Audiologist and Technology Expert - Current & Past Questions

Current Question:

A. The AVR you are speaking about is not compression, but frequency transposition.  I do not use this hearing aid, but my understanding is that if there is so much useable hearing in frequencies before 6000Hz., frequency transposition would not be necessary.  If the child is doing so well ( presuming he has been tested while aided ) with standard amplification, why have to learn a new way to hear with the frequency transposition.  There are now many new digital hearing aids BTE that are powerful enough to fit severe-profound hearing loss and are compatible with most FM systems.

My feeling would be to try those before thinking of frequency transposition-Also before frequency transposition I would want to know what greater benefits would be available with such amplification.  But I also agree it is time for trying new. 

Good luck, and keep us appraised of what follows.

IRA SPRINGER, AuD., CCC-A
 

Past Questions:

Q. I have moderate sloping hearing loss and for the past several months have been trying to find a Completely-in-the-Canal (CIC) hearing aid that works for me. My audiologist, a really nice and patient person who received her AuD. two years ago, has made several molds for me so far. But each resulting shell has had too much movement, particularly in my right ear. This produces what I perceive to be poor and changing sound quality, changing feelings of blockage (sometimes right, sometimes left), feedback, and a really bad occlusion effect. I have a lot of jaw movement, particularly in my right ear. All of the DIC's that I have tried so far have had a lot of movement, "pop" constantly, and make so much noise that I can't wear them and eat at the same time. The aids feel really loose and hard. I really need to find someone who can help me obtain an excellent fitting mold. I wonder if I should try a different fitting process or shell material? Any help would be greatly appreciated!

A. Did the audiologist try more than one manufacturer? If she only tried one manufacturer it doesn't mean you can't have a good fit with a CIC. Sometimes it takes a few tries to get a company that will be right for an individual. If she did try different companies and the problem was always the right ear, possible canal lock, to grip unit better. Jaw movement can vary greatly from ear to ear. It is not uncommon to have a great fit in one ear and torture on the other. I would question the audiologist on other possibilities, other CIC aids. If you don't have confidence try someone else. I recommend that consumers always use a multi-line hearing aid dispenser.

Q. My physician and audiologist have diagnosed me with a condition I don't understand: presbycusis. They said it means I can't understand words. I wear two hearing aids to assist with the loss of hearing frequencies, but they tell me the aids will not help the other condition. Is there anything that could help?

A. Simply defined, presbycusis is hearing loss that results from the degenerative changes associated with aging. Nothing can be done about the aging process, but that doesn't mean the person will not be able to benefit from hearing aids. It is simply a general term that is used for any hearing loss where age may be the only explanation for the loss. There are more specific, more technical ways to further differentiate presbycusis, e.g. research showing more exactly the areas of cochlear that are affected.

Q. What does a "cookie bite" hearing loss mean?

A. When an audiologist tests your hearing, the results are charted on a chart called an audiogram. An example of a cookie bite loss would look like this:

At 250Hz sound is detected at 25dB (decibels)
At 500Hz sound is detected at 45dB
At 1000Hz sound is detected at 60dB
At 2000Hz sound is detected at 50dB
At 4000Hz sound is detected at 35dB
At 8000Hz sound is detected at 25dB

When you chart the above example loss on an audiogram it looks like someone is taking a bite out of the middle set of frequencies, also known as the speech banana. It can also be the opposite, where the hearing loss at either end of the audiogram is poor and the hearing in between is better. This is called a reverse cookie bite and is less common.

To learn how to read and understand your audiogram, visit these links:
http://www.audiology.org/consumer/guides/uya.php
http://www.earinfo.com/howread1.html
 

Q. I recently had earmolds made for my new hearing aids (Siemens Infinity ITE). At that time, I asked for the T-coil. My audiologist said I did not need that option and did not order it. Was that a correct thing to do? I currently hear on the phone using a volume dial, but I am concerned for when my hearing loss reaches the point when that may not help. I have a progressive loss.

