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The Hearing-Loss Guide

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Yale University Press Health & Wellness


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The
Hearing-Loss Guide
Useful Information
and Advice for
Patients and Families
J ohn m. burkey
Foreword by Robert L. Daniels, M.D., F.A.C.S.

New Haven and London

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Copyright 2015 by John M. Burkey.


Foreword copyright 2015 by Yale University.
All rights reserved.
This book may not be reproduced, in whole or in part, including illustrations, in any form
(beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and
except by reviewers for the public press), without written permission from the publishers.
Yale University Press books may be purchased in quantity for educational, business, or
promotional use. For information, please e-mail sales.press@yale.edu (U.S. office) or
sales@yaleup.co.uk (U.K. office).
Designed by Sonia Shannon.
Set in Bulmer type by Newgen North America.
Printed in the United States of America.
Library of Congress Cataloging-in-Publication Data
Burkey, John M., 1959
The hearing-loss guide : useful information and advice for patients and families / John M.
Burkey ; foreword by Robert L. Daniels, M.D., F.A.C.S.
pages
cm
Includes bibliographical references and index.
isbn 978-0-300-20765-1 (alk. paper)
1. Deafness. 2. Hearing disorders. 3. Hearing aids. I. Title.
RF290.B872 2015
617.8dc23
2014030076
A catalogue record for this book is available from the British Library.
This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper).
10 9 8 7 6 5 4 3 2 1
The information and suggestions contained in this book are not intended to replace
the services of your physician or caregiver. Because each person and each medical
situation is unique, you should consult your own physician to get answers to
your personal questions, to evaluate any symptoms you may have, or to receive
suggestions for appropriate medications.
The authors have attempted to make this book as accurate and up to date as possible, but
it may nevertheless contain errors, omissions, or material that is out of date at the time
you read it. Neither the authors nor the publisher has any legal responsibility or liability
for errors, omissions, out-of-date material, or the readers application of the medical
information or advice contained in this book.

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Contents

Foreword ix
Preface xi
Acknowledgments xv
Introduction 1

part one: hearing-loss basics


1.

The ABCs of Hearing Loss 13

2. Hearing Aids and Other Gadgets 31


3. Treatments for Hearing Loss 49

part two: first-hand experience and advice


4. Real-Life Consequences of Hearing Loss 71
5. Coping and Getting Help 92
6. The Hearing-Aid Experience 112
7. A Wish List 136
8. First-Hand Advice 158
9. Advice from Spouses or Significant Others 183
10. Themes and Parting Advice 201

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Resources 219
Appendix: Hearing-Loss Questionnaires 227
Notes 243
Bibliography 247
Index 255

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Foreword

Hearing loss is a burden that many people bear unnecessarily. Hearing


loss touches many, many lives, affecting millions of individuals around
the world, and its impact does not spare friends, family, and those we
care about most. As Helen Keller said, Blindness separates people
from things, deafness separates people from people. On top of the accumulating frustration of constantly missing words and sounds, there
is the added embarrassment or denial of misunderstanding conversations, leading to gradual social isolation, which means hearing loss has
a seriously unpleasant effect on the quality and pleasure of life.
For those of us who have dedicated our lives and careers to the
diagnosis, treatment, and education of those suffering with hearing
loss and deafness, it is an honor and a pleasure to introduce you to
this book by John Burkey. This is a great and needful perspective in
addressing an issue so prevalent and debilitatingaffecting so many
people in the world today.
I have known John for many years, having completed part of my
neurotology and skullbase surgery fellowship training at the Lippy Ear
Group, then known as the Warren Otologic Group. John is supremely
qualified to address and advise those investigating hearing solutions for
themselves or their loved ones, having worked to solve these problems
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Foreword

on a near daily basis for more than twenty years as the lead audiologist
in a busy, community-based otology practice.
In this book, John comprehensively addresses the issues and impact of hearing loss, not only in educating the reader about the causes
of hearing loss in its different forms but describing the effects on the
person experiencing the loss and the consequences it has on those
around them. Particularly helpful are the coping strategies and explanation of resources for seeking and receiving assistance in proper diagnosis and treatment. He also systematically explains the myriad current
solutions, technologies, and treatments for hearing loss.
The main goal of the book, however, is to capture and utilize survey information gained from the lives and experiences of those dealing with hearing loss and its solutions on a daily basis. The result is
a comprehensive compilation of practical and helpful information
that readers can truly use, and perspectives that will help guide their
understanding.
Johns intent is to put at ease, console, and educate those whose
lives are so greatly affected by hearing loss, to give encouragement and
practical advice and dispel the myths and misinformation regarding
hearing loss and its solutions. This book will empower its readers to
seek and find the help that could really make a difference in their lives.
Robert L. Daniels, M.D., F.A.C.S.

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Preface

Hearing loss is an all too common problem that people dont talk much
about. Peoples natural response to other health issues or stressful
events is to seek information, advice, and support from others. Cancer
survivors gather to walk, share stories, and draw strength from others.
Expecting mothers commiserate in Lamaze classes. The overweight
exercise together at fitness centers or meet to weigh in and share lowcalorie recipes. Even if a persons support system is made up solely
of family and friends, their information, support, and advice remain
important. When faced with hearing loss, however, the first reaction
for many, if not most, people is to deny or hide the impairment, thereby
eliminating the chance for this kind of support.
Information and support are nevertheless needed. Hearing loss is
more limiting than people suspect. The ability to hear is interwoven in
nearly everything we do. Losing this ability consequently affects nearly
everything we do. Lives are turned upside downnot just the lives of
the people suffering hearing loss, but the lives of family and friends
as well.
Years as a clinical audiologist have repeatedly shown me how unprepared the majority of people are when faced with a hearing loss.
They werent taught anything about hearing loss in school, and it was
rarely or never the subject of any serious discussion in later years. They
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xii

Preface

dont know who to see if a problem is suspected, or if they do visit


a hearing professional, they have no way of putting the findings and
recommendations in perspective. Left to themselves, most people do
nothing, as if the problem will go away on its own. Many continue to
make lifestyle choices or engage in activities that further damage their
hearing. Others may find good medical advice but dont do anything
about it. They end up lacking the information and counsel necessary to
make informed hearing-care choices.
This book provides the combination of basic information and firsthand advice that is so clearly needed. Without the advice from others
who have sought help for hearing loss, a person might not think getting
help would be worthwhile. A person who has seen a professional and
been offered a medical or technological solution may not feel comfortable proceeding without first hearing from others who have chosen
these options. Even simple steps that people can take themselves to
improve listening may remain undone if not recognized as possibilities
or attested as having value.
Getting professional advice about hearing loss and hearing care
is not really that difficult. A person could see a hearing professional
or read one of the consumer health books on hearing loss. More of a
problem is to get the hearing-loss sufferers perspective. They dont
usually share and they certainly dont advertise their difficulties. Books
based on personal testimonials can offer some insight, but they are often published because they contain inspiring or tragic stories, not because they are representative of the everyday realities for most sufferers
of hearing loss.
The first-hand information found here was obtained through
open-ended questionnaires that seventy-seven hearing-impaired patients and twenty-three spouses (or significant others) completed and
returned anonymously. Their responses are included not because they

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Preface

xiii

were tragic, startling, or inspirational, but because their experiences are


representative of the patients routinely seen for hearing loss at our ear,
nose, and throat clinic. Their remarks show the reality of living with
hearing loss and can serve as much needed advice for others.
Part 1 of the book follows a traditional format and provides the basics about hearing, hearing loss, treatments, and technological options.
Part 2 is where things get interesting, as patients describe in their own
words their perspectives and advice about hearing loss. This second
part will be especially helpful for anyone who is uncomfortable asking
others about hearing loss or who dont know someone with hearing
loss to ask.
Individuals new to hearing loss could certainly benefit from this
combination of basic information and first-hand advice. Longtime
hearing-loss sufferers can learn more about hearing loss and the options available as well as obtain the advice of others in their own position. Family, friends, co-workers, and others who spend time with the
hearing impaired should also benefit, because some of the advice offered by patients and spouses was specifically meant for them.
My hope is that after readers have considered all of the information
and suggestions presented, they will have found some instructive and
helpful advice, but also some advice they can actually use.

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Acknowledgments

I wish to thank the patients, spouses, and significant others who made
this book possible by generously sharing their time, experiences, and
advice so that others might benefit. I also thank executive editor Jean
Thomson Black, manuscript editor Phillip King, editorial assistant
Samantha Ostrowski, and the other professionals at Yale University
Press who helped to make this a more useful and readable book than it
otherwise would have been. Return postage for survey questionnaires
was paid by the Warren Hearing and Research Foundation, and I appreciate the foundations assistance. I wish to thank the physicians and
staff of the Lippy Group for Ear, Nose, and Throat for their support
throughout this project. Finally, I especially thank William H. Lippy,
M.D., for fostering a medical environment that encouraged projects
such as this book that might benefit more than just our own patients.

xv

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The Hearing-Loss Guide

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Introduction

usan Tate loved to visit. She was active in her childrens parentteacher organization, her neighborhood association, and numerous church groups. When a new neighbor moved in down the
street, she delivered cookies and offered a warm welcome before the
moving truck was out of sight. Within a week she knew all the members
of the new family, what they did, where they had lived before, and why
they had moved. The information did not flow only one way, however,
as she also offered advice about local groceries, banks, city services,
and numerous other tidbits. Asking advice was always her first step
when making decisions or solving problems, so she was usually quick
to offer her thoughts when they might help others.
When Susan started having difficulty hearing in noisy situations
and groups, she wanted to approach this problem in her customary
way. The trouble was that she did not have any close friends with hearing loss whom she might ask for advice. Nor did she know anyone who
wore hearing aids. She supposed it was possible that one of her more
casual acquaintances might have some hearing loss or know someone
who did, but the subject seemed somehow taboo. Lacking good advice,
she decided perhaps she could let the hearing loss go for a while. This
went on for years before Susan sought professional help.
1

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Introduction

Susan is not alone. Many people find that useful first-hand advice
about hearing loss is in short supply, and they might reasonably conclude that this is because there are not many people who have experience with hearing loss. Yet this is rarely the situation. There are in
fact lots of people who struggle to hear. Conservative estimates place
10 percent, or over thirty million Americans, in this group.1 With increased longevity and the aging of the baby-boom generation, the number of people with hearing difficulties is increasing. The problem is
not limited to the United States, either. A large multi-country survey
in France, Germany, Italy, Japan, Norway, Switzerland, and the United
Kingdom reported a hearing-loss prevalence ranging from 8.8 percent
to 12.5 percent.2
Despite the prevalence, hearing loss largely goes unrecognized.
What attention it does garner is mostly expressed during commercials
with the basic message being that hearing aids are the solution. Because these are continually touting the smallest, least visible hearing
aids, a sometimes unintended secondary message is that hearing loss is
something that needs to be hidden. Many view the commercials as just
another sales pitch and dismiss the subject altogether. Few consider
the advertisements a source of good advice. Perhaps not surprisingly,
repeated watching of these ads hasnt resulted in multitudes of viewers
eager to discuss hearing loss.
Negative associations with aging, disability, and decline undoubtedly suppress discussion. Many dont want to admit a hearing loss
to themselves, let alone pointing it out to others. These bad associations may additionally delay or prevent people recognizing or getting
help for a hearing loss as well as at least partially explaining why only
25 percent of the people who could benefit from hearing aids actually
try them.3 Susan Tate likely knew several people with hearing loss and
possibly a couple with small hearing aids, but she was unaware of this

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Introduction

because they werent advertising their problem or going out of their


way to volunteer advice.
Neither a lack of discourse nor fear of a hearing-impaired label,
however, change the reality that hearing loss is a problem and that having some good advice might be useful. Even a mild loss can prevent
a person hearing a wide variety of sounds and interfere with normal
conversation. Someone with a more severe loss may not hear anyone
unless the person shouts. Still, understanding may be a problem.
Whats more, the difficulties that ensue go beyond hearing in and of
itself. Research shows the impact of hearing loss to be significant and
wide ranging. People with untreated hearing loss are more likely to suffer sadness, depression, worry, anxiety, paranoia, insecurity, emotional
turmoil, loneliness, and reduced socialization.4 Hearing loss has also
been associated with cognitive dysfunction and even dementia.5 All of
this underscores the importance of preventing, treating, or compensating for hearing loss whenever possible.
Anyone with hearing loss has a front-row seat to the difficulties
that can ensue. The impact is up close, personal, and, except for those
in denial, obvious. Things change, however, once coping with the loss
becomes an issue. What best to do may not be so obvious. Living with
normal hearing does not turn out to be good preparation for living with
poor hearing. People suffering hearing loss quickly discover that the
world assumes and sometimes requires hearing abilities they no longer
enjoy. Finding a way to improve their hearing, or finding ways to better live with their current hearing, becomes a priority. Helpful advice
toward these ends is almost always welcomed.
Is it possible to correct a hearing problem? Is hearing loss really
such a big deal that it needs to be corrected? Are hearing aids the only
option? If not, what are the alternatives? Is it possible to put off getting
hearing aids? What about hearing the telephone and the television?

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Introduction

Getting answers to questions such as these are an obvious first step


when confronting a hearing problem.
One way of obtaining answers to questions about hearing loss and
hearing aids would be through a visit to an ear, nose, and throat (ENT)
physician or audiologist. Based on the results of an evaluation, these
professionals could offer advice that is not only true but applicable to
the individual. All too often, however, this is seen as too big of a first
step. For some, it might be considered acknowledgment of a problem
that they are not yet ready to accept. They might view it as a commitment toward action, such as getting hearing aids or having surgery, that
a person does not wish to pursue. In contrast, listening to the perspective and advice of someone with hearing loss is a small step that requires
no firm acknowledgment of a problem or commitment to action. This
is likely where many would choose to start if they had easy access.
The purpose of this book is to provide useful information about
hearing loss and serve as a ready source of first-hand advice from
hearing-loss sufferers. For those new to hearing loss, it provides a way
to get their feet wet rather than jumping into the deep end. For longtime hearing-loss sufferers, this information can provide a wider perspective as well as a range of options to consider. Family and friends of
someone with hearing loss as well as professionals who work with, or
care for, the hearing impaired will likely also find these recommendations of interest.
The first-hand information and advice presented here was obtained through the use of an open-ended questionnaire given to patients in our office in Warren, Ohio. (The questionnaire is reproduced
in the Appendix.) A few of the patients surveyed had been evaluated and cared for exclusively by the professionals in our practice.
Others had previously been to a variety of other ENTs, audiologists,

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Introduction

hearing instrument specialists, and anyone else that might have offered
some help.
Patients surveyed were those diagnosed with a hearing loss severe
enough to interfere with communication. These participants were well
aware of their hearing difficulties and many had lived with a hearing
problem for years. There were additional patients whose hearing was
bad enough for inclusion but they denied any hearing loss. They were
not surveyed. Obtaining helpful advice seemed unlikely if a persons only
reason for an evaluation was being forced into it by friends or family.
The survey was explained to patients meeting the above criteria,
and those expressing an interest in participating were given a copy of
the questionnaire to take home and complete. In order to foster candid
responses patients were instructed to not write their names on the survey or provide any identifying information on the survey or the return
envelope. While compiling the surveys for this book, every effort was
made to include all of the information volunteered. The few necessary
exclusions were for illegible responses, information that might in some
way identify an individual, and recommendations that might be seen as
promoting our office. One other practical exclusion involved instances
where pages of patient comments or advice on a particular topic were
in complete agreement. When this did occur, some comments were
omitted to minimize redundancy. At no point were responses edited
(other than for spelling) or censored to promote a particular view.
When possible, a different open-ended questionnaire was given
to the spouse or significant other of the hearing-loss sufferer (this is
also reproduced in the Appendix). They were queried about how they
themselves were affected as well as how their hearing-impaired loved
one was affected. In addition to noting observations, spouses were also
asked for advice.

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Introduction

The goal was to obtain information and advice from one hundred
adults having direct experience with hearing loss. Nearly four hundred
questionnaires were distributed before the target of one hundred were
completed and returned. Seventy-seven of these were from individuals with hearing loss. The other twenty-three were from a spouse or
significant other. The greater number of respondents with hearing loss
resulted from patients more often than not coming to their appointment alone. The survey return rate was a little better than 25 percent
for each group. This does not take into account the one in three people
who for a variety of reasons declined to participate after the survey was
explained. Counting everyone, the participation rate was about 17 percent. Even here, getting first-hand advice about hearing loss was hard
to accomplish.
Our patients come from the northeastern Ohio and western Pennsylvania region, including Youngstown, Cleveland, Akron, Canton,
Columbus, Pittsburgh, and their surroundings, and all of the patients
surveyed were seen in our office in Warren. People who live outside
this area or who have seen different professionals could have different experiences and opinions from the patients who were surveyed,
although most of the problems and opinions associated with hearing
loss are likely to transcend region.
Surveys were given to people twenty to eighty-five years old, but
most were approaching or a little past retirement age. Patients questioned ranged from the poor to the affluent. Their incomes were not
recorded, but the median Ohio income is fairly close to the national average. Similarly, the distribution of our patient base by race and ethnicity reflected national averages, except for people of Hispanic or Latino
descent, who are underrepresented in Ohio.6
The one potential bias worth noting is that of motivation. These
people sought out ENT advice because they wanted to hear better. They

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Introduction

were also the ones who considered hearing loss a big enough problem
that it was worth going out of their way to help others by participating
in this project. Readers can take all of this into account when deciding
which patient advice appears relevant for their own situation.
Throughout the book, survey responses are grouped by subject,
but not necessarily by the survey question asked. Much like what happens in political debates, respondents sometimes used the questions as
a starting point to speak to the issues they wanted to address. Consequently, focusing on subject provided a more logical approach and also
allowed for the inclusion of observations, impressions, and advice that
were volunteered but not specifically asked.
Separate from the patients surveyed are the few stories used to
explain or illustrate particular points. These stories, such as that of
Susan Tate, are based on actual patients or a composite of patients.
Their names and other identifying information have been changed in
the interests of confidentiality.
The book has two parts. Part 1 explains the basics of hearing loss
to provide a background understanding for considering the patient
observations and advice offered in Part 2. The first chapter describes
the anatomy and function of the human ear, explains the tests commonly used to diagnose hearing loss, and introduces the professionals
involved. Common reactions to hearing loss are also explored.
Next is a look at some of the gadgets (amplified telephones, wireless headphones, closed captioning) that can help in specific situations. An overview of hearing-aid technology, styles, and useful options
rounds out the second chapter.
Treatments for hearing loss are discussed in chapter 3. Although
they are not the majority of cases, some hearing losses can be corrected.
The simplest example would be a hearing loss resulting from earwax
obstruction. A more complex case might be a damaged eardrum

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Introduction

requiring surgical reconstruction. These as well as a variety of other


possibilities are explored.
Following the objective information presented in Part 1, Part 2
shifts to first-hand perspectives and advice. Chapter 4 explores the impact of hearing loss through patients own accounts of how they are
affected. Some observations will be obvious, such as sounds going unheard or speech being misunderstood. Others are more involved and
detail how hearing loss affects relationships, leisure, independence,
mood, and so on.
Individual experiences with simple coping mechanisms such as
asking a person to repeat, increasing the volume on the television, or
buying an amplified telephone are examined in chapter 5. Survey respondents describe what they have tried and what they did or did not
find helpful.
The sixth chapter is all about hearing aids. It is not a presentation
of the slick advertising spiel. Rather, the focus is on what real patients
have to say about them. The good and the bad about these devices
are recounted from both the satisfied and the disgruntled. The mix of
responses is interesting, informative, and explains much.
Given a few wishes related to hearing, hearing aids, or hearing care,
what would people with hearing loss choose? If the hearing impaired
were completely satisfied with their lot, there would be little on their
list. As survey respondents demonstrated through their comments,
however, they have plenty to wish for. This is the subject of chapter 7.
Chapter 8 presents the first-hand advice that was offered by the
hearing-impaired patients surveyed. The majority of advice is aimed at
helping those with hearing loss, but some of the advice is for friends,
family, casual acquaintances, and others. More first-hand advice about
hearing loss is provided here than the majority of people are otherwise
likely to receive in a lifetime.

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Introduction

Spouses and significant others of a person with hearing loss have


their say in chapter 9. Even though the hearing loss is not theirs, they
still see its effects on their loved ones and have to find ways to cope
with it themselves. What are the effects they see on their spouses? How
does it affect their own lives? What advice can they offer? All of this is
examined.
The final chapter reviews the recurring themes and advice offered
by those with hearing loss. Also examined are some seemingly contradictory patient perceptions. Additionally discussed will be a few of the
options described in Part 1 that were often overlooked by patients.
Sources for additional information are suggested at various places
throughout the text. All of these resources as well as a few others are
listed at the end of the book for the convenience of readers, who are
encouraged to make use of this outside information.

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pa rt o n e

Hearing-Loss Basics

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1
The ABCs of Hearing Loss

am had no idea what to expect when he went to the ear doctor.


He was pretty sure, however, that the experience wouldnt be
good. He didnt ask to be there, didnt want to be there, and was
rather vocal in his opposition. Nevertheless, others had insisted Sam
be checked, leaving him little recourse. His last doctor visit had been
a painful fiasco, and Sam feared more of the same. This was all understandable, because Sam was three years old, and his previous medical
procedure had been a vaccination at the pediatricians office. Despite
his fear and more than a little screaming, Sam unexpectedly found his
ear examination and hearing evaluation to be not only painless but fun.
The shiny sticker and ticket he got for a free ice cream cone at the local
McDonalds were unanticipated bonuses.
Carol approached her hearing evaluation more calmly than Sam,
but she had no more idea of what to expect. She didnt know what
tests would be performed, their purpose, how long they would take, or
how to interpret the findings. There was nothing in her schooling, her
career as a secretary, her forty years of marriage, or her being a parent
and grandparent that provided helpful insights related to the ear. The
13

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14

hearing-loss basics

workings of the ear were a mystery. The variety of things that could go
wrong was a bigger mystery.
Confronted by hearing loss, even professionals such as bankers,
lawyers, managers, university professors, and engineers can find themselves unprepared. Their training is in areas unrelated to hearing, making it necessary for them to start at the beginning. Since the beginning
for many is to have their ears checked by a professional, the first thing
to do here is to provide an overview of this process.

An Examination of the Ear


Like so much in life, an examination of the ear starts with paperwork.
A history questionnaire is customary and usually asks for a statement
of the problem, time of onset, current medications, relevant family history, as well as whether there has been noise exposure, pain, ear infections, dizziness, or other medical concerns. The doctor will then ask
additional questions to clarify and build on the information presented.
This history is the foundation for everything that follows. The better
history a patient can provide, the easier it is for the doctor to know how
best to proceed.

Looking at the Ear


Looking in the ear canal is typically the next step in a hearing evaluation. A doctor, audiologist, nurse, or other medical professional does
this with a device called an otoscope. The otoscope is little more than
a fancy flashlight with a magnifying lens that makes it possible for the
user to better view the ear. A more high-tech version is called a video
otoscope. As the name implies, it includes a miniature camera that can
display the captured images on a video monitor. More specificand a

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The ABCs of Hearing Loss

15

bit scary soundingis an operating and diagnostic microscope. This


specialized magnifier may sometimes be used in place of an otoscope,
because it provides stereoscopic vision during an ear examination as
well as giving the best view for wax removal and other procedures. If
a doctor mentions wanting to look in the ear with a microscope, this
useful but harmless magnifier is the tool employed.
With the proper tool in hand, what can a professional see when
looking into the ear? The answer is: less than most people think. The ear
canal that the otoscope light shines into is about one inch long and ends
with the eardrum (figure 1). It may be possible to see earwax, swelling,
infection, or some other peripheral problem. More often than not, however, an observer sees a perfectly normal looking ear canal and eardrum.
A healthy eardrum is pearly gray in color and somewhat translucent,
like wax paper, limiting the view beyond. The dilemma is that there is a
lot more to the ear than only the visible ear canal and eardrum.
The ear consists of several parts that work together to allow a person to hear. All are important. The visible outer portion of the ear (the
pinna) collects and funnels sound into the ear canal. On examination
a physician will usually perform a cursory inspection of the pinna to
rule out congenital deformity, infection, or even skin cancer. An ENT
physicians focus rarely lingers here, since nearly all hearing-related
problems lie deeper.
Incoming sound in a normally functioning ear vibrates the eardrum, and these vibrations are then transferred through the three
small middle-ear bones (the malleus, incus, and stapesalso known,
respectively, as the hammer, anvil, and stirrup) to the inner ear. Collectively these bones are called the ossicles, and the air-filled space they
occupy between the eardrum and the inner ear is called the middle ear.
A physician can usually get a very good view of the eardrum, which
will reveal if there is a perforation, scarring, or other abnormality that

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hearing-loss basics

Figure 1. The human ear (Image courtesy of MED-EL)

might impede function. Fluid or infection behind the eardrum can also
usually be discerned even though the view through the eardrum is not
good. Problems with the ear bones arent likely to be visible.
Another structure important to the function of the ear is the Eustachian tube. This tube equalizes the pressure between the ear and
the outside world. Scuba divers, air travelers, and even people who
drive through the mountains may experience their ears popping as
the Eustachian tube does its job. A nonfunctional Eustachian tube can
result in pain, reduced hearing, an ear feeling plugged, and a variety of
chronic ear problems. Physicians cannot see a Eustachian tube problem directly, but they can infer it when unequal pressure visibly pulls
an eardrum back from its normal shape.
The small snail-shaped portion of the inner ear visible in figure 1
is called the cochlea, which houses thousands of sensory cells respon-

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sible for hearing. Incoming sound vibrations stimulate some or all of


these cells. Once stimulated, they create an electrical signal that is sent
along the auditory nerve to the brain. During an evaluation the function of the cochlea is usually assessed with a hearing test.
The vestibular portion of the inner ear is responsible for detecting
body motion and maintaining balance. If a person moves forward, the
fluids in the vestibular system of both ears are pushed back, stimulating the balance nerves and creating the sensation of linear acceleration.
If a person turns, the fluid in one ear is pushed forward while in the
other ear it is pushed back. The resulting difference in stimulation between ears is experienced as spinning. Because the hearing and balance
portions of the inner ear are closely related, a problem affecting one
part may affect the other. Consequently, a hearing test is routinely done
when dizziness or balance difficulties are reported.

Types of Hearing Loss


Hearing loss is divided into three general categories based on what
goes wrong. The first involves anything that prevents or blocks sound
from getting to the inner ear. A few examples might include an ear canal
filled with earwax, a broken eardrum that cannot vibrate properly, or
an ear bone damaged from disease, trauma, or infection. These types
of hearing losses are termed conductive since they occur when sound
is not conducted, or not conducted efficiently, to the inner ear. Fortunately, conductive losses usually represent a mechanical problem that
has the potential for correction or improvement. Earwax can be removed, an eardrum can be patched or reconstructed, and a damaged ear
bone can be replaced with a prosthesis. A conductive hearing loss is
the type people most want to have and physicians most want to find.

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The majority of hearing losses, however, are due to damage in the


inner ear. These are termed sensorineural. With very few exceptions,
they are permanent. Sensorineural hearing loss can be caused by excessive noise exposure, trauma, disease, infection, heredity, toxicity, and
several of the maladies that accompany aging. People often talk about
nerve loss or nerve damage when referring to a sensorineural hearing loss. These terms can be somewhat misleading, however, because
sensorineural hearing loss is twofold in nature. The problem may be
due to damaged, nonfunctional, or missing sensory cells that are responsible for detecting or enhancing sound to make it audible. Hearing
aids are the most common recommendation for these sensory hearing
losses. A sensorineural hearing loss may also be the result of damaged
nerve fibers. Auditory information becomes lost on the way to the brain
as a result of this neural damage. Sounds and speech go missingoften
unpredictably. This neural component explains how speech might be
heard but not understood and why hearing aids sometimes provide
only a limited benefit.
The final type of hearing loss is termed mixed. This loss is simply a combination of the two types previously described. A person can
have sensorineural loss from noise exposure that is compounded by an
ear canal full of wax. A soldier exposed to a bomb blast may experience
ruptured eardrums as well as inner-ear damage from the trauma. If the
conductive portion of the loss (in these cases the earwax and ruptured
eardrums) can be overcome, then the remaining loss will be considered
sensorineural.

Testing the Ear


Evaluation of a hearing loss requires more than a history and physical
examination. Tests are also needed. These can be done to confirm or

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rule out a hearing loss, to quantify the severity of a loss, or to differentiate the types of hearing loss just described. Not all hearing losses are
alike. A person may have a very slight problem that only prevents hearing the quietest sounds. Understanding normal speech may not be affected unless someone is speaking extremely softly or from a distance.
In contrast, another person may have a more significant hearing loss
that makes all but outrageously loud sounds inaudible. The majority
of people with hearing loss fall somewhere in between these extremes.
Hearing loss can occur across a wide range of frequencies or be focused in either the high or low pitches. High-pitched hearing losses
tend to be more common. The tests routinely used to sort this all out
are described next.

Basic Hearing Test Battery


A routine hearing evaluation includes four tests that are done in a quiet,
soundproof room. Together they are known as the audiometric or comprehensive test battery. This may on the surface sound daunting, but
all of the parts combined take only about fifteen minutes. Pure-tone
air-conduction testing is the first part and involves a patient listening
for beeps while wearing headphones or insert earphones. Many people
are familiar with this beep test from a kindergarten hearing screening
or industrial hearing test. The patients task is to push a button, raise
a hand, say yes, or respond in some other way whenever a beep is
heard. The goal is to find the softest sound a person can hear (the hearing threshold) across a range of pitches. The results are then graphed
on a form called an audiogram.
A different measure of hearing threshold is obtained using twosyllable words, such as baseball or hotdog. A patient is asked to repeat
the words as they are presented at quieter and quieter levels, in order to

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find the softest level where they can be understood. This speech reception threshold (SRT) should agree closely with the average threshold
for the beeps. If they do not agree then at least one of the thresholds
obtained is likely wrong and one or both of these tests are repeated
until the discrepancy can be explained.
Separate from how quiet a person can hear is how clearly something can be heard once it is loud enough. Some people with hearing
loss understand very well if the volume is raised. Others cannot hear
clearly regardless of the volume; sounds and voices may seem distorted,
like they are being played through a broken speaker. The third part of
the hearing test battery provides a measure of the extent to which this
might be an issue. Patients are asked to repeat single-syllable words
that are presented well above an individuals hearing threshold. The
percentage correct is then recorded. This measure of hearing clarity is
called speech discrimination or word recognition score (WRS) testing.
The final part of the hearing test battery is known as pure-tone
bone-conduction testing. The patient again listens for beeps, making it
clear when they are heard. The difference from the air-conduction testing is in the kind of headphone used and where it is placed. In boneconduction testing a small device called a bone oscillator is placed over
the bone behind the ear. The oscillator sends sound vibrations through
the skull to directly stimulate the inner ear. If a person hears poorly
during air-conduction testing but well in the bone-conduction test,
then the difference between the two (the air-bone gap) is the amount
of sound that is lost on the way to the inner ear. This is the amount of
conductive loss. If a person demonstrates the same amount of hearing
loss during both air- and bone-conduction testing, then no sound is
being lost as it passes through the ear canal, eardrum, and ear bones.
The hearing loss in this case is all sensorineural.

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The units of loudness employed to document the severity of a hearing loss are decibels hearing loss (dB HL). A person who can hear low
decibel levels (10 to 15 dB HL) is considered to have normal hearing.
Someone having a slight hearing loss would not hear sounds until they
reach 16 to 25 dB HL. Increasing in severity would be a mild loss (26 to
40 dB HL), a moderate loss (41 to 55 dB HL), a moderately severe loss
(56 to 70 dB HL), a severe loss (71 to 90 dB HL), and a profound loss
(91+ dB HL).1 All of the patients surveyed for this book had an average
hearing level worse than 30 decibels in at least the better ear.
As a reference, a whisper at five feet is about 20 dB when measured
using a slightly modified decibel scale (dBA) that ignores some lowfrequency reverberant noise. A quiet office or library is 40 dBA, normal
conversation is 60 dBA, and a flushed toilet 7585 dBA. Any sound of
85 dB or greater is considered potentially damaging to the ear. This
would include firearms, rock concerts, chainsaws, motorcycles, snowmobiles, and tractors.2
Related to the bone-conduction test just described is a screening
tool called the Rinne tuning-fork test. During this check the doctor
strikes a metal tuning fork so that it rings, and then alternates between
holding the tines of the tuning fork near the opening of the patients ear
and holding the base of the fork against the mastoid bone behind the
ear. The vibrating tuning fork is heard normally through air conduction when near the ear canal. When held against the mastoid, the tuning fork transmits the sound vibrations directly to the inner ear through
bone conduction. If the ear canal, eardrum, and ear bones work well in
transmitting sound to the inner ear, the tuning fork will appear louder
at the opening of the ear. If the tuning fork sounds louder when held
against the mastoid bone, then a conductive hearing loss is indicated.
This quick test from the physicians toolbox might seem archaic in the

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age of electronics. Even so, it can be up to 95 percent effective, and


many doctors use it to screen for conductive losses and to confirm
hearing test results.3

Tympanometry
Aside from the standard hearing test battery, tympanometry is the next
most likely test to have during an evaluation. As the name implies, tympanometry checks the tympanic membrane (eardrum). The patient sits
quietly while the tester holds a special earplug in the opening of the
ear canal. The person being tested hears a soft low-pitched hum and
feels a slight pressure change in the ear canal. The machine attached
to the earplug then measures how much sound is reflected back off the
eardrum as the pressure is changed. When the pressure in the ear canal matches the pressure on the opposite side of the eardrum then the
eardrum can move freely, transmitting sound farther into the ear. If, on
the other hand, the pressure on one side is greater or less than on the
other side, this stiffens the eardrum, reflecting sound back into the earplug. The result is a graph that should look much like a mountain peak.
Tympanometry can show if there is a pressure imbalance in the ear, or a
hole in the eardrum (even a pinpoint hole that is difficult to see), and it
can help to confirm an observation of fluid or infection, since these can
prevent the eardrum from moving. The test takes less than a minute for
each ear and is painless.

Testing Children
Evaluating the hearing of small children normally requires different
tests from those given to adults. A child who is four or five years of age

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can usually understand and follow the directions for the adult hearing
test battery. A two-year-old, however, is unlikely to raise a hand in response to beeps or repeat a list of words. An infant may do little more
than startle to loud sounds. Nevertheless, the hearing of these small
children can be tested.
Hospitals routinely screen newborns to rule out congenital hearing loss. The test used is called otoacoustic emissions (OAEs). In a
normal or near-normal hearing ear, the sensory cells in the cochlea vibrate in response to sound. This vibration results in the production of
a slight noise, which is the otoacoustic emission. During OAE testing
a small probe is placed in the infants ear. The probe presents a sound
and then it listens for the OAE response. If the response is present, the
infant is considered to have passed the screening. Otoacoustic emission testing can also be helpful for screening older children and even
noncompliant adults. The test is painless and usually takes only a few
minutes.
Auditory evoked potential (AEP) testing, in contrast, goes beyond
screening to provide a measure of the hearing level. During AEP testing a small electrode is taped behind the ear or on each earlobe. Another electrode is taped on the upper forehead or on top of the head.
Clicking sounds or tone pips are presented through an earphone, and
the brains electrical response to the sound is measured through the
electrodes. The hearing level is determined by presenting sounds at
different volumes and looking for the softest sounds that produce a response from the brain. Auditory evoked potential testing is often done
as a follow-up for infants who fail an OAE test. It can also be used with
children or adults who are developmentally delayed or in some other
way unable to respond. The test can take as little as twenty minutes or
last more than an hour.

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Beginning at about six months of age, visual reinforcement audiometry (VRA) becomes an option. During VRA a child sits on mom
or dads lap as sounds are presented through speakers or headphones
on the childs right and left side. A toy to the right or left is simultaneously lit or animated. After a few presentations the child associates the
sound with the toy and responds by looking in that direction. Once
this occurs, the toy is then turned on only if the child correctly turns in
response to a sound. Seeing the toy acts as a reward that keeps the child
turning whenever a sound is heard. Delaying the lighting or animation
of the toy prevents it acting as a cue for when to turn. The sound volume is reduced to find the quietest level at which the child correctly responds. This is then done at other pitches. The test is fun for the child,
takes only a few minutes, and provides a good estimation of the hearing.
By three or four years of age children begin to lose interest in VRA
testing too quickly for it to be effective. Fortunately, these children are
now ready for something else. While they still wont raise their hand
in response to sounds, they will usually respond if it is made into a
game. This is called play audiometry. The most common form is to
have the child throw a block into a box or bucket whenever a sound
is heard. Except for resulting in a mess of blocks everywhere, it works
surprisingly well. Similarly, children this age may not repeat words, but
they usually will point to pictures. A child who can correctly point to
a picture of a baseball or a hotdog when the word is presented much
softer than a whisper likely has good hearing. There may be a problem
if the words have to be louder. This combination of blocks and pictures
served as the games that Sam found enjoyable at the beginning of the
chapter.
Correctly identifying and quantifying a hearing loss is only one
part in the evaluation of a child with a hearing problem. Also of con-

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cern is how the loss might affect speech, language, and educational development. Because of this, referral to educational specialists as well
as speech and language pathologists is routine when an uncorrectable
hearing loss is found in a child.

