Suite 603
Los Angeles, CA 90017
(213) 977-1215
fax (213) 977-0404
Hours: M-F 9:00-5:00
_____________________
Home Page
About Us
-Our Staff
-Directions
-Contact Us
-Links
Our Services
-ENT Articles
-BOTOX® Cosmetic
-Audiology and
Hearing Aids
-Assistive Listening
Device Store
For Our Patients
-Office Forms
-VNG Instructions
-Privacy Policy
Legal Disclaimer
Site Map
Copyright© 2010
LA ENT, Associates.
All rights reserved.
Hearing Aids
This page on hearing aids is divided into different chapters. To skip ahead, click on the appropriate chapter heading:- Hearing aid sizes
- Circuit types or technologies (analog, programmable, digital)
- One hearing aid or two?
- Realistic expectations
- Caring for hearing aids
- Hearing aid warranties
- Adjusting to a new hearing aid
- Tips for better listening/hints for family and friends
- Assistive Listening Devices (ALDs)
- Hearing aids Los Angeles Ear Nose and Throat
Introduction to Hearing Aids
Hearing aids, also referred to as hearing instruments, are individual electronic devices powered by a battery, that amplify sounds to help the wearer hear better. The primary goal of a hearing aid is to improve the audibility of speech, and therefore increase communication abilities.Many people who wear hearing aids and are able to communicate better, report being more socially active, feel an increase of self worth, feel less stress and lead happier, healthier lives. They also make life more pleasant for family members and friends who may show frustration when trying to communicate with someone with hearing loss.
At our office, an audiologist determines the most appropriate instrument based on many factors:
- The type, degree and severity of hearing loss
- The lifestyle or social life of the wearer
- The wearer's cosmetic preference
- The wearer's physical limitations (ear shape and dexterity abilities)
- Any medical conditions
- The amount the wearer is willing to pay
Hearing Aids Sizes
There are many different sizes and models of hearing aids, but we will discuss the four most common sizes:1. Behind-The-Ear (BTE)
The components of this hearing aid are enclosed in a small plastic case that fits behind the ear. The amplified sound passes through a tube from the BTE to a custom made ear mold placed
inside the wearer's ear, which
anchors the instrument to the ear and directs the sound towards the ear drum.
BTEs offer greater power for those with greater amounts of hearing loss, have
larger controls for easier use, and are better for specific types of hearing loss
(drainage from the ear, etc.). Children are often fit with BTEs since their
ears are still growing. It is easier (and less expensive) to replace the
custom-made ear mold every year instead of re-making the hearing aid case.
This size fits all ranges of hearing loss.2. In-The-Ear (ITE)
This is the largest
of the custom-made hearing aids. All the components are placed within
the shell that fits in the outer portion and canal of the ear. This size
can fit many types of losses, from mild to severe. This larger custom size
(along with the BTE) allows for more space for components or options that can
improve hearing in specific listening environments (see
telecoils and directional microphones).3. In-The-Canal (ITC)
This
custom size hearing aid fits in the ear canal and ear canal opening
of the wearer. ITCs can only be fit on individuals with a mild to
moderately severe hearing loss. It is less visible than the larger sizes
and may have smaller controls and a smaller battery, which will not last as long
as a larger battery in a larger hearing aid.4. Completely-In-the-Canal (CIC)
This tiny custom hearing aid fits entirely in the ear canal of the wearer.
Due to the small size, there are usually no controls that the wearer would be able to
manipulate, and the battery size is the smallest of all instruments (lasts about
5 to 7 days). Even though this size is the most cosmetically appealing,
there are certain requirements needed by the wearer to take advantage of this
size. You have to have a large enough ear canal and only a mild to
moderately severe hearing loss. The small wire on the "face" of
the instrument is a pull string used to remove the instrument from the ear
canal.There are other custom sizes that typically fall between the sizes listed above. (ex: a mini canal is a size between an ITC and a CIC). Body aids are a wallet sized case that fit in a front pocket with cords that attach to custom ear molds. These aids are less common now than they used to be since BTEs are becoming more and more powerful for more severe or profound losses.
