| How do I know if I have a hearing loss? |
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| A) Adults |
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| You may have hearing loss if... |
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| -You hear people speaking but you have to strain to understand their words. |
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| -You frequently ask people to repeat what they said. |
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| -You talk loudly. |
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| -You frequently complain that people mumble. |
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| -You find it harder to hear in public gatherings. |
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| -You play the TV or radio louder than your friends, spouse and relatives. |
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| -You don’t always hear the doorbell or the telephone. |
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| -You find that looking at people when they speak to you makes it easier to understand. |
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| -You find it difficult to distinguish speech from other sounds and noises. |
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| If you have any of these symptoms, you should see an audiologist for hearing assessment. A hearing assessment allows the audiologist to determine the nature and degree of your hearing loss, and it tells the audiologist how well or how poorly you understand speech. A thorough investigation also includes a comprehensive case history (interview) as well as visual inspection of the ear canals and eardrum. The results of the hearing evaluation are useful to the physician should the audiologist conclude that your hearing problem may be treated with medical or surgical alternatives. If the results indicate that you are a suitable candidate for hearing aid, hearing aids that suit your type and degree of hearing loss, lifestyle, dexterity and budget will be prescribed. Post- fitting follow- up will be customised to ensure that you hear better in no time. |
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| B) Children |
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| Children should have their hearing tested if one of the following occurs: |
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| -risk factors during pregnancy, such as maternal rubella, syphilis |
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| -risk factors in the new-born, such as premature birth, low birth weight, severe jaundice |
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| -significant head trauma |
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| -meningitis |
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| -history of congenital hearing loss |
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| -recurrent middle ear infections |
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| -ototoxic medication |
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| -speech or language delay |
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| -parent or teacher has noticed or suspects a hearing loss abnormalities of the ears, nose or throat |
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| -syndromes, such as Down Syndrome |
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| How is hearing loss measured? |
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| Results of the hearing evaluation are plotted on a chart called an “audiogram ? Loudness is plotted from top to bottom, with the loudest at the bottom. Frequency/ pitch, from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) and is described in general categories, not in percentages. The general hearing loss categories used by most hearing professionals are as follows: |
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| i) Normal hearing (0 to 25 dB HL) |
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| ii) Mild hearing loss (26 to 40 dB HL) |
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| iii) Moderate hearing loss (41 to 55 dB HL) |
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| iv) Moderately severe (56 to 70 dB HL) |
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| v) Severe hearing loss (71 to 90 dB HL) |
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| vi) Profound hearing loss (greater than 91 dB HL) |
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| What are the common types of hearing loss? |
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| The external and the middle ear conduct and transform sound; the inner ear receives it. There can be problem in any part of the ear. When there is a problem in the external or middle ear, a conductive hearing impairment occurs. When the problem is in the inner ear, a sensorineural or hair cell loss is the result. Difficulty in both the middle and inner ear results in a mixed hearing impairment (i.e. conductive and a sensorineural impairment). Central hearing loss has more to do with the brain than the ear. |
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| Conductive hearing loss occurs when sound is not conducted efficiently through the ear canal, eardrum, or tiny bones of the middle ear, resulting in a reduction of the loudness of sound that is heard. Conductive losses may result from wax build- up, fluid in the middle ear, middle ear infection, obstructions in the ear canal, perforations (hole) in the eardrum membrane, or disease of any of the three middle ear bones. |
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Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear (retrocochlear) to the brain. Sensorineural hearing loss cannot be medically or surgically corrected. It is a permanent loss. Sensorineural hearing loss not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly. Sensorineural hearing loss can be caused by diseases, birth injury, drugs that are toxic to the auditory system, and genetic syndromes. Sensorineural hearing loss may also occur as a result of noise exposure, viruses, head trauma, aging, and tumors. |
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Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss.
