Hearing
Devices
Many devices are available to assist with hearing loss. The type of device chosen will depend on the age of the patient, degree of hearing loss, type of hearing loss diagnosed, and the progressive nature of the hearing loss. An experienced audiologist will help guide a person through the process of selecting the appropriate device to assist with their listening difficulties.
Hearing Aids:
The most common device used to assist with hearing is a hearing aid. Hearing aids are recommended typically for each ear with a hearing loss. Binaural fittings (aka. fitting both the right and left ear) are important for localizing sound, hearing speech more clearly, and understanding speech better in the presence of background noise.
Hearing aids today are digital and are programmed by an audiologist using a computer and verification equipment. Hearing aids have many features available for the user including volume controls, multiple programs for different listening situations, wireless adaptations for pairing instruments with various devices such as telephones, remote controls, televisions, and music players. Hearing aids generally help make sounds louder, more clear, and manage background noise for the listener. The clarity of sound heard through a hearing aid is highly dependent on the speech discrimination ability of the user without hearing aids on at a comfortable conversation level. This means that if a patient has a hearing loss with very poor unaided (aka. with no hearing aid) speech discrimination ability that they will benefit less from hearing aids than a patient who has very good unaided speech discrimination ability. Hearing aid benefit is very dependent on the patient's underlying speech discrimination ability. As such, other supplemental devices may be recommended if little benefit is obtained from hearing aids or if the user is exposed to complex listening situations that are still not managed well with hearing aids alone.
A Behind-the-Ear (BTE) style of hearing aid is usually recommended for children since it is safer and more durable than other models and so that it can be paired with a Frequency Modulated (FM) system at school to help hear the teacher better. Also, this style allows for adjustments as the child grows. The BTE style is held in the ear by a custom ear mold. The ear mold portion of the hearing aid needs to be replaced regularly as the child grows. The audiologist will do an ear mold impression routinely on the ear to ensure that the ear mold is custom fit for the wearer. Sometimes this is completed every 6 months especially during rapid growth periods.
A variety of styles of hearing aids are available for adults ranging from BTE to In-The-Ear(ITE) to open ear to completely-in-the-canal devices. Some styles are more visible than others and some styles are more comfortable than others and more appropriate for certain degrees of hearing loss, lifestyles, and ages.
A person being fit with a hearing aid will work closely with their audiologist to ensure that they are adjusting to the hearing aid/s and that they understand how to use them. Regular check ups are also necessary to ensure their hearing aid/s continue to be set appropriately and comfortably for their hearing loss and their communication needs. This means that it is common to be seeing your audiologist on a yearly basis or more to ensure the hearing aid/s are set appropriately. There is potential for progressive hearing loss following cancer treatment so regular hearing tests are necessary as well to monitor hearing levels and the frequency will be dependent on the individual's medical history. Adjustments will be made on your hearing aid by your audiologist to reflect changes noted in hearing levels.
Costs of hearing aids range from about $1200-3600.00 each. Hearing aids will on average last from 5-7 years. They are typically insured under a 2-3 year manufacturer warranty. Hearing aids are medical devices so they are not taxable and are considered a medical expense in British Columbia. Hearing aids are typically funded privately, and through extended medical plans or other third party medical plans for adults. Children are commonly funded through the provincial educational funding programs.
FM Systems: FM (Frequency Modulated) systems are lightweight compact devices that attach to the BTE style hearing aids. They are routinely used in school classrooms to help a child with hearing loss hear the teacher better. The teacher wears a small microphone and radio transmitter and the child wears either a small radio receiver alone or hearing aids connected to compact radio receivers. Sound is sent wirelessly directly between the teacher and the child. FM systems improve listening in difficult situations where a hearing aid alone may not help enough. The most difficult situations are noisy backgrounds, large distances between the speaker and hearing aid user, and rooms with a lot of reverberation or echo.
FM systems are highly recommended with children as well in the home environment by use by the parent. They are useful for instance in places like traveling in the car, playing at the park, or going to a museum or zoo when the mother or caregiver is often not directly facing the child but talking. An FM system can help in any situation that has loud background noise and big distances between parents and children because Mom's or Dad's voice is sent directly to the child's hearing aid. This system allows the child to receive more exposure to the speech signal from the user which helps with speech and language development. Research indicates that children learn a lot of language by overhearing conversations. This overhearing helps children learn new words and grows their understanding of how to use language. Children with hearing loss may miss opportunities to overhear if people are talking more than 1 meter away or if it is noisy. Using the FM with a hearing aid can give a child more opportunities to overhear some conversations. This can help grow a child's vocabulary.
