The Inner Ear

The Audiogram: Explanation and Significance

kwilleitner — Wed, 29 Nov 2006 18:46:11 +0000

The Audiogram: Explanation and Significance
Mark Ross, Ph.D.

This article is reprinted with permission from Hearing Loss the magazine of Hearing Loss Association of America. The article was first published in the May/Jun 2004 issue, www.hearingloss.org.

IntroductionRecently, I’ve been trying to organize some of the columns and articles I’ve written over the past ten years. As I was looking through them, it became apparent that I’ve neglected to discuss what is perhaps most important hearing dimension of all, the simple audiogram. In reality, however, the “simple” audiogram, and particularly its implications, is not quite so simple. Even though just about everybody who receives a hearing aid has his or her hearing tested with a pure-tone audiometer, not everybody receives a comprehensive explanation of exactly what the results mean and what the implications are for them. And even for those that do, at a time when prospective hearing aid purchasers are being inundated with new information, anxious about the test results, and worried about the cost involved, much of this explanation will be forgotten or misconstrued the time several weeks have passed. I know that I’m often bemused when I hear what some people recount to me what they think their audiologist told them about their audiogram and its implications. I’m sure this was not what they were told, but it is what they remember. And in this context, that is the only relevant consideration.The Audiogram

For audiologists, the audiogram is such a basic dimension and so self-evident that its explanation, after the thousandth time, is often unconsciously truncated and simplified. They may go through it by rote memory, unaware that their client simply isn’t getting it. For people who may not even have heard of a pure-tone audiometer before they stepped into the audiologist’s office, this is a quite understandable. To expect them to fully understand how the pattern of their hearing loss impacts upon their listening behavior is not very realistic.

Yet in spite of the recent advances made in diagnostic audiological evaluations, and they are truly impressive, the information and insights provided by the simple audiogram can still provide the most pertinent information to explain the behavioral implications of a hearing loss. Perhaps the most important insight of all is an appreciation of how specific audiograms impact upon the perception of certain speech sounds. Without including speech in the equation, it is simply not possible to intelligibly discuss the audiogram. This, after all, is the signal we are most interested in hearing (not to minimize the specific needs of certain groups of people for other types of sounds, such as musicians). The audiogram of a fairly typical audiogram can be seen in figure 1. (My thanks to Brad Ingrao for creating these figures for me.)

Figure 1. A fairly typical pattern for older peopleThe Audiogram – NumbersLet’s first go through the fundamentals. Frequency (or pitch) is depicted on the horizontal axis, from low frequencies on the left (250 Hz) to high frequencies on the right (8000 Hz). For some specific purposes, it may be useful to test 125 Hz as well as some frequencies higher than 8000 Hz (for example, a progressive hearing loss above 8000 Hz can occur with certain type of ototoxic medications). The amount of hearing loss is shown on the vertical axis with the higher numbers indicating a greater degree of hearing loss. A symbol on this axis (red circle for the right ear and blue cross for the left) is a measure of the person’s hearing threshold at this frequency, i.e., the loudness (intensity) point where sound is just audible. Thresholds from zero to 15 dB are considered to be within the normal hearing range. After that point, people will usually begin to display some communication difficulties because of the elevated hearing thresholds. The higher the number, the greater the impact of the hearing loss (referring only to the unaided condition). The 100 dB point should not be confused with a 100% hearing loss, which is a total lack of hearing. Hearing sensations do continue past this point, with some audiometers extending this vertical range to 120 dB. In short, the audiogram is a chart of a person’s hearing loss, frequency by frequency.

The Audiogram – Speech

Now note the shaded area extending across the audiogram (the so-called “speech banana”). This is a general, but static, representation of the acoustical speech energy across frequency. Some speech sounds, such as vowels are predominately composed of low frequency energy, with less of their power in the higher frequencies. Other speech sounds, in particular the voiceless consonants, are the reverse. They have most of their energy in the high frequencies and less in the lower frequencies. Only the shaded area of the speech banana above the threshold curve is audible; portions below will not be perceived. In spite of portrayals to the contrary on some charts, no speech sound can be pinpointed to a speech point on the audiogram; all of them spread their energy somewhat along some segment of the frequency spectrum.

In addition to their energy locations on the frequency axis, speech sounds also vary in intensity. Some are naturally weaker (like the voiceless /th/ sound, the weakest sound in the English language) and some are naturally more intense (like the vowel /aw/, the strongest). When these are spoken in a normal fashion, as in the word “thaw” there is a 30 dB intensity range between the two phonemes. The intensity of all other speech sounds in the English language fall within these bounds (note, however, that this does not take into consideration inflected speech, which will move the entire speech banana up and down).

As already noted, the speech banana is a static representation of speech sounds. In reality, however, conversational speech is a dynamic and time-varying event, with one speech sound (phoneme) following another in a rapid succession. The specific acoustical composition of speech sounds is partially shaped by the preceding and following sounds in an utterance. These specific effects, such as the unique modifications in vowels made by different preceding and following consonants, are actually secondary cues that can be helpful for understanding speech. Indeed, the ability to take advantage of these cues may help explain why some people seem to understand speech much better than one would predict on the basis of their audiogram. Still, there are certain anchor locations for all speech sounds, as displayed on the speech banana, and these can offer valuable insights in understanding the effects of differing hearing losses.

Looking at the audiogram again, and relating it to the speech banana, it is apparent that a person with this hearing loss will hear more of the lower frequency speech sounds than the higher ones. Indeed, some of the higher frequency sounds, such as the /s/ sound (the most frequently used phoneme in the English language) will barely be heard at all. Will this person be able to understand normal speech without a hearing aid? Yes, but only with some difficulty and then only if the talker is close by and raises his or her voice slightly. There are, unfortunately, many people with audiograms similar to this who do not, for one reason or another, wear hearing aids. One often sees this type of audiogram in older people whose hearing loss just “crept up” on them and who are still not fully aware of the difficulty they are causing themselves, their family and friends,

Conversing with such individuals is a strain on everyone’s part. Often, they’ll complain that they can “hear” the talker but cannot “understand” what is being said. This is, indeed, a very frequent complaint. Looking at the audiogram, we can understand somewhat why this should occur: they are not hearing the full range of high frequencies where many of the consonants have their predominant energy. And we know from many years of research, that consonants contribute more to the understanding of speech than vowels. Without a hearing aid, this person would be hearing primarily low frequency vowels energy and some part of the voiced consonants, but little or no portions of the crucial voiceless consonant sounds (such as /s/, /t/, and /k/).

I don’t want to give the impression that the perception of vowels is unimportant on the contrary, it is and can be very important — only that by not actually hearing some of the consonants, hearing-impaired people have to struggle to fill in the acoustical gaps they produce in the stream of speech. Those individuals with superior linguistic skills would perform this task better than those with lesser skills. Often, people with this type of loss are not aware of the sounds that they don’t hear. They define what they do hear as “normal” as it is, for them. In truth, they may be hanging on to speech comprehension with their finger tips; any further distortion in the speech signal, such as someone talking rapidly or in a foreign accent, or in the presence of noise and reverberation, and they lose it. And this audiogram depicts only a gradual high frequency hearing loss; were this person’s audiogram something like the one shown in figure 2, problems with speech perception would be even more severe.

