What causes hearing loss?

Hearing loss can have many causes which are rooted in the anatomy and physiology of the cochlea. Hearing loss can be a result of blockage in the ear canal – ear wax, foreign bodies, and ear canal infections can all cause hearing loss. The middle ear space – behind the ear drum may also contribute to hearing loss. Fluid in the middle ear (“Otitis media”), holes in the eardrum, or poorly functioning ear bones are some of these middle ear causes. In many cases, hearing loss is a result of deterioration of the nerves that bring hearing signals from the ear to the brain. This “sensorineural loss” is the most common source of hearing loss in adults and may be due to occupational and recreational noise exposure, or simple aging. The rise of portable listening devices such as the iPod have also been associated with hearing loss. Syndromic, hereditary, and congenital abnormalities may also contribute to hearing loss.

What are some signs of hearing loss?

Hearing loss often occurs in a gradual manner such that the person with hearing loss is unaware of the problem. In many cases, hearing loss is first detected by a family member who is having to speak louder or repeat themselves. Some signs of hearing loss include:

  • Turning the TV or radio volume louder than other family members prefer.
  • Difficulty understanding speech in crowded settings such as restaurants and meetings.
  • More difficulty hearing children and women than men.
  • Complaint of ringing in the ears.
  • Repeatedly asking for people to repeat what they say.
  • Excessive sensitivity to loud sounds.

If I think that I, or my loved one, has hearing loss, is there a way to determine this?

It is often important to have an objective measure of hearing loss. In coordination with your physician, a hearing test can be arranged which will help to tell you how much hearing loss exists, as well as what might be causing this hearing loss. A hearing test can help to determine the nature and level of your hearing loss and to rule out some conditions that might require medical attention.

Can hearing loss be treated?

Nearly all hearing loss can be treated. The cause of the impairment and the needs of the individual will help to determine the proper course of management. Some hearing loss can be eliminated, such as removing ear wax from the outer ear, or medically helping middle ear infections. If the loss has occurred in the inner ear, the treatment will usually be hearing instruments.

Many hearing losses can be successfully treated with hearing instruments, but only one-fourth of those who could benefit from hearing instruments actually purchase one. Some patients ignore their loss because they believe hearing instruments can’t help their specific type of loss. Others incorrectly believe they are too old to benefit from amplification. In fact, 95 percent of all losses can be successfully treated. No person is ever too old to benefit from the improved communication that hearing instruments can provide.

In our society, people will frequently ignore their hearing loss despite the significant dysfunction it can cause. Patients with untreated hearing loss often feel isolated and distant from their environment. While individuals with poor vision would never go without corrective eyeglasses, in our society, patients with poor hearing will often try to struggle through and ignore their sensory deficit.

Are there any health-related downsides to not treating hearing loss?

Patients with untreated hearing loss tend to find themselves gradually isolated from their environment. Patients may blame others for not speaking clearly, but often these same patients may end up withdrawing from social settings as a way to handle the difficulties they encounter with hearing loss. This can lead to feelings of insecurity and depression. A 1999 report from the National Council on Aging found that older adults who suffered from untreated hearing loss were more likely to report feelings of depression and anxiety than those whose hearing loss had been treated.

Will treating hearing loss reverse some of the health-related symptoms of hearing loss?

When hearing loss is treated, many of the negative health-related symptoms may resolve. A 2007 study compared adults with hearing loss who used and did not use hearing instruments and found that hearing instruments reduce the psychological, social, and emotional difficulties of hearing impairment, which in turn enhances life satisfaction.

What is that noise that I have in my ears?

Tinnitus is a common symptom indicated by a ringing, roaring, ‘cricket-like’ or other noise in the ear and/or head. Tinnitus is commonly associated with hearing loss.

What happens when I go for a hearing test and audiological evaluation?

At Becker Hearing Center, our Audiologists will begin your evaluation by asking some basic questions about your hearing loss. For example, they will want to know when you first started to be aware of your hearing loss, which ear is worse, are there other symptoms such as ringing or dizziness or drainage from the ear, and many other factors which will help them to characterize your symptoms. They will then inquire about any related congenital conditions, workplace exposure to loud noises, medications, surgeries, and family history of hearing loss, among other issues.

After performing a thorough interview, our Audiologists will examine your ears to rule out any simple anatomic reasons for your symptoms. Then a series of hearing assessments are performed in a comfortable sound-treated listening booth. They will then review the results and offer their recommendations with you in detail.

What is sound?

If a tree falls in a forest, and there is no one there to hear it, did it make a sound?

Before we can understand how we hear, we must know what we hear. Sound is everywhere around us. There are very few places on earth that are completely silent. Sound gives us vital information about our surroundings, allowing us to avoid dangers, navigate from place to place, and communicate. Sound is a wave-like series of compressions, typically in air, produced by a vibrating object. Frequency (commonly known as pitch) is how fast the compressions occur. Intensity (commonly referred to as loudness) has to do with how big the compressions are. These compressions, through an elastic medium such as air or water, cause structures in our ears to move and eventually to create the perception of hearing a sound.

How do we hear?

In order for us to hear, our ears have to have properly working outer, middle, and inner ears, as well as an intact auditory neural pathway to the part of the brain that hears and helps us to attach meaning to sound, the auditory cortex. The outer ear is made up of the pinna (the part that sticks out from the head) and the ear canal.

The air-filled middle ear starts with the tympanic membrane (eardrum) that completely seals the ear canal from the middle and inner ear structures. The three tiniest bones in the human body, the ossicles, are named the malleus (“hammer”), the incus (“anvil”), and the stapes (“stirrup”). The job of the middle ear system is to convert the sound collected by the outer ear into mechanical energy by vibrating, sending it into the inner ear at the oval window (the base of the stapes). The middle ear also has another important structure, the Eustachian (yoo-stay-shin) tube, which serves to aerate the middle ear on the other side of the tympanic membrane. This allows our ears to have the same air pressure on both sides of the tympanic membrane.

