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Fifteen
Rules for Satisfied Hearing
Aid Users
Ron
J. Leavitt, Audiologist, Hearing
Assistance Technology,
310
SW 4th St., Suite 180, Corvallis
OR 97333
Dean
E. Booster, Professor Emeritus,
Oregon State University
>>Ron:
Welcome, folks. I'm Ron Leavitt.
I want to tell you about a group
that we formed 13 years ago
called the Oregon Association
for Better Hearing (OABH). I
was an Oregon State University
faculty member and an audiologist
at the Corvallis Good Samaritan
Hospital. The hearing aid performance
information appearing in the
newspapers was supplied primarily
by hearing aid manufacturers.
It is natural to expect that
hearing aid manufacturers and
sales persons have a built-in
bias toward their products.
If people are to really learn
about what hearing aids can
and cannot do, they should have
a source of information based
upon the real life experiences
of people who have actually
used the hearing aids. OABH
has since become the largest
consumer product test group
for hearing aids in the Western
United States.
Hearing
aids selected for testing are
limited to those that are purported
to incorporate new signal processing
technology or useful new features.
A given hearing instrument is
evaluated by several product
testers. Test periods are usually
about two weeks in length. Product
testers are permitted unlimited
office visits for fine tuning
of the hearing aids. Product
testers report their findings
at regular meetings of the Oregon
Association for Better Hearing.
To
date, some 20 experienced hearing
aid users, all of whom are unpaid
volunteers, have participated
in the product testing. Their
ages range from the 20s to the
80s. They have varying degrees
of hearing loss ranging from
mild to profound. Their backgrounds
are varied. They are students,
housewives, professionals, and
retirees. None of them sell
or service hearing aids or have
an affiliation with a hearing
aid manufacturer. Thus, there
is no financial incentive to
promote one brand or one model
of hearing instrument over another.
Our goal is to provide our members
with the most unbiased hearing
aid performance information
possible.
Considering
the diversity of our product
testers, it is rather amazing
that we were able to get 20
people to agree on 15 items
associated with hearing aid
user satisfaction. These items
are documented in a publication
entitled, Fifteen Rules for
Satisfied Hearing Aid Users.
As
mentioned, I am an audiologist
and have a private hearing
and speech center in Corvallis.
I am also a member of the faculty
of the Oregon State University
Speech Communications Department.
With me today is one of the
OABH product testers who will
be presenting several of the
"Fifteen Rules." He is a retired
faculty member of the Oregon
State University Agricultural
Engineering Department and has
personal use experience with
27 different hearing aids. I
would like to introduce to you
at this time, Dean Booster.
>>Dean:
Good morning ladies and gentlemen.
According to the1993 edition
of the New Oxford Dictionary,
to "satisfy" means, among other
things, (1) fulfilling a person's
desires, hopes, and demands,
or (2) putting an end to a person's
wants or needs. In the case
of hearing aid performance,
achieving complete user satisfaction
is a pretty tall order. Not
only do hearing aid users have
different hearing losses, they
function in different listening
environments, and, to further
complicate matters, they have
different personal likes and
dislikes. The Fifteen Rules,
by themselves, cannot unconditionally
guarantee user satisfaction,
but persons following these
rules will certainly achieve
a greater degree of satisfaction
than those who do not.
It
is my pleasure to discuss with
you six of the Fifteen Rules
from the perspective of a hearing
aid user. Ron will cover the
remaining nine rules from the
perspective of an audiologist.
The comments that I will share
with you today are based on
approximately 11 years' experience
as a hearing aid user and nearly
10 years as an OABH product
tester. During that time, three
fundamental truths related to
hearing aids and hearing aid
users have become evident.
1.
The goal of any hearing aid
user should be to get the
simplest and least expensive
hearing instrument that does
what the user wants it to
do.
2.
A particular hearing aid may
meet the needs of someone,
but no single hearing aid
will meet the needs of everyone.
3.
User satisfaction is a personal
thing. It all depends upon
what the user is willing to
accept.
Rule
1–Get Past Denial
There
are at least 28 million people
in the United States who could
benefit from the user of hearing
aids, cochlear implants, or
other assistive listening devices.
Many in this group find it difficult
or even impossible to take an
active part in conversations
with family members at home,
with friends at social gatherings,
or with colleagues and clients
in the work place. Beside that,
they often do not hear many
of nature's sounds, such as
birds singing, or the rustling
of leaves in the fall. For most
people, not being able to hear
can have an adverse effect on
a person's quality of life.
There
are more than 60 hearing aid
manufacturers of consequence
in the world market. Collectively,
they produce literally hundreds
of hearing instrument models
from which to choose. Why is
it, then, that only about five
million individuals in this
country have taken advantage
of the technology available
that could potentially improve
their quality of life?
There
are numerous reasons, but one
that is oftentimes the most
difficult to deal with is denial.
Acknowledging that you have
a hearing loss is not easy or
pleasant. But, it is the necessary
first step in the long road
to better hearing. Unless the
individual is willing to accept
the responsibility for dealing
constructively with his/her
hearing loss, rehabilitation
is not likely to occur.
Rule
2–Use Two Hearing Aids If You
Have Hearing Loss in Both Ears
I
have similar high frequency
hearing losses in both ears.
Many of the consonants that
are so necessary for speech
understanding are beyond my
unaided hearing range. Without
the consonants, it is very difficult
to distinguish between words
like tin, thin, fin, sin, and
shin. I have found that my speech
understanding using two hearing
aids is far superior to that
using only one hearing aid.
To illustrate the improved hearing
capacity, let me describe the
increased benefits by means
of an analogy. Suppose the speech
understanding improvement using
only one hearing aid is represented
by one cup of water. Simple
logic would dictate that the
speech understanding improvement
using two hearing aids would
be represented by two cups of
water. This has not been my
experience. For me, the benefits
realized using two hearing aids
are more like three cups of
water.
Some
of the potential benefits from
using two hearing aids versus
one hearing aid are shown below:
•
Generally speaking, speech
understanding ability deteriorates
with the passage of time.
Research shows that for persons
wearing only one hearing aid,
the deterioration rate of
the unaided ear is likely
to be greater than that of
the aided ear over a given
period of time.
•
Improved speech understanding
in noisy environments.
•
Improved ability to hear soft
sounds and distant speech.
•
Improved ability to locate
the source or direction from
which sounds originate.
Please
keep in mind that an ear with
either normal hearing or no
hearing at all is not considered
aidable.
Rule
3–Get a Comprehensive Hearing
and Hearing Aid Evaluation from
a Nationally-Certified Audiologist
Identifying
the type and magnitude of a
person's hearing loss is of
utmost importance in achieving
even minimal user satisfaction.
The starting point is a medical
examination. No matter how sophisticated
they may be, hearing aids are
not remedies for medically treatable
hearing impairments.