Figure 2. A severe to profound bilateral high frequency hearing lossThis audiogram is often described as a “ski-slope” hearing loss. Somebody with this type of hearing loss actually hears better at 250 Hz than the one whose audiogram is shown in figure 1, but much worse at 1000 Hz and higher. Looking at the speech banana, it is apparent that while a great deal of low frequency vowel energy will be perceived, practically no high frequency consonants would be. An individual with this audiogram would have even more difficulty in understanding speech than the one whose audiogram is shown in figure 1. These people depend upon whatever low frequency energy they do receive for comprehending speech. The presence of noise and reverberation (not exactly an uncommon occurrence in our society!) would have a disproportionate effect on them, since it would mask the only speech energy they are able to receive.Complaints of “hearing” but not “understanding” would occur even more frequently. Without a hearing aid (and even with one) this person needs to depend upon visual cues (speechreading) to supplement the information received through hearing. Some people, because of their superior ability to utilize some of the secondary cues in a speech signal referred to above, or their superior linguistic ability may do better than these comments would suggest. But there are limits to even the keenest brain and the most developed auditory integration ability; at some point, people do need to detect speech energy in order to understand a spoken message. And this person is missing just too much of the speech signal to expect easy communication in any oral exchange.

The Audiogram - Labels

It is usual to describe the extent of a hearing loss with verbal labels. Thus, someone may be described as having mild, moderate, severe or profound hearing loss, or some combination of terms (”mild to moderate” or “severe to profound”). This is an easy and shorthand way of labeling the severity of a hearing loss. While there is merit and often necessity to this practice, there is also the danger of oversimplification. Or perhaps someone’s hearing loss is described by employing a single figure (derived usually from averaging the hearing losses at 500 Hz, 1000 Hz, and 2000 Hz). The numbers themselves then serve as the basis for the verbal label that is applied. For example people with an average 40 dB hearing loss are considered to have just a moderate hearing loss. But such a shorthand label does not reflect the pattern of a hearing loss, a pattern, as we have seen, that may lead to more insights into the behavioral implications of a hearing loss. For example, consider the audiograms shown in figure 3.

Figure 3. Two different ears with the same pure-tone averageThe average hearing loss is the same for both ears in the audiogram shown in figure 3. In the left ear, the hearing thresholds at 500 Hz, 1000 Hz, and 2000 Hz are 0 dB, 40 dB, and 80 dB respectively. Their average is 40 dB. In the right ear, the hearing loss at each of the three frequencies is the same, also resulting in an average of 40 dB. But it should be apparent, just from a visual inspection, that these two ears would perceive speech quite differently. Quite clearly this example demonstrates that the shorthand description of a hearing loss with a number or a verbal label can be quite deceptive.What I have often found useful in explaining the need to understand the audiogram is commenting that it is possible for someone to be completely deaf and have completely normal hearing in the same ear at the same time. Looking at this audiogram, we can state that this person has perfectly normal hearing in the left ear, but this is only true at 250 Hz and 500 Hz. Or one could assert that he is completely deaf in the left ear, as again indeed he is (but only at 4000 Hz and higher). Both statements are correct and both describe the left ear of this person. All it would take would to resolve this verbal conundrum would be an understanding of what the audiogram actually signifies (degree of hearing loss across frequency).

These three examples do not illustrate the full variety of possible audiograms. In a room full of people with hearing loss, it is doubtful that any two would exhibit exactly the same audiogram for both their ears. There would be differences in degree of hearing loss at the different frequencies as well as divergences between the ears. People with bilaterally symmetrical hearing losses (that is, with similar hearing losses in both ears) may have quite different auditory experiences than people with bilaterally asymmetrical hearing losses. While most people exhibit a gradually sloping hearing loss across frequency (such as in figure 1), some people have audiograms that are very atypical. This would include people with rising thresholds with frequency as well as those with perfectly normal hearing at the very low and high frequencies, but with moderately or severe hearing losses in the mid frequencies. The varieties are almost (but not quite) endless and many of these differences have behavioral implications. One has to look at the curve and not just some average figure or verbal label.

It is also true that some people with very similar audiograms “hear” quite differently. While an audiogram can help explain much of the auditory behavior of a person, it does not explain it all. We know that there are other dimensions to auditory experiences that cannot be explained by the audiogram. Still, the audiogram is a good place to begin when trying to understand someone’s speech perception problems. Hearing losses greater than about 70 dB may produce qualitatively different effects than losses less than this. The reason for this phenomenon is that more severe hearing losses usually involve different structures within the cochlea (i.e., more inner hair cell damage) and that these different structures will impact upon the cochlea’s ability to separate incoming speech sounds into their various frequency components. A hearing loss may also involve central auditory pathways and these, too, may affect speech perception quite severely. Nevertheless, in spite of all these caveats, the audiogram is still the most fundamental auditory dimension of all.

The Audiogram – Comfortable and Uncomfortable Levels

There is another dimension of hearing loss that is sometimes also included on an audiogram and that is the discomfort threshold. (But whether included or not, it is a dimension that every hearing aid dispenser has to take into consideration when fitting a hearing aid.) This is the loudest sound that an individual is willing to tolerate. When measured with tones across frequencies and compared to the hearing thresholds (i.e., the audiogram) at these same frequencies, the difference between them is the usable “listening area.” (It is also referred to as the “dynamic range”.) It is the auditory area — the “target” — within which a hearing aid is expected to provide amplified sound. Sounds delivered by the hearing aid below the threshold of hearing would not be audible; those exceeding the threshold of discomfort would not be tolerated (the hearing aid user would either turn the volume control down or simply remove the hearing aid).

The dilemma of the threshold of discomfort for hearing-impaired people is that it is often the same as that observed with normally hearing individuals (perhaps 90 dB or so across frequency). But because their threshold of hearing is elevated, but not their threshold of discomfort, this means that people with hearing loss generally have a reduced listening area (or narrow dynamic range). For example, if someone’s thresholds at 1000 Hz were 50 dB and their threshold of discomfort were 90 dB, their dynamic range would be 40 dB at this frequency. This is an adequate listening space within which to deliver amplified speech sounds. If, however, the loss were 75 dB and the tolerance level at 95 dB, then the resulting dynamic range would only be 20 dB. In this instance, it would be more of a challenge to package sound within this more restricted dynamic range (this is where advanced technology can be very helpful, as in hearing aids with fast acting automatic gain control circuits).

Conclusion

Finally, it is important for people to be familiar with the details of their audiogram so that they can track any changes with time. Hearing loss, particularly adult onset hearing losses, may get gradually worse. (Anybody experiencing rapid changes in their auditory thresholds should check with an Otolaryngologist as soon as possible.) After a while, these changes will likely have behavioral implications that may require reprogramming one’s hearing aid (if only a few frequencies are involved) or changing to another hearing aid if the deterioration extends across frequency.

It is a good idea for people to keep copies of all the audiometric tests administered to them so that comparisons can be made (and to be sure that they are dated correctly).

In brief, the audiogram is perhaps the most important indictor of one’s hearing function, the particulars of which everybody who has a hearing loss should be aware of.
Mark Ross, Ph.D., is an audiologist and associate at the Rehabilitation Engineering Research Center (RERC) at the Lexington Center in New York. He dates his emergence into the field of audiology to the time he attended the Army Aural Rehabilitation program as a patient in 1952. He received his doctoral degree from Stanford University and taught at the University of Connecticut and worked as a clinical audiologist at the Newington Children’s Hospital. Dr. Ross is the former director of research and training at the League for the Hard of Hearing and has served on the boards of SHHH and the International Federation of Hard of Hearing People. He has written a regular column on developments in research and technology in the Journal since 1990. He and his wife, Helen, live in Storrs, Connecticut. This article is supported in part by Grant #H133EO30006 from the U.S. Department of Education to Gallaudet University.

Noise Reduction Hearing Aids

kwilleitner — Wed, 29 Nov 2006 18:42:06 +0000

Noise Reduction Hearing Aids: Why They’re Needed, and How They Work
Mark Ross, Ph.D.

This article is reprinted with permission from Hearing Loss the magazine of Hearing Loss Association of America. The article was first published in the Sept/Oct 2005 issue, www.hearingloss.org.