Hearing Aid Circuit Types
All hearing aids have three important components: a microphone, an amplifier and a speaker (also called a receiver). How the instrument processes incoming sounds is determined by the type of circuit the hearing aid has. Each of these circuits can fit into any of the sizes listed above.Historically, there have been 3 different types of circuits for hearing aids. Today, digital hearing aids are primarily fit on all types of patients with hearing loss. Analog and programmable hearing aids are described for historical purposes:
1. Analog
An analog circuit is a plain, basic processor. We refer to a basic analog circuit as linear, which means "what goes in is what comes out". This is a somewhat simplified description since even analog hearing aids shape incoming signals to maximize speech sounds to some degree. Typically, the appropriate amount of gain or volume for an analog hearing aid is chosen by the manufacturer (or the audiologist) based on the hearing test results of the wearer. Volume can be controlled by using the volume wheel or dial. An analog hearing aid may have some controls the dispenser can use to change the quality of the sound, like turning up or down low pitched sounds or a reduction of very loud sounds (called compression). These controls are usually very basic filters.
2. Programmable or digitally programmable
A programmable (also called digitally programmable) hearing aid is an analog hearing aid that is connected to the computer by your audiologist, who then sets the amount of gain or amplification for the hearing aid based on the hearing test entered into the computer. Adjustments can be made to broad "channels", or frequency bands, to adjust the sound quality of the instrument. For example, most programmable instruments have a low frequency or "bass" channel and a high frequency or "treble" channel. Adjustments are made to these channels on the computer to improve the sound quality or fit of the instrument. Programmable instruments also have a user controlled volume control. NOTE: A digitally programmable hearing aid is not an all digital or 100% digital hearing instrument. It is an analog aid that can be adjusted digitally on a computer. Programmable hearing aids have all but disappeared and have been replaced by all digital hearing aids today.
3. Digital
A digital hearing aid allows for even more flexibility than a programmable aid, and offers a clearer, cleaner sound to the wearer. Instead of broad low or high frequency channels, a digital instrument can be adjusted on the audiologist's computer at each frequency of an individual's hearing test. This allows for even more precise fittings in relation to an individual hearing loss, giving a more natural, comfortable sound. Digital processing has allowed for more manipulation of incoming signals, allowing some manufacturers to develop special circuits that can reduce constant, steady noises in the environment. These hearing aids cannot eliminate "background" noise (see realistic expectations), but may improve a wearer's chances of understanding speech in the presence of noise. Newer digital models have features that are able to remove feedback (an annoying whistling sound) and reduce the occlusion effect (a plugged up sensation caused by wearing something in your ears). Most digital hearing aids do not have volume controls. They provide the appropriate amount of volume by adjusting to whatever listening environment they are in. Digital hearing aids compromise approximately 95% of all hearing aids fit in our office.
Other hearing aid options that are available in analog and digital instruments include:
Telecoil: A telecoil is a copper coil within the hearing aid that receives the electromagnetic signal of your telephone hand piece. This prevents feedback (a shrill, whistling noise) when placing the phone near the ear or hearing aid. Telecoils are typically only available in the BTE and ITE size, but can be found in some ITC models. The telecoil does not work with all cell phones.
Directional microphones (or dual-mics): This option refers to a hearing aid that has two microphones. One microphone amplifies sounds in front of the wearer just like a normal hearing aid would, and a second microphone turns down sounds coming from behind the wearer. This feature is utilized in a noisy room by putting the person you want to speak to in front of you and the noise behind you. Newer digital models incorporate an adaptive directional microphone capable of tracking moving noise sources and adjusting the sound appropriately. Directional microphones are available in the BTE to the ITC sizes.
One Hearing Aid or Two?
If hearing loss is present in both ears and can benefit from hearing aids, then two (or binaural) hearing aids are recommended instead of one (or monaural). Listed below are the main reasons why a binaural fitting is preferred:- Studies have shown that some people may lose perception abilities, including the understanding of speech, if the ear is left unaided over a period of time.
- The brain is programmed to listen with both ears. Wearers of two instruments need less volume than those that wear one, even though they have hearing loss in both ears.
- Binaural hearing aid wearers have a greater ability to pick out sounds against background noises.
- Binaural hearing aid users report a subjective reduction in communicative effort and more confidence in their responses to questions.
- Locating where a sound is coming from is improved with binaural hearing aids.
- Two hearing aids allow for more communication flexibility. For example, a binaural wearer who is driving a car may elect to turn off the left instrument which is receiving the most noise from an open window, and leave the right instrument on to listen to someone in the passenger seat. A person who wears a hearing aid in the left ear only, would have more difficulty in this situation when trying to hear the person in the passenger seat.
