Conscious Communication

             If you have read any of our previous articles on hearing loss and hearing aid use, you know that we always recommend wearing two hearing aids if you indeed have hearing loss in both ears. We recommend this for a very simple reason: you have two ears to provide you with natural, normal hearing; when you have hearing loss in both ears, you cannot expect a singular hearing device (the hearing aid) to do the work of two normally functioning ears. Many of you with two hearing aids will also comment that even with the use of two hearing aids, you’re still not able to hear as well as you did 20 to 40 years ago. Aside from getting into the detailed working and connections of your ears and your brain, it is important to understand that there is so much more to hearing than the physical act of hearing. When most people report that they cannot hear, they mean they cannot understand. Understanding is a much more complex process than hearing, but do know this: while your ears are meant for hearing, your brain is meant for understanding. The hearing aids we provide are currently only capable to providing assistance to your ears – the hearing part. It is up to your brain to do the rest of the work for understanding. The good news is that the earlier you have your hearing loss diagnosed and begin wearing hearing aids, the better success you will have in hearing and understanding.

            Beyond wearing two hearing aids consistently and having them cleaned and maintained regularly, there is another step you can take to provide yourself with the best possible hearing. You cannot expect to place the hearing aids on your ears and be able to hear and understand with ease. Hearing to understand takes attention, focus, and patience. A person with hearing loss must use other tools to give them a better understanding of the message or conversation. I lump these tools together in what I call “Conscious Communication”. To communicate consciously is to participate, be attentive, be aware, and be focused. Let’s break these down and consider each facet of conscious communication.

            When I say that you need to participate I mean that you have to take ownership of your hearing loss, and know that better hearing rests on your own individual participation. The first step in participation is wearing your hearing aids. You can’t expect to play the game if you don’t show up with the right equipment. With your hearing aids in, you’re ready to go! Participation is not limited to groups and gatherings, it starts at home. When you are one on one with your communication partner, participate in those small conversations you have at home. If you missed what was said to you, it is your responsibility to get up, get closer to the speaker, and ask for repetition. Every time someone speaks to you is an opportunity to practice your hearing skills. If you didn’t hear something, don’t let it slip by without asking for repetition. This is your hearing, you deserve to be involved, and only you can control your participation level.

            The second skill is to be attentive. We are all guilty of “tuning out” during a conversation, especially when we have other things on our minds. When you have a hearing loss, it is extremely important to your hearing and understanding success that you clear your mind and pay attention. Be a good listener, watch the person’s face as they speak to you – you may be surprised at how well you actually can lip read. Lip reading is a great tool to provide more information and assists in putting the message together for better understanding. When you watch a person’s face, you see their expression and can relate better to how they are feeling. Is this person happy about what they are saying to me, are they upset or frustrated, are they asking me a question? These are pieces of information you receive when you look at a person directly when they speak to you. This is much easier to do when you are alone with that person, or in very small groups, but it is great practice. If you get in the habit of being attentive, you will be better equipped to follow and understand the conversation when you are in a slightly larger group, or noisy place.

            The third skill to master is to be aware. I assume you are already aware of your hearing loss, and you are now wearing your hearing aids consistently. You are being attentive to your conversation partner, but you may find that you still have difficulty hearing. This is when being aware of your environment comes into play. Be aware of your surroundings and the limitations it could place on your hearing abilities. Are you in a well lit or dark room? Are you sitting near a source of noise such as a kitchen or band? Are you trying to talk to someone in another room or large distance? Is the television blasting away on commercial break? These are all questions to ask yourself when you have difficulty hearing someone. Be aware of the limitations of the environment, and then do something about it. At home, you can make sure your room is well lit, you can press the TV mute button during commercial breaks or when you want to talk, you can get up and go to the person who is trying to talk with you from another room, or ask them to come to you. When you are out and about, at parties or get-togethers, you can position yourself away from the kitchen and music, in a well lit part of the room. If you are using your other conscious communication skills, you should find it easier to carry a conversation.