Hearing Professionals
A variety of people may examine or in some way test the ear. A school
nurse or a parent volunteer may do a quick kindergarten hearing screening. A general practice physician may examine the ear for earwax or
signs of infection. There are professionals, however, that are specially
trained to work with ear problems. The first of these are ear, nose, and
throat (ENT) physicians. They are also known as otolaryngologists.
Physicians who focus strictly on the ear are called otologists. All of
these specialists can diagnose ear problems and medically or surgically
treat the ones that are correctable. The other professionals extensively
trained to evaluate and work with ear problems are audiologists. These
professionals evaluate hearing loss as well as provide a variety of rehabilitative measures, such as hearing aids and assistive devices. Audiologists are the mainstay for those who must cope with a hearing loss that
otologists and ENTs cannot fix. Ear, nose, and throat physicians and
otologists often work in close cooperation or partnership with audiologists to provide comprehensive hearing care.
A quick way to find an ENT physician in ones area would be
through the website for the American Academy of Otolaryngology
Head and Neck Surgery (www.entnet.org), where one can search for
a doctor by region. A local audiologist can also be found at the website for the American Academy of Audiology (www.audiology.org) or
the American Speech-Language-Hearing Association (www.asha.org).

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The websites also provide further information on the range of services


these professionals provide.

Common Reactions to Hearing Loss


Before most people entertain thoughts of hearing tests, an ear examination, or what might have gone wrong, suspicion of a hearing loss is
necessary. This frequently means that the first reaction to a beginning
hearing loss is no conscious reaction at all, since those afflicted may be
unaware there is a problem. That someone might not at first recognize
a hearing loss should not be surprising. A slight loss might not greatly
interfere with hearing the television, talking on the phone, knowing
when the doorbell rings, understanding face-to-face conversations, or
listening to most everyday activities. Besides, even people with normal
hearing periodically fail to hear or understand. When this does happen, those with good hearing correctly assume that the problem lies
elsewhere. Unfortunately, people with a beginning hearing loss often
incorrectly assume the same. They remain unaware of the problemat
least for a time.

Ignoring or Denying a Hearing Loss


Complicating recognition and seeking help are the common reactions
of denial or simply choosing to ignore a hearing problem. Negative
stereotypes associating hearing loss with disability, confusion, and decrepitude are common. Anyone trying to come to grips with a hearing
problem likely has some internalized baggage in this regard. Acceptance of a hearing loss may be perceived as acknowledging these negatives about oneself. Regardless of whether a person believes the stereotypes, there can also be fear about having to cope with others who do

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believe them. It can be much easier and more comforting to believe that
ones hearing remains fine and that others are mumbling. Concerns
about not hearing as well as friends and family can also be dismissed if
these people are viewed as having exceptionally good hearing. A person may instead acknowledge his or her hearing loss but dismiss it as
a normal part of aging. All of this can and often does delay or prevent
people seeking or getting help for a hearing loss.
Even full-time workers and the socially active that very much depend on their hearing have been shown to avoid acknowledging hearing difficulties. They felt stigmatized, were uneasy talking about the
problem, minimized the effects, tried to portray themselves as normal,
and had different perspectives than their spouses regarding hearing
deficits.4

Naturally Compensating for Hearing Loss


The next most common and more productive reaction to hearing loss
is asking others to repeat. Doing this makes sense, considering it is the
tactic used by those with normal hearing. It still works well with hearing loss and fortunately is already programmed in. A person can remain
unaware of a hearing loss or be fully in denial yet still rely greatly on
having others repeat. Recognizing this inconsistency is unlikely as long
as the problem can be attributed to mumbling, soft talking, or talking
away. Asking others to repeat is not usually a planned strategy. It is not
necessarily an acknowledgment of hearing loss. It is a reaction to not
hearing. Requesting others to repeat does have some drawbacks that
will be described later, but people do itespecially those with hearing
lossbecause it works.
Another reflexive response to hearing loss is to turn up the volume. People may not have volume controls, but radios, televisions,

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computers, cell phones, and a great many other electronic devices do.
Hearing loss or not, people adjust the volume to whats audible for
them. Since there are no standard volume settings from device to device or even from channel to channel on the radio or television, the setting on the dial may offer little feedback about a persons actual hearing
ability. What does it mean if a person turns the television up to number
17 on the loudness bar? Does this mean they hear well or poorly? More
often than not, the listener does not know and likely doesnt care. They
just want to use and enjoy these devices. For those with hearing loss
this often means doing so rather loudly.
People with hearing loss often get into the habit of watching the
person who is speaking. They do this for a couple of reasons. The first
is lip reading. Making use of lip reading may sound like some daunting
task akin to learning sign language, but this is not the case. Most people
have at least some lip-reading ability and use it without even trying. It
may not be possible to follow a conversation by lip reading alone, but it
can be a big help with filling in an occasional missed letter or word. As
long as a person can get into a position to watch the speaker, lip reading
can help. Related to this is that although sound radiates out in all directions from a source, spoken speech can be somewhat directional. Getting in front to better see a person speaking puts the listener directly in
the path of the sound.
One additional act people naturally employ to better hear and understand is to get closer. Sound volume drops off significantly the farther a person gets from a sound source. This can present a real problem
for someone who is already having hearing difficulties. Moving close
can help to bring speech and other sounds up to an audible level. It
also helps when there is background noise. From far away, a voice can
easily get lost in even a small amount of background noise. By moving
closer to a person speaking, the volume of speech increases relative to

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the level of surrounding sounds and results in easier listening. Getting


closer also makes it easier to lip-read.

Social Withdrawal
Rather than intentionally or unintentionally taking steps that make it
easier to hear, some people with hearing loss react by avoiding situations that require good hearing. After repeatedly failing to hear, understand, or be certain that what was heard was heard correctly, or
constantly asking others to repeat, many people will begin to withdraw
from social activities. People with hearing loss are more likely to decline invitations to parties and avoid going to church, movies, lectures,
and various other events. The unintended result is social isolation.5
A study looking at triggers for withdrawal and isolation in industrial
workers found that the fundamental issue was worker perception of
the problem of hearing loss. Fear of being stigmatized caused workers
to conceal the hearing loss and its impact.6 Whether hearing-impaired
individuals become absent from groups due to difficulty hearing or fear
of being stigmatized, the end result is the same. Their self-imposed exclusion from groups and social situations also helps explain why Susan
Tate could find no one to ask for advice about her hearing loss. The
hearing-loss sufferers she might have asked had removed themselves
from her social circle.

Moving from Reaction to Plan


Once recognition of a hearing problem does occur, another normal
response is to make a plan that deals with it. Scheduling a hearing
evaluation and ear examination to see what can be done is common.
Following through on the findings and recommendations completes

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the process. Many other plans to improve hearing start small, such as
making a conscious decision to better utilize the tactics (moving closer,
watching the speaker) that come naturally. Seeking information is another small step that can serve as a starting point. Others try to solve
their hearing problem in one big step, through hearing aids or, when
possible, surgery.
Some might consider choosing to ignore hearing loss as a plan,
but this leaves a person merely reacting to the negative consequences
that ensue. Deciding to ignore a hearing problem is more an argument
that hearing is irrelevant than a strategy. This choice, made all too frequently, has more in common with denial.
Whether people start big or small, those who do decide to solve
a hearing problem need options. Some of these options may include
the few just mentioned, but there are many more. The next couple of
chapters will describe the variety available.

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2
Hearing Aids and Other Gadgets

olutions for hearing loss are rarely one size fits all. This is also
true for devices that might help a person compensate for a hearing loss. The severity of hearing loss, word understanding ability, pattern of loss (high pitched versus low pitched), and sensitivity to
loud sounds varies from person to person. Listening needs and listening environments can also be unique.
Scott Wilson, for instance, was a forty-two-year-old computer support specialist who came to our office because he was having difficulty
hearing at work. Scott was healthy, and his ears looked good, but he
had a long history of skeet shooting, which had caused a permanent
mild high-pitched hearing loss. Both he and his wife agreed that it did
not cause him any appreciable listening difficulties at home or in his social life. Scott could also hear well on his home phone and cell phone.
The problem was using the phone at work. His job entailed troubleshooting computer problems over the phone, and he was struggling to
hear the callers. He surmised that his difficulties were partially due to
the hearing loss but also to the call center where he worked, which had
lots of background noise. Scott needed a solution that would let him
effectively do his job.
31

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Giovanna Pizzati also reported hearing difficulties. She misunderstood her husband, which became a big problem once he retired and
was home with her all the time. She often failed to hear the doorbell
when it rang unless she was in the same room. The grocery cashier,
bank tellers, and even her priest seemed to mumble. When she misunderstood her grandchildrenwhich was oftenthey became upset
and felt she wasnt paying attention to them. Mrs. Pizzati clearly needed
help, but her hearing loss and listening needs called for a different answer than the one that would work for Scott Wilson.
Both of these people knew they had a hearing loss and were motivated to seek a workable solution. For Scott there was a simple answer
he had not considered. Giovanna, on the other hand, knew of something that should help, but she was hesitant. Like so many others, they
both lacked the information necessary to move forward. This chapter and the next will describe the range of choices that are available
to those with hearing loss. First are some options that can help with
specific listening problems.

Tools for Hearing


Alerting Devices
The world is full of buzzers, ringers, alarms, and other indicators that
can be important for day-to-day activities and safety. The ability to hear
these sounds is largely assumed. Unfortunately, for someone with hearing loss, this assumption is often faulty. The standard auditory signals
or alarms that work well for those with normal hearing may go unheard
or not be loud enough to get the attention of someone with hearing
loss. Hearing aids can help to minimize this issue, but there are also a
variety of alerting devices available for people without hearing aids or
for those who wear hearing aids but still need some additional help.

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One of the most common is an amplified or vibrating alarm clock.


Having a hearing loss does not usually excuse a person from needing
to keep a schedule. Most of us start the daily schedule to the blare of
an alarm clock. This routine breaks down, however, if the alarm is not
heard. Fortunately, extra loud alarm clocks have been designed for
people with hearing loss. The name of one model, the Sonic Boom,
clearly conveys the intent. Some of these specialized clocks also include an attachment that will shake the bed. A related option would be
a vibrating alarm wristwatch or setting a cell phone to vibrate and using
its alarm feature.
Another useful alerting device is an amplified or flashing doorbell.
The doorbell is one of the signaling devices most taken for granted.
Someone comes to the door, presses a button, and everyone inside is
aware of his or her presence. With hearing loss, the doorbell may still
be heard up close, but all bets are off for hearing it at the other end of
the house. Replacing the doorbell with a louder chime or ringer would
be one simple option to improve the situation. Switching to a combination doorbell that also flashes the lights would be another.
Little should need to be said about the importance of smoke, fire,
and carbon monoxide detectors. The standard advice that every house
should have at least one working alarm is inadequate if a resident has a
significant hearing loss. Several are needed, and they should be linked
together so that all of the alarms sound if one of them is activated, to
avoid the risk of an alarm elsewhere in the house going unheard. Installing linked alarms that also include a strobe light would be even
better. Some advanced systems combine the above signals (doorbell,
fire, smoke, carbon monoxide) with an integrated home security system that includes window, door, and motion detectors. One available
add-on with some systems is a vibrating pager that alerts the owner to
the problem identified.

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When surveyed about the use of alerting devices, one person responded simply, I have a dog. Even though this wasnt what we expected, it was an excellent answer, because a dog is actually a mobile,
multi-purpose alerting device. Just try to keep it from barking when
someone is at the door! On a more formal level, there are dogs specifically trained for this task. They are called hearing dogs, and they are
taught to alert a hearing-impaired person to a variety of sounds. More
information on hearing dogs can be found at International Hearing
Dog (www.ihdi.org) or Dogs for the Deaf (www.dogsforthedeaf.org).

Amplified Listening Devices


Increasing the loudness of speech can usually help people overcome
many of the listening difficulties that result from hearing loss. It is easy
to turn up a radio or a television louder, but unfortunately, not everything has a volume control. It may be possible to add one, but some
hardware is usually required. It may be necessary to replace a device
with an amplified one instead.
The telephone is a prime example. Understanding on the phone
can be especially difficult because only one ear is being used, and
there is no chance for lip reading. Some phones do have an adjustable volume, but many of these are not designed to faithfully reproduce
speech at the loud levels required for some hearing losses. Filling this
need are amplified telephones specifically designed for the hearing impaired. These phones can increase the volume to the level the listener
needs with little distortion. A few also include a tone control so that the
sound can be adjusted for different pitched hearing losses. One other
telephone option is a microphone headset like those used by telemarketers, but with two amplified earphones so that the listener can use
both ears. In Scott Wilsons case, the answer to his telephone difficul-

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ties at work was one of these amplified headsets. The version he eventually got had extra large earphones that completely covered his ears
and blocked the outside sounds that often interfered with his hearing.
Whats more, his employer agreed to supply this special headset since
it would improve Scotts productivity.
A more general purpose listening device is a personal amplifier.
A personal amplifier looks a bit like an iPod or other personal music
device connected to a set of ear buds or a small headset, but instead of
playing music, it amplifies surrounding sound. It is an inexpensive option for a person who occasionally needs a boost in volume, but does
not want the expense of hearing aids.
A unique listening challenge is faced by physicians, physicians assistants, nurses, and other healthcare workers who use a stethoscope to
do their jobs. Even a little hearing loss can be a problem; a large hearing
loss can make it impossible. Switching to a stethoscope that is amplified can result in better care for the patient and a continued career for
the practitioner. An amplified stethoscope provides a good example
of the benefit that can result from finding and using the right assistive
listening device.

Captioned Devices
The ultimate goal when compensating for a hearing loss is not just to
hear, but to understandto communicate. If in spite of a persons best
efforts hearing remains impossible, the goal of communication may still
be within reach. The key is to read what cannot be heard. This may
work in only specific situations and require a little planning, but it can
be worth the effort.
The majority of people are aware that closed captioning is available on television programs. Even if they have never used it themselves,

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hearing-loss basics

they have likely seen the words scrolling across the bottom of a television screen in a sports bar or waiting room. There is no charge for a
viewer to use closed captioning at home. It is just a matter of searching
through a televisions setup menus to find the closed-captioning option and switch it on.
In contrast, a standard telephone is clearly an audio-only device.
There is no built-in option for closed captioning. This is not to say
that captioned telephones dont exist. They do. Rather than being a
single device, however, this phone is part of a system. A special phone
displays the text of what is said, but a service is required to translate the
conversation from voice into the text that is shown. This may sound
expensive, but most states have programs that help to cover the cost.
Go to www.captel.com or www.captioncall.com for more information.
Those of us with children or grandchildren know that much of
their communication is done by texting. They could easily talk on the
phone with their friends but choose instead to use their thumbs. Having a hearing loss should not stop a person from following this crowd.
Similarly, much of what is said or texted on the phone could just as
easily be conveyed through e-mail.
One time-honored way to communicate without the need for hearing is to write notes. As long as ones handwriting is legible, this does
work. The downside is that it can be slow and cumbersome. An alternative for those with a little computer know-how might be to display
the text of spoken speech on a computer screen through the use of
speech recognition software. Most of these computer programs were
originally designed for business uses, but they have evolved to provide
the general public with an alternative to typing. A person speaks into
a microphone headset and the words appear on the computer screen.
As long as the speaker, listener, and computer are all in the same place,
it can act as a form of closed captioning. Given a laptop or other small

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computer, it is portable. One popular example of this kind of software


is called Dragon Naturally Speaking. Smartphone applications that
can convert speech to text will likely also become common in the near
future.

Hearing from a Distance


Getting close to the person speaking is good advice. But what if you
cant? Your big-screen television is mounted to the wall and its impractical to move a chair close. You were able to get tickets to a major
play, but the only ones left available were the cheap seats in the balcony.
What are some other options?
One gadget that can improve television listening for the hearing
impaired is wireless headphones. The headphones include a small settop box that is plugged into the audio output jacks on the side or back
of the television. The box transmits sound from the television to the
headphones using FM radio waves. Not only does this provide sound
directly to the listeners ears, the headphones help to block outside
noise that may interfere with listening. The headphones also have an
adjustable volume control that is independent of the television volume,
so everyone can listen at a comfortable level.
FM technology also offers listening applications that go beyond
television. There are personal FM systems that include a small microphone and transmitter that can be worn by or placed near the person
speaking. Sound from this device is sent to the listener, who wears
a small FM receiver and earphones or ear buds. This can effectively
move the listener right up to the sound source, making it easier to hear
and understand.
A related option is an induction loop system. This alternative requires a special induction loop wire to be placed around the perimeter

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hearing-loss basics

of a room. The wire is then plugged into a television, stereo, or other


auditory device. Sound from these devices is converted into magnetic
waves that can be picked up by specially equipped hearing aids (ones
that contain a telecoil, described later in this chapter). Similar to wireless headphones and FM systems, induction loops can provide clear
sound without outside interference. More information about induction
loops is available at www.hearingloop.org.
The Americans with Disabilities Act requires that reasonable accommodations be made in a variety of venues for people with disabilities.1 Hearing loss falls under this purview. As a result, help is often
available in movie theaters, auditoriums, churches, hotels, universities,
and numerous other settings. The form of hearing assistance can vary
widely but might include an amplified listening device, sound systems
that can wirelessly connect with hearing aids, sign-language interpreters, captioning, or some other option.

Hearing Aids
Hearing aids are the best option for the majority of people with hearing loss, because they help in not only one or two listening situations
but over a variety of them. Hearing aids were the solution that Giovanna Pizzati needed, but she hesitated out of fear that they might be
too complicated for her to work. In the end she gave them a try. She
was surprised to find that they were not only easy to use but made it
possible for her to hear her husband at home, the cashier at the grocery,
the teller at the bank, and a variety of people who had seemed to be
mumbling. Mrs. Pizzati felt that had she known more about hearing
aids, she would not have hesitated so long. Other patients in our survey
have expressed similar sentiments.

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Some people become wary or even afraid of this device, which is


essentially just a small personal amplifier. It makes sounds louder. Just
how much louder varies by pitch and from user to user depending on
an individuals hearing loss, listening preferences, and loudness tolerance. A hearing aid has a microphone that picks up sound, an amplifier
that makes it louder, a signal processor that manipulates the output,
a small speaker (called a receiver in hearing-aid terminology) that reproduces the sound, and a battery that provides power. The battery
typically lasts one or two weeks, depending on the specific hearing aid,
and is easy for the user to change. A few hearing aids come with a rechargeable battery.
A hearing aid requires minimal care, such as wiping it off at night
and removing any buildup of earwax in order to keep it functioning
properly. Routine care also includes having a hearing aid professionally
cleaned and checked once or twice a year. The average life of a hearing
aid is around five years, but this can range from three to ten years depending on care, environment, and handling. Hearing-aid warranties
generally range from one to three years depending on the make, model,
and price.
There is a range of styles in hearing aids (figure 2). The smallest
fits deep in the ear canal, where it is unlikely to be seen. This is called
a completely-in-the-canal (CIC) aid. Other in-the-ear styles (canal,
half-shell, and full shell) are larger and fill more of the opening to the
ear. There is also a range of behind-the-ear sizes. Hearing-aid styles
and colors may vary slightly from model to model, manufacturer to
manufacturer, and from year to year. Some hearing losses or ear canal
shapes favor one style over another, but generally speaking, a more severe hearing loss will require a larger hearing aid. The various styles of
new devices as well as the full range of available features can be seen

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hearing-loss basics

Figure 2. Hearing-aid styles (Images courtesy of GN ReSound)

at major hearing-aid manufacturer websites (listed in Resources at the


end of the book).

Digital Technology
Technological advances have made hearing aids better than they were
years ago. Todays digital signal processing has definite advantages
over older analog technology, but these advantages are not always what
people expect. The most common assumption is that digital sound will
be noticeably clearer. What many forget is that the high-fidelity analog
stereo systems that were enjoyed years ago had awesome sound. Clarity wasnt an issue. Similarly, many of the older analog hearing aids had
very little distortion. Going digital didnt necessarily change this.
The real advantage of having a digital processor is that it makes a
hearing aid highly adaptable. It can be variably programmed for different pitches to bring a wide range of speech into an audible range,
while also limiting loud sounds from becoming uncomfortable. It can
also be fine-tuned based on a persons listening preferences. Digital
technology additionally makes possible or improves the functionality
of a variety of helpful features, such as noise reduction and feedback
suppression.
The adjustability of a digital hearing aid depends largely on how
many channels, or bands, it has. A hearing aid with only two bands, for

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instance, would divide the entire frequency range into high and low
pitches. Either band could be emphasized, similar to using the bass
and treble controls on a car radio. A hearing aid with multiple bands is
more like a graphic equalizer that can better balance sound for an individuals needs or preferences. Most of todays hearing aids incorporate
ten to twenty frequency bands that can be programmed independently.
Having this flexibility is especially important for individuals who hear
better at some pitches than others. Being able to adjust a small portion
of the frequency range is also helpful for limiting specific sounds that
might otherwise be uncomfortable.
Another advantage of digital technology is that it can allow a hearing aid to have several different programs. The default program might
be intended for everyday listening. A second might have reduced amplification and an aggressive noise filter to help in a loud work environment. A third program could be adjusted to faithfully reproduce
music rather than emphasizing the speech frequencies, as is the norm
in hearing-aid design. Older hearing aids had only one program that
was often an uneasy compromise between an individuals many listening needs. Digital models that perform as several different hearing aids
in one result in fewer compromises.
The microphone traditionally used in hearing aids is omnidirectional, meaning it collects sound from all directions. This helps to ensure that speech and important sounds are not missed, but it has the
disadvantage of bringing in a panorama of unwanted sounds. A man
wanting to hear his wife who is sitting across the table in a restaurant
hears the people behind him as well. A woman trying to listen to her
children in a school play hears an infant shaking car keys at the end of
her row. One way to overcome these shortcomings is to also include a
directional microphone in the hearing-aid design. This microphone
focuses on sounds coming from the front and ignores sounds from the

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hearing-loss basics

sides or from the back. A user can then switch back and forth between
the microphones (directional or omnidirectional) best suited to a situation. A more sophisticated style of directional microphone incorporated into many digital hearing aids looks for sounds that appear to be
human speech and focuses in that direction. These directional microphones are sometimes called adaptive or automatic. Two separate reviews examining directional microphone functionality both concluded
that this feature is a plus for hearing and understanding.2
Noise reduction is another feature incorporated into many hearing aids. The digital sound processing that allows for the amplification
of wanted sounds can also be used to minimize or eliminate sounds
that are unwanted. Hearing-aid manufacturers use a variety of different proprietary noise algorithms, but the general approach is to
minimize sounds that have a different acoustic signature than speech.
Reducing noise can improve listening comfort and in theory improve
understanding. The problem for understanding is that in a busy restaurant or at a church social, unwanted conversations may still crowd
out a particular person speaking. The noise-reduction algorithms
dont know which people to amplify and which to consider noise. This
issue may explain why the reviews that found directional microphones
helpful for improving speech understanding reported equivocal results
for noise reduction.3 Nevertheless, noise reduction remains important for reducing unwanted sounds and is often used in combination
with directional microphones as part of an overall strategy to improve
understanding.
A common complaint of older hearing aids was whistling. This occurred when sound from an aid escaped the ear and entered the hearing aids microphone. A feedback loop ensued in which sound would
be amplified again and again until an aid would screech at its maximum

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loudness. It was annoying for the user and for bystanders as well. Today, feedback suppression is included on all but the most basic digital
hearing aids. Some of the best employ noise cancellation technology,
which is highly effective. Feedback suppression might not completely
eliminate the chance for whistling, but it makes this unwanted noise
much less likely in everyday use.

Hearing-Aid Options and Accessories


Some hearing aids come equipped with an internal device called a
telecoil, which is designed to improve listening on the telephone. It
is an option on many others. A telecoil picks up the magnetic waves
that harmlessly radiate from the speaker in a telephone handset. The
magnetic waves are converted to sound and then amplified. When the
telecoil is on, the microphone in the hearing aid is typically turned off,
which allows a hearing aid to amplify only the sound from the phone
and not any other surrounding noise. Some telecoils are automatic and
will turn themselves on when near a phone. Others need to be turned
on manually with a button or a switch on the hearing aid.
Due to size limitations, a telecoil is not an option on some of the
smallest hearing aids. Another potential limitation is that some phones
are not as hearing-aid compatible as others. Telecoils usually work well
with traditional corded phones, but this is not always the case with cell
phones. Fortunately, compatibility guidelines have been established
that demystify cell phone selection.4 Phones that are most compatible with a telecoil have a rating of T3 or T4, with T4 being the best.
Cell phones are also rated based on their compatibility with a standard
hearing-aid microphone. People without a telecoil in their hearing aids
should look for a microphone rating of M3 or M4.

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The usefulness of a telecoil, however, extends beyond telephones.


Several wireless listening systems and devices communicate with hearing aids through a telecoil. The induction loop system previously described is a good example.
Another useful hearing-aid option is a wireless microphone that
can provide improved hearing in noisy situations or at a distance.
The mechanics are simple. Place a special microphone near a person
speaking or other wanted sound source, and the microphone sends the
sound to a listeners hearing aids. The result is like talking directly into
a persons ear. Some of the early remote microphones were big and
obtrusive. The newest ones are as small as a pack of matches and can
clip on a shirt collar or lapel. A few older hearing aids can be adapted
to work with a wireless microphone, and many new ones are designed
with this in mind.
John Schmidts story illustrates how a remote microphone can
help. John was a longtime hearing-aid user who recently purchased a
new set of aids that included a remote wireless microphone. He considered himself a successful hearing-aid user, because he could hear
almost nothing without hearing aids, but fairly well with them. His biggest problem was hearing his wifeespecially in noisy surroundings.
He found that having his wife wear the wireless microphone when they
went out improved their communication greatly. He could hear her
better at the mall, in restaurants, and when they walked each day. He
could even hear her if she turned away.
A more basic option is a user-adjustable volume control. This was
standard and something of a must years ago, because hearing aids were
so dumb. They might boost faint sounds 30 or 40 decibels, which made
them audible, but they would supply the same amount of amplification
to loud sounds, making them uncomfortably loud or painful. Users
constantly adjusted the volume to try to find an acceptable balance be-

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tween adequately hearing soft sounds and not being overwhelmed by


loud sounds. Hearing aids had to be turned up for the television, down
at the shopping mall, up in the library, down in the car, up to hear softspoken Becky, down for loudmouthed cousin Joe.
Modern hearing aids show a little more intelligence. They are
programmed specifically for an individuals hearing loss to bring quiet
sounds into an audible range yet not overamplify loud sounds. The
method employed is called compression, because the goal is to capture
the full range of sounds (soft to loud) and compress them between the
softest level a person can hear and the level that becomes uncomfortable. If this is done well, there is in theory no need for a volume control.
In practice, however, a person may still occasionally want a little more
or a little less sound than the hearing aids provide. Because of this, the
inclusion of a volume control should be a consideration when purchasing hearing aids.
Reduced need was one reason that volume controls became less
common on hearing aids. An equal or greater reason was the miniaturization of these devices. Hearing aids became too small or were placed
too deep in the ear canal for a standard volume control to be practical.
People had to choose between hearing aids that were cosmetically appealing and ones they could adjust. Buying hearing aids that include
a remote control can eliminate the need for this choice. A remote can
also provide easy access to other useful features (multiple memories,
noise reduction, directional microphones, telecoil) that may be built
into an aid.
One hearing-aid option for the tech savvy is Bluetooth compatibility. This technology allows compatible hearing aids to be used as wireless headphones for Bluetooth audio devices. Most Bluetooth hearing
aids use a small intermediary device called a streamer that is worn on a
neck loop or clipped on ones clothes. This intermediary unit receives

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the Bluetooth signal sent from external sound sources and then sends
the sound to the hearing aids. Once the parts are synchronized or
paired with each other, everyday connection between the hearing aids
and Bluetooth devices is usually seamless.
A wax guard is another hearing-aid option to consider. Earwax is
the arch nemesis of hearing aids. It can block the devices opening, preventing sound from getting to the ear. Wax can also build up against the
receiver, causing corrosion and failure and necessitating costly repairs.
A large number of hearing aids returned to manufacturers for repair
have stopped functioning solely because of earwax. With a little planning, however, preventing interference and damage from earwax need
not be difficult. Hearing-aid manufacturers offer a variety of guards
that act as a barrier to the wax. Most are either incorporated in the
original design or offered as an option at the time of manufacture. A few
are sold as an aftermarket item, such as disposable stick-on wax guards.
Hearing-aid buyers are inclined to focus on cosmetic and technological
features. A wax guard may seem inconsequential in comparison, but it
is not something to overlook.
One final option worth noting is a hearing-aid drier. Hearing aids
are not generally designed to get wet. A good soaking can damage the
electronic components. Even high humidity or excessive perspiration
can cause internal corrosion. A few hearing aids claim to be water resistant. Fewer still profess to be waterproof. Even so, a hearing-aid owner
will be best served by keeping his or her devices as dry as possible. Real
life, however, sometimes does its best to prevent this from happening.
A person gets caught in the rain, becomes the target of a grandchild
with a squirt gun, drops the hearing aid in the sink, or soaks it with
sweat while gardening. Fortunately there is an inexpensive accessory
called a hearing-aid drier to help in these situations. It consists of a

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small jar or other container that is filled with a desiccant similar to that
shipped with new shoes or electronics to keep them dry. The hearing
aid is closed in the drier overnight and the desiccant absorbs any moisture. There is also an electronic version of this device. Some people use
a hearing-aid drier only in case of emergency; others who live in damp
climates or perspire easily use it routinely.

Considerations Beyond Hearing


Aids and Assistive Devices
A person may be completely satisfied with nothing more than wireless
headphones or an amplified telephone. Another may find hearing aids
the answer. Even when one of these assistive devices helps, however, it
does not rule out conditions that might indicate the need for a medical
check. These include but are not limited to:
A hearing loss that is sudden or rapidly progressive
Drainage from the ear
An odor coming from the ear
A hearing loss that is worse in one ear than the other
Tinnitus (ringing) that is worse in one ear than the other
Dizziness
Pain
In addition to ear problems or hearing losses that require medical attention, there are also hearing losses that can be treated or corrected
electively. Part of a hearing-aid evaluation involves checking whether
a loss might be medically correctable (if there is a conductive hearing
loss, for instance). This helps to ensure that the hearing losses that can

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be fixed are fixed and that people are not sold hearing aids unnecessarily. There is no similar safeguard for people compensating for a hearing
loss in other ways. Some needlessly struggle with a correctable problem. Being aware of the medical possibilities can help a person to minimize this risk. The next chapter explains these possibilities.

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3
Treatments for Hearing Loss

lbert Baker had noticed a gradual decrease in hearing over


the previous twenty or twenty-five years. He was in generally
good shape for being one hundred and one, and offered very
few other complaints. The reason for his visit was mostly to placate
the concerns of his younger (ninety-four-year-old) wife and geriatric children. They thought he should get hearing aids. He wondered
whether his hearing difficulties might only be due to earwax.
Naomi Jackson also thought her hearing problem might be due
to wax, but her situation was a bit different from Alberts. Naomi was
much younger and had no difficulty hearing until two days prior to
her office visit. The problem started after swimming. Her right ear
had become plugged, like there might be water remaining in the canal. She decided to remove it by cleaning the ear canal with a cotton swab. Rather than improving the situation, however, this made
things worse: now she couldnt hear in addition to having the ear feel
plugged. Naomi continued working with the cotton swab but this
made the ear sore. She waited a day to see if the hearing and plugged
sensation would improve. When they did not, she called for an ENT
appointment.
49

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On examination, Albert Baker was found to have perfectly normal


appearing ears, even if they were old. He had a sensorineural loss similar to that found in at least half of people over eighty-five years of age.1
Naomi Jackson, in contrast, had plenty of wax that had been nicely
balled up against her eardrum by the cotton swab. This was removed in
the office, after which her hearing returned to normal. Either persons
hearing loss could have resulted from earwax. Naomi, however, had
the odds much in her favor. This was not because she was younger, but
because her onset and symptoms were more consistent with wax.
Hearing loss can have a variety of causes. Some are treatable.
This chapter provides an introduction to common and not so common hearing problems that may be treated or managed. It offers background should the need exist or arise. This background begins with
some more about earwax.

Common Treatable Hearing Losses


Earwax
A little earwax is normal. It may also be protective. Earwax helps to
keep the skin of the ear canal moist and, because it is slightly acidic,
may prevent fungus and infection in the canal. Hearing is not usually affected unless the wax completely blocks the ear or is pushed up
against the eardrum. Even a lot of wax may present no problem as long
as there is space for sound to work around it. Left alone, wax usually
dries, flakes off, and works its way out of the ear unnoticed.
Nevertheless, accumulated earwax does become a problem for
some people. Not only can the hearing be reduced, an individual may
suffer a plugged sensation, a feeling of fullness or pressure, ringing,
pain, or the sound of ones own voice reverberating in the ear. Impacted earwax affects up to 6 percent of the general population and

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represents the most common ear-related problem that is treatable by


physicians.2
Many cases of impacted earwax are self-inflicted, just like Naomi
Jacksons. People try to clean their ears with cotton swabs and only succeed in pushing the wax farther into the canal. This can also be an unintended consequence of using earplugs or deep-fitting hearing aids.
A variety of over-the-counter wax removal systems are available in
pharmacies. Some of the best include drops to soften the wax and an
ear syringe to wash it away. A few applications may be necessary if there
is a lot of wax or if the wax is hard and stuck to the ear canal; in some
cases, one use may result only in wet earwax. Ear washes such as these
are meant to be used as needed, but not on a daily basis since overuse
can irritate the ear.
Earwax may also be removed by a physician, nurse, or audiologist, often through irrigation to wash the wax away. Or the wax may
be removed manually with a small curette or loop. The advantages of
having an ear cleaned by a professional are that the wax can usually be
removed in one visit, and the ear canal examined to ensure that all the
wax was removed and that there is no visible damage or abnormality.
As with Naomi, any hearing loss due to earwax should be eliminated as
soon as the wax is removed.

Ear Infections
The other common treatable condition that can affect a persons hearing is an ear infection. Infections sometimes occur in the skin of the ear
canal or in the space behind the eardrum. The skin of the ear canal can
become infected through an abrasion from a fingernail, bobby pin, or
other object that would be better left out of the ear. Water remaining in
the ear after swimming can also contribute. Bacteria like dark, warm,

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moist places to grow such as a wet ear. This is why these infections are
often referred to as swimmers ear. Once infected, an ear canal can
itch, swell, seep, and hurt. Hearing is not usually affected unless the
ear canal swells shut, in which case sound is blocked from reaching the
eardrum. Swimmers ear is usually treated with medicated eardrops or
ear wash.
Another frequently seen problem is otitis media, in which the normally air-filled space behind the eardrum becomes filled with fluid.
This most often happens following an upper respiratory infection. The
infection prevents the Eustachian tube from adequately ventilating the
middle ear and results in the accumulation of fluid. Otitis media may
also occur as a result of sinus problems, allergies, and pollutants. Even
second-hand smoke increases the risk.3 The fluid usually resolves on
its ownbut if it does not, it provides an ideal environment for bacteria. Middle-ear fluid that becomes infected is then called acute otitis
media. It can cause the eardrum to bulge painfully or even burst. Acute
otitis media is treated with oral antibiotics.
Infected or not, otitis media usually impairs hearing. The fluid
presses against the eardrum, interferes with the motion of the ear bones,
and acts as a barrier to sound. A little fluid may have little impact, but a
lot of fluid or fluid that is thick creates a significant impairment. It may
be possible to wait to see if a slight hearing loss from otitis media might
go away on its own or following antibiotic treatment. Waiting in the
hope that a bigger loss will resolve can be more difficult.
Fluid in the middle ear that does not go away can be drained
through a procedure called a myringotomy. A physician first numbs the
eardrum with a drop of medicine, then puts a small nick in the drum.
Fluid is suctioned through this small hole. In most cases the eardrum
heals in a few days and the fluid does not reoccur. With the fluid gone,
there is no longer an impediment to sound transmission. If the fluid

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53

would reoccur or if there is a history of chronic fluid, a physician might


leave a small tube in the myringotomy hole to provide ventilation. A
myringotomy or myringotomy and tube are quick in-office ENT procedures for an adult. Children are usually done in a surgery center under anesthesia.