A. The question whether hearing aids should be fitted with a T-coil or not is an ongoing discussion. On paper, a T-coil is absolutely the correct thing to do for telephone and FM system use. However, many individuals have difficulty with the T-coil including handling it and knowing when it is on or off. They will complain that their hearing aid is not working, but it was in the T-coil position.

Another problem is that with a mild to moderate gain hearing aid, there is possibly not enough power in the T-coil. This is a problem in advanced compression hearing aids. There's not enough kick in the T-coil. As you can see, sometimes the possible cure is worse than the problem. An amplified telephone may do the trick.

A good way to handle this is for audiologists to discuss the advantages and disadvantages of a T-coil with their patients. Discuss the personal needs and abilities of the individual patient and then make an informed decision together as to whether to order hearing aids with the T-coil or not.

Q. I have a 3 year child with a moderate to severe hearing loss in one ear and a mild loss in the other. We are considering a digital aid but are confused regarding options and features. Which features are important?? How do we know that our audiologist is an expert is programming it? I have heard that the programming is the hard part.

A. There are many questions that should be discussed before deciding whether to get a digital hearing aid or an analog one. These include whether to aid just one ear or both, the bad ear fit or the good ear fit. An FM listening system is also important and may have an impact on choosing the hearing aid or aids. Usually, the audiologist will refer what he or she knows best so programming should not necessarily be a problem.

I think lots of other questions, as mentioned above, should be discussed before getting to digital. Advantages for digital aids are low distortion, low internal noise. Usually digital aids are very adjustable, but remember they should still be proved out in aided sound field testing situations. Another issue are directional digital aids.

Editor's note: It is recommended that children be seen by an educational audiologist or an audiologist who works with children daily. There are different issues for hearing impaired children than for hearing impaired adults. FM and Soundfield systems are important for many children in classroom environments. You can contact the Educational Audiology Association for help in locating an appropriate professional in your area. Educational Audiology Association, http://edaud.org/ Phone: 800.460.7322 Email: mailto:EAA@L-TGRAYE.COM

Q. I have two Siemens Music BTEs (behind the ear hearing aids). These are the first programmable hearing aids I've worn. My audiologist programs my aids while I am sitting on the other side of the room. I then put them on (in a very quiet room) and think, ok, I can handle this. However, when I get outside, the noises are overbearing. Then I have to wait for another appointment. I like the aids sometime but other times I am not sure. Can the hearing aid owner program the aids at home with the software where the environmental sounds are at its norm?

A. Your problem is not unique.  Trying a hearing aid in a quiet sound conditioned office is not the same as wearing it in the real world.  Today  many audiologists have available special environmental sounds that can realistically recreate many
different listening conditions.  Go back to your audiologist and ask about it.  If he or she doesn't have such a system, the Siemens program has many different suggestions as to what adjustments can be made to make you more comfortable.  Do not give up.  Go back and your audiologist will figure it out with you.

Q. My 5 year old daughter has minimal loss (bilateral) through 2000 hz with a drop off to 70 db at 3000 hz and above. I understand what sounds she should be missing, and she does have slight speech issues with those, as do many 5 yr olds. We have never noticed any issues with her, except sometimes have to call her more loudly than other kids. We are very torn about getting hearing aids for her. Part of me feels if she is going to need them for sure later, then now would be the right time to get her used to them. I don't want her to miss anything, but it seems she only marginally needs the aids. Any input?

A. The hearing aid fitting of a loss starting past 2000Hz is very difficult - though it is possible. Most important for educational purposes is an FM listening system. In the classroom FM direct amplification would probably be very helpful for your child-along with articultation therapy. (See the Parent Support Expert area for more on this subject.) Hearing loss can effect both speech articulation and language acquisition. It is important to speak to your audiologist, preferably an educational audiologist and find what works best for your daughter. It is certainly worth doing now. It will not get easier for her.

Q. How do you troubleshoot a hearing aid?

A. The battery should always be checked first. Then check the receiver for debris - the part that goes in the ear canal. Last and most carefully, check the microphone opening on the outside of the aid. This is most delicate but it can be clogged. If you have any doubts, check next with your audiologist. He or she can test the aid with equipment or may have to send it out for repairs. Be sure to ask if a loaner aid is available if yours needs to be sent out.

Q. What technology is available to assist in being able to hear/understand discussions in a board meeting (around a large table)? I have no hearing in my left ear and minimal in my right ear as a result of Meniere's Disease.

A. An FM listening system would be helpful to you in this situation. Such systems are available as stand alone units-without a hearing aid, or units that can be plugged in to a hearing aid. There are special microphones that can be set up right in the center of a table. Ask your audiologist if your hearing aid is compatible with any FM system. The most versatile is the Phonak MicroLink. It is expensive. There are certainly others available. If you have a T-coil on your hearing aid you may be able to weara a tele-loop with an external FM at a more modest cost. Be sure to discuss all of this with your audiologist.

Q. My 8 year old daughter has been diagnosed with a moderate hearing loss. She does extremely well in her studies, but she is not able to respond to whispers or hear students talking from the last benches. We have been advised to get her hearing aids. Will she be able to tolerate the closed feeling of both the ears? What about the high amplification of all the noises she hears? Please let us know of any negative sides to getting hearing aids.


A. Try the hearing aids and certainly use an FM listening system in school. A sound field system might work, however a personal FM is best. Though your daughter is doing well it is important to realize children learn significant amounts of speech, language and idioms through informal listening at school and at home. This is the importance of amplification at this time with even with a moderate, 30dB hearing loss. Inquire with your audiologist about the trial period for the different devices. It may take your daughter some time to get used to wearing hearing aids and using an FM system, but it will be well worth it. Don't wait and see how she fares without them.


Q. My 6 year old son has problems hearing at home and school. Today he had audiological tests at the local hospital. After apparently performing poorly at the audiography test (ear phones and audiometer) he had a bone conduction test. This showed that he has very good hearing on one side, but one ear gave very poor results. The consultant told me that even if he was completely deaf on one side, an aid would not be prescribed, as we only need two ears to determine the direction of sound. The social implications of wearing an aid are 'too great' at this age, and his education would not suffer by not having one. Is this correct? Do you recommend that I get a second opinion regarding the possible treatment? 

A. The information you received at the hospital was upsetting and a bit confusing. If you were told your son has one good ear and one bad ear and he only needs the two ears for directional hearing-they are WRONG. Two ears are needed for a lot more than that. Studies have also shown that children with only the mildest losses, or losses in only one ear suffer educationally. Your son is at a critical learning stage. 

I am surprised that an audiologist would tell you that the social implications of wearing a hearing aid were too great at this stage. His education might very well suffer without some assistive help. FM systems ( an assistive device ) have been shown to be very helpful for children with the kind of difficulty your son has. 

I certainly think you should get a second opinion. Find another audiologist-possibly the school might help you be in touch with an educational audiologist, who might be better at answering your questions. It is great you were in touch us at HearingExchange. Your questions are important, your care and interest as a parent are to be commended. With due diligence, you will find the best for your son. Good luck and be in touch with us.
 

Q. I just found out my son, who is 7, has mild sensorineural hearing loss in his right ear. He struggles in reading and has been in speech therapy since pre-school although he only has a little trouble with a few of his sounds. He has been tested by an audiologist who said his left is perfect but the right has mild loss at all except 40 decibels and she thought that was very strange. Please help me understand how we missed his hearing loss and what we should do next. 

A. Probably no one noticed the loss because your son has normal hearing in one ear, so it would not be obvious. What happens, even with the mildest of losses, is that as he progresses in school- and needs become more complex-like reading-these things become more evident. We need all the information we can get. Thank goodness the loss only seems to be mild.

Now that you and the school are aware of it, sit down with the faculty at the school and figure out the best plan to be sure your son gets all the help and information he needs. Your explanation of 40dB doesn't make sense. A forty dB hearing loss would be a moderate loss-not that strange-contact us again with more information on this. Right now, follow up-you are doing the right thing. I would also suggest a speech and language evaluation to be sure there are no processing disorders. 

A. You can find listings of competent and ethical hearing aid dispensers at the Academy of Dispensing Audiologists website at www.audiologist.org and the American Academy of Audiology website: www.audiology.org. Both organizations also offer many brochures on how to go about deciding on the purchase of a hearing aid.  There are no real rankings on hearing aid
manufacturers, however I have listed some of the highly respected ones that also have websites.  Make sure that the audiologist you go to has access to more than one brand of hearing aid and that you purchase it on a trial basis. Here are a sampling of the well-known manufacturers:  Oticon, Resound, Phonak, Beltone, Widex, Siemens, Starkey, Qualitone and Unitron. Links to many of these can be found at our Resource Directory. There are other good companies as well.  Educate yourself and find a good audiologist so that you will be comfortable with your decision.

Q. My daughter has a severe/profound loss in her left ear and a profound loss in her right ear. She is currently wearing Phonak Pico Fortes with the Microlink FM system. We have hard some positve information on digital aids in comparison with analog. Is there benefit to being fitted with digital hearing aids even with severe to profound loss?

A. The Phonak is an excellent aid. The Microlink is the best FM. Digital hearing aids can offer faster processing and less distortion, if they are strong enough. Studies over the past two years have shown the the best technolgy is twin microphone technology, in which Phonak is the leader. Also, nothing is better for a child -especially in an eductional setting- than using an FM. You can also use the MicroLink FM with many digital aids, including Widex Senso, Phonak Claro and Oticon Digifocus. All of these have models with fairly strong circuits. Speak to your audiologist about having your child evaluated with digital aids. A good audiolgist will offer choices. Digital is definitely a good potential aid, even with severe-profound loss.

Q. How important is it to have two hearing aids when there is loss in both ears?  Would it be ok to try just one first?

A. If both ears are the same, and the speech discrimination is equally very good in both ears, one could start with a single hearing aid, but the limitations of wearing the one aid must be understood at the outset.

With a single hearing aid you will NOT be able to to localize (understand the direction of) sounds.  You will  not hear as easily or clearly in noisy surroundings.  You will not understand soft speech as easily.  Sounds will not have the same clarity or depth with only one ear aided.

Recent studies have shown that by wearing only one aid, when the other ear is aidable, increases the risk of auditory deprivation.  This is when the brain gradually loses its ability to process information from the unaided ear because of a continued lack of sound stimulation.  This occurs over a long period of time.  The brain literally forgets how to hear.

One could start with just one aid, but the advantages of binaural hearing are great.

Q. My wife complains when the radio is too loud and then when I turn down the volume just a little bit she gets relieved. What's going on?

A. This is called HYPERCUSIS. This is a rare type of auditory disorder which makes normally tolerable sounds unbearably loud, disorganizing and sometimes even frightening. I would recommend that a person with this condition wear earplugs at wedding receptions, concerts or anyplace where there is loud noise. 

Q. I understand disposable hearing aids are now available. How good  are they and are they cost effective?

A. Disposable hearing aids will last for six weeks of use, then you throw them away. The consumer's cost is $40 per ear plus the audiologist's fee of $150-$200 for testing and fitting. If you don't like them, you throw them away, if you do, you order as needed. Over the long run, I think the company will bypass the audiologist by providing them by mail-order, if it is successful.

A few studies have shown that the quality of sound is very good, but the problem is fit. The important rehabilitative aspect of hearing aid fitting is lost with disposable hearing aids. The name of the company is Songbird Hearing and more information can be found at their website, www.songbirdhearing.com.

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