The inner ear is itself divided into three parts, by their jobs. The cochlea is the tiny, snail shell-shaped organ that changed the vibrations from the middle ear into electrical energy to travel up to the brain. In the inner ear is a fluid related to spinal fluid and many tiny structures that hold up hair cells to transmit the nerve impulses to the hearing nerve. The other two parts, the vestibule and the semi-circular canals, are the vestibular system, which monitors head movements, eye movements, and posture, contributing to our being able to stay standing. When patients are dizzy we want to rule out that there is a problem in the vestibular system.

The rest of the ear is actually made up of the nerves that lead to the auditory cortex in the brain and the auditory cortex itself. The brain attaches meaning to the sound it heard, whether it is music, words, environmental sounds, or an alarm. This is called auditory processing.

To get back to the question about the tree in the forest, yes, of course it makes a sound (sensation) whether anyone was there to hear it or not. Many sound waves were created when the tree fell. It can only be heard (perception) if an ear of an animal or person is within hearing range and receives the sound through its auditory pathways to the brain. The brain attaches meaning and tells the listener to get out of the way!

What is an Audiologist?

An audiologist is a person trained to perform specialized tests of hearing and vestibular function to determine if hearing loss or a vestibular problem is present. We determine where in the system the problem is, provide rehabilitative approaches, and make appropriate recommendations. Our scope of practice includes hearing aid dispensing, cochlear implant team, intra-operative monitoring for ear- and nervous system-related surgeries, hearing conservation design and implementation, newborn hearing screening, aural (hearing) rehabilitation, central auditory processing disorders, tinnitus management, and teaching audiology and speech-language pathology students. We deal with all ages, from infancy to childhood to adults to seniors. Our possible job settings include private practice, working with ENT physicians, hospitals, universities, mobile vans for hearing conservation, military service, government settings, and schools. Most audiologists have doctoral degrees such as an Au.D, Sc.D, or Ph.D. There are only approximately 16,000 audiologists in the United States. We are licensed in every state, Washington DC, and Puerto Rico.

What is hearing loss?

What happens when something goes wrong with the hearing system? Hearing loss occurs when the hearing system is no longer as efficient or has lost functionality totally. Some types of hearing loss are temporary, while others are permanent. Of the permanent variety, some can be surgically corrected, and others are not able to be helped with surgery or medicine.

What types of hearing loss are there?

In the outer ear problems can include foreign objects such as an insect, or in the case of a child, a piece of a toy; as well as growths in the outer ear. Some people are born with a condition where the outer ear is not open to the middle and inner ear (atresia), or the outer ear is partially narrowed (stenosis). These conditions may be surgically correctable; the patient may choose a type of hearing implant; or he or she may choose a non-surgical approach for hearing on that side, a special type of hearing aid. Another common condition is outer ear infection, or otitis externa. This is treatable with special ear drops. For people with chronic outer ear infections, avoidance of water in the ear canals and thorough cleaning and drying of the ear canals as well as ongoing drops may make sense.

For the most part, problems in the outer ear, or ear canal, do not cause hearing loss unless they cover up, or occlude, the canal. Wax can be present for a long time with no hearing loss, but people will often know of its presence by an occasionally or frequent itching in the canals. An outer ear infection should cause little to no hearing loss, but the patient will feel itching or pain from it.

Can we talk about ear wax before we go any further?

Sure. Earwax (cerumen) is a common culprit in the outer ear. Many people are concerned about their ear wax. How much is normal? Why does my left ear build up wax while my right ear doesn’t? Why did my ears never have wax before and now I have to get my ears flushed out every six months? Am I cleaning my ears properly? If I use Q tips will I damage my ears? My grandmother told me to never put anything smaller than my elbow in my ears.

The best way to safely clean ears is with a wash cloth on the outside. Earwax build up may frequently occur in some individuals because of ear canal shape and some health factors. Use of Q tips may push the wax back in the canal and closer to the eardrum. In some instances people have perforated their eardrums with Q tip use.

Excessive earwax is easily remedied by earwax removal by your healthcare professional.

What methods are used to remove earwax?

The three ways that a healthcare professional can remove wax from the ears are manually with a wax loop, by gently pressurized water, or with suction. The wax loop is a hand tool that scoops out wax. This is ideal if the wax is loose or soft and not adhering to the canal walls or is not too far down in the ear canal. For wax that has been in the ear canal for a while (and thus is usually dense, dark, often adhering to the canal walls), the best methods are to suction out with a mini specialized vacuum or to gently loosen it and wash it away with irrigation. Often wax removal needs to wait after discovery to allow for softening and loosening by the patient (for more comfortable removal) with an over-the-counter product such as Debrox or equal parts hydrogen peroxide and water. This is possible after the canal has been deemed medically ready; in other words, the tympanic membrane (eardrum) has no hole in it. Always check with your healthcare provider before using one of these products in case any change in hearing is due to an eardrum perforation. People with infections and open eardrums should not use these products.

What is ear candling and is it safe for my ears (or my child’s ears)?

Ear candling is the use of a hollow candle placed in the ear canal, lighting it, and allowing the candle to burn within five to ten centimeters from the person’s ear. The manufacturer claims that it removes impurities and earwax from the patient’s ears with suction created by the candle. In fact no suction occurs with the candles. The residue left behind has been found to be remnants of the candle and not earwax or toxins from the body. Ear candling is not therapeutic and places the user at risk for burns of the face, ears, and eardrums. It does not remove ear wax. The manufacturer also claims that ear candling originated with the Hopi tribe, but the tribe has stated that this is not true and has asked the manufacturer to stop making that claim.