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| Central hearing impairment occurs when auditory centres of the brain are affected by injury, disease, tumour, hereditary, or unknown causes. Loudness of sound is not necessarily affected, although understanding of speech, also thought of as the ''clarity'' of speech may be affected. In some cases, both loudness and clarity are affected. |
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| What is an audiologist? |
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| Audiology is the science of hearing. In Malaysia, an audiologist is a person who at least has a bachelor degree in audiology. An audiologist is only qualified to practise if he/ she fulfils 300 clock hours of supervised clinical practicum. |
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| Audiologists work in a variety of settings including hospitals, schools, clinics, private audiology practices, universities, rehabilitation facilities, speech and hearing centres, hearing aid dispensing offices, hearing aid manufacturing facilities, medical centres, as well as otolaryngology (ENT physician) offices. Although the vast majority of hearing problems do not require medical or surgical intervention, audiologists are clinically and academically trained to determine those that do need medical referral. As a qualified healthcare provider, the audiologist appropriately refers patients to physicians when the history, the physical presentation, or the results of the audiometric evaluation indicate the possibility of a medical or surgical problem. Many audiologists also dispense hearing aids and related assistive listening devices for the telephone, TV and special listening situations. |
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| What is an ENT (ear-nose-and-throat doctor) specilaist? |
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| Otolaryngologists (also called ear-nose-and-throat, or ENT doctors) are physicians who have advanced training in disorders of the ear, nose, throat and head and neck. They treat ear, nose and throat diseases requiring medical or surgical means. |
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| What are ear impressions? |
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| All custom made hearing aids and ear moulds are made from a ''cast'' of the ear. The cast is referred to as an ear impression. The audiologist makes the ear impression in the office. It takes less than 15 minutes. It is a painless process and please inform your audiologist if you feel pain at any point. The audiologist places a special cotton or foam dam (ie otoblock) in the ear canal to protect the eardrum, and then a waxy material is “pumped ?into the ear canal via a syringe. When the material hardens (about 5 to 10 minutes later), the cast, along with the otoblock are removed from the ear canal. Often, you will find the ear canal ''oily'' after removing the impression. This is normal. The oil comes from the wax material to prevent the wax material from sticking to the skin. |
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| What are the levels of hearing aid technology? |
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| There are essentially three levels of hearing aid technology. |
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| 1. ANALOG technology is the technology that has been around for many decades. Analogue technology is basic technology and offers limited adjustment capability. |
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| 2. DIGITALLY PROGRAMMABLE technology is the ''mid range ?technology. Digitally programmable units are actually analogue units digitally controlled by the computer/ handheld programmer in the office. |
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| 3. DIGITAL technology is the most sophisticated hearing aid technology. A “digital ?hearing aid means it is 100% digital. Simply put, it is a complete computer by itself. Digital technology gives the audiologist maximum control over sound quality and sound processing characteristics. The audiologist can easily manipulate the parameters according to what you need to hear and want to hear. As technology advances, many sophisticated features like feedback canceller, noise reduction and directional microphone are incorporated in the digital hearing aid. The digital hearing aid is now better in fulfilling the hearing needs of the hard- of- hearing. |
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| The most common styles of hearing aids. |
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| There are many styles of hearing aids. The degree of the hearing loss, power and options requirements, manual dexterity abilities, cost factors, and cosmetic concerns are some of the factors that will determine the style the patient will use. The most common styles are listed below: |
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| BTE: Behind-The-Ear hearing aids are the largest hearing aids and they have the most circuit options. They "hook" nicely at the ear via an ear mould. The ear mould is custom made from an ear impression to perfectly replicate the size and shape of your ear. |
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| ITE: It is the largest of the custom made styles. It is customised to fit neatly into the ear. |
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| ITC: In-The-Canal units are smaller than ITEs, they fit into the ear canal. Thsy are a little more expensive than ITEs. They require good dexterity to control the volume wheels and other controls on the hearing aid surface. |
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| CIC: Completely-In-the-Canal units are the tiniest hearing aids made. They fit deeply into the canal. |
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| Pocket aid/ body worn aid: This instrument is the largest of all hearing aid. It is connected to a cord, a receiver and an ear mould to fit the individual. |
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| What can hearing aids do? |
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| Hearing aids are getting smarter. Undoubtedly the most important thing a hearing aid does is still amplifying, but in a variey of ways, hearing aids are getting better at doing that. |
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Some examples of what hearing aids are able to do are: i) Noise reduction ii) Speech enhancement iii) Multiple listening program iv) Wireless synchronization v) Feedback management vi) Automatic program switching |
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| What can't hearing aids do? |
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| Restore hearing after wearing it for a period of time. |
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| Totally eliminate background noise while enhancing speech. |
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| Make you hear as natural as you did before the hearing impairment. |
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| It helps you to hear better but not in the sense of understanding speech perfectly. |
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| "I feel a fullness in my ear when I use my new hearing aids." |
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| You may also notice that your voice sounds funny and you hear your own voice echoing. This is due to air trapping between the tip of the earpiece and your eardrum, or maybe you have wax in your external auditory canal. This is normal and will usually go away in a few days. If the sensation continues to bother you, there are adjustments your audiologist can do to relieve these symptoms. |
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| Helpful Steps to Learning to Use a Hearing Aid: |
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| 1. Use the aid at home for the first few days. |
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| 2. Wear the aid only as long as you are comfortable with it. |
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| 3. Practise fitting and removing and the hearing aids from ears. |
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| 4. Practise switching the hearing aid on/ off and setting the volume control to the required position. |
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| 5. Try to have conversation with someone familiar in quiet environment- husband or wife, neighbour or friend. |
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| 6. Practice locating the source of the sound by listening only. |
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| 7. Increase your tolerance for loud sounds. |
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| 8. Practice learning to discriminate different speech sounds. |
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| 9. Gradually extend the number of persons with whom you talk, still within your own home environment. |
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| 10. Gradually increase the number of situations in which you use your hearing aid. |
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| 11. Try following the television and use the telephone. |
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| Realistic expectations: |
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| Hearing aids work very well when fit and adjusted appropriately. They amplify sound! You might find that you like one hearing aid better than the other. The left and right hearing aids will probably not fit exactly the same and they probably won't sound exactly the same. Nonetheless, hearing aids should be comfortable with respect to the physical fit and sound quality. Hearing aids do not restore normal hearing and are not as good as normal hearing. You will be aware of the hearing aids in your ears. Until you get used to it, your voice will sound ''funny'' when you wear hearing aids. Hearing aids should not to be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable; however, hearing aids cannot eliminate background noise. |
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| "Hearing aid" alone is not enough! |
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| To communicate effectively, you need to fully utilize your ears AND eyes. You will not communicate well using your hearing aids alone. To facilitate optimal communication, you will need to pick up cues from the speaker's gestures, body language and facial expressions! Besides that, remember to reduce the distance between the speaker and the listener, reduce or eliminate background noises from the listening environment and use good lighting. If someone is speaking to you from another room, while the radio is on, with children playing at your side, it will be very difficult to adequately communicate, despite fantastic hearing aids! |
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| Binaural hearing: Do I need two hearing aids? |
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| Listening with both ears is as normal as seeing with both eyes. Basically, if you have two ears with hearing loss that could benefit from hearing aids, you need two hearing aids. We are born with two ears for a reason. We have two ears because we need two ears! If we try to amplify sound in only one ear, you cannot expect to do very well. Even the best hearing aid will sound ''flat'' or ''dull'' when worn in only one ear. |
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| There are many advantages associated with binaural (two ear) listening and importantly, there are problems associated with wearing only one hearing aid -- if you are indeed a candidate for binaural amplification. |
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| i) Better overall sound quality |
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| ii) Clearer speech especially in challenging situations like public gatherings and noisy environment |
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| iii) Localization (the ability to locate the sources and directions of sounds) It is important to know where the warning signals (eg traffic noise, sirens) are coming from in order to react. |
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| iv) More balanced hearing |
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| v) Ability to hear from either side of the head, not just the "good" side |
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| People cannot hear well using only one ear. There are studies in the research literature that show that children with one normal ear and one ''deaf'' ear are ten times more likely to repeat a grade as compared to children with two normally hearing ears. Additionally, we know that if you have two ears with hearing impairment, and you wear only one hearing aid, the unaided ear is likely to lose word recognition ability more quickly than the ear wearing the hearing aid. |
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| Will wearing hearing aids make my hearing worse? |
