Hearing Aid Mileage

Have you ever stopped to think about how many hours your hearing aid(s) put in per day? If you are wearing your hearing aids every day, for as long as you should, that equates to about 12 hours per day. Thats 4000 hours per year!

They are expected to perform unfalteringly in rain, shine, amongst wax and perspiration, make-up and even after a shower or two. To put it another way, a car that travels 60kms per hour, for the same amount of time that a hearing aid should be worn, clocks up 260 000kms per year! Hearing aids are assets and generally have a 5 year lifespan, if they are looked after properly and services regularly. They require maintenance and looking after in order to ensure that they perform well throughout their lives.

Here are a few tips on keeping them going:

Service your hearing aid(s) annually. Just drop them off at one of our practices and await our call to come collect them when they are back.

Keep them dry. Silica gel capsules and sachets are only the start of moisture protection. If your hearing aids still seem to collect moisture then you should consider purchasing an electronic drying station which the hearing aids can sleep in at night to prevent damage from corrosion. There are different types and sizes – ask your audiologist!

Check your hearing aids every day – do they need a clean? Wipe them with a dry cloth or tissue when they come out of your ears at night (do not use liquids!). Check the tubes for wax and remove the wax if necessary. Also dont forget to check the waxguards.

For custom or receiver-in-the-ear hearing aids, be sure to change the waxguards every time you change the batteries. Even if it doesnt look blocked. A partially blocked waxguard will not cause the aid to stop working, but it will diminish the quality and quantity of sound.

When cleaning your hearing aids, it is helpful to work over a surface, preferably softened with a towel or the like, so that in case the hearing aid is dropped, it doesnt have far to fall and the landing will be soft. Is also useful for catching batteries which are very difficult to find once they have landed on the floor!

When your hearing aids are not in your ears, they have to be in their box! Hearing aids that are left next to the telephone or on a side table tend to go missing, or get stolen by the family pet.

Make sure that you know how to put the batteries in the right way and always use only the best quality batteries that you can. Remember that old, flat batteries should be removed from hearing aids as they can cause damage from leakage.

Hearing aids are complex but also very tiny computers. They are serviced by knowledgeable and trained professionals. Please do not try to open them or repair them yourself.

Most importantly: When in doubt, visit one of our practices or make an appointment with your audiologist. Remember that we are always available for help or advice.

Copyright: Francis Slabber & Associates 2017

Hearing Aids Stimulate the Brain

How long have you been aware that you arent hearing as well as you used to? Most people wait between 7 – 10 years before they do anything about their hearing loss. Its not usually something that you suddenly notice one morning when you wake up. Age-related hearing loss is a gradual process and is often only noticed after it has been going on long enough to start causing frustration.

Apart from the obvious complications that come with hearing loss – decreased speech understanding, impaired hearing in noise – it also interferes with the brains memory of speech and other common sounds in our listening environments. This happens because the hearing nerve receives less stimulation and gets rusty or unfit. This means that the brain receives less sound and begins to forget sounds that it is not hearing over time. The brains auditory memory can only actively store sound memories for 7 years. After that, it has to be re-introduced to certain sounds.

This means that even when we wear appropriate amplification, if a hearing loss has been present for the average 7 years, the brain has already begun to forget certain sounds or pitches. This means that it would have to relearn these sounds again – a possible, but potentially laborious process. It is normal for these forgotten sounds to sound like noise in the beginning. Give it time for the brain to relearn what these sounds are. They will no longer be bothersome then.

This is why it is so important to manage hearing loss appropriately (including amplification) as soon as possible. Remember, getting hearing aids and keeping them in the drawer, or only wearing them when in company, does not count! Wearing the hearing aids at home when it is quiet (even if there is nobody to talk to) allows the brain to practice with sounds most common to your environment first. It learns again how to filter relevant from irrelevant sounds.

Remember that if you are battling to get used the strange sounds around you, you can talk to your audiologist who may be able to give you some tips. Copyright: Francis Slabber & Associates 201

Overprocessing: The problems with Telephones, TVs and Hearing Aids

One of the most common complaints that Audiologists get is that hearing aids do not help with the TV or the telephone. A lot of the time this has to do with sound being processed too much – being sent out from a speaker in the phone or at the TV, picked up by the hearing aids microphones, being processed again, and being released by another speaker in your hearing aid, causing the sound to become distorted and unclear. People often ask us what can be done to try and improve your ability to hear these crucial sounds, and there are some strategies that can be tried, with consideration of other factors making it even more challenging.