So, go back to the things that cause hearing loss in the different parts of the ear. What’s next?

Middle ear problems include otitis media or middle ear infections, problems with the middle ear bones, and Eustachian tube dysfunction. There are many types of otitis media. These commonly occur in children but can also be seen in adults. They usually occur with or following a viral or bacterial infection such as a cold or flu. Some incidents of otitis media may be just fluid without infection (serous otitis media) while others are infected and painful (acute otitis media). If the fluid remains after the infection has been cleared it is known as chronic otitis media. The cause and type of middle ear problem is important to determine; this drives the treatment.

Antibiotics are a first choice for most cases of acute otitis media. With the serous type, a watch-and-see approach may be used. The ears may drain on their own. Chronic otitis media cases may require help to clear, in the form of an incision, drainage, and tube in the eardrum. Children will often be treated differently from adults with these issues. An ENT (Ear, Nose, and Throat) physician is the appropriate professional to determine the type of middle ear infection and the best course of treatment. A hearing assessment from the audiologist helps to guide the treatment for serous and chronic forms of otitis media.

When someone has Eustachian tube dysfunction he/she may feel sensations such as ear pain, pressure, fullness, clogged ears, hearing his/her own voice in the ear very loudly, and difficulty monitoring voice volume. Common causes are barotrauma (air travel or scuba diving) and sinus involvement. A traditional approach is for the patient to utilize nasal sprays to help to alleviate the discomfort and reduce swelling. Some patients have surgery to open the eardrum to relieve the pressure. Many people have been treated with a newer approach that is neither invasive nor painful. It is called middle ear insufflation. It works with the body to help the Eustachian tubes open with gentle air. It can be done from age five and older, in the office or home. Most patients that have middle ear insufflation see an improvement or full relief following the treatment. Children who use the home version of this device tend to have fewer episodes of otitis media.

Another middle ear problem can be damaged middle ear bones, with causes ranging from hereditary or congenital (person is born with the problem) conditions to damage from long-term chronic otitis media. A person with this condition may be a candidate for surgery or he/she may elect to be or may more appropriately be fitted with a hearing aid on the affected side.

I thought hearing loss is hearing loss. Why does it matter how much loss or where the loss occurs?

We want to know many different things about hearing loss to guide the patient to the proper treatment. We want to know whether it is in one ear or both, mild or severe, middle ear or inner ear, sudden or gradual, with an illness or head trauma, and many other questions. Does the patient also have vertigo or tinnitus? Does the patient have a family history of the problem? Do other family members need to get tested? Do the results show that other types of physicians should be seen by the patient? Is the patient a surgical candidate or hearing aid candidate? We know even a mild hearing loss or hearing loss in one ear can greatly affect a patient’s ability to communicate, in children and adults.

What causes inner ear hearing loss and what can help me if I have it?

We talked about the cochlea, which is in the inner ear. It is the organ that takes the mechanical signals from the middle ear and turns them into electrical impulses for the hearing nerve to carry to the brain. There are many health issues that can cause inner ear, or sensorineural hearing loss. Sensorineural hearing loss can be caused or exacerbated by chronic health conditions such as hypertension (high blood pressure), high cholesterol, diabetes, arteriosclerosis and other circulatory problems, kidney problems, heart disease, strokes, etc. It can also result from genetic, hereditary, and congenital conditions. Environmental factors include short- or long-term exposure to loud noise and music. Concussions can cause sensorineural hearing loss. Many medications can cause hearing loss, among them some chemotherapy drugs and some strong antibiotics. Infrequently inner ear hearing loss can be caused by a growth in the inner ear or brain.

We do not have a medical “fix” for sensorineural, or inner ear, hearing loss. There are no pills, injections, vaccinations, or surgeries to prevent or correct hearing loss that occurs in the inner ear. Once the patient is medically cleared for hearing aids, he will meet with the audiologist. He is welcome to bring his significant other.

What, then, is the way to help someone with an inner ear hearing loss? As a team the best rehabilitative method is chosen. For most patients the best help happens with digital hearing aids. Other assistive devices may also be appropriate such as a TV listening device or alerting devices for telephone, alarm clocks, door bells, or baby cries.

Can everyone with a hearing loss benefit from hearing aids?

Most people with inner ear hearing loss benefit from hearing aids, when fitted properly. Some patients may have an “unaidable” ear, in which there is too much hearing loss, the person’s ability to tolerate amplified sound is severely diminished, or there is extremely poor understanding of speech. Even if a person was told some time ago that he “can’t be helped” or “nothing can be done,” it is important to get a new opinion because so much in amplification science has changed! We are able to help more people than ever before!

Why is it that we often have no clue that we have a hearing loss, but those around us insist that we aren’t hearing them?

It is very common for people with gradually progressive hearing loss to think that nothing is wrong, that the ears are working just fine, and that the difficulty lies in others “mumbling” or “not speaking clearly” or “turning her back to me when she is speaking,” and other answers along these lines. The TV volume number may be much higher for the person with the suspected loss than for the family members. We often have no clue because the brain gradually adjusts to each slight incremental change in the hearing, tricking us into believing we are just fine. Part of the answer, too, is that hearing loss, when not total, can seem “intermittent.” “In some environments I hear just fine, and in background noise I am wiped out, can’t understand a thing.” That is all part of hearing loss.

Will I eventually lose all of my hearing? Does everyone inevitably get hearing loss? Am I “normal for my age?”

