by Neil Bauman, Ph.D.
A mother wrote:
My 2-year-old daughter really hates wearing her hearing aids. She has been fitted with bilateral hearing aids since she was 3 months old.
We have had many different ear molds made. We have adjusted settings on her hearing aids many times. I have recently taken her to a new audiologist to see if she can help this situation. She turned up her hearing aids to see if this would help her to see the benefit of her hearing aids. This has been a very frustrating experience since she was 7 months old and learned to pull them out. I have tried many measures to make her wear her hearing aids including setting time limits where she has to wear them, putting her in time out when she takes them out, rewarding her with praise when she has worn them for an extended period of time, etc. I do well to get her to wear them two hours a day. She still gets upset when I get her hearing aids out and make her wear them, and often when I leave the room she pulls them out. She has group speech therapy with 2 other children that have a hearing loss similar to hers and their parents don’t have this problem.
She has seen 2 audiologists that specialize in pediatrics and both of them I think are at a loss of what to do. She does perform better with her hearing aids on in the sound booth than when they are off.
I am her parent and I know that hearing aids are extremely important but I don’t have to wear them and I am afraid they are hurting her. I do not know what they feel like on my daughter’s ears, and she is not old enough to tell me why she does not like them. I feel as if everyone thinks I am being ridiculous and a negligent parent by not forcing her to wear them every waking hour. I would love for her to wear them all of the time and I get so excited if we have a few good days where she wears them for 5 to 6 hours. There is nothing more that I want than for my child to hear more clearly but I don’t want her to be miserable either. I don’t think that it is fair just because she is a child and I am an adult that I spank her, put her in timeout, act angry at her, etc. if she takes her hearing aids out. Do you have any insight into all of this.
I hear you. You are caught between the professionals that say she must wear her hearing aids all the time, and your daughter who much of the time hates wearing them and thus yanks them out. The professionals are theoretically correct, but your daughter is taking a practical approach as I’ll explain later.
In your letter, you reveal several clues as to what the problem really is, and thus the solution to all of this. Let me explain.
At the outset, you need to determine whether your daughter’s refusal to wear her hearing aids is an act of rebellion (defying your authority as a parent as many two-year-olds do), or if there is some other cause.
I do not believe your daughter is rebelling against you. Here’s why.
1. Punishments aren’t working. Neither are rewards. When the pain exceeds the gain, the bad behavior stops. This is not happening. Neither rewards nor punishments are working. To me, this indicates that there is a fundamental problem that needs correcting, so you need to look further.
2. She doesn’t hate her hearing aids as such, in fact, she is quite proud of them. You write, “I don’t feel that she feels different with her hearing aids in. In fact she is quite proud (because they are pink) and she wants to show them to people when she has them in.” Also, she has classmates with hearing aids too so doesn’t feel different. So it is not “wearing” the hearing aids themselves that is the problem, it is something about wearing them.
3. She reacts the same way each time you get her hearing aids out. You write, “She still gets upset when I get her hearing aids out and make her wear them, and often when I leave the room she pulls them out.” Some people would have you believe that she just needs to get “used” to wearing her hearing aids. You’ve been doing this for well over a year, and if this was the problem it would have ended long since.
Thus, I don’t believe she is rebelling either against the hearing aids or your authority, but is reacting to the pain they are causing her. All her actions are consistent with this.
In fact, you are questioning this yourself. You write, “Many times I have questioned whether the hearing aids were hurting her. It has been very difficult for me as a parent to force my child to wear them when I question if these things are painful to her. ” To your credit you have replaced her ear molds several times thinking that it was the ear molds that are hurting her. In addition, you have had her hearing aids adjusted numerous times, all to no avail.
The audiologists don’t seem to have a clue what to do. One even turned up her hearing aides “to see if this would help her to see the benefit of her hearing aides,” and I bet just the opposite happened. She is now even more insistent on not wearing them.