Prevention
Often overlooked in the search for possible treatments is the importance of prevention. The best treatment is one that avoids the development of a problem in the first place. Anything that stops a progressive
condition from becoming worse could also be considered an effective
treatment. Hearing-loss prevention meets both of these criteria.
Perhaps the most practical and well proven way to prevent hearing
loss is to avoid or protect oneself from loud noise. Keeping away from
loud noise can also avert additional damage for those who already have
some loss. More on this important and all too often neglected subject
will be presented in later chapters.
Medical conditions, medications, industrial solvents, and environmental hazards can also lead to or worsen hearing loss if left unchecked. Smokers and people who live with smokers have been found
to be twice as likely to develop hearing loss as non-smokers.4 People
with diabetes are at increased risk of hearing loss, and this is especially
true if the disease has been uncontrolled.5 High blood pressure is additionally a concern: better management of it might prevent many hearing losses that are now attributed to age.6
Ear, nose, and throat physicians routinely consider a patients
medical history, work environment, and personal habits when looking for factors such as those just mentioned that might have caused
or that might further contribute to a hearing loss. One way a patient

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can help in this process is to thoroughly complete any medical or history questionnaires that the doctor requests. Even seemingly unrelated
questions can be important and their answers may provide the clue
needed to head off a hearing problem or stop an existing problem from
worsening.

Less Common Treatable Hearing Losses


Perforated Eardrum
Topping the list of less common treatable hearing losses would be a
perforated eardrum. Perforating an eardrum is unlikely for most people
because its location deep in the ear canal is protective. Nevertheless,
perforations can still occur from trauma or infection. A slap to the
side of the head, a bad fall, a car accident, or proximity to an explosion are only a few causes of perforations. Some are self-inflicted as a
result of bumping an arm or sneezing while trying to clean an ear with
a bobby pin or a cotton swab. Others are even more unexpected, such
as a welder whose eardrum is damaged from a spark or a hunter in the
woods who turns and has a branch go into the ear canal and through
the eardrum. Infection, in contrast, will damage the eardrum from the
inside out. As we have seen, the bacteria that cause acute otitis media
can produce this result.
A hole in the eardrum often creates a conductive hearing loss.
One reason is that the hole may prevent the eardrum moving as a
single unit, similar to what happens with a torn stereo speaker. An eardrum with a hole also presents less surface area to collect sound. Not
surprisingly, larger holes usually result in worse hearing than smaller
holes.7 Fortunately, many eardrums heal on their own within a few
days of being perforated. Those that dont can usually be repaired
medically.

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Small traumatic perforations can often be repaired with the placement of a paper patch over the hole that serves as a template for healing. This simple procedure can be performed by an ENT physician
in-office and has been found to be effective in up to 92 percent of these
cases.8 Tympanoplasty surgery is required to repair larger or more
complicated perforations. During this surgery a tissue or vein graft is
placed over or under the remains of the eardrum, depending on the
size and location of the perforation and the preferred technique of the
surgeon. This is done on an outpatient basis at a hospital or surgery
center and can result in a dramatic hearing improvement. The success
rate has been reported at about 90 percent.9

Damaged Middle-Ear Bones


The same infections and trauma that can perforate an eardrum can
also damage the bones of the middle ear. Infection can eat through the
bones, and trauma can break or separate them from one another. This
is a big problem for hearing. The bones not only connect the eardrum
to the inner ear, they also serve an amplifying function. They take the
sound from the eardrum (a relatively large area) and transfer it to the
much smaller area of the stapes bone. This increases sound power.
The bones also work in a lever action, providing an additional boost.
Both of these amplifying effects are lost without functioning middleear bones. Whats more, the eardrum acts as a barrier to sound in that
case, because there is no connection to the inner ear. This can result in
a moderately severe conductive hearing loss that makes normal conversational speech inaudible.
The solution is surgical repair, or replacement of one or more of
the ear bones with a prosthesis. This surgery is called an ossiculoplasty.
The procedure is usually done on an outpatient basis under general

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anesthesia. If there is also the need to repair a hole in the eardrum, the
combined procedure is called a tympano-ossiculoplasty.
Ossiculoplasty can result in a big hearing improvement. The larger
the conductive hearing loss prior to surgery, the greater is the potential
for hearing gain. Even a successful ossiculoplasty, however, may not completely restore the hearing to normal. This is especially true if all of the ear
bones have to be replaced, because the one replacement prosthesis cannot reproduce the natural amplifying lever action of all three ear bones.

Cholesteatoma
Hearing loss can also occur from cholesteatoma, which is an abnormal
skin growth in the middle ear. Cholesteatoma most often develops after
a history of Eustachian tube dysfunction and ear infections. Skin from
the ear canal enters the middle ear through a hole or retracted area in
the eardrum. The skin and dead cells that are shed from the skin then
accumulate in the middle ear and become infected. Left unchecked,
cholesteatoma can further erode the eardrum, dissolve the ear bones,
and damage the facial, balance, and hearing nerves. More serious complications are also possible but rare.
One of the first signs of cholesteatoma is often a foul-smelling drainage from the ear. The initial diagnosis is sometimes an ear infection,
because drainage and swelling obscure the cholesteatoma. An ENT
physician will usually try to clean the canal so that the eardrum can be
inspected, but the ear may be too swollen or painful. When this is the
case, a diagnosis of cholesteatoma may not be made until a follow-up
visit, after treatment with antibiotics or a medicated ear wash. Patients
may be tempted to forgo the follow-up if the ear seems better after the
treatment, but those who succumb to this temptation end up returning
to the doctor a little later when the ear starts to drain again.

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The standard treatment for cholesteatoma is surgical removal under general anesthesia. The eardrum then needs to be reconstructed, to
prevent the process from starting anew. An ossiculoplasty may also be
required if the ear bones have been damaged or destroyed. All of this
is ideally done during one surgery. If the cholesteatoma removed was
extensive, however, a surgeon might close the eardrum without reconstructing the middle ear. After six months or a year a second surgery is
performed. If the cholesteatoma has reoccurred, it is removed, the eardrum closed, and another follow-up surgery scheduled. If the cholesteatoma has not reoccurred then the middle ear is reconstructed. Yearly
ear examinations are routine for anyone treated for cholesteatoma,
because the disease can be tenacious. If all goes well, cholesteatoma
surgery with ossicular reconstruction can result in a significant hearing
improvement, although some conductive loss may still remain.

Otosclerosis
Otosclerosis is a hereditary ear disease that produces an overgrowth of
soft spongy bone that fuses the smallest of the middle-ear bones (the
stapes) in place. This prevents it from transferring sound to the inner
ear. The disease is fairly rare, affecting an estimated 1.4 out of every
1,000 adults.10 Onset is most common in young adulthood but can take
place at any age; women are more likely to develop the disease than
men. Otosclerosis can occur in one or both ears. Hearing loss is progressive and can result in a severe conductive deficit. The disease process may also produce some gradual sensorineural loss over time.
Next to wax buildups and ear infections, hearing losses from otosclerosis are some of the most treatable. A surgical procedure called a
stapedectomy (or stapedotomy) is performed in which all or part of
the stapes bone is removed and then replaced with a prosthesis that

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restores sound transmission to the inner ear. The normal lever action
of the ear bones is maintained, so there is no loss in efficiency with
this reconstruction. Patients with otosclerosis who are deemed candidates for stapedectomy surgery have up to a 95 percent likelihood
of significantly improved hearing with little or no remaining conductive loss.11 In addition to surgery, medication may also be prescribed to
try to minimize or prevent the development of sensorineural loss from
otosclerosis.12
The benefits of this surgery were exemplified by a young woman
I met years ago during her preoperative visit. Through her childhood
and teenage years she had enjoyed perfectly normal hearing. Starting in
her early twenties, however, her hearing quickly diminished to a moderately severe loss in each ear. She couldnt hear her children, work had
become impossible, and she did not feel safe going out by herself. One
month following her surgery, testing showed the hearing in her surgical
ear to have been restored to normal. Six months later she had surgery
in the other ear, with a similar result. Her hearing was still good when I
saw her twenty years later during a routine follow-up.

Sudden Sensorineural Loss


Most hearing losses affect both ears and occur gradually over time. Sudden sensorineural hearing loss is a clear exception. A person may wake
up one morning to find the hearing in one ear greatly reduced or gone.
Another person may answer a ringing telephone and hear nothing out
of it, until the phone is moved to the other ear. There is no advance
warning. The loss can occur a little more graduallyperhaps over two
or three daysbut this will still appear sudden after a lifetime of hearing.
Sudden hearing losses are scary. If a person could hear well in both ears
yesterday and the hearing in one is gone today, what about tomorrow?

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Fortunately, sudden sensorineural hearing loss is rare. The yearly


incidence in the United States has been estimated at 27 cases per
100,000 people.13 That is 3700 to 1 odds against it happening to any
one individual in any given year. Unfortunately, this unlikelihood sometimes causes the loss to be overlooked until it is too late. Earwax and
ear infections are much more common and can also produce a sudden
drop in hearing. People may waste time trying to clean wax that is not
there or treat a suspected infection that is not the real problem. Even
if an ear infection is present, it does not rule out the possibility of an
underlying sudden sensorineural loss. The two can and sometimes do
occur simultaneously. Proper diagnosis requires not only an examination but also a hearing test to differentiate the sensorineural loss caused
by this problem from the conductive loss that results from wax and ear
infections.
More often than not the etiology of a particular sudden sensorineural loss is never known. The damage is definitely in the inner ear, but
infection, ear disease, trauma, and the variety of other documented
causes add up to less than 30 percent of the cases.14 Some of these
losses will improve or recover on their own. Many do not. Treatment
with steroids and other medications may improve a persons chance
for recovery, but prompt attention is required. Consequently, sudden
sensorineural hearing loss should be considered an emergency by both
patient and healthcare provider.15

Autoimmune Inner Ear Disease


Another rare cause for hearing loss that may be medically treatable is
autoimmune inner ear disease. A persons own immune system can go
badly wrong and harm the cells in the inner ear. This results in a rapidly progressive sensorineural hearing loss that usually involves both

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ears. The portion of the inner ear responsible for balance can also be
affected. Autoimmune inner ear disease may occur in isolation or in
combination with other autoimmune diseases, such as lupus. Physicians sometimes order a variety of blood tests to look for signs of the
disease, but diagnosis can be difficult because there is no one specific
diagnostic test.16 For patients who are diagnosed, however, steroid
therapy offers the hope of improved hearing and balance.17 Because of
diagnostic difficulties and the desire to catch the problem early while it
is more easily treated, physicians may try steroid therapy if there is even
a suspicion of autoimmune inner ear disease.

Mnires Disease
Mnires disease is another treatable inner-ear disorder that can adversely affect hearing. The classic symptoms of this disease are an incapacitating vertigo, fluctuating hearing loss, a roaring sound, and a
sensation of fullness in the affected ear. The symptoms occur together
during Mnires attacks, which typically last from several hours to a
few days. Attacks can happen days, weeks, or even years apart. Usually
only one ear is affected. A persons hearing may recover completely
after the first few attacks, but repeated attacks can result in a severe
hearing loss that does not return to normal.
Mnires disease is thought to be caused by a buildup of fluid
pressure in the balance portion of the inner ear. There is no known
cure, but there are treatments to minimize the frequency and severity of attacks. One of the most basic is switching to a low-salt diet to
help prevent any fluid buildups in the inner ear. Diuretics may also be
employed to reduce fluids in the body. Excess fluid may additionally
be reduced by surgically placing a small silicon tube (a shunt) into the
inner ear. Beyond controlling the dizziness, the hope is that fewer or

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less severe attacks will result in better hearing preservation. Judging


the effectiveness of these and other interventions for Mnires is difficult, however, due to the diseases episodic nature and variability from
person to person.

Congenital Loss
The overall incidence of congenital hearing lossmeaning it is present
from birthhas been estimated at 2 or 3 children out of every 1,000.18
One or both ears may be affected. The vast majority of congenital losses
are sensorineural and considered permanent. Some are hereditary, and
their likelihood is predictable based on family history. Genetic testing
can identify the cause for some others. Often the reason for the sensorineural hearing loss remains unknown. Hearing aids are the usual
recommendation when a congenital hearing loss is in the mild or moderate range. If the loss is severe or profound, the medical interventions
discussed in the next section become viable options.
A congenital hearing loss can also result if the outer portion of the
ear or ear canal fails to develop properly. This is called atresia or microtia. The inner ear may be unaffected, but there is no passageway
for sound to reach it. If the inner ear is good, it is sometimes possible
to surgically create a new ear canal to transmit sound into the ear. The
less invasive alternative to this surgery is the bone-anchored hearing
aid discussed next.

Surgical Treatments for Severe or Total Hearing Loss


Bone-Anchored Hearing Aid
A bone-anchored hearing aid is a medical device that has become
the standard of care for patients with single-sided deafness and large

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Figure 3. Parts of a bone-anchored hearing aid


(Image provided by Oticon Medical, LLC)

conductive hearing losses that cannot otherwise be corrected. The system consists of several parts (figure 3). On the right is shown a small titanium implant that is surgically inserted into the bone behind the nonhearing ear. A bell- or tulip-shaped titanium abutment is connected to
the implant with a threaded connecting pin. The abutment extends
slightly through the skin, much like a tooth pushing up through the
gum but with far less protrusion. A sound processor (shown on the
left) snaps on to the abutment and can be worn as much or as little as a
person wishes. Figure 4 shows the complete system in place behind an
ear. A persons hair almost always blocks the abutment from view and
sometimes also the processor, depending on hair length. In addition to
traditional bone-anchored hearing aids, there are also abutment-free
designs that hold the processor in place with a magnet implanted un-

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Figure 4. A bone-anchored hearing aid in place behind the ear


(Image provided by Oticon Medical, LLC)

der the skin. This works generally similar to directly attached models,
but there is nothing visible protruding through the skin.
A bone-anchored hearing aid works by taking outside sounds and
converting them into vibrations that travel through the skull to both
inner ears. If a person is deaf on one side, the sound vibrations travel to
the opposite side where they can be heard. If a hearing loss is instead
conductive, such as from atresia or other middle-ear pathology, sound

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vibrations travel through the bone to bypass the problem and reach the
inner ear directly. The sound is natural, and users require little or no
time to adjust to the improved hearing. It is also effective regardless of
whether the loss was from birth or acquired later in life.
Further information about traditional bone-anchored hearing aids
can be obtained from Cochlear Corporation (www.cochlear.com) and
Oticon Medical (www.oticonmedical.com). Information on the Cochlear Attract and MED-EL Bonebridge magnetic systems are available at www.cochlear.com and www.medel.com.

Cochlear Implant
A cochlear implant is a medical device specifically designed to help a
person overcome a severe or profound sensorineural hearing loss that
is beyond the range of hearing aids. It is todays bionic ear. Worldwide
there are more than 300,000 in use.19
A cochlear implant consists of at least two parts (figure 5). The
first part is the implant itself. The electrode portion of the implant is
inserted into the inner ear (cochlea) to replace the nonfunctioning sensory cells. The body of the implant sits under the skin a little behind
the ear. Surgery is performed on an outpatient basis under general anesthesia and usually takes two or three hours. Healing takes four to six
weeks, and then the second essential part of the implant systemthe
externally worn sound processoris programmed for the individual.
The traditional style of processor looks similar to a behind-the-ear
hearing aid, except that it also has a transmitting coil that talks to the
implant. Other parts of the implant system shown in figure 5 include an
alternate one-piece style of sound processor and a remote control. The
relative position of the implant and externally worn processor behind
the ear are shown in figure 6.

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Figure 5. Parts of a cochlear implant system (Image courtesy of MED-EL)

Nothing is heard with a cochlear implant until the sound processor is programmed and turned on. When this first happens, sound
may have little meaning and seem like gibberish. The recipients brain
needs time to adjust to this new input. People who could hear and had
developed speech and language before becoming deaf adapt the most
quickly. Those with a congenital hearing loss have to learn everything
from the beginning. This takes longer and requires extensive speech,

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Figure 6. A cochlear implant and external sound processor


shown on the head (Image courtesy of MED-EL)

language, and auditory training. Someone with congenital deafness


also needs to get started early with an implant, because there is a developmental period in early childhood beyond which the brain is unlikely
to learn to make sense of sound it has never known.
A cochlear implant cannot restore normal hearing. It can, however,
usually bring a person with a profound hearing loss and no word understanding up to a mild loss with fair word understanding. Resulting
improvements in communication can be dramatic. Equally dramatic
can be regaining a world of sound. One of my cochlear implant patients
described the tears of joy that resulted simply from opening her win-

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dow and hearing birds sing. Reactions such as hers are common with
a cochlear implant.
Additional information about cochlear implants is available from
Advanced Bionics (www.bionicear.com), Cochlear Corporation (www
.cochlear.com), and MED-EL Medical Electronics Corporation (www
.medel.com).

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P a rt T wo

First-Hand Experience
and Advice

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4
Real-Life Consequences of Hearing Loss

nowing that 10 percent of the population has hearing loss does


little to explain how hearing loss affects an individual. Reports
associating hearing loss with social difficulties remain abstract
compared with a woman who cannot hear her waiter at a restaurant or
a man who cannot understand the people attending his class reunion.
We saw in both the introduction and chapter 1 that hearing loss has a
large incidence and impact. Much can be lost in translation, however,
when peoples day-to-day struggles are turned into statistics. Numbers,
graphs, and charts that are typically used to illustrate these realities can
be a distraction, depersonalize hardships, and distance a person from
the fact that hearing loss has real consequences.
Shortly after the publication of one of my earlier books on hearing
loss, a patient pulled me aside because she wanted to talk about the difference she saw between my writing and her reality. She did not dispute
the accuracy of the information I had presented. She even said she had
learned a lot. Her issue was with my perspective. She thought that because I had normal hearing I could not truly portray the reality of hearing loss. She felt this could only be done by someone with first-hand
experience. The more I thought about what she said, the more I could
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understand and sympathize with her viewpoint. I also began to recognize her view as prevalent among many other patients. They wanted at
least some of their hearing-loss information first-hand. This realization
was the impetus for the patient survey that provides the first-hand information and insights offered through the rest of this book.
What is the first-hand reality of hearing loss? What are the specific
ways individuals see their lives affected? The answers are personal, and
as the responses that follow attest, there is not just one answer. This
chapter begins with a few of the more obvious problems that patients
described. A variety of other issues resulted as secondary effects that
were every bit as real, but might not on the surface have seemed as apparent. The second part of the chapter focuses on these.

Obvious Effects of Hearing Loss


Sounds Go Missing
The most obvious result of hearing loss is a persons inability to hear
sounds that are clearly audible to others. It is not difficult to see how
this might become an issue in a world full of sound. With only a mild
hearing loss, watches do not tick. Insects do not buzz. Waves lap silently against the shore. Footsteps on carpets make no noise. Doors
open without a sound. Leaves do not rustle. Cats dont purr. All of
this is without mentioning the people who silently mouth their words
rather than whispering or seem to mumble rather than speaking normally. This list grows exponentially with bigger hearing losses.
Despite living in this quiet world, survey respondents gave little
voice to the missed sounds that were unrelated to speech. Most did not
mention them at all and focused instead on other aspects of hearing
loss. Nonetheless, a few people did comment that these missed sounds
were a concern.

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I miss all the sounds of nature. At night I cant hear if its


raining.
I cannot hear sounds that are around the house like water running or a motor sounding wrong. I didnt realize that I was not
hearing everything until I couldnt follow the conversations.
Not always hearing the phone ring or someone at the door.

Misunderstanding
Difficulty understanding speech was the most frequently reported
problem resulting from hearing loss. While only a few people lamented
not hearing the doorbell ring or the sound of raindrops, everyone who
responded mentioned problems with understanding what others are
saying. At times the problem appeared to be the hearing loss making
a speaker largely inaudible. More often, speech was heard or heard
poorly, but not well understood. This happened not only in person
but also with devices like the telephone and television. Especially
problematic was understanding in noisy settings. Some understanding
trouble was obvious to the listener. At other times the listener thought
he or she understood what was said, only to find that this was not the
case. The following comments illustrate some of these difficulties with
understanding.
I cant understand what people are saying particularly in
groups or with background noise.
I sometimes misunderstand when or where to do things.
Sometimes fail to hear all that others say resulting in misunderstandings. My interpretation of not clearly heard words may
be wrong.
I have difficulty understanding in large groups.

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first-hand experience
This past week I bought a new ear plug for my amplifying
gadget I use in church. When we left the store my friend told me I
had bought a warranty for it. I didnt understand the clerk.
While in groups at restaurants, meetings, I have difficulty
hearing when many are conversing or many other noises are in the
background. At church, it is difficult when different microphones
are used in different places.
I dont hear clearly what people are saying.
My hearing loss is relatively minor, but I do have trouble hearing some voices (especially soft voices, people who do not speak
up, people who do not speak clearly, and sometimes I have trouble
with telephone calls).
Difficult to carry on conversation in large crowds.
Sometimes I dont get all of a conversation. I may agree with
someone without knowing what really has been said. I ask people
to repeat things a lot.
People have to repeat what they say to me.
The telephone was the biggest obstacle. Words sounded different than what the person was saying.
Miss parts of conversation when more than one or two people
are around me. Retired so its mostly friends and relatives. Background noise is the biggest problem.
Difficult to hear when people speak quietly.
Unable to understand children, hear on phone, TV, etc. Day
to day tasks such as banking cannot hear teller.
Its difficult to carry on a conversation with a group of people
at restaurants or gatherings. Others have to repeat themselves so
often when having a conversation. If everything is quiet its not as
difficult to hear.

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A hearing loss affects communication plain and simple.


In large noisy crowds I could not hear discussions/conversations and became very quiet and did not participate. I would answer questions inappropriately because of this.

Needing Others to Repeat


Also obvious are the linguistic changes that result from hearing loss.
By this I am not referring to deaf speech, in which a persons tone
or pronunciation sounds distorted due to not hearing well enough to
monitor ones own voice. Rather, the transformation involves the type
of statements made. A hearing-impaired persons side of any conversation can turn into a series of questions. Huh? What? Pardon me?
Would you please speak up? The list goes on.
Someone with hearing loss might not like to ask, or their conversational partner might not like to repeat, but both may be necessary for
communication to take place. Many noted this reality.
I ask people to repeat.
Makes it hard to talk to peoplerepeat words 2 or 3 times.
The effects on me are: having people repeat what they are saying, not hearing them whisper and/or mumble. I have difficulty in
crowds and places where there is a lot of background noise.
I would have to ask people to repeat what they were saying.
Just have to sometimes have people repeat a little louder.
They repeat to me the things I need to hear.
I sometimes need to ask people to repeat what they said or to
slow down their speech.
Others must repeat or sit near me when talking.

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first-hand experience
I had to ask people to repeat.
I can perform most activities myself. I sometimes ask people to
repeat even though I am wearing hearing aids.
I always got to ask someone to repeat what they said.
People have to repeat what they said to me.
They often have to repeat what they said to me.
I still perform all my normal tasks. I often ask people to repeat
what was said.

Secondary Effects of Hearing Loss


Safety Becomes a Concern
As important as communication is to our daily lives, it is not the only
possible concern related to hearing loss. Also important is how it might
affect a persons safety. Hearing loss could certainly cause an oncoming
car, truck, fire engine, or train to go unnoticed. Even if a person does
hear those hazards, hearing loss can produce localization difficulties
that put an individual at risk. Picture rounding a corner in a wholesale
club and stepping in front of a forklift because it was not heard or because it sounded like it was somewhere else. Alarms of all sorts (smoke,
fire, carbon monoxide) may become inaudible, or if heard, not be loud
enough to demand a persons attention. Other safety concerns include
things as frightening as not hearing a burglar or something more mundane, but also dangerous, such as failing to hear a swarm of bees. An
individuals hearing loss may also present a safety issue for others. A
common concern is that a parent or grandparent might not hear a child
who is out of sight. Below are some observations related to safety.
People have come up behind me and scared me because I cant
hear them coming.

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Im more careful because of my hearing.


Have to be careful when loud noises come and you dont know
what they are.
I get scared when driving and hear a siren because I dont
know where the vehicle is coming from.
Im always on guard when driving a car.
Safety is only an issue when driving (i.e., will I hear a
siren?).
I work in an industrial environment. Wearing hearing protection leads me to be extra careful.
I was uncomfortable driving a car because I could not hear a
car passing me or the turn signal blinking.
You learn to be more aware of your surroundings.
My initial hearing loss before surgery was profound. I could
not hear my babies cry at night.
As far as safety goes, I couldnt hear ambulances, police sirens
until they were close.
I have trouble hearing cars, trucks, etc. when crossing the road
or sirens when driving.
Be aware of your surroundings. You might not hear a car or
person on a bike approaching.
I sometimes dont hear soon enough police or fire sirens.
I cant hear if someone might be trying to break in. I could still
hear a siren for warning. But if something went wrong in the house
I might not hear it.

Activities Become Limited


Because hearing is a part of so much that we do, it should not be surprising that difficulty hearing might limit what we do. Think of almost

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any activity, and there is a good chance that hearing is involved. Even
something as seemingly unrelated to hearing as bird watching has a
hearing component. First, hearing helps a birdwatcher locate birds.
Then, being able to listen to any birdsong adds to the enjoyment. If
an activity includes other people, the chance of hearing being involved
increases significantly. With few exceptions, movies, music, lectures,
meetings, church, family gatherings, and everyday conversation are
dependent on good hearing. Difficulty hearing may reduce the enjoyment of any of these activities or cause a person to forgo them entirely.
The effort and fuss required to participate can reach a point that it just
doesnt outweigh the benefit. People begin to skip things.
I avoid crowds and parties.
I tend to stay out of groups. I have insulted people who spoke
to me and I ignored them. I have answered questions I wasnt
asked. Misunderstood what was said. I only watch TV shows
without background noise (music, clapping).
Not able to hear what people are saying. Background noises make
dining out and attending church and other functions hard to hear.
I dont go out as much. I cant do jury duty.
Hard to hear unless person is very close.
I avoid loud places, i.e. bars.
Theaters and concerts are not enjoyable anymore.
I really do not swim anymore because I cant wear hearing aid
and I feel helpless without it.
It is a problem not hearing well. I miss hearing my TV programs well. I read a lot and that helps.
Went on a trip with friends recentlyreduced enjoyment. Between cataracts and hearing problems our love of travel has been
very curtailed.

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It was hard watching TV with othersnot hearing all that was


spoken.
I dont go to theaters and concerts, places with loud noise.
Too hard to hear. Too loud for hearing aid and jumbled without
the hearing aid.
Dont listen to music muchsounds flat.
Belong to United States Coast Guard Auxiliary. Mates are very
patient. Do not take office anymore.
There are times that I dont want to attend a function because
I know I wont be able to hear.
I dont listen to music, dont go to noisy places. Hearing loss
doesnt affect much else except I dont have directional hearing so
dont know who is speaking if I cant see the talker.
I try to stay away from loud noise and loud crowded areas.

Work Can Be Affected


Hearing loss can also be a problem in many work situations. Salespeople need to hear their clients. A waiter has to understand customer
orders. Pharmacists must correctly hear each prescription that is called
in. Any hearing difficulty could make these jobs harder. Police, military,
truck drivers, commercial equipment operators, and others may not
even be able to obtain or keep a job without good hearing.
Despite the protections provided by the Americans with Disabilities
Act, hearing loss remains a workplace issue.1 It is not just a matter of
keeping a job or coping with the loss in the workplace, but also one of
compensation. In a study of more than forty thousand households, significant differences in earnings were found between people with normal
hearing and those with hearing loss.2 Little if any earning deficit was apparent for individuals with a very mild loss. For those with a more severe

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loss, however, average annual earnings declined $14,100. The worst hearing losses resulted in as much as $30,000 less per year. Interestingly, this
same study found little evidence that those with hearing loss felt they had
been discriminated against in terms of promotions or earnings. The comments that follow illustrate several workplace-related hearing difficulties,
but as in the study, the issue of income was largely left unaddressed.
I was a teacher and often did not hear my students questions
and I did (and still do) answer questions wrong because I fill in
words that I didnt hear and what I did hear was wrong.
It affected me at my educational administrative position.
Sometimes dont hear directions or names correctly. At work I
may not relay messages accurately.
Had trouble at work because I would only hear bits and pieces
of conversation.
At work I had a difficult time hearing my students. I am a Spanish teacher and good hearing was essential to my job.
It also impacted me at work as sometimes I could not hear a
soft spoken person on the phone.
Employment is limited. Before I retired, I had to change my job
duties where I didnt have to talk to people except on the phone (I
can hear fine on the phone).
Cannot do most things that require you hear in order to do a
job or run machinery.
Work as a police officer, need to hear for public safety.
My work includes many meetings and telephone conversations. Without hearing aids I would not be able to function in
those environments.
At work I aim to stay out of meetings.

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It limits my professional work. I dont attend meetings in


crowded rooms. I have difficulty in hearing children and in environments in which many are talking.
I think hearing loss prevented a promotion while working. Im
retired now.

Spouses and Significant Others Make


Up for What Goes Unheard
Some may at first be tempted to consider hearing loss a personal matter that does not affect anyone else. A little first-hand experience and
introspection, however, usually dispels this view. Unless a person is a
hermit or lives in a bubble, a hearing loss is bound to affect others.
There is much that needs to be heard and if a person is unable to do
this him or herself then at least some of the responsibility gets passed
around. Whether other people are happy to assist or see no alternative
and grudgingly comply is secondary to the point that someone else is
picking up the slack. Patients surveyed seemed well aware of this truth
and the strain that can result.
My wife sometimes becomes a little irritated at having to repeat things to me.
Yes, it affects conversations with my spouse. She gets tired of
repeating comments or newsworthy items.
Family members get irritated having to repeat.
Your spouse or friend sometimes will get mad if they have to
repeat words.
They pretty much have to remember to face me and speak
clearly at all times.

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I have others repeat, but does not hinder anything else to the
best of my knowledge.
Yes. Others have to constantly repeat themselves and express
themselves.
My hearing affects others because of conversation and they
may need to repeat or speak louder in some situations.
Family thinks they have to raise their voices to talk to you. They
have to get up close and repeat themselves. It irritates them.
My long suffering wife needs to repeat herself.
I ask people to repeat words. Says they told me but I didnt
hear them.
My relatives get impatient with me because I always ask them
to repeat themselves.
Sometimes people get impatient when I ask them to repeat.
Having others repeat is annoying to them and myself.
Friends and family have to repeat what they say.
I think people get annoyed because they have to keep repeating what they say to you.
Others get disgusted because they have to repeat what they
said.
My friends, co-workers, family have to speak clearly, not whispering or mumbling.

Relationships Become Affected


When hearing loss causes people to avoid difficult listening situations,
the impact is also felt by those who are close to them. If these situations involve shared activities, such as going to movies or restaurants,
then a spouse or friend will be absent a partner, and often must choose
between going alone and not going at all. Relationships are based on

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shared experiences. Curtailing some of these shared encounters brings


the risk of diminishing ones relationships. The old expression out of
sight, out of mind applies here, because shared activities left undone
can easily go unrecognized. At least they did for almost all of those
surveyed.
More obvious was how the constant struggle to hear and understand put a strain on relationships.
My hearing loss affects my relationship. I avoid conversation. My marriage is solid and my wife is patient. Until recent
years I could hear her well, but now she has to speak direct in my
best ear.
I had difficulty hearing/understanding anything. My wife
would get upset with me and me with hervery annoyed.
Irritates wife.
Occasionally my spouse asks if I have the hearing aids in and
usually he is right when I do not.
Affects all my family and friends.
My hearing loss affected every aspect of my life.
My hearing loss affects my relationships and moods because
quite often I dont have my aids in and I hear words that just sound
like what the person is actually saying. Even with my aids in, some
people talk too fast and dont enunciate clearly and I miss half the
conversation. If someone speaks all of a sudden without getting my
attention first, I have to ask them to repeat themselves, which they
dont appreciate.
My family (husband) gets very annoyed if I dont hear everything he says. Sometimes I just say OK to whatever he has said.
My family, friends, and co-workers are sometimes frustrated
and annoyed they constantly have to repeat themselves.

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Wife gets very upset having to repeat.
Just my kidsall grown up and love to tease mom.
Im sure it does sometimes. I might ask them to repeat what
they said or give me an answer not related to what they said because I misunderstood the words they spoke.
At home Im affected because my husband refuses to talk directly to me. He talks while walking away from me or from another
room.

Others Loudly Affronted


When asked if her hearing loss affected others, one person responded,
Hope not. Another was sure her hearing loss was her problem alone
until neighbors started mentioning the loudness of her television.
Turning things louder is a natural response to hearing loss, but it can
be annoying to others.
Children always complain of TV too loud and tell me I have
selective hearing.
My family doesnt want the TV as loud as I listen to it. I struggle with phones, especially cell phones, and they tire of having to
repeat.
TV set louder, closed captioning is on.
Needing TV being turned up too loud for others comfort.
People say you are talking too loud.
It affected my family because of my saying what or OK if I
didnt hear what they said and because the TV and radio are at a
loud volume.
They say I talk too loud. Tell them to repeat what they say.
Often times my family complains TV too loud.

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When I am alone I can turn volumes on the radio and TV to


suit me, but I am aware of the discomfort to others when in shared
situations.

Hearing Loss Can Limit Autonomy


Numerous comments made plain how a hearing loss can affect others and how these others may try to help by repeating what goes unheard. An unintended consequence is that a person with hearing loss
may come to depend on this help. Once this occurs, it is not without a
certain loss of autonomy.
Hearing loss puts a damper on your whole life. You feel left out
and sometimes embarrassed because you dont know whats going
on. You have to depend on others to be your ears for you.
I just make sure someone is with me when I am out in
public.
I have to have people repeat often in any conversation. My
wife has to interpret for me and act as an intermediary in conversation.
When you have a hearing loss you avoid situations that will
bring attention to your hearing loss. You will have a family member with you to help respond to questions or people who mutter,
look down when they talk or turn away when speaking. I try not
to put myself in too many of these situations. So I may have withdrawn being around people who do not communicate distinctly
and clearly.
It especially affects my wife, friends, and co-workers who all
have to check to be sure I understand conversations, decisions,
directions, etc.

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I try to have someone with me when I have to go somewhere
that I have to follow directions.
At a busy restaurant I often look to family members to repeat what the servers say or to answer for me because I cant hear
them.
I have others make calls for me. Many times I have to give the
phone to my wife or someone else to help me make calls.
Even though I wear hearing aids all the time, I sometimes ask
others (especially my wife) to deal with telephone calls.
I let others talk on the phone for me when phone does not have
a speaker or in situations where a speakerphone is inappropriate.
I have my wife do most of my telephone chores.

Hearing Loss Can Result in Feelings of


Being Left Out and Isolated
Picture a person standing in the center of a very large circle. Everyone
and everything within the circle can easily be heard. Now consider a
person with hearing loss. This person too will be standing in the center of a circle, but this circle will be smaller and contain fewer people
and things that are audible. The greater the hearing loss becomes, the
smaller the circle. A person may still do well with the few people inside
this smaller circle, but become isolated from those on the outside. Even
people in the circle may become a problem if they wander outside,
such as someone who walks away when talking.
A direct one-on-one conversation is the situation most likely to
remain audible for someone with hearing loss, since this speaker will
likely be close and talking directly toward the listener. Unfortunately
this represents only a fraction of the conversations that we depend on
to keep us in the loop. So many peripheral conversations that are eas-

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ily overheard and utilized by someone with normal hearing are inaccessible with hearing loss. All of this casual overhearing and perhaps
downright eavesdropping left undone can also be isolating. It may not
necessarily be clear to someone with hearing loss exactly what is being
missed, but they do feel left out.
A good example was recently described to me by a retired college
administrator. Many years ago he had suffered a sudden hearing loss
that left him essentially deaf in one ear. He had learned to cope fairly
well by turning toward the person talking or by positioning himself so
that family, friends, or others he wished to hear were on his good side.
This method, however, was not foolproof. He told of being seated at an
event with a pastor at his side. After the event he was surprised when
the pastor seemingly out of nowhere asked if he had a hearing loss. Apparently the pastor had been talking to him the whole time and he had
been unaware. How many other situations in which something like this
may have occurred, he could not say. His experience of being left out
was not unusual.
I feel like Im missing out on most conversations, only getting
partial stories. I sometimes embarrass my children when I respond
to what I think people are saying to me.
Im less likely to join in a group conversation because many
talk too fast, too softly, or not plainly for me to understand what
is said.
There are times when its a blessing, but in reality it isolates you.
You miss out on a lot of conversations in social settings.
I feel left out of many conversations because I cant hear all the
words. People must repeat things over and over.
You miss out on conversations.