Let’s answer that last question first. There is no such thing as “normal amount of hearing loss for your age.” Since many types of hearing loss are preventable there are seniors who have minimal or no hearing loss. Still, the majority of seniors will have some hearing loss in later years. Many adults have gradual inner ear hearing loss during their working years; it is not limited to seniors. Any hearing loss that is present and interferes with communication is not normal for any age and needs to be treated. At no age do we want to be left out of conversations and treated like we are not in the room. We know, for example, from studies out of Johns Hopkins and University of Pennsylvania, that untreated hearing loss can put a person at a greater risk of dementia and brain atrophy. University of Florida studies have shown that untreated hearing loss often leads to isolation, withdrawal, depression, and worsening of physical medical ailments. Gradual hearing loss does NOT mean that a person will necessarily lose all hearing. By the same token, wearing hearing aids will not prevent further hearing loss.

What is a hearing test like? Does it hurt? How do I convince my loved one to get one?

By sharing this information with your loved one, you may help alleviate fears about getting a hearing test. No, it does not hurt. It is simple to do and does not take a long time. Most people find the process interesting and often relate that the last hearing test was done by the school nurse in elementary or middle school.

Hearing tests should be given to adults once they reach the age of 50, and every three years after, to monitor hearing stability. Of course, any sudden change in hearing is considered a medical emergency and needs immediate medical intervention. If wax occlusion and middle ear infections have been ruled out, the person is often asked to take oral steroids in the hopes that it will help to recover hearing.

The first part of the hearing test consists of objective testing, or “automatic” tests; in other words, no answers are needed from the patient. The computers will get answers from each ear. The two tests done in this manner are middle ear testing and otoacoustic emissions. For middle ear testing the patient feels a slight air pressure change then hears some louder tones, checking the eardrum and acoustic reflexes. During otoacoustic emissions the patient hears quiet tones; the inner ear sends a tone back that the computer records. This same test is used to check newborn babies’ hearing in the nursery.

The patient’s cooperation is needed for the actual hearing test. The patient sits in a spacious listening room that blocks out extraneous environmental noise. Many people report that once the earphones are in place, they can hear their breathing and heartbeat. If a person has tinnitus it may seem louder during the test in the listening room due to the lack of environmental sounds to mask. This test is divided into two parts: speech testing and pure tones. For the pure tones, the patient pushes a button or verbally indicates that she hears a pulsed tone, each time it is heard. During speech testing the patient will repeat back both very softly spoken words and words at a comfortable listening level. The audiologist will work with the patient to make the test as “user-friendly” as possible, giving the person multiple opportunities to hear the tones and words.

The audiologist will counsel you about what the results of the test show, including how much hearing loss, where in the auditory system the problem lies, and what the recommendations are.

So, let’s say the test shows that I need hearing aids. What happens next?

You will have a hearing education appointment, which involves talking with your audiologist (many patients like to have a significant other along to share the discussion)bout what makes the most sense to solve your listening dilemmas and the communication dilemmas which hearing loss has brought to the family. A questionnaire will be used. Styles of hearing aids, different manufacturers and their models’ special features, technology level, pricing, and financing will be shared. Some patients have insurance benefits to assist or pay in full for the aids. Others may require some help with the purchase and those options are discussed at this time.

Does everyone with hearing loss in both ears need hearing aids in both ears?

For people with aidable hearing loss in both ears, we know that the best listening happens with both ears giving the auditory cortex the same information. They will hear and understand better in quiet and in background noise; they won’t have a “useless side” in a restaurant or family gathering (the people on the unaided side get ignored); and they can better localize the direction of the sound source, which is critical in communication and for safety purposes. We also know that a small percentage of monaurally aided patients will lose understanding of speech in the unaided ear, and we cannot predict who will experience that unfortunate situation. It is important to discuss this with the audiologist to determine the best outcome for each individual.

If needed earmold impressions are made of the ears to send to the lab for custom fit products. First a foam tip is placed in the ear canal, and then the ear canal is gently filled with silicone impression material. It is removed in five minutes. If the patient has excessive earwax the audiologist or ENT will remove wax to make the impression more accurate and comfortable. If ear hair is in the canal and blocking the production of an accurate representation of the ear, the patient will be asked to have that removed first before the impression is taken.

Does it take a long time for the aids to arrive?

Custom-fit hearing aids need to go to a lab to be handmade, so they may take approximately two weeks to arrive at the audiologist’s office. Aids that do not have custom fit parts arrive quickly and the appointment for the fitting can be arranged sooner, based on the audiologist’s and patient’s availability.

Why did hearing aids in the past get a bad reputation from some wearers? Why are aids different now?

Digital hearing aids are nothing like their old analog counterparts. Older hearing aids were bigger and the sound quality was much poorer. In addition there was relatively little adjustment for sound quality. There were few ways to avoid amplifying in areas where the wearer did not need amplification. There were no adjustments for hearing better in background noise. Old aids used to whistle while sitting in the person’s ears, and the wearer was unable to prevent it or even hear it when it was happening. Despite these disadvantages, there were, in fact, many satisfied hearing aid wearers, even with older hearing aids. We all tended to hear about the unsatisfied patient, not the satisfied ones!

With new digital technology we can shape the sound specifically for the person’s hearing loss, giving sound only where it is needed. This is done through a computer and a patient-worn interface at the time of the appointment, allowing the computer to send changes to the aids. We can adjust the type and method of noise management in the aids. We can digitally suppress feedback, the whistling that used to be common. There are even many aids which have Bluetooth capability, allowing a user to have the sound of the cell phone or television directly in the aids, for infinitely more clarity and ease of use.