Introduction

Some years ago on a visit to New York, my family and I decided to have brunch at one of the “in” places in Greenwich Village. As we entered, we were greeted by the happy chatter of other diners. While these sounds would be a problem for me, it was an expected one and one that I was prepared to face. The loud music coming from the many loudspeakers on the walls, however, was another matter. When I asked the manager if he could turn the level down, he nodded and I went back to the table. Nothing happened. Then my daughter, who can be more assertive on my behalf than I am, went to him and said “My father wears hearing aids and he can’t hear when the music is so loud. Could you please turn the sound down just a bit?” He ignored her and she asked again. Finally, in apparent exasperation, he exploded “The sound is part of our ambience and I will not turn it down.” Needless to say, our visit to the “in” place ended quickly.

I’m sure that just about anybody wearing hearing aids can relate to this experience. It is certainly not unique to me. As a 1993 Hearing Instruments article put it, “Restaurateurs perceive noise as communicating the popularity and success of the restaurant to patrons. Noise, they contend, creates an image or ambience.” The study found an average of 73 dBA in 27 San Francisco restaurants, with a range extending beyond 80 dBA. To put these figures in perspective, at three feet an average speech signal would measure about 45-50 dBA. While this is a 12-year-old study, the situation has, if anything, gotten worse since then. And therein lies the dilemma faced by hearing aid users. Most of us would classify noise (any sound that interferes with verbal communication or that we perceive as unpleasant) as a noxious stimulus, one that has been proven to cause a host of problems. However, for many people in our society, sounds - at least of certain types and in certain situations - are not regarded as “noise” but rather as a desirable part of everyday life. “Lively” restaurants are just one example.

Piped-in music can be found in just about every large public place (supermarkets, drug stores, department stores, etc.). My complaints to the management and personnel in these places have been met with a blank stare of incredulity: What on earth could I be talking about? They evidently believe that the background music is not only desirable, but necessary. On many city streets, the normal sounds of traffic can make conversation very difficult for the hearing aid user. And to the normal traffic noise, we can add the thunderous blare emanating from car stereos, which “treat” bystanders to the ultimate limits of advanced sound systems (as well as the driver’s taste in “music”). The newest exhibitionist trend is the installation of train horns in cars that can deliver an unbelievable 150 dB blast of sound to nearby listeners (whose subsequent reactions are a source of amusement to the drivers!). In my neighborhood, the sounds of spring include the roar of noisy lawn mowers; autumn is greeted by the howl of leaf blowers; and the fall can boast the intense buzz of a chain saw. Winter has its snow blowers, but fortunately we’re indoors at that time. Mufflers, I’m sure, can be made for all of these devices, but they appear to be an unknown entity.

The level of sound radiating from the loudspeakers at some musical performances is enough to cause the sternum to vibrate and the ears to ring. (Second-hand reporting only; I’m not about to experience this myself!) Discotheques, nightclubs and raves are notorious for the levels of sound they provide to their patrons (who evidently wouldn’t have it any other way). Apparently, at least in public settings, we’re uncomfortable with quiet. Everyday life, it seems, now requires that we be immersed in some type of background sound with the level apparently getting higher all the time. It is not unusual now for people to leave a movie house with ringing or a “stuffy” feeling in their ears. This is understandable, since sound levels as high as 118 dB have been reported in some of them.

Of course much depends on how the sound is perceived by listeners. For young people listening to the music they like, it may be next to impossible to overdo the loudness level. The higher the better. For people who don’t like the music, however, then any level is too high (and I personally put piped-in music in this category). For me, it really doesn’t matter what the musical selection is - not when I am an unwilling listener to what I perceive to be a noxious stimuli). I put this involuntary exposure to sound in the same category as second-hand smoke. But regardless of how positively or negatively the sounds may be regarded by a listener, there is an intensity level at which the ear will begin to sustain damage.

The long-term negative effects of excessive sound exposure have been known for many years. The most notable consequence is a noise-induced hearing loss (NIHL), but a prolonged exposure to loud sounds can cause other problems as well. There is a body of research that demonstrates that such exposure can raise blood pressure, affect the cardio-vascular system, disrupt sleep, cause breathing and digestive problems, and reduce efficiency in performing daily tasks. Children’s learning can also be affected. Several studies have compared the test results of children in noisy schools to those in quieter schools. These have found superior performance by the children in the quieter schools.

An alarming number of studies have documented the presence of a noise-induced hearing loss (NIHL) among school-age children. There is no question but that children are often exposed to excessive levels of sound. Many children, particularly the older ones, make a practice of prolonged listening to earphones, whose measured sound output is often in excess of 115 dB. Just about every parent can testify to the high volume level on the TV or stereo preferred by their youngsters. Children (and people in general) do exhibit individual differences in their ability to tolerate loud sounds. While some may show little damage from continuous sound exposure, others are not so lucky. For them, it won’t take too long to develop a permanent hearing loss given long-term exposures in excess of 115 dB. One researcher reports that excessive sound exposure is apparently the reason why up to 75 percent of high-school seniors he examined have the beginnings of a permanent hearing loss (at 4000 Hz, usually the first frequency to be affected). From what I’ve been able to determine, this was not the case 40 or 50 years ago.

For people with hearing loss, the most immediate and apparent effect of noise is its impact on interpersonal communication. There is no such thing as “desirable” sound for the hearing-impaired person at a time when they’re trying to communicate. They are not immune to the other problems that may be caused by noise, but for them its interference with communication is something that occurs daily, every time they talk to somebody in a noisy place. In this instance, the nature of the noise doesn’t matter, whether it is considered “desirable,” i.e., music (and the selection is irrelevant), or undesirable sounds such as the racket produced by a pneumatic drill. People wearing hearing aids have to communicate under every acoustic circumstance.

There are a number of different ways for a hearing aid user to improve speech perception in the presence of competing sounds. One, as has been alluded to, is to attempt to get the offending sounds reduced. I know one young man who required that the musicians at his wedding reception sign a contract agreeing to keep the music level below 70 dB. Any more than that and they would be penalized. It was wonderful; it was actually possible to talk to the other people at the table. A second technique is to use strategic seating in an unavoidably noisy location by trying to find the quietest spot in the room. But this is not possible in many places. A third method would be to employ a close-talking mike, such as a personal FM system. This is probably the most effective technique of all, since it directly boosts the speech-to-noise ratio. A fourth option is to use hearing aids that include directional microphones. These really do work, but also require strategic seating for maximum effectiveness. And a fifth solution, and the topic of this paper, is to use hearing aids equipped with a digital noise reduction (DNR) circuit. A very informative article on DNR hearing aids by Gus Mueller and Todd Ricketts recently appeared in The Hearing Journal.

In an ideal DNR system, the hearing aid will reduce only the undesired noise while leaving desired speech signals intact. In this ideal situation, the hearing aid is supposed to “know” what sounds it is expected to “hear” and pass on to the listener and what sounds it should reject. To reach this goal, engineers and scientists have focused on the acoustic differences between speech and noise and devised sensors that respond to these differences. While noise can vary in an almost infinite number of ways, we know that the nature of speech is syllabic, with relatively intense vowels followed by weaker consonants and pauses. In normal speech, there are about four to six such syllables (or “modulations”) per second.

In the most common type of DNR implementation, speech is differentiated from noise by an analysis of the modulations. In a quiet environment, the intensity range of these modulations is at a maximum. In this instance, the hearing aid “knows” that the signal is purely speech. However, when other sounds are present, the situation changes. These sounds can consist of other people talking, music, or just everyday background sounds. The presence of these other sounds tends to flatten the modulations; that is, the competing sounds fill the gaps between syllables or even override the vowel peaks. The full range of the modulated speech signal is no longer observed.