On the Telephone:

When a person without a hearing aid uses the telephone, the speaker is placed tightly against the opening of the ear, allowing the sound to travel directly into the ear canal. Unless there is a bad line, a problematic speaker, or an unidentified hearing loss, the person should be able to hear clearly. When a person is wearing a hearing aid, the ear is often blocked by the aid itself, so holding the phone as one usually would might make the sound seem worse instead of better! There is also the added complication of feedback that often occurs as a result of holding something too close to the hearing aid. Unfortunately for some there is no alternative but the last resort- to remove the hearing aid- but there are some tricks to try before resigning to this.

Positioning the Phone: Hold the telephones receiver in line with the microphones on the hearing aids- they usually sit at the top of the aid, not inside the ear. Also angle the handset so that the phone does not rest directly against the hearing aid.

Hearing Aid Settings: Some hearing aids can be set up with a specific telephone program- with an easy push of a button or connection with a magnet the sound can be adjusted to be more suitable for telephone use. Speak to your audiologist about whether this might be an option for you.

Special Telephones: Amplifying telephones are cost effective, and they allow you to adjust the volume of the telephone for each call. The can also often be used on speaker phone mode, which eliminates the need for the handset to be too close to the hearing aid. You can also get telephones that have a feature called Telecoil, which can be directly connected to some hearing aids to get a clearer sound.

Bluetooth connectivity: New hearing aids these days have the ability to be connected to your cellphone or even your landline using Bluetooth devices- some can even be connected to specific phones directly. These give the best possible sound signal for talking on the phone, but do require a bit of an investment, and take a little bit of tech-savvy.

When Watching Television:

There are many factors that contribute to poor TV Hearing, and the biggest of all is accents. Listening to anyone with an accent that is different to your home accent, especially with a hearing aid, increases the understanding difficulty substantially. This is made even more difficult by the very common inclusion of background music, multiple speakers, rapid delivery of speech, and the very popular mumble, made famous by Marlon Brando. Another huge frustration is that certain programs or adverts are louder than others. So how do we try to overcome all of these challenges?

Control the Volume: Of course, there is always the option to turn the volume up on the television. This sometimes works but can create a lot of extra stress and conflict in the household and even in the neighbourhood if the TV is loud enough! The better option would be to control the volume on your hearing aids, either with buttons on the aids or by using a remote control or Smartphone App. Talk to your audiologist about making sure that you have the facility to adjust the volume of your hearing aids if you need to.

Manage the Distance: When we watch the TV, we rarely sit right on top of the screen or the speaker! Creating distance between the sound source and the hearing aids will always increase the difficulty.
There is a way to reduce the distance without moving the TV or your seat- using a TV listener, headphones, or a Bluetooth Streamer with cause the sound to be transmitted directly to your ears. For those using hearing aids it is always best to consult with an audiologist before purchasing a device like this, to make sure that it will be suitable for your hearing loss and your hearing aids.

With the development of new technology it is possible to hear better when talking on the phone, or when watching the TV- speak to an Audiologist about the possibilities for your unique needs.

Copyright: Francis Slabber & Associates 2017

Hearing Aid Styles

Does size really matter anymore?

Yes, but not as much as you might think. These days, hearing aid size has little to do with performance, less to do with price and nothing to do with quality. To choose the most appropriate size, one has to look at the type and degree of hearing loss, required extras needed, dexterity, eyesight and personal preference.

Today, most hearing aids can be adapted to give the required amount of power. So even severe losses can be amplified with a discreet hearing aid.

So size isn’t everything?
No. Quality, performance and appropriateness should always be the main concern. It is the quality of what goes into the hearing aid, as well as how the hearing aid processes the sound, that determines the quality of the sound that comes out.

Current Hearing Aid Styles
There are a few basic sizes available:

BTE – Behind-the-Ear
RIC – Receiver-in-Canal
ITE –In-the-Ear
ITC –In-the-Canal
CIC – Completely-in-Canal
CID – Completely-in-Drawer!

A BTE hearing aid has all of the mechanics sitting on top of/behind the ear, with a tube trailing down from the top and into the ear. This is secured by a dome or an earmould in the ear itself. Remember that when you wear a hearing aid, something always has to go into your ear!

These look almost like BTEs with most of the mechanics behind the ear, but the receiver (speaker unit) of the hearing aid sits in your ear canal and is held in place by either a dome or a custom made earmould. Placing the speaker unit in the ear allows for the BTE portion to be smaller and for the sound exit point to be placed closer to the eardrum, which in turn improves the quality of sound.

These are custom made to fit each individual ear canal (ITEs sit in the canal and in the outer ear, ITCs sit in the canal).