A
comprehensive audiological evaluation
involves more than just a pure
tone air conduction test where
you raise your hand or press
a button each time you hear
a tone. It involves a battery
of tests. In addition to the
pure tone air conduction test,
the following tests are recommended
for adults:
- Impedance
test–helps identify hearing
disorders that may be medically
treatable.
- Bone
conduction test–measures
the amount of hearing loss
that is due to dysfunction
of the hearing nerve cells.
- Determination
of the hearing aid user's
most comfortable and uncomfortable
loudness levels.
- Tone
decay test–evaluates the
auditory system beyond the
hearing nerve cells.
- Speech
reception and speech recognition
tests–measures the listener's
maximum and real world speech
understanding ability.
- Real-ear
aided hearing test–required
for a meaningful hearing
aid evaluation. It allows
the hearing aid's performance
to be monitored while the
user is wearing the hearing
aid.
The
importance of having qualified
personnel conduct these tests
cannot be over emphasized. The
hearing aid dispenser is at
least as important as the brand
and model of hearing aid in
achieving user satisfaction.
This must have the appropriate
equipment at his/her disposal
and possess the knowledge, training,
and experience to properly conduct
the tests and accurately interpret
the test results. As you might
expect, the training and skill
levels of hearing aid dispensers
vary widely.
The
minimum education and training
requirements for hearing aid
dispensers in Oregon are as
follows:
For
Hearing Instrument Specialists
(HIS)
- Be
a high school graduate at
least 18 years of age.
- Have
completed 160 clock hours
of supervised training (68
hours of theory and 92 hours
of practical experience).
- Pass
a State examination.
- Purchase
a State license.
For
Clinically-Certified Audiologists
(CCC-A)
- Have
a minimum of a masters degree
in audiology from an accredited
institution offering course
work in audiology.
- Have
completed a one-year full-time
practicum.
- Pass
a national examination.
- Purchase
a State license.
Considering
the importance of hearing to
one's quality of life, we recommend
that the hearing aid users avail
themselves of the services of
a clinically-certified audiologist.
>>Ron:
Up to this point, you may be
thinking this has been a fairly
noncontroversial presentation.
But, you can't imagine the amount
of trouble these first three
rules have given us. For example,
the actual amount of amplification
being provided by the hearing
aid can be determined using
the real-ear aided test talked
about in Rule Three. We were
very surprised last year when
the results of a national survey
of showed that only 15 percent
of the people dispensing hearing
aids in this country routinely
make use of real-ear aided testing
equipment.
Some
manufacturers have told us that
today's sophisticated hearing
aids are far too complex to
be performance-tested in the
provider's office. They have
suggested that all we have to
do is follow their fitting instructions
and everything will be fine.
Our experience has been that
following the manufacturer's
fitting instructions to the
letter more often than not results
in hearing aid performance unacceptable
to experienced hearing aid users.
At a recent OABH meeting, we
asked one of our product testers
to evaluate the performance
of one of the most highly rated,
and coincidentally one of the
most expensive fully digital
hearing aids, in the meeting
room environment. The hearing
aid had been programmed according
to the manufacturer's recommendations
and using product tester's audiological
evaluation data. When asked
how it performed, she said she
could not tell if the hearing
aid was turned on or not. Numerous
programming adjustments were
required to raise the performance
to an acceptable level to meet
the product tester's listening
needs and preferences.
Do
not let people tell you these
sophisticated hearing aids cannot
be tested with conventional
testing equipment. They can,
and they must be if your goal
is to have the user achieve
maximum satisfaction from their
use.
Rule
4–Get Behind-the Ear Style Hearing
Aids for Maximum Reliability
This
is another bit of advice that
is contrary to the message contained
in much of the manufacturers'
promotional materials. The traditional
classifications of hearing aids
based upon their physical size,
in descending order beginning
with the largest, are: (1) Behind-the-Ear,
(2) In-the-Ear, (3) In-the-Canal,
and (4) Completely-in-the-Canal.
Vanity
often plays a large role when
the user selects a hearing aid
style. Manufacturers would like
you to believe that "smaller
is better" and place added emphasis
on completely-in-the-canal (CIC)
style instruments. This tends
to promote the idea that "People
will not know I am hearing impaired
if they cannot see my hearing
aids." Our experience, from
the standpoint of trouble-free
hearing aid operation, is that
smaller is not always better.
As
the style name suggests, completely-in-the-canal
aids are positioned deep in
the ear canal. One of the most
prevalent problems with CIC
hearing aids is that they get
fouled with ear wax. It takes
only a minute amount of ear
wax to render them inoperative.
Even the best wax-guard systems
available today, cannot guarantee
freedom from wax plugging. You
may say, "I know a lot of people
who wear hearing aids in their
ear canal, and they don't seem
to have that much trouble with
them." I do, too. But I also
know people who come in every
month, and sometimes more often,
with a dead hearing aid because
of the ear wax in it.
I
don't mean to imply that all
of our product testers are behind-the-ear
hearing aid users. Far from
it. We are not trying to change
people's mind. We only want
them to be able to make a style
choice base upon facts rather
than hype. We want them to know
that behind-the-ear hearing
aids provide the best protection
against ear wax plugging because
the electronic circuit components
of the hearing aid are far removed
from the source of the ear wax.
Rule
5–Choose and Audiologist Who
Offers Multiple Brands of Hearing
Aids
We
have been testing hearing aids
for a little over 12 years.
As was stated earlier, there
are numerous hearing aid manufacturers
in the world market place. No
one manufacturer has all of
the "best" features incorporated
in a single hearing instrument
model. Nor has any one company
consistently been at the top
of our ratings for prolonged
periods . If you have only one
hearing aid brand from which
to choose, you will be limiting
your access to hearing aids
that have the most desirable
features and the top consumer
ratings.
Individual
companies change personnel and
corporate philosophies frequently.
Sometimes, these changes are
not user friendly changes. For
example, some companies have
recently decided that they will
not service their hearing aids
if they are more than five years
old. This amounts to forced
obsolescence. We believe that
if a given hearing aid meets
the user's needs, and the user
is willing to pay for any needed
repairs, the user should not
be forced into buying new hearing
aids every five years. We are
reluctant to do business with
companies that have such policies.
We recommend that you choose
an audiologist who offers multiple
brands of hearing aids.
Rule
6–Buy Hearing Aids that can
be Programmed
A
programmable hearing aid is
one which permits the instrument's
operating characteristics to
be changed in the audiologist's
office. Up until the mid 1980s,
this was not possible. The operating
characteristics of a non-programmable
hearing aid were pretty much
fixed at the time of manufacture.