When the extent of the modulations is reduced, the DNR circuit “knows” that noise is present. When this occurs, the hearing aid automatically turns itself down. The amount of gain (amplification) reduction usually depends upon how much the noise affects the modulations. Usually, the greater the effect upon the modulations, the more the gain is reduced. We should understand that while this gain reduction reduces the amplification of the competing noises, it also decreases the energy in the speech signals. In other words, DNR circuits affect both speech and noise in exactly the same way. There is no way that I know of that a DNR circuit can eliminate only the noise from a simultaneous speech and noise signal. (Noise reduction earphones can do this but they require a predictable noise source in order to operate, unlike the normal acoustical environment of a hearing aid user.)

Fortunately, modern hearing aids are “multi-band” and since the DNR circuit works within each separate band, it is possible to reduce the amplification in the noisiest channels only. The amount of gain reduction depends upon a number of acoustical factors, with different manufacturers using their own decision rules. Primarily this would depend upon how much noise is present, but other factors, such as the overall levels of the speech and noise, may also be considered. It is a common practice for a DNR circuit to vary the amount of gain reduction depending upon a band’s frequency location. Frequencies more important for understanding speech are not reduced as much as frequency bands less important for the understanding of speech.

All DNR aids, then, are not alike. Some hearing aids provide 16 dB or more in gain reduction, while others will reduce the gain by only 5 dB at the same frequencies. They also differ in how rapidly they increase and decrease the gain and how they affect different types of sound. For example, Ruth Bentler compared two DNR aids in the degree to which they reduced speech, noise, and music at different frequencies. The two hearing aids differed not only from each other but also in the extent to which they reduced the gain of speech, music and noise across frequency. In other words, all hearing aids that contain a DNR system are not alike in this respect (nor in many others as well). It is not known how these two aids, and by implication other hearing aids with DNR systems, would compare in respect to objective testing and subjective preferences in a real-life situation.

There has been a fair amount of research performed on DNR systems in hearing aids. From what I can see a consensus appears to be emerging: people do prefer listening in a noisy situation while wearing a hearing aid that includes a DNR circuit. Hearing aid users report that the background noise does appear to recede and that incoming speech does “sound” better with the DNR system. The entire listening experience is not quite as stressful or as fatiguing as it ordinarily would be. These subjective preferences have been found when people wear DNR hearing aids under both high and low-noise conditions.

In view of these findings, it may be surprising to note that these subjective preferences are rarely found when speech perception scores with and without a DNR system are compared. One study (conducted by Jason Galster from Vanderbilt University) did show a slight preference for the DNR condition, but this was attributed to the noise condition (a steady-state white-like noise unlike a normally complex and changing acoustical environment). A follow-up study now being conducted, with a more realistic competing noise situation, is not demonstrating the same improvement found earlier. Generally, therefore, it can be concluded that short-term speech perception studies have not found higher scores with a DNR system than without one.

It has been speculated that speech perception scores would demonstrate an improvement after long-term listening, since there would be less fatigue when listening with a DNR system in a noisy situation. More relaxed people do “listen” better than people under stress. While this comment is only speculative, it may explain why many people wearing such systems report an improvement in their ability to understand speech. Perhaps, after a while they really do hear better. But this is not the same as the promise inherent in the label “digital noise reduction,” that is, the technical capability of some miracle hearing aid to virtually eliminate all competing sounds when listening to speech in a noisy situation. That’s a dream still to be realized.

Mark Ross, Ph.D., is an audiologist and associate at the Rehabilitation Engineering Research Center (RERC) at Gallaudet University. He dates his emergence into the field of audiology to the time he attended the Army Aural Rehabilitation Program as a participant in 1952. He received his doctoral degree from Stanford University and taught at the University of Connecticut and worked as a clinical audiologist at Newington Children’s Hospital. Dr. Ross is the former director of research and training at the League for the Hard of Hearing and has served on the boards of SHHH and the International Federation of Hard of Hearing People. This article is supported in part by Grant #H133EO30006 from the U.S. Department of Education to Gallaudet University. The opinions expressed herein are those of the author and do not necessarily reflect those of the Department of Education.

Hearing Aid “Sticker Shock”

kwilleitner — Wed, 29 Nov 2006 18:37:56 +0000

Hearing Aid “Sticker Shock” and Things to Consider When Purchasing
Steve Barber, Hard of Hearing Consumer and SHHH Member
5/16/2005

Introduction:

We’ve all heard about the guy that knows the price of everything, but the value of nothing? It turns out the price of things is not always linked to some intrinsic value, their materials or their size.

The price of gasoline has risen dramatically. It seems obscene that we could be paying $2 or more for a gallon of gas, but then again…there’s a lot of value that gallon of gas provides. The ability to travel 20 or 30 miles (unless you bought one of those SUVs) is certainly worth 2 dollars; at least it is to me, so I pay it.

When you consider the specific costs involved, in some respects, there’s more value in a gallon of gas than a gallon of bottled water. The gallon of water probably bubbled out of the ground, almost directly into a bottle and required no serious processing or transportation costs. The gallon of gas required major cost for exploration, drilling, pumping, transporting half way around the world, refining, transporting again, and retailing … yet, some bottled water costs more than gasoline.

So although gasoline is indeed far more expensive than we’re used to, what makes gasoline so cheap when compared to water? And — what’s that got to do with the price of hearing aids?

With hearing aids, some of the same issues apply. Everyone knows the cost of hearing aids isn’t based on the materials that go into them – that’s a given. From a “materials” standpoint, there’s a little plastic, a wire or two, a tiny microphone or two, a speaker and the equivalent of millions and millions and millions of digital chips, but still, the actual dollar cost of raw materials is fairly low. Then again, based on raw materials, the average human being is worth less than $1. Both human beings and hearing aids are worth (and cost) a lot more than the cost of their materials.

PART ONE: Why Do Hearing Aids Cost So Much?

I will address a few of the specific things that contribute to the retail price of hearing aids, but please understand, the list below is not comprehensive. Some of the factors that go into the price of hearing aids include:

Technology
Durability and Reliability
Personal Fitting
Professional Costs
Product Lifecycle
Manufacturing Costs
Marketing Costs
Warrantee Costs
Free Trial Costs
Inflation
Customization

1- Technology:

Just 20 years ago, most hearing aids were analog; they were not programmable and certainly not digital. Hearing aids had no software, they were adjusted using a screwdriver, and generally, there were only two adjustment screws. Most hearing aids didn’t have telecoils, and very few had directional microphones. FM, remote controls and Bluetooth didn’t exist. In 2005, all those things are common.

These things didn’t just “happen”. They are the result of hearing aid manufacturers investing heavily in developing new technology and features. They are the result of hearing aid users being willing to pay for the advantages that these (and future) “bleeding edge” improvements provide.

The cost to the manufacturer for staying on the bleeding edge of technology is a killer. Consumers, of course, pay for those advances, but that’s the cost (and benefit) of staying on the bleeding edge. Very good hearing aids with older technology are available at lower prices, but when most people buy a hearing aid, they want the best they can get, not the best that was available 20 years ago.

When I bought my first home computer in 1983, the retail price was $6,000. It was an amazing piece of equipment and a good bargain to me, at that time. I’d worked on mainframe computers that cost millions of dollars, and I recall being blown away that I could actually buy a personal computer for only $6,000, which 22 years ago seemed very fast (4 MHz.), had lots of memory (it came with 16 kilobytes, although I bought the 48 kilobyte upgrade), and it had not one, but two floppy drives — holding a mammoth 180 kilobytes on each diskette, for only $6000. But remember, 20 years ago, that was a bargain.

