Virtually all patients wearing hearing aids complain about background noise at one time or another. There is no way to completely eliminate background noise.

Remember, when you had normal hearing there were still times when background noise was a problem. It is no different now, even with properly fit hearing aids! The good news is there are circuits and features that help to reduce (or minimize) background noise and other unwanted sounds. In fact, there are research findings that demonstrate digital hearing aids with particular circuit and microphone options which can effectively reduce background noises. Please speak with your specialist about this.

Many early digitally programmable (and even some digital) circuits, which claimed to reduce or eliminate background noise, actually filtered out low frequency sounds. This indeed made the sounds appear quieter; however, not only was the background noise made quieter, but so too, was the signal (the speech sound).

Newer ways to reduce background noise are based on timing and amplitude cues and other noise processing strategies, which 100% digital hearing aids can incorporate. These methods work, but are not perfect. Directional microphones are available and are useful as they help to focus the amplification in front of you, or towards the origin of the sound source. Directional hearing aids can offer a better signal-to-noise ratio in difficult listening situations by reducing a little bit of the noise from the sides or behind you. In most 100% digital hearing aids, the noise control features help make noise more tolerable, but do not completely eliminate the noise.

Basically, if you have two ears with hearing loss that could benefit from hearing aids, you need two hearing aids. It is important to realize there are no "normal" animals born with only one ear. Simply stated, you have two ears because you 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.

Assuming you have two ears that hear about the same, you can do a little experiment at home to better understand how important binaural hearing is:

First, gently close just one ear, by simply pressing the little fleshy part in the front of your ear canal (the tragus) into your ear canal -- a little. Do not apply pressure, do not hurt yourself. Just close the ear canal to eliminate sound from entering the ear. The idea is to close that ear for about ten minutes while you watch TV or listen to the radio, or speak with your spouse. Then, after a full ten minutes, remove your finger. What an amazing difference!

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.

Localization (knowing where the sound came from) is only possible with two ears, and just about impossible with one ear. Localization is not just a sound quality issue; it may also be a safety issue. Think about how important it is to know where warning and safety sounds (sirens, screams, babies crying, etc) are coming from. Using both ears together also impacts how well you hear in noise because binaural hearing permits you to selectively attend to the desired signal, while "squelching" or paying less attention to undesired sounds such as background noise.

Binaural hearing allows a quality of "spaciousness" or "high fidelity" to sounds, which cannot occur with monaural (one ear) listening. Understanding speech clearly, particularly in challenging and noisy situations, is easier while using both ears. Additionally, using two hearing aids allows people to speak with you from either side of your head - not just your "good" side!

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.

The term DIGITAL is used so often today, it can be confusing. When the term "digital" is used while referring to hearing aids, it generally means the hearing aid is 100% digital. In other words, the hearing aid is indeed a "complete computer". 100% digital hearing aids have been commercially available since 1996 and are wonders of modern technology. 100% digital hearing aids can process sound using incredibly fast speeds such as 100 to 200 million calculations per second. Interestingly, most 100% digital hearing aids have analog components, such as the microphone and the receiver. 100% digital hearing aids transform analog information into a digital signal and process the sound to maximize the speech information you want to hear, while minimizing the amplification of sounds you do not want to hear.

Digital technology is tremendous and it allows the specialist maximal control over the sound quality and loudness of the hearing aid. Importantly, digital technology allows the specialist to tailor or customize the sound of your hearing aids to what you need and want to hear. In summary, if you want the best technology-- get 100% digital hearing aids.

All custom made hearing aids and earmolds are made from a "cast" of the ear. The cast is referred to as an ear impression. The specialist or hearing aid dispenser makes the ear impression in the office. It takes about 10 to 15 minutes. The specialist places a special cotton or foam dam in the ear canal to protect the eardrum, and then a waxy material is placed in the ear canal. When the material hardens (about 5 to 10 minutes later) the wax cast, along with the dam are removed from the ear canal. Often, the ear canal will be "oily" after the impression is removed. This is normal. The oil comes from the wax material and prevents the wax material from sticking to the skin.

Tell the specialist before the ear impression is obtained if you are allergic to plastic or dyes or if you have had any type of ear surgery!

All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery, it is a medical emergency and the individual needs to see a physician immediately.

One question often asked is "How long does the battery last?" Typically they last 7-14 days based on a 16 hour per day use cycle. Batteries are very inexpensive, costing less than a dollar each. Generally, the smaller the battery size, the shorter the battery life. The sizes of hearing aid batteries are listed below along with their standard number and color codes.

