December 9, 2009

Ask the Audiologist

By Tara Hartman, AU.D, CCC-A
Audiology Consultants, P.C.

My spouse wears hearing aids but I still have to repeat things quite often. Shouldn’t my spouse be able to understand me better?

This is a great question and frankly, it’s a pretty common question. Let’s face it. When we spend hundreds to thousands of dollars on hearing aids, we expect to hear normal again. It is not uncommon for a person to be fit with a hearing aid and still have difficulty hearing. It is very difficult to predict how well a person will perform with hearing aids because there are so many factors that affect our ability to hear. I want to explore some of these factors, which means we need to go back to the beginning.

The first place we need to start is with the hearing test. Before you are fit with a hearing aid, it is important that you understand your hearing loss because this will help you form realistic expectations about what you are able to hear. For example, if you are considered legally deaf at most pitches, then you probably will not understand soft speech or maybe even normal to loud speech when using the most powerful hearing aid on the market. It would not be a realistic expectation, based on your hearing loss. You may have good hearing at some pitches but very poor hearing at others. Talk to your audiologists about your hearing loss and let them help you form realistic expectations.

Next, you need to remember that you are an individual. You do not hear like anyone one else. Let me explain. Two people have the exact same hearing loss, but when each person is asked to repeat a list of words without seeing the speaker, one person gets 90% of the words correct while the other person gets only 40% of the words correct. The hearing loss is the same, but the damage to the ear is affecting how clearly each person can interpret the words. We hear with our brains, and sound has to travel a long way through many obstacles to get to our brain. If there is any damage along that pathway, the sound may become distorted or unclear and therefore cannot be interpreted properly. Your audiologist can perform different types of speech testing to get a better understanding of how clearly you are able to hear. The important thing here is to remember that you cannot compare yourself with how well others do with their hearing aids. Your hearing needs are probably very different from that other person.

Once you get a better understanding of how and what you can hear, then its time to select the appropriate assistive device. Typically that means a hearing aid but not necessarily. There are many types of amplified devices that can assist you in different environments. The next step is to discuss your listening goals with your audiologist. Where and what do you want to hear better? Be specific. Here are some examples. “I want to hear the TV better, particularly the news.” “I meet with a group of friends to play cards every week. There are five of us and the room has a lot of background noise.” “ I want to be able to hear my wife better. She is very soft spoken.” By listing your goals, we now have something specific to work towards and we have a better idea of what listing device would suit you best.

Remember what the goal is when selecting a hearing aid. Find an audiologist you trust and then listen to what they recommend. Why do they recommend that? Ask questions. Why do you need all these extra features? How does it relate to my listening goals? Sometimes hearing better means compromise. Sometimes you need a larger hearing aid for more power so if you have to have the “invisible” hearing aid, then you may be loosing volume. If cosmetics are a concern, be sure to add that to your goals and discuss whether or not you will have to compromise sound quality for better looks. If a larger hearing aid is recommended because you need the power, but you choose the smaller hearing aid, then you cannot expect to hear as well. Hearing aids are getting smaller and smaller with the digital era. Who knows, you may get the best of both worlds.

The next factor to discuss is your follow-up care. Hearing aids require adjustment. What that means is that you must adjust to the new sounds as well as get your hearing aid adjusted from time to time. Depending on the listening device chosen, there is a lot of programming that can be done to change the way the hearing aid sounds. Do not expect the hearing aid to sound perfect the first day you are fit. It may require several visits to get it right. With each small adjustment, you need to try it out for a while to see if the problem has been corrected. If not, then you need to return to your audiologist and try another adjustment. Hearing is complicated and by changing one sound, it may affect many other sounds. For example, to hear speech loud and clear, we may have to increase the volume at certain pitches. When this is done, many other sounds such as running water, high heels on a ceramic floor, kids yelling and banging toys, and dishes clanging together may all sound louder as well. Some of these sounds may not be desirable.

Remember that word compromise? While hearing aids are more sophisticated than ever, they are after all only hearing aids. They are no where near being able to replace the complexity of the ear, but they are improving.

Fitting a hearing aid is a process. It takes time and effort from both you and your audiologist. So next time you feel like you or your spouse’s hearing aids are not working the way you expect them to, talk to your audiologist. Find out if your expectations are accurate or too high, based on all the factors we have discussed, and remember to be specific in reporting your complaints. Together we will get you hearing the best you possibly can.