the hearing-loss guide

The Hearing-Loss Guide

Y6609.indb iY6609.indb i 12/10/14 9:38:29 AM12/10/14 9:38:29 AM

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Useful Information

and Advice for

Patients and Families

John 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 [email protected] (U.S. offi ce) or

[email protected] (U.K. offi ce).

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 DataBurkey, 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

617.8—dc23 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it may nevertheless contain errors, omissions, or material that is out of date at the time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for errors, omissions, out-of-date material, or the reader’s application of the medical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 Signifi cant 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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ix

Foreword

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

loss touches many, many lives, aff ecting 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 ac-

cumulating frustration of constantly missing words and sounds, there

is the added embarrassment or denial of misunderstanding conversa-

tions, leading to gradual social isolation, which means hearing loss has

a seriously unpleasant eff ect 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 suff ering 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 debilitating—aff ecting 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

qualifi ed to address and advise those investigating hearing solutions for

themselves or their loved ones, having worked to solve these problems

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x 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 im-

pact of hearing loss, not only in educating the reader about the causes

of hearing loss in its diff erent forms but describing the eff ects on the

person experiencing the loss and the consequences it has on those

around them. Particularly helpful are the coping strategies and expla-

nation of resources for seeking and receiving assistance in proper diag-

nosis 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 sur-

vey information gained from the lives and experiences of those deal-

ing 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.

John’s intent is to put at ease, console, and educate those whose

lives are so greatly aff ected 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 fi nd the help that could really make a diff erence in their lives.

Robert L. Daniels, M.D., F.A.C.S.

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xi

Preface

Hearing loss is an all too common problem that people don’t talk much

about. People’s 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 fi tness centers or meet to weigh in and share low-

calorie recipes. Even if a person’s support system is made up solely

of family and friends, their information, support, and advice remain

important. When faced with hearing loss, however, the fi rst 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 aff ects nearly

everything we do. Lives are turned upside down—not just the lives of

the people suff ering hearing loss, but the lives of family and friends

as well.

Years as a clinical audiologist have repeatedly shown me how un-

prepared the majority of people are when faced with a hearing loss.

They weren’t 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

don’t know who to see if a problem is suspected, or if they do visit

a hearing professional, they have no way of putting the fi ndings 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 fi nd good medical advice but don’t 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 fi rst-

hand 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 off ered a medical or technological solution may not feel comfort-

able proceeding without fi rst 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 diffi cult. 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 suff erer’s perspective. They don’t

usually share and they certainly don’t advertise their diffi culties. Books

based on personal testimonials can off er some insight, but they are of-

ten published because they contain inspiring or tragic stories, not be-

cause they are representative of the everyday realities for most suff erers

of hearing loss.

The fi rst-hand information found here was obtained through

open-ended questionnaires that seventy-seven hearing-impaired pa-

tients and twenty-three spouses (or signifi cant 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 ba-

sics 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 don’t know someone with hearing

loss to ask.

Individuals new to hearing loss could certainly benefi t from this

combination of basic information and fi rst-hand advice. Longtime

hearing-loss suff erers can learn more about hearing loss and the op-

tions available as well as obtain the advice of others in their own posi-

tion. Family, friends, co-workers, and others who spend time with the

hearing impaired should also benefi t, because some of the advice of-

fered by patients and spouses was specifi cally 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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xv

Acknowledgments

I wish to thank the patients, spouses, and signifi cant others who made

this book possible by generously sharing their time, experiences, and

advice so that others might benefi t. 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 ap-

preciate the foundation’s 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 benefi t more than just our own patients.

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1

Introduction

Susan Tate loved to visit. She was active in her children’s parent-

teacher organization, her neighborhood association, and numer-

ous church groups. When a new neighbor moved in down the

street, she delivered cookies and off ered 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 fl ow only one way, however,

as she also off ered advice about local groceries, banks, city services,

and numerous other tidbits. Asking advice was always her fi rst step

when making decisions or solving problems, so she was usually quick

to off er her thoughts when they might help others.

When Susan started having diffi culty 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 hear-

ing 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.

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2 Introduction

Susan is not alone. Many people fi nd that useful fi rst-hand advice

about hearing loss is in short supply, and they might reasonably con-

clude that this is because there are not many people who have expe-

rience 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 in-

creased longevity and the aging of the baby-boom generation, the num-

ber of people with hearing diffi culties 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. Be-

cause 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 hasn’t resulted in multitudes of viewers

eager to discuss hearing loss.

Negative associations with aging, disability, and decline undoubt-

edly suppress discussion. Many don’t want to admit a hearing loss

to themselves, let alone pointing it out to others. These bad associa-

tions 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 benefi t 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 3

because they weren’t 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 hav-

ing 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.

What’s more, the diffi culties that ensue go beyond hearing in and of

itself. Research shows the impact of hearing loss to be signifi cant and

wide ranging. People with untreated hearing loss are more likely to suf-

fer 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 compensat-

ing for hearing loss whenever possible.

Anyone with hearing loss has a front-row seat to the diffi culties

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 suff ering 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 fi nding ways to bet-

ter 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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4 Introduction

Getting answers to questions such as these are an obvious fi rst 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 off er advice that is not only true but applicable to

the individual. All too often, however, this is seen as too big of a fi rst

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 commit-

ment toward action, such as getting hearing aids or having surgery, that

a person does not wish to pursue. In contrast, listening to the perspec-

tive and advice of someone with hearing loss is a small step that requires

no fi rm 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 fi rst-hand advice from

hearing-loss suff erers. For those new to hearing loss, it provides a way

to get their feet wet rather than jumping into the deep end. For long-

time hearing-loss suff erers, this information can provide a wider per-

spective 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 fi nd these recommenda-

tions of interest.

The fi rst-hand information and advice presented here was ob-

tained through the use of an open-ended questionnaire given to pa-

tients in our offi ce in Warren, Ohio. (The questionnaire is reproduced

in the Appendix.) A few of the patients surveyed had been evalu-

ated 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 5

hearing instrument specialists, and anyone else that might have off ered

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 diffi culties 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 person’s 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 sur-

vey or provide any identifying information on the survey or the return

envelope. While compiling the surveys for this book, every eff ort 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 offi ce. 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 diff erent open-ended questionnaire was given

to the spouse or signifi cant other of the hearing-loss suff erer (this is

also reproduced in the Appendix). They were queried about how they

themselves were aff ected as well as how their hearing-impaired loved

one was aff ected. In addition to noting observations, spouses were also

asked for advice.

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6 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 individu-

als with hearing loss. The other twenty-three were from a spouse or

signifi cant other. The greater number of respondents with hearing loss

resulted from patients more often than not coming to their appoint-

ment 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 per-

cent. Even here, getting fi rst-hand advice about hearing loss was hard

to accomplish.

Our patients come from the northeastern Ohio and western Penn-

sylvania region, including Youngstown, Cleveland, Akron, Canton,

Columbus, Pittsburgh, and their surroundings, and all of the patients

surveyed were seen in our offi ce in Warren. People who live outside

this area or who have seen diff erent professionals could have diff er-

ent 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-fi ve years old, but

most were approaching or a little past retirement age. Patients ques-

tioned ranged from the poor to the affl uent. Their incomes were not

recorded, but the median Ohio income is fairly close to the national av-

erage. Similarly, the distribution of our patient base by race and ethnic-

ity refl ected 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 7

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 hap-

pens in political debates, respondents sometimes used the questions as

a starting point to speak to the issues they wanted to address. Conse-

quently, focusing on subject provided a more logical approach and also

allowed for the inclusion of observations, impressions, and advice that

were volunteered but not specifi cally 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 confi dentiality.

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 off ered in Part 2. The fi rst chapter describes

the anatomy and function of the human ear, explains the tests com-

monly 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 (amplifi ed telephones, wire-

less headphones, closed captioning) that can help in specifi c situa-

tions. 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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8 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 fi rst-hand perspectives and advice. Chapter 4 explores the im-

pact of hearing loss through patients’ own accounts of how they are

aff ected. Some observations will be obvious, such as sounds going un-

heard or speech being misunderstood. Others are more involved and

detail how hearing loss aff ects 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 amplifi ed telephone are examined in chapter 5. Survey re-

spondents describe what they have tried and what they did or did not

fi nd 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 satisfi ed 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 satisfi ed 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 fi rst-hand advice that was off ered 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 fi rst-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 9

Spouses and signifi cant 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 eff ects on their loved ones and have to fi nd ways to cope

with it themselves. What are the eff ects they see on their spouses? How

does it aff ect their own lives? What advice can they off er? All of this is

examined.

The fi nal chapter reviews the recurring themes and advice off ered

by those with hearing loss. Also examined are some seemingly contra-

dictory 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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part one

Hearing-Loss Basics

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13

1

The ABCs of Hearing Loss

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

He was pretty sure, however, that the experience wouldn’t be

good. He didn’t ask to be there, didn’t 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 fi asco, and Sam feared more of the same. This was all under-

standable, because Sam was three years old, and his previous medical

procedure had been a vaccination at the pediatrician’s offi ce. 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

McDonald’s were unanticipated bonuses.

Carol approached her hearing evaluation more calmly than Sam,

but she had no more idea of what to expect. She didn’t know what

tests would be performed, their purpose, how long they would take, or

how to interpret the fi ndings. 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

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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 fi nd them-

selves unprepared. Their training is in areas unrelated to hearing, mak-

ing it necessary for them to start at the beginning. Since the beginning

for many is to have their ears checked by a professional, the fi rst 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 his-

tory, as well as whether there has been noise exposure, pain, ear infec-

tions, 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 evalua-

tion. A doctor, audiologist, nurse, or other medical professional does

this with a device called an otoscope. The otoscope is little more than

a fancy fl ashlight 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 specifi c—and a

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The ABCs of Hearing Loss 15

bit scary sounding—is an operating and diagnostic microscope. This

specialized magnifi er 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 magnifi er 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 (fi gure 1). It may be possible to see earwax, swelling,

infection, or some other peripheral problem. More often than not, how-

ever, 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 per-

son 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

physician’s focus rarely lingers here, since nearly all hearing-related

problems lie deeper.

Incoming sound in a normally functioning ear vibrates the ear-

drum, and these vibrations are then transferred through the three

small middle-ear bones (the malleus, incus, and stapes—also known,

respectively, as the hammer, anvil, and stirrup) to the inner ear. Collec-

tively these bones are called the ossicles, and the air-fi lled 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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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 aren’t likely to be visible.

Another structure important to the function of the ear is the Eu-

stachian 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 prob-

lem 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 fi gure 1

is called the cochlea, which houses thousands of sensory cells respon-

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

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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 func-

tion 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

fl uids in the vestibular system of both ears are pushed back, stimulat-

ing the balance nerves and creating the sensation of linear acceleration.

If a person turns, the fl uid in one ear is pushed forward while in the

other ear it is pushed back. The resulting diff erence in stimulation be-

tween ears is experienced as spinning. Because the hearing and balance

portions of the inner ear are closely related, a problem aff ecting one

part may aff ect the other. Consequently, a hearing test is routinely done

when dizziness or balance diffi culties are reported.

Types of Hearing Loss

Hearing loss is divided into three general categories based on what

goes wrong. The fi rst involves anything that prevents or blocks sound

from getting to the inner ear. A few examples might include an ear canal

fi lled 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 effi ciently, to the inner ear. Fortu-

nately, conductive losses usually represent a mechanical problem that

has the potential for correction or improvement. Earwax can be re-

moved, 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 fi nd.

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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 exces-

sive 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 hear-

ing 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 re-

sponsible 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 fi bers. Auditory information becomes lost on the way to the brain

as a result of this neural damage. Sounds and speech go missing—often

unpredictably. This neural component explains how speech might be

heard but not understood and why hearing aids sometimes provide

only a limited benefi t.

The fi nal type of hearing loss is termed mixed. This loss is sim-

ply 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 confi rm or

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rule out a hearing loss, to quantify the severity of a loss, or to diff erenti-

ate the types of hearing loss just described. Not all hearing losses are

alike. A person may have a very slight problem that only prevents hear-

ing the quietest sounds. Understanding normal speech may not be af-

fected unless someone is speaking extremely softly or from a distance.

In contrast, another person may have a more signifi cant 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 fo-

cused 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 com-

prehensive test battery. This may on the surface sound daunting, but

all of the parts combined take only about fi fteen minutes. Pure-tone

air-conduction testing is the fi rst 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 patient’s 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 fi nd the softest sound a person can hear (the hear-

ing threshold) across a range of pitches. The results are then graphed

on a form called an audiogram.

A diff erent measure of hearing threshold is obtained using two-

syllable 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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fi nd the softest level where they can be understood. This speech recep-

tion 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 some-

thing 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 individual’s hearing threshold. The

percentage correct is then recorded. This measure of hearing clarity is

called speech discrimination or word recognition score (WRS) testing.

The fi nal 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 diff erence from the air-conduction test-

ing is in the kind of headphone used and where it is placed. In bone-

conduction 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 diff erence 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 hear-

ing 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 fi ve feet is about 20 dB when measured

using a slightly modifi ed decibel scale (dBA) that ignores some low-

frequency reverberant noise. A quiet offi ce or library is 40 dBA, normal

conversation is 60 dBA, and a fl ushed toilet 75–85 dBA. Any sound of

85 dB or greater is considered potentially damaging to the ear. This

would include fi rearms, rock concerts, chainsaws, motorcycles, snow-

mobiles, 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 patient’s ear

and holding the base of the fork against the mastoid bone behind the

ear. The vibrating tuning fork is heard normally through air conduc-

tion when near the ear canal. When held against the mastoid, the tun-

ing 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 physician’s toolbox might seem archaic in the

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

many doctors use it to screen for conductive losses and to confi rm

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, tym-

panometry 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 refl ected back off the

eardrum as the pressure is changed. When the pressure in the ear ca-

nal 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 stiff ens the eardrum, refl ecting sound back into the ear-

plug. 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 diffi cult to see), and it

can help to confi rm an observation of fl uid 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 diff erent

tests from those given to adults. A child who is four or fi ve 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 re-

sponse 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 hear-

ing loss. The test used is called otoacoustic emissions (OAEs). In a

normal or near-normal hearing ear, the sensory cells in the cochlea vi-

brate 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 infant’s 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 emis-

sion 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 test-

ing a small electrode is taped behind the ear or on each earlobe. An-

other 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 brain’s electrical response to the sound is measured through the

electrodes. The hearing level is determined by presenting sounds at

diff erent volumes and looking for the softest sounds that produce a re-

sponse 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 audi-

ometry (VRA) becomes an option. During VRA a child sits on mom

or dad’s lap as sounds are presented through speakers or headphones

on the child’s right and left side. A toy to the right or left is simultane-

ously 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 vol-

ume is reduced to fi nd the quietest level at which the child correctly re-

sponds. 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 eff ective. Fortunately, these children are

now ready for something else. While they still won’t 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 aff ect speech, language, and educational de-

velopment. 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 screen-

ing. 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 fi rst 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 reha-

bilitative measures, such as hearing aids and assistive devices. Audiolo-

gists are the mainstay for those who must cope with a hearing loss that

otologists and ENTs cannot fi x. Ear, nose, and throat physicians and

otologists often work in close cooperation or partnership with audiolo-

gists to provide comprehensive hearing care.

A quick way to fi nd an ENT physician in one’s 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 web-

site for the American Academy of Audiology (www.audiology.org) or

the American Speech-Language-Hearing Association (www.asha.org).

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http://www.entnet.org

http://www.audiology.org

http://www.asha.org


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 exami-

nation, or what might have gone wrong, suspicion of a hearing loss is

necessary. This frequently means that the fi rst reaction to a beginning

hearing loss is no conscious reaction at all, since those affl icted may be

unaware there is a problem. That someone might not at fi rst 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 hap-

pen, 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 problem—at

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 de-

crepitude are common. Anyone trying to come to grips with a hearing

problem likely has some internalized baggage in this regard. Accep-

tance of a hearing loss may be perceived as acknowledging these nega-

tives about oneself. Regardless of whether a person believes the stereo-

types, 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

one’s hearing remains fi ne 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 per-

son 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 de-

pend on their hearing have been shown to avoid acknowledging hear-

ing diffi culties. They felt stigmatized, were uneasy talking about the

problem, minimized the eff ects, tried to portray themselves as normal,

and had diff erent perspectives than their spouses regarding hearing

defi cits.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 hear-

ing 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 it—especially those with hearing

loss—because it works.

Another refl exive response to hearing loss is to turn up the vol-

ume. 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 what’s audible for

them. Since there are no standard volume settings from device to de-

vice or even from channel to channel on the radio or television, the set-

ting on the dial may off er little feedback about a person’s 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 doesn’t 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 fi rst

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 fi lling 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 direc-

tions from a source, spoken speech can be somewhat directional. Get-

ting 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 un-

derstand is to get closer. Sound volume drops off signifi cantly the far-

ther a person gets from a sound source. This can present a real problem

for someone who is already having hearing diffi culties. 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 situ-

ations that require good hearing. After repeatedly failing to hear, un-

derstand, 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 de-

cline 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 diffi culty hearing or fear

of being stigmatized, the end result is the same. Their self-imposed ex-

clusion from groups and social situations also helps explain why Susan

Tate could fi nd no one to ask for advice about her hearing loss. The

hearing-loss suff erers 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 fi ndings 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 an-

other 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 fre-

quently, 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.

Y6609.indb 30Y6609.indb 30 12/10/14 9:38:32 AM12/10/14 9:38:32 AM

31

2

Hearing Aids and Other Gadgets

Solutions for hearing loss are rarely one size fi ts all. This is also

true for devices that might help a person compensate for a hear-

ing loss. The severity of hearing loss, word understanding abil-

ity, pattern of loss (high pitched versus low pitched), and sensitivity to

loud sounds varies from person to person. Listening needs and listen-

ing environments can also be unique.

Scott Wilson, for instance, was a forty-two-year-old computer sup-

port specialist who came to our offi ce because he was having diffi culty

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 diffi culties at home or in his so-

cial life. Scott could also hear well on his home phone and cell phone.

The problem was using the phone at work. His job entailed trouble-

shooting computer problems over the phone, and he was struggling to

hear the callers. He surmised that his diffi culties 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

eff ectively do his job.

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Giovanna Pizzati also reported hearing diffi culties. She misunder-

stood 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 mis-

understood her grandchildren—which was often—they became upset

and felt she wasn’t paying attention to them. Mrs. Pizzati clearly needed

help, but her hearing loss and listening needs called for a diff erent an-

swer than the one that would work for Scott Wilson.

Both of these people knew they had a hearing loss and were moti-

vated to seek a workable solution. For Scott there was a simple answer

he had not considered. Giovanna, on the other hand, knew of some-

thing that should help, but she was hesitant. Like so many others, they

both lacked the information necessary to move forward. This chap-

ter 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

specifi c listening problems.

Tools for HearingAlerting 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 hear-

ing 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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Hearing Aids and Gadgets 33

One of the most common is an amplifi ed 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 in-

clude 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 amplifi ed or fl ashing 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 combina-

tion doorbell that also fl ashes the lights would be another.

Little should need to be said about the importance of smoke, fi re,

and carbon monoxide detectors. The standard advice that every house

should have at least one working alarm is inadequate if a resident has a

signifi cant 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. In-

stalling linked alarms that also include a strobe light would be even

better. Some advanced systems combine the above signals (doorbell,

fi re, smoke, carbon monoxide) with an integrated home security sys-

tem 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 identifi ed.

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When surveyed about the use of alerting devices, one person re-

sponded simply, “I have a dog.” Even though this wasn’t what we ex-

pected, 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 specifi -

cally 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).

Amplifi ed Listening Devices

Increasing the loudness of speech can usually help people overcome

many of the listening diffi culties that result from hearing loss. It is easy

to turn up a radio or a television louder, but unfortunately, not every-

thing 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 amplifi ed one instead.

The telephone is a prime example. Understanding on the phone

can be especially diffi cult because only one ear is being used, and

there is no chance for lip reading. Some phones do have an adjust-

able 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 amplifi ed telephones specifi cally designed for the hearing im-

paired. 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 diff erent pitched hearing losses. One other

telephone option is a microphone headset like those used by telemar-

keters, but with two amplifi ed earphones so that the listener can use

both ears. In Scott Wilson’s case, the answer to his telephone diffi cul-

Y6609.indb 34Y6609.indb 34 12/10/14 9:38:32 AM12/10/14 9:38:32 AM

http://www.ihdi.org

http://www.dogsforthedeaf.org


ties at work was one of these amplifi ed headsets. The version he even-

tually got had extra large earphones that completely covered his ears

and blocked the outside sounds that often interfered with his hearing.

What’s more, his employer agreed to supply this special headset since

it would improve Scott’s productivity.

A more general purpose listening device is a personal amplifi er.

A personal amplifi er 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 amplifi es surrounding sound. It is an inexpensive op-

tion 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, physician’s as-

sistants, 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 ampli-

fi ed can result in better care for the patient and a continued career for

the practitioner. An amplifi ed stethoscope provides a good example

of the benefi t that can result from fi nding 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 understand—to communicate. If in spite of a person’s best

eff orts 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 specifi c situations and require a little planning, but it can

be worth the eff ort.

The majority of people are aware that closed captioning is avail-

able on television programs. Even if they have never used it themselves,

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they have likely seen the words scrolling across the bottom of a televi-

sion 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 television’s setup menus to fi nd the closed-captioning op-

tion 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 don’t 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. Hav-

ing 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 hear-

ing is to write notes. As long as one’s handwriting is legible, this does

work. The downside is that it can be slow and cumbersome. An alter-

native 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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http://www.captel.com

http://www.captioncall.com


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

can’t? Your big-screen television is mounted to the wall and it’s im-

practical 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 set-

top 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 listener’s 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 off ers listening applications that go beyond

television. There are personal FM systems that include a small micro-

phone 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 eff ectively

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 re-

quires a special induction loop wire to be placed around the perimeter

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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 wire-

less 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 ac-

commodations be made in a variety of venues for people with disabili-

ties.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 amplifi ed listening device, sound systems

that can wirelessly connect with hearing aids, sign-language interpret-

ers, captioning, or some other option.

Hearing Aids

Hearing aids are the best option for the majority of people with hear-

ing loss, because they help in not only one or two listening situations

but over a variety of them. Hearing aids were the solution that Gio-

vanna 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 fi nd 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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http://www.hearingloop.org


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

essentially just a small personal amplifi er. It makes sounds louder. Just

how much louder varies by pitch and from user to user depending on

an individual’s hearing loss, listening preferences, and loudness toler-

ance. A hearing aid has a microphone that picks up sound, an amplifi er

that makes it louder, a signal processor that manipulates the output,

a small speaker (called a receiver in hearing-aid terminology) that re-

produces the sound, and a battery that provides power. The battery

typically lasts one or two weeks, depending on the specifi c hearing aid,

and is easy for the user to change. A few hearing aids come with a re-

chargeable 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 fi ve years, but this can range from three to ten years de-

pending 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 (fi gure 2). The smallest

fi ts 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 fi ll 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 se-

vere 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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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. Today’s digital signal processing has defi nite 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-fi delity analog

stereo systems that were enjoyed years ago had awesome sound. Clar-

ity wasn’t an issue. Similarly, many of the older analog hearing aids had

very little distortion. Going digital didn’t 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 dif-

ferent pitches to bring a wide range of speech into an audible range,

while also limiting loud sounds from becoming uncomfortable. It can

also be fi ne-tuned based on a person’s 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

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

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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 indi-

vidual’s needs or preferences. Most of today’s hearing aids incorporate

ten to twenty frequency bands that can be programmed independently.

Having this fl exibility 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 specifi c sounds that

might otherwise be uncomfortable.

Another advantage of digital technology is that it can allow a hear-

ing aid to have several diff erent programs. The default program might

be intended for everyday listening. A second might have reduced am-

plifi cation and an aggressive noise fi lter to help in a loud work envi-

ronment. 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 individual’s many listen-

ing needs. Digital models that perform as several diff erent hearing aids

in one result in fewer compromises.

The microphone traditionally used in hearing aids is omnidirec-

tional, meaning it collects sound from all directions. This helps to en-

sure 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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sides or from the back. A user can then switch back and forth between

the microphones (directional or omnidirectional) best suited to a situ-

ation. A more sophisticated style of directional microphone incorpo-

rated into many digital hearing aids looks for sounds that appear to be

human speech and focuses in that direction. These directional micro-

phones are sometimes called adaptive or automatic. Two separate re-

views 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 hear-

ing aids. The digital sound processing that allows for the amplifi cation

of wanted sounds can also be used to minimize or eliminate sounds

that are unwanted. Hearing-aid manufacturers use a variety of dif-

ferent proprietary noise algorithms, but the general approach is to

minimize sounds that have a diff erent acoustic signature than speech.

Reducing noise can improve listening comfort and in theory improve

understanding. The problem for understanding is that in a busy res-

taurant or at a church social, unwanted conversations may still crowd

out a particular person speaking. The noise-reduction algorithms

don’t 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 impor-

tant 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 oc-

curred when sound from an aid escaped the ear and entered the hear-

ing aid’s microphone. A feedback loop ensued in which sound would

be amplifi ed 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. To-

day, feedback suppression is included on all but the most basic digital

hearing aids. Some of the best employ noise cancellation technology,

which is highly eff ective. 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 amplifi ed. 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 compat-

ible 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 hear-

ing aids through a telecoil. The induction loop system previously de-

scribed 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 listener’s hearing aids. The result is like talking directly into

a person’s 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 Schmidt’s 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 con-

sidered himself a successful hearing-aid user, because he could hear

almost nothing without hearing aids, but fairly well with them. His big-

gest problem was hearing his wife—especially 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 amplifi cation

to loud sounds, making them uncomfortably loud or painful. Users

constantly adjusted the volume to try to fi nd 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 soft-

spoken Becky, down for loudmouthed cousin Joe.

Modern hearing aids show a little more intelligence. They are

programmed specifi cally for an individual’s 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 uncomfort-

able. 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 purchas-

ing hearing aids.

Reduced need was one reason that volume controls became less

common on hearing aids. An equal or greater reason was the miniatur-

ization 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 ap-

pealing 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 compatibil-

ity. This technology allows compatible hearing aids to be used as wire-

less 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 one’s 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 device’s opening, pre-

venting 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 plan-

ning, however, preventing interference and damage from earwax need

not be diffi cult. Hearing-aid manufacturers off er a variety of guards

that act as a barrier to the wax. Most are either incorporated in the

original design or off ered 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 fi nal 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 resis-

tant. 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 fi lled 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 mois-

ture. 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 satisfi ed with nothing more than wireless

headphones or an amplifi ed telephone. Another may fi nd 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 at-

tention, 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 fi xed are fi xed and that people are not sold hearing aids unnecessar-

ily. There is no similar safeguard for people compensating for a hearing

loss in other ways. Some needlessly struggle with a correctable prob-

lem. Being aware of the medical possibilities can help a person to mini-

mize this risk. The next chapter explains these possibilities.

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49

3

Treatments for Hearing Loss

Albert Baker had noticed a gradual decrease in hearing over

the previous twenty or twenty-fi ve years. He was in generally

good shape for being one hundred and one, and off ered very

few other complaints. The reason for his visit was mostly to placate

the concerns of his “younger” (ninety-four-year-old) wife and geriat-

ric children. They thought he should get hearing aids. He wondered

whether his hearing diffi culties might only be due to earwax.

Naomi Jackson also thought her hearing problem might be due

to wax, but her situation was a bit diff erent from Albert’s. Naomi was

much younger and had no diffi culty hearing until two days prior to

her offi ce visit. The problem started after swimming. Her right ear

had become plugged, like there might be water remaining in the ca-

nal. She decided to remove it by “cleaning” the ear canal with a cot-

ton swab. Rather than improving the situation, however, this made

things worse: now she couldn’t 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.

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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 simi-

lar to that found in at least half of people over eighty-fi ve 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 offi ce, after which her hearing returned to normal. Either person’s

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 com-

mon hearing problems that may be treated or managed. It off ers back-

ground should the need exist or arise. This background begins with

some more about earwax.

Common Treatable Hearing LossesEarwax

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 usu-

ally aff ected 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, fl akes 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

suff er a plugged sensation, a feeling of fullness or pressure, ringing,

pain, or the sound of one’s own voice reverberating in the ear. Im-

pacted earwax aff ects up to 6 percent of the general population and

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Treatments for Hearing Loss 51

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

physicians.2

Many cases of impacted earwax are self-infl icted, just like Naomi

Jackson’s. People try to clean their ears with cotton swabs and only suc-

ceed in pushing the wax farther into the canal. This can also be an un-

intended consequence of using earplugs or deep-fi tting 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 audiolo-

gist, 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 aff ect a person’s hear-

ing 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 fi ngernail, 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 “swimmer’s ear.” Once infected, an ear canal can

itch, swell, seep, and hurt. Hearing is not usually aff ected unless the

ear canal swells shut, in which case sound is blocked from reaching the

eardrum. Swimmer’s ear is usually treated with medicated eardrops or

ear wash.

Another frequently seen problem is otitis media, in which the nor-

mally air-fi lled space behind the eardrum becomes fi lled with fl uid.

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 fl uid. Otitis media may

also occur as a result of sinus problems, allergies, and pollutants. Even

second-hand smoke increases the risk.3 The fl uid usually resolves on

its own—but if it does not, it provides an ideal environment for bacte-

ria. Middle-ear fl uid 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 fl uid

presses against the eardrum, interferes with the motion of the ear bones,

and acts as a barrier to sound. A little fl uid may have little impact, but a

lot of fl uid or fl uid that is thick creates a signifi cant 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 diffi cult.

Fluid in the middle ear that does not go away can be drained

through a procedure called a myringotomy. A physician fi rst 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 fl uid does not reoccur. With the fl uid gone,

there is no longer an impediment to sound transmission. If the fl uid

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

leave a small tube in the myringotomy hole to provide ventilation. A

myringotomy or myringotomy and tube are quick in-offi ce ENT pro-

cedures for an adult. Children are usually done in a surgery center un-

der anesthesia.

Prevention

Often overlooked in the search for possible treatments is the impor-

tance of prevention. The best treatment is one that avoids the develop-

ment of a problem in the fi rst place. Anything that stops a progressive

condition from becoming worse could also be considered an eff ective

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 envi-

ronmental hazards can also lead to or worsen hearing loss if left un-

checked. 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 ad-

ditionally a concern: better management of it might prevent many hear-

ing losses that are now attributed to age.6

Ear, nose, and throat physicians routinely consider a patient’s

medical history, work environment, and personal habits when look-

ing 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 his-

tory 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 LossesPerforated 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 explo-

sion are only a few causes of perforations. Some are self-infl icted 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 ear-

drum 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 don’t can usually be repaired

medically.

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Small traumatic perforations can often be repaired with the place-

ment of a paper patch over the hole that serves as a template for heal-

ing. This simple procedure can be performed by an ENT physician

in-offi ce and has been found to be eff ective 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 eff ects are lost without functioning middle-

ear bones. What’s 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 conver-

sational 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 com-

pletely restore the hearing to normal. This is especially true if all of the ear

bones have to be replaced, because the one replacement prosthesis can-

not 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 com-

plications are also possible but rare.

One of the fi rst signs of cholesteatoma is often a foul-smelling drain-

age 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 un-

der 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 recon-

structing the middle ear. After six months or a year a second surgery is

performed. If the cholesteatoma has reoccurred, it is removed, the ear-

drum closed, and another follow-up surgery scheduled. If the choleste-

atoma 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 signifi cant 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, aff ecting 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 pro-

gressive and can result in a severe conductive defi cit. The disease pro-

cess may also produce some gradual sensorineural loss over time.

Next to wax buildups and ear infections, hearing losses from oto-

sclerosis 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 effi ciency with

this reconstruction. Patients with otosclerosis who are deemed can-

didates for stapedectomy surgery have up to a 95 percent likelihood

of signifi cantly improved hearing with little or no remaining conduc-

tive 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 benefi ts of this surgery were exemplifi ed 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 mod-

erately severe loss in each ear. She couldn’t 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 aff ect both ears and occur gradually over time. Sud-

den sensorineural hearing loss is a clear exception. A person may wake

up one morning to fi nd 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 gradually—perhaps over two

or three days—but 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 some-

times 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 examina-

tion but also a hearing test to diff erentiate 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 sensorineu-

ral loss is never known. The damage is defi nitely 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 person’s 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 person’s own immune system can go

badly wrong and harm the cells in the inner ear. This results in a rap-

idly 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

aff ected. Autoimmune inner ear disease may occur in isolation or in

combination with other autoimmune diseases, such as lupus. Physi-

cians sometimes order a variety of blood tests to look for signs of the

disease, but diagnosis can be diffi cult because there is no one specifi c

diagnostic test.16 For patients who are diagnosed, however, steroid

therapy off ers the hope of improved hearing and balance.17 Because of

diagnostic diffi culties 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.

Ménière’s Disease

Ménière’s disease is another treatable inner-ear disorder that can ad-

versely aff ect hearing. The classic symptoms of this disease are an in-

capacitating vertigo, fl uctuating hearing loss, a roaring sound, and a

sensation of fullness in the aff ected ear. The symptoms occur together

during Ménière’s 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 aff ected. A person’s hearing may recover completely

after the fi rst few attacks, but repeated attacks can result in a severe

hearing loss that does not return to normal.

Ménière’s disease is thought to be caused by a buildup of fl uid

pressure in the balance portion of the inner ear. There is no known

cure, but there are treatments to minimize the frequency and sever-

ity of attacks. One of the most basic is switching to a low-salt diet to

help prevent any fl uid buildups in the inner ear. Diuretics may also be

employed to reduce fl uids in the body. Excess fl uid 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 eff ectiveness of these and other interventions for Ménière’s is diffi -

cult, however, due to the disease’s episodic nature and variability from

person to person.

Congenital Loss

The overall incidence of congenital hearing loss—meaning it is present

from birth—has been estimated at 2 or 3 children out of every 1,000.18

One or both ears may be aff ected. 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 sen-

sorineural hearing loss remains unknown. Hearing aids are the usual

recommendation when a congenital hearing loss is in the mild or mod-

erate 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 mi-

crotia. The inner ear may be unaff ected, 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 LossBone-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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conductive hearing losses that cannot otherwise be corrected. The sys-

tem consists of several parts (fi gure 3). On the right is shown a small ti-

tanium implant that is surgically inserted into the bone behind the non-

hearing 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 person’s 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-

Figure 3. Parts of a bone-anchored hearing aid

(Image provided by Oticon Medical, LLC)

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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 eff ective 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 Co-

chlear Attract and MED-EL Bonebridge magnetic systems are avail-

able at www.cochlear.com and www.medel.com.

Cochlear Implant

A cochlear implant is a medical device specifi cally designed to help a

person overcome a severe or profound sensorineural hearing loss that

is beyond the range of hearing aids. It is today’s bionic ear. Worldwide

there are more than 300,000 in use.19

A cochlear implant consists of at least two parts (fi gure 5). The

fi rst part is the implant itself. The electrode portion of the implant is

inserted into the inner ear (cochlea) to replace the nonfunctioning sen-

sory cells. The body of the implant sits under the skin a little behind

the ear. Surgery is performed on an outpatient basis under general an-

esthesia and usually takes two or three hours. Healing takes four to six

weeks, and then the second essential part of the implant system—the

externally worn sound processor—is 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 fi gure 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 fi gure 6.

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http://www.cochlear.com

http://www.oticonmedical.com


http://www.medel.com


Nothing is heard with a cochlear implant until the sound proces-

sor is programmed and turned on. When this fi rst happens, sound

may have little meaning and seem like gibberish. The recipient’s 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,

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

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language, and auditory training. Someone with congenital deafness

also needs to get started early with an implant, because there is a devel-

opmental 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 un-

derstanding 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-

Figure 6. A cochlear implant and external sound processor

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

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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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http://www.bionicear.com





Part Two

First-Hand Experience and Advice

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71

4

Real-Life Consequences of Hearing Loss

Knowing that 10 percent of the population has hearing loss does

little to explain how hearing loss aff ects an individual. Reports

associating hearing loss with social diffi culties 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 people’s 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 dif-

ference 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 be-

cause I had normal hearing I could not truly portray the reality of hear-

ing loss. She felt this could only be done by someone with fi rst-hand

experience. The more I thought about what she said, the more I could

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72 first-hand experience

understand and sympathize with her viewpoint. I also began to recog-

nize her view as prevalent among many other patients. They wanted at

least some of their hearing-loss information fi rst-hand. This realization

was the impetus for the patient survey that provides the fi rst-hand in-

formation and insights off ered through the rest of this book.

What is the fi rst-hand reality of hearing loss? What are the specifi c

ways individuals see their lives aff ected? 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 eff ects that

were every bit as real, but might not on the surface have seemed as ap-

parent. The second part of the chapter focuses on these.

Obvious Eff ects of Hearing LossSounds Go Missing

The most obvious result of hearing loss is a person’s inability to hear

sounds that are clearly audible to others. It is not diffi cult 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 si-

lently against the shore. Footsteps on carpets make no noise. Doors

open without a sound. Leaves do not rustle. Cats don’t purr. All of

this is without mentioning the people who silently mouth their words

rather than whispering or seem to mumble rather than speaking nor-

mally. 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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Real-Life Consequences 73

“I miss all the sounds of nature. At night I can’t hear if it’s

raining.”

“I cannot hear sounds that are around the house like water run-

ning or a motor sounding wrong. I didn’t realize that I was not

hearing everything until I couldn’t follow the conversations.”

“Not always hearing the phone ring or someone at the door.”

Misunderstanding

Diffi culty 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 fi nd that this was not the

case. The following comments illustrate some of these diffi culties with

understanding.

“I can’t 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 misun-

derstandings. My interpretation of not clearly heard words may

be wrong.”

“I have diffi culty understanding in large groups.”

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“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 didn’t understand the clerk.”

“While in groups at restaurants, meetings, I have diffi culty

hearing when many are conversing or many other noises are in the

background. At church, it is diffi cult when diff erent microphones

are used in diff erent places.”

“I don’t hear clearly what people are saying.”

“My hearing loss is relatively minor, but I do have trouble hear-

ing 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).”

“Diffi cult to carry on conversation in large crowds.”

“Sometimes I don’t 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 dif-

ferent than what the person was saying.”

“Miss parts of conversation when more than one or two people

are around me. Retired so it’s mostly friends and relatives. Back-

ground noise is the biggest problem.”

“Diffi cult 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.”

“It’s diffi cult 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 it’s not as

diffi cult to hear.”

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“A hearing loss aff ects communication plain and simple.”

“In large noisy crowds I could not hear discussions/conversa-

tions and became very quiet and did not participate. I would an-

swer 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 person’s tone

or pronunciation sounds distorted due to not hearing well enough to

monitor one’s own voice. Rather, the transformation involves the type

of statements made. A hearing-impaired person’s side of any conver-

sation 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 conver-

sational 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 people—repeat words 2 or 3 times.”

“The eff ects on me are: having people repeat what they are say-

ing, not hearing them whisper and/or mumble. I have diffi culty 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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“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 Eff ects of Hearing LossSafety 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

aff ect a person’s safety. Hearing loss could certainly cause an oncoming

car, truck, fi re engine, or train to go unnoticed. Even if a person does

hear those hazards, hearing loss can produce localization diffi culties

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 be-

cause it sounded like it was somewhere else. Alarms of all sorts (smoke,

fi re, carbon monoxide) may become inaudible, or if heard, not be loud

enough to demand a person’s attention. Other safety concerns include

things as frightening as not hearing a burglar or something more mun-

dane, but also dangerous, such as failing to hear a swarm of bees. An

individual’s 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 can’t

hear them coming.”

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“I’m more careful because of my hearing.”

“Have to be careful when loud noises come and you don’t know

what they are.”

“I get scared when driving and hear a siren because I don’t

know where the vehicle is coming from.”

“I’m 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 protec-

tion 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 couldn’t 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 don’t hear soon enough police or fi re sirens.”

“I can’t 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 sur-

prising that diffi culty 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 signifi cantly. With few exceptions, movies, music, lectures,

meetings, church, family gatherings, and everyday conversation are

dependent on good hearing. Diffi culty hearing may reduce the enjoy-

ment of any of these activities or cause a person to forgo them entirely.

The eff ort and fuss required to participate can reach a point that it just

doesn’t outweigh the benefi t. 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 wasn’t

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 don’t go out as much. I can’t 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 can’t wear hearing aid

and I feel helpless without it.”

“It is a problem not hearing well. I miss hearing my TV pro-

grams well. I read a lot and that helps.”

“Went on a trip with friends recently—reduced enjoyment. Be-

tween cataracts and hearing problems our love of travel has been

very curtailed.”

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“It was hard watching TV with others—not hearing all that was

spoken.”

“I don’t go to theaters and concerts, places with loud noise.

Too hard to hear. Too loud for hearing aid and jumbled without

the hearing aid.”

“Don’t listen to music much—sounds fl at.”

“Belong to United States Coast Guard Auxiliary. Mates are very

patient. Do not take offi ce anymore.”

“There are times that I don’t want to attend a function because

I know I won’t be able to hear.”

“I don’t listen to music, don’t go to noisy places. Hearing loss

doesn’t aff ect much else except I don’t have directional hearing so

don’t know who is speaking if I can’t see the talker.”

“I try to stay away from loud noise and loud crowded areas.”

Work Can Be Aff ected

Hearing loss can also be a problem in many work situations. Sales-

people need to hear their clients. A waiter has to understand customer

orders. Pharmacists must correctly hear each prescription that is called

in. Any hearing diffi culty 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, sig-

nifi cant diff erences in earnings were found between people with normal

hearing and those with hearing loss.2 Little if any earning defi cit was ap-

parent 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 hear-

ing 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 com-

ments that follow illustrate several workplace-related hearing diffi culties,

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 fi ll in

words that I didn’t hear and what I did hear was wrong.”

“It aff ected me at my educational administrative position.”

“Sometimes don’t 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 diffi cult time hearing my students. I am a Span-

ish 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 didn’t have to talk to people except on the phone (I

can hear fi ne on the phone).”

“Cannot do most things that require you hear in order to do a

job or run machinery.”

“Work as a police offi cer, need to hear for public safety.”

“My work includes many meetings and telephone conversa-

tions. 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 don’t attend meetings in

crowded rooms. I have diffi culty in hearing children and in envi-

ronments in which many are talking.”

“I think hearing loss prevented a promotion while working. I’m

retired now.”

Spouses and Signifi cant Others Make Up for What Goes Unheard

Some may at fi rst be tempted to consider hearing loss a personal mat-

ter that does not aff ect anyone else. A little fi rst-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 aff ect 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 re-

peat things to me.”

“Yes, it aff ects 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 aff ects 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 suff ering wife needs to repeat herself.”

“I ask people to repeat words. Says they told me but I didn’t

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 repeat-

ing 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 whis-

pering or mumbling.”

Relationships Become Aff ected

When hearing loss causes people to avoid diffi cult listening situations,

the impact is also felt by those who are close to them. If these situa-

tions 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 one’s 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 under-

stand put a strain on relationships.

“My hearing loss aff ects my relationship. I avoid conversa-

tion. 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 diffi culty hearing/understanding anything. My wife

would get upset with me and me with her—very annoyed.”

“Irritates wife.”

“Occasionally my spouse asks if I have the hearing aids in and

usually he is right when I do not.”

“Aff ects all my family and friends.”

“My hearing loss aff ected every aspect of my life.”

“My hearing loss aff ects my relationships and moods because

quite often I don’t 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 don’t enunciate clearly and I miss half the

conversation. If someone speaks all of a sudden without getting my

attention fi rst, I have to ask them to repeat themselves, which they

don’t appreciate.”

“My family (husband) gets very annoyed if I don’t hear every-

thing 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 kids—all grown up and love to tease mom.”

“I’m sure it does sometimes. I might ask them to repeat what

they said or give me an answer not related to what they said be-

cause I misunderstood the words they spoke.”

“At home I’m aff ected because my husband refuses to talk di-

rectly to me. He talks while walking away from me or from another

room.”

Others Loudly Aff ronted

When asked if her hearing loss aff ected 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 doesn’t want the TV as loud as I listen to it. I strug-

gle 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 aff ected my family because of my saying ‘what’ or ‘OK’ if I

didn’t 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 aff ect oth-

ers and how these others may try to help by repeating what goes un-

heard. 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 don’t know what’s 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 con-

versation.”

“When you have a hearing loss you avoid situations that will

bring attention to your hearing loss. You will have a family mem-

ber 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 with-

drawn being around people who do not communicate distinctly

and clearly.”

“It especially aff ects 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 re-

peat what the servers say or to answer for me because I can’t 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 cen-

ter 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 inac-

cessible 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 suff ered 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. Ap-

parently 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 I’m 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.”

“I’m 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 it’s a blessing, but in reality it iso-

lates you.”

“You miss out on a lot of conversations in social settings.”

“I feel left out of many conversations because I can’t 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 aff ects 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 socialize—back-

ground noise. Problem understanding conversation on TV. Espe-

cially on the phone.”

“I try not to go places where there is a crowd and so I know I

miss out on a lot.”

“I’ve become a little more isolated, especially avoiding crowds.”

“I notice they talk low and I feel left out.”

Hearing Loss Is Bad for One’s Mood

Communication becomes a problem, activities can be limited, rela-

tionships are challenged, work is made more diffi cult, 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 one’s mood.

“I don’t hear a lot going on around me. People don’t 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 aren’t 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.”

“It’s embarrassing when I don’t hear what someone is trying

to tell me. I also feel badly when the person I don’t understand

becomes impatient or disgusted.”

“I can get very irritable and edgy when trying to hear some-

thing.”

“It really doesn’t bother me! Sometimes I get upset if I can’t

hear people with soft voices.”

“I can be irritable with someone who talks when I’m trying to

hear something like the news.”

“My hearing loss made it much more diffi cult to communi-

cate 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 can’t hear something.”

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“It is embarrassing when meeting people and when answer-

ing the telephone—having to say please speak louder, I can’t

hear you!”

“Makes me mad when unable to hear.”

“I get frustrated at not being able to hear what is being said.”

“Aff ects my mood and leisure. Am retired. Very depressing.”

“People get impatient with me.”

“It sometimes aff ects 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 af-

fect relationships. My husband, family and most friends are very

understanding.”

“I’m insecure and don’t 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 can’t hear conversations. I then

usually give up on it. I feel embarrassed to keep saying ‘pardon

me?’ When I taught elementary school it was diffi cult because the

children mumbled or turned their head away and could not hear

them at all.”

“I miss many words and conversations. It’s frustrating.”

“A lot of embarrassment when I misunderstand what is being

said because I don’t hear all of the questions or conversation. My

friends get tired of repeating themselves and I still don’t know if I

heard them correctly.”

“It makes me feel stupid because I don’t hear everything. Peo-

ple talk softly or mumble and have their back to me and I don’t

hear them.”

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Moving from Hearing Loss to Hearing Help

Many people cope well with their hearing loss and the resultant chal-

lenges that have been described. They do this by correcting the loss

if possible or taking steps that minimize any eff ect it might have on

their quality of life. Some even fi nd an upside. One person reported:

“There’s times I actually enjoy the quiet and will take my hearing aids

out when I’m home alone.”

On the other hand, all of the associated negatives make it very

easy to view hearing loss as a hopeless aff air. If this perspective takes

hold it can become a self-fulfi lling prophecy, preventing an individual

from seeking any solution. As the fi rst-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

diff erence.

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92

5

Coping and Getting Help

Except for his hearing loss, Gunnar Schmidt was a fairly typi-

cal seventeen-year-old. He was a senior in high school, played

on the basketball team, and looked forward to college. What’s

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 Gunnar’s hearing from the start,

because his mother and older brother both had hearing loss. When

Gunnar’s newborn hearing screening indicated a problem, his mother

saw to it that further testing and a medical evaluation quickly followed.

Gunnar was soon fi tted with hearing aids, and she made sure he wore

them. The close interaction she maintained with his ENT doctor, au-

diologist, speech language pathologist, teachers, and school educa-

tional specialists meant that Gunnar had all the tools he needed to do

his best.

Gunnar’s 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 speak-

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Coping and Getting Help 93

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 or-

chestrated it all. Gunnar was the benefi ciary.

The story is very diff erent for most people with hearing loss. They

don’t have someone to round up a whole team of the right profession-

als or off er fi rst-hand advice about how best to cope with the range

of diffi culties 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 diff erence be-

tween hearing and not hearing or understanding and misunderstand-

ing. 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 in-

formation 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 fol-

lowing chapter about hearing aids is on what patients actually did and

experienced. What patients recommend based on these experiences

comes later.

Seeking Information and HelpSources 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 advertise-

ments might be printed in their local newspaper, or quiz friends and ac-

quaintances. 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 fi nd

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 maga-

zine that you don’t 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 I’m older, most of my information comes from people simi-

larly affl icted.”

“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 infor-

mation 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 Maga-zine) 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 don’t explain a lot.”

“Internet.”

“Doctor’s offi ce, Internet, news stories. I don’t really get a lot

of information.”

“Reputable hearing-aid agents and friends who are knowl-

edgeable.”

“Family and friends I guess.”

“My ENT physician and hearing-aid supplier. I believe the in-

formation I’ve received has been accurate and helpful.”

“People who conduct the hearing test, also most helpful the audi-

ologist or person who fi ts 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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“Doctor’s offi ce. 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 doctor’s offi ce is good at explaining

things.”

“Online, material from doctor’s offi ce, 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 fi nding 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 nega-

tive stereotypes that have already been mentioned, as well as possible

fi nancial concerns and the general inertia of continuing to do nothing.

A study of more than two thousand older veterans showed how fre-

quently inaction wins out.1 The study participants were checked with a

questionnaire, a hearing screening, or both to fi nd individuals who had

some degree of hearing loss. Of those failing the screening, only 15 per-

cent to 27 percent (depending on the screening method used) went

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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 benefi ts

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 confi rming 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 fi nancial

obligations that I thought were more important.”

“No, because I thought perhaps it went along with sinus prob-

lems 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 fi nd 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

didn’t 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 fi rst it didn’t seem too bad. Once it started causing prob-

lems, 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 traffi c. 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 didn’t 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

dad’s 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. It’s work-

ing out for me now though.”

“Yes. My mother had problems and waited a long time to get

hearing aids—it was diffi cult to communicate with her and our re-

lationship suff ered.”

“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 hear-

ing 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 don’t

think that much about having a loss of hearing. I’m thankful it isn’t

any worse than it is. Few people even know about it.”

Simple Coping StrategiesAsking Others to Repeat

As we have seen, the fi rst and most refl exive way people react when

they cannot understand is to ask the speaker or a convenient bystander

to repeat. The patients surveyed were no diff erent. 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 I’m 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 I’m having trouble fi guring 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 can’t 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 can’t 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 didn’t

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 mu-

sic 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 can’t 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 don’t have my

hearing aids in.”

“I can turn it up or boost, but still almost impossible—espe-

cially 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 un-

derstanding. 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 benefi t to show that lip

reading can be helpful.

“I have used lip reading.”

“Do a lot of lip reading.”

“I’m not good at lip reading, but I tend to try.”

“In some situations, I hear and understand better when watch-

ing 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 an-

other 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 don’t

know who is talking unless I see lips moving.”

“Lip reading, I can hear better.”

“I try to read lips but it’s hard. I hate to have people keep re-

peating 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 fi nd myself gravitat-

ing 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 it’s immersed in a noisy environ-

ment. 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 re-

ducing or eliminating background noise would have been an often re-

peated 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 sur-

prisingly 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 fi nd 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. Nei-

ther of these options rules out adding lip reading or some other strat-

egy. A person may instead fi nd one thing to be most helpful in a partic-

ular situation and something diff erent 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 fi nd 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 situa-

tion. 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 re-

peat) 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, wouldn’t 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 busi-

ness 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 person’s imagination. With just these few excep-

tions, 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, I’ve 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 can’t 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 wouldn’t expect help from others (except my spouse who is

very helpful).”

“No. I am very dependent on myself.”

Technological and Medical OptionsHelp with the Telephone

As the story of Scott Wilson (chapter 2) and numerous patient com-

ments demonstrated, hearing loss can make using a telephone diffi cult.

A standard telephone may not be loud enough, plus it can only be used

with one ear and doesn’t allow for lip reading. All of this assumes, of

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course, that the phone was heard to ring in the fi rst place. Several pa-

tients reported using an amplifi ed telephone to overcome these diffi -

culties. Also found helpful were speakerphones that allowed listeners

to use both ears and vibrating phones to make a person aware of calls.

“Amplifi ed phone helps a lot. You can control the volume and

the tone.”

“Use amplifi ed telephone.”

“I use an amplifi ed telephone. Yes it helps.”

“An amplifi ed telephone is helpful in clarifying sound and mini-

mizing feedback.”

“I use the vibrating function on my cell phone/pager when I’m

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 val-

ued 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 can’t enjoy the show. Several

patients mentioned wireless headphones, with a separate volume con-

trol from the TV’s 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 doesn’t

have to be so loud, but I cannot hear conversations when wear-

ing 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 off er 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 don’t hear

correctly.”

“Closed captioning, amplifi ed telephone both helps.”

“Use closed captioning. It helps a little (usually can’t 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 amplifi cation. Headphones don’t

usually work alone (can’t hear as well) and using with the aids is

uncomfortable.”

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“Used closed captioning when watching movies. It is a distrac-

tion 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 didn’t have this function—been 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 ex-

perience with these devices that they could discuss. The few that were

shared are listed below.

“I use assistive devices at seminars, conferences. Listen to au-

dio books in the car.”

“I use an amplifi er 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 amplifi ers to wear if needed.”

“Church has a good sound system and off ers electronic as-

sistance.”

Most people surveyed left the questions about assistive devices blank.

Those who did answer often had responses such as:

“Don’t have any of these devices. Don’t use any of these

devices.”

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“Never have used any of the aforementioned.”

“I haven’t used any.”

“I suppose there are special devices, but I have never tried any.”

“No I don’t use any.”

“No.”

Sign Language

The option of sign language deserves some discussion, since it pro-

vides a workable alternative to spoken language. It is the primary com-

munication 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 fi rst problem, but not the most diffi cult one. The big-

ger 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 fi nd 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.

“I’ve tried off and on.”

“Tried but failed.”

“Have tried a bit. Not seriously.”

“I’m 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 vari-

ety 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 off ered comments on

their experience.

“First let it be said that I have had chronic ear problems since

four years of age. My parents fi nally took me to ear specialist at six-

teen years. Both ears had new eardrums. One ear—all three bones

replaced—helped for about fi fteen years. I wore a hearing aid until

surgery. I then went twenty-fi ve 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 hear-

ing gets worse.”

“When I had a virus in one ear—I had three injections in the

eardrum at diff erent intervals. It helped.”

“Treated only when my ears become fi lled 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 fi fteen years of

good hearing before needing a hearing aid.”

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112

6

The Hearing-Aid Experience

Loud noise was the downfall of Jackson Jones, and hearing aids

were his penance. At least that was how he described it. Jack-

son 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 fi ve-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 wouldn’t 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 offi ce job he now had at the auto com-

pany. But he also made some of the same complaints off ered by other

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The Hearing-Aid Experience 113

users of hearing aids. The complaints didn’t 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 pa-

tients as did hearing aids. People surveyed may have said little about lip

reading, fl ashing doorbells, or penance, but they were not at all shy say-

ing 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 hear-

ing loss aff ect you?” or “Does your hearing loss aff ect 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 ex-

periences 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 god-

send 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 AidsSocietal Perceptions About Hearing

Aids Often Seen as Negative

The views people hold about hearing aids in general serve as the back-

ground 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,

ineff ective, 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 aff ect 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 diff erently than eye glasses. That’s 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.”

“It’s 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 aff ect me.”

“Something to avoid.”

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“Most people I’ve talked to don’t want to wear them, like they

are embarrassed to admit they need them. I defi nitely 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 old—senile.”

“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, they’re 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 wouldn’t want one.

I grew up around hearing aids as my mother wore one. It’s OK

with me.”

“I used to think ‘one aid you had trouble hearing; two aids and

you were deaf.’ Now I don’t 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 grandchildren’s col-

lege, 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 society’s opinion of hearing aids to be nega-

tive. Slightly less than half (48 percent) of the patients surveyed saw so-

ciety’s 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 benefi cial 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 don’t 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 don’t think too much about

it. I think it’s 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 don’t know most of the time. If I don’t care, they don’t care.”

“I’m extremely happy with mine—improved my quality of life.

I don’t 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 can-

didates either delay or have no intention of getting hearing aids. Some

of this can be attributed to people being unaware of hearing diffi cul-

ties or to their diffi culties 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 diff erent concerns. Sometimes the

true objection to hearing aids is never known. A ninety-six-year-old

patient recently seen at our offi ce provides a good example. She had

suff ered with hearing loss for many years. It was a problem for both her

and her family. Yet when off ered hearing aids, her response was simply,

“I’m 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 fi rst I didn’t 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 one—fear of

not being able to get used to it.”

“Hearing loss did not seem to be serious.”

“Didn’t 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 fi gured 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 didn’t help my sen-

sorineural hearing loss—haven’t worn them in twenty years. They

just made everything louder—every situation and noise was ampli-

fi ed. 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 fi rst seem strange—not necessarily because it is unnatural or bad,

but simply because it is diff erent. Also diff erent might be the feeling of

having a hearing aid in the ear canal. Do people have diffi culty adapt-

ing? Is it as natural as turning up the TV, as comfortable as wearing

earplugs, or is it more like a psychology experiment gone wrong? Per-

haps surprising and reassuring is that more than half (55 percent) of

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the patients surveyed reported no diffi culty adjusting to hearing aids.

Eighteen percent reported only a little diffi culty, while the remaining

27 percent reported that hearing aids defi nitely took some getting used

to. Their assorted comments follow.

“Did not have a problem adjusting.”

“No diffi culty.”

“Only at fi rst with diff erent intense background noises.”

“No, they are a godsend.”

“Hearing aids must be properly fi tted 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 wear-

ing them no matter what the situation. I know people who just

wouldn’t wear them.”

“Not especially diffi cult, 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 fi rst, but then you become accustomed to them and it’s

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 magnifi ed. 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 ear—getting used to diff erent 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 diffi cult in crowded areas, such as res-

taurants, 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-fi t’ ones. Easy to adjust to.”

“At fi rst it was diffi cult, but you can tell the diff erence 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 diff erence 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 fi tted with

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aids, try to give them time to work for you, and you to get adjusted

to them.”

“I honestly don’t 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. Inter-

estingly, diffi culty getting used to them wasn’t 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 satisfi ed with the perfor-

mance of a new pair of hearing aids. I returned them and pur-

chased a pair from a diff erent company.”

“I tried in-the-ear ones on trial. Didn’t like the tunnel sound.”

“Yes. Was teaching school—did not help much, could not han-

dle putting in and out, cost. I am wearing hearing aids now. Hear-

ing aids help a lot.”

“I did try them for a month. I found my hearing to be im-

proved—but was not ready to have them. Plus at the time, cost was

a factor.”

Living with Hearing AidsSituations 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, un-

derstanding 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 diffi culties. 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 living—meetings, company.”

“Watching a show or dining out with friends.”

“In a library, courtroom, etc. where only one person is talking.”

“I can’t understand anything anybody says without them.”

“Church, TV watching, telephone, out to dinner (conversa-

tions). 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 sides—such

as a restaurant.”

“Driving a car (traffi c). Your TV doesn’t have to be turned up

so loud that other people are bothered. You can hear without peo-

ple shouting and it’s 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 mov-

ies, 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 couldn’t 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. It’s 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 impos-

sible and I would not indulge my love of music and theater without

hearing instruments.”

“At all meetings of my professional groups and family gather-

ings. It makes all relationships more authentic.”

“If not wearing hearing aids, diffi cult to hear/understand TV

programs and movies. Others have to repeat if I’m 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 Consumer’s Perspective”

detailed several performance-related issues.3 Background noise and

poor benefi t were the two leading criticisms. People who purchased

hearing aids were found to have continued diffi culty 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 pri-

mary 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 unre-

alized hope or expectation was that the aids would eliminate background

noise altogether. This didn’t 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 identifi ed as the albatross.

“I have diffi culty following a conversation in a noisy en vi-

ronment.”

“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 don’t 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 don’t seem to.”

“If I am around lots of conversations, all of the voices are ampli-

fi ed 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 diffi culty 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 noise—especially

when biking.”

“When there are too many people talking and background

noises.”

“It is more diffi cult in crowded settings due to multiple side

noises.”

“Don’t 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 diffi culties related

to noise.

“They can’t begin to compare to what God gave me.”

“Music isn’t as good.”

“Movie theaters. Even though I wear a hearing aid I can’t 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

fi shing or skiing in wet conditions.”

“I struggled on the job. Hearing aids work fi ne fi ve to six

feet back. In a classroom the students are usually much further

away.”

“Don’t like high pitch.”

“Sometimes when people speak softly.”

“In groups, watching TV, someone calling to you from a dis-

tance or talking to you with their back turned.”

“Not having a special phone. Can’t 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 con-

sidered recurring complaints. These as well as a few fi nal matters are

mentioned here. Cost and battery life crop up again elsewhere.

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“Expensive, batteries need to be replaced, can’t 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 aff ected it.”

“I have decided to stay away from water sports to prevent hear-

ing-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 be-

cause of uncomfortable sweating.”

“Battery doesn’t 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 defi nite 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 us-

ers 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:

“Diffi cult to hear some TV dialog. Can’t use earphones, listen to

music on iPod, some phone conversations diffi cult.”

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 maintenance—sometimes costly.”

Pro: “Makes life easier at home and socially.” Con: “Battery fail-

ures 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. You’re always buying batteries.”

Pro: “You can hear one person at a time.” Con: “Are uncomfort-

able to wear and you hear things you don’t want to hear.”

Pro: “Hearing vastly improved.” Con: “Taking proper care of

the aids—cleaning, 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 back-

ground 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, don’t fi t tight, sweat-

ing is a big problem.”

Pro: “I can hear.” Con: “They pick up too much background

noises. Bothersome to use wearing a hard hat. Sweating af-

f ected it.”

Pro: “Hearing is a major pro. I could not function in daily life

without my aids.” Con: “Squealing, wind noise, clicking when eat-

ing or chewing, can’t lay your head on the side, can’t get wet.”

Older Versus Newer Aids

As with other products, advertisements for hearing aids frequently fo-

cus on their being new and improved. There is little doubt that hear-

ing 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 au-

thors of a recent study evaluating advanced digital hearing aids.4 They

found that 92 percent of users studied were at least somewhat satis-

fi ed with their digital aids. In comparison, earlier studies showed a

70 percent to 76 percent satisfaction rate.5 The few comments off ered

here on the issue of older versus newer aids seemed to support this

conclusion.

“Years ago it was more diffi cult to shut out background noise.

Now the aids are great if you have them fi tting 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 defi nite 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 back-

ground. The question here is whether patients noticed these advan-

tages. Ninety-two percent said they did.

“Two are better than one.”

“Absolutely. Two ears always hear better than one. The hearing

loss is also diff erent in each ear (40 percent left and 30 percent

right). You need two devices to properly balance the sound.”

“Two are more eff ective. You simply hear more of what’s going

on around you.”

“I always wear both, it balances out. Just wearing one doesn’t

help much if you need them both.”

“No diff erence.”

“Two are defi nitely better because both of my ears are bad.”

“Two are better than one. It somehow allows you to hear con-

versations from all sides.”

“Defi nitely two are better than one. I used to wear one aid

and started using two and it makes a world of diff erence 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 aff ord one then one is

better than none.”

“I found just using one you don’t 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 can’t

understand anything with my right ear alone but it helps me un-

derstand some words.”

“Yes, together. Strain to hear with only one.”

“Defi nitely, one broke on me and I had to revert to wearing one

and that was diffi cult, 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 aff ect the likelihood

of use. Nevertheless, the higher usage rate in our survey almost cer-

tainly 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

didn’t 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.”

“I’ve worn hearing aids for forty years. I wear them from morn-

ing until bedtime. I couldn’t 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

glasses—on 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 ex-

cept 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 needed—church or

very large room with multiple speakers spread out across the room.”

“Yes, sometimes just one. Not always my choosing. I’ve had one

that’s worked fi ne 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 peo-

ple for conversation.”

“Yes I do wear them even though I don’t like it.”

“I have worn mine (both ears) for thirty-fi ve years.”

“Sometimes. Don’t 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 don’t 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 percep-

tions of satisfaction become something of a balancing act. A detailed

study of subjective benefi t and satisfaction with hearing aids agreed

with those previously mentioned and concluded that the scales tilted

toward the good.7 Specifi cally 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 benefi t and satisfaction—frequency of hearing-

aid use by owners—has already been discussed and argues in favor of

hearing aids. A perhaps more salient measure—whether users would

recommend hearing aids to others—is addressed in chapter 8.

A summary combining many of the issues discussed in this chap-

ter was volunteered by one thoughtful hearing-aid user.

“Hearing aids can be a nuisance to wear, care for, and eventu-

ally 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 one’s quality of life and become

an asset to relationships with family and others.”

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136

7

A Wish List

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

Whether it developed in early childhood or was from birth she

couldn’t say. The loss had been found during a hearing screen-

ing 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

wouldn’t like for some things to have been diff erent. 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 suff ering hearing loss are not any

diff erent. A person might wish to eliminate his or her hearing loss. An-

other 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 diffi cult to achieve, unavailable, or fi nancially

out of reach.

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A Wish List 137

Nevertheless, these wishes are important because they show the

hearing-related aspirations of those who are aff ected. 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 diff er-

ently, and for a variety of hearing-related breakthroughs. Each of these

desires will be examined in turn.

Wished-for Societal and Individual ChangesSocietal 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 second-

class citizen. Rather than working as a unifi ed whole, however, society

often acts more like a schizophrenic centipede, with some or all of the

legs pulling in diff erent 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 don’t want my hearing loss to ever be brought up to me.”

“Just be willing to recognize it and accept people the way

they are.”

“What’s wrong with it now?”

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“Be more understanding. We didn’t ask for hearing loss.”

“It doesn’t 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 educa-

tion 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 ac com-

modations.”

“It will go the way the stigma of wearing eyeglasses has dis-

appeared.”

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A Wish List 139

“Respond as they would to vision loss corrected with eyewear.

It’s a decrease in one of the senses and some accommodation on

their part is needed.”

“Don’t always link hearing loss to old age.”

“Realize that it isn’t just in the elderly.”

“I fi nd most people understanding.”

“Be respectful of everyone’s needs or abilities.”

“I don’t think I am any diff erent. I can hear now because I have

hearing aids. If I don’t hear them, I say I’m sorry and didn’t 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 off ered.

“Just understand the situation.”

“Not get angry if I don’t 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 diff erent than vision loss, although not as common.”

“Be aware of my hearing loss, speak clearly and louder.”

“Be more patient with you if you don’t hear or understand what

they say—or believe you when you say you can’t hear them all

the time!”

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“Treat me like I didn’t wear hearing aids. I do the same for oth-

ers who wear them.”

“I expect others to accommodate my hearing loss when I re-

mind 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 don’t hear them when

I want.”

“More patience.”

Communication Help from Family, Friends, and Society

People with hearing loss wanted patience and understanding from fam-

ily, friends and society, but they also wished for help with communica-

tion. 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 communi-

cation 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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A Wish List 141

“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 articulate—not mumble.”

“The only change I would make is that when they start a con-

versation they’d stay in the room and not go walking off some-

where.”

“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 AidsChanges Regarding Hearing Care

Rising healthcare costs, debate and confusion over new federal and state

programs, misunderstandings regarding the benefi ts 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 prob-

lems confronting healthcare in general. Problems with the ear or hear-

ing can require a specialist, adding the need for a managing physician

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referral or invoking specifi c 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 fi nd a physician who will refer to the top

person in their fi eld and not their golf partner.”

“It is confusing.”

“Making doctors more aware that allergies and allergy meds

can/could aff ect one’s hearing.”

“Think of life—all of life—but with a piece missing and what we

can do to provide that missing link. Challenge the medical profes-

sion 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.”

“They’re 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 aids—either the testing process or the directions from the dis-

pensing audiologist.

“When testing hearing they would be able to adjust your hear-

ing 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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A Wish List 143

“There needs to be more practical direction from the audiolo-

gist 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 fi rst 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 prevent-

able cause of hearing loss. Similar instruction is also provided in the

military and in the workplace. Several comments serve to illustrate that

these eff orts were not always seen as being enough.

“More education on hearing loss and using more ear protec-

tion. Did not realize hearing loss was aff ected by the loud noises

that I worked with every day.”

“Work needed to provide ear protection for loud noises. Thirty,

forty, fi fty 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 fi ne 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 appar-

ent that there is still much to wish for regarding hearing aids. This was

confi rmed by the sheer number of wishes off ered. 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 diff erent. 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 fi nd 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 major-

ity 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 back-

ground noise. I only wore them at work—not home—too many

distractions.”

“Nothing. I fi nd them quite an asset.”

“Hearing aids that can get wet and that work better in a lot of

background noise.”

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A Wish List 145

“The discomfort of wearing them.”

“So that you could better adjust the hearing aids for close con-

tact and for distance better than they are.”

“Hearing aids have progressed in the last few years. Keep work-

ing 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 feed-

back 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, fi t totally inside the ears so no one notices them in-

cluding yourself.”

“If I could aff ord a better hearing aid, that the batteries last lon-

ger, and I don’t 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.”

“I’m happy with mine, but I wish they were less expensive. It

would be nice to have a hearing aid that fi lters 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 don’t have to open aids to pre-

vent 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 wished-

for 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 bat-

teries. Not that the expense is that high—but 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 people’s fi ngers 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 fi ltering 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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A Wish List 147

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.

“Aff ordable Bluetooth integration in hearing aids. Durable and

eff ective 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 hear-

ing aid.”

“Hearing-aid compatibility with other sound-producing de-

vices.”

“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 men-

tioned. Interestingly, there were more wished-for changes regarding bat-

teries 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 effi cient aids—especially 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 aff ord-

ability. For some the focus was on price while for others it was insur-

ance. 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

“can’t aff ord.”1 That was in 1993, when hearing aids cost much less.

Today’s hearing aids generally range in price from $1,000 to $3,000

each, depending on the style, sophistication, and features. Regardless

of whether aff ordability was seen as an obstacle to care or simply as an

aggravation, many patients wished for something better.

“They (hearing aids) wouldn’t cost so much.”

“Make hearing care and hearing aids more aff ordable.”

“For most people, especially the elderly, many do not get hear-

ing aids due to cost. Perhaps the insurance companies/Medicare

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A Wish List 149

should cover partial expenses. I know I put it off for a while due

to cost.”

“I’m thinking in my situation, living on Social Security, I had

to take a great chunk out of savings. No one will let you make pay-

ments. 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 sellers—too much markup in

price. Provide more insurance coverage at aff ordable rates.”

“A cheaper but good hearing aid.”

“The high cost is defi nitely a deterrent for the geriatric

crowd.”

“Make hearing aids more cost eff ective for people on fi xed in-

come. 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 aff ord them so won’t 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 fi xed incomes. I’m on a fi xed

income and can’t aff ord 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 aff ord 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 peo-

ple just don’t 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 hear-

ing 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 today’s economy I cannot aff ord 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 doesn’t cover hearing aids, I’ll 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 consider-

ing whether they would be better off having done things diff erently.

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 diff erently regarding their hearing?

“I would have protected my hearing from loud noises, in the

mill and fl ying without hearing protection.”

“I would have seen my doctor earlier than I did.”

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A Wish List 151

“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 loss—both parents chain smoked.”

“Wish I knew sooner I had Ménière’s disease. Maybe I wouldn’t

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 fi fteen years of good hearing be-

fore 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 don’t 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 don’t think I could have done anything

diff erent. 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 di-

agnostic tests, and innovative medical procedures, it might not be un-

reasonable to hope for something on the horizon that might benefi t the

ear. But what something would those with hearing loss want?

“Miracles—youthful hearing restored.”

“Surgery to help nerve loss.”

“Looking forward to implants.”

“Solution for tinnitus—please!”

“That I could hear without aids. I would like it fi xed with

surgery.”

“Employ nanotechnology to develop implantable devices.”

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A Wish List 153

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

“Implantable hearing devices.”

“Improved surgery that fi xes 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 can’t

remember not having it. I don’t know anything I did to cause my

problems.”

“Wish there was a solution to nerve damage so I wouldn’t need

hearing aids.”

“I wish there was a drug or surgery to restore my hearing to

100 percent, but I know that’s not possible and I’m just thankful

my condition isn’t 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. Pub-

lic venues are typically designed in a way that minimizes building costs

rather than maximizing ease of listening. Add a crowd and some back-

ground 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, im-

proved 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

clearly—most mumble and don’t 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. It’s 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 chil-

dren. This is great!”

“Theaters could have earphones for the hearing impaired.”

“Background music on TV or movies could be stifl ed so things

would be clearer.”

“Church and theaters—scrolling words/dialogs or audio en-

hancers.”

“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. Theaters—background

noise too loud.”

“The use of amplifi ers in large groups.”

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A Wish List 155

“Sound systems are a bitch. They’re often over modulated and

too loud. Can’t understand a thing. Telephones aren’t really good

either, but that’s in most instances the fault of the party you’re con-

versing with.”

“Often microphones are not used in meetings, ceremonies, and

other situations in large areas. Actually, the church could prob-

ably have more microphones. They do provide hearing devices I

haven’t used.”

“Perhaps movie theaters could off er 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 fi nd background music and sound eff ects especially

annoying.”

“Turn down the music at restaurants. I can’t hear the person

talking.”

“Have more public buildings looped. We’re 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 under-

stand conversations and know what’s 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 don’t have it!”

“Put closed captioning on all TVs.”

“I wish the people that do the closed caption pay more atten-

tion and do a better job.”

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A Wish List 157

Wishing for What Already Exists

The many wishes expressed highlighted issues that should be a con-

cern 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 break-

throughs that already exist. One person was unaware that closed caption-

ing 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 fi nances 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 off ered on

more basic models. One fi nal example of wished-for assistance that may

already be available is that amplifi ed headphones or other assistive listen-

ing 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 phy-

sician if a medical treatment is possible. Ask the audiologist about all

the hearing-aid features that might be helpful. Ask the physician or au-

diologist 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 assis-

tive 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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158

8

First-Hand Advice

I 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 off er 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 an-

swered 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

offi ce. That the patient had done well with his device was not surpris-

ing. 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 ad-

vice. They may advertise in the newspaper, come to the door, call on

the phone, stuff the mailbox, spam your computer, or pontifi cate 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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First-Hand Advice 159

want or need advice about. Even if the adviser does hit on an appli-

cable point—in this case hearing loss—there 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.

What’s 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 off ered information and helpful advice

based on their own fi rst-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 CareAdvice for Someone Who Suspects a Hearing Loss

What is the fi rst step someone suspecting a hearing loss should take? Ig-

nore it? Wait to see if it gets better? Send in cotton swabs? Run scream-

ing 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 experi-

ence, 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 (al-

though 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 fi nd 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 fi rst 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 there’s 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.”

“Don’t 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, it’s time for a hearing test. Have the hearing test by a

reputable audiologist.”

“Don’t ignore it because it only gets worse.”

“Seek care immediately. See an audiologist or ear specialist.”

“I have such a friend and I’ve 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 hear-

ing aid.”

“Get the best advice you can for the problem you have.”

“Be proactive and go to specialists.”

“Seek medical attention ASAP. Things probably won’t 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 un-

usual reaction.1 Rather than accepting listening diffi culties as being

due to one’s own hearing loss, some fi nd it easier to attribute super-

powers to others. A wife’s hearing is so good that she can hear rain-

drops falling. A friend hears so well that he understands actors in a

play even when he doesn’t sit up front. A daughter’s 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 dis-

missed as unimportant. It doesn’t matter if the television can’t be heard

since there is nothing good on it anyway. I’ve already heard everything

my husband/the children/the priest/my doctor/the salesperson has to

say. Why bother since the hearing loss isn’t noticeable and doesn’t af-

fect 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 yourself—honest. 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 don’t know till you lose it!”

“Let them know that it’s so much better to understand what

people are saying so you can stay connected. If you can’t hear

every thing you actually look dumb! Sorry but it’s 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 con-

tacts, 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 fi xed the more loss you’ll have.

It’s not a sin, it’s a medical condition.”

“You can’t 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! Let’s go! Be proactive! Think about how it aff ects

others.”

“You’re annoying because I have to repeat everything to you. It

is important. It ages you.”

“I’ve 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 don’t seem to have any luck either. So I guess I’m

not a good source for this advice!”

“Advice wouldn’t 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 them—you might refuse to

repeat for them—see 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. Rec-

ommend seeing a professional. Don’t wait. You’re missing out on

things you may not have to.”

“Continuing denial only detracts from your quality of life.”

“Ask if it doesn’t bother them to miss so much of the conversa-

tion and if it does then go get checked.”

“Try not to be so vain as I am.”

“Tell them to get hearing aids as it’s 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.

“Don’t ignore the problem.”

“Get mad. Make people mad and shout.”

“Stay home, avoid social situations, going to movies, etc. be-

cause you can’t hear.”

“Shooting guns, loud noise, big machinery.”

“Be in a loud setting without earplugs, cutting grass, con-

certs, etc.”

“Fail to take action.”

“Don’t 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 aff ects personal

relationships, work situations, enjoyment of recreational and so-

cial activities.”

“Don’t isolate yourself because of it.”

“Avoid circumstances that might increase hearing loss, and

don’t fall into denial that a hearing loss exists.”

“Not give up.”

“Don’t 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 rifl e or gun, use hair pins or other sharp objects to dig

out wax in ears.”

“Ignore it. Don’t wait to check it out and act on it.”

“Do not deny yourself any of life’s pleasures.”

“Don’t shower or swim with hearing aids in.”

“Take hearing aids out when you go to the beauty parlor. Can’t

get them wet, wear them swimming.”

“Avoid thinking the problem will go away.”

“Don’t 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 them—a 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 specifi cally about hearing loss from noise ex-

posure or other preventable causes, the advice that was off ered zeroed

in on the noise.

“Stay away from loud noise.”

“I would advise them to be careful because it is diffi cult to so-

cialize with hearing loss.”

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“Use your hearing protection.”

“Defi nitely earplugs—but if they could change their situation to

get out of it—I would suggest that.”

“If at all possible fi nd a job or other situation that will not dam-

age your hearing. Nothing is worth losing your hearing for.”

“Wear your hearing protection. I discussed this with many peo-

ple 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.

It’s precious and not repairable.”

“Use devices to fi lter loud noises. See an ENT for any ear prob-

lems (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 operat-

ing 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 won’t take the advice—just hu-

man nature.”

“In the presence of noise wear ear protectors. Follow profes-

sional advice to avoid hearing loss from other causes.”

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“Some jobs you can’t do a thing to help. Constant background

noise.”

“Wear earplugs and avoid loud noises if you can. I rode an air-

boat in Florida one time which made a permanent diff erence on

my hearing.”

“Seek professional advice to minimize the risk.”

“Get the proper preventative equipment for the job. Avoid ma-

jor construction where there is major noise being produced.”

“Wear earplugs—always.”

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 physician’s offi ce, 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 off ered 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 qualifi ed audiologist.”

“Seek professional help from providers who are reputable and

ethical and best qualifi ed 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 center—one 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, audi-

ologist, 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 non-

professional 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 prob-

lem but don’t 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 per-

son 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 don’t know of any support

groups.”

“Not sure. Maybe fi nd 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 encour-

age 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 AidsReasonable 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 pur-

chasing hearing aids anticipate loving them? Might one instead foresee

them as a necessary evil, like bad-tasting medicine? What did experi-

enced hearing-aid users advise as reasonable expectations?

“Aids don’t replace your hearing completely, but they make life

much easier, less frustrating.”

“Nothing is like God given ears and hearing.”

“They’re not perfect because I don’t hear and understand ev-

erything. But I’m thankful they really do help.”

“When fi rst getting hearing aids you will begin hearing—often

very loud sounds you have been missing—birds, doors, fans, heat-

ers, other background sounds that most people who hear tend to

fi lter out. With hearing aids you will need to learn to fi lter again.

Don’t get discouraged by initially overwhelming background

sounds. Also, if hearing aids seem not to be quite right, go get them

adjusted. Don’t 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 hear-

ing aids is enormous.”

“Don’t 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 don’t cure the situa-

tion 100 percent. One must be proactive. Pay attention and train

yourself to handle the situation.”

“You still aren’t 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.”

“Don’t expect to hear whispering or low voices.”

“It is realistic to expect hearing aids, if recommended, to im-

prove 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 help—some. 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 off ered 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 physician’s offi ce or hearing-aid center.

“Don’t be ashamed to wear your hearing aid, you will be sur-

prised 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 recom-

mended by professionals that hearing aids would help.”

“If you can’t 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 don’t buy a hear-

ing 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: I’m 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 fi t better (short hair) as you couldn’t 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 breakable—keep them in a safe place when they aren’t in use.”

“As your hearing worsens through the years keep changing

hearing aids to meet those needs.”

“Don’t drop it. Don’t wear it in the shower or swimming.”

“I would tell anyone getting hearing aids to make sure they fi t

correctly. It’s all about who you choose to do the molds and get the

right fi t or correct type of aid.”

“If you need aids, get the best fi t possible and wear them all of

the time!!”

“Everyone should own an induction loop for their T-coil aid.

I’ve invited people to my house to hear the induction loop.”

“Be careful when applying makeup or hair spray.”

“Try diff erent hearing aids to fi nd 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 insur-

ance. Most health plans do not consider hearing aids a medical neces-

sity. Plans that do provide this benefi t 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 vet-

erans’ benefi ts, 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 off ered fi nan-

cial 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 can’t aff ord seek government aid.”

“Try to go the cheapest route because of the cost, but make sure

you get the correct help.”

“That’s 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 diff erent 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 don’t cover them, see about fi nancing

them, getting a loan, etc. Don’t put off getting them due to cost

alone.”

“Talk with your doctor if you can’t aff ord hearing aids. They

should work with you.”

“Don’t go the cheap route.”

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“Get the best hearing aid you can aff ord. 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 hear-

ing 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 expense—Getting hearing aids, maintain-

ing hearing aids, and buying batteries.”

“Don’t 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 aff ord. Good hearing

should be a fi nancial priority.”

“Watch for those hearing-aid batteries on sale.”

“Plan for hearing-aid replacement every three to fi ve years.”

“See if medical coverage will help. Most do not. Would be a big

improvement if health programs would pay a portion.”

“If you can’t aff ord 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 proj-

ect where doctors and costs are already analyzed and noted.”

“Save up money to get hearing aids. People don’t 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 don’t spend the money for your hear-

ing 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 benefi t. Did users hear better with

than without these devices? Another useful measure examined was fre-

quency of use. Did people wear their hearing aids or stuff them out of

sight in a drawer? The consensus of opinion for both benefi t and use

was found to be favorable toward hearing aids. One fi nal factor worth

considering is whether people who use or tried hearing aids would rec-

ommend 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 can’t hear.”

“I defi nitely would recommend hearing aids. I can explain my

situation and how it helped. Testimonies are a great thing—espe-

cially 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 hear-

ing aids. It’s 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 can’t distinguish.”

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“Yes because they are very helpful and you don’t have to keep

saying ‘I beg your pardon or what’s that you said.’ ”

“Yes, it makes it easier to socialize.”

“Yes, defi nitely. 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.”

“Defi nitely yes. If you have hearing loss, hearing aids defi nitely

help.”

“Yes—if they help! Don’t know or realize what you’re

missing.”

“Yes. You are missing out on too much of life.”

“If needed and can aff ord them—defi nitely.”

“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. You’ll be a more compatible mate.”

“Yes. Even just giving them a try for a month until they are ready.

They really do make a diff erence. 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 hap-

pened to me.”

“Yes. Hearing loss leads to other complications.”

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“Yes. I saw how they helped my mother. I’m in the process of a

trial period for a hearing aid.”

“Yes, at any and all costs.”

“Yes, absolutely. Don’t live with hearing loss, get hearing aids. Pro-

tect your hearing and swallow your pride if you need hearing aids.”

“Yes. It’s so much better to hear someone clearly. If you don’t

wear aids and need them you will gradually isolate yourself from

others. As long as I wear my hearing aids, keep them in good con-

dition 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 hear-

ing aid.”

“They are not worth the money.”

“Yes most defi nitely. 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 diffi cult with hearing loss.”

Additional Advice for Hearing-Loss Suff erers and Others

Advice for Living with Hearing Loss

The last question on the hearing-loss survey asked for fi nal 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 out-

doors.”

“Hang in there and don’t go bonkers; bite the bullet and get

hearing aids.”

“Help is probably available. You will be more confi dent 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 you’re missing.”

“Take care of your hearing.”

“Let people know if you don’t understand what they say.”

“Be patient.”

“Don’t 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 pre-

vent 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.”

“Don’t 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 get-

ting 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 en-

vironments, however, I try to live life to the fullest.”