Size 5	RED
Size 10 (or 230)	YELLOW
Size 13	ORANGE
Size 312	BROWN
Size 675	BLUE

Today's hearing aid batteries are "zinc-air." Because the batteries are air-activated, a factory-sealed sticker keeps them "inactive" until you remove the sticker. Once the sticker is removed from the back of the battery, oxygen in the air contacts the zinc within the battery, and the battery is "turned-on". Placing the sticker back on the battery will not prolong its life. Since many of today's automatic hearing aids do not have "off" switches, removing the battery at night assures that the device is turned off. Zinc-air batteries have a "shelf life" of up to three years when stored in a cool, dry environment. Storing zinc-air hearing aids in the refrigerator has no beneficial effect on their shelf life, in fact, quite the opposite may happen. The cold air may actually form little water particles under the sticker. Water is made of oxygen and hydrogen. If the water vapor creeps under the sticker, the oxygen may contact the zinc, and the battery could be totally discharged by the time you peel off the sticker! Therefore, the best place to store batteries is in a cool dry place, like the back of your sock drawer, not the fridge!

Realistic Expectations:

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 be worn in extremely noisy environments. Some hearing aids have features that make noisy environments more tolerable, however, hearing aids cannot eliminate background noise.

Your Own Voice:

When you wear hearing aids for the first time, you will probably notice your voice sounds funny! You will hear your voice amplified through the hearing aid. You may describe this sensation as feeling "plugged up" or hearing your voice echoing. This is normal and will usually go away in a few days after you have given yourself a chance to get accustomed to your new hearing aids and learned to adjust the volume control. There are adjustments that the specialist can do to relieve these symptoms, should these persist beyond the first few days of wearing your new aids.

Getting Used To Hearing Aids:

People learn at different rates. Some people need a day or two to learn about and adjust to their hearing aids, most need a few weeks and some may need a few months. There is no perfect way to learn about hearing aids. I usually recommend you wear the hearing aids for a few hours the first day, and add about an hour a day for each day that follows. Do not try to set an endurance record. Over a period of time you will lengthen the amount of time that you wear the aid. Eventually you will wear the hearing aids most of your waking hours. It is recommended that you interact with those people you are most familiar with during your first few days. Start off listening with your hearing aids in a favorable listening environment and work towards more difficult listening situations. Let your friends and family know that you are using your new hearing aids.

Helpful Steps to Learning to Use a Hearing Aid:

1. Use the aid at first in your own home environment.
2. Wear the aid only as long as you are comfortable with it.
3. Accustom yourself to the use of the aid by listening to just one other person - husband or wife, neighbor or friend.
4. Do not strain to catch every word.
5. Do not be discouraged by the interference of background noises.
6. Practice locating the source of the sound by listening only.
7. Increase your tolerance for loud sounds.
8. Practice learning to discriminate different speech sounds.
9. Listen to "something," even reading aloud.
10. Gradually extend the number of persons with whom you talk, still within your own home environment.
11. Gradually increase the number of situations in which you use your hearing aid.
12. Take part in an organized course of aural rehabilitation, see your specialist to learn about these courses.

Physical Fit:

One concern with all new hearing aids is the physical fit. Hearing aids need to be comfortable, not too tight and not too loose, they should fit just right. Do not wear the hearing aids if they cause any discomfort or irritations. Do call your specialist to schedule an appointment time to remedy the problem as soon as possible. Do not wear them if they are uncomfortable.

Hearing loss occurs to most people as they age. Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. In the year 2001, there are some 28 million people in the USA with hearing loss. Hearing loss is the single most common birth "defect" in America. Hearing loss in adults, particularly in seniors, is common.

You may have hearing loss if...

• You hear people speaking but you have to strain to understand their words.
• You frequently ask people to repeat what they said.
• You don't laugh at jokes because you miss too much of the story or the punch line.
• You frequently complain that people mumble.
• You need to ask others about the details of a meeting you just attended.
• You play the TV or radio louder than your friends, spouse and relatives.
• You cannot hear the doorbell or the telephone.
• You find that looking at people when they speak to you makes it easier to understand.

If you have any of these symptoms, you should see a specialist to get an "audiometric evaluation." An audiometric evaluation (AE) is the term used to describe a diagnostic hearing test, performed by a licensed specialist. An AE is not just pressing the button when you hear a "beep." Rather, an audiometric evaluation allows the specialist to determine the type and degree of your hearing loss, and it tells the specialist how well or how poorly you understand speech. After all, speech is the single most important sound, and the ability to understand speech is extremely important. The AE also includes a thorough case history (interview) as well as visual inspection of the ear canals and eardrum. The results of the AE are useful to the physician should the specialist conclude that your hearing problem may be treated with medical or surgical alternatives.

Written hearing tests, "dial a hearing test" and other online hearing tests are not particularly accurate and are certainly not diagnostic tests, but may be utilized as screening tools. These screenings are usually free and can be scored within a few seconds. Written hearing screenings may point the patient (or consumer) in a particular direction and may help validate that a hearing problem may indeed exist.

Therefore, we have designed a written hearing screening to provide you with some general guidelines about your hearing ability. It is free and it may offer you insight regarding the likelihood that a hearing loss is present.

Click here to download the written hearing screening.