Now, you can buy a PC literally 1000 times faster with 8000 times the memory and 10,000 times the disk space and other amazing things (too numerous to mention) all for one-tenth the cost of my original computer. That kind of price reduction is not going to happen with hearing aids; because so few hearing aids are sold compared to computers, but the rapid and uncertain direction of technology caused early personal computers to be very expensive … just as that same factor has affected hearing aid prices.

2- Durability and Reliability

Hearing aids have to work and endure some nasty situations. Most people wear their hearing aids some 12 to18 hours daily. They wear them in freezing winter weather and on hot summer days. They wear them when it rains, maybe with an umbrella, maybe not. They wear them when they play tennis and sweat trickles around their ears. Worse still, is when you consider that the majority of all hearing aids sold (perhaps 2/3rds or so) are custom made to be inserted in the ear canal, the product is has to function in an ear canal that literally exudes wax and humidity. Dr. Beck (editor of www.healthyhearing.com assures me that even the cleanest of all ear canals have bacteria, fungi and viruses too. So beyond moisture, heat and earwax, we have unimaginable germs working to negatively impact the environment in which hearing aids live every moment of their life cycle.

Speaking of life cycles, digital custom-made hearing aids are expected to survive nicely in even the nastiest ear canals for approximately 5 to 7 years. Behind-The-Ear (BTE) instruments generally last longer than in-ear models.

Durability and reliability that can handle that kind of abuse is not cheap. When NASA wants a transistor for a spacecraft, they don’t pop over to Radio Shack, choose a bubble pack and hope it works all the way to Saturn. They need to know that their transistor will handle the rigors of space. You can bet that the transistors NASA does buy are going to be a lot more expensive than the ones you can buy in a bubble pack.

Likewise, most hearing aid manufacturers have to invest heavily making sure their switches, mics, receivers, chips, cases, connectors, and even battery contacts hold up through years of normal and abnormal use, too. If they use cheap parts and crummy assembly techniques, they will pay over and over again to correct very costly errors.

I’ve got a remote control for my hearing aid. I love it, but was horrified a couple of weeks after I bought my hearing system as I picked it up from the parking lot after a car had run over it! You might be surprised that 6 years later I’m still using that same remote. It didn’t even need to be repaired. Don’t try this with your hearing aid or assistive technology, but it gave me a good deal of respect for the reliability and durability of my remote.

3 - Personal Fitting

When you buy glasses, the doctor measures your vision, writes a prescription, and you buy glasses from someone who inserts the lenses in the frame and adjusts the frames so they fit correctly. With hearing aids it’s similar, but a lot more problematic. With glasses, the prescription is almost always a near perfect match for your needs. With new glasses you can immediately see quite well. It doesn’t matter how bright the light is or whether the colors are properly adjusted; you can see almost perfectly in all situations.

With hearing aids, the prescription is less likely to result in an immediate perfect fit. Your hearing loss and your hearing test is just the starting point. Hearing aids can make a huge difference in your ability to hear, but no hearing aid can achieve near-perfect hearing right out of the box. Considerable and highly specialized attention throughout the fitting process is required to adjust the hearing aids, not just to your hearing loss, but indeed, to your hearing needs.

If your hearing aid just had to match your hearing loss, that would be easy. Like glasses, the “first fits” would likely all be perfect. But it’s just not that simple. Your brain is really where hearing occurs, and your ears are merely the transmitters of the information. The professional has to adjust the hearing aids to amplify the soft sounds you don’t hear well without making the other sounds too loud. All the amplified sounds have to be placed in your comfortable listening range. Ear molds, or the aid’s body itself, have to be designed with appropriate bores and vents to match your needs and to straddle a, sometimes, thin line between that “plugged-up” feeling and feedback. Features that can minimize background noise must be properly set so that you can hear your best at parties, in restaurants or in the car. Getting the aids to work well for you on the phone adds another challenge to the fitting, with telecoils, or assistive technology requiring special attention.

The amazing thing about all this personal fitting stuff is that it has to be done without the professional being able to actually hear what you are hearing. No one can hear what you are hearing.

Fitting glasses is more like a science and fitting hearing aids is more like an art … and it’s likely to remain so. Frequently, several visits are required for you to get the most comfortable and effective fitting. A lot depends on your ability to convey your experiences and needs to your fitter, and a lot depends on their skill, training and ability to work with you.

4- Professional Costs

Fitting hearing aids is indeed a complicated affair. Most people buying hearing aids expect to be fitted by someone who is really good at what they do. An audiologist in the United States must have a bachelor’s degree and also, at least a master’s degree in audiology, and many of them have doctorates too, such as an Au.D. (Doctor of Audiology) or a Ph.D. degree. Degrees cost a lot of time and money! Another important issue is that technology changes so rapidly that anyone licensed to fit hearing aids (audiologists and hearing aid specialists) must attend seminars and other training events to stay current and to maintain their licenses. They can’t fit hearing aids with a $2 screwdriver anymore; special computers, adaptors, experience and skill are needed to fit them correctly.

5 - The High Cost of Low Volumes

Not sound volume — I’m talking about sales volumes. Hearing aids are typically not high volume products. In fact, less than two million units are fit per year in the USA. When you consider the number of manufacturers (many dozens) and the different models and circuits offered, the “number of units sold per model” is relatively low, never really achieving the “economies of scale” apparent with lap-tops, cell phones, PC computers, DVD players, TV, CD players, iPODs automobiles, eyeglasses, sunglasses, digital cameras, calculators or contact lenses. The lack of sales drives up the cost in at least two important ways:

Research and Development: When a company manufactures a product, the pricing of that product must recover the cost of research and development (R&D) for that product. Because hearing aids are often “bleeding edge” products, the research and development costs can be substantial and must be spread over a relatively small number of units sold.

Manufacturing Costs: Most hearing aids are not manufactured in huge volumes (see above). Manufacturing costs for any product are high (on a per unit basis) when volumes are low. Costs, such as bricks and mortar, leases/mortgages, insurance, warrantees, production equipment and personnel, administrative staff, phones, shipping, packaging, returns for credit, marketing, heat, lights, taxes and on and on…. all add to the per-unit cost of hearing aids.

Interestingly, the cost of research is relatively fixed. For example, it takes a team of engineers X amount of time (and equipment and related costs) to design a new hearing aid circuit. However, if only one person purchases that circuit, that one person pays the whole bill. If ten people purchase that circuit, they each pay a tenth, and if a hundred people buy it they each pay one one-hundredth. Economy of scale is an important issue.

6 - Marketing Costs

There’s a lot of competition in the hearing aid industry. The Sunday papers sometimes have full page ads offering “free hearing screenings.” They say you should come in and be tested because it “might just be wax“ and you can get a $1000 discount if you buy now. Yawn. These ads are typically from the “mass marketing” distributors that typically sell one brand (theirs, of course). Somebody’s got to pay for those ads, right?

Even major name brand hearing aids marketed through independent hearing aid dealers and audiologists require a substantial amount of money for marketing. A lot of money is needed for to market any product. Advertisements, web pages, slick brochures, product launch events, seminars, training, nice packaging, and toll-free numbers are examples of marketing costs. Someone has to pay for all of those things too! Of course, the local professionals need their own marketing materials too, and computers, and offices, and administrative staff, and business cards, and telephones, and lights and signs, etc.

7 - Warrantee Costs

When you purchase hearing aids from a reputable dealer or audiologist, it will come with a warrantee. If you have any problems, they’ll fix it or replace it for free (see above). Some warrantees even cover problems that aren’t the fault of the hearing aid or fitting itself. For instance, if you step on your hearing aid and crush it, or if your dog chews it up, the professional will generally replace it for free, or perhaps charge a slight “refit” fee. Try that with your car, iPOD, DVD player, CD Player, cell phone or TV. It pays to understand what your warrantee covers, but whatever it covers, somebody’s got to pay for maintenance or replacement when something does go wrong.

