programming “trick” first.) This means you can program/tweak the Clik hearing aid in your home, or office, or wherever you typically spend your time in order to get optimal hearing with it under real-life conditions.

The Clik hearing aid is specifically designed for the millions of people who have the typical mild to moderate ski-slope (high-frequency) hearing loss. It comes with 5 algorithms pre-programmed for quiet environments, and another 5 algorithms for noisy situations.

In addition, the Clik hearing aid comes with not one, but two t-coils—something I’ve been wanting for years. One t-coil is vertically polarized for use with telephones and neckloops, and the other t-coil is horizontally polarized for use with room loops. That way you almost always get optimal coupling with any magnetic induction device. Furthermore, the hearing aid automatically uses the t-coil with the louder signal—you don’t have to fool around switching between them.

The Clik hearing aid is simple to use. One button controls the volume. The second button controls its three memories—one for quiet, one for noise, and the third for t-coil use.

I love their sense of humor. Instead of one beep for memory one, two beeps for memory two etc., they give you the typical sounds for which these various memories are used. Thus for the noise setting you hear a short burst of (white) noise. When switching into the t-coil mode, you momentarily hear a dial tone. Cool, huh? (For the quiet setting, since you can’t hear “quiet”, it has to beep to let you know you are in that memory.)

You have full control over the volume—you set it to what is comfortable for you. Its 8 channel wide dynamic range compression (WDRC) keeps loud sounds from becoming too loud while at the same time amplifying softer sounds so you can hear them.

Like most new hearing aids, it has adaptive feedback cancellation so it won’t “squeal” in your ear. It also uses directional microphones and incorporates noise reduction technology to reduce the background sounds that make it so hard to understand speech in noise.

Another cool feature is that it functions as either an open fit aid for those with mild to moderate losses, or as a regular aid with an ear mold for those with more severe hearing losses.

Oh, yes, before I forget, the Clik hearing aid doesn’t cost an arm and a leg—an arm maybe, but definitely not the leg!

For more information on this neat new hearing aid, talk to your audiologist, or check out the Clik web site.

by Neil Bauman, Ph.D.

A question I get asked is:

Where can I get financial help for purchasing hearing aids? They are so expensive, and I can’t afford them, but need them. Can you help me?

There are a number of sources of help, but ferreting them out is quite a chore. The good news is that the Better Hearing Institute has just done all that work for you.

You can find 69 sources of financial help for purchasing new hearing aids in their new publication “Your Guide to Financial Assistance for Hearing Aids”. This is the first comprehensive guide of this kind of information. It contains information on charitable foundations, private organizations, insurance plans, corporate benefits and government programs that can help you get the hearing aids you need.

Be aware that your eligibility for financial assistance may depend on where you live (various organizations/states/counties may require you to live in their “area” to be eligible. In addition, you will be subject to a means test in order to prove that you really can’t afford new hearing aids. Often, you will find there is a sliding scale of funding depending on your means. In some cases, if your income is below a certain threshold you may be eligible for 100% (or close to 100%) funding.

You can download a free copy of this valuable 48-page guide from the Better Hearing Institute website.

Note: While you are on this web page, you may want to download some/all of their other great guides in this series. These include:

• Your Guide to Better Hearing
• Your Guide to Your Child’s Hearing
• Your Guide to Hearing Aids

In addition, the Northern Virginia Resource Center has published a 6-page fact sheet entitled, “Financial Assistance for Hearing Aids” which you can download.

(Currently it’s the fifth link listed on the page.) This Fact Sheet naturally emphasizes local (northern Virginia) sources of help as well as some national sources. And while you are on the NVRC website, there are 15 other good facts sheets you may want to look at or download.

by Neil Bauman, Ph.D.

A short article in the November, 2009 issue of the AARP Bulletin recommends that you do what most people don’t do—and that is, haggle over the price of your next hearing aids.

The worst that can happen is that they say no, but if they want your business, they may sweeten the deal, and you’ll save some of your precious dollars as a result.

Apparently, only about 15% of shoppers in general ever ask for a discount, but the good news is that of those that do ask, close to half get a better price, according to this article. You may find that a bit of haggling gets you a better price on your next pair of hearing aids too. It’s certainly worth a try.