I think the real problem is that her hearing aids are not adjusted properly and are allowing some, or all, sounds to be amplified to the point where she feels pain.
This becomes clear when you write: “We went to a baseball game and were standing in line for the concession stand, it was very noisy and in a confined area. She immediately became upset and within 30 seconds she was pulling her hearing aides out. She can’t stand them in any noisy environments–restaurants and WalMart, etc. She also lives in a very lively house. She has a four year old brother with whom she loves to rough-house and play loud games. She also has some difficulties with loud noises such as the hair dryer even without her hearing aids in.”
You need to understand that there are two kinds of “sounds being too loud.” The first one is the one everyone is familiar with–typical noisy situations can get so loud that the sounds eventually become painful. Any audiologist worth her salt knows this, and sets the hearing aids so that they won’t amplify above this level. Thus after a person gets used to wearing hearing aids, and their brain gets used to hearing louder sounds again, this is not a problem.
However, there is another kind of “loudness” that few people know about, and few audiologists really understand. It goes by the fancy name of recruitment. With recruitment, even normal, everyday sounds can be perceived as so loud that they are painful.
I believe this is your daughter’s problem. When she perceives sounds as painful, she yanks her hearing aids out. Since she can’t tell you this is happening, she does the only thing she can do to stop the pain.
Recruitment accompanies hearing loss. If you have a sensorineural hearing loss, you will have recruitment to some degree or other. Your daughter seems to have a severe case, just like I have. That is why I understand what she is going through. To learn more about recruitment, read my article called “Recruitment from Hearing Loss Explained.”
Louder sounds recruit. So can softer sounds. For example, just putting a glass on the table makes a little “thunk” sound–but that particular sound blows the top of my head off (figuratively of course) because, to me, that sound is excruciatingly loud. So are dogs barking and many other sounds.
It’s hard to believe how much these sounds can hurt unless you have experienced recruitment for yourself. If you observe your daughter, you’ll likely notice she yanks her hearing aids off as the sound level increases or certain sounds are present.
As you have discovered, some audiologists do not have a clue how to really adjust hearing aids to fit a person. Many just use the manufacturer’s standard algorithm and fit according to that. This does not work if you have recruitment!
For 50 years I wore hearing aids that could not effectively compensate for my recruitment. Thus whenever certain sounds were around, I yanked them out–for 50 years. Recently, I got hearing aids that can be set to control most of my recruitment. Now I finally can wear my hearing aids under most listening conditions! It’s wonderful!
If your daughter’s hearing aids are not adjusted properly to account for her recruitment, no wonder she can’t stand them and yanks them out. You should be able to tell if sounds are recruiting for her. If a sound that is not too loud to your ears causes her to startle, blink or jump, that sound is recruiting and hurting her.
You mentioned that one audiologist turned up your daughter’s hearing aids to see if this would help her to see the benefit of her hearing aides. I cringed when I read that because this is the wrong thing to do. Sounds are already too loud for her to stand (except in quiet settings) and turning them up makes it even worse! This just exacerbates her recruitment problem.
The solution to recruitment is to set the compression on her hearing aids such that no sounds can ever exceed the recruiting level, whatever that level is.
Her audiologist needs to test for recruitment at each standard test frequency, and then set the compression appropriately in those channels that contain any recruiting frequencies.
Another point. Do her hearing aids have automatic volume controls, manual volume controls or automatic volume controls with manual overrides?
You should never have automatic volume controls unless you also have manual overrides–especially for those with recruitment! If you can control the volume manually, then you just turn it down in noisy situations. It’s that simple. This will go a long ways in controlling recruitment in many, but not all, situations.
To sum this all up, until you get your daughter’s hearing aids properly adjusted for her, don’t make her wear them in any except quiet situations. You might be surprised to know that many adults dump their hearing aids in dresser drawers and don’t wear them because of this very same unresolved recruitment problem, and they can say that their hearing aids are hurting them.