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Friends obviously avoid conversation; others try not to be
obvious.
My close friends will not visit or watch TV with me because I
have to have the volume up!
Atmosphere of isolation if hearing loss continues.
It affects you in all aspects of life. You constantly feel left out
because of hearing loss.
I cannot participate in group discussions.
I feel I miss quite a bit.
Staying away from groups. Not wanting to socializebackground noise. Problem understanding conversation on TV. Especially on the phone.
I try not to go places where there is a crowd and so I know I
miss out on a lot.
Ive become a little more isolated, especially avoiding crowds.
I notice they talk low and I feel left out.

Hearing Loss Is Bad for Ones Mood


Communication becomes a problem, activities can be limited, relationships are challenged, work is made more difficult, and safety is a
concern. Is it any wonder a person with hearing loss might not be in
a good mood? Sadness, frustration, unhappiness, or depression can
easily result. Unfortunately, any reduction in motivation, outlook, or
attitude that does occur can cause even more problems at work and
with relationships. There are many ways that hearing loss can have an
impact on ones mood.
I dont hear a lot going on around me. People dont want to
repeat to you, get mad if they do, yell, talk really loud or ignore you.

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Makes you sad. Sometimes they blame you, say you arent trying
to hear them.
Many questions/statements made to me need to be repeated.
Can get frustrating at times.
Mostly annoying. Makes me very aware of my age.
Its embarrassing when I dont hear what someone is trying
to tell me. I also feel badly when the person I dont understand
becomes impatient or disgusted.
I can get very irritable and edgy when trying to hear something.
It really doesnt bother me! Sometimes I get upset if I cant
hear people with soft voices.
I can be irritable with someone who talks when Im trying to
hear something like the news.
My hearing loss made it much more difficult to communicate with others. I was constantly asking people to repeat things.
This frustrated me, made me anxious and sometimes annoyed
others.
It is very discouraging.
There are many times that I do not know what is going on
around me. I feel that I miss out on important information and
facts. Family gets nervous and yell for me to hear and then I get
frustrated.
I cannot carry on a conversation in a large group or a noisy
place. People have to repeat much of what they say to me. So I get
embarrassed and just give up.
It makes you irritable not being able to hear people.
I have a spouse who is soft spoken and I must ask him to speak
up repeatedly and it becomes frustrating.
Sometimes makes me mad when I cant hear something.

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It is embarrassing when meeting people and when answering the telephonehaving to say please speak louder, I cant
hear you!
Makes me mad when unable to hear.
I get frustrated at not being able to hear what is being said.
Affects my mood and leisure. Am retired. Very depressing.
People get impatient with me.
It sometimes affects my mood because it is stressful when I
am around people whose voices I cannot hear. I am saddened
because I cannot go to movie theaters anymore. It does not affect relationships. My husband, family and most friends are very
understanding.
Im insecure and dont like to tell people I have a problem. The
guys at work joke about it. I get mad when people are insensitive.
I get very frustrated when I cant hear conversations. I then
usually give up on it. I feel embarrassed to keep saying pardon
me? When I taught elementary school it was difficult because the
children mumbled or turned their head away and could not hear
them at all.
I miss many words and conversations. Its frustrating.
A lot of embarrassment when I misunderstand what is being
said because I dont hear all of the questions or conversation. My
friends get tired of repeating themselves and I still dont know if I
heard them correctly.
It makes me feel stupid because I dont hear everything. People talk softly or mumble and have their back to me and I dont
hear them.

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Moving from Hearing Loss to Hearing Help


Many people cope well with their hearing loss and the resultant challenges that have been described. They do this by correcting the loss
if possible or taking steps that minimize any effect it might have on
their quality of life. Some even find an upside. One person reported:
Theres times I actually enjoy the quiet and will take my hearing aids
out when Im home alone.
On the other hand, all of the associated negatives make it very
easy to view hearing loss as a hopeless affair. If this perspective takes
hold it can become a self-fulfilling prophecy, preventing an individual
from seeking any solution. As the first-hand accounts in the following
chapters show, however, there is help. This help may not transform a
life with hearing loss into one of wine and roses, but it can make a big
difference.

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5
Coping and Getting Help

xcept for his hearing loss, Gunnar Schmidt was a fairly typical seventeen-year-old. He was a senior in high school, played
on the basketball team, and looked forward to college. Whats
more, his grades and standardized test scores had earned him a full
scholarship to a respected university. None of this was an accident,
however, because many people had worked to make sure that hearing
loss did not stand in his way.
There had been concern about Gunnars hearing from the start,
because his mother and older brother both had hearing loss. When
Gunnars newborn hearing screening indicated a problem, his mother
saw to it that further testing and a medical evaluation quickly followed.
Gunnar was soon fitted with hearing aids, and she made sure he wore
them. The close interaction she maintained with his ENT doctor, audiologist, speech language pathologist, teachers, and school educational specialists meant that Gunnar had all the tools he needed to do
his best.
Gunnars mother had also taught him to move closer to the person
speaking, lip-read, and engage the help of others wherever practical. He
would often let others know they should get his attention before speak92

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ing, seek a copy of classroom notes from a friend, or ask his teachers
to present homework assignments on the blackboard as well as orally.
Hearing aids provided his primary assistance, but he did not overlook
the little things that might additionally help.
Mrs. Schmidt knew the ins and outs of living with a hearing loss.
She had also learned a lot about childhood hearing loss and made a
variety of medical and educational contacts when her oldest son was
diagnosed and cared for. Whether there was something Gunnar could
do to more easily hear or something others could do to help, she orchestrated it all. Gunnar was the beneficiary.
The story is very different for most people with hearing loss. They
dont have someone to round up a whole team of the right professionals or offer first-hand advice about how best to cope with the range
of difficulties hearing loss can impose. They may not even be aware
of the problem. Recognition can be slow in coming because hearing
loss often develops gradually over months and years. Without a sudden
change to create a light-bulb moment of recognition, the hearing may
be perceived as normal long after it is anything but.
Whether folks acknowledge a hearing loss or not, they almost
always take at least a few steps to cope with it. Lacking the advice of
Mrs. Schmidt, some of these steps turn out to be well planned while
others not so much. Still, little things can make the difference between hearing and not hearing or understanding and misunderstanding. Some of these things are free. Several require buying hardware.
Unfortunately, a few that work well, such as asking people to repeat
themselves, can also be annoying to others. They are easy to spot
when described.
Patients explain in this chapter how they went about getting information and help as well as what simple listening strategies and

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non-hearing-aid technologies they tried. The focus here and in the following chapter about hearing aids is on what patients actually did and
experienced. What patients recommend based on these experiences
comes later.

Seeking Information and Help


Sources of Information
Years ago people who wanted information about hearing loss had few
options. They could talk with a hearing professional, search the card
catalog for a book in the library, read whatever articles or advertisements might be printed in their local newspaper, or quiz friends and acquaintances. Living in the information age means there are now other
alternatives. Most of these are related to the Internet, beginning with
informational websites and social networking services. Perhaps most
important, search engines like Google make it easy for a person to find
the information he or she wants. An article that appeared on an obscure
website, in a newspaper from the other side of the world, from a magazine that you dont generally read, or never heard of, is now accessible.
The question is whether this access is being utilized. Where are people
getting their information about hearing loss?
As Im older, most of my information comes from people similarly afflicted.
Reading articles if they are in the paper or magazines.
Asking others, shopping around some before buying.
Through work.
Fliers, TV, newspapers, friends.
A friend who is an audiologist, a friend who is a doctor, family
member (nurse), and family doctor. Good information.

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I am a health educator, familiar with hearing loss. Most information I received about hearing aids came from other people who
had them.
Ear doctors and hearing-aid center. Very good quality.
After I was diagnosed I read a magazine (Hearing Loss Magazine) that explained many aspects of hearing loss, evaluation and
real-life case scenarios.
Experience observing how my wife managed her hearing loss,
books, computer searches (used with caution).
My relatives. The quality is OK but I need a professional for
exact information.
Hearing tests and information given by hearing-aid personnel.
Reading about products in paper and in ads.
Veterans Administration. I broke eardrum while serving in
Korea.
My doctor and his staff. He helped me see I needed my aids.
I see ads but they dont explain a lot.
Internet.
Doctors office, Internet, news stories. I dont really get a lot
of information.
Reputable hearing-aid agents and friends who are knowledgeable.
Family and friends I guess.
My ENT physician and hearing-aid supplier. I believe the information Ive received has been accurate and helpful.
People who conduct the hearing test, also most helpful the audiologist or person who fits your hearing aid and gives instructions.
Went to clinic sponsored by local hospital (very good) then
sought testing from audiologist and hospital and subsequently got
hearing aids.

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Doctors office. Good information.
Other people with hearing loss. Good information.
Mailings.
Doctors and hearing-aid people. I think they have done a
good job.
Primary source is my doctor. I rely on his opinion 100 percent.
I read articles and my doctors office is good at explaining
things.
Online, material from doctors office, talking to others who
were having trouble hearing or had hearing aids.
From friends that have the same problem.
Got a lot of info from my doctors. Some from general
advertisements.

Seeking Help
How often do people seek help once a hearing loss is suspected? Do
they do it on their own or get pushed into it? Few hurdles actually stand
in the way of finding out what can be done. A person can easily meet
with a physician or audiologist to determine whether a hearing loss can
be corrected or visit a hearing-aid center to see if one of their devices
would help. Weighed against this easy access are the denial and negative stereotypes that have already been mentioned, as well as possible
financial concerns and the general inertia of continuing to do nothing.
A study of more than two thousand older veterans showed how frequently inaction wins out.1 The study participants were checked with a
questionnaire, a hearing screening, or both to find individuals who had
some degree of hearing loss. Of those failing the screening, only 15 percent to 27 percent (depending on the screening method used) went

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97

on to have a formal evaluation. Of those evaluated, less than 7 percent


went on to use hearing aids. As dismal as this behavior in seeking help
may appear, hearing-aid use in a similarly matched control group that
had not undergone hearing screening was only 3.3 percent. Putting this
into further perspective, all of these people likely had veterans benefits
that would have paid for a thorough workup and also for hearing aids
if they were indicated.
Since all of the people surveyed for this book had already sought a
full evaluation, their comments do not speak to how frequently people
seek help for a hearing loss. They could, however, explain whether
they sought help right away and whether they did it on their own or
required some outside encouragement.
My wife made me go.
I delayed several months, in essence denying my problem. I was
reluctant to face the consequence of confirming hearing loss.
No, because I thought ears were clogged due to colds.
No, a sign of old age.
No. Hearing loss was a gradual thing and I had other financial
obligations that I thought were more important.
No, because I thought perhaps it went along with sinus problems and I felt like there was water in my ear.
Not right away as it appeared to not be too serious at the
time.
No, I did not think I could have hearing loss. I assumed people
were mumbling. Once it became apparent that it was a problem I
did seek help.
Yes. My wife has had a severe hearing loss for many years, so I
realized early attention to the problem is important.

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No. The loss was so gradual that I became accustomed to it
until it became acute. I tried to find other reasons for the hearing
loss, made excuses.
My wife noticed the hearing loss. She insisted.
Yes, I did seek help. I wanted to hear clearly. To be truthful I
didnt realize my hearing loss was as bad as it was. It came to me
that I could not distinguish certain letters over the phone. Also, my
daughter-in-law said to me one day that she had been talking to me
and I did not respond.
No, I thought it was a temporary thing.
Yes. Because I was missing out on what people said.
Fairly soon. I felt it would not be as large an adjustment.
At first it didnt seem too bad. Once it started causing problems, I got help.
No because I was told by others that hearing aids were not the
answer.
No, because I was a truck driver and saw no reason to amplify
the noise of the truck and traffic. At that time I was either driving
or sleeping 6 days a week.
I did not seek help right away because I was thirty years old
and didnt want to admit that I was having trouble hearing
vanity!!
Yes. Realized I needed to have a device for certain situations;
otherwise it was not fair to others around me. I learned from my
dads reluctance to get hearing devices. Sooner versus later!
Yes, was teaching at the time and obviously had to hear.
Yes. I was young and had many ear infections and hearing loss
runs in family.
Yes, my father-in-law had hearing loss and surgery to help him
and encouraged me to follow up.

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Yes, did not want people to get mad or annoyed.


Yes I did. I retired about that time and my daughter was going
to have a beautiful wedding.
You kind of deny your loss. I think I waited too long. Its working out for me now though.
Yes. My mother had problems and waited a long time to get
hearing aidsit was difficult to communicate with her and our relationship suffered.
It was a gradual loss, but once I knew something was wrong I
went for a hearing test. I was surprised as to the extent of my hearing loss (50 percent in both ears), but I resolved to accept the facts
and thankful that hearing aids were able to help me hear better.
Now I just live my life pretty much the way I did before and dont
think that much about having a loss of hearing. Im thankful it isnt
any worse than it is. Few people even know about it.

Simple Coping Strategies


Asking Others to Repeat
As we have seen, the first and most reflexive way people react when
they cannot understand is to ask the speaker or a convenient bystander
to repeat. The patients surveyed were no different. Three-fourths of
them admitted doing this as part of their listening strategy or as their
sole strategy. A few of them explain:
I am always asking person to repeat. Sometimes I have my wife
or others translate for me. Example: My doctor had a high voice
and she also had an accent.
To soft-spoken people I just say Im sorry and they repeat, no
problem.

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Sometimes ask person to repeat or say what I believe I heard
to check if I got the whole message correctly.
If Im having trouble figuring out what someone is saying I
will ask another person who is with me to repeat what the speaker
is saying.
Sometimes I ask others to repeat even though it irritates them.
I tell them that I forgot my hearing aid.
Sometimes they have to repeat, and talk clearer.
I ask my husband to repeat what I cant hear. It helps but it can
be exhausting for him. Some people do not have the patience to
handle a disability!
Sometimes I ask someone to repeat what was said.
I say What did you say? Others repeat. I can do my normal
tasks.
I have my wife answer the phone most of the time or repeat
message again if I cant hear.

Increasing the Volume


Patients admitted making good use of a volume control when available
to help them compensate for their hearing loss, although they didnt
claim this was a cure-all, since not everything has a volume control.
Nevertheless, there were situations where this simple act was reported
to help.
I need to have the TV loud.
Turning up the television helps but not if the background music is louder than the voices.
You can if by yourself, but this is not good if someone else is
with you.

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Yes. Increasing the volume was helpful.


Yes. I turn them up loud when I cant put my hearing aids in
(when my hair is wet after a shower). I turn the TV back down
when they are in.
Yes, clearer tones while listening to the TV or talking on the
telephone.
Yes, it helps in certain situations.
I was turning up everything sometimes to about 60 percent.
Now (with hearing aids) I only go to about 40 percent.
Yes, but the volume must not be too high to disturb family
members with normal hearing.
Need to turn up the radio and television when I dont have my
hearing aids in.
I can turn it up or boost, but still almost impossibleespecially if they have a foreign accent.
Yes, I turn everything up louder than my family would have
me do.
Yes, except if others are around.
It helps sometimes, but not enough to hear all conversations.
No. I lower them when wearing hearing aids.
Yes it helps except for music background on TV programs
and TV commercials.
I do not, because of my type of hearing loss (pitch). No matter
how loud, I cannot distinguish the words.

Lip Reading
A few of the patients reported using lip reading to improve their understanding. Few is the key word here, in that only 13 percent said this.
This percentage is likely misleading, however, because even people

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who claim not to use lip reading can and usually do understand the
unheard words of a football coach when his player fumbles the ball.
The point is that enough patients reported a benefit to show that lip
reading can be helpful.
I have used lip reading.
Do a lot of lip reading.
Im not good at lip reading, but I tend to try.
In some situations, I hear and understand better when watching lip movements.
Lip reading does help.
If I cannot see their lips, have their heads down, sideways and
behind me, I need someone to repeat what they say or have another person tell me what was said.
Apparently I do some lip reading.
Seeing who is speaking as I am deaf on one side I often dont
know who is talking unless I see lips moving.
Lip reading, I can hear better.
I try to read lips but its hard. I hate to have people keep repeating themselves.

Moving Closer
Some of the patients also noted the value of moving closer to the
speaker. As their comments demonstrate, not everything that works
has to seem like rocket science.
Try to have person get closer to your ears
I do get closer and ask for people to repeat. This does help.
I move closer to the speaker.

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One on one with friends and family helps a lot.


I sit close to people talking.
Yes, like getting closer.
Getting closer helps. It cuts down on asking for a repeat
dialog.
During my years in school I always had to sit in front of
class.
Prior to wearing hearing aids I would always try to position
myself to the softest speaking person. I would find myself gravitating more toward a person(s) who articulated well with a deeper
tone or quality to their voice.
Sometimes I get close enough to read their lips.
It is helpful to get closer and have a person repeat slowly.
I ask others to repeat and get closer to them.

A Bit More Planning


Many things that interfere with hearing can be circumvented with a bit
of planning. The biggest of these is background noise. Everything is
harder to hear and understand when its immersed in a noisy environment. This is true for people with normal hearing and especially true
for those with hearing loss. Rolling up a car window to eliminate wind
and road noise, sitting farther away from a fan or air-conditioning vent,
turning down the television when talking on the phone, and similar
acts can make it easier to hear. Consequently, it seemed likely that reducing or eliminating background noise would have been an often repeated tactic. Noise was clearly recognized as a problem but seemed to
prompt little action in everyday life beyond complaints about hearing
aids. Other plans to ease listening and understanding were also surprisingly limited.

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I try to be in smaller groups.
I sit in the middle of the table instead of at the end.
I find the proper seating at gatherings.
I try to avoid locations with a lot of background noise.
Right ear is better so I turn to the right side to converse. In
restaurant I sit in corner with back to wall. It reduces ambient
noise.

Most or All of the Above


Selecting a method that helps compensate for a hearing loss need not
be an either/or proposition. It can be whatever works and everything
that works. A person can get closer and have the speaker repeat. Neither of these options rules out adding lip reading or some other strategy. A person may instead find one thing to be most helpful in a particular situation and something different to work best when the situation
changes. Few of us would hire a carpenter who only knows how to use
one tool. Similarly, when it comes to hearing loss, people can find it
advantageous to have more than one tool in their toolkit.
Yes, getting closer, lip reading or having the words repeated do
help. Some people talk very quietly.
Getting closer and person repeating. Also I evaluate the situation. If I know what they are talking about I can usually follow the
conversation.
All three: lip reading, getting closer, and having person repeat.
Getting closer helps. Having things repeated. Looking at the
speaker helps.
Lip reading, getting close, cupping my hands behind my ears,
and asking people to repeat have all been helpful.

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Lip reading, leaning into the person talking, having the person
repeat.
Repeating and getting closer.
Lip-read, repeat, talk slower.
All of the above (lip reading, getting closer, having person repeat) at one time or another.
Use lip reading, getting closer, etc. when situation requires it.

Getting Help from Others


Coping with hearing loss need not be a do-it-yourself endeavor. In
fact, if one includes having others repeat, then coping with hearing loss
is more a group activity. Since others are already likely helping in the
communication process, wouldnt it make sense to enlist their aid in
ways that would be the most helpful? For instance, a person might ask
others to get his or her attention before speaking. One might ask business associates to leave important messages as e-mails rather than as
voicemail. The variety of ways that others could potentially help might
be limited only by a persons imagination. With just these few exceptions, however, those surveyed seemed more focused on what they
themselves could do.
I have the person face me.
Just having the person face me when speaking is a big help.
Getting closer, repeating, asking people to speak up or directly
to me.
If you let someone know about your hearing loss they speak
louder for you to hear.
In a joys and concerns time at church, Ive asked the deacons
to write down what is said.

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I have to have people face me when talking.
I just tell them I cant hear them in a normal way and they
respond.
Have wife listen for me or make calls etc. due to not being able
to hear.
If you ask in a nice way, people will respond.
Have person talk straight to me (not with head down in book,
looking away etc.) and repeat things.
Ask a person to speak louder, more clearly, or repeat.
I have found that if you politely ask the person you are talking
to to please speak up and or speak clearly, they will understand
and do what they can to help.

A few people, however, were opposed to the idea of asking others


for help.
I did not seek help from family members, co-workers or
church groups. I think you owe it to yourself to help and take
care of yourself.
I wouldnt expect help from others (except my spouse who is
very helpful).
No. I am very dependent on myself.

Technological and Medical Options


Help with the Telephone
As the story of Scott Wilson (chapter 2) and numerous patient comments demonstrated, hearing loss can make using a telephone difficult.
A standard telephone may not be loud enough, plus it can only be used
with one ear and doesnt allow for lip reading. All of this assumes, of

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course, that the phone was heard to ring in the first place. Several patients reported using an amplified telephone to overcome these difficulties. Also found helpful were speakerphones that allowed listeners
to use both ears and vibrating phones to make a person aware of calls.
Amplified phone helps a lot. You can control the volume and
the tone.
Use amplified telephone.
I use an amplified telephone. Yes it helps.
An amplified telephone is helpful in clarifying sound and minimizing feedback.
I use the vibrating function on my cell phone/pager when Im
in a crowd.
Vibrating phone.
I use the speaker phone.
I use speakerphone for phone conversation.

Wireless Headphones
Throughout the survey patients mentioned television watching as a valued activity, as well as the negative impact hearing loss has on it. If the
television is loud enough to overcome the hearing loss, it is often too
loud for others in the room. If it is comfortable for those with normal
hearing, then the person with hearing loss cant enjoy the show. Several
patients mentioned wireless headphones, with a separate volume control from the TVs regular speaker, as their solution for this dilemma.
Wireless headphones for the TV.
I use TV Ears [a brand name of wireless headset] for
viewing.

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Wireless earphones helped TV before hearing aids.
Wireless headphones.
I got wireless headphones attached to the TV so it doesnt
have to be so loud, but I cannot hear conversations when wearing them.
Headphones help because they block out background noise
and isolate what you want to hear. I tried them but not for long
because I moved closer to the TV.

Closed Captioning
Closed captioning is another option utilized by patients who struggle
with television listening. As they explained:
I use closed captioning for all programs that offer it. I had a
workable TV given to me but did not have closed captioning so I
gave it away.
Yes, closed captioning on TV. I can see words I dont hear
correctly.
Closed captioning, amplified telephone both helps.
Use closed captioning. It helps a little (usually cant read
that fast).
Closed captions help sometimes with complex dialog.
I use closed captions for some TV shows (i.e. British
comedies).
We use closed captioning so volume can be at a normal level.
I use closed caption on TV. Yes it is great. It sure does help.
I use closed captioning, also amplification. Headphones dont
usually work alone (cant hear as well) and using with the aids is
uncomfortable.

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Used closed captioning when watching movies. It is a distraction for rest of family members as well as myself.
Turn up the volume when by self, otherwise closed-captioning.
I use the closed captioning on TV. Yes, it does help. I would miss
a lot if I didnt have this functionbeen using it for thirteen years.
I always use closed captions when available.

Other Assistive Devices


A number of the assistive listening devices described in chapter 2 were
never mentioned by the patients surveyed. This absence of responses
was not from lack of asking. Patients just seemed to have little or no experience with these devices that they could discuss. The few that were
shared are listed below.
I use assistive devices at seminars, conferences. Listen to audio books in the car.
I use an amplifier in movie theaters.
I have a loud security system.
My alarm vibrates bed. I have searched out alarms with right
frequency. Also cell phone ring tones with the right frequency.
Church has amplifiers to wear if needed.
Church has a good sound system and offers electronic assistance.
Most people surveyed left the questions about assistive devices blank.
Those who did answer often had responses such as:
Dont have any of these devices. Dont use any of these
devices.

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Never have used any of the aforementioned.
I havent used any.
I suppose there are special devices, but I have never tried any.
No I dont use any.
No.

Sign Language
The option of sign language deserves some discussion, since it provides a workable alternative to spoken language. It is the primary communication method of the deaf community. Yet wherever possible
spoken language usually remains the communication method of choice
for those who are hearing impaired but not deaf. Having to learn sign
language is the first problem, but not the most difficult one. The bigger issue is that family, friends, co-workers, and the majority of people
in the surrounding community are unlikely to know sign language. It
can be like trying to use only French in an English-speaking country.
An interpreter could help bridge the gap, but try to find one when you
just drop in at the bank or the grocery. Of those surveyed, few reported
knowing or having tried to learn sign language. No one reported using
it in place of spoken language.
Ive tried off and on.
Tried but failed.
Have tried a bit. Not seriously.
Im trying but not doing very well.
I already know sign language as I taught hearing-impaired
children in school.
I used some in my teaching at school, but do not use it for
myself.

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Surgery and Medical Care


The information in this chapter has shown that patients used a variety of options for hearing loss that exist between doing nothing and
jumping into hearing aids. Before moving on to hearing aids in the next
chapter, however, it is worth mentioning again that for a few hearing
losses there are the options of medical or surgical intervention. Some
of the patients surveyed made this choice and offered comments on
their experience.
First let it be said that I have had chronic ear problems since
four years of age. My parents finally took me to ear specialist at sixteen years. Both ears had new eardrums. One earall three bones
replacedhelped for about fifteen years. I wore a hearing aid until
surgery. I then went twenty-five years before I had to start wearing
one again.
I have had two surgeries and two revision surgeries and I also
take medicine. It has helped enormously.
I have had many surgeries but I think the older I get my hearing gets worse.
When I had a virus in one earI had three injections in the
eardrum at different intervals. It helped.
Treated only when my ears become filled with liquid and I
need to get them lanced and liquid suctioned out.
Yes, two stapedectomies.
Yes. Stapedectomies in each ear for otosclerosis. I take three
tablets of Florical daily along with vitamin D. Had fifteen years of
good hearing before needing a hearing aid.

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6
The Hearing-Aid Experience

oud noise was the downfall of Jackson Jones, and hearing aids
were his penance. At least that was how he described it. Jackson had the start of a high-frequency hearing loss by the time
he was done with his military service in Vietnam. After that, he worked
for years in a steel mill. When the mill closed, he found another noisy
but well-paying job at a stamping plant for an auto factory. He also had
a side job several summers cutting grass for a lawn service. When not at
work, he liked to hunt, target shoot, and do woodworking. When asked
if he had used hearing protection through all this noise, his answer was
sometimes. His hearing had gradually worsened over time until it
reached a point ten years ago that he felt little choice but to get hearing
aids. He was on his second set and trying to decide whether it was time
to retire these five-year-old hearing aids in favor of new ones.
Mr. Jones wore his hearing aids through most of his waking hours
every day. Even though he wore them, he wouldnt admit to liking the
aids so much as needing them. They brought peoples voices up to a
volume he could hear. He readily acknowledged that they made life
easier at home and at the quieter office job he now had at the auto company. But he also made some of the same complaints offered by other
112

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users of hearing aids. The complaints didnt stop him from purchasing
a new set of hearing aids, this time Bluetooth compatible, but within
several months he was describing these new ones as his penance.
No hearing-related subject generated as many comments from patients as did hearing aids. People surveyed may have said little about lip
reading, flashing doorbells, or penance, but they were not at all shy saying what they thought about hearing aids. Do hearing aids work? Do
people actually wear them? Are they a lot of fuss? Are two better than
just one? What are the pros and cons? These questions almost always
prompted a response. This was true for people who used hearing aids
and those who did not. Even questions such as How does your hearing loss affect you? or Does your hearing loss affect others? were
often answered in relation to hearing aids. A hearing loss may not have
been considered bad enough for hearing aids or considered poor
even with hearing aids. Hearing aids were seen as not only something
to be judged, but something to be judged against.
Despite all of the attention hearing aids received, there was not
always consensus about them. There were at times a wide range of experiences and beliefs. Some people felt hearing aids were very helpful
while others found fault. More often than not individuals had mixed
feelings much like Mr. Jones. For a reader whose mind is already made
up about hearing aids, the observations provided in the following pages
could easily be used to support an existing view of them as either a godsend or a curse. For those who are open minded, the following pages
should provide a more nuanced, interesting, and useful perspective.

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Getting Started with Hearing Aids


Societal Perceptions About Hearing
Aids Often Seen as Negative
The views people hold about hearing aids in general serve as the background for how this technology is received. If hearing aids are seen as
a technological marvel like a smart phone or global positioning satellite
(GPS) navigation device, then people may be eager to try one. If on
the other hand the general perception is that hearing aids are big, ugly,
ineffective, or surrounded by negative stereotypes, then the prospects
for acceptance are not as bright. Unfortunately, evidence supports this
latter view that the perceived stigma of hearing loss and hearing aids
do negatively affect their use.1 Answers to the simple question How
do you feel most people view hearing aids? illustrate why this might
be the case.
Happy it is not them.
They tend to make fun of them. They connote them with old
age. They view them differently than eye glasses. Thats why I
never tell anyone I wear them.
As a crutch.
Most people see hearing aids as something related to old
people.
As a weakness.
Its a sign you are getting old.
Many people consider you handicapped. I never did. Most
people know I wear hearing aids and are very accommodating. I do
take some joking from some people but this does not affect me.
Something to avoid.

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Most people Ive talked to dont want to wear them, like they
are embarrassed to admit they need them. I definitely do wear
them and I tell them.
I think hearing aids have improved so much that people have
a better view nowadays . . . but some young people do make fun of
hearing aids.
You are getting oldsenile.
As a negative. View it as something expected in the elderly, but
not with someone younger.
As being undesirable and a social handicap.
Expensive!! And troublesome and I can attest to both. When
they work right, theyre wonderful.
Most people I know feel uncomfortable with them.
A bit troublesome and cumbersome to use.
They probably think only old people need hearing aids.
Most people view hearing aids as a necessity for older
people.
Some view you as handicapped and dismiss me.
Just something to help you. Most people wouldnt want one.
I grew up around hearing aids as my mother wore one. Its OK
with me.
I used to think one aid you had trouble hearing; two aids and
you were deaf. Now I dont care. I wear hearing aids on both ears
and am grateful that I can hear. I do not care what others think. I
want to hear!!
Most ignore. Others who need them either do not want to pay
the price, some want to save money for their grandchildrens college, or they do not want to be bothered taking care of them.

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Not All Perceptions About Hearing Aids Were Bad


In truth, not everyone held societys opinion of hearing aids to be negative. Slightly less than half (48 percent) of the patients surveyed saw societys view as unfavorable. Many responses were neutral (40 percent)
while a few (12 percent) were even positive. Yet when compared against
the range of negative perceptions, it is easy to see how the following
views can be overshadowed.
A beneficial necessity. I never found them to be embarrassing.
Vanity regarding hearing loss is dumb.
People are generally very tolerant . . . more so today than
years ago.
I think hearing aids are viewed positively as a way of getting
back in the mainstream.
Hearing aids seem so common today that most people, at least
those in my circle of acquaintances, accept them readily.
I think most people dont think much one way or the other
about them unless they need one.
Needed if you have a hearing problem.
I found everyone was gracious about seeing them in my ears,
no one said a thing about them. I was not embarrassed having them
either. It is your outlook that counts.
Because I am older most people dont think too much about
it. I think its great that people who have one have taken the steps
to do so.
As a helpful tool.
At my age they are commonplace.
Most do not even notice them.

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I dont know most of the time. If I dont care, they dont care.
Im extremely happy with mineimproved my quality of life.
I dont know anyone who has had a negative opinion of my using
a hearing aid.

Reasons for Delaying or Declining Hearing-Aid Use


As the introduction explained, at least three-fourths of hearing-aid candidates either delay or have no intention of getting hearing aids. Some
of this can be attributed to people being unaware of hearing difficulties or to their difficulties being attributed to folks mumbling or having
poor diction. Others know or suspect a hearing loss but for a variety of
reasons are hesitant to act. In the book Overcoming Hearing-Aid Fears:
The Road to Better Hearing, I detailed the many obstacles and concerns
that can stand in the way of hearing-aid use.2 These range from cost to
vanity, including nearly a hundred different concerns. Sometimes the
true objection to hearing aids is never known. A ninety-six-year-old
patient recently seen at our office provides a good example. She had
suffered with hearing loss for many years. It was a problem for both her
and her family. Yet when offered hearing aids, her response was simply,
Im just not ready yet.
Most of the survey participants (87 percent) wore hearing aids.
There were a few, however, who did delay trying aids and a few others
who never tried them. Their reasons are explained.
At first I didnt follow through; vanity reasons.
Embarrassment.
Cost of hearing aid. Plus how well does it really work?
Vanity!

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Fear and price. It had been recommended that I get two. But
insurance only covered one. I was afraid to only wear onefear of
not being able to get used to it.
Hearing loss did not seem to be serious.
Didnt think I needed it.
I just did not feel ready for them six years ago. I was in my
early forties and felt I was too young to become dependent on
hearing aids.
I could always ask people to repeat.
No. I had tinnitus and I figured hearing aids would only make
the constant ringing louder.
I was told by others that hearing aids are not the answer.
The cost. Hearing aids should not cost as much as they do.
First tried hearing aids in 1989 but they didnt help my sensorineural hearing losshavent worn them in twenty years. They
just made everything louderevery situation and noise was amplified. Actually, I have an appointment coming up to evaluate new
hearing aids.

Getting Used to Hearing Aids


No matter how well hearing aids work, it should not be surprising if
it takes a while for a new user to get used to them. Any amount that
hearing is enhanced beyond the level a person is accustomed to may
at first seem strangenot necessarily because it is unnatural or bad,
but simply because it is different. Also different might be the feeling of
having a hearing aid in the ear canal. Do people have difficulty adapting? Is it as natural as turning up the TV, as comfortable as wearing
earplugs, or is it more like a psychology experiment gone wrong? Perhaps surprising and reassuring is that more than half (55 percent) of

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the patients surveyed reported no difficulty adjusting to hearing aids.


Eighteen percent reported only a little difficulty, while the remaining
27 percent reported that hearing aids definitely took some getting used
to. Their assorted comments follow.
Did not have a problem adjusting.
No difficulty.
Only at first with different intense background noises.
No, they are a godsend.
Hearing aids must be properly fitted and that takes time. Some
noises were too loud until adjustments were made. Background
noise was also a problem.
Easy to adjust.
Actually, I had no trouble adjusting. You have to keep wearing them no matter what the situation. I know people who just
wouldnt wear them.
Not especially difficult, although my audiologist says my
ear canals are quite narrow so I have problems setting the aids
properly.
It took me about one year to get to the point when I could
forget their presence in my ear and accept the new way my voice
sounded to me as normal.
Yes, could be hurtful in the ear.
Yes at first, but then you become accustomed to them and its
like second nature to you.
No, I wished I had gotten them sooner, they have allowed me
to participate in conversations.
Could not adjust to hearing aid in ears. Could not get batteries
in, get in wrong place, could not get battery out.
Yes, but worth the trouble.

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Yes. It seems as if every little noise is magnified. I heard every
choir member turn the pages at church. The little noises are too
distracting.
I did not have that much trouble adjusting to hearing aids.
Yes. Something in your eargetting used to different noise.
Yes. They pick up outside sounds louder than what you want
to hear in front of you.
Somewhat, but I was willing to allow time for my brain (or
whatever) to adjust to the change. I learned from audiologist
(1) it takes time to adjust, (2) devices can be adjusted and (3) some
have capability for self programming and adjustment based on
usage.
In-the-ear bothered me more and itched. Now outside the ears
more comfortable.
At the beginning it was difficult in crowded areas, such as restaurants, so many people talking at once. But, I did not give up, I
was determined to get used to it. It does not bother me at all.
Still bothers me.
Not really. I have in-the-ear aids and they from the beginning
have been very comfortable to wear. From time to time I forget to
take them out at night.
Not the open-fit ones. Easy to adjust to.
At first it was difficult, but you can tell the difference and pick
up sounds you were not able to hear.
Yes, until I got used to normal sounds.
No it was quite easy for me. Best thing ever happened after
hearing loss was the aids.
Minor adjustment to difference in sounds.
It took several months to get adjusted to them. Sort of tinny
sound of your own voice is hard to get used to. When fitted with

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aids, try to give them time to work for you, and you to get adjusted
to them.
I honestly dont remember having trouble. I really needed
them!
They have helped, but I never have gotten to the point where
I can hear clearly.
Background noise, tires on the road when driving, but it was a
pretty easy adjustment because I could hear so much better.
A few patients reported trying but then returning hearing aids. Interestingly, difficulty getting used to them wasnt the primary cause.
I tried them early on in my life and rejected them because of
my young age.
Almost twenty years ago I was not satisfied with the performance of a new pair of hearing aids. I returned them and purchased a pair from a different company.
I tried in-the-ear ones on trial. Didnt like the tunnel sound.
Yes. Was teaching schooldid not help much, could not handle putting in and out, cost. I am wearing hearing aids now. Hearing aids help a lot.
I did try them for a month. I found my hearing to be improvedbut was not ready to have them. Plus at the time, cost was
a factor.