Despite the amazing flexibility that the digital platform provides for hearing intervention, hearing aids still require acclimation. Remember that the hearing impaired individual most likely gradually lost hearing over many years. Suddenly we are asking that person to listen to a lot of sound that she has not had to process. We certainly can shape it to make it comfortable but the new wearer still will hear things that have been inaudible for a very long time. The person who patiently and consistently uses the aids over a period of time will be rewarded for her efforts with an ease of communication and an access to a palette of music and sounds that she has been missing.

Will the wearer become dependent on the hearing aids? Will the aids hurt my ears?

The first question is asked so frequently that I have begun bringing it up in my counseling. There is no dependency, as in an addiction. Once the person acclimates to the new sound over a period of weeks, there is a wonderful enhancement to communication that he will notice. He will definitely notice the difference when he takes the aids off for the night, but no actual permanent hearing change happened in the head or ears. It is just the brain noticing the stark contrast between aided and unaided. If we have worked together as a team, it will be preferable to listen to speech with the hearing aids on. If that is not the preferred situation then adjustments and changes need to be made.

Hearing aids should never hurt the wearer’s ears, either with the physical fit or by causing a greater loss of hearing. If the aids are not completely comfortable that needs to be communicated to the audiologist who can fix that. Hearing levels should be monitored and verification of the fitting will ensure that the sound is not too intense for the person’s hearing.

Where should I wear my hearing aids?

Aids should be worn in almost all listening situations except those listed below in the next question. They should be removed at night and placed in a dehumidifier to remove moisture from the day. If a wearer is taking a nap, it is fine to leave the aids in the ears if desired.

Where should I not wear my hearing aids?

Hearing aids should not be worn in excessive noise or music, or where water is involved (shower, hot tub, swimming, etc). Even ears with hearing loss, especially ears with hearing loss, need to be protected from intense noise such as loud music, power tool use, and impact noise such as firearms of any type. Aids are not worn to bed. If a hearing-impaired person fears not hearing alarm clocks or a fire alarm, there are special alerting devices. The audiologist can suggest the best options.

What do I do with hearing aids during air travel?

You may wear hearing aids through the security check point. You are not required to remove them from your ears at this time. Of course, you may be asked to remove them by the TSA agent, or regulations could change in the future which require air passengers to remove aids from their ears. Almost all hearing aids are vented in some way in the ear canal to keep ears comfortable during the pressure changes that occur during the flight, so it is not necessary to remove hearing aids for flying if you do not wish to do so. If you are someone who finds that the pressure changes in the cabin are bothersome to your ears, you may wish to try a pair of Ear Planes, which are available at drug stores and pharmacy areas of groceries and discount stores. These are designed to slowly change the air pressure in the wearer’s ear canals to help reduce the discomfort some people feel in their ears when flying. If you are using Ear Planes, you cannot wear the aids at the same time. Be certain to bring your case with you to store the aids to avoid having to roll up the aids in a tissue, an easy way to break, launder, or lose the devices.

Do all hearing aids use batteries?

All hearing aids use batteries, but there are different sizes. It is important to purchase the correct battery size for the aids. Just like a cell phone or watch, the wrong size will not allow the hearing aids to operate. The audiologist will tell you the correct size and may offer suggestions about where to buy batteries. A few hearing aid manufacturers have begun offering models that use rechargeable batteries, and they are working on perfecting them, such as getting them to power the instruments for the wearer’s full day. This technology may be utilized by more hearing aid models in the future but is not yet widely available.

Battery manufacturers have begun offering mercury-free batteries; these have just started to be available in many areas. Although the manufacturers say that batteries can be thrown out in the trash, recycling is environmentally friendly and easy to do. Many audiologists will collect spent batteries to recycle for you if you are a patient at their facility.

Batteries, no matter what chemicals comprise them, are dangerous if swallowed. Never keep batteries where a child or pet can get to them. They should never be handled near medications. The batteries are small and pill-shaped. They should not be placed on any horizontal surface (like a counter or bureau top) other than in the case itself so that they will not be accidentally ingested with food or pills. If a pet or person is thought to have swallowed a battery, immediate emergency medical services are needed. Do NOT attempt to make the pet or person vomit to retrieve the battery. Again, emergency medical services are needed immediately to properly and safely remove the battery from the person or pet.

Batteries should not be kept in the refrigerator or a hot car. They can be stored at room temperature away from children and pets.

While we are on this topic, each year many hearing aids are brought back to the audiologist, damaged by a pet who chewed it. No matter how carefully the aids are cleaned, the scent of earwax will not be removed. It is the perfect size and scent for a pet appetizer. This, of course, is dangerous for both the pet and the device! Most hearing aids have a loss and damage policy for the first year or two, but these always charge a deductible. If the loss and damage policy has been used, the wearer may wish to purchase new loss and damage insurance on that aid. The pet does not have loss and damage insurance on it, so for all concerned, please keep hearing aids and batteries away from pets.

How do I care for my hearing aids?

Hearing aids should be wiped with a clean, lint-free cloth after each day’s use. The battery doors should be opened to prevent battery drain during the night. Moisture and wax are two common enemies of hearing aids. Wax traps at the end of the earmold or aid keep wax out of the electronics. If wax has collected in the wax trap, it is easy to change by the wearer. A wonderful place to store the hearing aids at night is a hearing aid dehumidifier. It removes the moisture that might have developed in the aids during the day. This is good to use in any weather, not just humid days, since the wearer’s body transfers moisture to the devices in the cold or heat.

Hearing aids can go anywhere a person can go, with the exception of water and noise. Never store hearing aids in extreme heat or extreme cold. It is best not to wear the aids in very dusty or dirty environments.

What do I do with my hearing aids if I am hospitalized or need long-term rehabilitation care?