Obviously, when a hearing aid fails, it costs money to repair it, and of course, if it’s under warranty, you don’t receive an additional bill. However, the manufacturer does pay dearly.

Imagine if even a ten-cent switch breaks during the 11th month of hearing aid ownership. You bring the hearing aid to the professional, they fill in the paperwork, send it via air express, the factory takes it apart, troubleshoots it, fixes it, re-assembles it, sends it back to the professional air express, the professional receives the hearing aid, calls you, and you pick up the instrument…what did the ten cent switch cost the manufacturer to repair?

That’s why durability and reliability and warrantee costs are very real issues for the manufacturers too!

8 - Free Trial Costs

Most states require that hearing aids can be returned within a 30-day period for just about any reason, with only a small fitting fee kept by the professional. Try that with your travel agent (“But I didn’t like visiting Greenland!), or with your automobile dealer (Can I have my money back for that new car I bought last week, please?). Obviously, it’s not really free, and such costs are just one more reason that hearing aids are expensive.

9 - Inflation

I mention this only because others frequently bring it up when explaining why the price of anything is high. Yes, inflation affects everything, even hearing aids. But, it’s not really the main reason, or even a primary reason that hearing aids are expensive. One recent article even tried to show that since the first hearing aids were produced almost a century ago, that the current price isn’t all that far out of line after it’s been adjusted for inflation. Of course, it’s pointless to compare the price of things over so much time and technological advancement. An airliner costs a lot more than the Wright Brothers’ plane did in 1903 even after adjusting for inflation. Does that mean that airplanes are too expensive now? Of course not! Even if they are too expensive, it’s not because of inflation.

In some ways, hearing aids are like airplanes. Just as a 747 has much more capability than did the Wright Brothers’ plane, today’s hearing aids are dramatically improved compared to even aids of 20 or 30 years ago. So, while inflation does matter, it’s not really the key price factor for airplanes or hearing aids.

10 - Customization

The vast majority (approximately 2/3rds) of all hearing aids sold are custom made devices. That means the hearing healthcare professional has to physically examine your ear, safely take an ear impression with appropriate medical grade silicone, using universal precautions (to protect you and the professional) and then safely remove the ear impression from your ear, and then ship the ear impression to either an ear mold lab for BTE instruments, or to the hearing aid manufacturer for custom made in-ear instruments. The hearing aid shell is manufactured before the circuit is installed, and by the way, it takes a computer to figure out how to place an amplifier, miscellaneous computer chips, a microphone, a receiver, a power supply, a vent and other wires and components into a shell that has been custom built for your ear canal, which may be the size of a pencil eraser, in such a way as to not cause electrical “cross-talk” problems or acoustic feedback. Remember the “Economies of Scale” from earlier? Well, each hearing aid is brand new, and has never before been assembled in a shell to exactly fit your ear!

PART TWO: Things to Consider When Buying Hearing Aids

Here are a few tips on saving money … or at least, not wasting money. Taking these things to heart can help more people become happy hearing aid users, and that will eventually encourage quality hearing aids at lower prices.

Watch out for Scams: It’s important to not waste money on hearing aids that don’t give you a reasonable improvement in your ability to hear and understand speech. There are many products that claim to help with hearing, but many are not effective. Don’t be taken in by products that make exaggerated or ridiculous claims. In fact, be very careful if the product claims to NOT to be a hearing aid! Some products claim remarkable similarity to hearing aids; they claim you will hear “whispers across a room”. and that’s a clue to you, as a consumer, to be suspicious. Ads for products sneaking in under the FDA’s radar by stating they are “NOT a hearing aid” is usually a secret code for products so useless; that the company offering them could get into legal difficulties if they claimed it was a hearing aid! Being a hearing aid is not easy. Hearing aids are regulated by the FDA and they have to be well made and must incorporate safety, quality and health standards that most “mail order” and over-the-counter products cannot achieve. Of course, those “come on” ads prey on people in denial and those who think they don’t need or want a hearing aid, or perhaps purchasers who believe they can save lots of money by purchasing unregulated products…they can’t. You get what you pay for.

Check your Insurance: Most insurance policies don’t cover hearing aids, although some do. Often it’s only partial coverage, but don’t miss out if your insurance covers hearing aids.

Here’s an interesting and common scenario: Some insurance programs tout their “hearing aid benefit,” indeed they claim to “cover hearing aids” but what you’ll learn as you go through the process, is that they may only pay 400 or 500 dollars towards a hearing aid, which costs the professional perhaps twice that. If the professional were to supply you with a product completely paid for by your insurance, you would get the equivalent of an 8 track player in the iPOD age, or simply, a very bad product that does not meet your expectations or your needs. But before you get upset with the hearing healthcare professional, understand that it was the insurance company that sold you the “hearing aid benefit” and not the hearing healthcare professional!

See if You Qualify for Veterans’ Administration Benefits: If you’re a veteran, and if your hearing loss has been demonstrably connected to your military service, it’s possible that the VA will provide aids for you. You must contact your VA to see if you are eligible for VA benefits.

See if You Qualify for Vocational Rehabilitation Support: People who are unemployed but are employable may qualify for help thorough Vocational Rehabilitation, within your state. If hearing loss is preventing you from being hired, and if hearing aids might make a job possible, your state’s Vocational Rehabilitation department might buy hearing aids for you.

Don’t assume because you’re not employed or looking for work that you don’t qualify. Some states have companion programs for “independent living” associated with their Vocational Rehabilitation programs to help people who might be able to remain independent with financial aid for a disability, including hearing loss. You’ll need to check with them personally. There are strict guidelines, stringent limitations and red tape, but you may get help in obtaining hearing aids or assistive technology and maybe even a job.

Check with Civic Organizations: Lions International has programs to help people obtain hearing aids. Sertoma also helps people with hearing loss. Sometimes even local organizations can help; at least one SHHH Chapter has gotten a grant to help local people who can’t afford hearing aids. Your hearing healthcare professionals are usually aware of the civic and charitable groups available to you based on your specific situation; speak with them about this issue.

Learn about Overcoming Hearing Loss: Most people who purchase hearing aids have very little understanding of hearing loss or hearing aids. For many people, the two factors they initially consider when shopping for hearing aids is they want hearing aids “so small, no one will know” and frankly, they usually want the “least expensive.” Neither of those factors will typically steer you in the best direction!

Before you shop for hearing aids, speak with successful hearing aid users, not someone who bought hearing aids and returned them, or doesn’t use them. Of course, you can learn a lot from someone else’s negative experiences, but realize you are looking for the “right way” to acquire hearing aids, and learning what some people did wrong is probably not as valuable as learning what successful people did right!

One of the very best things you can do is to join Self Help for Hard of Hearing People (SHHH). Learn more at http://www.hearingloss.org/.

SHHH members get a wonderful magazine about hearing loss from which you can learn a great deal about overcoming hearing loss. SHHH also has hundreds of local chapters. If there’s one near you, attend a meeting and meet people who have been successful in overcoming their hearing loss, and they’ll be happy to share the lessons they’ve already learned.

Choose hearing aids that help you hear best: That seems obvious, but too many people choose the aid they think is the smallest, the cheapest or the most invisible. However, Behind-The-Ear (BTE) models usually are cheaper, more reliable and have more impressive features than smaller, custom made in-ear hearing aids. The smaller aids aren’t necessarily the wrong choice, but their main sales point is usually their size, and that comes with a higher price tag and fewer features.

Learn about Hearing Aid Features: There are plenty of weird words and acronyms related to hearing loss. If you don’t know about telecoils, DAI, directional microphones, ALD, clipping, compression, digital, analog, FM, IR, neckloop, feedback suppression, noise reduction, etc., then go to www.nchearingloss.org and open the consumers’ hearing loss glossary.