Living with Hearing Aids


Situations Where Hearing Aids Help
Hearing loss presents many problems to overcome. Understanding
soft-spoken people, hearing someone calling from another room or

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from far away, listening on the phone, hearing in background noise, understanding when in a group, making out foreign accents, and keeping
up when people speak fast are only a few of the listening challenges that
can be caused by hearing loss. Ideally, the goal in using hearing aids is
to negate these difficulties. But do hearing aids actually meet this need?
Are they a cure-all or do they solve only some of these problems? What
are the situations in which hearing aids were found to help?
Just in general everyday livingmeetings, company.
Watching a show or dining out with friends.
In a library, courtroom, etc. where only one person is talking.
I cant understand anything anybody says without them.
Church, TV watching, telephone, out to dinner (conversations). Any situation!
Before getting my hearing aids I had to turn up TV and radio.
TV level 21, I just got new aids, now TV is on level 12.
When I watch TV. When people speak to me on the phone.
Work, meetings, social relationships.
In a large group where people are talking from all sidessuch
as a restaurant.
Driving a car (traffic). Your TV doesnt have to be turned up
so loud that other people are bothered. You can hear without people shouting and its easier to listen on the phone.
Everyday activities, conversations, radio, TV. With hearing
aids I do not need to turn up the television or radio.
Listening to conversation in a crowd, being able to hear movies, etc. Hear sermon at church, just normal conversations.
They do amplify sound so that I can hear more.
I can hear the TV and hear what people are saying. You can
hear sounds now that you couldnt hear before.

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Listening to TV, chatting in restaurant, listening to speaker


during casual conversations, participating in meeting.
I cannot go without them if I leave home or have persons over.
Church services, concerts, meetings, movies.
Everywhere except in noisy crowds.
One-on-one conversation.
Listening to TV, music, hearing things in a distance.
They are helpful in almost all situations. I simply could not
function without them.
Especially helpful for hearing on the telephone.
In group conversations.
Normal conversations, phone, church, theater, TV.
All situations. Its great to hear what you could be missing.
They do me the most good when I have a quiet conversation
with people.
Hearing aids are most helpful in church or in school where
teacher may have high voices where most of my hearing loss is.
I am deaf without them.
Understanding a little better what is happening around you.
Conversations with my family and friends would be impossible and I would not indulge my love of music and theater without
hearing instruments.
At all meetings of my professional groups and family gatherings. It makes all relationships more authentic.
If not wearing hearing aids, difficult to hear/understand TV
programs and movies. Others have to repeat if Im not wearing my
hearing aids.
Before hearing aids I avoided plays and other performances
and really blasted TV volume chasing others out of the room. With
hearing aid do not worry about avoiding any situations!

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Background Noise Was a Problem


While hearing aids were reported to help in numerous situations, there
were areas where these devices were found to disappoint. An article titled
Why My Hearing Aids Are in a Drawer: The Consumers Perspective
detailed several performance-related issues.3 Background noise and
poor benefit were the two leading criticisms. People who purchased
hearing aids were found to have continued difficulty understanding
in some situations, and background noise topped the list. It interfered
with communication and was at times found to be overwhelming.
In this project there were also a variety of concerns, but one of the primary themes was similarly centered around hearing through background
noise. Even though the hearing aids did not cause the noise, they did
make people more aware of the noise that was already present. The unrealized hope or expectation was that the aids would eliminate background
noise altogether. This didnt happen. Some were also disappointed that
in a room full of people, the aids could not block out everyone other than
the person one wished to hear. When asked to name the situations in
which hearing aids did not help, noise was identified as the albatross.
I have difficulty following a conversation in a noisy environment.
When in a noisy restaurant or in large group.
Some TV shows with lots of background noise (cop shows).
Yard work and road noise when traveling or in restaurants.
Noisy sport events, large crowds.
Background noise is a problem. I dont know how to deal with
it sometimes.
Driving in the car. Many distractions. Picked up road noise.
Too loud for the closeness of a car.

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Riding on my Harley and cutting grass or wood.


Loud concerts. Wearing aviation headsets.
Crowd of people, music in background, movie theaters.
Running equipment or in any really noisy environment. Mine
are supposed to blunt background noise. They dont seem to.
If I am around lots of conversations, all of the voices are amplified and it is annoying.
Large groups of people with a lot of background noise; small
areas with music.
Hearing aids did not help in large crowds or outside when it
is windy.
I have difficulty where there is loud talk from many people.
Crowded rooms. Oy!
Some telephone conversations or if seated near a loud band,
music, hard rock etc.
In large crowds or a room full of people.
Outside on a windy day. Too much wind noiseespecially
when biking.
When there are too many people talking and background
noises.
It is more difficult in crowded settings due to multiple side
noises.
Dont like certain sounds like running water, crowded areas.
In a movie or places with too much sound and on the
phone.

Performance Issues
Noise was not the only problem reported with hearing aids. Some of
the other complaints could be broadly grouped as performance issues,

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although they did not form as coherent a picture as difficulties related


to noise.
They cant begin to compare to what God gave me.
Music isnt as good.
Movie theaters. Even though I wear a hearing aid I cant hear
clearly.
TV. Often dialogue is garbled! Outside in high wind. Talking
on cell or portable phone without speaker phone option.
At a band concert, but I turn off at least one.
Air transportation, crowded events, outdoor activities such as
fishing or skiing in wet conditions.
I struggled on the job. Hearing aids work fine five to six
feet back. In a classroom the students are usually much further
away.
Dont like high pitch.
Sometimes when people speak softly.
In groups, watching TV, someone calling to you from a distance or talking to you with their back turned.
Not having a special phone. Cant turn the volume up in order
to hear the other person on the line.
I take hearing aids out at the movies.

Other Hearing-Aid Concerns


People also voiced a range of additional concerns about hearing aids.
Of these, cost and battery life were the only ones that could be considered recurring complaints. These as well as a few final matters are
mentioned here. Cost and battery life crop up again elsewhere.

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Expensive, batteries need to be replaced, cant jump in the


shower without having to remove, ringing when I hug someone.
They cost too damn much. They are not worth the money.
I constantly lose my hearing aid because it is so little even
though I have a case for it.
When my hearing aids start to whistle I get irritated and turn
them off.
Sweating affected it.
I have decided to stay away from water sports to prevent hearing-aid damage.
Cost and length of usefulness before you have to get new ones.
Warranty period too short.
Financially it seems every few years I need a new hearing
aid so I try to stretch the time before I desperately need new
hearing aid.
Uncomfortable to wear and still do not have real good
hearing.
I do not wear them when working outside in hot weather because of uncomfortable sweating.
Battery doesnt last long enough. Also afraid to wear it when I
sweat (exercise or heavy work).
The fact that it is visible.

A Few Had No Complaints


There was also a small number of users who seemed completely happy
with their hearing aids. In response to a question that asked if there
were any situations in which a hearing aid was unhelpful, some of
these people left the question blank, and others stated their response

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explicitly. The comments from these few individuals, however, formed


a definite minority.
No situation.
It is always helpful.
None.
Only when they are in my dresser drawer.
Always helpful.
Always more helpful than not.

Pros and Cons of Hearing Aids


A review of the comments in the last few pages might lead one to
conclude that peoples attitudes toward hearing aids are in as much
agreement as political views from red and blue states. Many of the
observations were very positive, while at least an equal number were
just as negative. Unlike politics, however, it was not one ideological
group against another, but rather the majority of individuals holding
mixed views. Looked at one person at a time, most hearing-aid users saw both the good and the bad in these devices. They saw pros
and cons.
Pro: They help. Con: But not enough.
Pro: Hearing what you would be missing without them. Con:
Unable to use in certain activities.
Pro: Allows me to function fully as member of society. Con:
Difficult to hear some TV dialog. Cant use earphones, listen to
music on iPod, some phone conversations difficult.
Pro: Hear people at dinner, meetings, groups. Con: Makes
noises louder.

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Pro: It helps communication. Con: Expensive, somewhat


fragile, batteries seem to fail when you do not have spare(s) handy,
requires maintenancesometimes costly.
Pro: Makes life easier at home and socially. Con: Battery failures at inappropriate times.
Pro: Hearing more clearly and participating. Con: Negative
viewpoint of some people that those who wear hearing aids are
inferior somehow.
Pro: You hear somewhat better. Con: They are not what I
thought they would be.
Pro: Good communication. Con: Needs adjustment.
Pro: You can hear better. Con: They squeal when certain
frequencies occur. You have to be aware of them and make sure
they have not worked their way out of your ears if you are doing
much physical activity. Youre always buying batteries.
Pro: You can hear one person at a time. Con: Are uncomfortable to wear and you hear things you dont want to hear.
Pro: Hearing vastly improved. Con: Taking proper care of
the aidscleaning, storage, etc. The need to carry extra batteries
always. Occasional squealing. Harder to use a telephone.
Pro: I can hear most things. Con: Background noise and still
not being able to hear really well.
Pro: Being able to hear normal conversations, not feeling left
out due to missing part of conversations. Con: Too much background noise is a distraction, wearing glasses over them or laying
down to watch a movie.
Pro: They do help with hearing. Con: Sometimes they can
be a nuisance with feedback (whistling) if you are bending over or
like working under the car or something. Also have to be careful,
they can break easily.

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Pro: I can hear better. Con: Ugly, people notice, have to have
your hair cut to cover ears, too loud, too soft, dont fit tight, sweating is a big problem.
Pro: I can hear. Con: They pick up too much background
noises. Bothersome to use wearing a hard hat. Sweating affected it.
Pro: Hearing is a major pro. I could not function in daily life
without my aids. Con: Squealing, wind noise, clicking when eating or chewing, cant lay your head on the side, cant get wet.

Older Versus Newer Aids


As with other products, advertisements for hearing aids frequently focus on their being new and improved. There is little doubt that hearing aids have advanced a great deal over the past couple of decades,
most notably changing from analog to digital technology. Do people,
however, notice this change? The answer is yes, according to the authors of a recent study evaluating advanced digital hearing aids.4 They
found that 92 percent of users studied were at least somewhat satisfied with their digital aids. In comparison, earlier studies showed a
70 percent to 76 percent satisfaction rate.5 The few comments offered
here on the issue of older versus newer aids seemed to support this
conclusion.
Years ago it was more difficult to shut out background noise.
Now the aids are great if you have them fitting correctly.
They keep getting better.
The technology has come a long way.
They have changed a lot since the 60s.
I think they have improved so much over the years.

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Two Versus One


There are definite advantages to hearing through two ears rather than
just one. Being able to localize sound and moving from mono to stereo
sound are two advantages that easily come to mind. Less well known is
that the two ears work together to make sounds a little louder and that
using two ears makes it easier to sort out speech from a noisy background. The question here is whether patients noticed these advantages. Ninety-two percent said they did.
Two are better than one.
Absolutely. Two ears always hear better than one. The hearing
loss is also different in each ear (40 percent left and 30 percent
right). You need two devices to properly balance the sound.
Two are more effective. You simply hear more of whats going
on around you.
I always wear both, it balances out. Just wearing one doesnt
help much if you need them both.
No difference.
Two are definitely better because both of my ears are bad.
Two are better than one. It somehow allows you to hear conversations from all sides.
Definitely two are better than one. I used to wear one aid
and started using two and it makes a world of difference in my
opinion.
Obviously you have a better sense of sound direction. Why
would you just wear one?
Two. Better balance, quality of voices.
Yes, they are better together but it takes some getting used to.
Also some adjustment might be needed.

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Having two aids seems to produce a more balanced sound.
With one the location of a noise is distorted and hard to locate
and identify.
Yes. What one does not get the second one does.
Wearing the two together is always better than just one because
hearing clarity and balance is improved.
I own two. Wear one because two seem to interfere with my
hearing. I get an echo and hear my own voice louder.
Yes because sounds are more equal.
I need both of them.
Two are better, but if you could only afford one then one is
better than none.
I found just using one you dont hear as well.
Two are better than one because if you have loss in one ear you
probably have loss in both ears and the sound is better balanced.
Yes. My left ear is my best and I can understand with it. I cant
understand anything with my right ear alone but it helps me understand some words.
Yes, together. Strain to hear with only one.
Definitely, one broke on me and I had to revert to wearing one
and that was difficult, it seemed I was off balance.
If you have any loss, wearing two is better. I wore only one for
many years, but in hindsight realize I was not helping myself.

Frequency of Hearing-Aid Use by Owners


Do people who buy hearing aids actually use them or do they serve as a
space holder inside a drawer? The concern that hearing aids might go
unused is valid and frequently acts as an impediment to their purchase.

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Seventeen percent of hearing-aid owners were reported as non-users


in the previously cited study about satisfaction with hearing aids.6 In
our survey, a more encouraging 66 of the 67 people (98.5 percent) who
owned a hearing aid or aids reported using them at least some of the
time. These two usage rates cannot easily be compared, since individual
expectations, motivation, severity of the hearing loss, appropriateness
of the aids chosen, and numerous other factors can affect the likelihood
of use. Nevertheless, the higher usage rate in our survey almost certainly resulted at least in part from our insistence that the people who
purchased hearing aids should want them, and that they be returned if
they are not found to be satisfactory. The issue of wanting hearing aids
might seem like a given. Why would someone buy hearing aids they
didnt want? This can and sometimes does happen, however, solely
to placate a friend or relative. These unwanted hearing aids then go
unused. Focusing on motivated candidates and insisting that hearing
aids found unsatisfactory be returned likely decreased the total number
of people who owned hearing aids but almost certainly increased the
percentage who actually used them. Those who did wear their hearing
aids explained their usage this way.
I wear my hearing aids from 8 a.m. to 10 p.m.
I wear two aids daily. I could not function without them.
Yes. I do every day.
Ive worn hearing aids for forty years. I wear them from morning until bedtime. I couldnt function without them.
I wear both of them whenever I am awake.
Yes I do wear it. I have worn a hearing aid in my left ear
since 2000, and it becomes more important every day. Like my
glasseson in the a.m.off at bedtime.

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Yes, but not every day.
I need to wear mine pretty much steady, otherwise I would
have a hard time hearing.
All the time. Could not function without. Carry old pair as
spare when out of town.
I wear my hearing aid every waking moment.
Just in a group.
I usually wear them in the evening.
Yes except in loud machinery areas.
I wear them when I am going out to church, social activities,
etc. With the need to wear a hair piece, glasses, and hearing aids it
causes discomfort over my ears (aids are behind the ear).
All the time except bedtime.
Yes. I own hearing aids and I wear them every day, all day until
bedtime.
Wear daily. Wear my hearing aids from morning to night except sleeping, shower, using hair spray.
In most situations hearing loss is not a problem. I do not always
wear hearing aids. In certain situations they are neededchurch or
very large room with multiple speakers spread out across the room.
Yes, sometimes just one. Not always my choosing. Ive had one
thats worked fine from day one and the other has been a SOB to
keep working properly.
I wear them when I know I am going to be around other people for conversation.
Yes I do wear them even though I dont like it.
I have worn mine (both ears) for thirty-five years.
Sometimes. Dont like to put phone next to hearing aid while
talking on the phone.

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Always unless at hobby which is woodworking/dusty.


I wear mine morning till bedtime unless I dont want to hear
something (joke).

More on Overall Hearing-Aid Satisfaction


Even a quick skim through this chapter makes it obvious that there
are both good and bad aspects related to hearing aids. They usually
help a person to hear in some but not necessarily all situations. There
are also issues of cost and general bother. As such, overall perceptions of satisfaction become something of a balancing act. A detailed
study of subjective benefit and satisfaction with hearing aids agreed
with those previously mentioned and concluded that the scales tilted
toward the good.7 Specifically they found that 85 percent of current
hearing-aid users felt their aids helped quite a lot or very much
and that 90 percent believed their quality of life had been improved.
One measure of overall benefit and satisfactionfrequency of hearingaid use by ownershas already been discussed and argues in favor of
hearing aids. A perhaps more salient measurewhether users would
recommend hearing aids to othersis addressed in chapter 8.
A summary combining many of the issues discussed in this chapter was volunteered by one thoughtful hearing-aid user.
Hearing aids can be a nuisance to wear, care for, and eventually replace. It takes some time to become accustomed to wearing
them. It may be helpful to think of wearing them and living with
them as a challenge to be met rather than a nuisance to be avoided.
When properly used they improve ones quality of life and become
an asset to relationships with family and others.

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7
A Wish List

or as long as she could remember Mary Joseph had hearing loss.


Whether it developed in early childhood or was from birth she
couldnt say. The loss had been found during a hearing screening while she was in kindergarten, and she had worn hearing aids ever
since. Living with the hearing loss and hearing aids seemed perfectly
normal. It was all she had ever known. This is not to say that Mary
wouldnt like for some things to have been different. She wished that
children had not made fun of her when she was in school. She wished
her family members were more understanding and did not blame her
when she misunderstood things. She wished regulations that made
places accessible for the disabled included a requirement for better
acoustic designs and more accessories to help with hearing loss.
We all have wishes, and those suffering hearing loss are not any
different. A person might wish to eliminate his or her hearing loss. Another may hope that hearing aids can always help. Like Mary Joseph,
many yearn for support and understanding from family, friends, and
society. Wish, hope, and yearn are the key words here, because what
these people want may be difficult to achieve, unavailable, or financially
out of reach.
136

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Nevertheless, these wishes are important because they show the


hearing-related aspirations of those who are affected. They form a list
of things needing to be improved, changed, or developed. The patients
surveyed wished for societal and individual changes, for alterations to
hearing care and hearing aids, that they had done some things differently, and for a variety of hearing-related breakthroughs. Each of these
desires will be examined in turn.

Wished-for Societal and Individual Changes


Societal Reactions to Hearing Loss
Asking how society treats a particular problem such as hearing loss
can be misleading, in that the question implies a collective response.
Everyone with hearing loss is either treated well or treated as a secondclass citizen. Rather than working as a unified whole, however, society
often acts more like a schizophrenic centipede, with some or all of the
legs pulling in different directions. This indirection results in a range
of reactions to hearing loss and, as a result, mixed views of what does
or does not need to be changed. Earlier comments showed that the mix
of societal views about hearing loss leaned negative. This negative tilt
provided many opportunities for individuals to wish for some positive
societal change.
More acceptance from others.
More accepting of the problem and more tolerant.
I dont want my hearing loss to ever be brought up to me.
Just be willing to recognize it and accept people the way
they are.
Whats wrong with it now?

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Be more understanding. We didnt ask for hearing loss.
It doesnt bother me.
Less joking about it. More realistic expectations.
Be more considerate of this disability.
Other people have a tendency to not care about what they
themselves take for granted!
Maybe not to associate it with old age. Ads on TV/media often
portray the elderly with hearing aids.
I wish they would realize that no one wants to have hearing
loss and if the person has a hearing aid or aids and still has some
trouble. Be patient!
When younger people tend to pity you. As you age they think
it is all age related.
I think society responds to some extent.
I wish society would respond positively.
To be treated as a hard-of-hearing person instead of a mutant.
I think hearing loss is accepted more and more. Deaf education is improved and available for very young children.
I think they respond great. Society seems to have taken great
strides in making people with disabilities enjoy themselves.
You can only change yourself.
Need to respond to someone with hearing loss the same way
they respond to person with bad eyesight.
Hearing aids should be viewed the same as they do for
glasses.
Realize it is a medical condition and needs more accommodations.
It will go the way the stigma of wearing eyeglasses has disappeared.

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Respond as they would to vision loss corrected with eyewear.


Its a decrease in one of the senses and some accommodation on
their part is needed.
Dont always link hearing loss to old age.
Realize that it isnt just in the elderly.
I find most people understanding.
Be respectful of everyones needs or abilities.
I dont think I am any different. I can hear now because I have
hearing aids. If I dont hear them, I say Im sorry and didnt quite
hear that.
Have more patience.

Reactions to Hearing Loss from Family and Friends


A few comments about wished-for changes in perspective or treatment
were directed at family or friends rather than society at large. The gist
of these remarks was generally similar to those already offered.
Just understand the situation.
Not get angry if I dont hear them speak or misunderstand
what they are saying.
Maybe sometimes a little more patience.
They are empathetic and adjust to how they speak to me. My
mom wore a hearing aid when young and my dad later in life. Treat
it no different than vision loss, although not as common.
Be aware of my hearing loss, speak clearly and louder.
Be more patient with you if you dont hear or understand what
they sayor believe you when you say you cant hear them all
the time!

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Treat me like I didnt wear hearing aids. I do the same for others who wear them.
I expect others to accommodate my hearing loss when I remind them.
Try and be more understanding.
Be more considerate and patient. People in our society today
have a tendency to care only about themselves!
For them to understand it is just as frustrating for me as it is for
them. They can walk into my room instead of me coming to them
or just face me when talking.
It is very irritating when people walk into another room and
try to carry on a conversation with you.
They treat me great and I can pretend I dont hear them when
I want.
More patience.

Communication Help from Family, Friends, and Society


People with hearing loss wanted patience and understanding from family, friends and society, but they also wished for help with communication. Ideally, a person could ask family members, friends, and others
to speak or act in ways that would make hearing easier. Unfortunately,
family and friends may not always remember or be cooperative. The
situation is even less encouraging with regard to casual acquaintances
and strangers. These obstacles are the reason many of the following
statements remain wishes. But if they could come true, what communication help would be asked?
My close family realizes my problem and speak slowly and
clearly for my sake. I wish they all would do the same.

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Slow down and speak more distinctly.


Softer spoken persons could learn to speak louder.
Some people talk too softly. Others speak up but talk too fast.
Some avoid talking to you.
Speak clearly and louder.
People could speak slower and enunciate better.
Be courteous if you have to repeat yourself, look at the person
speaking and articulatenot mumble.
The only change I would make is that when they start a conversation theyd stay in the room and not go walking off somewhere.
It would be better if they would speak slower and enunciate
better.
Would like to be looked at, no mumbling, talking behind you,
repeat if needed without getting frustrated. Everyone should be
more aware of the challenge people have. Try to speak directly at
them.
Only to speak up.
Do not talk too fast. That causes the words to run together.
The whole world needs to speak slower!

Wished-for Changes in Healthcare and Hearing Aids


Changes Regarding Hearing Care
Rising healthcare costs, debate and confusion over new federal and state
programs, misunderstandings regarding the benefits and limitations of
private plans, the rat race of managed care, staying within network, and
limited access due to physician shortages are only a few of the problems confronting healthcare in general. Problems with the ear or hearing can require a specialist, adding the need for a managing physician

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referral or invoking specific coverage exclusions. Given all of this, what


changes did people wish from their physicians or healthcare?
I think the PCPs [primary care physicians] need to be updated
on options and who to refer to. A patient depends on a referral to
a specialist. It is hard to find a physician who will refer to the top
person in their field and not their golf partner.
It is confusing.
Making doctors more aware that allergies and allergy meds
can/could affect ones hearing.
Think of lifeall of lifebut with a piece missing and what we
can do to provide that missing link. Challenge the medical profession to challenge the colleges in regard to this particular issue.
I guess nothing. My experiences have been satisfying.
None. Make sure you go to audiologist.
Theyre doing the best they can.
Schooling for doctors to check hearing loss and not shrug
if off.
I would like to see more frequent testing for hearing loss to go
along with ear cleaning and ear exam.
A few of the wished-for changes in hearing care were related to
hearing aidseither the testing process or the directions from the dispensing audiologist.
When testing hearing they would be able to adjust your hearing aids to what the test shows to give me perfect hearing.
When getting hearing aids adjusted it is always in a quiet
surrounding. How can I possibly know if hearing aid is good
or bad?

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There needs to be more practical direction from the audiologist when it comes to choosing aids. Forget the sale. Do the best
for the client.

Better Education About Hearing Loss


Caring for people after they become sick or have a problem is not the
sole function of healthcare. Prevention is equally important, if not
more, and patient education serves as the first step toward this goal.
Chapter 5 showed that many people rely on their doctor or audiologist
as their primary source of information about hearing loss. Some of this
information would have focused on how to avoid or protect oneself
from loud sounds, since noise exposure is the number one preventable cause of hearing loss. Similar instruction is also provided in the
military and in the workplace. Several comments serve to illustrate that
these efforts were not always seen as being enough.
More education on hearing loss and using more ear protection. Did not realize hearing loss was affected by the loud noises
that I worked with every day.
Work needed to provide ear protection for loud noises. Thirty,
forty, fifty years too late.
Make earplugs mandatory for service personnel.
Better education for school children and adults.
I would like to see more emphasis on hearing-loss prevention.
Make the military take more steps to minimize hearing loss.
Encourage young people to use ear protection when using power
equipment (e.g., mower, blower, saws).
Educate the fine arts about sound tracks. Turn down
volume.

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Improvements in Hearing-Aid Performance


After even a quick reading of the previous chapter, it should be apparent that there is still much to wish for regarding hearing aids. This was
confirmed by the sheer number of wishes offered. Using wished-for
changes as a metric to evaluate hearing aids might be seen as unfair in
some respects, since even devices that look, feel, and function well do
not prevent the desire for something more or something different. A
person might have a perfectly good hearing aid but still think it would
be nice for it to glow in the dark so it would be easy to find at night.
Most of the suggestions made, however, concerned more mainstream
issues. None of the comments seemed to imply that hearing aids did
not help, but there were clearly wished-for improvements. The majority were related to performance or function.
Technology that would make aids perform like normal
hearing.
Able to hear two or more people at same time.
As they improve, less noise around earpiece. Always smaller
and not obvious that you are wearing one. The ability to somehow
block out background noise and bring conversations clearer.
Get rid of background noise.
Advance in separation of sounds.
Perhaps a way to just amplify voices and not all of the background noise. I only wore them at worknot hometoo many
distractions.
Nothing. I find them quite an asset.
Hearing aids that can get wet and that work better in a lot of
background noise.

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The discomfort of wearing them.


So that you could better adjust the hearing aids for close contact and for distance better than they are.
Hearing aids have progressed in the last few years. Keep working on improvements.
In-the-ear hearing aids without the tunnel aspects. The
price.
Aids that help more.
Blocking out outside or surrounding sounds.
It would be nice if the technology would evolve to limit feedback and allow easy use of the telephone and diminish further the
impact of noisy environments. It would also be good if their cost
could be reduced.
Smaller, fit totally inside the ears so no one notices them including yourself.
If I could afford a better hearing aid, that the batteries last longer, and I dont have to adjust as much.
Comfort level of wearing them.
I would like in my dreams a hearing aid that I could wear all
day and sleep with it.
Im happy with mine, but I wish they were less expensive. It
would be nice to have a hearing aid that filters out all the noise.
Would be great to have hearing aid that could be worn to bed
to sleep on. A person would not feel so vulnerable at night.
No feedback. No clicking. No discomfort when putting head
on side when laying down.
To have an off button so you dont have to open aids to prevent them from discharging.
Keep making hearing aids better.

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Better Hearing-Aid Batteries


The battery that powers a hearing aid was another subject of wishedfor improvement. Hearing-aid batteries last one or two weeks in most
devices, and this was frequently seen as inadequate.
Batteries would last longer.
Not having to replace batteries as often! Or rechargeable batteries. Not that the expense is that highbut for some it may be.
Longer-life batteries. Better clarity when volume increases.
Bluetooth integration.
Improve battery life.
Changing batteries too often is not as nice. Perhaps a longer
lasting one?
Battery life, cost, better way to adjust the volume and changing
the batteries. Old peoples fingers are less sensitive. It is hard to
feel that little wheel or the battery compartment opening.
Would be nice if batteries lasted longer.
Make batteries last longer. Be able to raise volume a little easier.
Longer-life batteries and filtering out background noise.

Greater Compatibility with Other Devices


Another occasional wish involved compatibility with other devices. This
is an issue most people associate with computers, but it can also present
a problem for hearing-aid users. One well-known example is older cell
phones. Some of these created so much interference that a hearing aid
could not function. Newer ones are sold with a hearing-aid compatibility
rating on the box. Numerous other devices can work with hearing aids
that are Bluetooth compatible. Hearing aids that have an incorporated

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telecoil can also process the magnetic waves that come from a standard
telephone or from an induction loop system that plugs into a television,
radio, microphone, or other audio device. These options can provide a
very clear sound with little outside interference. Unfortunately, as some
people describe, not all hearing aids have these capabilities and not all
audio devices will work with the ones that do. People wished for better.
Affordable Bluetooth integration in hearing aids. Durable and
effective ear or neck loops.
I believe the wireless aids are the answer to my problem.
Telephone/cell phones that could actually be used with a hearing aid.
Hearing-aid compatibility with other sound-producing devices.
Headphones that can be used without the ringing when you
put them on. I have over the ear hearing aids.
A lot of items say they are hearing-aid compatible. They
are not.

Improved Hearing-Aid Cosmetics


Not all hearing-aid wishes were related to hearing or performance. The
size of hearing aids and the desire to hide hearing-aid use were also mentioned. Interestingly, there were more wished-for changes regarding batteries than cosmetics. Relatively speaking, these few cosmetic concerns
could actually be a good sign about the look or visibility of hearing aids.
It would be nice to have them smaller, less conspicuous for a
woman but still be able to handle when one gets older.
I would like one that you could not see with short hair.

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Smaller but efficient aidsespecially when background noise
is present.
Out of sight.
They have done a good job making them smaller and not
noticeable.
Make them more inconspicuous.
Smaller hearing aids.
Invisibility.
An advanced hearing aid that could be implanted in the ear
that is not visible.

Paying for Hearing Aids and Hearing Care


One recurring wish regarding hearing aids and hearing care was affordability. For some the focus was on price while for others it was insurance. The price may have been seen as unreasonable or out of reach.
Insurance may have excluded coverage for hearing care or hearing aids,
or provided only limited coverage. An investigation seeking reasons
why millions of people in the United States do not use hearing aids for
their hearing loss found that the number one consumer issue cited was
cant afford.1 That was in 1993, when hearing aids cost much less.
Todays hearing aids generally range in price from $1,000 to $3,000
each, depending on the style, sophistication, and features. Regardless
of whether affordability was seen as an obstacle to care or simply as an
aggravation, many patients wished for something better.
They (hearing aids) wouldnt cost so much.
Make hearing care and hearing aids more affordable.
For most people, especially the elderly, many do not get hearing aids due to cost. Perhaps the insurance companies/Medicare

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should cover partial expenses. I know I put it off for a while due
to cost.
Im thinking in my situation, living on Social Security, I had
to take a great chunk out of savings. No one will let you make payments. A person with no savings has to take out a loan. It can keep
a person from getting them.
I wish hearing care and hearing aids were less expensive.
Cost reduction by hearing-aid sellerstoo much markup in
price. Provide more insurance coverage at affordable rates.
A cheaper but good hearing aid.
The high cost is definitely a deterrent for the geriatric
crowd.
Make hearing aids more cost effective for people on fixed income. Just bring down the cost!
Cost and that they would last longer and insurance to pick up
the cost.
Hearing-aid companies should discount batteries so you buy
their aids.
Hearing aids are too expensive. I did not have insurance. It
was all on me. Some people cannot afford them so wont even go
to the doctor for their problem.
Make hearing aids less expensive. Most people who are elderly
start losing their hearing and are on fixed incomes. Im on a fixed
income and cant afford a hearing aid as they are too expensive.
Otherwise I just live with the problem.
Insurance should pay for hearing aids for young persons.
Cheaper prices for hearing aids and cochlear implants. I would
like to see hearing aids covered by insurance.
I think there are newer and better hearing aids on the market
but I am not able at this time to afford them.

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Have a free clinic that repairs hearing aids or have the cost
lower for hearing aids. Basically money is an issue and some people just dont have the money for hearing tests or doctors to check
the real loss of hearing.
I think insurance companies should help with the cost. If they
can pay for meds that are fun drugs they should pay for the hearing aids to help people in everyday living. I am not one that wants
something for nothing but the cost of hearing aids is not cheap.
With todays economy I cannot afford the second one.
Have insurance pick up some of the cost. Especially senior
citizens, as the hearing loss gets worse as we age.
Why insurance doesnt cover hearing aids, Ill never know.

Second Chances, Breakthroughs, and


Other Wished-for Changes
Given a Second Chance
It seemed a good idea at the time is the way many of us describe
decisions that turn out to be less than stellar. Perhaps all of the facts
were not in when a decision was made. Maybe something changed.
As may frequently happen instead, people unthinkingly go through
their daily, weekly, monthly, or yearly routine without even considering whether they would be better off having done things differently.
Hindsight about these choices or non-choices can be enlightening. If
it were possible to do things all over again, what did people wish they
had done differently regarding their hearing?
I would have protected my hearing from loud noises, in the
mill and flying without hearing protection.
I would have seen my doctor earlier than I did.

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Hearing protection. It was not an issue in the 1960s or 1970s. I


was not aware of the consequences.
Yes. Get help sooner. My initial hearing loss was caused by a
severe ear infection. I should have gone to an ENT for treatment.
Tried to avoid certain military situations.
I should have admitted the reality of a hearing loss a bit
sooner.
I would have worn hearing protection in areas with loud noise
above that allowed in work, etc.
I would not ride an airboat. I would have worn earplugs as
often as I could have at work.
Get both hearing aids at the same time.
I wish I had gone to get tested sooner! Listen to others.
Accept it!
Too bad sixty years ago it was not known that second-hand
smoke caused hearing lossboth parents chain smoked.
Wish I knew sooner I had Mnires disease. Maybe I wouldnt
have hearing loss.
I would have went and got hearing aids sooner. Better late than
never.
Used (hearing) protection at a young age.
I would have gone to Dr. sooner. I put it off, but I still had
good results with surgery. I had fifteen years of good hearing before needing a hearing aid.
I would have worn something over my ears so that my hearing
would not have been damaged as bad as it was over time.
Probably gotten hearing aids sooner. Replaced old aid sooner.
I should have asked for Bluetooth-equipped hearing aids.
I would not have had surgery because it did not improve my
hearing and in addition to deafness, I have vertigo.

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Perhaps get a hearing aid six years ago. I have missed so much.
You dont realize how much you miss until you are able to hear
what others do.
I would have worn ear protection when working in a lot of
noise.
I have otosclerosis so I dont think I could have done anything
different. I have had many surgeries, but I think the older I get my
hearing gets worse.
I wish I knew about my doctor sooner rather than being the
third surgeon. I should have got the hearing aids sooner when I
could not hear multiple people speaking in a group.
Early in army life and later in a noisy workplace where hearing
protection was not stressed, I believe now that this may have been
the beginning of my hearing loss.

Wished-for Medical Breakthroughs


Amid the rise of shiny modern medical complexes, increased dollars
for research and healthcare, new pharmaceuticals, more accurate diagnostic tests, and innovative medical procedures, it might not be unreasonable to hope for something on the horizon that might benefit the
ear. But what something would those with hearing loss want?
Miraclesyouthful hearing restored.
Surgery to help nerve loss.
Looking forward to implants.
Solution for tinnitusplease!
That I could hear without aids. I would like it fixed with
surgery.
Employ nanotechnology to develop implantable devices.

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Have an implant to be able to hear all the time.


Implantable hearing devices.
Improved surgery that fixes neuroma like advised instead of
making deaf. Facial neuroma craniotomy made me deaf on left.
Was supposed to improve hearing loss.
A way to restore normal hearing without aids.
A cure for tinnitus. I thought everyone had head noise. I cant
remember not having it. I dont know anything I did to cause my
problems.
Wish there was a solution to nerve damage so I wouldnt need
hearing aids.
I wish there was a drug or surgery to restore my hearing to
100 percent, but I know thats not possible and Im just thankful
my condition isnt any worse than it is.
Restorative treatment for hearing loss instead of assistive
devices.

Changes at Work, Church, Theaters, Malls


People may have wished for medical miracles, but barring that, they
wanted to see changes that would make listening easier in public. Public venues are typically designed in a way that minimizes building costs
rather than maximizing ease of listening. Add a crowd and some background noise and even people with normal hearing struggle. Those
with hearing loss may be unable to cope. Not surprisingly, many with
hearing loss wished for reduced background noise, better acoustics, improved sound systems, or assistive listening devices in these settings.
Keep noise down as much as possible.
Theaters way too loud/same for concerts.

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Better quality microphones. People need to speak more
clearlymost mumble and dont look at you when they speak.
Yes. Have better acoustics so I can hear better.
Background noise is hard to eliminate!!
Church. The acoustics are terrible.
Less intrusive extra noise. Its hard enough to hear without
music blaring overhead for example.
Something to aid theater-movie goers.
Theaters might employ more closed captions.
High ceilings and plain walls are tough.
New schools are equipped for hearing loss, handicapped children. This is great!
Theaters could have earphones for the hearing impaired.
Background music on TV or movies could be stifled so things
would be clearer.
Church and theatersscrolling words/dialogs or audio enhancers.
Church. Some priests are very soft spoken.
Churches could tone down the organs etc. Theaters the same.
Makes me want to remove the hearing aid.
Meetings in very large, or high-ceilinged rooms need loud
speakers etc.
Additional advances in wireless and lower cost wireless
options.
Media could do away with the loud music which drowns out
the voices. Large areas/halls when speeches are being made could
be more tuned so voices carry.
Playing music everywhere is annoying. Theatersbackground
noise too loud.
The use of amplifiers in large groups.