            The final and most important skill in conscious communication is to be focused. This is often a difficult behavior to conquer as we all seem to have a hundred things on our minds at one time. We are all guilty of zoning out during conversation, thinking about the grocery list, returning someone’s phone call, plans you have made for later that day or week. To be focused is to clear your mind of other thoughts, place priority on the current conversation you are having, and fully be part of that conversation. This is perhaps the toughest of the skills to learn in conscious communication, but it really is the heart. You are wearing hearing aids because you have a hearing loss and want to be able to improve your hearing. You want to improve your hearing because communication is important; it is what connects us to our family and friends. If you follow all the other rules of conscious communication, but are not focused on the conversation, you will never hear and understand to the best of your potential. You know you have a hearing loss; the hearing aids cannot do the work for you. You need to take responsibility and focus on the moment. Communication is precious, and in order to get the most out of it, it has to be a priority. Conversations with your husband or wife, with friends, children and grandchildren are far more important than grocery lists, what’s coming on TV, and bills that need to be paid.

            Finally, if you feel you are following the rules of conscious communication, and you continue to have difficulty hearing discuss these problems with your audiologist. Make sure to tell him/her which situations are causing you difficulty, if it’s large groups, one on one or certain speakers. By now, you are paying attention and focused and should be able to relay to your audiologist precisely the trouble you’re having. In turn, your audiologist can adjust the sound in your hearing aids to accommodate those difficulties. By putting all of this together, being involved, in the moment, attentive, aware, and focused and you will improve your hearing and understanding. It’s not easy, but by practicing conscious communication I am confident that you can improve!

The Learning Process of Hearing Aid Use

There are many aspects to hearing aid use that are often overlooked, or not specifically addressed, that can make a tremendous difference in the success you will have in using these devices. As most users know, hearing aids cannot replace normal hearing. However, with an appropriate hearing aid selection, good quality products, consistent follow-up appointments, dedication from the user and fitting professional, and an understanding of some of the details I will discuss over the next few issues of “Choices After 50,” we can help you to hear better in most situations and improve your success in conversation.

            One of the most glaring omissions from many hearing aid fittings is a discussion regarding the learning process involved in being a successful hearing aid user. In most cases, people feel that their hearing has gradually deteriorated over time and they are just now unable to hear clearly. I hear it all the time, “people today mumble” or “I just can’t hear soft talkers” or “if people pronounced their words clearly I wouldn’t have any problem.” These things may be true, but in the great majority of cases it is your ears that are the problem, not the way other people are speaking.

            As your ears gradually lose their ability to hear over time, you becomes less able to clearly hear what is being said because your brain forgets what certain sounds are and what they mean. Things don’t sound clear because your ears aren’t able to pick up the soft speech sounds that are critical for you to understand what someone is trying to say. For example, the difference between words like “wish” and “which,” or “sit” and “fit.” If you add in some background noise, have the television on, or if someone turns their back while they’re talking, then it all sounds like a mumble. This occurs because your brain has forgotten what those sounds sound like, what they mean, and how they fit into the context of what is being said. With the use of hearing aids this will improve over time because your brain becomes more and more used to hearing those sounds again and understanding what they mean. Hence, there is a learning process in hearing aid use that typically lasts several months.

            Perhaps the most common comparison to hearing is your sense of sight, and more specifically, how glasses are used to address this problem. Glasses do an excellent job of “fixing” your vision because they simply help the lens in your eye to focus light more appropriately on your retina. If the glasses are fit properly, then things become clear and most people who wear them would have close to 20/20 vision. Unfortunately, it is not this simple with your sense of hearing. In most cases, people need hearing aids because they have nerve cell loss in their hearing organs, and this is not something that can be “fixed.” Nerve cell loss is permanent, and it means that there is a section of your inner ear (i.e. an area responsible for certain types of sound) that has been damaged, making those particular sounds very difficult to hear. Hearing aids function to amplify and clarify each of these sounds that a person struggles to hear, and this custom approach can take a long time to address.

            The comparison between hearing and vision really becomes complex when you begin to consider all the environmental factors that influence your ability to hear and see. With vision you basically have light, dark, and any obstacles that may be in your line of sight. A person looks like the same person if it’s bright, dimly lit, if they are in a restaurant or their own living room; but, they very well may not sound the same based on the environment around them. A person you have no trouble speaking with one-on-one may be exceedingly hard to understand when in a room full of people, if the TV is on, if it’s windy outside, or if they’re not looking directly at you. This is not to mention if they are in another room, have their back to you, are trying to talk between bites of a sandwich, are doing the dishes, or getting something from the fridge. A person may look the same while doing all of those things, but they definitely don’t sound the same if you have a hearing loss.

            So, what was the point of all that? It is basically to reiterate that hearing aids take time to get used to and learning HOW to hear well with your hearing aids can be a great challenge. They aren’t like glasses where you put them on and things become clear, it takes time and patience to become a successful hearing aid user. However, don’t despair and think all hope is lost. Hearing aids today are extremely effective and the use of digital technology allows us to adjust and fine-tune them as many times as necessary until you’re satisfied with the quality of sound you’re receiving. This technological side of things is supported with assistance through something called aural rehabilitation. Aural rehabilitation basically gives you a better understanding of how you can help yourself hear better by recognizing and adjusting to different environments (e.g. where to sit at a dinner table to hear better with a crowd of people around), and teaches you how to repair broken conversations so that you aren’t just saying “What??” all the time. It will take time, that is a certainty, but if you can appreciate and understand that things WILL improve if you’re patient with the process, then you’ve already got the battle half won. 

            If you would like any further explanation of the learning process, or any other important details about hearing aid use, please contact your audiologist as they are the hearing experts and will be better able to address your specific issues. If you would like a consultation with me directly then please do not hesitate to call and make an appointment. I hope you enjoyed the article and continue to enjoy the additional segments of hearing health care that I will cover in the upcoming issues of this newspaper. If there is ever a specific topic that is of particular interest to someone out there please pass it along and I will gladly give it consideration for a future article. Thanks for reading!!

A Discussion about Hearing Aids

            I often wonder what people expect from hearing aids (HAs) before they walk into my office. Do they think that a HA will fix all of their hearing problems? Do they believe it’s a quick one-shot deal where you put HAs in and that’s it, problem solved? Do they have reservations because of poor experiences that friends or family have had? Are they afraid of being mislead or taken for a ride? Do they understand what I am as an audiologist and what my training has covered? Do they see me as a salesman? There are many stigmas and tidbits of information regarding HAs out there, so today I will attempt to shed some light on a few of those topics.

            First off, HAs are an AID, they do not fix any of the underlying parts in your hearing system. HAs simply function to amplify the sounds that you no longer hear naturally. This gives you more speech information so you can better understand what’s being said. The problem many people don’t quite appreciate is that, in most cases, you have a hearing loss because part of your inner ear (i.e. the nerves) is damaged or dead. We, as audiologists or hearing instrument practitioners, have to try and replicate how your natural hearing system works, but without the full system at our disposal. It’s kind of like going fishing in a boat full of holes, we can stay afloat but only if we bail constantly and don’t run into any big waves. With hearing aids, we typically do better with them than without them, but we will continue to have problems in certain situations. The key to being a successful HA user is to realize that there will be issues and to be prepared for them. Don’t go fishing without your bailing bucket, so to speak.

            Most people, even those with normal hearing, have more difficulty hearing when there is a lot of background noise present. So, can we expect HAs to make this situation as easy as it was when we were teenagers? Can we expect that a hearing AID will replace our lost ability to hear perfectly in groups or crowds, even though the hearing system itself is damaged? It’s not realistic to expect that we can duplicate naturally perfect hearing, but all is not lost. For those who struggle to hear in noisy places and have hearing loss, today’s digital hearing aids can be accurately programmed to improve your ability to follow conversation. Granted, it’s not perfect, but it’s better than nothing, and A LOT better than it was in years past. Today’s HAs can do a lot, but we need some patience from the user as it may take us several “tune-up” appointments to get it right. We promise to do our part, but you also have to do yours.