Of course, another excellent resource is the website you’re reading at this moment (www.healthyhearing.com) . If you place any key words in the search engine, you’ll retrieve lots of useful information. You might also want to visit the section called “Testimonials” where you’ll be able to read the experiences of hundreds of people, who have already gone through what you’re going through. No one needs much training on how to wear glasses, but there’s a lot to learn about hearing more effectively with hearing aids and assistive listening devices.

Consider These Features: Hearing aids have several features you should understand. You may not need or want these features, but if you don’t know about them, you could be missing something that could help you hear a lot better than you can hear without such features.

Volume control: Some people think that the more automatic a hearing aid is, the better. Modern digital hearing aids are very good at keeping the loudness just about right where you want it…but sometimes you may want to turn it up or down. For some people with hearing loss, the ability to increase or decrease the volume is important. So you may actually want a volume control (VC). Many hearing aids offer them as an option, and even many automatic aids offer them as a manual override in case the automatically selected volume isn’t what you feel is best for you. People who are unable to properly control their hearing aid’s volume may be better off without a volume control, but many people appreciate having one. The VC is something you certainly should consider before ordering a hearing aid.

Multiple Microphone Noise Reduction: Some hearing aids have more than one microphone, which can filter out some of the background noise — allowing you to actually hear speech better in noisy situations. These are referred to as “directional mics.” It’s one of the most effective and important features on hearing aids. If hearing in noise is one of your problems, this feature is a “must consider.” Directional mics are available on most BTE aids and on many custom-made in-the-ear aids.

Telecoil: A telecoil (T-coil) is nearly standard in most BTEs and is an option on some in-the-ear custom made hearing aids. T-coils “hear” magnetic signals, such as the signal transmitted by most phones, representing an audio signal. The T-coil is an important way to “couple” your hearing aids directly with audio sources such as the TV, telephones, and assistive listening devices. However, the smaller the aid is, the less likely it is to have a telecoil. When you couple your hearing aid directly to an input signal, you automatically eliminate background noise, you maximize the signal, and you get the best sound signal possible directly to your hearing aid. Many experienced hearing aid users will not buy a new hearing aid without a telecoil.

These are not the only useful hearing aid features, but they are certainly ones you should understand when considering a new hearing aid. If you understand them and still decide against them, then fine. But you don’t want miss them because you didn’t know about them.

Get a Professional Audiometric Evaluation: Get a serious evaluation of your hearing, not just a “hearing screening”. Many places offer “free screenings” and that’s fine, but it’s not a thorough test of your hearing. Think about the value of the “free blood pressure” check at the pharmacy, as compared to your nurse or doctor checking it…big difference. A comprehensive audiometric evaluation may involve much more than measuring which tones you hear. Comprehensive evaluations typically include things like measurement and analysis of your eardrums and middle ear, a determination of how well you understand speech in quiet and in noise, whether your hearing loss is sensorineural or conductive, how well your auditory nerve is transmitting the signal to your brain, and how well your cochlea is functioning. And importantly, when you have a comprehensive audiometric evaluation, if any warning or danger signs are observed by the professional, they are obligated to refer you to an appropriate physician.

See an Ear Doctor: If you haven’t seen an ear doctor recently, do that. As noted above, some types of hearing loss can be a symptom of medical problems that require medical attention or intervention. In some rare cases, certain specific types of hearing loss can be treated medically or surgically, too. Your family doctor might be a great family doctor, but is probably not an ear specialist! Choose an ear, nose and throat doctor (ENT), also called an otolaryngologist, or an otologist. Most of them have one or more audiologists working in the same office, so you’ll most likely see both at one appointment.

Shop Around: Prices of hearing aids, professionals, locations, sales and service policies are all important. Choose a provider you feel comfortable working with, and one who is willing to discuss options, and how your needs can be met within your budget. Ask about return policies. Ask which brands they recommend and why. Ask about payment options. Ask about aural rehabilitation (AR) programs. It is nothing less than remarkable – patients who go to few AR classes learn so much more about their hearing aids and effective and appropriate use for their hearing aids, that the return rate for these patients/consumers is less than half of the non-AR class attendees, and the AR attendees report much higher satisfaction from their hearing aid purchase.

Evaluate Your Hearing Aids During the Trial Period: If you’ve learned what you need to know about hearing, hearing loss and hearing aids, you’ll be well prepared to make a decision regarding the purchase of your hearing aids based on — How does it improve your ability to hear in the situations that matter to you?

It’s very important to keep records of what sounds are good and what sounds are not good, to explain to the professional what you like and what you don’t like, and then with this information, they can tweak the settings to make it better for you. Modern hearing aids are almost limitless in the settings, sound quality and loudness they can provide. Basically if the hearing aids fit well, they’re comfortable, and you like the way they feel, the professional can make them sound great…not on the first day, but over a few visits.

Take Good Care of Your Investment: Hearing aids are pretty durable, but there are some things that are bad for them. Dogs and cats love to chew them. It’s easy to leave your hearing aids in a pocket and send it thorough the washing machine. Bad move. Always place them in their case or the “dry aid” kit, and make sure the hearing aids are either in your ears, or in their storage container.
Keeping your hearing aids dry on the inside can prevent corrosion. Keeping it clean and germ free can prevent ear infections.

Understand Your Warrantee: New hearing aids are usually covered for a year or more, so if you have a problem, then check to see if it’s covered.

Also, if your hearing aid needs to be repaired, you may receive a warrantee covering the repair, even if your original warrantee has expired.

You can usually purchase an extension to cover your aids after that original coverage ends. Check with your hearing aid provider to see if that’s a good idea for you.

Accept Your Hearing Aids: Some estimates suggest that when people buy their first hearing aid, they have waited about 7 years from the time they really needed one. Research also tells us only 20% of people who could benefit from hearing aids use hearing aids.

One of the biggest reasons for these disturbing figures is denial, not just the cost of hearing aids. Hearing aids aren’t yet as “fashionable” as glasses, but they are getting there. A very similar situation emerged with glasses, many years ago, before they became a fashion statement. Almost everyone has heard Dorothy Parker’s famous quote: “Men don’t make passes as women who wear glasses”. That might have been true when Dorothy said it, but it’s certainly not true any more.

Hearing aids are finally becoming more acceptable … even fashionable. Cell phones and personal music players are ubiquitous. Headsets, ear inserts, hands free sets, and even Bluetooth wireless connections to things that look like hearing aids are adorning even the youngest and “coolest” of consumers. Rock stars routinely wear “hearing aids” with wireless connectivity while on stage. Some rock stars also need real hearing aids, after being in all that noise, too.

Hearing aid manufacturers are recognizing that hearing aids can be “cool” and don’t have to look like bland “flesh” colored appliances. These things will make it much more acceptable, even desirable, to wear hearing aids.

SHHH is only a little over 25 years old, but as the premier organization for people with hearing loss, it’s already starting to help people actually accept and take charge of their hearing loss. That’s going to help broaden the market.

As people accept and buy hearing aids in larger numbers, and as the technology stabilizes, the price will eventually come down. We’re already starting to see some low cost digital hearing aids becoming available.

Conclusion

If you demand the absolute best product you can get, it’s going to cost you more than the run-of-the-mill product. That’s true of everything, not just hearing aids.

One of the reasons that we have made so much progress in hearing aid technology over the last 20 years is because people who buy hearing aids have been willing to pay for that technology. It’s painful to pay that much, but there’s some comfort that the money is helping the industry make better hearing aids. I’m certainly happy that I’m able to buy a much better hearing aid today, than I was able to buy 20 years ago.

The most important thing we, as consumers, can do to help reduce the price of hearing aids is to broaden the market for them. If we can help make wearing a hearing aid as acceptable (even as fashionable) as wearing glasses, more will be sold, and prices will come down. So, wear your hearing aid with confidence, stop hiding them as if they were something to be ashamed of. You can help others see that hearing aids are not something to avoid.

If you’ve gotten this far and still want more about the cost of hearing aids, then check out the January-February issue of SHHH’s Hearing Loss magazine. That issue has several excellent articles by various hearing loss professionals. If you’re already an SHHH member, you’ve already got that issue. If you’re not an SHHH member, then go to http://www.hearingloss.org/ and ask if they’ve still got a back issue when you join.

————————–

Steve Barber has gradually lost most of his hearing over the last 25 years. He’s retired from IBM and currently working as a software tester for SAS Inc.

Steve has been a volunteer/leader in Self Help for Hard of Hearing People for 14 years and he served as the chairperson for the North Carolina Council for Deaf and Hard of Hearing people during 4 of his 10-year tenure with that council.

He built and maintains the NCSHHH web site at http://www.nchearingloss.org/ and the Beyond-Hearing web site at www.geocities.com/nc-shhh/bhframe.htm.

Hearing Aid Tax Credit

kwilleitner — Wed, 29 Nov 2006 18:22:41 +0000

Important Hearing Aid Legislation - Hearing Aid Tax Credit
7/15/2006

Known as H.R. 414 in the congress and S. 1060 in the senate, the Hearing Aid Assistance Tax Credit Act would allow persons over age 55, or parents of a hearing impaired dependent child a $500 tax credit per hearing instrument purchased, once every five years. We urge all consumers and hearing professionals to contact your congressional representative and senators in support of the bills.

The Hearing Aid Assistance Tax Credit Act would help countless Americans who need hearing instruments, but simply cannot afford them. The benefits of reducing special education costs for children, as well as injuries, psychological and mental disorders associated with hearing loss in older adults are immense.
To contact your representative and senators in support of these important bills, click here for sample letters.

News copy and letter samples courtesy of Starkey Labs and www.healthyhearing.com.

Additional information can be found from:

Hearing Aid Stigma Declining?

kwilleitner — Wed, 29 Nov 2006 18:05:17 +0000

The Hearing Aid Stigma Declining?
1/25/2006

Could the increasing use of IPods, MP3 players and in-the-ear cell phones possibly lessen the stigma associated with hearing aid usage? Every day millions of people of all ages walk around listening to their MP3 players or other electronic devices. With the growing normalcy and broad reach of the use of earwear, those needing hearing aids may not feel as conspicuous and uncomfortable as even a year ago. Dr. Jackler, chair of otolaryngology at the Stanford University School of Medicine, in a Stanford news release hypothesized, “within a few years, wearing a device in your ear will be as common as wearing a wristwatch. We are in the midst of an ear-level device revolution.”

Of the one third of adults over the age of 65 who have some level of hearing loss, only a staggeringly small 20% use some kind of hearing aid. In determining if the widespread usage of in-the-ear consumer electronics has had an impact on hearing aid acceptance, Dr. Catherine Palmer, director of audiology at the Eye & Ear Institute at the University of Pittsburgh Medical Center says, “we have not seen a big change so far,” though she does acknowledge the potential for such a cause and effect relationship to develop in the future.

The creation of devices using Bluetooth communication technology to turn select hearing aids into wireless, hands-free headsets is an encouraging sign. Deborah Albaugh, audiologist and owner/operator of HearBest, Inc in Mt. Lebanon predicts that though these devices were not yet available in 2005, they are not far from becoming a reality. A promising advancement related to the use of Bluetooth technology is the ability to make hearing aids compatible with cell phones, currently of serious concern to hearing aid users.

Baby Boomers are approaching their fifties and sixties with optimism and a fresh outlook on aging. Because Boomers have consistently embraced new technology, the development of these devices may very well translate into a less stigmatized and therefore more exciting and useful answer for those who experience hearing loss.

Adapted from: Fuoco, Linda Wilson. The Pittsburg Post-Gazette, “Popularity of wireless ear pieces lessening the stigma of hearing aids.” January 25, 2006. News copy taken from www.betterhearing.org.

Today’s Hearing Aids - Smaller, Sleeker, Better Sound

kwilleitner — Wed, 29 Nov 2006 18:02:53 +0000

Today’s Hearing Aids - Smaller, Sleeker, Better Sound
4/17/2005

Remember those clunky hearing aids that amplified every little sound and made it all but impossible to hear a conversation in a crowded restaurant? Today’s digital technology introduces models that are smaller, sleeker and have vastly improved sound, allowing wearers to discriminate differences in noise level.

New digital models not only have the capabilities to deal with various sound environments, such as crowded restaurants or stores, but also offer tiny in-the-canal models, especially attractive to those who don’t want the device to be noticed by others. But the small size comes at a price, with typical digital models running from about $2,500 to $3,500 per ear, versus the conventional hearing-aid models procured for as little as $600 to $700 each.

Despite advances in hearing-aid technology, devices are used by only a quarter of the 28 million Americans believed to suffer from hearing loss. After age 65, as many as 1 in 4 people may need to use a hearing aid. Still many senior citizens, unaware of the new technology and wary of negative stereotypes, refuse to wear them.

This new digital technology provides an increased subtlety of sound and clarity, according to David Fabry, vice president of education and public relations at the hearing-aid company Phonak and the former president of the American Academy of Audiology. Soft sounds are soft, and louder sounds do not become uncomfortably loud. “Many hearing aids in the past have not really achieved that,” said Fabry, who noted that the older models merely amplified sound. “And through the use of digital… we’re providing a person with hearing loss the same capability, to offer dynamics of sounds that someone with normal hearing would (perceive).”

Still, one concern audiologists said they repeatedly hear from patients is a fear of being negatively judged for wearing a hearing aid. “Many people associate hearing loss with getting older, and many people don’t want to,” said Fabry. “As we have baby boomers who are living longer and working longer, the idea of wearing a hearing aid might be seen by some as a sign of weakness - in some way, you’re not going to be able to do your job as well as that young Gen-Xer who wants your job.”

Karen Spayd, a California State University, Northridge, audiology lecturer and clinic supervisor, said that hearing loss is often gradual and can have a variety of causes - and it’s not always apparent to a person that he or she has lost hearing until communication with family and friends suffers. “We try to tell our patients that the hearing aid will provide better quality of life,” said Spayd, noting that not hearing well can have ramifications beyond missing a few words.

“If you let the hearing loss go, the hearing loss is associated with not only communication breakdowns but depression, isolation and other factors. And all that can be avoided by just having a hearing aid.”
Unfortunately, the cost of a hearing aid is a major concern for many. Apart from some union plans, most insurance options do not cover the cost of hearing aids. But as audiologist Rose Bongiovanni, director of training and development at the hearing-aid company Widex, explained, digital devices, which typically last four to six years, can pay for themselves as audiologists can tweak the instruments to match a patient’s changing hearing ability over time.

Even with the new advances, though, patients do not always heed their audiologist’s recommendations to get help for their hearing in a timely fashion. “Research has shown that from the time a hearing loss is diagnosed to the time a person does something about it, it is seven years,” said Spayd. “That’s seven years of not having good quality of life.”

As Carol Fee, a senior citizen who uses a digital model summed it up: “If you want to communicate, get a hearing aid.”

News copy adapted from: dailynews.com, Health Beat (Published: April 17, 2005) and www.betterhearing.org.

Mattison Audiology Now Online

kwilleitner — Thu, 23 Nov 2006 17:21:03 +0000

Welcome to our new site. Hurray! As you see, Mattioson Audiology Online is up and running. Please feel free to send any suggestions or comments to info@mattisonaudiology.com. Some links may be under construction for a little longer. Special thanks to Kevin Willeitner for our web design and maintenance, to whom we owe our gratitude.