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Sound systems are a bitch. Theyre often over modulated and


too loud. Cant understand a thing. Telephones arent really good
either, but thats in most instances the fault of the party youre conversing with.
Often microphones are not used in meetings, ceremonies, and
other situations in large areas. Actually, the church could probably have more microphones. They do provide hearing devices I
havent used.
Perhaps movie theaters could offer wireless headphones or
something for the hearing impaired to wear during a movie.
Place speakers around where possible.
Eliminate background music and general noise.
Yes. I find background music and sound effects especially
annoying.
Turn down the music at restaurants. I cant hear the person
talking.
Have more public buildings looped. Were forty years behind
Europe with this technology.
Have special earphones in theaters.
Microphones that are clear and for people who are using one
to speak into it while talking.

Wished-for Changes to Television


Closer to home, people wished for simple changes that would make
television listening easier or more comfortable.
TV stations need to eliminate much of the background noise,
music, etc. Very hard to hear conversations. TV shows could lessen
background noises like they reduced the volume of commercials.

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TV shows need to have much more clarity. So hard to understand conversations and know whats going on.
Keep background noise away from newscasts.
People need to be more aware of devices to watch TV with
other people.
Have commercials on TV not get louder than the TV
program.
Radio and TV commentators should speak slower.
Media should not be permitted to raise and lower the volume
for certain things like advertisements.
Commercials are too loud.
Keep background music not so loud or just not have it at all.
In old times, one was able to hear a movie because there was no
background music.

One might think something as simple as closed captioning would


need little change. Even here, however, there were a few areas of
wished-for improvement.
Closed captioning on TV would be synchronized with the
people and pictures all the time.
Large screens to read.
That closed captioning would be more convenient. Even some
new DVDs dont have it!
Put closed captioning on all TVs.
I wish the people that do the closed caption pay more attention and do a better job.

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Wishing for What Already Exists


The many wishes expressed highlighted issues that should be a concern or perhaps opportunity for family members, healthcare providers,
hearing-aid manufacturers, builders, broadcasters, event planners, and
everyone else who lives, socializes, or works with the hearing impaired.
However, a few people wished for changes, improvements, or breakthroughs that already exist. One person was unaware that closed captioning is already available on all new televisions. Several existing hearing-aid
features were also overlooked, such as active feedback cancellation to
eliminate unwanted whistling or a built-in telecoil that helps to make an
aid compatible with other devices. Because some advanced features are
available only on more expensive, high-end hearing aids, it is easy to see
how someone with limited finances or with insurance that would only pay
for a basic model might never have learned of Bluetooth compatibility or
feedback cancellation. Regardless, the wish here should not have been
for these options to exist but that they be standard or at least offered on
more basic models. One final example of wished-for assistance that may
already be available is that amplified headphones or other assistive listening devices would be provided at church, in theaters, and for movies.
Wishing can be good. Asking can sometimes be better. Ask friends
and family to speak up and speak clearly. Ask for patience. Ask the physician if a medical treatment is possible. Ask the audiologist about all
the hearing-aid features that might be helpful. Ask the physician or audiologist if there is a sliding fee schedule based on income or if there is
an organization or special program that might help to defray medical or
hearing-aid costs. Ask the television salesperson how to turn on closed
captioning. Ask the church pastor or movie ticket taker whether assistive listening devices are available. Asking the right questions might be
all it takes to turn some of these wishes into reality.

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8
First-Hand Advice

once overheard a patient in our waiting room telling someone all


about the bone-anchored hearing aid he had been using for six
years. He had seen another patient with a brochure for a similar
device and wanted to offer his advice. A whole waiting room full of
patients became a captive audience as he described the surgery, his
experience with the device, and what made him a candidate. He answered many questions (correctly, I might add) from the man with the
brochure and from his wife. He also answered questions from others in
the waiting room and showed them his implant and sound processor.
The guy was a walking, talking advertisement for the device and for our
office. That the patient had done well with his device was not surprising. That he was excited to tell his story to a room full of strangers was.
The end result was a reassured and better informed fellow patient, who
went on to get a bone-anchored hearing aid himself.
Sometimes there appears no shortage of folks willing to give advice. They may advertise in the newspaper, come to the door, call on
the phone, stuff the mailbox, spam your computer, or pontificate in
the work lunchroom. Most of this unsolicited onslaught is usually
well off target, having little relevance to anything an individual would
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want or need advice about. Even if the adviser does hit on an applicable pointin this case hearing lossthere is often little knowledge
or relevant experience to back up the opinions given. These unhelpful
views instead derive from overheard comments, second-hand stories,
and marketing hype.
Whats needed is real advice, accurate and useful. The man in the
waiting room who shared his experience provided a real-life example
of the kind of advice that is needed. Unfortunately it was not possible
to stuff an interactive version of this guy into the book, but there are
many patients who generously offered information and helpful advice
based on their own first-hand experience. What should someone with
hearing loss do? What can a person expect from hearing aids? Are they
worth the fuss? How can family, friends, or others help? These are a
few of the questions addressed in the pages that follow.

Advice About Hearing Loss and Hearing Care


Advice for Someone Who Suspects a Hearing Loss
What is the first step someone suspecting a hearing loss should take? Ignore it? Wait to see if it gets better? Send in cotton swabs? Run screaming to the hospital emergency room? Reports from those surveyed
showed that ignoring the obvious or delaying as much as possible were
some of the most common responses. But speaking now from experience, is this what they recommended to others? Apparently not!
Get it checked out ASAP.
Have your hearing tested by a competent professional.
Get it checked NOW! Let others know what you suspect (although they may already suspect it).

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Get it checked. You may be able to do more for yourself and
your hearing problem.
Not to put off seeing a professional. Go as soon as you think
you have a problem.
Having your hearing tested is at least a start to find a solution
to your loss.
Have your hearing checked. Find out what is causing the loss.
Wax, loud noise, etc.
Get to an audiologist for a hearing test first to determine bone
or nerve deafness or just a build-up of wax.
Get ears tested. Get hearing aids. Do as doctor tells you.
Get tested. See if theres something to help you hear better.
I would suggest they get a hearing test. Do all you possibly can
to get the help that is much needed.
Dont delay getting help. Get hearing tested ASAP. Time is
essential.
Get help from a professional. Get a hearing test.
When you have to ask a person to repeat and others can hear
what is said, its time for a hearing test. Have the hearing test by a
reputable audiologist.
Dont ignore it because it only gets worse.
Seek care immediately. See an audiologist or ear specialist.
I have such a friend and Ive told her to get a hearing test.
Find out what is causing the loss and seek help.
Make sure they get their hearing checked and if needed a hearing aid.
Get the best advice you can for the problem you have.
Be proactive and go to specialists.
Seek medical attention ASAP. Things probably wont get any
better, so accept your situation and seek professional help.

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Advice for Someone Who Denies a Hearing


Loss or Feels It Is Unimportant
Not everyone embraces the idea of hearing loss. In fact, some go out
of their way to deny it. Years ago I described an extreme but not unusual reaction.1 Rather than accepting listening difficulties as being
due to ones own hearing loss, some find it easier to attribute superpowers to others. A wifes hearing is so good that she can hear raindrops falling. A friend hears so well that he understands actors in a
play even when he doesnt sit up front. A daughters hearing is so
acute that she hears a siren even when it is far away. Failing to hear a
storm, understand a play, or be alerted by a siren are not recognized
as signs of a problem, but instead serve as evidence of feats of super
hearing by others.
Even if a hearing problem is recognized, it may instead be dismissed as unimportant. It doesnt matter if the television cant be heard
since there is nothing good on it anyway. Ive already heard everything
my husband/the children/the priest/my doctor/the salesperson has to
say. Why bother since the hearing loss isnt noticeable and doesnt affect anyone else. Attitudes such as these are common and were likely
held at some point by at least a few of the people questioned. But given
some experience, does denying a hearing loss, discounting the impact,
or attributing super powers to others still seem like a good idea? There
was plenty of advice.
Be real with yourselfhonest. It is not going to go away and
maybe there is help for you surgically, or if not, through a hearing
aid. Hearing is very important. You dont know till you lose it!
Let them know that its so much better to understand what
people are saying so you can stay connected. If you cant hear
everything you actually look dumb! Sorry but its true!

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Sometimes knowing someone else with the same problem(s)
helps.
If it bothers them enough they will get help.
He should get more information because if let go too long it
could turn into a serious situation.
Some people in this situation cannot be helped, stubborn and
set in their ways.
Try to show them what they are missing in life: human contacts, relationships, needless frustration for themselves, imposition
and harassment experienced by others.
You are missing out on so much. Denial is just one of the stages
before admitting you have a problem.
The longer you wait to get it fixed the more loss youll have.
Its not a sin, its a medical condition.
You cant change people. Some just do not want to admit that
they have a problem.
Being that I had to get help I would tell them what I went
through. I would explain how important it is to hear and get
help.
Do not put it off because it will get worse! Trust me I did.
Wake up! Lets go! Be proactive! Think about how it affects
others.
Youre annoying because I have to repeat everything to you. It
is important. It ages you.
Ive tried to help neighbor who refuses to admit problem and
I have yet to have any success. His family (children) have medical
training and they dont seem to have any luck either. So I guess Im
not a good source for this advice!
Advice wouldnt help if they are in denial.

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Learn how to deal with it. Denying it does not help the
situation.
Your hearing is very important!! The loss of it means you have
lost a part of you, your freedom, the person you are! Take care of
you. Take care of your hearing.
Depends on your relationship to themyou might refuse to
repeat for themsee if they can be convinced.
Patiently test and encourage. Test them by speaking in low
sounds so they experience the loss.
Let them see by my example how you can help yourself. Recommend seeing a professional. Dont wait. Youre missing out on
things you may not have to.
Continuing denial only detracts from your quality of life.
Ask if it doesnt bother them to miss so much of the conversation and if it does then go get checked.
Try not to be so vain as I am.
Tell them to get hearing aids as its a lot better than not hearing
at all.
My husband is a perfect example as his hearing is much worse
than mine, but he refuses to get a hearing test no matter what I say.
Uses all kinds of excuses such as ringing of the ears or complains
about the way they talk.
I would tell them it is so important, it can change your life. You
will want to do more things because you are able to hear.

What a Person with Hearing Loss Should Not Do


Occasionally it helps to look at a problem from a reverse perspective.
Surgeons, chefs, parents, and pilots among many others would likely

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agree that knowing what not to do can be just as important as knowing


what to do. One may simply be the opposite of the other, but sometimes
not. It therefore seemed reasonable after asking what people should do
about a hearing loss to ask what they would advise against.
Dont ignore the problem.
Get mad. Make people mad and shout.
Stay home, avoid social situations, going to movies, etc. because you cant hear.
Shooting guns, loud noise, big machinery.
Be in a loud setting without earplugs, cutting grass, concerts, etc.
Fail to take action.
Dont deny you have a hearing loss.
Avoid help. Avoid hearing aids. Not let others know your
problem.
Put themselves in a dangerous situation.
Ignore or try to muddle through.
Do not tolerate hearing loss to a point where it affects personal
relationships, work situations, enjoyment of recreational and social activities.
Dont isolate yourself because of it.
Avoid circumstances that might increase hearing loss, and
dont fall into denial that a hearing loss exists.
Not give up.
Dont try to hide it from others.
Get in situations where hearing loss is detrimental to person
or others.
Be around loud environments without hearing protection.

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Use a rifle or gun, use hair pins or other sharp objects to dig
out wax in ears.
Ignore it. Dont wait to check it out and act on it.
Do not deny yourself any of lifes pleasures.
Dont shower or swim with hearing aids in.
Take hearing aids out when you go to the beauty parlor. Cant
get them wet, wear them swimming.
Avoid thinking the problem will go away.
Dont turn up the sound unbearably loud.
Pretend you can hear what is going on.
A person with hearing loss should never let vanity play a part
in not wearing hearing aids. It is better to hear what someone says
to you than stare blankly or keep saying what?
Ignore the advice given to you as I did for many years.
Avoid wearing hearing aids in heavy rain unless protected.
Do not be in denial. Face up to their situation and know there
is help for thema new perspective on life.

Advice About Noise Exposure or Other


Preventable Hearing Loss
Part of the advice for what not to do about a hearing loss focused on
loud noise. When asked specifically about hearing loss from noise exposure or other preventable causes, the advice that was offered zeroed
in on the noise.
Stay away from loud noise.
I would advise them to be careful because it is difficult to socialize with hearing loss.

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Use your hearing protection.
Definitely earplugsbut if they could change their situation to
get out of itI would suggest that.
If at all possible find a job or other situation that will not damage your hearing. Nothing is worth losing your hearing for.
Wear your hearing protection. I discussed this with many people that I work with in an industrial environment, but to no avail.
Wear protective earphones. Once you lose your hearing you
can never get it back to exactly the way it was.
Wear earplugs. Turn the volume down. Protect your hearing.
Its precious and not repairable.
Use devices to filter loud noises. See an ENT for any ear problems (i.e., serious infections, drainage, etc.).
Get help. Insist on protective devices. Report abuses to proper
authorities.
Think!
Protect their hearing at all cost. You miss out on so much by
not being able to hear.
Cut out exposure to loud sounds, wear ear plugs when operating power equipment (lawn mowers, power saws, etc.).
Do whatever you can to protect your ears.
Make someone aware of the consequences.
If you can change it, then do so.
Use earplugs if possible. Avoid noisy environments.
Take all necessary precautions. Wear protective head/hearing
gear. Protect your hearing at all costs.
Warn them, but most people wont take the advicejust human nature.
In the presence of noise wear ear protectors. Follow professional advice to avoid hearing loss from other causes.

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Some jobs you cant do a thing to help. Constant background


noise.
Wear earplugs and avoid loud noises if you can. I rode an airboat in Florida one time which made a permanent difference on
my hearing.
Seek professional advice to minimize the risk.
Get the proper preventative equipment for the job. Avoid major construction where there is major noise being produced.
Wear earplugsalways.

Advice Regarding Hearing-Care Professionals


Most people surveyed reported having been evaluated by a local ear,
nose, and throat doctor or by an audiologist. A few others said they were
evaluated at a physicians office, hearing-aid center, or hospital, but were
uncertain as to what kinds of professional they saw. Remarks (good and
bad) about the professionals seen and the care received have already been
shared. A few patients also offered advice about what qualities or skills
they would recommend looking for in a hearing-care professional.
See a good doctor who specializes in hearing.
A person who takes time to explain hearing problems. Visiting
my audiologist several times a year has been most helpful.
Find an honest and qualified audiologist.
Seek professional help from providers who are reputable and
ethical and best qualified of the many available.
Go to a good M.D.
Audiologist and medical personnel helpful. Also others who
have gone through the process of getting it checked and getting
help.

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See a specialist, not a general doctor. Have hearing checked.
Go to a reputable hearing-aid centerone that will do more
than sell you hearing aids.
See the MD who knows what they are doing, not everyone
does! Listen to your MD for all options. Rule nothing out.
Talk with a doctor who is well versed on hearing loss.
Get help from the best available source.
Be certain the people you deal with for hearing problems are
professional and accredited.

Advice Regarding Non-Professional Support


Not everyone helpful to a person with hearing loss is a physician, audiologist, or healthcare professional. There are others who can provide
useful information or sorely needed emotional support. A variety of
recommendations were provided regarding who to turn to for this nonprofessional help.
Family, friends, and whoever they are in contact with a lot.
Spouse or a close friend.
Depend on the family.
Family, friends, groups, or anyone that you are involved with.
You would be surprised at how many people have the same problem but dont talk about it. Start the conversation!
Your friends and family can help you adjust.
Talk to a friend.
Perhaps relatives or friends who have hearing aids would share
experiences and advice.
Other people with a hearing loss.

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Family member, close friends, to be understanding, talk to person and see how loud they have to talk.
Ask for help from those you love and trust.
Family members could be helpful for support but they need
professional help also.
My relatives. The quality is OK but I need a professional for
exact information.
Church, family, and anyone else that they come into contact
with at work.
Church groups and support groups.
Seek out family members.
Other than professionals, I dont know of any support
groups.
Not sure. Maybe find others with hearing loss. Find out what
works best for them. Find out what hearing aid works from those
who already have them.
Family members, co-workers, church groups etc. Any one of
these.
Person should look for help where ever they can get it.
Seek support from family and co-workers. They will encourage you to get help and they will be patient and support you by
taking measures to help you hear them.
Family. Ask for advice.
Family, friends who are honest with you about your problems
caused by your hearing loss and from friends that have the same
problem.
Other people with hearing loss. Good information.

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Advice About Hearing Aids


Reasonable Expectations About Hearing Aids
Advice is usually about what one person thinks another should do,
but it can also be about what one might expect. Should a person purchasing hearing aids anticipate loving them? Might one instead foresee
them as a necessary evil, like bad-tasting medicine? What did experienced hearing-aid users advise as reasonable expectations?
Aids dont replace your hearing completely, but they make life
much easier, less frustrating.
Nothing is like God given ears and hearing.
Theyre not perfect because I dont hear and understand everything. But Im thankful they really do help.
When first getting hearing aids you will begin hearingoften
very loud sounds you have been missingbirds, doors, fans, heaters, other background sounds that most people who hear tend to
filter out. With hearing aids you will need to learn to filter again.
Dont get discouraged by initially overwhelming background
sounds. Also, if hearing aids seem not to be quite right, go get them
adjusted. Dont try to live with it. They can and should work.
Never perfect, but certainly feel like you are back in society
again with hearing aid.
Quality of life improves with hearing aids.
You will never hear the same again. It is not like eyeglasses that
can restore your vision to 20/20. But, the improvement with hearing aids is enormous.
Dont expect to hear and understand as you would if you had
no hearing loss.
Will hear much better with aids.

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I wear hearing aids. They help a lot but dont cure the situation 100 percent. One must be proactive. Pay attention and train
yourself to handle the situation.
You still arent going to hear everything and the background
noise is very distracting. But try them and try to get used to it. It
will improve your life.
Dont expect to hear whispering or low voices.
It is realistic to expect hearing aids, if recommended, to improve hearing. It is unrealistic to expect normal hearing with
hearing aids.
Living with hearing aids is much better than living without.
I have some friends who have serious hearing loss and they
live a normal life.
Hearing aids may not cure all your needs.
That they do helpsome. One can never be as good as they
were before hearing loss.
Unrealistic that hearing aids will return your hearing back to
normal.

Practical Hearing-Aid Advice


Hearing-aid owners offered a range of advice about using and living
with these devices. Some of it focused on perspective or attitude. Other
advice, such as being sure to carry spare batteries, was more concrete.
Several suggestions addressed hearing-aid questions a person might
not think to ask or that he or she might not learn during the nickel tour
to a physicians office or hearing-aid center.
Dont be ashamed to wear your hearing aid, you will be surprised how many young people need and wear them.

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Get hearing aids and let people know you have them. People
talk louder when they see a hearing aid.
It seems unrealistic to live with hearing loss if it is recommended by professionals that hearing aids would help.
If you cant hear with your own ears well, hearing aids are the
next best thing.
Get hearing aids and wear them! They are no good in the
cupboard.
Just live with it. Lot worse things to deal with than hearing
loss. Could be worse things you could have and nothing to help
you with it.
You have to want them yourself.
Unrealistic to think hearing loss will get better or that you will
hear better without a hearing aid.
As long as you can get along fairly well dont buy a hearing aid.
Get hearing aids. Live again. Forget cosmetics.
Most likely your hearing will keep getting worse. Keep on top
of it.
The only advice I can give is: Im so glad they make hearing
aids. I put mine in as soon as I get up and take them out at bedtime.
I forget I have a hearing loss. I even forget I have them in. I wish
they would fit better (short hair) as you couldnt see them behind
your ears. But I deal with it.
Take care of them. Clean them each night, have them cleaned
professionally and they will last much longer. They are very
expensive.
Maintain a program of regular check-ups for both hearing and
hearing aids.

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Keep up to date with the latest technology.


I use an induction loop. With the induction loop I seldom need
captions. I no longer attend movies unless the theater is looped.
I always carry extra batteries where ever I go.
Keep the aids clean. Keep your ears clear of wax. Hearing aids
are breakablekeep them in a safe place when they arent in use.
As your hearing worsens through the years keep changing
hearing aids to meet those needs.
Dont drop it. Dont wear it in the shower or swimming.
I would tell anyone getting hearing aids to make sure they fit
correctly. Its all about who you choose to do the molds and get the
right fit or correct type of aid.
If you need aids, get the best fit possible and wear them all of
the time!!
Everyone should own an induction loop for their T-coil aid.
Ive invited people to my house to hear the induction loop.
Be careful when applying makeup or hair spray.
Try different hearing aids to find the best one for you. One
hearing aid I had on trial was not helpful. Get another one.

Financial Advice About Hearing Aids


Hearing aids are a major expense that is often not covered by insurance. Most health plans do not consider hearing aids a medical necessity. Plans that do provide this benefit usually cost more, resulting in
individuals and employers opting for something cheaper than one of
these Cadillac plans. Traditional Medicare (at least currently) also
excludes hearing-aid coverage. Other than employees whose union
fought for a comprehensive healthcare package, individuals who paid

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extra for a higher level of coverage, former service members with veterans benefits, or those included under special programs for children
or the needy, most people are on their own and must pay for their own
hearing aids. Having lived with this reality, many patients offered financial advice about hearing aids.
Save your money. They are expensive and do help.
Look for a zero percent 12-month or 18-month loan to help
you spread (hearing aid) payments out.
It is expensive and an investment.
If you cant afford seek government aid.
Try to go the cheapest route because of the cost, but make sure
you get the correct help.
Thats a puzzle. Hearing aids are super expensive! Mine
are $2,000 each! Then on top of that are repairs at hundreds of
dollars.
Do not get a hearing aid from magazine ads, mail order ads,
etc. I encountered so many unhappy people with hearing aids.
Some had paid $$$$ for their hearing aids and cannot hear. One
man has eight different aids. They are buying them from magazine
ads. Save your money to buy a good hearing aid.
Buy the best no matter what the cost.
Sometimes your insurance can be helpful depending on who
you are covered with.
If insurance companies dont cover them, see about financing
them, getting a loan, etc. Dont put off getting them due to cost
alone.
Talk with your doctor if you cant afford hearing aids. They
should work with you.
Dont go the cheap route.

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Get the best hearing aid you can afford. Get one that you feel
comfortable with so you will wear it.
Determine if hearing aids and hearing tests are covered by
your health insurance programs; consider insuring your hearing aids.
Pay close attention to what you pay. Check around for price.
The cheapest may or may not work for you.
Be ready for a lot of expenseGetting hearing aids, maintaining hearing aids, and buying batteries.
Dont buy devices that promise the world yet cost very little
you get what you pay for. However, some folks I know have really
been duped by spending lots of money with little results.
Get best-quality hearing aids you can afford. Good hearing
should be a financial priority.
Watch for those hearing-aid batteries on sale.
Plan for hearing-aid replacement every three to five years.
See if medical coverage will help. Most do not. Would be a big
improvement if health programs would pay a portion.
If you cant afford hearing aids, put it on the credit card.
Small church groups are often looking for projects. Steering a
friend to seek a chairperson for a prospective money-raising project where doctors and costs are already analyzed and noted.
Save up money to get hearing aids. People dont have $3,000
to $4,000 around for hearing aids. Insurance does not cover this.
Maybe we should lobby the insurance companies to have this as
coverage.
People spend money for big TVs, expensive cell phones etc.
but what good are they if you dont spend the money for your hearing so you can enjoy the other things!
Check all options.

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Recommending Hearing Aids to Others


Hearing aids could be judged on a variety of criteria. The one most
explored in chapter 6 was perceived benefit. Did users hear better with
than without these devices? Another useful measure examined was frequency of use. Did people wear their hearing aids or stuff them out of
sight in a drawer? The consensus of opinion for both benefit and use
was found to be favorable toward hearing aids. One final factor worth
considering is whether people who use or tried hearing aids would recommend them to others. Of the 67 patients who owned hearing aids,
64 (95.5 percent) said they would recommend them to others. Two of
the remaining three people with hearing aids left this question blank,
and only one recommended against hearing aids because of not having
done well himself. Perhaps more interesting than the percentage saying
yes or no is why.
Yes. Get hearing aids. At least it will help more than not having
them.
Of course. Why miss out if you cant hear.
I definitely would recommend hearing aids. I can explain my
situation and how it helped. Testimonies are a great thingespecially from a person who has been in their situation. I lost half of
my hearing and there are sounds I never heard until I got my hearing aids. Its a joy every day that I can hear so well.
Yes. The way you hear things will change the way you see
things.
Yes, without them I am lost.
Yes, if they need them. The tiny ones like mine are programmed
to amplify only the sounds I cant distinguish.

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Yes because they are very helpful and you dont have to keep
saying I beg your pardon or whats that you said.
Yes, it makes it easier to socialize.
Yes, definitely. It will open up a whole new world to you. You
really should hear what you are missing. I hate to take mine out. I
feel helpless without it.
Yes, I can now have TV volume lower and hear conversations
in groups.
Definitely yes. If you have hearing loss, hearing aids definitely
help.
Yesif they help! Dont know or realize what youre
missing.
Yes. You are missing out on too much of life.
If needed and can afford themdefinitely.
Yes. They are a tremendous help and are a wonderful piece of
technology.
Yes, if they need them. Why struggle to hear? Asking others to
repeat annoys them.
Yes, if testing supports their use. Quality of life can be greatly
improved.
Yes. Youll be a more compatible mate.
Yes. Even just giving them a try for a month until they are ready.
They really do make a difference. The longer you wear them the
better it is.
Yes, but only if the person gets tested by a professional.
Yes, yes, yes. If you need hearing aids get them. After I got over
the shock of my needing aids, it was the best thing that ever happened to me.
Yes. Hearing loss leads to other complications.

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Yes. I saw how they helped my mother. Im in the process of a
trial period for a hearing aid.
Yes, at any and all costs.
Yes, absolutely. Dont live with hearing loss, get hearing aids. Protect your hearing and swallow your pride if you need hearing aids.
Yes. Its so much better to hear someone clearly. If you dont
wear aids and need them you will gradually isolate yourself from
others. As long as I wear my hearing aids, keep them in good condition and wear them always my life is good and I am able to lead
a very normal life.
Yes, it is worth the money or seeking other help to get a hearing aid.
They are not worth the money.
Yes most definitely. Have hearing evaluated at a young age and
use aids as soon as necessary.
Yes, they help a lot. Having hearing aids is a lot better as you
can hear what is said a lot of the time and not have to ask for it to
be repeated so many times.
Yes, life is difficult with hearing loss.

Additional Advice for HearingLoss Sufferers and Others


Advice for Living with Hearing Loss
The last question on the hearing-loss survey asked for final comments
or advice for those with hearing loss. These comments, along with
some general advice, provide a good overview of the range of issues
that were considered important. Most ideas were touched on earlier
in one way or another, but these explanatory and concluding thoughts
still deserve mention.

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Deal with the facts, get professional help, and live life to the
fullest.
Let others know of your inability to hear. Ask if they would
speak clearly and loud enough and face toward you.
Look at people when talking.
Have someone with them who can repeat in a louder voice.
Make sure you heard what you thought you heard.
Watch, pay close attention while driving or walking outdoors.
Hang in there and dont go bonkers; bite the bullet and get
hearing aids.
Help is probably available. You will be more confident and your
friends will be relieved that you are not such a burden to them.
Your hearing is very important to you. You may not be aware
of what youre missing.
Take care of your hearing.
Let people know if you dont understand what they say.
Be patient.
Dont be afraid or embarrassed to let people know you have a
hearing problem. Remind them to speak to you face to face and not
scream at you. If at all possible get a hearing aid. You will love it.
It is not something you should be embarrassed about or prevent you from living life.
Get the best care you can.
Always sit in the front row or near the front at meetings,
church, etc.
Make the best of it with help of aids. It will work out.
Dont be ashamed to wear a hearing aid.
Have patience and wear hearing aids all the time. Not just on
special occasions.

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Do not deny the presence of hearing loss and be assertive in getting a correct diagnosis of the cause. If hearing aids are prescribed,
be persistent in learning how to use and care for them.
Do what is necessary to protect the hearing that you still
have.
I try to use common sense and manage certain undesirable environments, however, I try to live life to the fullest.
Just let people know you have difficulty hearing. Most people
will speak up a little louder. Dont be reluctant to say I have a hearing problem.

Advice for Friends, Family, and Others


Folks who live with or know someone with hearing loss often want to
help, but may not know how best to proceed. Because hearing loss
can be a touchy subject, they may also be hesitant to ask. On the other
hand, individuals with hearing loss may avoid offering advice so as not
to impose on others or draw attention to themselves. The end result is
often poor communication and little help. Fortunately for those interested in helping, some of the people surveyed explained exactly what
they would most like from others.
Speak up. Always get their attention before starting to talk.
Speak up a little and dont drop the tone on the last few words.
Also, speak a little slower.
Look at people and dont cover your mouth when talking.
If you know someone with a hearing loss dont mumble. Raise
your voice slightly and pronounce your words distinctly. Look at
them when you speak.

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Be patient, they did not ask for this to happen. Educate them
when you can, help by being their ears for sounds/noises they cannot hear.
Try to speak more slowly and better diction.
Learn to tolerate asking you to repeat sentences. Also tolerate
loud TV, radio, etc. Speak clearly to them.
Be understanding! Take your cues from the person.
Help them to avoid denial of the loss. Help others understand
what conditions are best for understanding conversations. Make
an effort to face them and speak distinctly when communicating.
Minimize background noise (radio, TV, running motors, etc.)
when talking.
Just be patient and find best way to overcome.
Dont talk to them or ask anything from another room or when
walking away from them.
Keep trying to have person seek treatment.
Speak louder to them.
Be patient. Try to be accommodating. Look at them when talking. Go into the same room when speaking as well. Dont become
angry or frustrated with them.
Be patient. Never make fun or joke about it. Encourage the
person to get help.
Be patient, talk slower, get closer, talk louder. Solicit patience
from them. Ask them to help.
I would appreciate patience and kindness.
I would like them to get my attention rather than just blurting
something out and to let me know what they are talking about so I
dont miss anything while trying to figure out what they are talking
about.

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Make sure the speakers work at church and at other social
programs.
Give support.
Be patient with their lack of hearing and frustration. Encourage them to do something about it.
Need to be as supportive as possible and most really are!
Be patient and speak slow and clearly. Most people dont understand hearing loss. They think all we need is more volume. In
my caseand I understand most peoplewith nerve damage, dont
need volume so much as clarity. People who speak slow, clearly, at
an even tone, are blessings to mealso few and far between.

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9
Advice from Spouses or Significant Others

he point of view expressed so far has been primarily from the


person with hearing loss. A change in perspective, however,
might be helpful. As Donald Rumsfeld famously (or infamously) noted in a 2002 press briefing: There are known knowns;
there are things we know we know. We also know there are known unknowns; that is to say, we know there are some things we do not know.
But there are also unknown unknownsthe ones we dont know we
dont know.1 While not spoken with hearing loss in mind, these logical
conundrums nevertheless apply. One cant assume that just because
a person has hearing loss he or she will fully recognize the impact, be
acquainted with all options, or accurately assesses their effectiveness.
Unknowns can and often do remain. Some of these unknowns can be
reduced, however, by looking at the problem from the perspective of a
spouse or significant other. They can provide a reality check.
Spouses and significant others also deserve input because hearing loss is about more than the individual afflicted. A spouse may in
many ways be a solution to the hearing loss by repeating words, taking over tasks that require good hearing, or as the motivating force in
seeking help. A significant other may instead suffer as a result of the
183

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communication breakdown and reduced interaction that occurs. Both


ways, spouses and significant others are involved.
Helen Grant certainly was involved. As she explained, I just told
my husband where to go and what he should do with himself. She
didnt say this in order to be mean but as a way of showing that she
was the impetus behind his hearing being checked and then his getting
hearing aids. Mr. Grant knew he had a hearing problem. He recognized
that there were times when others heard things that he did not. Nevertheless, he wouldnt have done anything about it if his wife had taken
no for an answer. Mr. Grant said he wasnt happy about her insistence
at the time but is now grateful for the improved hearing. Her perspective and advice mattered.
This chapter provides perspective and advice about hearing
loss from over twenty spouses or significant others. Not surprisingly
spouses did not always share the same views as their hearing-impaired
partner. Their views help develop a better picture of the problem and
what they felt should be done.

A Second Look at the Consequences of Hearing Loss


Recognition of the Problem
Did the hearing-impaired people surveyed truly recognize how the loss
affected them? The answer here should have been yes. All of the people included in the survey had a significant hearing loss, came to our
practice for an evaluation, and acknowledged hearing loss as the reason
for the visit. The many difficulties described in the preceding chapters would also seem to confirm clear recognition. But did spouses and
significant others agree with this seemingly obvious conclusion? The
answer was not always.

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Yes he does. He knows that he cannot comprehend especially


if there is background noise.
Yes. Hes the one who told me he has trouble with pitch while
singing.
Yes, but its not admitted. He doesnt feel theres a problem.
Hes used to this. Family will recognize, but strangers are not aware
even at doctors office.
Sometimes.
Now he does.
No. My husband doesnt feel that he has a problem. He says
that people, especially me, talk softly to him on purpose.
When she doesnt hear things right I tell her.
Just a little, has a habit of saying the person talks softly.
No. Says people talk softly.
Yes. Because it not only takes over his life but mine also.
Oh yes. She cannot communicate with people at a table in restaurants if there is too much noise around us. Also has difficulty in
large room settings.
Yes. He becomes extremely anxious and it is visible. He may
also be cranky and almost always offers an excuse why he didnt
hear: I was around the corner, had my head in the closet, TV was
making too much noise.

Communication Breakdowns Were Obvious


Partners saw everyday communication as the first casualty of hearing
loss. The perspective was a little different from that of their hearingimpaired spouse, but the general conclusion was the same. Whats
more, the observations below show that the understanding difficulties

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were obvious to spouses and significant others. Anyone who thinks


untreated hearing loss is an invisible condition that will go unnoticed
by family, friends, co-workers, or acquaintances might consider the following observations.
Yes, he doesnt hear what other people are saying. Sometimes
he thinks he heard something but it wasnt what was said. Also he
loses interest in conversations.
The guys on the construction crew sometimes have a hard time
getting my [spouses] attention or theyll make jokes about it.
Yes. He misses a great deal of conversation. He probably
doesnt realize how much he misses. Hes good about it if I tell him
what the other person is really saying.
Sometimes cannot hear.
Yes in that people speak too softly, or not clearly or too fast.
He hears some of what is said then guesses the rest.
Unable to carry on a conversation. It is a problem when in a
group and he misses what is said. We get stupid answers when
questions are misunderstood.
Difficult time understanding the kids (high-pitched voices).
He gets frustrated asking people to repeat themselves. Must be in
same room and looking at him when you talk.
Conversation is limited when hearing aid is not wornmust
repeat many things to make sure they are heard.
You have to repeat the questions sometimes to him.
He has a hard time hearing in a large crowd or if loud music is
being played.
I have to repeat myself and speak louder than the television.
My wife has difficulty hearing/understanding me!

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It seems that sometimes when I say something she hears something else than what I said.
Sometimes she cant hear what Im saying. I need to repeat
myself.
He does not hear what most people are saying in a room full of
people. I tell him what the TV is saying.
He asks for things to be repeated.
It is a problem in the workplace and at home.
He hears part of a conversation and makes up what he doesnt
hear!
When he does not wear his hearing aids, I cannot talk
to him.
He doesnt hear words correctly and has to turn the TV up
real loud.
I sometimes repeat what someone has said or point to what is
being talked about. I try not to answer for him, but sometimes I do.
We adjust the car speakers with more volume on his side.

Other Ways a Person Was Seen to Be Affected


Misunderstanding was not the sole problem identified by spouses and
significant others. Some issues previously detailed by those with hearing loss such as dependency, withdrawal, safety, as well as other concerns were similarly noted by partners. Spouses recognized that the
impact of hearing loss went well beyond the sufferer saying what?
He has become a bit antisocial when he knows the atmosphere
is going to be difficult for him.
He cant hear things and gets mad.