We are always told that we should not take valuables to a hospital. There is no one who can monitor their whereabouts. The difficulty with this thinking is that patients need to communicate in the hospital with the staff, nurses, and physicians. Without their hearing aids, this can be a very difficult to impossible proposition. If a family member is able to bring the aids each day and remember to take them home again, that is ideal. If that option is not available, ask if the hospital can loan a personal listener to the patient. Many hospitals have a loan program for these devices, which look like a Walkman with over-the-ear earphones for listening. These can be used to better hear the TV (and keep the volume down) as well as understanding essential communication with the healthcare professionals. They can be removed when the patient is resting or sleeping. These devices are returned at the end of the patient’s stay.

In long-term rehabilitation, it is more common for a patient to wear his or her hearing aids to this type of facility. For example, a container labeled with the patient’s name may be kept on the medicine cart and given to the patient each morning, returned to the cart at night with the aids inside. Each facility has different policies; it is essential to discuss the hearing aid policy with the facility’s patient care coordinator. Specifically ask where the devices will be stored, who will handle them, who has access, and how a loss or damage claim would be handled if such a need arose.

What accessories can I use with my aids?

Hearing aids can be paired with many devices to enhance the listening experience. These include Bluetooth devices that interface with cell phones, television, MP3 players, computers, etc., sending the sound directly into the wearer’s hearing aids. The listener hears as if the voices were speaking right in their ears, like wearing earphones, significantly increasing the signal to noise ratio and boosting intelligibility. The listener can walk away from the device, in some cases up to thirty feet, and still be connected to the sound streaming from that device. The listener can choose to listen alternately to the streamed device and activating the microphones to hear someone speaking to him in the room. Phone calls are heard in both ears, if desired.

People can also use a mini microphone that streams to the aids, again enhancing intelligibility by decreasing the distance and increasing the signal to noise ratio. If the mini microphone is placed on a lectern or meeting table or clipped to the person who is speaking, the listener can sit almost anywhere in the room, up to approximately thirty feet away, and hear very clearly what the speaker is saying. This mini mic may also be extremely useful in a car or in a noisy restaurant.

Alerting devices are important for helping people who have difficulty hearing alarm clocks, smoke detectors, door bells, infant monitors, etc. The electronics are remade for hearing impaired people with different types of signals, or they can be wired to a central device that alerts the individual with flashing strobe light or vibration. For people who have difficulty hearing on the telephone, there are amplified phones or phones that send a signal directly into the hearing aids through a special program.

What if my loved one needs hearing help but is unable to manage hearing aids?

This may be the case with people who have mental disabilities such as dementia and Alzheimers. Many seniors with disabilities may have limited access to help and may not feel able to manage hearing aids. Even if help is available the aids are small and need some care, and they require consistent placement after removal to avoid damaging and losing them. The audiologist can suggest alternative devices, such as simple amplifiers with insert or over-the-ear headsets.

What do I do with hearing aids that were worn by a loved one who is now deceased?

Hearing aids can be donated to various organizations that are able to remake the devices for underserved communities in the United States or abroad. Your audiologist can supply you with a list of organizations.

What causes hearing loss?

Hearing loss can have many causes which are rooted in the anatomy and physiology of the hearing organ. Hearing loss can be a result of blockage in the ear canal – ear wax, foreign bodies, ear canal infections can all cause hearing loss. The middle ear space – behind the ear drum may also contribute to hearing loss. Fluid in the middle ear (“Otitis media”), holes in the eardrum, or poorly functioning ear bones are some of these middle ear causes. In many cases, hearing loss is a result of deterioration of the nerves that bring hearing signals from the ear to the brain. This “sensorineural loss” is the most common source of hearing loss in adults and may be due to occupational and recreational noise exposure, or simple aging. The rise of portable listening devices such as the iPod have also been associated with hearing loss. Syndromic, hereditary, and congenital abnormalities may also contribute to hearing loss.

What are some signs of hearing loss?

Hearing loss often occurs in a gradual manner such that the person with hearing loss is unaware of the problem. In many cases, hearing loss is first detected by a family member who is having to speak louder or repeat themselves. Some signs of hearing loss include:

  • Turning the TV or radio volume louder than other family members prefer.
  • Difficulty understanding speech in crowded settings such as restaurants and meetings.
  • More difficulty hearing children and women than men.
  • Complaint of ringing in the ears
  • Repeatedly asking for people to repeat what they say.
  • Excessive sensitivity to loud sounds.

If think that I, or my loved one, has a hearing loss, is there a way to determine this?

It is often important to have an objective measure of hearing loss. In coordination with your physician, a hearing test can be arranged which will help to tell you how much hearing loss exists, as well as what might be causing this hearing loss. A hearing test can help to determine the nature and level of a hearing loss and to rule out some conditions that might require medical attention.

Can hearing loss be treated?

Nearly all hearing loss can be treated. The cause of the impairment and the needs of the individual will help to determine the proper course of management. Some hearing loss can be eliminated, such as removing ear wax from the outer ear, or medically helping middle ear infections. If the loss has occurred in the inner ear, the treatment will usually be hearing instruments.

Many hearing losses can be successfully treated with hearing instruments, but only one-fourth of those who could benefit from hearing instruments actually do so. Some patients ignore their loss because they believe hearing instruments can’t help their specific type of loss. Others incorrectly believe they are too old to benefit from amplification. In fact, 95 percent of all losses can be successfully treated. No person is ever too old to benefit from the improved communication that hearing instruments can provide.

In our society, people will frequently ignore their hearing loss despite the significant dysfunction it can cause. Patients with untreated hearing loss often feel isolated and distant from their environment. While individuals with poor vision would never go without corrective eyeglasses, in our society, patients with poor hearing will often try to struggle through and ignore their sensory deficit.

Are there any health-related downsides to not treating hearing loss?

Patients with untreated hearing loss tend to find themselves gradually isolated from their environment. Patients may blame others for not speaking clearly, but often these same patients may end up withdrawing from social settings as a way to handle the difficulties they encounter with hearing loss. This can lead to feelings of insecurity and depression. A 1999 report from the National Council on Aging found that older adults who suffered from untreated hearing loss were more likely to report feelings of depression and anxiety than those whose hearing loss had been treated.

Will treating hearing loss reverse some of the health-related symptoms of hearing loss?

When hearing loss is treated, many of the negative health-related symptoms may resolve. A 2007 study compared adults with hearing loss who used and did not use hearing instruments and found that hearing instruments reduce the psychological, social, and emotional difficulties of hearing impairment, which in turn enhances life satisfaction.

What is that noise that I have in my ears?

Tinnitus is a common symptom indicated by a ringing, roaring, ‘cricket-like’ or other noise in the ear and/or head. Tinnitus is commonly associated with hearing loss.

Does it take a long time for the hearing aids to arrive?

Custom-fit hearing aids need to go to a lab to be handmade, so they may take approximately two weeks to arrive at the audiologist’s office. Aids that do not have custom fit parts arrive quickly and the appointment for the fitting can be arranged sooner, based on the audiologist’s and patient’s availability.

Why did hearing aids in the past get a bad reputation from some wearers? Why are aids different now?

Digital hearing aids are nothing like their old analog counterparts. Older hearing aids were bigger and the sound quality was much poorer. In addition there was relatively little adjustment for sound quality. There were few ways to avoid amplifying in areas where the wearer did not need amplification. There were no adjustments for hearing better in background noise. Old aids used to whistle while sitting in the person’s ears, and the wearer was unable to prevent it or even hear it when it was happening. Despite these disadvantages, there were, in fact, many satisfied hearing aid wearers, even with older hearing aids. We all tended to hear about the unsatisfied patient, not the satisfied ones!

With new digital technology we can shape the sound specifically for the person’s hearing loss, giving sound only where it is needed. This is done through a computer and a patient-worn interface at the time of the appointment, allowing the computer to send changes to the aids. We can adjust the type and method of noise management in the aids. We can digitally suppress feedback, the whistling that used to be common. There are even many aids which have Bluetooth capability, allowing a user to have the sound of the cell phone or television directly in the aids, for infinitely more clarity and ease of use.

Despite the amazing flexibility that the digital platform provides for hearing intervention, hearing aids still require acclimation. Remember that the hearing impaired individual most likely gradually lost hearing over many years. Suddenly we are asking that person to listen to a lot of sound that she has not had to process. We certainly can shape it to make it comfortable but the new wearer still will hear things that have been inaudible for a very long time. The person who patiently and consistently uses the aids over a period of time will be rewarded for her efforts with an ease of communication and an access to a palette of music and sounds that she has been missing.

Will the wearer become dependent on the hearing aids? Will the aids hurt my ears?

The first question is asked so frequently that I have begun bringing it up in my counseling. There is no dependency, as in an addiction. Once the person acclimates to the new sound over a period of weeks, there is a wonderful enhancement to communication that he will notice. He will definitely notice the difference when he takes the aids off for the night, but no actual permanent hearing change happened in the head or ears. It is just the brain noticing the stark contrast between aided and unaided. If we have worked together as a team, it will be preferable to listen to speech with the hearing aids on. If that is not the preferred situation then adjustments and changes need to be made.

Hearing aids should never hurt the wearer’s ears, either with the physical fit or by causing a greater loss of hearing. If the aids are not completely comfortable that needs to be communicated to the audiologist who can fix that. Hearing levels should be monitored and verification of the fitting will ensure that the sound is not too intense for the person’s hearing.

Where should I wear my hearing aids?

Aids should be worn in almost all listening situations except those listed below in the next question. They should be removed at night and placed in a dehumidifier to remove moisture from the day. If a wearer is taking a nap, it is fine to leave the aids in the ears if desired.

Where should I not wear my hearing aids?

Hearing aids should not be worn in excessive noise or music, or where water is involved (shower, hot tub, swimming, etc). Even ears with hearing loss, especially ears with hearing loss, need to be protected from intense noise such as loud music, power tool use, and impact noise such as firearms of any type. Aids are not worn to bed. If a hearing-impaired person fears not hearing alarm clocks or a fire alarm, there are special alerting devices. The audiologist can suggest the best options.

What do I do with hearing aids during air travel?

You may wear hearing aids through the security check point. You are not required to remove them from your ears at this time. Of course, you may be asked to remove them by the TSA agent, or regulations could change in the future which require air passengers to remove aids from their ears. Almost all hearing aids are vented in some way in the ear canal to keep ears comfortable during the pressure changes that occur during the flight, so it is not necessary to remove hearing aids for flying if you do not wish to do so. If you are someone who finds that the pressure changes in the cabin are bothersome to your ears, you may wish to try a pair of Ear Planes, which are available at drug stores and pharmacy areas of groceries and discount stores. These are designed to slowly change the air pressure in the wearer’s ear canals to help reduce the discomfort some people feel in their ears when flying. If you are using Ear Planes, you cannot wear the aids at the same time. Be certain to bring your case with you to store the aids to avoid having to roll up the aids in a tissue, an easy way to break, launder, or lose the devices.

Do all hearing aids use batteries?