If you didn't like those characteristics
in any way, you sent it back
to the manufacturer and said,
"Try again." Unhappily, as recently
as three years ago, non-programmable
hearing aids made up the majority
of hearing aids sold in this
country. Finally, in 2000, the
programmable instrument sales
numbers slightly exceeded the
non-programmable numbers.
On
a national average, programmability
adds about $500 to the cost
of a hearing aid. We believe
the added cost is a good investment.
Using a personal computer or
a manufacturer's proprietary
programming device, the audiologist
is able to send operating instructions
directly to the computer chip
inside the hearing aid. Because
this can be done in the audiologist's
office and with the hearing
aid in the user's ear, the changes
in operating characteristics
can be immediately evaluated.
If you don't have programmable
hearing aids, the same changes
can be made only by opening
the case and rebuilding the
instrument circuitry.
Secondly,
we find that new hearing aid
wearers cannot initially tolerate
as much amplification as experienced
users. However, in a very short
time, the new users are back
in the office requesting more
power. The audiologist cannot
easily respond to these types
of requests if the hearing aid
is non-programmable.
Although
programmable hearing aids have
a higher first cost, we believe
they are cost effective in the
long run. I can dramatically
improve the fitting if I have
more control of it. That control
can come only when the programming
capability is used in conjunction
with real-ear aided testing.
There have been a series of
studies over the last 20 years
that show manufacturers' fitting
recommendations are oftentimes
inappropriate for meeting the
user's needs. The manufacturers
are handicapped because they
do not have access to the user
when making their fittings.
>>Question
from the audience: Are Behind-the-Ear
hearing aids easier to program
than other hearing aid styles?
>>Ron:
Fortunately, for a given manufacturer,
the same programming software
is used for all hearing aid
styles. The second bit of good
news is that most all of the
sophisticated hearing aid features
available can be incorporated
in any of the instrument styles.
Once you have that manufacturer's
software in your computer, it
does not matter whether it is
a behind-the-ear or a completely-in-the-canal
hearing aid.
>>Question
from the audience: You talked
about users having to return
to the office three or four
times for hearing aid adjustment.
What length of time period are
you talking about–a week or
a month, and do you charge a
new hearing aid user for each
office visit?
>>Ron:
The length of time required
for users to get their new hearing
aids adjusted to their liking
varies from person to person.
In our clinic, we let people
have as many no-charge follow-up
visits as they want during the
first two months. After that,
depending upon circumstances,
there is usually a charge. Our
typical charge is $35. It takes
about half an hour of time to
make the changes and to give
the user a chance to evaluate
the changes before leaving the
office. This question leads
into Rule 7 very nicely.
Rule
7–Allot Two Months for Hearing
Aid Adaption and Three 30-Minute
Sessions for Hearing Aid Fine
Tuning
>>Dean:
Whether you are a first-time
hearing aid user or an experienced
user, new hearing aids will
almost always present a set
of new challenges. Recently
I was trying out a pair of fully-digital,
multi-memory, behind-the-ear
hearing aids with automatic
volume control, and a manual
volume control override feature.
The toggle-switch used to change
memories and the volume control
override wheel were quite close
together on the hearing aid
case. Initially, this was a
problem for me. Changing memories
nearly always resulted in an
unwanted change in the volume
setting. Ultimately, I learned
how to change memories without
disturbing the volume setting,
and the problem was solved.
However, it is a good example
of a challenge I had to overcome.
The
two-month recommendation is
merely a starting point. Some
may require more time, other
less time. In any event, the
new user needs to be prepared
for the fact that it takes time
and effort to learn how to live
with and appreciate his/her
new hearing aids.
What
are some of the challenges a
new hearing aid user may encounter?
•
Your ears may feel plugged
up.
•
Your voice may sound different
to you.
•
You have to learn how to change
batteries and properly care
for your new hearing aids.
•
You are likely to hear more
and different sounds than
you did without hearing aids.
•
Things do not always sound
the same in your normal living
and working environments as
they do in the audiologist's
office.
Keep
in mind that the mere act of
inserting a pair of hearing
aids into your ears does not
guarantee user satisfaction.
Be prepared for several follow
up visits to your audiologist
to fine tune the operating characteristics
of your hearing aids. The results
of a survey of more than 20,000
hearing aid users, conducted
by Sergi Kochkin, a Chicago
researcher working for Knowles
Electronics, indicated that
a greater degree of user satisfaction
was achieved by those persons
who spent 90 minutes or more
with their audiologist in the
fitting and fine tuning processes
than those who spent 30 minutes
or less regardless of hearing
aid brand or degree of hearing
loss.
Rule
8–Maintain a Positive Attitude
and Guard Against Unrealistic
Expectations
Great
progress has been made in hearing
aid technology in the last 10
years, but it is still not realistic
to expect that hearing aids
will restore a person's hearing
capabilities to so-called "normal"
hearing. Many of us know people
who have hearing aids , but
do not use them because "they
don't work." The owners are
unhappy, and the hearing aids
are relegated to a shelf in
the bathroom or to a bureau
drawer. Why don't the work?
There are two principle reasons.
The hearing aids "don't work"
because either they did not
live up to the user's expectations
or their operating characteristics
are not properly matched to
the user's needs. It is important
that the user know what hearing
aids can and cannot do.
Achieving
a high degree of user satisfaction
requires a team effort. The
team players are the user and
the hearing aid dispenser. Each
has certain responsibilities.
Certainly, the education and
experience levels of the hearing
aid dispenser are of major importance
in successful hearing instrument
selection and fitting. But,
in addition, the hearing aid
dispenser is also responsible
for providing adequate and appropriate
counseling so the user does
not develop unrealistic expectations.
User
attitude is definitely a key
factor. Without a proper user
attitude, the competency of
the hearing aid dispenser and
the degree of sophistication
of the hearing aid are of little
consequence. The user must have
a positive attitude toward hearing
aids and really want them to
work. What does that mean? It
means the user must have patience,
persistence, and a willingness
to try new ways of doing things.
If a hearing aid has a telecoil,
for example, how the telephone
hand set is oriented with respect
to the hearing aid makes a big
difference in what the user
will be able to hear. But, if
the user is not willing to try
different handset positions,
he or she may never find the
one that maximizes the telecoil
benefits.
Recently,
an article entitled, "What Should
Users of New Hearing Aids Realistically
Expect?" appeared on the web
site of the American Academy
of Audiology. Some of the expectations
include:
•
Your hearing in quiet environments
should be improved.
•
Your hearing in moderate background
noise should be improved.
•
Your hearing in background
noise is NOT going to be as
good as your hearing in quiet.
•
Your hearing in loud background
noise should be NO WORSE than
without hearing aids.
•
Soft speech should be audible;
loud speech should be loud,
but not uncomfortably loud.
•
Your own voice should be "acceptable"
to you.