CICs are custom made but sit inside the ear canal. We fit these when one is particularly concerned about the cosmetics of the aid and if the hearing loss is suitable.

Custom made hearing aids rely on having enough space inside the ear canal to fit all of the mechanics inside. Also, the movement of the TM-joint can cause these canal aids to work their way out of the canal causing problems like feedback and loss of sound quality.

The smaller the hearing aid, the less space there is for batteries, volume or program buttons and functional hardware. One may have to sacrifice these things when choosing a very small hearing aid. With a small or narrow ear canal, sometimes there isn’t enough space for all of the necessary components.

Remember that sometimes a hearing aid inside your ear can be even more visible than one sitting on top, often underneath your hair!

Copyright: Francis Slabber & Associates 2017

Hearing Aid Misconceptions…

Hearing aids today are sophisticated, well-designed instruments, not only comfortable to wear but with many options to make them as appropriate as possible to each user. They are designed to cater for all hearing losses and lifestyles and are usually chosen after open discussion between the audiologist and the wearer as to what their hearing, lifestyle and budget needs are.

Many people still have the impression that hearing aids don’t help, don’t function well, are expensive, unsightly and uncomfortable to wear. Most of these misconceptions come from observing parents or grandparents’ experiences, but thankfully times have changed and many of the advances made with computers, cell-phones and other electronic devices, have filtered down to hearing aids.

Some common misconceptions include:
Hearing aids do not work and do not help: Not true. The degree of help that you get from a modern hearing aid depends on your hearing loss. Hearing aids are programmed individually by the audiologist and are almost always helpful once adaptation has occurred. Hearing aids will not restore your hearing to normal, but they do result in better hearing and improved quality of life. The degree of benefit however, will differ from person to person and one should never compare hearing, hearing aids or the performance thereof. Every case is as different and individual as a fingerprint.

Hearing aids are big and unsightly: Not true. Today, most hearing aids are small, discreet and well designed. Some have even won international design awards! They can be worn behind the ear or custom-made to fit inside the ear canal. They are usually matched to hair colour and depending on the severity of hearing loss, can be almost invisible. They should be comfortable to wear and most people comment on how quickly they forget that there is something in their ears!

Hearing aids are expensive: Not always true. What is true, is that you get what you pay for. As with most things, the best is the most expensive. Compared to what was available 10 years ago, we have much more technology at our disposal which continues to filter through the different levels of hearing aid technology. For an entry level hearing aid today, one can pay around R6000, but the same technology would have cost R10 000 not even 5 years ago. For a top-end aid, one can expect to pay around R35 000, but again, this technology was not even dreamt of 5 years ago. Between these two levels there is a world of choice, depending on whether you need a Lamborghini, a Citi Golf or one of the many in-between options.

Hearing aids just amplify noise: Not true. As mentioned above, we are lucky these days to have access to much better technology before. If a person is very socially active and spends a lot of time in noisy places, they would need to purchase a more sophisticated hearing aid which would be better at noise suppression than its entry-level cousins. One’s hearing loss also plays a role here, with the more severe losses requiring more help in these difficult to hear environments. We also rely heavily on the brain’s ability to filter unwanted noise, so cognitive decline has to be considered.

Remember that most medical aids contribute something to the purchase of hearing aids. There is also a company called First Health Finance which offers flexible financing options where medical aid cover is insufficient or not available.

The best thing to do is to have your hearing checked regularly by a registered audiologist and openly discuss any concerns you may have about amplification options.

Copyright: Francis Slabber & Associates 2017

Why Hearing Aids take some getting used to

Statistics show that most people wait between 7 – 10 years before doing anything about their hearing loss. However, the auditory memory is only active for 7 years. This means that by the time they get to hearing aids, the brain has had ample time to forget what normal sound sounds like.

Whilst hearing aids, these days, are highly sophisticated devices, they are still just machines, trying to replicate and amplify natural sound. Amplified sounds are quite different to normal hearing and thus take some getting used to.

Studies have found the following to be important when first wearing a hearing aid:

1)Have realistic expectations: Most people will expect their hearing to immediately go back to normal the moment they first put the hearing aid on. This cant happen because a hearing aid is not replacing your loss.The new sound requires a lot of getting used to by the wearer. Make sure that you clarify your expectations before trying out a new device.

2)Hours of use: People who wear their hearing aids all day, every day, do better than those who just put them in when they need them. Some may say but Im at home alone, I dont need to hear. Just because you arent actively listening to conversation, does not mean that your brain should go to sleep. The fridge makes a noise, the birds outside make a noise, its important that you give yourself time to learn what these new sounds are as well as time to get used to them. Learn to filter noises that are ear-friendly before you try to filter noise in difficult situations.

3)Degree of Hearing Loss: Remember that the more severe your hearing loss, the greater the difference will be with and without them in. Sounds may not only sound a bit different to you, but they may be new sounds altogether! Have patience with yourself.

The moral of the story here is, you cannot get used to something that you are not exposed to. Wear the hearing aids from morning to night (except when you bath, swim or shower, and take them out when you go to bed) and you will find that you will acclimatise to the new sound and even wonder how you managed without them. 5 – 8 hours a day is usually recommended in the beginning, but you will end up with 12 – 15 hours wear per day. You may find that baby steps are easier to manage: wear your hearing aid in quiet places first, before graduating to noisy environments which require a lot more concentration. Finally, expect to have to see your audiologist at least twice after the fitting for some fine-tuning adjustments. This is completely normal and necessary – everyone is different and need individual adjustments to their new hearing ears.

Copyright: Francis Slabber & Associates 2017

Feeling Blocked Up?

A blocked feeling in the ear when you have your hearing aid(s) in could be due to a few things:

1.Check for wax Wax in the ear canal may cause the sound from the hearing aid to bounce off it and result in a whistle or cause a cotton wool feeling in the ear.
If your hearing aid(s) used to sound fine, and then started sounding blocked, muffled, or dull, have your ear checked for wax.
If there is no wax in the ear, check the hearing aid for a wax block that may be preventing the sound from moving through the hearing aid as it should.

2.Occlusion Effect The Occlusion Effect if the closed off feeling you get when your ears are plugged with your finger, ear moulds, or earphones. We hear through sound moving through the air (into the ear through the ear canal) but also through the bones of our skull that are vibrated by the same sounds. When we speak or chew, these sounds are vibrated through the skull bones. When the ear is unblocked, this sound escapes and we do not notice it. If the ear canal is blocked, additional sound pressure is generated and transferred into the middle and inner ear. The result is a feeling like you are speaking into a barrel, with a hollow or booming quality that is considerably loud.

3.Ear Moulds and Hearing Aids Ear moulds and hearing aids block the ear to some degree depending on the anatomy of the canal, material used in the ear mould or hearing aid, the depth of insertion, venting (air pressure tube) or a combination of all of these factors.

What can be done?
Occlusion is mostly dealt with in the first few months of wearing new hearing aid(s). Consistent wearing helps with getting used to the feeling of hearing your own voice, but sometimes this process of adaptation can take a little longer. The brain needs time and opportunity to shape itself around its new hearing world.
Venting the mould or hearing aid, creating optimum air circulation inside the ear canal can decrease the problem. Unfortunately, these vents can also cause feedback (whistling) and can even compromise the hearing. A deeper shell or ear mould may help in certain situations. Reshelling the hearing aid or sizing up the ear mould to a bigger option may be necessary.

Copyright: Francis Slabber & Associates 2017

Assistive Listening Devices

We all know that hearing aids can change the life of a person with hearing loss by improving their ability to hear. We also know that for some people hearing aids alone are not enough to assist with our complex and constantly changing lives.

We are challenged by films, theatres, phone calls, restaurants, and shopping malls, just to name a few, and we need to be able to converse with friends, spouses, children, and unfamiliar, often accented voices. Without adequate infrastructure in public places, people living with hearing loss are expected to cope without any additional support, which often causes people to feel even more isolated and dependent, even with hearing aids.

While hearing instruments aim to support, or aid the user, they cannot normalise the hearing, and they cannot compensate for any other issues such as loss of vision or change in cognition. They also may not be able to cope with every different listening demand that the user encounters. This is where Assistive Listening Devices become useful.

Assistive Listening Devices, or ALDs, are devices that work with your hearing aids, or without them if you do not have them, to assist you to function better. They can be selected based on the individuals specific needs to help in many different situations. These include our traditionally challenging environments, such as when there is distance between the listener and the sound source, when there is competing noise, when there are poor acoustics in the room, or when listening to people with heavy accents.

Some people, especially younger people, are able to cope in all of these challenging situations. However, for some, a little more help is needed. A person may require a special telephone, a TV streamer or amplifier, or a personal listening device that would help them to direct the sound towards the person they want to listen to. There are also devices to assist a person living with hearing loss when they may not be wearing their hearing aids, such as an alarm clock that vibrates under their pillow to wake them up, or a doorbell that initiates a flashing light, or a baby monitor.

For more information about the available Assistive Listening Devices, see www.sahearing.co.za, or contact Francis Slabber and Associates nearest branch to arrange a viewing.

Copyright: Francis Slabber & Associates 2017

Two is Better Than One

Most of us are born with two ears. We hear best when these two ears work together, how nature intended. Years of research supports the claim that people with hearing loss in both ears benefit more from wearing a hearing aid in each ear. This helps to give sound a more balanced, natural quality and, in complicated listening situations, hearing with two ears helps the brain to make better sense of your listening environment.

So what improvements can I expect with two hearing aids?

Improved Listening in Noise
Two hearing aids makes soft speech more accessible and in more noisy places, the speech is more easily separated from the background noise.

Improved Hearing Sensitivity
When wearing two hearing aids together, one gains a volume boost just by having the two ears working together. There is even a natural volume increase provided by the brain! People who only wear one hearing aid are likely to want to turn the hearing aid up quite a bit, leading to possible sound distortion and increased chance of feedback, or whistling. The sound quality is also improved when both ears are working together.

Improved Sound Localisation
It is the brain’s job to determine where a sound is coming from. This is possible because sounds may arrive at each ear at different times and intensities depending on which side/direction the sound came from. The brain is then able to analyse the timing (nanoseconds!) and volume differences to quite precisely locate the direction of the sound source, and thus, which way you need to look.

With one hearing aid, it will always feel as if sound is coming from your aided side, which may not always be correct.

Stimulation of the Pathway
A big benefit of wearing two hearing aids is that both auditory pathways get stimulated together. Nerve pathways that aren’t used can get rusty or unfit, so it is important to keep them active and firing! When there is a hearing loss present. This is done by wearing appropriate hearing aids.

Copyright: Francis Slabber & Associates 2017

Listening to Speech in Noise…

According to research, 16% of people with hearing aids never wear them. Of those individuals, 25% reported that it was either because the hearing aid provided no help in difficult listening environments, they amplified loud sounds too much or that listening in background noise was impossible.

In order to understand how hearing in speech in noise happens, we first have to understand how listening happens. In the inner ear there are 4 rows of hair cells: 3 rows of outer cells whose job it is to listen to soft sounds and detect speech in background noise, and 1 row of inner cells designed to manage loud sounds and stimulate the auditory nerve which sends the sound signal up to the brain. In most cases of hearing loss (particularly to do with aging), the outer hair cells are damaged first, hence most peoples’complaint of not hearing soft speech when there is noise in the environment. Should the hearing loss be more severe and the inner cells also be damaged, the signal would not be sent to the nerve. Should the nerve be damaged, the sound may not even reach the brain at all, or it will reach it in bits and pieces which sound like nonsense. After all of this travelling, the sound signal finally reaches the real ear – the brain. In combination, all of these structures are referred to as the Auditory System. We have found that in most cases people with limited damage to their auditory system do well with hearing aids, given that they received appropriate training and allowed adaptation to happen. After all, we can’t expect an external, electronic device to replace the real thing.

Just like we forget names, places or faces when we get older, the auditory system forgets and needs to be reminded and retrained. Complex sounds are more difficult to listen to, process and understand and hearing aids can only work with a loss of hearing, not a loss of understanding.Listening is not only a decision, it is a skill which has to be perfected and like all skills, it takes training and practice. If you have not heard properly in background noise for years and you expect to hear perfectly in noisy places with your new hearing aids, you would probably feel that the aids are making the noise louder than the speech. This is because the noise is easier to recognise and requires little to no understanding, than speech. The brain forgets how to process things it hasn’t experienced in a while and reverts back to the language it does know. Usually, this language is noise, especially when its amplified. The alternative is: don’t get old, never watch television and lock yourself in a quiet room where you only ever speak to one person at a time who has been trained to speak slowly and clearly!

Manufacturers tend to put a lot of emphasis on a hearing aid’s ability to reduce background noise and amplify speech, however, research is showing that the ear’s ability to do this is unique and is very difficult, if not impossible to recreate. To decipher speech properly, one needs fast cognitive abilities. I.e. One needs to be able to predict speech based on the context of the conversation and to be able to correct what you may have misheard, without requesting any more information. For this to happen smoothly, you need an active short term memory. Younger people are better at this because they are better able to listen, hear and think all at the same time! Older people need to devote cognitive effort to each of these processes in turn. Although some hearing aid technology can give you a fighting chance by controlling background noise, enhancing speech and automatically adjusting to the environment (some devices can do this at a speed of 100 times per second!), it can’t slow things down to a pace that each aging individual brain can cope with – yet!

The moral of the story is to visit a professional audiologist before too much damage sets in, get the best set of hearing aids that you can to make use of as much new technology as possible. Follow this up with good training with your audiologist and practise, practise, practise!

Copyright: Francis Slabber & Associates 2017