All hearing aids use batteries, but there are different sizes. It is important to purchase the correct battery size for the aids. Just like a cell phone or watch, the wrong size will not allow the hearing aids to operate. The audiologist will tell you the correct size and may offer suggestions about where to buy batteries. A few hearing aid manufacturers have begun offering models that use rechargeable batteries, and they are working on perfecting them, such as getting them to power the instruments for the wearer’s full day. This technology may be utilized by more hearing aid models in the future but is not yet widely available.

Battery manufacturers have begun offering mercury-free batteries; these have just started to be available in many areas. Although the manufacturers say that batteries can be thrown out in the trash, recycling is environmentally friendly and easy to do. Many audiologists will collect spent batteries to recycle for you if you are a patient at their facility.

Batteries, no matter what chemicals comprise them, are dangerous if swallowed. Never keep batteries where a child or pet can get to them. They should never be handled near medications. The batteries are small and pill-shaped. They should not be placed on any horizontal surface (like a counter or bureau top) other than in the case itself so that they will not be accidentally ingested with food or pills. If a pet or person is thought to have swallowed a battery, immediate emergency medical services are needed. Do NOT attempt to make the pet or person vomit to retrieve the battery. Again, emergency medical services are needed immediately to properly and safely remove the battery from the person or pet.

Batteries should not be kept in the refrigerator or a hot car. They can be stored at room temperature away from children and pets.

While we are on this topic, each year many hearing aids are brought back to the audiologist, damaged by a pet who chewed it. No matter how carefully the aids are cleaned, the scent of earwax will not be removed. It is the perfect size and scent for a pet appetizer. This, of course, is dangerous for both the pet and the device! Most hearing aids have a loss and damage policy for the first year or two, but these always charge a deductible. If the loss and damage policy has been used, the wearer may wish to purchase new loss and damage insurance on that aid. The pet does not have loss and damage insurance on it, so for all concerned, please keep hearing aids and batteries away from pets.

How do I care for my hearing aids?

Hearing aids should be wiped with a clean, lint-free cloth after each day’s use. The battery doors should be opened to prevent battery drain during the night. Moisture and wax are two common enemies of hearing aids. Wax traps at the end of the earmold or aid keep wax out of the electronics. If wax has collected in the wax trap, it is easy to change by the wearer. A wonderful place to store the hearing aids at night is a hearing aid dehumidifier. It removes the moisture that might have developed in the aids during the day. This is good to use in any weather, not just humid days, since the wearer’s body transfers moisture to the devices in the cold or heat.

Hearing aids can go anywhere a person can go, with the exception of water and noise. Never store hearing aids in extreme heat or extreme cold. It is best not to wear the aids in very dusty or dirty environments.

What do I do with my hearing aids if I am hospitalized or need long-term rehabilitation care?

We are always told that we should not take valuables to a hospital. There is no one who can monitor their whereabouts. The difficulty with this thinking is that patients need to communicate in the hospital with the staff, nurses, and physicians. Without their hearing aids, this can be a very difficult to impossible proposition. If a family member is able to bring the aids each day and remember to take them home again, that is ideal. If that option is not available, ask if the hospital can loan a personal listener to the patient. Many hospitals have a loan program for these devices, which look like a Walkman with over-the-ear earphones for listening. These can be used to better hear the TV (and keep the volume down) as well as understanding essential communication with the healthcare professionals. They can be removed when the patient is resting or sleeping. These devices are returned at the end of the patient’s stay.

In long-term rehabilitation, it is more common for a patient to wear his or her hearing aids to this type of facility. For example, a container labeled with the patient’s name may be kept on the medicine cart and given to the patient each morning, returned to the cart at night with the aids inside. Each facility has different policies; it is essential to discuss the hearing aid policy with the facility’s patient care coordinator. Specifically ask where the devices will be stored, who will handle them, who has access, and how a loss or damage claim would be handled if such a need arose.

What accessories can I use with my aids?

Hearing aids can be paired with many devices to enhance the listening experience. These include Bluetooth devices that interface with cell phones, television, MP3 players, computers, etc., sending the sound directly into the wearer’s hearing aids. The listener hears as if the voices were speaking right in their ears, like wearing earphones, significantly increasing the signal to noise ratio and boosting intelligibility. The listener can walk away from the device, in some cases up to thirty feet, and still be connected to the sound streaming from that device. The listener can choose to listen alternately to the streamed device and activating the microphones to hear someone speaking to him in the room. Phone calls are heard in both ears, if desired.

People can also use a mini microphone that streams to the aids, again enhancing intelligibility by decreasing the distance and increasing the signal to noise ratio. If the mini microphone is placed on a lectern or meeting table or clipped to the person who is speaking, the listener can sit almost anywhere in the room, up to approximately thirty feet away, and hear very clearly what the speaker is saying. This mini mic may also be extremely useful in a car or in a noisy restaurant.

Alerting devices are important for helping people who have difficulty hearing alarm clocks, smoke detectors, door bells, infant monitors, etc. The electronics are remade for hearing impaired people with different types of signals, or they can be wired to a central device that alerts the individual with flashing strobe light or vibration. For people who have difficulty hearing on the telephone, there are amplified phones or phones that send a signal directly into the hearing aids through a special program.

What if my loved one needs hearing help but is unable to manage hearing aids?

Hearing Loss Hamilton NJThis may be the case with people who have mental disabilities such as dementia and Alzheimers. Many seniors with disabilities may have limited access to help and may not feel able to manage hearing aids. Even if help is available the aids are small and need some care, and they require consistent placement after removal to avoid damaging and losing them. The audiologist can suggest alternative devices, such as simple amplifiers with insert or over-the-ear headsets.

What do I do with hearing aids that were worn by a loved one who is now deceased?

Hearing aids can be donated to various organizations that are able to remake the devices for underserved communities in the United States or abroad. Your audiologist can supply you with a list of organizations.