•
There should be no feedback
when the hearing aids are
properly seated in your ears.
Rule
9–Be Sure the Hearing Aid is
Comfortable from the Start
It
is pretty hard to maintain a
positive attitude when your
hearing aid earmold causes you
physical pain. And, believe
me, an earmold of improper shape
and/or size can cause severe
pain. At one time, I tried out
a completely-in-the-canal style
hearing aid. This particular
instrument was new on the market.
The manufacturer's representative
insisted on making the earmold
impression because "doing it
right" was very important. In
due time, the hearing aid arrived.
When I inserted it in my ear,
I thought to myself, Wow! This
is a pretty tight fit. Within
a couple of hours, I began to
experience noticeable physical
pain. Never having worn a CIC
style instrument before, I assumed
that probably a little discomfort
was to be expected and that
my ear would adjust. That turned
out to be an erroneous assumption
on my part. The pain continued
to get progressively worse.
By evening, I had had enough
and tried to remove the hearing
aid from my ear. It took several
tries. The pain was so severe,
that I seriously considered
going to the hospital emergency
room to have it removed.
Properly
fitted earmolds should not hurt
your ears. If you experience
even the slightest pain, contact
your audiologist immediately
and have the problem remedied.
>>Question
from audience: How long does
it take for a new hearing
aid wearer to become really
comfortable having a foreign
object like a hearing aid in
his/her ear?
>>Ron:
The majority of our product
testers, all long-time hearing
aid users, will tell you that
they are almost always aware
that there is a foreign object
in their ear. But, that awareness
is not one that is incapacitating
if the earmold is properly fitted.
There are some, however, that
make the transition in a relatively
few days. For these individuals,
they say they have to continually
remind themselves that they
are wearing hearing aids in
order to avoid taking a shower
with them still in their ears.
Rule
10–Choose a Manufacturer Who
Will Repair Your Hearing Aid
Regardless of Its Age
We
have already discussed the supporting
reasons for this Rule.
Rule
11–Get Hearing Aids With Automatic
Volume Control
Most
people with impaired hearing
have lost their ability to hear
soft sounds Those with a greater
loss across a wider frequency
range will also have difficulty
with medium and loud sounds.
Even though their ability to
hear has changed over time,
their loud sound discomfort
level probably has not changed
dramatically from when they
had normal hearing. This introduces
a strange phenomenon called
recruitment. For people troubled
with recruitment, the amplification
level difference between barely
audible and uncomfortably loud
is quite small. Consequently,
the user of a linear hearing
aid with manual volume control
is frequently changing the volume
setting in order to be able
to hear but also to avoid the
pain of excessively loud sounds.
AT&T
Bell Laboratories introduced
a hearing aid 10 years ago that
would give proportionally less
power as the input level of
the sounds increased, i.e.,
non-linear amplification. With
this technology, the audiologist
is able to program the hearing
aid so that its amplification
characteristics stay within
the barely audible and uncomfortably
loud levels. Many OABH members
have changed from their old
linear hearing aids, which give
equal amplification regardless
of the input sound level, to
the newer non-linear hearing
aids with automatic volume control.
Nationally,
the switch from linear hearing
aids to non-linear hearing aids
has been slow. As I mentioned
earlier, non-linear hearing
aid sales did not surpass linear
hearing aid sales until last
year. While this is progress,
it still means that more than
40 percent of the people buying
hearing aids last year are still
using 30- or 40-year old amplification
technology.
>>Question
from the audience: Are you talking
about programmable non-linear
hearing aids or non-programmable
linear hearing aids?
I
am talking about programmable
non-linear hearing aids. The
good news is that once you get
to the programmable level, there
is usually some type of automatic
volume control included.
>>Comment
from the audience: I have been
wearing digital hearing aids
for about two years. In some
situations, I need more volume
for soft sounds than the hearing
aid provides.
>>Ron:
There are times when you want
dramatically more power or less
power depending upon the source
of the sound. And, it is not
just a function of gain per
frequency. It has to do with
sound quality and the user's
personal likes and dislikes.
A number of manufacturers of
both analog and fully-digital,
programmable, non-linear hearing
aids now offer instrument models
that have a manual volume control
override.
>>Question
from the audience: Are you going
to explain the difference between
linear and non-linear amplification?
>>Ron:
Linear hearing aids, as their
name implies, give the same
amount of volume increase to
every sound that comes through
the hearing aid. For example,
let's say you have a sound of
30 dB coming through the hearing
aid and the hearing aid gives
40 dB of additional gain.
That will put a 70 dB sound
against your eardrum. By contrast,
if a 70 dB sound comes into
the hearing aid, and the hearing
aid gives it 40 dB additional
gain as before, you will have
a 110 dB sound hitting your
eardrum. That is loud!
A
non-linear hearing aid, on the
other hand, provides progressively
less volume as the input level
increases. The maximum gain
provided by the hearing aid
is determined by the user's
uncomfortable loudness level.
You will recall that in Rule
3 one of the tests recommended
for inclusion in a complete
audiological evaluation was
determination of the user's
most comfortable and uncomfortably
loudness levels.
>>Question
from the audience: Does the
non-linear and linear discussion
apply only to fully-digital
hearing aids?
>>Ron:
Definitely not. Non-linear hearing
aids utilizing analog technology
have been available for 10 years.
It just hasn't been widely used,
and we are concerned about that.
Rule
12–Get an Air Vent in Your Hearing
Aid
An
air vent is a passage way through
the hearing aid earmold that
connects the outside world with
the space between the inner
end of the hearing aid and the
user's eardrum. How important
can this be? A study conducted
by Robin Cox and Genevieve Alexander
at Memphis State University
showed that venting topped the
list of variables that determined
hearing aid user satisfaction.
Users of unvented hearing aids
report a plugged up feeling,
like their head is in a barrel,
and that their voice does not
sound normal to them.
Completely-in-the-canal
style hearing aids generally
cannot be effectively vented
because of their small size.
The hearing industry would like
you to believe that if the hearing
aid is placed deep enough in
the ear canal, the user will
not experience the plugged up
feeling. Our long time hearing
aid users who have tried CIC
instruments do not agree. The
plugged up feeling still exists.
Moreover, they frequently have
a finger in their ear as they
try to break the air seal between
the earmold and the ear canal.
As the user of an unvented hearing
aid which is deeply seated in
the ear canal talks or chews,
the earmold moves and creates
a suction against the eardrum.
In some instances, the pressure
differential may cause ear discomfort.
An appropriately sized air vent
on a hearing aid can make a
big difference in raising the
user's comfort level.
>>Question
from the audience: Is the lack
of venting and the unbroken
air seal the cause of the loud
hearing aid squeaking or whistling?
>>Ron:
No, the whistling or feedback
comes from a variety of potential
sources including over-amplification,
poor physical fit, or poor insertion
to name a few.