There are essentially three levels of hearing aid technology. We refer to these as analog, digitally programmable, and digital.

1. ANALOG technology is the technology that has been around for many decades. Analog technology is basic technology and offers limited adjustment capability. It is the LEAST expensive.
2. DIGITALLY PROGRAMMABLE technology is the "middle grade" technology. Digitally programmable units are analog units digitally controlled by the computer in the office to adjust the sounds of the hearing aid.
3. DIGITAL technology is the most sophisticated hearing aid technology. Digital technology gives the specialist maximum control over sound quality and sound processing characteristics. There are qualitative indications that digital instruments do outperform digitally programmable and analog hearing aids. Digitals are not perfect, but they are very good. Digital hearing aids have been widely available since 1996.

Tinnitus is an abnormal perception of a sound which is reported by patients that is unrelated to an external source of stimulation. Tinnitus is a very common disorder. It may be intermittent, constant or fluctuant, mild or severe, and may vary from a low roaring sensation to a high pitched type of sound. It may or may not be associated with a hearing loss. It is also classified further into subjective tinnitus (a noise perceived by the patient alone) or objective (a noise perceived by the patient as well as by another listener). Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. The location of tinnitus may be in the ear(s) and/or in the head.

Degree of Hearing Loss

Results of the audiometric evaluation are plotted on a chart called an audiogram. Loudness is plotted from top to bottom. Frequency, from low to high, is plotted from left to right. Hearing loss (HL) is measured in decibels (dB) and is described in general categories. Hearing loss is not measured in percentages. The general hearing loss categories used by most hearing professionals are as follows:

_____Normal hearing (0 to 25 dB HL)

_____Mild hearing loss (26 to 40 dB HL)

_____Moderate hearing loss (41 to 70 dB HL)

_____Severe hearing loss (71 to 90 dB HL)

_____Profound hearing loss (greater than 91 dB HL)

Types of Hearing Loss

The external and the middle ear conduct and transform sound; the inner ear receives it. 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, and will be discussed only briefly.

______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 earwax blocking the ear canal, 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.

A person with a conductive hearing loss may notice that their ears may seem to be full or plugged. This person may speak softly because they hear their own voice quite loudly. Crunchy foods, such as celery or carrots, sound very loud and this person may have to stop chewing to hear what is being said. All conductive hearing losses should be evaluated by a specialist and a physician to explore medical and surgical options.

______Sensorineural hearing loss is the most common type of hearing loss. More than 90 percent of all hearing aid wearers have sensorineural hearing loss. The most common causes of sensorineural hearing loss are age related changes and noise exposure. A sensorineural hearing loss may also result from disturbance of inner ear circulation, increased inner fluid pressure or from disturbances of nerve transmission. Sensorineural hearing loss is also called "cochlear loss," an "inner ear loss" and is also commonly called "nerve loss." Years ago, many professionals said there was nothing that could be done for sensorineural hearing loss - that is totally incorrect today. There are many excellent options for the patient with sensorineural hearing loss.

A person with a sensorineural hearing loss may report that they can hear people talking, but they can't understand what they are saying. An increase in the loudness of speech may only add to their confusion. This person will usually hear better in quiet places and may have difficulty understanding what is said over the telephone.

______Central hearing impairment occurs when auditory centers of the brain are affected by injury, disease, tumor, 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. Certainly both loudness and clarity may be affected also.

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:

ITE: In-The-Ear units are probably the most comfortable, the least expensive and the easiest to operate. They are also the largest of the custom made styles.

ITC: In-The-Canal units are a little more expensive than ITEs. They require good dexterity to control the volume wheels and other controls on the faceplate, and they are smaller than ITEs.

MC: Mini-Canals are the size between ITC and CIC. A mini canal is a good choice when you desire the smallest possible hearing aid while still having manual control over the volume wheel and possibly other controls.

CIC: Completely-In-the-Canal units are the tiniest hearing aids made. They usually require a "removal string" due to their small size and the fact that they fit so deeply into the canal. CICs can be difficult to remove without the pull string. CICs do not usually have manual controls attached to them because they are too small.

BTE: Behind-The-Ear hearing aids are the largest hearing aids and they are very reliable. BTEs have the most circuit options and they can typically have much more power than any of the custom made in the ear units. BTEs are the units that "sit" on the back of your ear. They are connected to the ear canal via custom-made plastic tubing. The tubing is part of the earmold. The earmold is custom made from an ear impression to perfectly replicate the size and shape of your ear.

RIC (Receiver-in-canal) or OTE (Over-the-ear): These hearing aids have a plastic housing for the components which rests behind the ear. A clear plastic tube and a custom made earmold funnels amplified sound into the ear canal. This model, though developed decades ago, can be every bit as sophisticated as smaller hearing instruments. In fact, it can hold more circuitry and amplify sounds to a greater degree than in-the-ear types. RIC or OTE hearing aids can be more durable than other types and a few are even waterproof.