Realistic Expectations
The most common misconception about hearing aids is that they will restore hearing to "normal". For some individuals, it may be possible to obtain normal hearing thresholds through the use of hearing aids, but there are many factors that have to be considered, including (but not limited to):- The amount, type and configuration of hearing loss (see Hearing Basics)
- The ability to understand speech, even if it is loud enough to hear
- The type of technology or circuit chosen for the hearing aid
- How well the instrument is fit on the individual
- The realistic expectations of the individual
Hearing aids do not amplify only the sounds you want to hear. They cannot tell the difference between background sounds and foreground sounds. However, there are some options that may allow for greater understanding in noise (see digital instruments and directional microphones). They may allow the wearer greater speech audibility in noise, but the noise will still be present. Most hearing aid wearers who complain of background sounds do so because they have not been exposed to these softer sounds due to their hearing loss. It takes time for the brain to adjust to all the sounds it has not heard over the years now that they hear them again with hearing aids.
Hearing aids do not "correct" hearing like glasses can correct for vision problems. They are tools to be used to help increase the amount of speech sounds a hearing impaired person would normally miss otherwise.
One thing to keep in mind is that every person's hearing loss is different. The results of someone you know with hearing aids may be completely different than what you may experience if you try hearing aids.
Taking care of Hearing Aids
Hearing aids can be very delicate and expensive. Keep them away from water or extreme heat or cold. Do not store them in the bathroom, where there is typically high humidity. Keep them out of reach of children and pets (who like to chew on them).Batteries will need to be changed every 5 days to 4 weeks, depending on the size, power and circuit type of the hearing aid and how often it is used. Batteries can cause serious injury if swallowed or inhaled.
Daily care should involve wiping the aid with a clean, dry cloth. Ear wax and moisture are the main reasons why hearing aids malfunction. It is important to remove all debris according to the manufacturer's instructions that come with the instruments. Never use water or cleaning solutions to clean the instruments. When not using them, the battery door should be left open. This will dry out any moisture inside the aid as well as help the batteries last longer. If there are any problems with the instruments, contact the audiologist or hearing instrument dispenser they were purchased from.
Hearing Aid Warranties
Hearing aids come with a repair warranty and a loss and damage warranty. The repair warranty covers any repairs in-office or at the manufacturer's repair lab. The manufacturer will replace any instrument lost during the first year under the loss and damage warranty. Both of these warranties can be extended, typically before they expire.All hearing aids come with at least a 30 day trial period. If you wish to return the hearing aids within that time, you will receive your money back.
At Los Angeles Ear, Nose and Throat Associates, we provide extra
coverage on our hearing aids called Complete Hearing Health Care.
When you purchase hearing instruments from us, we will provide you with
free batteries, free hearing aid cleanings and free ear canal inspections
during your 6 month check-ups. We will also provide free annual
hearing screenings to make sure that your hearing has remained
stable. These services (including batteries) are free for the life
of the hearing aid.
Feel free to contact us if you would like a
hearing aid repaired or would like to extend your hearing aid warranties.
Adjusting to a New Hearing Aid
Soon after being fit with a hearing aid, the wearer will begin hearing sounds they may not have heard for a long time. Some sounds may sound different or even louder than what they are used to. Their own voice may also sound different to them. These sensations are all common and the wearer will get used to them over time, as long as the hearing aids are working and/or are programmed appropriately. The more the instruments are worn, the sooner the wearer will be comfortable with them.It is typically recommended to start off using the instruments in quiet one-on-one conversations with family or friends, then gradually try more difficult listening situations (more people, noisier environments). The new hearing aid user will also need to remember to control their listening environment (see Tips for Better Listening).
Since hearing loss typically happens slowly over time, it also takes time to get used to hearing with hearing aids. It is important to have patience and realistic expectations of what the instruments can do. It may take up to six months of consistently using the hearing aids in order to receive the full benefits that they can offer.
Tips for Better Listening
TIPS FOR PEOPLE WITH HEARING LOSS:- Control your environment. Position yourself so that you can see the talker well and hear the person most clearly with the least interference from others. Turn on lights or move to a brighter room. Turn off noise sources or move to a quieter room. Favor your better ear if you have one.
- Look at the speaker to ease the strain of listening. Whether you can lip read or not, face the speaker so you can pick up speech cues, body language and facial expressions to help you understand the message better. Be within 10 feet of the speaker.