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| No, the hearing aid cannot damage your hearing. When you wear the aid regularly, your hearing will feel 'dull' without it as you have become used to amplification. "Use it or lose it" is a principle of hearing mechanism. The longer a person with a hearing loss goes without hearing help, the poorer the listening habits and speech understanding become. Relearning to use hearing then takes much more time and is more difficult. |
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| "The hearing aids pick up more noise than speech." |
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| Hearing aids amplify every sound within range of their microphones, including background noise. It is confusing at first, as you have not heard loud background sounds for a long time. Actually you have merely forgotten what background noises sounded like and how you learned to ignore some of them. You’ll probably be able to train your mind to block out the noise and concentrate on speech and the meaningful sounds you want to hear. You might try to turn the hearing aid volume down. This might cut down some of the background noise levels. Fortunately, people usually speak louder in a noisy environment. |
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| You must relearn how to listen and to sort out sounds that are important. Remember, even those who have normal hearing cannot stop interference on background noise. However, the ability to concentrate on sounds that are important can be relearned with practice. |
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| Owing to the advancement of technologies, certain hearing aids come with special features to enhance speech and reduce background noise. They are directional microphone and noise reduction circuit. Please talk to your audiologist about this. |
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| How should I care for and maintain my hearing aids? |
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| It is important to clean the entire hearing aid every time it is removed from your ear by wiping it with disinfectant (do not wash the hearing aid!) and brushing it. The hearing aid is electronic and moisture is the enemy! To better protect your investment, use a dehumidifier kit every night. Or you can make your own by putting some silica gel in an airtight container. You can get the disinfectant and dehumidifier kit easily from your audiologist. Preventive maintenance is the key to trouble-free, long life from a hearing aid. |
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| How long will my hearing aids last? |
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| Many factors determine the life expectancy of hearing aids. This includes the care taken by you, periodic cleaning by your dispenser, your work environment, your body chemistry (salts and acids in your perspiration) and the part of country you live in (shorter in high humidity areas). |
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| Mechanically, a good hearing aid can last, with proper care, for many years. However changing needs on your part and continued improvements in electronics typically shorten the period to about 3-5 years. Even when they last longer, and many do, improvements in the performance of hearing aids and your desire to have something better, may be the deciding factor. |
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| When hearing aids begin to be costly in the way of repairs, this provides a good indication that new ones may be needed. |
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| Can I use the telephone while I'm wearing my hearing aids? |
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Since our country does not have built-in telecoil in the regular house phone yet, use of the telephone can present a problem. The only way is to lift the telephone receiver near (but not too near, lest it causes feedback!) the microphone of the hearing aid. You may also consider a telephone pad if you are wearing a custom made hearing aid. It serves to reduce feedback and you can put the receiver on your ear as usual. Alternatively, you can purchase a special telephone with telecoil built-in. In that way, you may use the telecoil in your hearing aids to converse without the interruption of background noise. Please talk to your audiologist on hearing aids and telephones with telecoil. Or you may like to consider using an amplified telephone that elevates the volume for ease of listening. Similarly, your audiologist will be able to provide you with suitable device that suits your listening needs. |
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| What is tinnitus? |
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| Tinnitus is of sound inside the ear or head when no external sound is present. It is often referred to as ''ringing in the ears,'' although some people hear buzzing, hissing, roaring, whistling, pulsating, chirping, or clicking. Tinnitus can be intermittent or constant, with single or multiple tones. Its' perceived volume can range from very soft to extremely loud. |
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| What causes tinnitus? |
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| The exact cause (or causes) of tinnitus is not known in every case. There are, however, several likely factors which may cause tinnitus or make existing tinnitus worse: noise-induced hearing loss, wax build-up in the ear canal, certain medications, ear or sinus infections, age-related hearing loss, ear diseases and disorders, jaw misalignment, cardiovascular disease, certain types of tumours, thyroid disorders, head and neck trauma and many others. Of these factors, exposure to loud noises and hearing loss are the most probable causes of tinnitus. |
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| What are the options for tinnitus management and treatment? |
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| There are many options for people who experience tinnitus. Normally they wear hearing aids to help cover up their tinnitus (by listening more to the environmental sound instead of the noise inside the ear), some wear tinnitus maskers. Additionally, there are combined tinnitus maskers and hearing aids - all in one unit! Some patients require counselling to help them develop strategies to manage their tinnitus. |
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