Rule
13–Get Loss-Damage Insurance
for Your Hearing Aids
Most
manufacturers provide some form
of loss-damage insurance for
the first year in the initial
price of the hearing aid. After
that, it becomes the user's
responsibility. We have tested
hearing aids for which the manufacturer's
suggested retail price is $4,500
each. We believe that such an
investment should be protected
by loss-damage insurance.
Rule
14–Choose a Telephone Option
that is Right for You
Self
Help for Hard of Hearing People
National (SHHH) National promotes
the use of T-Switches. My personal
preference is not consistent
with that advice. There a number
of other ways to handle telephone
usage. We discuss them in our
book, Fifteen Rules for Satisfied
Hearing Aid Users.
>>Question
from the audience: Is the T-Switch
the same as a telecoil?
>>Ron:
Yes, T-Switch and telecoil are
two words for the same thing.
One of the problems associated
with telecoils is the loss of
fidelity. It is like making
a photocopy of a photocopy.
The image is degraded each time
you make a copy of a copy. Using
a good amplified telephone,
such as the State of Oregon
provides for persons with severe
hearing loss, or a telephone
amplifier will get better fidelity.
>>Comment
and question from the audience:
Telecoils can be used with many
assistive devices. Don't telecoils
get rid of background noise?
>>Ron:
Yes, it is true that telecoils
can be used in conjunction with
other assistive listening devices,
such as loop systems. FM systems,
or infrared systems. Telecoil
usage may also present new problems.
For example, telecoils react
to fluorescent lights and computer
monitors.
Rule
15–Get Some Perspective
Evaluate
manufacturers' hearing aid benefit
claims very carefully. If they
sound too good to be true, they
are probably false or misleading.
We have never seen a manufacturer-sponsored
study that highlighted the disadvantages
of their product. Even the hearing
aids that received the highest
ratings from our product testers
have short comings.
I
would like to mention some of
the things that did not appear
in our book. These are items
in which there is not a consensus
among our product testers.
•
Fully-digital hearing aids.
We do not suggest that everyone
should immediately switch
to fully-digital hearing aids.
Those that are well-designed
do have certain advantages
over the traditional analog
instruments in terms of sound
quality and programming flexibility.
However, the cost-benefit
ratio may not be attractive
to all users.
•
Directional microphones. A
number of manufacturers now
offer hearing aids with directional
microphones which potentially
can improve the user's speech
understanding capability by
reducing the adverse effects
on background noise. The majority
of these hearing aids have
two microphones–one facing
forward and one facing backward.
When operating in the background
noise reduction mode, the
hearing aid becomes "front"
sensitive. This is achieved
by subtracting portions of
the signal received by the
backward facing microphone,
primarily background noise,
from the signal received by
the front facing microphone.
To date, we have tested 11
instruments from eight different
manufacturers having background
noise reduction benefit claims.
Only four of them, all of
which were behind-the-ear
style instruments, received
a " Good" rating from our
product testers.
•
Assistive listening devices
or systems for use with the
telephone. Alternatives include
telecoils, infrared, loop,
and FM systems, amplified
telephones and telephone amplifiers.
Even though all of these devices
have certain advantages, they
also each have certain shortcomings
or limitations. No single
approach to enhance telephone
usage is widely used by hearing
impaired persons.
•
Disposable hearing aids. A
recent entry in the hearing
industry is a disposable hearing
aid. It is a non-programmable,
one size fits all instrument.
Our product testers encountered
several problems with this
disposable hearing aids. All
of the testers reported some
degree of ear discomfort ranging
from mild to painful. Half
of them could not use the
hearing aids because of uncontrollable
feedback.
Hearing
aid user satisfaction is an
evolutionary quality. As the
user gains experience with hearing
aids and knowledge of what hearing
aids can and cannot do, their
level of acceptability changes.
As mentioned earlier, the Fifteen
Rules do not unconditionally
guarantee user satisfaction,
but following them will help
the user minimize the frustration
associated with being a hearing
aid user.
_____________________________
To
order "Fifteen Rules for Satisfied
Hearing Aid Users," send $10/copy
to Hearing Assistance Technology,
301 SW 4th Street, Suite 180,
Corvallis OR 97333, or to use
Visa/Mastercard, call (503)
754-1377.
Fifteen Rules for Satisfied Hearing Aid Users
Dean E. Booster, Professor Emeritus, Oregon State University
>>Ron: Welcome, folks. I'm Ron Leavitt. I want to tell you about a group that we formed 13 years ago called the Oregon Association for Better Hearing (OABH). I was an Oregon State University faculty member and an audiologist at the Corvallis Good Samaritan Hospital. The hearing aid performance information appearing in the newspapers was supplied primarily by hearing aid manufacturers. It is natural to expect that hearing aid manufacturers and sales persons have a built-in bias toward their products. If people are to really learn about what hearing aids can and cannot do, they should have a source of information based upon the real life experiences of people who have actually used the hearing aids. OABH has since become the largest consumer product test group for hearing aids in the Western United States.
Hearing aids selected for testing are limited to those that are purported to incorporate new signal processing technology or useful new features. A given hearing instrument is evaluated by several product testers. Test periods are usually about two weeks in length. Product testers are permitted unlimited office visits for fine tuning of the hearing aids. Product testers report their findings at regular meetings of the Oregon Association for Better Hearing.
To date, some 20 experienced hearing aid users, all of whom are unpaid volunteers, have participated in the product testing. Their ages range from the 20s to the 80s. They have varying degrees of hearing loss ranging from mild to profound. Their backgrounds are varied. They are students, housewives, professionals, and retirees. None of them sell or service hearing aids or have an affiliation with a hearing aid manufacturer. Thus, there is no financial incentive to promote one brand or one model of hearing instrument over another. Our goal is to provide our members with the most unbiased hearing aid performance information possible.
Considering the diversity of our product testers, it is rather amazing that we were able to get 20 people to agree on 15 items associated with hearing aid user satisfaction. These items are documented in a publication entitled, Fifteen Rules for Satisfied Hearing Aid Users.
As
mentioned, I am an audiologist
and have a private hearing
and speech center in Corvallis.
I am also a member of the faculty
of the Oregon State University
Speech Communications Department.
With me today is one of the
OABH product testers who will
be presenting several of the
"Fifteen Rules." He is a retired
faculty member of the Oregon
State University Agricultural
Engineering Department and has
personal use experience with
27 different hearing aids. I
would like to introduce to you
at this time, Dean Booster.
>>Dean:
Good morning ladies and gentlemen.