Adults with hearing loss can also benefit from the use of FM systems in certain situations where they find they are struggling with the use of hearing aids alone. This may be in situations such as meetings, conference, and or lectures where it might be difficult to hear the main speaker due to distance or background noise.
Buying an FM system for home use is an additional expense beyond personal hearing aids. An FM package, including the transmitter/microphone and ear-level receivers may cost around $2,500. If extra warranties or special microphones are needed, the cost may be higher. Parents often look for financial help to buy an FM system. Insurance policies often do not cover FM systems. Families and or adults seeking these devices should work with their audiologist to find funding.
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Auditory Devices:
Telephone Devices: People with hearing loss often struggle with hearing on the telephone even with hearing aids. Telephone amplifiers can provide a louder sound to the hearing aid or send a signal that works with a special hearing aid setting. Some amplifiers are loud enough to use without a hearing aid. The worse the hearing loss the more difficult it is to listen and understand on the telephone. The use of a TTY (telephone typewriter) or wireless messaging system allows communication with typed messages. Text messaging on a cell phone can also be used. A camera connected to a computer can send video messages to another computer or possibly a cell phone. Instead of a text message, video communication can use sign language or lip-reading with audio signals which also will assist with understanding a verbal message.
TV Devices: These systems allow an adult or child to listen to the TV at a comfortable listening level without disturbing others in the room. The best systems use blue tooth, FM, or infrared signals to send the sound directly from the TV to a headset or the hearing aids. The advantage to these systems is that they are wireless and allow freedom to move around. TV closed captioning is also useful to help provide further information on the content of the message.
Alerting Devices: Alerting systems help a hearing impaired person be aware of important events that happen in the home such as doorbells ringing or knocks at the door, telephones ringing, smoke and fire alarms and alarm clocks. Some people with hearing loss may not be able to hear important warning signals, even when they are using hearing aids. It also is important to alert people to some alarms at times when they are not wearing their aids. For example, when sleeping. Alerting devices use amplified sounds, visual signals such as flashing lights or vibration. The method that works best to alert to different sounds may vary from person to person and from situation to situation. It is important to experiment with different options to see what works best.
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Cochlear Implants:
Cochlear implants are devices that can provide sound for people who receive little or no benefit from hearing aids. Hearing aids generally will amplify sound where needed depending on the hearing loss. However, for children and adults who have severe to profound hearing loss, making sounds louder may not be enough to allow the ear to process sound if clarity is poor. A cochlear implant may be more successful than hearing aids in some cases, because it bypasses the damaged sense organ of hearing (cochlea) and directly stimulates the hearing (auditory) nerve. Part of the cochlear implant includes tiny electrodes that are surgically inserted into the cochlea. The cochlear implant converts sound into electrical signals that go to the auditory nerve.
Cochlear implant surgery requires general anesthesia and lasts about 2 to 3 hours. Surgery is usually completed as an outpatient procedure, and may include a one-night stay in the hospital. It generally takes 3 to 5 weeks for the surgical incision to heal. Between 4 to 6 weeks after surgery, the patient will return to the clinic to have the device activated for the first time. Some patients will continue to wear a hearing aid in their non-implanted after the implant is activated to improve their ability to determine from what direction a sound is coming (localization) and to improve listening in noise. Device activation may be either a one or two-day process. Up to 20 return visits may be needed within the first year for both fine-tuning of the speech processor and auditory training or aural rehabilitation. The benefit from cochlear implants is not often immediate. Improvements occur over a period of months or even years. The amount of benefit seen is linked to the age of the patient at the time of implantation, the cause of the hearing loss, and family support and involvement. Reasonable expectations may include improved detection of environmental sounds and speech, improved speech reading ability, and improved clarity of the patient's speech. How much speech understanding a patient with a cochlear implant will obtain and how clear his or her speech will be is difficult to predict.
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Communication methods:
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