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The television is very loud. Car radio is loud also. He must be
looking face to face to see that youre speaking. Hearing loss has
worsened and is worse in one ear. Im concerned about emergency
situations.
He feels he has to depend on me.
Not hearing ringing of a phone, doorbell, sleep machine going
off, smoke alarm.
The TV is very loud!
He sings and has some trouble with hearing pitch.
My spouse has been a choir director and band director since
his college days. Because of his hearing loss, he doesnt feel he can
hear all of the highs and lows to make sure a group is well balanced
in sound. With hearing aids his own instruments sound terrible
and sometimes his own voice sounds badly to him. He becomes
frustrated and sometimes anxious when not hearing well. He has
given up conducting and giving private lessons. It is hard to watch
music leave his life when he loves it so.

How Hearing Loss Affects the Significant Other


By now it should be clear that the question is not whether a persons
hearing loss might affect a spouse, but rather how it is likely to affect
the spouse. Several years ago I was witness to an unforgettable example when a man was evaluated for hearing loss at our office. He had
been brought in by his wife and teenage daughter. They were frantic
for help. They reported that the man had a severe hearing loss that
was then confirmed through testing. His daughter said the television
at home was so loud that she had difficulty studying and that if friends
visited, she could not hear them. Regardless of where in the house she

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went, the noise was overwhelming. His wife said her husband would
do nothing to help himself and that she was held responsible for whatever he could not hear. Everything misheard was her fault. She was
essentially a slave to his hearing loss. The man was an imposing figure.
He was tall and beginning to gray, and had a deep, commanding voice
and the build of a professional wrestler who had let himself go. His
demeanor was almost as good. All of the pleas for assistance from the
wife and daughter were made easily understandable by his response to
their concerns and to his test results. I dont have a hearing problem,
he boomed. I make it other peoples problem! He was serious.
Fortunately for everyone, the average person with hearing loss is
not likely to be so demanding, controlling, or obnoxious. Nevertheless,
a persons hearing loss can and does affect others. Even if produced
unintentionally, the effects are real. An examination of more than four
hundred older married couples drawn from a large well-known epidemiological study concluded that spouse hearing loss increases the
likelihood of subsequent poorer physical, psychological, and social
well-being in partners.2 While the experiences from spouses and significant others described below are not as alarming as the conclusions
from this cited study, it is possible to understand how these encounters
could result in stress and negative effects.
As a wife I have been trying to speak to him in a normal tone
and slowly. We no longer go to places where there are lots of people.
Birthday parties, weddings, things of that sort. I have to learn to be
more patient and pronounce each word more slowly. Sometimes I
forget and have some exciting news and I blast off. He does not get
what Im saying. I realize and start over and talk more slowly. We
have learned to live with it.

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I have to repeat to him what others have said. And I usually
have to repeat myself at least twice.
Sometimes I have to translate to explain what someone says.
I always sit to his right so he can hear me when I repeat what
he misses in conversation. Its just another long-term wifely duty.
I also do all of his telephone answering and direct his attention to
anyone wanting to talk to him.
I have to attend to more things so that things are understood
correctly. I get tired of repeating.
Im not heard and must repeat information to spouse.
She asks me to repeat things or turn the TV up or radio.
I make most of his phone calls and help with ordering in restaurants or I am a go-between in other situations.
Having to repeat over and over again.
It is hard to carry a conversation with him if there is noise
around. You cant talk softly and have him hear you.
I act as translator. Its hard to have a quiet conversation
when others are around. When eating out, he chews and cant
hear so we sit quietly. He gets impatient when he cannot understand me.
We all (family and friends) just repeat what we have said and
try to face him directly. Sometimes I forget he is behind me or has
one or both of his hearing aids removed.
I am often not heard and have to repeat what Ive said.
Sometimes I have to repeat what others say. I have to remember to be in the same room when we talk. I go into another room
when he watches TV and has it too loud.
I have to know if he hears what I say or understands what
others say.

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Yes. Yes. We get tired of repeating. I have to tell him what people say.
I have to speak louder and close to her. If she didnt answer
something I said or asked and she is thinking of the answer, Im not
sure she heard me unless I ask her if she did.
Sometimes for others. For me yes because I am his ears
constantly.
Yes. Because you constantly have to translate back to him on
what everyone is saying.
You always have to repeat what others are saying.
Sometimes I repeat something that someones said that I know
he didnt catch. I let subjects go when I realize hes not hearing
enough to understand me and that my explaining would just frustrate him.
Sometimes he will turn volume up on our phone. Big surprise
when I use it or big wait a minute if he uses it after I have had it
turned down.

Hearing Loss and Relationships


Good communication is often touted as being the key to a healthy
relationship. It lets people share experiences and activities. It helps
prevent misunderstandings. It assists people to plan and know what
to expect. In short, it allows couples to be a team and feel like a team
rather than act as individuals engaged in some form of adult parallel
play. Individuals with hearing loss, spouses, and significant others have
all detailed how hearing loss negatively affects communication. Great
leaps of insight are not required to see how it might also affect relationships. What, if anything, did partners have to say about this? Did they
feel hearing loss hurt their relationship?

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No, not really. I am annoyed at times, but try to be understanding.
Sometimes. Because I think he hears me but he doesnt.
It would if the aids didnt work, but so far they do. In fact, we
finally got the bad one fixed, so hes hearing better than ever.
I sometimes do not start conversations unless it is pertinent to
him. I miss the spontaneous conversations because it is easier.
Yes. It gets very trying to keep repeating or youre not sure he
even hears you in the first place.
Not really. After so many years we have adjusted and take care
of each others needs. Hearing loss is a great problem that my
spouse has learned to deal with and he copes quite well most of
the time.
After a while I dont even want to talk to him. It gets very frustrating having to repeat myself.
Not really. We have been married for almost fifty years and have
worked together to make the best of all complications or problems.
We have learned to adjust.

Seeking Help and Coping with Hearing Loss


Seeking Help
In chapter 5, patients explained how they were not always quick to
investigate possible hearing loss. Some did report seeking help right
away, but others knowingly put it off for quite a while. Bridging this
gap were those who sought help once they realized they had a hearing
problem. Often unsaid was how long this realization took. A common
regret was that they had not sought help sooner. Also often unsaid was
whether a person sought help on his or her own or was forced into it
by a partner.

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Several factors have been shown to increase the likelihood of a


person seeking help and trying hearing aids. Increased age, a more
severe hearing loss, the individual perceiving his or her hearing as
being poor, and the recognition that the loss is limiting or preventing participation in hearing-related activities are some documented
examples.3 A spouse cannot control the first two, but can help a
hearing-impaired partner to recognize the loss and its impact. One
other relevant factor was whether the significant other was perceived
as being supportive of rehabilitation. A measure of this support would
be the amount of encouragement given to have a hearing evaluation
or try hearing aids. Comments from spouses and significant others
about seeking help showed that they were often a moving force, much
like Helen Grant.
The idea was mine totally. He has refused to seek help for several years and I actually had to get unpleasant. I went with him
to our family doctor and had it checked there. Our family doctor
recommended an ENT.
No it was my idea because he wasnt hearing correctly.
We both decided we were having too much trouble communicating.
Mutual decision. He knew of my hearing loss over many years
and became aware of his own.
In his own way by getting treatment.
He pretty much agreed that it was necessary after I bugged
him about it.
He went on his own.
He knew he had a hearing loss and talked about going to have
it checked. I encouraged him when he mentioned it. Then he went
on his own.

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It was not his idea. He had an ear infection and went to the
doctor.
She found her hearing loss out when her yearly checkups
were showing some more loss. Im surprised shes ready for
hearing aids.
Yes. He said you call and get an appointment.
My idea, as he knows he cant wear hearing aids in the workplace or where there is loud noise. Theyre used to the work routine
and ignore the noise because they cant hear above the noise.
I dont remember. Probably on his own after failing the hearing screening at the local fair.
Both of our ideas.
On her own after having a hearing test.

Spouses View of Hearing Aids


First-hand reports clearly showed that hearing aids are no cure-all,
but that they do help. Users extensively described both the pros and
cons. But do spouses or significant others hold similar perspectives?
Published reports say the answer should be yes. Hearing aids have
been found to improve the quality of life of not just the user, but also
the spouse.4 The question here is whether spouses agreed with these
findings.
Aids help enormously for her to hear me and others speaking
to her. Without hearing aids I would have to speak louder for her
to hear me.
Yes, when he wears it. If he wears it all the time he would have
to sit in a chair constantly. He sweats and gets moisture in the hearing aid if he does any work.

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Yes they help.


Yes. Of course it helps!
He has had his hearing aids for one week. It is like a miracle!
Helps some of the time. Bought a new set and are in the process of fine tuning to his needs. Sometimesespecially at a concert
he wears only one. He hears speaking voices better, if other people,
but his own voice bothers him often.
Yes. Helps tremendously. However, its been beyond frustrating returning at least a dozen times to get ones that work when they
cost $2,000 each. He was so angry he didnt wear the right one for
a year.
Yes, but they are not helping much.
Yes, help a great deal.
Yes it helps somewhat. He cannot hear me in another room
without them.
Yes it helps when he wears them. At night he likes to watch TV
after he takes his hearing aids out and has the TV very loud.
Yes. Yes. He can hear what is going on.
No. The hearing aid does not help much. Still have much repeating to do. The hearing aid does not solve the problem. Big
disappointment after spending $4,800 and still doesnt hear well.
My wife has been through a lot with her hearing aids and is constantly on the lookout for help. Cost for both of us is prohibitive.
Yes, it helps immensely. He wears them every day, all the
time.

Other Ways of Coping with Hearing Loss


A person may take deliberate steps to compensate for a hearing loss
or develop certain habits unconsciously because these are ones that

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improved communication in the past. In either case, these strategies


or conditioned habits are likely to be perceptible to a spouse or significant other. Even if a listener is unaware of moving closer to hear
or of intently watching the speaker to better understand, a spouse is
likely to notice. Some of those with hearing loss who were surveyed
listed specific things they did that helped. But what, aside from hearing aids, did partners see their spouse do to compensate for a hearing
loss? When asked specifically about this, a lot of the responses were not
encouraging. Many spouses left this question unanswered. Those who
did answer reported the following measures.
Nothing.
Nothing.
Nothing!
He says he guesses at what is said in some situations.
Tries to be in same room when talking to someone, asks people to repeat themselves, mentions he wears an aid, or has trouble
hearing. It works.
Always asking what was said, or he just didnt hear.
He carries fresh hearing-aid batteries at all times away from
home just in case he needs them.
Try to look directly at the person speaking. Uses TV Ears
when watching flat screen TV or sound bar with TV. TV Ears
work best in a larger room. He uses a sound bar in a smaller room.
He also changes the volume level of electronic devices or uses ear
buds.
Wireless headphones for the TV so the volume does not have
to be so loud.
The wireless headset for listening to the TV. He can adjust
sound independently! We take a set on vacation. A Godsend!

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Advice from Spouse or Significant Other


Advice for People with Hearing Loss
People with hearing loss are not the only ones who might offer useful guidance about their problem. Spouses and significant others also
had advice for this group. More often than not their suggestions mirrored those given by the hearing-impaired individuals themselves. For
a hearing-impaired reader, these spousal recommendations may seem
a familiar echo of ones own partner.
Go as early as possible. Pay special attention at the onset of
hearing loss.
Dont be so sensitive. Speak up and tell someone that you are
hard of hearing instead of trying to conceal it.
Be tested. Try aids if advised.
Fix what you can. Try different aids. People who have a hearing loss may seem uncaring, withdrawn, or less intelligent than
they really are because of lack of interaction or responses to what
is going on.
Believe those around you when they accuse you of not
hearing.
See your doctor immediately! Learn about different kinds
of aids.
Consult a doctor immediately. It may stop further hearing loss.
Seek professional help. Check your options.
Im sure that going to a very good audiologist is super important. Saw one that wasnt so great.
Think of the way that best lets you continue your regular busy
life and tell your friends or family if you have taken your aids out.

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Get help or at least talk with a doctor about it.
Wear ear protection when possible: on tractor, when working
with power equipment, shooting guns.
Get hearing test. Get hearing aids if they can help you.
Get a hearing aid.
Hearing aids are expensive, so buy those that can be changed
or adjusted if your hearing should become worse. Be patient while
aids are being fine-tuned.
Get a hearing test. Then see what can be done to help.
Look at someones face when talking and reading lips. Never
be embarrassed to let someone know you cant understand them.
Get hearing aids.

Advice for Family, Friends, and Others


The main goal of this book has been to provide first-hand advice from
people with hearing loss to people with hearing loss. Those with direct
experience provided advice so that others might benefit. Using a similar rationale, friends and family of those with hearing loss were asked
what advice they could offer to others in their own position. Unlike the
wide variety of comments and advice offered by hearing-loss sufferers, friends and family primarily had one suggestion for others in their
situation.
Try to be understanding. Its a very disturbing disability for
the individual that has it.
Patience. Patience. Patience!
Always remember that they may not be hearing what is going
on. Make sure they are hearing you. Encourage them to wear hear-

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ing aid. Make sure others talk right to him and he is paying attention to them.
Be patient and understanding and pray that hearing aids help.
Pray a lot!
Be patient.
Be gentle. Be loving. Learn to anticipate the hearing
problem.
Be patient with that person! Although it is very hard! Try to
insist and encourage them to get a hearing test.
Deal with it.
Be patient and understanding. Help any way you can without
making them feel dependent. Be willing to adjust.
Pay more attention to how you talk so you can carry on a
conversation.
Be patient. Sometimes you forget they cant hear and there can
be misunderstandings as a result.

Summing Up
Beyond simply answering the survey questions, a couple of spouses
provided their own overview of the problem. They summed up for all
of the spouses and significant others.
Its very hard to admit that we cant hear, and also we dont
want anyone to see hearing aids. We listen to all of the failures
that others have had, and this allows us to not want to seek professional help because of their problems. A person has to be
pushed to seek medical advice. No one wants to spend thousands
of dollars on a risk (hearing aids) that may not work, even with a

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thirty-day return policy. It makes one very cautious in these economic times. A person must realize this is extremely important just
like a prescription.
Hearing loss is no game. Its serious. Being someone elses
ears for a long time does affect your significant other. Its like having two lives wrapped into one because you have to be two people
at one time.

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10
Themes and Parting Advice

othing unusual was the doctors comment when he asked


me to talk with Ralph Benson about his hearing loss. Summing up an individuals history, diagnosis, and treatment plan
in these two words may sound crass, but it was apt for Mr. Benson. His
was a story ENT doctors and audiologists hear over and over again
every day.
Mr. Benson had noticed his hearing difficulty beginning shortly
after he retired about five years ago. His wife said his problem started
much earlier than that. She had urged him to get his hearing checked,
but at first he didnt think there was any problem and later he didnt
feel it was bad enough. Gradually his hearing worsened, until he found
it hard to disagree with his wife. Once the hearing loss was confirmed
and hearing aids were recommended, he was hesitant to follow through.
My job was to educate him about hearing aids and discuss how they
could alleviate many of the listening problems that brought him to us.
Ultimately he decided to go ahead with hearing aids, but the outcome
for too many others is inaction.
Aspects of Ralph Bensons story resonate through the comments
that patients and their spouses provided. Arguments why Mr. Benson
201

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and others like him should not hesitate with regard to hearing aids
were even more abundant. This was a theme that ran through patient
and spouse recommendations. There were others. These are examined
in the following pages, along with a few issues that might benefit from
further explanation.

Areas of Agreement
Getting a Hearing Evaluation Is Essential
Of all the subjects examined in the hearing-loss survey, the need for a
hearing evaluation was the recommendation made most often. Nearly
every respondent addressed this issue, and all of those who did stressed
its importance. This was true of both the people with hearing loss and
their spouses. While the wording varied from person to person, there
was no ambiguity of intent. Some people may think hearing professionals can be a little preachy about the importance of having ones
hearing checked, but those with hearing loss and their partners took
no backseat in this regard.
Survey contributors sometimes recommended having this evaluation performed by an audiologist or a physician, but more often they
did not specify whom to see. Because most people prefer to obtain their
medical and hearing care locally, finding someone good who is easily
accessible becomes a priority. No one recommended advertisements
from the newspaper, TV, radio, Internet, or elsewhere as the best way
to do this. Asking the advice of a primary care doctor, nurse, member
of the clergy, relative, or friend with hearing loss was most often the
suggested road to finding a good hearing professional.

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Denial or Delay Is Not in a Persons Best Interest


The majority of patients considered denying a hearing loss or delaying action to be a mistake. Even a number of those who were guilty of
doing this themselves considered denial and delay to be a poor choice.
Nevertheless, denial and delay were common. About half of the contributors in this survey admitted to at least some delay. For perspective,
a study in the United Kingdom found that people there typically put off
seeking hearing help until they were elderly. This resulted in an average
delay of ten years.1 Some of the advice offered by patients in this survey
was rather blunt about people falling into this trap.
Continuing denial only detracts from your quality of life.
Face reality and get help.
Rethink your priorities before it is too late.
Get real. Dont feel sorry for yourself.

Avoid or Protect Yourself from Noise Exposure


Another area of 100 percent agreement was that people should avoid
or protect themselves from excessive noise exposure. The need for earplugs or earmuffs to block loud sounds was cited over and over again.
Unfortunately, this need was all too often recognized only in hindsight.
Many of the people were recommending hearing protection because
it was loud sound that damaged their own hearing. When asked what
they might have done differently regarding their hearing if given a second chance, the majority of responses went like this:
I would have worn something over my ears so that my hearing
would not have been damaged as bad as it was over time.

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first-hand experience
Used (hearing) protection at a young age.
Wore earplugs in the artillery and at work.

That so many people stressed the importance of hearing protection based on their own experiences should not be a surprise. Educational campaigns and occupational hearing protection programs have
tried for years to alert people to the damage caused by excessive noise.
A few statistics help to explain the urgency. Forty-two percent of employees in a typical Midwest automotive factory were found to have
hearing loss.2 When dairy farmers were compared to a matched group
of non-farmers, 25 to 28 percent more farmers suffered hearing loss.3 A
recreational firearm study of more than fifteen hundred men found that
the risk of hearing loss increased 7 percent for every five years the men
had hunted.4 Recreational woodworkers were found to be 30 percent
more likely to have hearing loss than non-woodworkers.5 Even onethird of classical musicians may be at risk of hearing loss depending on
the instrument they play.6
Survey participants made clear that the key to prevent hearing
loss from loud noise is to avoid loud noise or use hearing protection. For those who work in industry, the employer should alert employees if sound levels are potentially damaging and then provide
appropriate hearing protection. At home or recreationally, individuals should use earplugs or muffs during any very loud activity. This
includes using lawn tractors, snowblowers, gasoline-powered string
trimmers, chain saws, circular saws, shop vacuums, and firearms, to
name only a few examples, as well as attending rock concerts. Earplugs and earmuffs work well, are inexpensive, and are readily available at most home improvement centers. An alternative is to have
custom earplugs made that exactly match the contours of the users
ears. These are available from most hearing-aid centers. Regardless

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of whether hearing protection is over-the-counter or custom, the key


is to actually use it.

Communication Is the Problem


Hearing loss prevented listeners from hearing or understanding those
around them. Simple conversations were no longer simple. For many,
life had become a what fest. Furthermore, the impact on themselves
and others went well beyond asking people to repeat. Some patients
saw how their communication difficulties were isolating them from
others or how it was causing them to avoid activities, which caused
further isolation. Misunderstandings put strains on relationships.
My family (husband) gets very annoyed if I dont hear everything he says. Sometimes I just say OK to whatever he has said.
It affected my family because of my saying what or OK if I
didnt hear what they said and because the TV and radio are at a
loud volume.
Unable to carry on a conversation. It is a problem when in a
group and he misses what is said. We get stupid answers when
questions are misunderstood.
The end result of these communication difficulties can be a negative effect on a persons mood or sense of well-being. Already discussed
was evidence showing how untreated hearing loss can cause sadness,
depression, and other emotional troubles.7 Survey participants were
not immune to these negative effects. For instance:
I get very frustrated when I cant hear conversations. I then
usually give up on it. I feel embarrassed to keep saying pardon

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me? When I taught elementary school it was difficult because the
children mumbled or turned their head away and I could not hear
them at all.
I dont hear a lot going on around me. People dont want to
repeat to you, get mad if they do, yell, talk really loud or ignore you.
Makes you sad. Sometimes they blame you, say you arent trying
to hear them.
I miss many words and conversations. Its frustrating.

Patience Is Recommended
Throughout the survey patients were queried on a variety of subjects.
Nowhere was there a question about anyone having patience. Yet this
was a matter that kept popping up. Over one-third of patients (36 percent) and spouses (35 percent) had something to say. Patients lamented
that people frequently do not have patience if they misunderstand
or ask others to repeat. They wished and recommended that family,
friends, and society as a whole be more patient with them and with
others who have hearing loss. Spouses also noted that patience was not
just a recommendation but a must. Anyone wanting to help a person
with hearing loss would do well to heed this advice.

Hearing Aids in Perspective


Hearing Aids Are Recommended
Readers who scour the range of positive and negative comments about
hearing aids are likely to be surprised at the number of people who
recommended these devices to others. One might certainly wonder
whether this consensus came about artificially through the careful selection of the comments printed. This was not the case. Ninety-five

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percent of the people who owned hearing aids said they would recommend them to others. Why? How could so many people recommend hearing aids and there also be so many disparaging remarks?
The problem here is in trying to view hearing-aid satisfaction as an
all-or-nothing proposition. People dont have to love everything about
their hearing aids for them to be of benefit. They can even hate certain
aspects but still find the devices to be of value overall. The portion of
chapter 6 that detailed the pros and cons of hearing aids showed that
patients had a mixed bag of perceptions. A few examples provided one
individual at a time illustrates this reality.

patie nt 1
I purchased hearing aids and it was some help, but did not
solve the problem.
I have them in both ears and use them.
It depended on the type of group you are with and whether
they were quiet or noisy as to how well you could hear. They do
me the most good when I have a quiet conversation with people.
Do not help in a noisy restaurant or in large group.
Having hearing aids is a lot better as you can hear what is said
a lot of the time and not have to ask for it to be repeated so many
times.
Would this person recommend hearing aids to others? Yes. They
help a lot.

patie nt 2
I cant understand anything anybody says without them.
They cant begin to compare with what God gave me.
Not helpful in loud rooms. When the wind is blowing.

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They are better than nothing but in general they are a big
hemorrhoid!

Would this person recommend hearing aids to others? If


neededyes.

patie nt 3
They do help some. One can never be as good as they were
before hearing loss.
Most helpful when talking with other people.
They pick up too much background noise.
Theaters and concerts too loud for hearing aid.
Not helpful when there are too many people talking and loud
background noise.
Would this person recommend hearing aids to others? Yes. Its
worth the money.
The preceding comments were representative of those seen
throughout the survey. Nearly everyone had positive and negative
views about hearing aids. There were few unqualified endorsements.
Nevertheless, survey participants recommended hearing aids, not because they were loved, but because they helped them hear better.

An Outsider May Have a Different View of Hearing Aids


All of this good and bad about hearing aids can be more than a little confusing to an outside observer. What can one conclude when a
hearing-aid owner says that hearing aids did not solve the problem,
and are not helpful if there are too many people talking or if there is
background noise? What if the person making these comments also

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occasionally misunderstands or still asks others to repeat? What would


any reasonable person conclude?
The problem is that unlike testimonials for weight-loss programs,
there are no before and after photos. A casual observer sees that even
with hearing aids a person may still have difficulty hearing. The observer may not recognize how much the hearing aids actually helped.
This one-sided perspective of seeing the problem but not the benefit
almost certainly contributes to society having a generally negative perception of hearing aids.
For a spouse or family member of a person with hearing loss, the situation is different. They are all too familiar with the before-hearing-aid
side of the problem. All of the spouses and significant others surveyed
saw how the hearing loss affected not just their partner but themselves
as well. Even though the hearing aids were not a cure, they recognized
that they do help. This was true not only for family members but also
for the person with hearing loss once he or she tried hearing aids. The
dilemma is that prior to hearing-aid use, hearing-impaired individuals
are in the position of casual observer. They see that those with hearing
aids may complain and still struggle. As such, they have a disincentive
to become hearing-aid users themselves.

Expectations Matter
By now it should be apparent that a hearing-aid user or prospective
user should not expect some hearing equivalent of brass bands and
fireworks. As a couple of survey participants explained:
It is realistic to expect hearing aids, if recommended, to improve hearing. It is unrealistic to expect normal hearing with
hearing aids.

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Theyre not perfect because I dont hear and understand
everything. But Im thankful they really do help.

The majority of hearing-aid users surveyed had similar expectations. The most negative hearing-aid comments came from the few
people who expected not only to hear better, but to hear well. For them,
anything misunderstood was a sign that the hearing aids didnt work.
While their overall descriptions of how the hearing aids performed
were not very different from those of seemingly happier users, the difference was in how their expectations shaped their perception of the
experience. Those who viewed their cup as half full were happier with
the outcome.

Buying Hearing Aids: One Important Safeguard


As we saw, a few unhappy patients did return their hearing aids to the
seller, because they come with the understanding that they may be returned within a set period of time for a refund (minus a trial fee) if the
user is dissatisfied for any reason. Given the cost of hearing aids and
the many reservations of potential buyers, this safeguard can provide
reassurance. The key is to be aware of this option and to use it if appropriate. One clear example of an appropriate time to return hearing aids
was demonstrated in the comments of a dissatisfied hearing-impaired
husband and his wife.
I was told by others that hearing aids are not the answer and
its true.
They cost too damn much for what they do.
I should have returned them.
Dont get a hearing aid.

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Big disappointment after spending $4,800 and still doesnt


hear well. Have to repeat many times what we are talking about.
This persons entire experience was seen as negative, and he was absolutely correct that he should have returned them. Had he done this,
the worst that could have been said would be that he had tried hearing
aids and found them unsatisfactory. Additionally he would still have his
money should he decide to try a different brand or style or if he wanted
to wait for something new to come along.
Returning hearing aids can end on a positive note. As one person described, Almost twenty years ago I was not satisfied with the
performance of a new pair of hearing aids. I returned them and purchased a pair from a different company. It was not necessary to remain
a disgruntled hearing-aid owner or walk away a non-user. This person
today continues as a hearing-aid wearer and describes the aided hearing as vastly improved.

Areas Overlooked or Underutilized


Reducing Background Noise
Difficulty hearing with a noisy background was a common complaint.
It was often expressed in regard to hearing-aid use, but was more accurately a problem that people hoped hearing aids would fix. Largely
overlooked as an option was reducing, eliminating, or avoiding the
noise. Patients didnt talk about muting the television when conversing
with a spouse, rolling up the car windows or turning down the radio to
better hear a passenger, sitting away from a fan or noisy air conditioner,
going to restaurants on weekdays or off hours when it is quieter, or taking a conversation out of the kitchen when the dishwasher is running.
Another rampant noise problem that received little attention was sound

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first-hand experience

reverberating in large rooms with hardwood floors or other reflective


surfaces. Patients didnt talk about using a few well-placed sound absorbing materials like curtains or area rugs to stop reverberation and
make it easier to hear. Many forms of background noise that interfere
with hearing are not that difficult to reduce or sidestep. It does, however, require some effort and planning.

Changing the Listening Situation


Habits can be hard to recognize and even harder to change. Those
that interfere with hearing are no different. A woman may always sit in
the same pew at church because that is where she always sits. It may
be in the back, where sound from the front is greatly reduced and the
ministers lips are not easily visible. Small children may also squirm
and make other interfering noises between the minister and her seat.
Simply moving toward the front would make the service more audible,
the minister more visible, and leave the children far behind and out of
the way. At home a man and wife may sit side by side in their favorite
chairs. The man doesnt hear well in one ear and cant understand his
wife because she sits on that side. The answer is obvious: move the
chairs or trade places. Basic changes to a listening situation such as
sitting up front at church or moving a chair can have big rewards. For
this to happen, however, a person must be willing to consider his or her
own listening challenges and what changes might provide a listening
edge. Patients, unfortunately, provided little evidence that they modified situations to provide themselves with a listening advantage.

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213

Letting Friends and Family Know How


They Can Help You Hear
A person with hearing loss rarely has to tell friends and family that he
or she is having a problem. What they may not know is how they can
help. We have already seen how simple acts such as getting closer, facing the speaker, and reducing background noise can make it easier to
hear, and friends and family can certainly help in these areas. They may
even find these basic actions easier than repeating. Two other requests
occasionally made by patients that may be worth asking of friends and
family are speaking slowly and having others get your attention.
Many communication breakdowns are caused by only a few letters or words not being heard. Most people can fill in at least some of
the missing parts from the surrounding context if given a moment to
think about what was said. Speaking slowly allows time for this. As one
survey participant noted: People who speakslowclearly at an even
tone, are blessings to me. Ask others to slow down.
Since hearing loss may soften or distort speech, people with hearing loss do best when they can focus on what is being said. Someone
unexpectedly starting a conversation may be casually heard but not
understood. Ask others to call your name, touch your arm, or in some
other way get your attention before speaking. Then there is time to
look at the person, lip-read, and do the other things that can improve
understanding.

Getting Hearing Aids Does Not Negate the


Benefit of Other Listening Strategies
As frequently as patients made the point that hearing aids are not a
cure for hearing loss, they still often tried to act as if they were. When

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first-hand experience

spouses were asked what aside from using hearing aids their partner
does to cope with the hearing loss, the answer was often nothing.
When hearing-aid users were asked if they used non-technological
tricks to help them hear, such as lip reading or getting closer, all too often the answer was no. One person said when questioned about using
these measures: No, I wear aids. It was as if hearing aids precluded
doing anything else that might help. The reality is that the combination
of hearing aids and a few listening strategies is better than hearing aids
alone. Use an all-of-the-above approach.

Tinnitus Can Be an Issue


Tinnitus is a perceived ringing, roaring, hissing, cricket-like, or other
sound that is not present in the outside world. It can be quiet or loud,
intermittent or constant. Some people may find it to be little more than
a nuisance, while for others it can be very distracting or even debilitating. Millions live with it. Hearing loss is by far the number one predictor for someone having tinnitus.8 Despite tinnitus being rampant in the
hearing-impaired population, few people in this survey mentioned it.
For those who did, however, the gist was expressed clearly by one person who wished for a solution for tinnitusplease!
Although there is currently no cure for tinnitus, there are some
options that may help. Topping the list is hearing aids. In a survey,
hearing-care providers estimated that 60 percent of patients experience at least minor relief from their tinnitus while using hearing aids.9
Surveying several thousand people with hearing loss directly yielded
a lower figure (43.5 percent), but this was still a significant chance of
relief.10 This same survey found that listening to music was the second
most effective choice for tinnitus amelioration, and that both of these
options outperformed medications from a physician, herbs, dietary

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215

supplements, counseling, and relaxation techniques. I find soft music


played in the background to be helpful with my own tinnitusespecially at quiet times such as when I read.
A good starting point for those seeking more information about
tinnitus is the American Tinnitus Association. Their website (www.ata
.org) provides information about tinnitus, treatment options, and a variety of resources. The organization also publishes a tinnitus magazine
(Tinnitus Today) and provides contacts for regional support groups.

Resources Were Often Overlooked


Perhaps the biggest surprise from the questionnaire was how few people utilized the informational resources that are available. The question
Was there a group, association, or publication that you found helpful
and would recommend? was usually left blank. Similarly, in response
to the question What is your primary source of information about
hearing loss, hearing care, or hearing aids? people often listed their
own medical or audiology provider, but not books, magazines, websites, or organizations. Nor did they criticize resources. For whatever
reason, they were just overlooked.
Retail websites are one often overlooked resource. It might at first
appear odd to consider a retail website for hearing products as a resource. For a person who wants to learn more about available hearing
products, however, it is a good place to start. Amplified telephones,
wireless headphones, and the many other gadgets mentioned here have
to come from somewhere. The situation is not that different from years
ago when many of us used the Sears Wish Book Catalog to plan our
holiday shopping.
Fewer than one in three patients (31 percent) reported using any
kind of assistive listening device other than hearing aids. They may

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first-hand experience

have been unaware of the options available or not known how to obtain one. Easy access through the Internet can solve both problems.
A few of the better known websites for hearing products are Adco
Hearing Products (www.adcohearing.com), Harris Communications
(www.harriscomm.com), Hear-More (www.hearmore.com), Independent Living Aids (www.independentliving.com), and LS&S (www
.lssproducts.com). Do a little window shopping.
Some people may have no interest in hearing loss beyond finding
a booming alarm clock or an amplified telephone. Others want a full
evaluation and find it through an otologist or audiologist. Books serve
as another source of information, but not one that was often mentioned
by patients. Perhaps most of their concerns were already addressed
through the healthcare system or they simply didnt know which hearing-loss books would be worth reading. A few suggestions are offered
with the resources at the end of this book.
Numerous organizations provide information, support, and resources to the hearing impaired. A few are definitely worth looking
up. As the preceding pages demonstrate, however, most people are
unaware of these organizations. As one person asked: Is there one?
Two good places to start would be the Hearing Loss Association of
America (www.hearingloss.org) and the Hearing Health Foundation
(www.hearinghealthfoundation.org). They also publish informative
magazines, Hearing Loss Magazine and Hearing Health Magazine,
respectively.

Parting Advice
A lot of information and advice has been offered. A quick reading is
likely sufficient for most people to gain a better understanding of the
problem and some of the solutions. To make the best use of this infor-

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217

mation and advice, however, may require a second look at the parts
most applicable to any particular reader. This revisit should include
exploring the suggested websites. Useful information and help really
are out there. Still, in line with the old adage that the best information
comes first-hand, some final parting advice is warranted.
Have a good doctor examine you and take his advice. The
sooner you get examined youll realize how important it is!! Also
how important it is for the people around you. You will find your
life a lot more pleasurable when you can hear better.
Dont expect miracles with hearing aids. They will help, but it
wont be like you have perfect hearing.
Always be up front about your hearing problem. Take good
care of your hearing aid. It is your best friend.
Having a hearing loss should not be a crutch or be something
that causes you to be afraid of interaction.
Be kind to your ears. Stay away from places with loud amplifiers. Cover your ears when you use loud machinery (lawn mowers,
saws, snow blowers, etc.).
Talk to a variety of people candidly; ask questions about hearing loss, then think seriously about opinions and suggestions you
get. Seek professional opinion. Get second opinion.
Youll be surprised by what you are not hearing in your everyday life. Dont be afraid, its a whole new world again.
Talk to your family member/friend. Offer to go with them to an
appointment. Dont make them feel bad for their hearing loss.
Anyone can have hearing loss. No one can understand what it
is like unless they live it. But with our sharing they can have a better understanding.
Have patience. They dont like it either.

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Resources

Here is a list of resources the reader may find helpful. Each has a website that
offers information on hearing-care professionals, organizations, ear and hearing problems, hearing aids, medical devices, or assistive products.

Associations and Professional Organizations


Alexander Graham Bell Association for the Deaf and Hard of Hearing
3417 Volta Place
Washington, D.C. 20007
Website: www.agbell.org (www.listeningandspokenlanguage.org)
American Academy of Audiology
11480 Commerce Park Dr., Suite 220
Reston, Virginia 20191
Website: www.audiology.org
American Academy of OtolaryngologyHead and Neck Surgery
1650 Diagonal Rd.
Alexandria, Virginia 22314
Website: www.entnet.org
American Speech-Language-Hearing Association
2200 Research Blvd.
Rockville, Maryland 20850
Website: www.asha.org

219

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220

Resources

American Tinnitus Association


P.O. Box 5
Portland, Oregon 97207
Website: www.ata.org
Canadian Hard of Hearing Association
2415 Holly Lane, Suite 205
Ottawa, Ontario K1V 7P2
Website: www.chha.ca
Hearing Loss Association of America
7910 Woodmont Ave., Suite 1200
Bethesda, Maryland 20814
Website: www.hearingloss.org
National Association of the Deaf
8630 Fenton St., Suite 820
Silver Springs, Maryland 20910
Website: www.nad.org

Bone-Anchored Hearing Aids


Cochlear Corporation
13059 East Peakview Ave.
Centennial, Colorado 80111
Website: www.cochlear.com
MED-EL Medical Electronics Corporation
2511 Old Cornwallis Rd.
Suite 100
Durham, North Carolina 27713
Website: www.medel.com
Oticon Medical
580 Howard Ave.