According to the1993 edition
of the New Oxford Dictionary,
to "satisfy" means, among other
things, (1) fulfilling a person's
desires, hopes, and demands,
or (2) putting an end to a person's
wants or needs. In the case
of hearing aid performance,
achieving complete user satisfaction
is a pretty tall order. Not
only do hearing aid users have
different hearing losses, they
function in different listening
environments, and, to further
complicate matters, they have
different personal likes and
dislikes. The Fifteen Rules,
by themselves, cannot unconditionally
guarantee user satisfaction,
but persons following these
rules will certainly achieve
a greater degree of satisfaction
than those who do not.
It is my pleasure to discuss with you six of the Fifteen Rules from the perspective of a hearing aid user. Ron will cover the remaining nine rules from the perspective of an audiologist. The comments that I will share with you today are based on approximately 11 years' experience as a hearing aid user and nearly 10 years as an OABH product tester. During that time, three fundamental truths related to hearing aids and hearing aid users have become evident.
1. The goal of any hearing aid user should be to get the simplest and least expensive hearing instrument that does what the user wants it to do.
2. A particular hearing aid may meet the needs of someone, but no single hearing aid will meet the needs of everyone.
3. User satisfaction is a personal thing. It all depends upon what the user is willing to accept.
Rule 1–Get Past Denial
There are more than 60 hearing aid manufacturers of consequence in the world market. Collectively, they produce literally hundreds of hearing instrument models from which to choose. Why is it, then, that only about five million individuals in this country have taken advantage of the technology available that could potentially improve their quality of life?
There
are numerous reasons, but one
that is oftentimes the most
difficult to deal with is denial.
Acknowledging that you have
a hearing loss is not easy or
pleasant. But, it is the necessary
first step in the long road
to better hearing. Unless the
individual is willing to accept
the responsibility for dealing
constructively with his/her
hearing loss, rehabilitation
is not likely to occur.
Rule 2–Use Two Hearing Aids If You Have Hearing Loss in Both Ears
Some of the potential benefits from using two hearing aids versus one hearing aid are shown below:
• Generally speaking, speech understanding ability deteriorates with the passage of time. Research shows that for persons wearing only one hearing aid, the deterioration rate of the unaided ear is likely to be greater than that of the aided ear over a given period of time.Please keep in mind that an ear with either normal hearing or no hearing at all is not considered aidable.
• Improved speech understanding in noisy environments.
• Improved ability to hear soft sounds and distant speech.
• Improved ability to locate the source or direction from which sounds originate.
Rule 3–Get a Comprehensive Hearing and Hearing Aid Evaluation from a Nationally-Certified Audiologist
Identifying
the type and magnitude of a
person's hearing loss is of
utmost importance in achieving
even minimal user satisfaction.
The starting point is a medical
examination. No matter how sophisticated
they may be, hearing aids are
not remedies for medically treatable
hearing impairments.
A
comprehensive audiological evaluation
involves more than just a pure
tone air conduction test where
you raise your hand or press
a button each time you hear
a tone. It involves a battery
of tests. In addition to the
pure tone air conduction test,
the following tests are recommended
for adults:
- Impedance test–helps identify hearing disorders that may be medically treatable.
- Bone conduction test–measures the amount of hearing loss that is due to dysfunction of the hearing nerve cells.
- Determination of the hearing aid user's most comfortable and uncomfortable loudness levels.
- Tone decay test–evaluates the auditory system beyond the hearing nerve cells.
- Speech reception and speech recognition tests–measures the listener's maximum and real world speech understanding ability.
- Real-ear aided hearing test–required for a meaningful hearing aid evaluation. It allows the hearing aid's performance to be monitored while the user is wearing the hearing aid.
The
importance of having qualified
personnel conduct these tests
cannot be over emphasized. The
hearing aid dispenser is at
least as important as the brand
and model of hearing aid in
achieving user satisfaction.
This must have the appropriate
equipment at his/her disposal
and possess the knowledge, training,
and experience to properly conduct
the tests and accurately interpret
the test results. As you might
expect, the training and skill
levels of hearing aid dispensers
vary widely.
The minimum education and training requirements for hearing aid dispensers in Oregon are as follows:
For Hearing Instrument Specialists (HIS)
- Be a high school graduate at least 18 years of age.
- Have completed 160 clock hours of supervised training (68 hours of theory and 92 hours of practical experience).
- Pass a State examination.
- Purchase a State license.
- Have a minimum of a masters degree in audiology from an accredited institution offering course work in audiology.
- Have completed a one-year full-time practicum.
- Pass a national examination.
- Purchase a State license.
>>Ron: Up to this point, you may be thinking this has been a fairly noncontroversial presentation. But, you can't imagine the amount of trouble these first three rules have given us. For example, the actual amount of amplification being provided by the hearing aid can be determined using the real-ear aided test talked about in Rule Three. We were very surprised last year when the results of a national survey of showed that only 15 percent of the people dispensing hearing aids in this country routinely make use of real-ear aided testing equipment.
Some manufacturers have told us that today's sophisticated hearing aids are far too complex to be performance-tested in the provider's office. They have suggested that all we have to do is follow their fitting instructions and everything will be fine. Our experience has been that following the manufacturer's fitting instructions to the letter more often than not results in hearing aid performance unacceptable to experienced hearing aid users. At a recent OABH meeting, we asked one of our product testers to evaluate the performance of one of the most highly rated, and coincidentally one of the most expensive fully digital hearing aids, in the meeting room environment. The hearing aid had been programmed according to the manufacturer's recommendations and using product tester's audiological evaluation data. When asked how it performed, she said she could not tell if the hearing aid was turned on or not. Numerous programming adjustments were required to raise the performance to an acceptable level to meet the product tester's listening needs and preferences.
Do
not let people tell you these
sophisticated hearing aids cannot
be tested with conventional
testing equipment. They can,
and they must be if your goal
is to have the user achieve
maximum satisfaction from their
use.
Rule 4–Get Behind-the Ear Style Hearing Aids for Maximum Reliability
Vanity often plays a large role when the user selects a hearing aid style. Manufacturers would like you to believe that "smaller is better" and place added emphasis on completely-in-the-canal (CIC) style instruments. This tends to promote the idea that "People will not know I am hearing impaired if they cannot see my hearing aids." Our experience, from the standpoint of trouble-free hearing aid operation, is that smaller is not always better.
As the style name suggests, completely-in-the-canal aids are positioned deep in the ear canal. One of the most prevalent problems with CIC hearing aids is that they get fouled with ear wax. It takes only a minute amount of ear wax to render them inoperative. Even the best wax-guard systems available today, cannot guarantee freedom from wax plugging. You may say, "I know a lot of people who wear hearing aids in their ear canal, and they don't seem to have that much trouble with them." I do, too. But I also know people who come in every month, and sometimes more often, with a dead hearing aid because of the ear wax in it.
I
don't mean to imply that all
of our product testers are behind-the-ear
hearing aid users. Far from
it. We are not trying to change
people's mind. We only want
them to be able to make a style
choice base upon facts rather
than hype. We want them to know
that behind-the-ear hearing
aids provide the best protection
against ear wax plugging because
the electronic circuit components
of the hearing aid are far removed
from the source of the ear wax.
Rule 5–Choose and Audiologist Who Offers Multiple Brands of Hearing Aids
Individual
companies change personnel and
corporate philosophies frequently.
Sometimes, these changes are
not user friendly changes. For
example, some companies have
recently decided that they will
not service their hearing aids
if they are more than five years
old. This amounts to forced
obsolescence. We believe that
if a given hearing aid meets
the user's needs, and the user
is willing to pay for any needed
repairs, the user should not
be forced into buying new hearing
aids every five years. We are
reluctant to do business with
companies that have such policies.
We recommend that you choose
an audiologist who offers multiple
brands of hearing aids.
Rule 6–Buy Hearing Aids that can be Programmed
On a national average, programmability adds about $500 to the cost of a hearing aid. We believe the added cost is a good investment. Using a personal computer or a manufacturer's proprietary programming device, the audiologist is able to send operating instructions directly to the computer chip inside the hearing aid. Because this can be done in the audiologist's office and with the hearing aid in the user's ear, the changes in operating characteristics can be immediately evaluated. If you don't have programmable hearing aids, the same changes can be made only by opening the case and rebuilding the instrument circuitry.
Secondly, we find that new hearing aid wearers cannot initially tolerate as much amplification as experienced users. However, in a very short time, the new users are back in the office requesting more power. The audiologist cannot easily respond to these types of requests if the hearing aid is non-programmable.
Although programmable hearing aids have a higher first cost, we believe they are cost effective in the long run. I can dramatically improve the fitting if I have more control of it. That control can come only when the programming capability is used in conjunction with real-ear aided testing. There have been a series of studies over the last 20 years that show manufacturers' fitting recommendations are oftentimes inappropriate for meeting the user's needs. The manufacturers are handicapped because they do not have access to the user when making their fittings.
>>Question from the audience: Are Behind-the-Ear hearing aids easier to program than other hearing aid styles?
>>Ron: Fortunately, for a given manufacturer, the same programming software is used for all hearing aid styles. The second bit of good news is that most all of the sophisticated hearing aid features available can be incorporated in any of the instrument styles. Once you have that manufacturer's software in your computer, it does not matter whether it is a behind-the-ear or a completely-in-the-canal hearing aid.
>>Question from the audience: You talked about users having to return to the office three or four times for hearing aid adjustment. What length of time period are you talking about–a week or a month, and do you charge a new hearing aid user for each office visit?
>>Ron:
The length of time required
for users to get their new hearing
aids adjusted to their liking
varies from person to person.
In our clinic, we let people
have as many no-charge follow-up
visits as they want during the
first two months. After that,
depending upon circumstances,
there is usually a charge. Our
typical charge is $35. It takes
about half an hour of time to
make the changes and to give
the user a chance to evaluate
the changes before leaving the
office. This question leads
into Rule 7 very nicely.
Rule 7–Allot Two Months for Hearing Aid Adaption and Three 30-Minute Sessions for Hearing Aid Fine Tuning
The two-month recommendation is merely a starting point. Some may require more time, other less time. In any event, the new user needs to be prepared for the fact that it takes time and effort to learn how to live with and appreciate his/her new hearing aids.
What are some of the challenges a new hearing aid user may encounter?
• Your ears may feel plugged up.Keep in mind that the mere act of inserting a pair of hearing aids into your ears does not guarantee user satisfaction. Be prepared for several follow up visits to your audiologist to fine tune the operating characteristics of your hearing aids. The results of a survey of more than 20,000 hearing aid users, conducted by Sergi Kochkin, a Chicago researcher working for Knowles Electronics, indicated that a greater degree of user satisfaction was achieved by those persons who spent 90 minutes or more with their audiologist in the fitting and fine tuning processes than those who spent 30 minutes or less regardless of hearing aid brand or degree of hearing loss.
• Your voice may sound different to you.
• You have to learn how to change batteries and properly care for your new hearing aids.
• You are likely to hear more and different sounds than you did without hearing aids.
• Things do not always sound the same in your normal living and working environments as they do in the audiologist's office.
Rule 8–Maintain a Positive Attitude and Guard Against Unrealistic Expectations
Achieving a high degree of user satisfaction requires a team effort. The team players are the user and the hearing aid dispenser. Each has certain responsibilities. Certainly, the education and experience levels of the hearing aid dispenser are of major importance in successful hearing instrument selection and fitting. But, in addition, the hearing aid dispenser is also responsible for providing adequate and appropriate counseling so the user does not develop unrealistic expectations.
User attitude is definitely a key factor. Without a proper user attitude, the competency of the hearing aid dispenser and the degree of sophistication of the hearing aid are of little consequence. The user must have a positive attitude toward hearing aids and really want them to work. What does that mean? It means the user must have patience, persistence, and a willingness to try new ways of doing things. If a hearing aid has a telecoil, for example, how the telephone hand set is oriented with respect to the hearing aid makes a big difference in what the user will be able to hear. But, if the user is not willing to try different handset positions, he or she may never find the one that maximizes the telecoil benefits.
Recently, an article entitled, "What Should Users of New Hearing Aids Realistically Expect?" appeared on the web site of the American Academy of Audiology. Some of the expectations include:
• Your hearing in quiet environments should be improved.
• Your hearing in moderate background noise should be improved.
• Your hearing in background noise is NOT going to be as good as your hearing in quiet.
• Your hearing in loud background noise should be NO WORSE than without hearing aids.
• Soft speech should be audible; loud speech should be loud, but not uncomfortably loud.
• Your own voice should be "acceptable" to you.
• There should be no feedback when the hearing aids are properly seated in your ears.
Rule 9–Be Sure the Hearing Aid is Comfortable from the Start
Properly fitted earmolds should not hurt your ears. If you experience even the slightest pain, contact your audiologist immediately and have the problem remedied.
>>Question from audience: How long does it take for a new hearing aid wearer to become really comfortable having a foreign object like a hearing aid in his/her ear?
>>Ron:
The majority of our product
testers, all long-time hearing
aid users, will tell you that
they are almost always aware
that there is a foreign object
in their ear. But, that awareness
is not one that is incapacitating
if the earmold is properly fitted.
There are some, however, that
make the transition in a relatively
few days. For these individuals,
they say they have to continually
remind themselves that they
are wearing hearing aids in
order to avoid taking a shower
with them still in their ears.