“Just let people know you have diffi culty hearing. Most people

will speak up a little louder. Don’t be reluctant to say ‘I have a hear-

ing 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 off ering 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 inter-

ested 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 don’t drop the tone on the last few words.

Also, speak a little slower.”

“Look at people and don’t cover your mouth when talking.”

“If you know someone with a hearing loss don’t 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 can-

not 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 eff ort to face them and speak distinctly when communicating.

Minimize background noise (radio, TV, running motors, etc.)

when talking.”

“Just be patient and fi nd best way to overcome.”

“Don’t 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 talk-

ing. Go into the same room when speaking as well. Don’t 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

don’t miss anything while trying to fi gure 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. Encour-

age 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 don’t un-

derstand hearing loss. They think all we need is more volume. In

my case—and I understand most people—with nerve damage, don’t

need volume so much as clarity. People who speak slow, clearly, at

an even tone, are blessings to me—also few and far between.”

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183

9

Advice from Spouses or Signifi cant Others

The 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 infa-

mously) noted in a 2002 press briefi ng: “There are known knowns;

there are things we know we know. We also know there are known un-

knowns; that is to say, we know there are some things we do not know.

But there are also unknown unknowns—the ones we don’t know we

don’t know.”1 While not spoken with hearing loss in mind, these logical

conundrums nevertheless apply. One can’t 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 eff ectiveness.

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 signifi cant other. They can provide a reality check.

Spouses and signifi cant others also deserve input because hear-

ing loss is about more than the individual affl icted. A spouse may in

many ways be a solution to the hearing loss by repeating words, tak-

ing over tasks that require good hearing, or as the motivating force in

seeking help. A signifi cant other may instead suff er as a result of the

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communication breakdown and reduced interaction that occurs. Both

ways, spouses and signifi cant 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

didn’t 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. Never-

theless, he wouldn’t have done anything about it if his wife had taken

no for an answer. Mr. Grant said he wasn’t happy about her insistence

at the time but is now grateful for the improved hearing. Her perspec-

tive and advice mattered.

This chapter provides perspective and advice about hearing

loss from over twenty spouses or signifi cant 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 LossRecognition of the Problem

Did the hearing-impaired people surveyed truly recognize how the loss

aff ected them? The answer here should have been yes. All of the peo-

ple included in the survey had a signifi cant hearing loss, came to our

practice for an evaluation, and acknowledged hearing loss as the reason

for the visit. The many diffi culties described in the preceding chap-

ters would also seem to confi rm clear recognition. But did spouses and

signifi cant others agree with this seemingly obvious conclusion? The

answer was not always.

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Advice from Spouses 185

“Yes he does. He knows that he cannot comprehend especially

if there is background noise.”

“Yes. He’s the one who told me he has trouble with pitch while

singing.”

“Yes, but it’s not admitted. He doesn’t feel there’s a problem.

He’s used to this. Family will recognize, but strangers are not aware

even at doctor’s offi ce.”

“Sometimes.”

“Now he does.”

“No. My husband doesn’t feel that he has a problem. He says

that people, especially me, talk softly to him on purpose.”

“When she doesn’t 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 res-

taurants if there is too much noise around us. Also has diffi culty in

large room settings.”

“Yes. He becomes extremely anxious and it is visible. He may

also be cranky and almost always off ers an excuse why he didn’t

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 fi rst casualty of hearing

loss. The perspective was a little diff erent from that of their hearing-

impaired spouse, but the general conclusion was the same. What’s

more, the observations below show that the understanding diffi culties

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were obvious to spouses and signifi cant 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 fol-

lowing observations.

“Yes, he doesn’t hear what other people are saying. Sometimes

he thinks he heard something but it wasn’t what was said. Also he

loses interest in conversations.”

“The guys on the construction crew sometimes have a hard time

getting my [spouse’s] attention or they’ll make jokes about it.”

“Yes. He misses a great deal of conversation. He probably

doesn’t realize how much he misses. He’s 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.”

“Diffi cult 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 worn—must

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 diffi culty hearing/understanding me!”

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“It seems that sometimes when I say something she hears some-

thing else than what I said.”

“Sometimes she can’t hear what I’m 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 doesn’t

hear!”

“When he does not wear his hearing aids, I cannot talk

to him.”

“He doesn’t 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 Aff ected

Misunderstanding was not the sole problem identifi ed by spouses and

signifi cant others. Some issues previously detailed by those with hear-

ing loss such as dependency, withdrawal, safety, as well as other con-

cerns were similarly noted by partners. Spouses recognized that the

impact of hearing loss went well beyond the suff erer saying “what?”

“He has become a bit antisocial when he knows the atmosphere

is going to be diffi cult for him.”

“He can’t 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 you’re speaking. Hearing loss has

worsened and is worse in one ear. I’m 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 doesn’t 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 Aff ects the Signifi cant Other

By now it should be clear that the question is not whether a person’s

hearing loss might aff ect a spouse, but rather how it is likely to aff ect

the spouse. Several years ago I was witness to an unforgettable exam-

ple when a man was evaluated for hearing loss at our offi ce. 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 confi rmed through testing. His daughter said the television

at home was so loud that she had diffi culty 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 what-

ever he could not hear. Everything misheard was her fault. She was

essentially a slave to his hearing loss. The man was an imposing fi gure.

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 don’t have a hearing problem,”

he boomed. “I make it other people’s 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 person’s hearing loss can and does aff ect others. Even if produced

unintentionally, the eff ects are real. An examination of more than four

hundred older married couples drawn from a large well-known epi-

demiological 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 sig-

nifi cant 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 eff ects.

“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 I’m 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 some-

one says.”

“I always sit to his right so he can hear me when I repeat what

he misses in conversation. It’s 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.”

“I’m 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 res-

taurants 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 can’t talk softly and have him hear you.”

“I act as translator. It’s hard to have a quiet conversation

when others are around. When eating out, he chews and can’t

hear so we sit quietly. He gets impatient when he cannot under-

stand 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 I’ve said.”

“Sometimes I have to repeat what others say. I have to remem-

ber 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 peo-

ple say.”

“I have to speak louder and close to her. If she didn’t answer

something I said or asked and she is thinking of the answer, I’m 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 someone’s said that I know

he didn’t catch. I let subjects go when I realize he’s not hearing

enough to understand me and that my explaining would just frus-

trate 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 signifi cant others have

all detailed how hearing loss negatively aff ects communication. Great

leaps of insight are not required to see how it might also aff ect relation-

ships. 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 under-

standing.”

“Sometimes. Because I think he hears me but he doesn’t.”

“It would if the aids didn’t work, but so far they do. In fact, we

fi nally got the bad one fi xed, so he’s 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 you’re not sure he

even hears you in the fi rst place.”

“Not really. After so many years we have adjusted and take care

of each other’s 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 don’t even want to talk to him. It gets very frus-

trating having to repeat myself.”

“Not really. We have been married for almost fi fty 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 LossSeeking 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 prevent-

ing participation in hearing-related activities are some documented

examples.3 A spouse cannot control the fi rst two, but can help a

hearing-impaired partner to recognize the loss and its impact. One

other relevant factor was whether the signifi cant 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 signifi cant 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 sev-

eral 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 wasn’t hearing correctly.”

“We both decided we were having too much trouble com-

municating.”

“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. I’m surprised she’s ready for

hearing aids.”

“Yes. He said you call and get an appointment.”

“My idea, as he knows he can’t wear hearing aids in the work-

place or where there is loud noise. They’re used to the work routine

and ignore the noise because they can’t hear above the noise.”

“I don’t remember. Probably on his own after failing the hear-

ing screening at the local fair.”

“Both of our ideas.”

“On her own after having a hearing test.”

Spouse’s 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 signifi cant 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

fi ndings.

“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 hear-

ing 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 pro-

cess of fi ne tuning to his needs. Sometimes—especially 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, it’s been beyond frustrat-

ing returning at least a dozen times to get ones that work when they

cost $2,000 each. He was so angry he didn’t 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 re-

peating to do. The hearing aid does not solve the problem. Big

disappointment after spending $4,800 and still doesn’t hear well.”

“My wife has been through a lot with her hearing aids and is con-

stantly 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 sig-

nifi cant 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 specifi c things they did that helped. But what, aside from hear-

ing aids, did partners see their spouse do to compensate for a hearing

loss? When asked specifi cally 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 peo-

ple to repeat themselves, mentions he wears an aid, or has trouble

hearing. It works.”

“Always asking what was said, or he just didn’t 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 fl at 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 Signifi cant OtherAdvice for People with Hearing Loss

People with hearing loss are not the only ones who might off er use-

ful guidance about their problem. Spouses and signifi cant others also

had advice for this group. More often than not their suggestions mir-

rored those given by the hearing-impaired individuals themselves. For

a hearing-impaired reader, these spousal recommendations may seem

a familiar echo of one’s own partner.

“Go as early as possible. Pay special attention at the onset of

hearing loss.”

“Don’t 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 diff erent aids. People who have a hear-

ing 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 diff erent kinds

of aids.”

“Consult a doctor immediately. It may stop further hear-

ing loss.”

“Seek professional help. Check your options.”

“I’m sure that going to a very good audiologist is super impor-

tant. Saw one that wasn’t 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 fi ne-tuned.”

“Get a hearing test. Then see what can be done to help.”

“Look at someone’s face when talking and reading lips. Never

be embarrassed to let someone know you can’t understand them.

Get hearing aids.”

Advice for Family, Friends, and Others

The main goal of this book has been to provide fi rst-hand advice from

people with hearing loss to people with hearing loss. Those with direct

experience provided advice so that others might benefi t. Using a simi-

lar rationale, friends and family of those with hearing loss were asked

what advice they could off er to others in their own position. Unlike the

wide variety of comments and advice off ered by hearing-loss suff er-

ers, friends and family primarily had one suggestion for others in their

situation.

“Try to be understanding. It’s 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 atten-

tion 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 can’t 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 signifi cant others.

“It’s very hard to admit that we can’t hear, and also we don’t

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 pro-

fessional 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 eco-

nomic times. A person must realize this is extremely important just

like a prescription.”

“Hearing loss is no game. It’s serious. Being someone else’s

ears for a long time does aff ect your signifi cant other. It’s like hav-

ing two lives wrapped into one because you have to be two people

at one time.”

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201

10

Themes and Parting Advice

Nothing unusual” was the doctor’s comment when he asked

me to talk with Ralph Benson about his hearing loss. Sum-

ming up an individual’s 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 diffi culty beginning shortly

after he retired about fi ve years ago. His wife said his problem started

much earlier than that. She had urged him to get his hearing checked,

but at fi rst he didn’t think there was any problem and later he didn’t

feel it was bad enough. Gradually his hearing worsened, until he found

it hard to disagree with his wife. Once the hearing loss was confi rmed

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 Benson’s story resonate through the comments

that patients and their spouses provided. Arguments why Mr. Benson

“

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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 benefi t from

further explanation.

Areas of AgreementGetting 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 profes-

sionals can be a little preachy about the importance of having one’s

hearing checked, but those with hearing loss and their partners took

no backseat in this regard.

Survey contributors sometimes recommended having this evalu-

ation 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, fi nding 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 fi nding a good hearing professional.

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Themes and Parting Advice 203

Denial or Delay Is Not in a Person’s Best Interest

The majority of patients considered denying a hearing loss or delay-

ing 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 con-

tributors 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 off ered 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. Don’t 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 ear-

plugs or earmuff s 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 diff erently regarding their hearing if given a sec-

ond 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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“Used (hearing) protection at a young age.”

“Wore earplugs in the artillery and at work.”

That so many people stressed the importance of hearing protec-

tion based on their own experiences should not be a surprise. Educa-

tional 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 em-

ployees 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 suff ered hearing loss.3 A

recreational fi rearm study of more than fi fteen hundred men found that

the risk of hearing loss increased 7 percent for every fi ve 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 one-

third 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 protec-

tion. For those who work in industry, the employer should alert em-

ployees if sound levels are potentially damaging and then provide

appropriate hearing protection. At home or recreationally, individu-

als should use earplugs or muff s during any very loud activity. This

includes using lawn tractors, snowblowers, gasoline-powered string

trimmers, chain saws, circular saws, shop vacuums, and fi rearms, to

name only a few examples, as well as attending rock concerts. Ear-

plugs and earmuff s work well, are inexpensive, and are readily avail-

able at most home improvement centers. An alternative is to have

custom earplugs made that exactly match the contours of the user’s

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 diffi culties 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 don’t hear every-

thing he says. Sometimes I just say ‘OK’ to whatever he has said.”

“It aff ected my family because of my saying ‘what’ or ‘OK’ if I

didn’t 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 diffi culties can be a nega-

tive eff ect on a person’s 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 eff ects. For instance:

“I get very frustrated when I can’t 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 diffi cult because the

children mumbled or turned their head away and I could not hear

them at all.”

“I don’t hear a lot going on around me. People don’t 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 aren’t trying

to hear them.”

“I miss many words and conversations. It’s 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 per-

cent) 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 PerspectiveHearing 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 artifi cially through the careful se-

lection of the comments printed. This was not the case. Ninety-fi ve

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percent of the people who owned hearing aids said they would rec-

ommend them to others. Why? How could so many people recom-

mend 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 don’t have to love everything about

their hearing aids for them to be of benefi t. They can even hate certain

aspects but still fi nd 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.

patient 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.”

patient 2

“I can’t understand anything anybody says without them.”

“They can’t 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

needed—yes.”

patient 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. It’s

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 unqualifi ed endorsements.

Nevertheless, survey participants recommended hearing aids, not be-

cause they were loved, but because they helped them hear better.

An Outsider May Have a Diff erent View of Hearing Aids

All of this good and bad about hearing aids can be more than a lit-

tle 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 diffi culty hearing. The ob-

server may not recognize how much the hearing aids actually helped.

This one-sided perspective of seeing the problem but not the benefi t

almost certainly contributes to society having a generally negative per-

ception of hearing aids.

For a spouse or family member of a person with hearing loss, the sit-

uation is diff erent. They are all too familiar with the before-hearing-aid

side of the problem. All of the spouses and signifi cant others surveyed

saw how the hearing loss aff ected 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

fi reworks. As a couple of survey participants explained:

“It is realistic to expect hearing aids, if recommended, to im-

prove hearing. It is unrealistic to expect ‘normal’ hearing with

hearing aids.”

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“They’re not perfect because I don’t hear and understand

every thing. But I’m thankful they really do help.”

The majority of hearing-aid users surveyed had similar expecta-

tions. 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 didn’t work.

While their overall descriptions of how the hearing aids performed

were not very diff erent from those of seemingly happier users, the dif-

ference 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 re-

turned within a set period of time for a refund (minus a trial fee) if the

user is dissatisfi ed 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 appro-

priate. One clear example of an appropriate time to return hearing aids

was demonstrated in the comments of a dissatisfi ed hearing-impaired

husband and his wife.

“I was told by others that hearing aids are not the answer and

it’s true.”

“They cost too damn much for what they do.”

“I should have returned them.”

“Don’t get a hearing aid.”

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“Big disappointment after spending $4,800 and still doesn’t

hear well. Have to repeat many times what we are talking about.”

This person’s entire experience was seen as negative, and he was ab-

solutely 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 diff erent 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 per-

son described, “Almost twenty years ago I was not satisfi ed with the

performance of a new pair of hearing aids. I returned them and pur-

chased a pair from a diff erent 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 hear-

ing as “vastly improved.”

Areas Overlooked or UnderutilizedReducing Background Noise

Diffi culty hearing with a noisy background was a common complaint.

It was often expressed in regard to hearing-aid use, but was more ac-

curately a problem that people hoped hearing aids would fi x. Largely

overlooked as an option was reducing, eliminating, or avoiding the

noise. Patients didn’t 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 tak-

ing 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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reverberating in large rooms with hardwood fl oors or other refl ective

surfaces. Patients didn’t talk about using a few well-placed sound ab-

sorbing 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 diffi cult to reduce or sidestep. It does, how-

ever, require some eff ort and planning.

Changing the Listening Situation

Habits can be hard to recognize and even harder to change. Those

that interfere with hearing are no diff erent. 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

minister’s 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 doesn’t hear well in one ear and can’t 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 modi-

fi ed situations to provide themselves with a listening advantage.

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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, fac-

ing 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 fi nd 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 let-

ters or words not being heard. Most people can fi ll 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 speak—slow—clearly at an even

tone, are blessings to me.” Ask others to slow down.

Since hearing loss may soften or distort speech, people with hear-

ing 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 Benefi t 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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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 of-

ten 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 fi nd it to be little more than

a nuisance, while for others it can be very distracting or even debilitat-

ing. Millions live with it. Hearing loss is by far the number one predic-

tor 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 per-

son who wished for a “solution for tinnitus—please!”

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 experi-

ence at least minor relief from their tinnitus while using hearing aids.9

Surveying several thousand people with hearing loss directly yielded

a lower fi gure (43.5 percent), but this was still a signifi cant chance of

relief.10 This same survey found that listening to music was the second

most eff ective choice for tinnitus amelioration, and that both of these

options outperformed medications from a physician, herbs, dietary

Y6609.indb 214Y6609.indb 214 12/10/14 9:38:40 AM12/10/14 9:38:40 AM


supplements, counseling, and relaxation techniques. I fi nd soft music

played in the background to be helpful with my own tinnitus—espe-

cially 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 va-

riety 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 peo-

ple 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, web-

sites, or organizations. Nor did they criticize resources. For whatever

reason, they were just overlooked.