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Resources

221

Somerset, New Jersey 08873


Website: www.oticonmedical.com

Books
Shouting Wont Help: Why Iand 50 Million Other AmericansCant Hear
You, by Katherine Bouton (Sarah Crichton Books).
Baby Boomers and Hearing Loss: A Guide to Prevention and Care, by
John M. Burkey (Rutgers University Press).
Overcoming Hearing Aid Fears: The Road to Better Hearing, by John M.
Burkey (Rutgers University Press).
The Consumer Handbook on Hearing Loss and Hearing Aids: A Bridge to
Healing, edited by Richard Carmen (Aural Ink Publishers).
Living with Hearing Loss, by Marcia B. Dugan (Gallaudet University
Press).
What Did You Say? An Unexpected Journey into the World of Hearing Loss,
by Monique E. Hammond (Two Harbors Press).
The Complete Idiots Guide to Hearing Loss, by House Clinic, William M.
Luxford, M.D., M. Jennifer Derebery, M.D., Karen I. Berliner, Ph.D.
(Alpha).
Hear Your Life: Inspiring Stories and Honest Advice for Overcoming Hearing
Loss, by Melissa Kay Rodriguez (Greenleaf Book Group).
Mayo Clinic on Hearing: Strategies for Managing Hearing Loss, Dizziness,
and Other Ear Problems, by Wayne Olsen (Kensington Publishing
Corporation).

Captioned Telephones
CaptionCall
4215 South Riverboat Rd.
Salt Lake City, Utah 84123
Website: www.captioncall.com
CapTel Customer Service
450 Science Dr.

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222

Resources

Madison, Wisconsin 53711


Website: www.captel.com

Cochlear Implants
Advanced Bionics
28515 Westinghouse Place
Valencia, California 91355
Website: www.bionicear.com
Cochlear Corporation
13059 East Peakview Ave.
Centennial, Colorado 80111
Website: www.cochlear.com
MED-EL Medical Electronics Corporation
2511 Old Cornwallis Rd.
Suite 100
Durham, North Carolina 27713
Website: www.medel.com

Hearing-Aid Manufacturers
Beltone
2601 Patriot Blvd.
Glenview, Illinois 60026
Website: www.beltone.com
GN ReSound
8001 East Bloomington Freeway
Bloomington, Minnesota 55420
Website: www.gnresound.com
Miracle Ear
5000 Cheshire Parkway North

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Resources

223

Minneapolis, Minnesota 55446


Website: www.miracle-ear.com
Oticon
580 Howard Ave.
Somerset, New Jersey 08873
Website: www.oticon.com
Phonak
4520 Weaver Parkway
Warrenville, Illinois 60555
Website: www.phonak.com
Rexton
5010 Cheshire Parkway North, Suite 2
Plymouth, Minnesota 55446
Website: www.rexton.com
Siemens Hearing Instruments
10 Constitution Ave.
Piscataway, New Jersey 08855
Website: www.hearing.siemens.com
Sonic Innovations
2501 Cottontail Lane
Somerset, New Jersey 08873
Website: www.sonici.com
Starkey
6700 Washington Ave. South
Eden Prairie, Minnesota 55344
Website: www.starkey.com
Unitron
14755 27th Ave., North

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Resources

Plymouth, Minnesota 55447


Website: www.unitron.com
Widex
3553 24th St.
Long Island City, New York 11106
Website: www.widex.com

Hearing Loop Information


Hearingloop.org
Website: www.hearingloop.org

Magazines
Hearing Loss Magazine
7910 Woodmont Ave., Suite 1200
Bethesda, Maryland 20814
Website: www.hearingloss.org/content/hearing-loss-magazine
Hearing Health Magazine
363 Seventh Ave., 10th Floor
New York, New York 10001
Website: www.hearinghealthfoundation.org/hearing-health-magazine
Tinnitus Today
P.O. Box 5
Portland, Oregon 97207
Website: www.ata.org/about-ata/news-pubs/tinnitus-today

Retail Outlets for Assistive Products


ADCO Hearing Products
4242 South Broadway

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Resources

225

Englewood, Colorado 80113


Website: www.adcohearing.com
Harris Communications
15155 Technology Dr.
Eden Prairie, Minnesota 55344
Website: www.harriscomm.com
Hear-More
42 Executive Blvd.
Farmingdale, New York 11735
Website: www.hearmore.com
Independent Living Aids
137 Rano Rd.
Buffalo, New York 14207
Website:www.independentliving.com
Learning, Sight & Sound Made Easier (LS&S)
145 River Rock Dr.
Buffalo, New York 14207
Website: www.lssproducts.com

Service Dogs for the Hearing Impaired


International Hearing Dog Inc.
5901 East 89th Ave.
Henderson, Colorado 80640
Website: www.ihdi.org
Dogs for the Deaf
10175 Wheeler Rd.
Center Point, Oregon 97502
Website: www.dogsforthedeaf.org

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Appendix: Hearing-Loss Questionnaires

Hearing-Loss Questionnaire
You are being given this questionnaire as research and possible source material for an article or book about hearing loss. Completing and returning this
questionnaire will be taken as permission to use the information provided.
While you are under no obligation to answer these questions, the information
you volunteer may help others with hearing loss. The more completely and
candidly you answer the questions, the more others are likely to benefit. The
results from this questionnaire are intended to be anonymous so please do not
sign your name or provide any identifying information.

he ar in g los s
How does your hearing loss affect you? How does it affect your relationships,
work, mood, leisure, safety, finances, etc.?

227

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228

Appendix

Does your hearing loss affect others? If yes, please describe.

Once you began to suspect a hearing loss, did you seek help right away?
Why or why not?

What is your primary source of information about hearing loss, hearing care,
or hearing aids? What is the quality of this information?

What types of professionals have you found to be most helpful regarding


your hearing loss? Please describe.

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229

he ar in g a i ds
Have you ever been advised that you need or would benefit from a hearing aid
or aids? Yes / No (please circle)
Do you own a hearing aid or aids? Yes / No (please circle)
How do you feel most people view hearing aids?

If a hearing aid or aids was recommended, but you did not follow through,
please share your reason(s).

Did you try, but then return a hearing aid or aids? If yes, please explain.

If you own a hearing aid or aids, do you wear it? If not, please explain.

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Appendix

Please describe the situations in which you have found a hearing aid or aids
to be helpful.

Please describe the situations in which you have not found a hearing aid or
aids to be helpful.

If you use or have tried a hearing aid or aids, was it difficult to adjust to?
Please explain.

If you use or have tried a pair of hearing aids, are wearing the two together
better than just one? Please explain.

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231

What do you see as the major pros and cons of hearing aids?

other s o lutio n s f o r h e a r i n g l os s
Do you turn up the radio, television, or other devices? Does this help?

Do you use closed captioning on the TV, an amplified or captioned telephone, wireless headphones, or other electronic gadget to help you hear or
communicate? Does it help? Please describe:

Are there alerting devices such as vibrating pagers or phones, amplified or


flashing doorbells, amplified alarm clocks, or special smoke detectors that
you have found helpful? If yes, please describe.

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Appendix

Are there non-technological tricks that help you to hear (lip-reading, getting
closer, having person repeat, etc.)? Please explain.

Have you learned or tried to learn sign language?

Have you changed your activities in some way to increase your likelihood
of hearing or changed your activities to limit your need for hearing? Please
explain.

Is your solution to hearing loss to have others repeat or perform tasks that
you cannot hear well enough to perform yourself ? If yes, please describe.

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233

Have you had surgery or taken medicine to treat your hearing loss? If yes,
please describe. Did it help?

Have you tried or do you know of any other solutions for hearing loss? If yes,
please describe. Did it help?

wis h list
What would you change about hearing care?

What would you change about hearing aids?

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234

Appendix

Would you like your family or others to treat you differently because of your
hearing loss? Please explain.

How do you wish society or the media would view or respond to hearing
loss?

Are there changes you would like at work, church, shopping malls, theaters,
or other settings that might lessen your hearing difficulties? If yes, please
describe.

What hearing-related product, service, or breakthrough would you like to see


developed?

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235

adv ic e f ro m o n e he ari n g -i m pa i r e d
per s o n to an ot h e r
What advice would you give to someone with hearing loss?

What advice would you give to someone who suspects a hearing loss?

What advice would you give to someone at risk to develop hearing loss from
noise exposure or other preventable cause?

What advice would you give to someone who has a hearing loss but denies it
or feels it is unimportant?

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236

Appendix

What should a person with hearing loss avoid or not do?

Given a second chance, is there anything related to your hearing that you
would have done differently? If yes, please explain.

What advice would you give to family or friends of someone with hearing loss?

Was there a group, association, or publication you found helpful and would
recommend?

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237

Aside from health care professionals, who should a person look to for support? Should a person seek help from family members, co-workers, church
groups, etc.? What kind of help?

What would you suggest as some realistic or unrealistic expectation for living
with hearing loss and/or hearing aids?

Would you recommend hearing aids to others? Please explain.

Do you have any financial advice related to hearing care, hearing aids, or living with a hearing loss?

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238

Appendix

What other advice or comments can you offer regarding hearing loss, hearing
aids, or hearing care?

Spouse and Significant Other Questionnaire


You are being given this questionnaire as research and possible source material for an article or book about hearing loss. Completing and returning this
questionnaire will be taken as permission to use the information provided.
While you are under no obligation to answer these questions, the information
you volunteer may help others with hearing loss. The more completely and
candidly you answer the questions, the more others are likely to benefit. The
results from this questionnaire are intended to be anonymous so please do not
sign your name or include any identifying information.
Is the hearing loss a problem for your spouse or significant other? If yes,
please describe.

Does your spouse or significant other recognize how the hearing loss affects
him or her? Describe their perspective.

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239

Did your spouse or significant other seek help for the hearing loss on his or
her own, or was it your idea? Please explain.

Does your spouse or significant other wear a hearing aid or aids? Does this
help? Please explain.

What else does he or she do to cope with the loss? Does it work?

Is the hearing loss a problem for others? Is it a problem for you? Please
explain.

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240

Appendix

Do you have to compensate for your spouse or significant others hearing


loss? If yes, please explain.

Does the hearing loss affect your relationship? If yes, please explain.

In what other ways does your spouse or significant others hearing loss affect
you or your family?

What advice would you give to someone with hearing loss?

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241

What advice would you give to the spouse or family of someone with hearing
loss?

What other comments would you like to offer?

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Notes

Introduction
1. Kochkin, MarkeTrak VII: Hearing Loss Population Tops, 1629; National Institute on Deafness and Other Communication Disorders, Report on the Task Force.
2. Hougaard, Ruf, and Egger, EuroTrak + JapanTrak 2012: Societal and Personal Benefits, 1626.
3. Kochkin, MarkeTrak VIII: 25-Year Trends, 1231.
4. National Council on Aging, Consequences of Untreated Hearing Loss,
1216; Kramer et al., Association of Hearing Impairment, 122137.
5. Uhlmann et al., Relationship of Hearing Impairment, 19161919; Lin
et al., Hearing Loss and Incident Dementia, 214220.
6. U.S. Census Bureau, State and County Quick Facts.

Chapter 1: The ABCs of Hearing Loss


1. Clark, Uses and Abuses of Hearing Loss, 493500.
2. Center for Hearing and Communication, Common Environmental Noise
Levels.
3. Burkey et al., Clinical Utility of the 512-Hz Rinne, 5962.
4. Hetu et al., Reluctance to Acknowledge Hearing Difficulties, 265276;
Rawool and Keihl, Perception of Hearing Status, 2742.
5. Arlinger, Negative Consequences of Uncorrected Hearing Loss, 1720.
6. Hetu, Getty, and Waridel, Attitudes Towards Co-Workers, 313325.

243

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244

Notes to Pages 3859

Chapter 2: Hearing Aids and Other Gadgets


1. U.S. Congress, Americans with Disabilities Act.
2. McCreery et al., Evidence-Based Systematic Review, 295312; Bentler,
Effectiveness of Directional Microphones, 473484.
3. McCreery et al., Evidence-Based Systematic Review, 295312; Bentler,
Effectiveness of Directional Microphones, 473484.
4. American National Standards Institute, Methods of Measurement of
Compatibility.

Chapter 3: Treatments for Hearing Loss


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

Y6609.indb 244

Desai et al., Trends in Vision and Hearing, 18.


Jabor and Amedee, Cerumen Impaction, 358362.
Jones et al., Parental Smoking and the Risk, 1827.
Cruickshanks et al., Prevalence of Hearing Loss, 879886.
Akinpelu et al., Is Type 2 Diabetes; Kakarlapudi, Sawyer, and Staecker,
The Effect of Diabetes, 382386.
Brant et al., Risk Factors Related to Age-Associated Hearing Loss,
152160.
Lerut et al., Functional Correlations of Tympanic, 379386.
Camnitz and Bost, Traumatic Perforations of the Tympanic Membrane,
220223.
Rizer, Overlay Versus Underlay Tympanoplasty. Part I, 125; Rizer,
Overlay Versus Underlay Tympanoplasty. Part II, 2636.
Sakihara, Christensen, and Parving, Prevalence of Hereditary Hearing,
3946.
Shea, Forty Years of Stapes Surgery, 5255; Rizer and Lippy, Evolution
of Techniques of Stapedectomy, 443451.
Shambaugh, How and When to Prescribe, 146147; Brookler, Medical
Treatment of Otosclerosis, 9296.
Alexander and Harris, Incidence of Sensorineural Hearing Loss,
15861589.
Chau et al., Systematic Review of the Evidence, 10111021.

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Notes to Pages 59148

245

15. Vijayendra et al., Sudden Sensorineural Hearing Loss, 14.


16. Bovo, Aimoni, and Martini, Immune-Mediated Inner Ear Disease,
10121021.
17. Niparko et al., Serial Audiometry in a Clinical Trial, 908917; Dayal,
Ellman, and Sweiss, Autoimmune Inner Ear Disease, 591596.
18. Vohr, Overview: Infants and Children, 6264.
19. National Institute on Deafness and Other Communication Disorders,
Cochlear Implants.

Chapter 4: Real-Life Consequences of Hearing Loss


1. U.S. Congress, Americans with Disability Act.
2. Kochkin, MarkeTrak VIII: The Efficacy of Hearing Aids, 1926.

Chapter 5: Coping and Getting Help


1. Yueh et al., Long-Term Effectiveness of Screening, 427434.

Chapter 6: The Hearing-Aid Experience


1.
2.
3.
4.
5.

Wallhagen, The Stigma of Hearing Loss, 6675.


Burkey, Overcoming Hearing Aid Fears.
Kochkin, MarkeTrak V: Why My Hearing Aids, 3442.
Kaplan-Neeman et al., Hearing Aid Satisfaction and Use, 20292036.
Hosford-Dunn and Halpern, Clinical Application of the SADL,
1536; Jerram and Purdy, Technology, Expectations, and Adjustment,
6479; Cox and Alexander, Measuring Satisfaction with Amplification,
306320.
6. Kaplan-Neeman et al., Hearing Aid Satisfaction and Use, 20292036.
7. Takahashi et al., Subjective Measures of Hearing, 323349.

Chapter 7: A Wish List


1. Kochin, MarkeTrak III: Why 20 Million, 2027.

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246

Notes to Pages 161214

Chapter 8: First-Hand Advice


1. Burkey, Overcoming Hearing Aid Fears, 32.

Chapter 9: Advice from Spouses or Significant Others


1.
2.
3.
4.

Rumsfeld, Department of Defense News Briefing.


Wallhagen et al., Impact of Self-Assessed Hearing Loss, 190196.
Meyer and Hickson, What Factors Influence Help-Seeking, 6674.
Stark and Hickson, Outcomes of Hearing Aid Fitting, 390398; Brooks,
Hallam, and Mellor, Effects on Significant Others, 165171.

Chapter 10: Themes and Parting Advice


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Y6609.indb 246

Davis et al., Acceptability, Benefit and Costs, 1294.


McCullagh et al., Prevalence of Hearing Loss, 340347.
Marvel et al., Occupational Hearing Loss in New York, 517531.
Nondahl et al., Recreational Firearm Use, 352357.
Dalton et al., Association of Leisure-Time Noise, 19.
Pawlaczyk-Luszczynska et al., Risk Assessment of Hearing Loss,
493511.
National Council on Aging, Consequences of Untreated Hearing Loss,
1216; Kramer et al., Association of Hearing Impairment, 122137.
Stouffer and Tyler, Characterization of Tinnitus, 439453.
Kochkin and Tyler, Tinnitus Treatment and the Effectiveness, 1418.
Kochkin, Tyler, and Born, The Prevalence of Tinnitus, 1027.

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Index

Note: Italic page numbers refer to illustrations.


Adco Hearing Products, 216
Advanced Bionics, 67
Advice. See First-hand advice
Aging: and cost of hearing aids,
148149; hearing aids associated
with, 114, 115, 116; negative associations of, 2, 27, 138, 139; and
sensorineural hearing loss, 18, 50
Air-bone gap, 20
Alarm clocks, amplified, 33, 216
Alerting devices, 3234, 109
Allergies, 52
American Academy of Audiology, 25
American Academy of
OtolaryngologyHead and
Neck Surgery, 25
American Speech-LanguageHearing Association, 25
Americans with Disabilities Act,
38, 79
American Tinnitus Association, 215
Asking others to repeat: as coping strategy, 99100, 104,

105; effect of hearing loss on


mood, 8889; as impact of
hearing loss, 8, 27, 7576; and
misunderstood speech, 74; and
moving closer, 102, 103; and
patience, 100, 206; relationships affected by, 10, 84, 93,
162, 177; and social withdrawal,
29; spouses and significant
others compensating for hearing loss, 8182, 100, 183, 186,
187, 190, 191, 192, 195
Assistive listening devices, 109110,
153, 154, 155, 157, 173, 215216
Atresia, 61, 63
Audiograms, 19
Audiologists: and ear examinations,
1417, 25; and earwax removal,
51; evaluation of hearing loss, 4,
13; on hearing-aid use, 119, 120,
157; as information sources, 95,
143, 160; rehabilitative measures
provided by, 25

255

Y6609.indb 255

12/10/14 9:38:41 AM

256

Index

Auditory evoked potential (AEP)


testing, 23
Auditory training, 66
Autoimmune inner ear disease,
5960
Autonomy, limited by hearing loss,
8, 8586
Background noise: and asking
others to repeat, 75; first-hand
advice on, 170, 171; and hearingaid use, 119, 121, 122, 124125,
129, 130, 144, 145, 154, 155, 208,
211212; and limitation of activities, 78; and misunderstood
speech, 73, 74; and moving
closer, 2829; and planning,
103, 104; and social isolation,
88; wireless headphones
and, 108; work situations
and, 31, 35
Balance: and autoimmune inner
ear disease, 60; and Mnires
disease, 60; and vestibular
system, 17
Blood pressure, high, 53
Bluetooth compatibility, in hearing
aids, 4546, 113, 146, 147, 151,
157
Body motion, and vestibular system,
17
Bone-anchored hearing aids, 6164,
62, 63, 158
Bone oscillator, 20

Y6609.indb 256

Cell phones: and hearing-aid use,


126, 146, 147; and telecoils for
hearing aids, 43; volume of, 28,
8485. See also Telephones
Children, hearing tests for, 2225,
92, 136
Cholesteatoma, 5657
Churches. See Public venues
Clocks, amplified, 33, 216
Closed captioning, 3536, 108109,
154, 156, 157
Cochlea: cochlear implant, 6467,
65, 66; and ear examinations,
1617, 23
Cochlear Attract, 64
Cochlear Corporation, 64, 67
Cognitive dysfunction, hearing loss
associated with, 3
Communication: and captioned
devices, 3537; help from family, friends, and society, 140141,
213; interference from hearing
loss, 5, 205206; spouses and
significant others on communication breakdowns, 185187. See
also Conversation
Completely-in-the-canal (CIC) aid,
39
Compression, and volume control in
hearing aids, 45
Concerts. See Public venues
Conductive hearing loss: amount of,
20; and cholesteatoma, 57; and
damaged middle-ear bones, 55,

12/10/14 9:38:41 AM

Index

56; as medically correctable,


47; and otosclerosis, 5758; and
perforated eardrum, 54; testing
for, 19, 20, 2122; as type of
hearing loss, 17
Congenital hearing loss, 23, 61,
6566
Conversation: asking others to repeat and, 7576, 8182; effect of
hearing loss on mood, 89, 90;
hearing-aid use and, 122, 123,
128, 129, 131; impact of hearing loss on, 3; missing sounds
and, 73; misunderstood speech
and, 7375; and social isolation,
8688; spouses and significant
others compensating for hearing loss, 81, 85, 99, 186, 190, 192
Coping strategies: asking others
to repeat, 99100, 104, 105;
first-hand advice on, 8, 178180;
first-hand experiences with,
91, 9293, 99106; getting help
from others, 105106; lip reading, 101102, 104, 105; loudness
and, 100101; moving closer,
2829, 102103, 104, 105, 212;
planning and, 103104; technological and medical options for,
106111
Crowds: and hearing-aid use, 120,
122, 125; and limitation of activities, 78, 79; and misunderstood
speech, 74, 75; and social isola-

Y6609.indb 257

257
tion, 88; spouses and significant others on, 186; and work
situations, 81

Decibels hearing loss (dB HL),


measurement of, 21
Dementia, hearing loss associated
with, 3
Developmentally delayed persons, 23
Diabetes, 53
Digital technology, and hearing aids,
4043, 130
Disability, negative associations of,
2, 26
Dizziness, and Mnires disease,
6061
Dogs, as alerting systems, 34
Dogs for the Deaf, 34
Doorbells, amplified, 33
Dragon Naturally Speaking, 37
Driving: and hearing-aid use, 122,
124; safety concerns and, 77
Ear, illustration of, 16
Ear, nose, and throat (ENT) physicians: consideration of factors
in hearing loss, 5354; and ear
examinations, 1417, 25; evaluation of hearing loss, 4, 67, 13;
as information sources, 95, 96;
and tympanoplasty surgery, 55
Ear canal: and ear examinations,
1417; and ear infections, 5152;
earwax in, 17

12/10/14 9:38:41 AM

258

Index

Ear drainage, 5657


Eardrum: broken eardrum, 17; and ear
examinations, 1516; and otitis
media, 52; perforated eardrum,
5455; and tympanometry, 22
Ear examinations: basic hearing
test battery, 1922; conditions
indicating need for, 4748;
and ear canal, 1417; hearing
professionals, 1417, 2526; history questionnaire, 14; testing
children, 2225, 92, 136; tests
included in, 1826; types of
hearing loss and, 1718, 19
Ear infections: and cholesteatoma,
56; and sudden sensorineural
loss, 59; treatment of, 5153,
56, 59
Earning deficit, as secondary effect
of hearing loss, 7980
Earwax: as cause of hearing loss,
49, 50, 59; in ear canal, 17;
impacted earwax, 5051; wax
guard for hearing aids, 46
Educational development, impact of
hearing loss on, 25
E-mail, 36, 105
Eustachian tubes: and cholesteatoma, 56; and ear examinations,
16; and otitis media, 52
Experiences. See First-hand
experiences
Eyeglasses, hearing-aid use compared to, 138139, 170

Y6609.indb 258

Feedback suppression, in hearing


aids, 40, 4243, 145, 157
First-hand advice: on coping strategies, 8, 178180; on denial of
hearing loss, 161163, 164;
financial advice about hearing
aids, 173175; for friends and
family, 180182, 213; on hearing
aids, 170178; on hearing-care
professionals, 167168, 202;
on hearing loss and hearing
care, 159169; and hearing-loss
questionnaires, 46, 72; on living with hearing loss, 178180,
217; and negative associations of
hearing loss, 1, 23; on nonprofessional support, 168169;
practical hearing-aid advice,
171173; reasonable expectations about hearing aids,
170171, 209210, 217; recommending hearing aids to others,
176178, 206207; sources of,
45, 6, 158159; of spouses and
significant others, 9, 183184,
199200; on suspected hearing
loss, 159160; what not to do,
163165
First-hand experiences: coping
strategies, 91, 9293, 99106;
hearing evaluations, 1314; of
hearing loss, 7172; with information sources, 9499; obvious
effects of hearing loss, 7276;

12/10/14 9:38:41 AM

Index

secondary effects of hearing


loss, 7690; with technological
and medical options, 106111.
See also Hearing-aid use
Flashing doorbells, 33
FM technology, 37
Group situations: and hearing-aid
use, 122, 123, 124, 125, 128, 154,
177, 207, 208; limitation of
activities and, 78; and misunderstood speech, 74; planning and, 104; and social isolation, 88; spouses and significant
others on, 186
Hammer, anvil, and stirrup, 15
Harris Communications, 216
Headphones, wireless, 3738, 47,
107108, 196
Headsets, amplified, 3435
Healthcare: changes regarding
hearing care, 141143; wishedfor medical breakthroughs,
152153
Hearing aids: batteries for, 39, 119,
126, 127, 129, 145, 146, 171, 173,
196; Bluetooth compatibility,
4546, 113, 146, 147, 151, 157;
care of, 39, 127, 129, 130, 172,
173; cost of, 118, 121, 126, 127,
129, 145, 148150, 157, 172,
173175, 195, 199200, 210211;
cosmetics, improvements

Y6609.indb 259

259

needed in, 147148; and digital


technology, 4043, 130; driers
for, 4647; first-hand advice on,
170178; function of, 39; options
and accessories for, 4347, 113;
and pitch adjustment, 4041;
return policy, 46, 121, 127, 133,
195, 200, 210211; as solution to
hearing loss, 2, 3847; styles of,
3940, 40; testing of, 142143
Hearing-aid use: adjusting to,
118121; and background noise,
119, 121, 122, 124125, 129, 130,
144, 145, 154, 155, 208, 211212;
and comfort in wearing, 134,
145; compatibility with other
devices, 146147, 157; first-hand
advice on, 8; frequency of use,
132135; getting started with,
114121; living with, 121135;
negative societal perceptions of,
114115, 127, 129, 130; neutral or
positive perceptions of, 116117;
older versus newer aids, 130;
performance issues with,
125127, 144; pros and cons
of, 128130, 206209; reasons
for delaying or declining use,
112113, 117118, 201202, 203;
satisfaction with, 127128, 135;
situations helped by, 121123;
spouses and significant others
on, 194195; two versus one,
131132, 151

12/10/14 9:38:41 AM

260

Index

Hearing clarity: and digital technology, 40; testing of, 20, 142
Hearing Health Foundation, 216
Hearing-impaired patients: contradictory perceptions of, 9; fear
of being labeled, 3; first-hand
advice of, 8
Hearing loss: common reactions
to, 2630; concealment of,
29; denial of, 3, 5, 2627, 30,
97, 98, 99, 161163, 164, 203;
education about, 143; first-hand
advice on, 159169; ignoring
of, 2627, 30, 98; impact of, 3,
25, 71; natural compensation
for, 2729; negative stereotypes
of, 1, 23, 2627, 96, 137139;
plan for, 2930; prevalence,
population estimates of, 2, 71;
prevention of, 53, 143; types of,
1718; variety of solutions for,
3132, 50. See also First-hand
advice; First-hand experiences;
Treatments
Hearing Loss Association of
America, 216
Hearing-loss questionnaires: and
first-hand advice, 46, 72;
sample of, 227238; survey
methods, 5, 67
Hearing protection. See Noise
protection
Hearing tests: basic test battery,
1922; for children, 2225, 92,

Y6609.indb 260

136; and cochlea, 17; and ear examinations, 1826; for suspected
hearing loss, 159160, 202
Hearing threshold, testing of, 1920
Hear-More, 216
Help from others, as coping strategy,
105106
Incus, 15
Independent Living Aids, 216
Induction loop systems, 3738, 44,
147, 173
Information sources: first-hand
experiences with, 9499; list of,
219225; overlooked resources,
215216, 217
Inner ear: autoimmune inner ear
disease, 5960; and ear examinations, 15, 17; and Mnires
disease, 6061; and vestibular
system, 17
Insurance coverage, 148149, 150,
157, 173, 174, 175
International Hearing Dog, 34
Internet, information sources on,
94, 216
Language, impact of hearing loss
on, 25
Language pathologists, 25, 66
Leisure, impact of hearing loss on, 8
Limitation of activities, as secondary
effect of hearing loss, 7779,
85, 88

12/10/14 9:38:41 AM

Index

Lip reading: as compensation for


hearing loss, 28, 29; as coping
strategy, 101102, 104, 105
Listening devices, amplified, 3435,
47, 107, 108, 216
Listening situation, changes in, 212
Listening strategies, 2829, 99, 179,
213214
Localization difficulties, as secondary effect of hearing loss, 76
Loop systems, 3738, 44, 147, 173
Loudness: affecting others, 8485,
88, 100, 101, 107, 122, 123, 188,
190, 195, 196; as coping strategy,
100101; as effect of hearing
loss, 8485, 88, 101. See also
Volume settings
LS&S, 216
Lupus, 60
Malleus, 15
Mastoid bone, 21
MED-EL Bonebridge magnetic
systems, 64
MED-EL Medical Electronics Corporation, 67
Medicare, 148149, 173
Mnires disease, 6061, 151
Microphones, 37, 74, 154, 155; in
hearing aids, 39, 4142, 43, 45;
remote, 44
Microtia, 61
Middle ear, 15; bones in, 15, 5556,
57

Y6609.indb 261

261

Missing sounds, 7273


Misunderstood speech: compensation for, 28; and hearing aids,
42; as impact of hearing loss,
8, 7375, 205; and limitation of
activities, 78. See also Asking
others to repeat
Mixed hearing loss, 18
Modified decibel scale (dBA), 21
Mood: impact of hearing loss on, 3,
8, 83, 8890, 205206; spouses
and significant others on, 89,
187
Movies. See Public venues
Moving closer, as coping strategy,
2829, 102103, 104, 105, 212
Myringotomy, 5253
Noise protection: education on,
143; first-hand advice on, 164,
165167, 203205, 217; and
hearing-loss prevention, 53; and
wished-for changes, 150, 151, 152
Noise reduction, in hearing aids, 40,
42, 45
Noisy situations: and hearing-aid
use, 124, 125, 145, 211212; and
misunderstood speech, 73. See
also Background noise
Note writing, 3637
Online search engines, 94
Operating and diagnostic microscopes, 15

12/10/14 9:38:41 AM

262

Index

Ossicles, 15, 17, 5556


Ossiculoplasty, 5556, 57
Oticon Medical, 64
Otitis media, 5253, 54
Otoacoustic emissions (OAEs), 23
Otolaryngologists. See Ear, nose, and
throat (ENT) physicians
Otologists, 25
Otosclerosis, 5758, 111, 152
Otoscopes, 14, 15
Overcoming Hearing-Aid Fears
(Burkey), 117

limitation of activities, 78, 79;


and listening strategies, 179,
212; and misunderstood speech,
74; and social withdrawal, 29;
spouses and significant others
on hearing aids in, 195; wishedfor changes to, 153155. See also
Crowds
Pure-tone air-conduction testing,
19, 20
Pure-tone bone-conduction testing,
20, 2122

Pagers, vibrating, 33
Patience: asking others to repeat
and, 100, 206; first-hand advice
on, 179, 206, 217; friends and
family reactions, 140, 181, 198,
206; and societal reaction to
hearing loss, 139, 157, 206
Personal amplifiers, 35
Pinna (outer ear), 15
Play audiometry, 24
Pollutants, 52
Protection. See Noise protection
Public venues: assistive listening
devices in, 38, 109110, 153, 154,
155, 157, 173; and background
noise, 120, 125, 154; and closed
captioning, 154; and effect
of hearing loss on mood, 90;
getting help from others and,
105, 106; hearing-aid use in,
42, 122, 123, 126, 134, 208; and

Relationships: asking others to


repeat and, 10, 84, 93, 162, 177;
first-hand advice for friends and
family, 180182, 213; hearing-aid
use and, 123; impact of hearing
loss on, 8, 8284, 88, 188192;
reactions to hearing loss from
family and friends, 139140. See
also Social isolation; Spouses
and significant others
Remote controls, for hearing aids, 45
Respiratory infection, 52
Rinne tuning-fork test, 21
Rumsfeld, Donald, 183

Y6609.indb 262

Safety concerns, as secondary effect


of hearing loss, 7677, 88
Second-hand smoke, 52, 53, 151
Sensorineural hearing loss: and
autoimmune inner ear disease,
5960; causes of, 18, 50; and co-

12/10/14 9:38:41 AM

Index

chlear implant, 6467; and congenital loss, 61; and otosclerosis, 58; sudden sensorineural
loss, 5859; testing of, 20
Sign language, 110
Single-syllable words, 20
Sinus problems, 52
Smoke detectors, 33
Smoking, 53
Social isolation: first-hand advice
on, 164; hearing loss associated
with, 3, 29, 85, 8688, 205;
spouses and significant others
on, 187, 189
Social networking services, as information sources, 94
Sounds, missing, 7273
Speech, impact of hearing loss on, 25
Speech discrimination, testing of, 20
Speech pathologists, 25, 6566
Speech reception threshold (SRT),
testing of, 20
Speech recognition software, 3637
Spouses and significant others: on
communication breakdowns,
185187; compensating for
hearing loss, 8182, 85, 99,
100, 106, 183, 186, 187, 188189,
190, 191, 192, 195196, 200; on
consequences of hearing loss,
184192; effect of hearing loss
on mood, 89, 187; effect of hearing loss on relationships, 8384,
188191; on family and friends,

Y6609.indb 263

263

198199; first-hand advice of, 9,


183184, 199200; on hearingaid use, 194195, 209; hearingloss questionnaires given to, 5,
6, 238241; on patience, 206;
perspectives regarding hearing
deficits, 27, 98; on seeking help
with hearing loss, 192194
Stapedectomy, 5758, 111
Stapes, 15, 5758
Stethoscopes, amplified, 35
Sudden sensorineural loss, 5859
Surgical treatments, 6167, 111
Swimmers ear, 5152
Technological and medical options:
as coping strategies, 106111. See
also Hearing aids; Treatments
Telecoils, 38, 4344, 45, 147, 157
Telephones: amplified listening
devices and, 3435, 47, 107, 108,
216; and captioned devices,
36, 37; effect of hearing loss
on mood, 89; hearing-aid use
and, 122, 123, 125, 129, 145,
147; and loss of autonomy, 86;
and misunderstood speech,
73, 74; and social isolation, 88;
spouses and significant others
compensating for hearing loss,
86, 106, 190, 191; technological
options, 106107; and telecoils
in hearing aids, 43, 147. See also
Cell phones

12/10/14 9:38:42 AM

264

Index

Television: closed captioning and,


3536, 108109; and hearingaid use, 122, 123, 124, 126, 128,
177; induction loop system and,
147; and limitation of activities, 78, 79; loudness affecting
others, 8485, 88, 100, 101, 107,
122, 123, 188, 190, 195, 196; and
misunderstood speech, 73, 74;
spouses and significant others
compensating for hearing loss,
187, 188189, 190; wireless
headphones for, 38, 107108,
196; wished-for changes in,
155156
Texting, 36
Theaters. See Public venues
Tinnitus, 47, 118, 152, 153, 214215
Tools for hearing: alerting devices,
3234; amplified listening
devices, 3435, 47, 107, 108, 216;
captioned devices, 3537, 108
109, 154, 156, 157; and hearing
from a distance, 3738
Treatments: and autoimmune inner ear disease, 5960; and
bone-anchored hearing aids,
6164, 62, 63; and cholesteatoma, 5657; cochlear implant,
6467, 65, 66; and congenital
loss, 61; and damaged middleear bones, 5556; and ear
infections, 5153, 56, 59; and
earwax, 5051; and hearing-loss

Y6609.indb 264

prevention, 5354; and Mnires disease, 6061; and otosclerosis, 5758; and perforated
eardrum, 5455; and sudden
sensorineural loss, 5859; surgical treatments for severe or total
hearing loss, 6167, 111; types
of, 78, 50
Two-syllable words, and hearing
threshold, 1920
Tympanometry, 22
Tympano-ossiculoplasty, 56
Tympanoplasty surgery, 55
User-adjusted volume control, 4445
Vertigo, and Mnires disease, 60
Vestibular system, and inner ear, 17
Vibrating alarm clocks, 33
Video otoscopes, 14
Visual reinforcement audiometry
(VRA), 24
Volume settings: adjustment of devices, 8, 2728, 8485, 100101;
adjustment of hearing aids,
4445; and hearing clarity, 20.
See also Loudness
Websites, as information sources, 94,
215216, 217
Whistling, of hearing aids, 4243,
127, 129, 130
Windy conditions, and hearing-aid
use, 125, 126, 130

12/10/14 9:38:42 AM

Index

Wireless headphones, 3738, 47,


107108, 196
Wireless microphones, 44
Wish list: for healthcare and hearingaid performance changes, 136,
141150, 211212; for medical
breakthroughs, 152153; for second chances, 150152; societal
and individual changes, 136,

Y6609.indb 265

265

137141, 153155, 206; for television changes, 155156


Word recognition score (WRS), testing of, 20
Work situations: and background
noise, 31, 35; effect of hearing
loss on mood, 90; and noise
protection, 152; and secondary
effects of hearing loss, 7981, 88

12/10/14 9:38:42 AM

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