Rule 10–Choose a Manufacturer Who Will Repair Your Hearing Aid Regardless of Its Age
Rule 11–Get Hearing Aids With Automatic Volume Control
AT&T Bell Laboratories introduced a hearing aid 10 years ago that would give proportionally less power as the input level of the sounds increased, i.e., non-linear amplification. With this technology, the audiologist is able to program the hearing aid so that its amplification characteristics stay within the barely audible and uncomfortably loud levels. Many OABH members have changed from their old linear hearing aids, which give equal amplification regardless of the input sound level, to the newer non-linear hearing aids with automatic volume control.
Nationally, the switch from linear hearing aids to non-linear hearing aids has been slow. As I mentioned earlier, non-linear hearing aid sales did not surpass linear hearing aid sales until last year. While this is progress, it still means that more than 40 percent of the people buying hearing aids last year are still using 30- or 40-year old amplification technology.
>>Question from the audience: Are you talking about programmable non-linear hearing aids or non-programmable linear hearing aids?
I am talking about programmable non-linear hearing aids. The good news is that once you get to the programmable level, there is usually some type of automatic volume control included.
>>Comment from the audience: I have been wearing digital hearing aids for about two years. In some situations, I need more volume for soft sounds than the hearing aid provides.
>>Ron: There are times when you want dramatically more power or less power depending upon the source of the sound. And, it is not just a function of gain per frequency. It has to do with sound quality and the user's personal likes and dislikes. A number of manufacturers of both analog and fully-digital, programmable, non-linear hearing aids now offer instrument models that have a manual volume control override.
>>Question from the audience: Are you going to explain the difference between linear and non-linear amplification?
>>Ron: Linear hearing aids, as their name implies, give the same amount of volume increase to every sound that comes through the hearing aid. For example, let's say you have a sound of 30 dB coming through the hearing aid and the hearing aid gives 40 dB of additional gain. That will put a 70 dB sound against your eardrum. By contrast, if a 70 dB sound comes into the hearing aid, and the hearing aid gives it 40 dB additional gain as before, you will have a 110 dB sound hitting your eardrum. That is loud!
A non-linear hearing aid, on the other hand, provides progressively less volume as the input level increases. The maximum gain provided by the hearing aid is determined by the user's uncomfortable loudness level. You will recall that in Rule 3 one of the tests recommended for inclusion in a complete audiological evaluation was determination of the user's most comfortable and uncomfortably loudness levels.
>>Question from the audience: Does the non-linear and linear discussion apply only to fully-digital hearing aids?
>>Ron:
Definitely not. Non-linear hearing
aids utilizing analog technology
have been available for 10 years.
It just hasn't been widely used,
and we are concerned about that.
Rule 12–Get an Air Vent in Your Hearing Aid
Completely-in-the-canal style hearing aids generally cannot be effectively vented because of their small size. The hearing industry would like you to believe that if the hearing aid is placed deep enough in the ear canal, the user will not experience the plugged up feeling. Our long time hearing aid users who have tried CIC instruments do not agree. The plugged up feeling still exists. Moreover, they frequently have a finger in their ear as they try to break the air seal between the earmold and the ear canal. As the user of an unvented hearing aid which is deeply seated in the ear canal talks or chews, the earmold moves and creates a suction against the eardrum. In some instances, the pressure differential may cause ear discomfort. An appropriately sized air vent on a hearing aid can make a big difference in raising the user's comfort level.
>>Question from the audience: Is the lack of venting and the unbroken air seal the cause of the loud hearing aid squeaking or whistling?
>>Ron:
No, the whistling or feedback
comes from a variety of potential
sources including over-amplification,
poor physical fit, or poor insertion
to name a few.
Rule 13–Get Loss-Damage Insurance for Your Hearing Aids
Rule 14–Choose a Telephone Option that is Right for You
>>Question from the audience: Is the T-Switch the same as a telecoil?
>>Ron: Yes, T-Switch and telecoil are two words for the same thing. One of the problems associated with telecoils is the loss of fidelity. It is like making a photocopy of a photocopy. The image is degraded each time you make a copy of a copy. Using a good amplified telephone, such as the State of Oregon provides for persons with severe hearing loss, or a telephone amplifier will get better fidelity.
>>Comment and question from the audience: Telecoils can be used with many assistive devices. Don't telecoils get rid of background noise?
>>Ron:
Yes, it is true that telecoils
can be used in conjunction with
other assistive listening devices,
such as loop systems. FM systems,
or infrared systems. Telecoil
usage may also present new problems.
For example, telecoils react
to fluorescent lights and computer
monitors.
Rule 15–Get Some Perspective
I would like to mention some of the things that did not appear in our book. These are items in which there is not a consensus among our product testers.
• Fully-digital hearing aids. We do not suggest that everyone should immediately switch to fully-digital hearing aids. Those that are well-designed do have certain advantages over the traditional analog instruments in terms of sound quality and programming flexibility. However, the cost-benefit ratio may not be attractive to all users.
• Directional microphones. A number of manufacturers now offer hearing aids with directional microphones which potentially can improve the user's speech understanding capability by reducing the adverse effects on background noise. The majority of these hearing aids have two microphones–one facing forward and one facing backward. When operating in the background noise reduction mode, the hearing aid becomes "front" sensitive. This is achieved by subtracting portions of the signal received by the backward facing microphone, primarily background noise, from the signal received by the front facing microphone. To date, we have tested 11 instruments from eight different manufacturers having background noise reduction benefit claims. Only four of them, all of which were behind-the-ear style instruments, received a " Good" rating from our product testers.
• Assistive listening devices or systems for use with the telephone. Alternatives include telecoils, infrared, loop, and FM systems, amplified telephones and telephone amplifiers. Even though all of these devices have certain advantages, they also each have certain shortcomings or limitations. No single approach to enhance telephone usage is widely used by hearing impaired persons.
• Disposable hearing aids. A recent entry in the hearing industry is a disposable hearing aid. It is a non-programmable, one size fits all instrument. Our product testers encountered several problems with this disposable hearing aids. All of the testers reported some degree of ear discomfort ranging from mild to painful. Half of them could not use the hearing aids because of uncontrollable feedback.
Hearing
aid user satisfaction is an
evolutionary quality. As the
user gains experience with hearing
aids and knowledge of what hearing
aids can and cannot do, their
level of acceptability changes.
As mentioned earlier, the Fifteen
Rules do not unconditionally
guarantee user satisfaction,
but following them will help
the user minimize the frustration
associated with being a hearing
aid user.
_____________________________
To order "Fifteen Rules for Satisfied Hearing Aid Users," send $10/copy to Hearing Assistance Technology, 301 SW 4th Street, Suite 180, Corvallis OR 97333, or to use Visa/Mastercard, call (503) 754-1377.
WROCC at WOU •
345 North Monmouth Avenue • Monmouth, OR 97361
Modified January 2006© WROCC at WOU • All rights reserved
Send comments or questions to wroccweb@wou.edu