- Be realistic about your communication abilities. Understand that in very difficult listening environments, you will have problems understanding speech. Anticipate these situations and plan options for dealing with these communication breakdowns. For example, have a friend explain the specials or order for you while in a noisy restaurant.
- Be assertive. Let others know that you have difficulty hearing and encourage them to get your attention before they speak to you. Let them know that short, uncomplicated sentences are easier to understand. Move the conversation away from noise and tell people to slow down or talk louder. Most people will be helpful if you are pleasantly assertive.
- Learn communication strategies. If you miss something in a conversation, repeat back what you did understand and have the speaker clarify what you missed. Have the people spell or write down words that you are missing. Begin conversations or be sure you know what the topic of conversation is about. Having people repeat all the time can be embarrassing. Try to do it in an amusing or honest way. For example, say: "I'm going to listen the best I can now, so please say it once more", instead of saying "What?".
- Face the person with hearing loss and make sure your face is in appropriate light so it can be seen easily. Stand within 10 feet and never talk from another room. Keep your hands away from your mouth and avoid using cigarettes, chewing gum or other distracting facial movements.
- Slow, exaggerated speech is just as difficult to understand as fast speech, so keep it at a moderate speed with slight pauses between phrases or sentences.
- Empathize and be patient. Stick both fingers in your ears while having a conversation. You will appreciate the constant challenges a person with hearing loss goes through. Re-phrase to clarify important information.
- Get the listeners attention before speaking. Ask how you can make communication easier. Encourage feedback.
- Control the listening environment. Stand within 10 feet, move away from noise and make sure it is well lighted. Also avoid standing in front of windows, this can "blind" someone trying to see your face.
- Anticipate difficult listening situations and plan strategies in advance. You may have to order food or repeat the specials to the listener in a noisy restaurant.
Assistive Listening Devices (ALDs)
ALDs are devices to be used alone or in conjunction with hearing aids that help facilitate hearing for people with hearing loss. See our ALD page with a link to our ALD store here.Hearing Aids at Los Angeles Ear, Nose and Throat
Here at Los Angeles Ear, Nose and Throat Associates, we work with many different manufacturers in order to provide the appropriate hearing aid for each individual's hearing loss. We can also help with repairs, ear molds, and warranty extensions.Our audiologists provide a free hearing instrument consultation at our office. This involves a quick screening to determine what type and how much hearing loss you have. If you are a hearing aid candidate, this exam will also let you know what restrictions you may have in terms of size or circuit options.
They will then discuss your hearing loss with you as it relates to everyday communication or conversation. Sizes and circuit options are discussed, as well as prices, warranties and realistic expectations as it pertains to your specific hearing loss. During this part of the hearing instrument consultation, you may be able to listen to a hearing aid specifically programmed to your hearing loss. This may give you a better understanding of what a hearing aid can do for you.
Once you and our audiologist have chosen a specific model, then an impression or mold may be taken of your ear. This impression will be used by the manufacturer to custom make the hearing aid shell for in-the-ear instruments or for the ear mold that attaches to the standard behind-the-ear models. Once the impression is sent to the manufacturer, it takes approximately two weeks to receive the hearing aid back at our offices. At that time, we will call you to schedule a hearing instrument fitting.
During the hearing instrument fitting, the audiologist first makes sure the fit is appropriate. Then, any fine-tuning or programming is done to make sure the sound quality is acceptable. At this point, instructions in how to care for it (clean, store, minor repair, changing batteries, etc.) are discussed. You will practice changing batteries and putting the instruments in and taking them out. It takes a lot of patience and practice to perform these actions smoothly. The warranties for the instruments begin on the day you are fit with them.
Our audiologists typically see patients one or two weeks following the fitting, and again at the end of the 30 day trial period. This ensures that the instruments are fit comfortably and any acoustic changes or fine tuning can be done (if possible) once the instruments are used in the patient's "real world" communication environments.
We recommend that you visit our office every six months to clean and check the instruments. However, if your instruments are not working properly, then we recommend calling our office and scheduling an appointment as soon as the problem occurs (and if you are not able to fix it yourself - like changing a dead battery for example).
Hearing instrument consultations typically last from 1 hour to 1 ½ hours. Hearing instrument fittings typically last about 1 hour.
If you would like to schedule a FREE hearing instrument consultation, please call our office at:
