you can contact the state licensing board in your state, your state attorney general, or a local consumer protection agency. You can find contact information in the government pages of your telephone book. In addition, you should report serious problems to the Better Business Bureau (www.bbb.org).

Tips for Buying a Hearing Aid

Educate yourself. The more you know about hearing loss and hearing aids, the better your decisions will be.

Be cautious about aggressive sales tactics. No one should pressure you into buying a hearing aid.

Don’t be misled by exaggerated advertising claims about hearing aids that can eliminate all background noise or amplify only one conversation in the midst of many. Remember, if it sounds too good to be true, it probably is.

Take a relative or friend with you to your appointments. You’ll receive a great deal of information at once. Having another person there to listen (and maybe take notes) is helpful and also makes the visit less stressful.

Keep all of the follow-up appointments with your audiologist (the cost is probably included in the price of your hearing aids).

Take advantage of other services that your audiologist offers, including hearing rehabilitation services, literature on hearing loss and amplification, guidance on how to adjust to your hearing aids, and information about hearing aid care and maintenance.

Keep a journal of your daily listening experiences. This can provide valuable information for your audiologist during follow-up visits.

Be assertive during your appointments. Jot down questions prior to appointments and take them with you. Write down the answers (or ask your audiologist to provide written information).

Ask about hearing assistance technology that might help you in challenging listening situations.

Don’t be afraid to try other hearing aid models, features, or styles if the first aids you try do not help you.

Don’t assume that the most high-tech or expensive hearing aids are the best ones for you; what you need depends on the nature of your hearing loss, your lifestyle, and your individual hearing needs.

THE SECRET OF SUCCESS

You probably know people who appreciate their hearing aids, people who do nothing but complain about them, and people who own them but never use them. What accounts for the difference? Are people who buy more expensive hearing aids happier with them? Are people who wear a certain

hearing aid style (BTE, mini-BTE, ITE, ITC, or CIC) more satisfied than others? Is there a technical feature or combination of features that makes a hearing aid fitting successful? Many factors affect the outcome of a hearing aid fitting, including the listener’s type, severity, and configuration of hearing loss; speech perception ability (in quiet and in noise); and dynamic range. But what’s the real secret to success with hearing aids? The answer is simple, but it isn’t always easy: the real secret to success is wanting to hear as well as you possibly can and being willing to do whatever it takes to make that happen.

Success with hearing aids (and nearly everything else in life) is about motivation. In fact, motivation is the single best predictor of success with hearing aids. For example, research suggests that a listener’s willingness to tolerate background noise might be more important to his success with hearing aids than his speech perception ability.6

If you really want to hear better, you’ll have to work at it. Hearing aids alone are only part of the solution; the rest is up to you. Make an effort to adjust to your hearing aids. Wear two hearing aids if you can manage it financially. Take advantage of any hearing rehabilitation services that are available. Learn to appreciate the improvement your hearing aids provide, even though it’s less than perfect. The outcome is in your hands. If you decide (in the absence of special problems or circumstances) that you want to hear as well as you possibly can, and you’re willing to really try, then you’re likely to be successful with hearing aids.

The following comments by a hearing aid user provide a good illustration. Notice that the writer never claims hearing aids are perfect; rather, he’s able to accept the imperfections and enjoy the benefits. This acceptance is important because there’s nothing you can buy that’s as good as the human auditory system. Thus far, no feat of engineering can match it. Given the times in which we live, this reality can be difficult to accept; we’ve come to believe that a technological solution exists for every problem.

Changing the Muted World by Peter Whitis, MD

I lost my hearing so gradually I barely noticed it. My wife, whose hearing is so exquisite she can hear the conversation at a table 20 feet away in a noisy restaurant, learned to repeat herself rather frequently in our conversations, now going past 50 years.

I subtly withdrew from most group activities, movies, concerts, parties, as it just got too difficult to understand people. I would nod my head for most of the conversation and then make some inane remark off the subject and see this stunned look. I often had a ten-second delay in processing the conversation while trying to fill in the gaps I couldn’t hear. It would be like trying to read this article with parts of the words

erased. It was easy for my mind to wander. My work was affected and I decided to retire earlier than I had planned.

My wife wondered if I really heard the music she loved to play. I didn’t know if I did or not. How could I know what I didn’t hear? I found myself leaving music out of my life too and even began thinking why did so many people think it such an important part of their lives.

People with soft voices, accents, rapid speech, highor low-pitched tones out of my hearing range were the most difficult to hear. My son and his wife could converse from either end of the dining room table in their normal voices and I, sitting in the middle of the table, could not comprehend them.

My spouse would try to seat me at places in church or concerts where the acoustics were favorable. Friends at lectures would scout out the seats for me nearest the auditorium speakers. In the car, we used an amplifier with a microphone attached to my wife’s shoulder seatbelt.

With all these limitations, I was losing contact with people. Increasingly my life was dominated by reading, closed-captioned TV whenever I watched it, solitary pursuits like bird-watching, the Internet, longdistance running, biking. Tennis, my passion, continued to be fun but my partners knew I couldn’t hear let calls or had to come to the net to talk to me.

On the whole, at work and home, people were kind, considerate and forgiving of my hearing loss. But I knew it was not easy to have to repeat themselves for my benefit or raise their voice to talk to me.

Then the digital age arrived. I was fitted with a pair of behind-the-ear (BTE) hearing aids to replace my 13-year-old canal aids. Abruptly, my aural world boomed.

It’s a noisy world out there.

My bilateral BTE aids are automatically programmed to switch for music listening, phone mode, TV or conversation in noisy environments, have a volume switch and a mute button. By hooking them up to her computer, my audiologist can tell how much volume I have increased in different listening situations, how much time I’ve spent in voice/noisy or voice/quiet situations. She can reprogram them individually depending on my needs and comfort level.

Now I could hear the furnace turning on and the washing machine spin cycle take off like a jet engine. The dishwasher sloshed through its cycles with impressive violence. Stacking plates and bowls in the cupboard was fearfully noisy with each plate sounding like a pistol shot. I understood now why my wife used to leave the kitchen to make the bed when I began to put away the dishes. I could hear the coffee gurgling and the toaster pop up.

Best of all, I could now talk to people and understand what they were saying better. I still needed to face the person, voices behind me were lost, background noise interfered but less so, fast talkers still had to slow down for me. Playing tennis was a totally new experience. Now I could hear the ball being hit with an exhilarating sound like chopping wood.

. . . I noted that the poetry I had written over the years used singular visual imagery. New aural imagery became possible (“the gate swinging to and fro” could become “a creaky swinging gate”.) Being a backyard bird-watcher I longed to hear and identify birdcalls but knew it was impossible to hear them before. With my new aids, I confidently bought a book and tape of common birdcalls.

It’s not all peachy. All this ambient noise is stressful at home, in the car, and in social situations. It’s understandable why some choose not to use hearing aids. But there is some relief when the TV is too loud at the health club (as it usually is), when I’m trying to read and the washing machine is gaining altitude, when I just need quiet, there is that little mute button. Then I know my hearing loss is no longer just a handicap, but a blessing.

Peter Whitis, MD, is a 73-year-old child/adolescent psychiatrist working part-time in a residential adolescent treatment center in Eau Claire, Wisconsin. Along with an active sports program including strength training, tennis, running, and biking, he loves to read, write, and is active in current affairs. He and his wife Martha have been married 53 years and have four sons and ten grandchildren.

Adapted from the September/October 2006 issue of Hearing Loss Magazine, with permission from the Hearing Loss Association of America.

CHAPTER 8

When Hearing Aids Are Not Enough:

Cochlear Implants

The renowned poet John Keats wrote,

“Heard melodies are sweet, but those unheard are sweeter,” but he was wrong.

Ode on a Grecian Urn, John Keats

Hearing aids provide substantial benefit to most users, but for people with severe-to-profound sensorineural hearing loss, they may not be enough. Basically, hearing aids work by making sounds louder, then sending them through a dysfunctional auditory system. In most cases, the dysfunction is caused by damaged or missing hair cells within the cochlea (see Chapters 3 and 4). People with mild, moderate, and sometimes even severe hearing losses have enough working hair cells to transmit the amplified sound energy to Cranial Nerve (CN) VIII and the brain, however imperfectly. When hearing loss is more severe, however, there may not be enough working hair cells to make the connection. In this case, the auditory fibers that form CN VIII are available to carry information to the brain, but there aren’t enough hair cells to trigger the neural activity (or the activity that does get through is too degraded to be useful). When this is the case, a cochlear implant may be the solution. A cochlear implant converts sounds into patterns of electrical pulses; these electrical pulses bypass most of the auditory system and stimulate CN VIII fibers directly. CN VIII then carries the bioelectrical (neural) information to the brain, which interprets it as sound. Cochlear implants are a true miracle of modern medicine; they’re the only medical technology to functionally restore a human sense.