Retail websites are one often overlooked resource. It might at fi rst

appear odd to consider a retail website for hearing products as a re-

source. For a person who wants to learn more about available hearing

products, however, it is a good place to start. Amplifi ed telephones,

wireless headphones, and the many other gadgets mentioned here have

to come from somewhere. The situation is not that diff erent 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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http://www.ata.org

http://www.ata.org


have been unaware of the options available or not known how to ob-

tain 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), Indepen-

dent 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 fi nding

a booming alarm clock or an amplifi ed telephone. Others want a full

evaluation and fi nd 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 didn’t know which hear-

ing-loss books would be worth reading. A few suggestions are off ered

with the resources at the end of this book.

Numerous organizations provide information, support, and re-

sources to the hearing impaired. A few are defi nitely 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 off ered. A quick reading is

likely suffi cient 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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http://www.adcohearing.com

http://www.hearmore.com

http://www.harriscomm.com

http://www.independentliving.com

http://www.lssproducts.com


http://www.hearingloss.org

http://www.hearinghealthfoundation.org


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 fi rst-hand, some fi nal parting advice is warranted.

“Have a good doctor examine you and take his advice. The

sooner you get examined you’ll realize how important it is!! Also

how important it is for the people around you. You will fi nd your

life a lot more pleasurable when you can hear better.”

“Don’t expect miracles with hearing aids. They will help, but it

won’t 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 amplifi -

ers. Cover your ears when you use loud machinery (lawn mowers,

saws, snow blowers, etc.).”

“Talk to a variety of people candidly; ask questions about hear-

ing loss, then think seriously about opinions and suggestions you

get. Seek professional opinion. Get second opinion.”

“You’ll be surprised by what you are not hearing in your every-

day life. Don’t be afraid, it’s a whole new world again.”

“Talk to your family member/friend. Off er to go with them to an

appointment. Don’t 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 bet-

ter understanding.”

“Have patience. They don’t like it either.”

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219

Resources

Here is a list of resources the reader may fi nd helpful. Each has a website that

off ers information on hearing-care professionals, organizations, ear and hear-

ing 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 Otolaryngology—Head 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

Y6609.indb 219Y6609.indb 219 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

http://www.agbell.org

http://www.listeningandspokenlanguage.org

http://www.audiology.org

http://www.entnet.org

http://www.asha.org

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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http://www.ata.org

http://www.chha.ca

http://www.hearingloss.org

http://www.nad.org



Resources 221

Somerset, New Jersey 08873

Website: www.oticonmedical.com

Books

Shouting Won’t Help: Why I—and 50 Million Other Americans—Can’t 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 Idiot’s 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.

Y6609.indb 221Y6609.indb 221 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

http://www.oticonmedical.com

http://www.captioncall.com

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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http://www.captel.com

http://www.bionicear.com



http://www.beltone.com

http://www.gnresound.com

Resources 223

Minneapolis, Minnesota 55446

Website: www.miracle-ear.com

Oticon

580 Howard Ave.


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


Website: www.sonici.com

Starkey

6700 Washington Ave. South

Eden Prairie, Minnesota 55344

Website: www.starkey.com

Unitron

14755 27th Ave., North

Y6609.indb 223Y6609.indb 223 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

http://www.miracle-ear.com

http://www.oticon.com

http://www.phonak.com

http://www.rexton.com

http://www.hearing.siemens.com

http://www.sonici.com

http://www.starkey.com

224 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

Y6609.indb 224Y6609.indb 224 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

http://www.unitron.com

http://www.widex.com

http://www.hearingloop.org

http://www.hearingloss.org/content/hearing-loss-magazine

http://www.hearinghealthfoundation.org/hearing-health-magazine

http://www.ata.org/about-ata/news-pubs/tinnitus-today

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.

Buff alo, New York 14207

Website:www.independentliving.com

Learning, Sight & Sound Made Easier (LS&S)

145 River Rock Dr.

Buff alo, 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

Y6609.indb 225Y6609.indb 225 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

http://www.adcohearing.com

http://www.harriscomm.com

http://www.hearmore.com

http://www.independentliving.com


http://www.ihdi.org

http://www.dogsforthedeaf.org

227

Appendix: Hearing-Loss Questionnaires

Hearing-Loss Questionnaire

You are being given this questionnaire as research and possible source mate-

rial 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 benefi t. The results from this questionnaire are intended to be anonymous so please do not sign your name or provide any identifying information.

hearing loss

How does your hearing loss aff ect you? How does it aff ect your relationships,

work, mood, leisure, safety, fi nances, etc.?

Y6609.indb 227Y6609.indb 227 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

228 Appendix

Does your hearing loss aff ect 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.

Y6609.indb 228Y6609.indb 228 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 229

hearing a ids

Have you ever been advised that you need or would benefi t 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.

Y6609.indb 229Y6609.indb 229 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

230 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 diffi cult 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.

Y6609.indb 230Y6609.indb 230 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 231

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

other solutions for hearing loss

Do you turn up the radio, television, or other devices? Does this help?

Do you use closed captioning on the TV, an amplifi ed or captioned tele-

phone, 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, amplifi ed or

fl ashing doorbells, amplifi ed alarm clocks, or special smoke detectors that

you have found helpful? If yes, please describe.

Y6609.indb 231Y6609.indb 231 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

232 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.

Y6609.indb 232Y6609.indb 232 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 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?

wish l ist

What would you change about hearing care?

What would you change about hearing aids?

Y6609.indb 233Y6609.indb 233 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

234 Appendix

Would you like your family or others to treat you diff erently 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 diffi culties? If yes, please

describe.

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

developed?

Y6609.indb 234Y6609.indb 234 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 235

advice from one hearing- impaired person to another

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?

Y6609.indb 235Y6609.indb 235 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

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 diff erently? If yes, please explain.

What advice would you give to family or friends of someone with hear-

ing loss?

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

recommend?

Y6609.indb 236Y6609.indb 236 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 237

Aside from health care professionals, who should a person look to for sup-

port? 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 fi nancial advice related to hearing care, hearing aids, or liv-

ing with a hearing loss?

Y6609.indb 237Y6609.indb 237 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

238 Appendix

What other advice or comments can you off er regarding hearing loss, hearing

aids, or hearing care?

Spouse and Signifi cant Other Questionnaire

You are being given this questionnaire as research and possible source mate-

rial 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 benefi t. 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 signifi cant other? If yes,

please describe.

Does your spouse or signifi cant other recognize how the hearing loss aff ects

him or her? Describe their perspective.

Y6609.indb 238Y6609.indb 238 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

Questionnaires 239

Did your spouse or signifi cant other seek help for the hearing loss on his or

her own, or was it your idea? Please explain.

Does your spouse or signifi cant 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.

Y6609.indb 239Y6609.indb 239 12/10/14 9:38:40 AM12/10/14 9:38:40 AM

240 Appendix

Do you have to compensate for your spouse or signifi cant other’s hearing

loss? If yes, please explain.

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

In what other ways does your spouse or signifi cant other’s hearing loss aff ect

you or your family?

What advice would you give to someone with hearing loss?

Y6609.indb 240Y6609.indb 240 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

Questionnaires 241

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

loss?

What other comments would you like to off er?

Y6609.indb 241Y6609.indb 241 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

243

Notes

Introduction

1. Kochkin, “MarkeTrak VII: Hearing Loss Population Tops,” 16–29; Na-

tional Institute on Deafness and Other Communication Disorders, “Re-

port on the Task Force.”

2. Hougaard, Ruf, and Egger, “EuroTrak + JapanTrak 2012: Societal and Per-

sonal Benefi ts,” 16–26.

3. Kochkin, “MarkeTrak VIII: 25-Year Trends,” 12–31.

4. National Council on Aging, “Consequences of Untreated Hearing Loss,”

12–16; Kramer et al., “Association of Hearing Impairment,” 122–137.

5. Uhlmann et al., “Relationship of Hearing Impairment,” 1916–1919; Lin

et al., “Hearing Loss and Incident Dementia,” 214–220.

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,” 493–500.

2. Center for Hearing and Communication, “Common Environmental Noise

Levels.”

3. Burkey et al., “Clinical Utility of the 512-Hz Rinne,” 59–62.

4. Hetu et al., “Reluctance to Acknowledge Hearing Diffi culties,” 265–276;

Rawool and Keihl, “Perception of Hearing Status,” 27–42.

5. Arlinger, “Negative Consequences of Uncorrected Hearing Loss,” 17–20.

6. Hetu, Getty, and Waridel, “Attitudes Towards Co-Workers,” 313–325.

Y6609.indb 243Y6609.indb 243 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

244 Notes to Pages 38–59

Chapter 2: Hearing Aids and Other Gadgets

1. U.S. Congress, “Americans with Disabilities Act.”

2. McCreery et al., “Evidence-Based Systematic Review,” 295–312; Bentler,

“Eff ectiveness of Directional Microphones,” 473–484.

3. McCreery et al., “Evidence-Based Systematic Review,” 295–312; Bentler,

“Eff ectiveness of Directional Microphones,” 473–484.

4. American National Standards Institute, “Methods of Measurement of

Compatibility.”

Chapter 3: Treatments for Hearing Loss

1. Desai et al., “Trends in Vision and Hearing,” 1–8.

2. Jabor and Amedee, “Cerumen Impaction,” 358–362.

3. Jones et al., “Parental Smoking and the Risk,” 18–27.

4. Cruickshanks et al., “Prevalence of Hearing Loss,” 879–886.

5. Akinpelu et al., “Is Type 2 Diabetes”; Kakarlapudi, Sawyer, and Staecker,

“The Eff ect of Diabetes,” 382–386.

6. Brant et al., “Risk Factors Related to Age-Associated Hearing Loss,”

152–160.

7. Lerut et al., “Functional Correlations of Tympanic,” 379–386.

8. Camnitz and Bost, “Traumatic Perforations of the Tympanic Membrane,”

220–223.

9. Rizer, “Overlay Versus Underlay Tympanoplasty. Part I,” 1–25; Rizer,

“Overlay Versus Underlay Tympanoplasty. Part II,” 26–36.

10. Sakihara, Christensen, and Parving, “Prevalence of Hereditary Hearing,”

39–46.

11. Shea, “Forty Years of Stapes Surgery,” 52–55; Rizer and Lippy, “Evolution

of Techniques of Stapedectomy,” 443–451.

12. Shambaugh, “How and When to Prescribe,” 146–147; Brookler, “Medical

Treatment of Otosclerosis,” 92–96.

13. Alexander and Harris, “Incidence of Sensorineural Hearing Loss,”

1586–1589.

14. Chau et al., “Systematic Review of the Evidence,” 1011–1021.

Y6609.indb 244Y6609.indb 244 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

Notes to Pages 59–148 245

15. Vijayendra et al., “Sudden Sensorineural Hearing Loss,” 1–4.

16. Bovo, Aimoni, and Martini, “Immune-Mediated Inner Ear Disease,”

1012–1021.

17. Niparko et al., “Serial Audiometry in a Clinical Trial,” 908–917; Dayal,

Ellman, and Sweiss, “Autoimmune Inner Ear Disease,” 591–596.

18. Vohr, “Overview: Infants and Children,” 62–64.

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 Effi cacy of Hearing Aids,” 19–26.

Chapter 5: Coping and Getting Help

1. Yueh et al., “Long-Term Eff ectiveness of Screening,” 427–434.

Chapter 6: The Hearing-Aid Experience

1. Wallhagen, “The Stigma of Hearing Loss,” 66–75.

2. Burkey, Overcoming Hearing Aid Fears.

3. Kochkin, “MarkeTrak V: Why My Hearing Aids,” 34–42.

4. Kaplan-Neeman et al., “Hearing Aid Satisfaction and Use,” 2029–2036.

5. Hosford-Dunn and Halpern, “Clinical Application of the SADL,”

15–36; Jerram and Purdy, “Technology, Expectations, and Adjustment,”

64–79; Cox and Alexander, “Measuring Satisfaction with Amplifi cation,”

306–320.

6. Kaplan-Neeman et al., “Hearing Aid Satisfaction and Use,” 2029–2036.

7. Takahashi et al., “Subjective Measures of Hearing,” 323–349.

Chapter 7: A Wish List

1. Kochin, “MarkeTrak III: Why 20 Million,” 20–27.

Y6609.indb 245Y6609.indb 245 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

246 Notes to Pages 161–214

Chapter 8: First-Hand Advice

1. Burkey, Overcoming Hearing Aid Fears, 32.

Chapter 9: Advice from Spouses or Signifi cant Others

1. Rumsfeld, “Department of Defense News Briefi ng.”

2. Wallhagen et al., “Impact of Self-Assessed Hearing Loss,” 190–196.

3. Meyer and Hickson, “What Factors Infl uence Help-Seeking,” 66–74.

4. Stark and Hickson, “Outcomes of Hearing Aid Fitting,” 390–398; Brooks,

Hallam, and Mellor, “Eff ects on Signifi cant Others,” 165–171.

Chapter 10: Themes and Parting Advice

1. Davis et al., “Acceptability, Benefi t and Costs,” 1–294.

2. McCullagh et al., “Prevalence of Hearing Loss,” 340–347.

3. Marvel et al., “Occupational Hearing Loss in New York,” 517–531.

4. Nondahl et al., “Recreational Firearm Use,” 352–357.

5. Dalton et al., “Association of Leisure-Time Noise,” 1–9.

6. Pawlaczyk-Luszczynska et al., “Risk Assessment of Hearing Loss,”

493–511.

7. National Council on Aging, “Consequences of Untreated Hearing Loss,”

12–16; Kramer et al., “Association of Hearing Impairment,” 122–137.

8. Stouff er and Tyler, “Characterization of Tinnitus,” 439–453.

9. Kochkin and Tyler, “Tinnitus Treatment and the Eff ectiveness,” 14–18.

10. Kochkin, Tyler, and Born, “The Prevalence of Tinnitus,” 10–27.

Y6609.indb 246Y6609.indb 246 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

247

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255

Index

Adco Hearing Products, 216

Advanced Bionics, 67

Advice. See First-hand advice

Aging: and cost of hearing aids,

148–149; hearing aids associated

with, 114, 115, 116; negative as-

sociations of, 2, 27, 138, 139; and

sensorineural hearing loss, 18, 50

Air-bone gap, 20

Alarm clocks, amplifi ed, 33, 216

Alerting devices, 32–34, 109

Allergies, 52

American Academy of Audiology, 25

American Academy of

Otolaryngology– Head and

Neck Surgery, 25

American Speech-Language-

Hearing Association, 25

Americans with Disabilities Act,

38, 79

American Tinnitus Association, 215

Asking others to repeat: as cop-

ing strategy, 99–100, 104,

105; eff ect of hearing loss on

mood, 88–89; as impact of

hearing loss, 8, 27, 75–76; and

misunderstood speech, 74; and

moving closer, 102, 103; and

patience, 100, 206; relation-

ships aff ected by, 10, 84, 93,

162, 177; and social withdrawal,

29; spouses and signifi cant

others compensating for hear-

ing loss, 81–82, 100, 183, 186,

187, 190, 191, 192, 195

Assistive listening devices, 109–110,

153, 154, 155, 157, 173, 215–216

Atresia, 61, 63

Audiograms, 19

Audiologists: and ear examinations,

14–17, 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

Note: Italic page numbers refer to illustrations.

Y6609.indb 255Y6609.indb 255 12/10/14 9:38:41 AM12/10/14 9:38:41 AM

256 Index

Auditory evoked potential (AEP)

testing, 23

Auditory training, 66

Autoimmune inner ear disease,

59–60

Autonomy, limited by hearing loss,

8, 85–86

Background noise: and asking

others to repeat, 75; fi rst-hand

advice on, 170, 171; and hearing-

aid use, 119, 121, 122, 124–125,

129, 130, 144, 145, 154, 155, 208,

211–212; and limitation of ac-

tivities, 78; and misunderstood

speech, 73, 74; and moving

closer, 28–29; 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 Ménière’s

disease, 60; and vestibular

system, 17

Blood pressure, high, 53

Bluetooth compatibility, in hearing

aids, 45–46, 113, 146, 147, 151,

157

Body motion, and vestibular system,

17

Bone-anchored hearing aids, 61–64,

62, 63, 158

Bone oscillator, 20

Cell phones: and hearing-aid use,

126, 146, 147; and telecoils for

hearing aids, 43; volume of, 28,

84–85. See also Telephones

Children, hearing tests for, 22–25,

92, 136

Cholesteatoma, 56–57

Churches. See Public venues

Clocks, amplifi ed, 33, 216

Closed captioning, 35–36, 108–109,

154, 156, 157

Cochlea: cochlear implant, 64–67,

65, 66; and ear examinations,

16–17, 23

Cochlear Attract, 64

Cochlear Corporation, 64, 67

Cognitive dysfunction, hearing loss

associated with, 3

Communication: and captioned

devices, 35–37; help from fam-

ily, friends, and society, 140–141,

213; interference from hearing

loss, 5, 205–206; spouses and

signifi cant others on communi-

cation breakdowns, 185–187. 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,

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Index 257

56; as medically correctable,

47; and otosclerosis, 57–58; and

perforated eardrum, 54; testing

for, 19, 20, 21–22; as type of

hearing loss, 17

Congenital hearing loss, 23, 61,

65–66

Conversation: asking others to re-

peat and, 75–76, 81–82; eff ect of

hearing loss on mood, 89, 90;

hearing-aid use and, 122, 123,

128, 129, 131; impact of hear-

ing loss on, 3; missing sounds

and, 73; misunderstood speech

and, 73–75; and social isolation,

86–88; spouses and signifi cant

others compensating for hear-

ing loss, 81, 85, 99, 186, 190, 192

Coping strategies: asking others

to repeat, 99–100, 104, 105;

fi rst-hand advice on, 8, 178–180;

fi rst-hand experiences with,

91, 92–93, 99–106; getting help

from others, 105–106; lip read-

ing, 101–102, 104, 105; loudness

and, 100–101; moving closer,

28–29, 102–103, 104, 105, 212;

planning and, 103–104; techno-

logical and medical options for,

106–111

Crowds: and hearing-aid use, 120,

122, 125; and limitation of activi-

ties, 78, 79; and mis understood

speech, 74, 75; and social isola-

tion, 88; spouses and signifi -

cant 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,

40–43, 130

Disability, negative associations of,

2, 26

Dizziness, and Ménière’s disease,

60–61

Dogs, as alerting systems, 34

Dogs for the Deaf, 34

Doorbells, amplifi ed, 33

Dragon Naturally Speaking, 37

Driving: and hearing-aid use, 122,

124; safety concerns and, 77

Ear, illustration of, 16Ear, nose, and throat (ENT) physi-

cians: consideration of factors

in hearing loss, 53–54; and ear

examinations, 14–17, 25; evalu-

ation of hearing loss, 4, 6–7, 13;

as information sources, 95, 96;

and tympanoplasty surgery, 55

Ear canal: and ear examinations,

14–17; and ear infections, 51–52;

earwax in, 17

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258 Index

Ear drainage, 56–57

Eardrum: broken eardrum, 17; and ear

examinations, 15–16; and otitis

media, 52; perforated eardrum,

54–55; and tympanometry, 22

Ear examinations: basic hearing

test battery, 19–22; conditions

indicating need for, 47–48;

and ear canal, 14–17; hearing

professionals, 14–17, 25–26; his-

tory questionnaire, 14; testing

children, 22–25, 92, 136; tests

included in, 18–26; types of

hearing loss and, 17–18, 19

Ear infections: and cholesteatoma,

56; and sudden sensorineural

loss, 59; treatment of, 51–53,

56, 59

Earning defi cit, as secondary eff ect

of hearing loss, 79–80

Earwax: as cause of hearing loss,

49, 50, 59; in ear canal, 17;

impacted earwax, 50–51; wax

guard for hearing aids, 46

Educational development, impact of

hearing loss on, 25

E-mail, 36, 105

Eustachian tubes: and cholestea-

toma, 56; and ear examinations,

16; and otitis media, 52

Experiences. See First-hand

experiences

Eyeglasses, hearing-aid use com-

pared to, 138–139, 170

Feedback suppression, in hearing

aids, 40, 42–43, 145, 157

First-hand advice: on coping strate-

gies, 8, 178–180; on denial of

hearing loss, 161–163, 164;

fi nancial advice about hearing

aids, 173–175; for friends and

family, 180–182, 213; on hearing

aids, 170–178; on hearing-care

professionals, 167–168, 202;

on hearing loss and hearing

care, 159–169; and hearing-loss

questionnaires, 4–6, 72; on liv-

ing with hearing loss, 178–180,

217; and negative associations of

hearing loss, 1, 2–3; on non-

professional support, 168–169;

practical hearing-aid advice,

171–173; reasonable expecta-

tions about hearing aids,

170–171, 209–210, 217; recom-

mending hearing aids to others,

176–178, 206–207; sources of,

4–5, 6, 158–159; of spouses and

signifi cant others, 9, 183–184,

199–200; on suspected hearing

loss, 159–160; what not to do,

163–165

First-hand experiences: coping

strategies, 91, 92–93, 99–106;

hearing evaluations, 13–14; of

hearing loss, 71–72; with infor-

mation sources, 94–99; obvious

eff ects of hearing loss, 72–76;

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Index 259

secondary eff ects of hearing

loss, 76–90; with technological

and medical options, 106–111.

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 mis-

understood speech, 74; plan-

ning and, 104; and social isola-

tion, 88; spouses and signifi cant

others on, 186

Hammer, anvil, and stirrup, 15

Harris Communications, 216

Headphones, wireless, 37–38, 47,

107–108, 196

Headsets, amplifi ed, 34–35

Healthcare: changes regarding

hearing care, 141–143; wished-

for medical breakthroughs,

152–153

Hearing aids: batteries for, 39, 119,

126, 127, 129, 145, 146, 171, 173,

196; Bluetooth compatibility,

45–46, 113, 146, 147, 151, 157;

care of, 39, 127, 129, 130, 172,

173; cost of, 118, 121, 126, 127,

129, 145, 148–150, 157, 172,

173–175, 195, 199–200, 210–211;

cosmetics, improvements

needed in, 147–148; and digital

technology, 40–43, 130; driers

for, 46–47; fi rst-hand advice on,

170–178; function of, 39; options

and accessories for, 43–47, 113;

and pitch adjustment, 40–41;

return policy, 46, 121, 127, 133,

195, 200, 210–211; as solution to

hearing loss, 2, 38–47; styles of,

39–40, 40; testing of, 142–143

Hearing-aid use: adjusting to,

118–121; and background noise,

119, 121, 122, 124–125, 129, 130,

144, 145, 154, 155, 208, 211–212;

and comfort in wearing, 134,

145; compatibility with other

devices, 146–147, 157; fi rst-hand

advice on, 8; frequency of use,

132–135; getting started with,

114–121; living with, 121–135;

negative societal perceptions of,

114–115, 127, 129, 130; neutral or

positive perceptions of, 116–117;

older versus newer aids, 130;

performance issues with,

125–127, 144; pros and cons

of, 128–130, 206–209; reasons

for delaying or declining use,

112–113, 117–118, 201–202, 203;

satisfaction with, 127–128, 135;

situations helped by, 121–123;

spouses and signifi cant others

on, 194–195; two versus one,

131–132, 151

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260 Index

Hearing clarity: and digital technol-

ogy, 40; testing of, 20, 142

Hearing Health Foundation, 216

Hearing-impaired patients: contra-

dictory perceptions of, 9; fear

of being labeled, 3; fi rst-hand

advice of, 8

Hearing loss: common reactions

to, 26–30; concealment of,

29; denial of, 3, 5, 26–27, 30,

97, 98, 99, 161–163, 164, 203;

education about, 143; fi rst-hand

advice on, 159–169; ignoring

of, 26–27, 30, 98; impact of, 3,

25, 71; natural compensation

for, 27–29; negative stereotypes

of, 1, 2–3, 26–27, 96, 137–139;

plan for, 29–30; prevalence,

population estimates of, 2, 71;

prevention of, 53, 143; types of,

17–18; variety of solutions for,

31–32, 50. See also First-hand

advice; First-hand experiences;

Treatments

Hearing Loss Association of

America, 216

Hearing-loss questionnaires: and

fi rst-hand advice, 4–6, 72;

sample of, 227–238; survey

methods, 5, 6–7

Hearing protection. See Noise

protection

Hearing tests: basic test battery,

19–22; for children, 22–25, 92,

136; and cochlea, 17; and ear ex-

aminations, 18–26; for suspected

hearing loss, 159–160, 202

Hearing threshold, testing of, 19–20

Hear-More, 216

Help from others, as coping strategy,

105–106

Incus, 15

Independent Living Aids, 216

Induction loop systems, 37–38, 44,

147, 173

Information sources: fi rst-hand

experiences with, 94–99; list of,

219–225; overlooked resources,

215–216, 217

Inner ear: autoimmune inner ear

disease, 59–60; and ear exami-

nations, 15, 17; and Ménière’s

disease, 60–61; and vestibular

system, 17

Insurance coverage, 148–149, 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

eff ect of hearing loss, 77–79,

85, 88

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Index 261

Lip reading: as compensation for

hearing loss, 28, 29; as coping

strategy, 101–102, 104, 105

Listening devices, amplifi ed, 34–35,

47, 107, 108, 216

Listening situation, changes in, 212

Listening strategies, 28–29, 99, 179,

213–214

Localization diffi culties, as second-

ary eff ect of hearing loss, 76

Loop systems, 37–38, 44, 147, 173

Loudness: aff ecting others, 84–85,

88, 100, 101, 107, 122, 123, 188,

190, 195, 196; as coping strategy,

100–101; as eff ect of hearing

loss, 84–85, 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 Cor-

poration, 67

Medicare, 148–149, 173

Ménière’s disease, 60–61, 151

Microphones, 37, 74, 154, 155; in

hearing aids, 39, 41–42, 43, 45;

remote, 44

Microtia, 61

Middle ear, 15; bones in, 15, 55–56,

57

Missing sounds, 72–73

Misunderstood speech: compensa-

tion for, 28; and hearing aids,

42; as impact of hearing loss,

8, 73–75, 205; and limitation of

activities, 78. See also Asking

others to repeat

Mixed hearing loss, 18

Modifi ed decibel scale (dBA), 21

Mood: impact of hearing loss on, 3,

8, 83, 88–90, 205–206; spouses

and signifi cant others on, 89,

187

Movies. See Public venues

Moving closer, as coping strategy,

28–29, 102–103, 104, 105, 212

Myringotomy, 52–53

Noise protection: education on,

143; fi rst-hand advice on, 164,

165–167, 203–205, 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, 211–212; and

misunderstood speech, 73. See also Background noise

Note writing, 36–37

Online search engines, 94

Operating and diagnostic micro-

scopes, 15

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262 Index

Ossicles, 15, 17, 55–56

Ossiculoplasty, 55–56, 57

Oticon Medical, 64

Otitis media, 52–53, 54

Otoacoustic emissions (OAEs), 23

Otolaryngologists. See Ear, nose, and

throat (ENT) physicians

Otologists, 25

Otosclerosis, 57–58, 111, 152

Otoscopes, 14, 15

Overcoming Hearing-Aid Fears (Burkey), 117

Pagers, vibrating, 33

Patience: asking others to repeat

and, 100, 206; fi rst-hand advice

on, 179, 206, 217; friends and

family reactions, 140, 181, 198,

206; and societal reaction to

hearing loss, 139, 157, 206

Personal amplifi ers, 35

Pinna (outer ear), 15

Play audiometry, 24

Pollutants, 52

Protection. See Noise protection

Public venues: assistive listening

devices in, 38, 109–110, 153, 154,

155, 157, 173; and background

noise, 120, 125, 154; and closed

captioning, 154; and eff ect

of hearing loss on mood, 90;

getting help from others and,

105, 106; hearing-aid use in,

42, 122, 123, 126, 134, 208; and

limitation of activities, 78, 79;

and listening strategies, 179,

212; and misunderstood speech,

74; and social withdrawal, 29;


on hearing aids in, 195; wished-

for changes to, 153–155. See also

Crowds

Pure-tone air-conduction testing,

19, 20

Pure-tone bone-conduction testing,

20, 21–22

Relationships: asking others to

repeat and, 10, 84, 93, 162, 177;

fi rst-hand advice for friends and

family, 180–182, 213; hearing-aid

use and, 123; impact of hearing

loss on, 8, 82–84, 88, 188–192;

reactions to hearing loss from

family and friends, 139–140. See also Social isolation; Spouses

and signifi cant others

Remote controls, for hearing aids, 45

Respiratory infection, 52

Rinne tuning-fork test, 21

Rumsfeld, Donald, 183

Safety concerns, as secondary eff ect

of hearing loss, 76–77, 88

Second-hand smoke, 52, 53, 151

Sensorineural hearing loss: and

autoimmune inner ear disease,

59–60; causes of, 18, 50; and co-

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Index 263

chlear implant, 64–67; and con-

genital loss, 61; and oto sclero-

sis, 58; sudden sensorineural

loss, 58–59; testing of, 20

Sign language, 110

Single-syllable words, 20

Sinus problems, 52

Smoke detectors, 33

Smoking, 53

Social isolation: fi rst-hand advice

on, 164; hearing loss associated

with, 3, 29, 85, 86–88, 205;


on, 187, 189

Social networking services, as infor-

mation sources, 94

Sounds, missing, 72–73

Speech, impact of hearing loss on, 25

Speech discrimination, testing of, 20

Speech pathologists, 25, 65–66

Speech reception threshold (SRT),

testing of, 20

Speech recognition software, 36–37

Spouses and signifi cant others: on

communication breakdowns,

185–187; compensating for

hearing loss, 81–82, 85, 99,

100, 106, 183, 186, 187, 188–189,

190, 191, 192, 195–196, 200; on

consequences of hearing loss,

184–192; eff ect of hearing loss

on mood, 89, 187; eff ect of hear-

ing loss on relationships, 83–84,

188–191; on family and friends,

198–199; fi rst-hand advice of, 9,

183–184, 199–200; on hearing-

aid use, 194–195, 209; hearing-

loss questionnaires given to, 5,

6, 238–241; on patience, 206;

perspectives regarding hearing

defi cits, 27, 98; on seeking help

with hearing loss, 192–194

Stapedectomy, 57–58, 111

Stapes, 15, 57–58

Stethoscopes, amplifi ed, 35

Sudden sensorineural loss, 58–59

Surgical treatments, 61–67, 111

Swimmer’s ear, 51–52

Technological and medical options:

as coping strategies, 106–111. See also Hearing aids; Treatments

Telecoils, 38, 43–44, 45, 147, 157

Telephones: amplifi ed listening

devices and, 34–35, 47, 107, 108,

216; and captioned devices,

36, 37; eff ect 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;


compensating for hearing loss,

86, 106, 190, 191; technological

options, 106–107; and telecoils

in hearing aids, 43, 147. See also

Cell phones

Y6609.indb 263Y6609.indb 263 12/10/14 9:38:42 AM12/10/14 9:38:42 AM

264 Index

Television: closed captioning and,

35–36, 108–109; and hearing-

aid use, 122, 123, 124, 126, 128,

177; induction loop system and,

147; and limitation of activi-

ties, 78, 79; loudness aff ecting

others, 84–85, 88, 100, 101, 107,

122, 123, 188, 190, 195, 196; and

misunderstood speech, 73, 74;


compensating for hearing loss,

187, 188–189, 190; wireless

headphones for, 38, 107–108,

196; wished-for changes in,

155–156

Texting, 36

Theaters. See Public venues

Tinnitus, 47, 118, 152, 153, 214–215

Tools for hearing: alerting devices,

32–34; amplifi ed listening

devices, 34–35, 47, 107, 108, 216;

captioned devices, 35–37, 108–

109, 154, 156, 157; and hearing

from a distance, 37–38

Treatments: and autoimmune in-

ner ear disease, 59–60; and

bone-anchored hearing aids,

61–64, 62, 63; and cholestea-

toma, 56–57; cochlear implant,

64–67, 65, 66; and congenital

loss, 61; and damaged middle-

ear bones, 55–56; and ear

infections, 51–53, 56, 59; and

earwax, 50–51; and hearing-loss

prevention, 53–54; and Mé-

nière’s disease, 60–61; and oto-

sclerosis, 57–58; and perforated

eardrum, 54–55; and sudden

sensorineural loss, 58–59; surgi-

cal treatments for severe or total

hearing loss, 61–67, 111; types

of, 7–8, 50

Two-syllable words, and hearing

threshold, 19–20

Tympanometry, 22

Tympano-ossiculoplasty, 56

Tympanoplasty surgery, 55

User-adjusted volume control, 44–45

Vertigo, and Ménière’s disease, 60

Vestibular system, and inner ear, 17

Vibrating alarm clocks, 33

Video otoscopes, 14

Visual reinforcement audiometry

(VRA), 24

Volume settings: adjustment of de-

vices, 8, 27–28, 84–85, 100–101;

adjustment of hearing aids,

44–45; and hearing clarity, 20.

See also Loudness

Websites, as information sources, 94,

215–216, 217

Whistling, of hearing aids, 42–43,

127, 129, 130

Windy conditions, and hearing-aid

use, 125, 126, 130

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Index 265

Wireless headphones, 37–38, 47,

107–108, 196

Wireless microphones, 44

Wish list: for healthcare and hearing-

aid performance changes, 136,

141–150, 211–212; for medical

breakthroughs, 152–153; for sec-

ond chances, 150–152; societal

and individual changes, 136,

137–141, 153–155, 206; for televi-

sion changes, 155–156

Word recognition score (WRS), test-

ing of, 20

Work situations: and background

noise, 31, 35; eff ect of hearing

loss on mood, 90; and noise

protection, 152; and secondary

eff ects of hearing loss, 79–81, 88

Y6609.indb 265Y6609.indb 265 12/10/14 9:38:42 AM12/10/14 9:38:42 AM

the hearing-loss guide

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