by Neil Bauman, Ph.D.
As changes in technology surge forward at a frenetic pace, you are bombarded with the hype that newer is better. But is this really so?
Here are some myths and their corresponding facts concerning hearing aids.
Myth No. 1: The latest hearing aids let you hear well under all listening conditions.
Brad Ingrao, Au.D., one of my favorite audiologists, wrote, “In 20 years of practicing audiology, I have almost never encountered a person whose hearing aids were unable to help them hear well, in a small, quiet room with carpet, drapes or no air-conditioning.” (1)
Notice the conditions: it is quiet, there is little reverberation and the speaker is close to the listener. Under those conditions, yes, hearing aids typically work wonderfully well.
Brad continues, “On the other hand, almost all of my hearing aid patients complain that no matter how much they spent on their hearing aids, they still struggle in noisy and reverberant rooms.” (1)
The myth breaks down here. You see, noise and distance are the two main enemies of hearing aids. As soon as you add distance and noise and all the reverberation and distortions of sounds that come with increasing noise and distance, hearing aids quickly cease to help you like they did before. This is when you need to use assistive devices. That is the reality. As Brad says, “the ideal solution in noise is a remote microphone connected to the hearing aid” via an assistive listening device.
Myth No. 2: Automatic hearing aids let you hear well because the hearing aid automatically changes the settings as the sound environment changes.
Brad explains, “Some people can do very well with a fully automatic hearing aid, assuming they spend most of their time listening to one or two kinds of sound in the same setting”. (1)
Some people do very well under these conditions. However, there is another side of the coin. Brad continues, “The more common reality is that people with hearing loss are out and about listening and living in many complex environments. They need to be able to tell their hearing aids how to behave, rather than the other way around.” (1)
To which I add, “Amen, brother.” You see, if you are like most hard of hearing people, you are better off getting hearing aids that are not fully automatic. Yes, you can have some automatic features as long as you can manually override them whenever you want. For example, I love my automatic volume controls, but I have manual volume control wheels as well and I can (and do) override my hearing aids whenever I want to. You want to be able to switch to different settings when the sound environment changes significantly.
Myth No. 3: The manufacturer’s fitting algorithm, together with the audiologists input, will give you a good fit the first time around.
You would like to think that an experienced Doctor of Audiology would be able to do this, wouldn’t you. But as Thomas Powers, Ph.D., vice-president of audiology at Siemens Hearing Instruments explains, “In general it is unreasonable to expect that even the most carefully designed prescriptive fitting method would be appropriate within plus or minus 3 dB for more than two-thirds of all patients.” (2)
In other words, you need to go back to your audiologist or hearing aid dispenser a few times to have your hearing aids tweaked until they get it right. A good fitting probably won’t happen the first time around. This is because “the prescribed gain and output is only appropriate for the average patient, and it too needs to be individualized.” (2) You are you—not Mr. Average—so you need your hearing aids specifically tweaked to fit your unique hearing needs.
Myth No. 4: The fitting that sounds the best lets you hear the best.
This sounds logical, but it is often not true. You see, what sounds the best is what sounds comfortable to you—but you may not hear (understand) the best at that setting.
Dr. Powers again explains, “In many cases better hearing audibility compromises sound comfort and vice versa. In some cases the prescribed high-frequency gain may improve speech intelligibility [so you understand more of what you hear], but the patients perceive the sound quality as too shrill and unacceptable [and if you have recruitment, certain louder sounds may even hurt]. As a result, they will turn down overall gain, resulting in reduced overall audibility.
The fitting challenge therefore is to find the right balance among desired loudness, good audibility, and sound comfort for every patient.” (2) This can be a definite challenge, especially if you have recruitment issues, or have a more unusual hearing loss (e.g. cookie-bite loss, reverse cookie-bite loss, reverse-slope loss). Thus, you may end up with less than optimal hearing (understanding) in order that what you do hear is not too uncomfortable. That is the reality of wearing hearing aids. You need to make trade-offs to best fit your lifestyle to your hearing aids.
(1) Brad Ingrao, Au.D., Decibels and Dollars. Hearing Loss Magazine. September/October 2011. p. 32.
(2) Powers, Thomas, Ph.D., Finding Optimum Gain, Compression, and Frequency Shape in Different Listening Situations. Hearing Review Products. Fall 2011. p. 14.