            One of the most curious things I’ve noticed about working with HAs is how many people believe, or have been told, that one HA works as well as two. Would you buy one shoe of a pair? Put one lens in your glasses? Not likely, because it doesn’t really make sense. It is no secret that HAs are expensive, and if finances are the reason why only one HA is purchased, then that’s perfectly understandable. However, if you have the financial backing and truly desire an improvement in your communicative abilities, then wearing two HAs is of critical importance. I state it this way because in the vast majority of cases when we have hearing loss it is in both ears, and we need both ears working together to give us the best chance to hear. Most people tell me that they struggle the most in group situations and this is where they want my help, yet many of them only want to purchase one HA. The problem with this approach is that humans need two ears to hear in complex situations (i.e. in background noise). Wear one HA in this environment and you will likely continue to struggle, simply because you haven’t provided your body with the assistance it needs. The truth of it all comes down to this statement, “we were born with two ears for a reason.” All I ask is that you think strongly about your decision and accept the difficulties you will likely have, if you choose to buy one HA when you have hearing loss in both ears.

            There are many people who think that today’s HAs are the same as those their parents/family/friends had back in the 1980’s, 90’s, or even in the early years of the new century. This leads many people to come into my office partially convinced that HAs will not work, even though they’ve never tried one. I always try to help people feel excited about purchasing HAs. You have a hearing problem, HAs help with this problem; but, we can’t be successful if you don’t believe in the solution we have to offer. Unfortunately, there are few options for people with hearing loss, and if you want to improve your communication abilities then HAs may be your only recourse. I simply recommend trying them to see if they work. If your wife/husband/family is at their wits end because you’re always asking them to repeat or because the TV is up too loud, what do you have to lose? If you give it a sincere, committed attempt, and it doesn’t work, then you’ve done your part to at least give it a shot. But, to just say “Oh, HAs don’t work, they’re no good for nothing” without even trying them yourself, that’s a cop-out that doesn’t serve anyone well. I hope there are less and less of these people as time goes on because the quality of HAs today has dispelled a lot of the issues that ravaged our industry in the past.

            To all those people who think there’s a chance they have a hearing loss, don’t be afraid to find out for sure. Audiologists (and hearing instrument practitioners) are here to help, not pressure you into buying a HA if that’s not what you want. We can tell you your options and then we can decide together if it’s time to try HAs. You have nothing to lose and potentially an entire world of communication to gain. As I’ve written about before, you are entitled to at least a two month trial period at all respectable HA dispensaries, so the HAs can be returned if they aren’t helping you as you hoped they would. Use this safety cushion to your advantage, be open-minded about the products, give them an honest try, and you’ll be successful more often than not. Best of luck!!

A Good Start is Key

In my last article for “Choices After 50,” I discussed the learning process of hearing aid use and how patience is a critical component of a successful fitting. It takes time for your brain to relearn how to hear and understand the different speech sounds it may not have heard in many years. Your hearing aids serve to amplify the sounds you have been missing, but these sounds must often be introduced gradually over a period of time so that you don’t become overloaded with noise. Through the consistent use of your hearing aids, you become more accustomed to amplified sound and your brain becomes better at understanding what these sounds mean. If the process is done properly, you should hear better on Day 1 than you did before getting the products. You should hear better on Day 30 than Day 1, better on Day 90 than Day 30, and so on. It is a process that takes time, but you should see a steady, albeit gradual, improvement in your ability to function on a day-to-day basis. This is why we have a trial period with hearing aids, so that you get to try the products and see if they work for you before the transaction is complete. But, this is a two way street, the hearing aid user must also be willing to commit to the process of consistently wearing their hearing aids, so that they give themselves the best chance of success. Hearing aids cost a lot of money, you might as well try to get as much use out of them as possible. All hearing aid dispensaries should offer a trial period as it is the industry standard, I recommend that you use yours wisely.

Many people do not realize that they can be much more successful hearing aid users if they pay attention to the situations where they have the most difficulty hearing. Is it in the car? The kitchen? On the telephone? In a mall? It is important for the audiologist/dispenser fitting your hearing aids to know details about where you are still struggling to hear. If we know these things, then we can adjust and change the hearing aid settings to improve your ability to hear clearly in those environments. We can’t make it perfect, but we can certainly help, and the more you tell us the better off you’ll be. This is why it is important to feel comfortable with the person you purchase your hearing aids from. You will be dealing with them regularly for the life of your hearing aids, so an open dialogue and ease of interaction is critical. Again, use your trial period wisely. Your contribution to the process of learning to hear with hearing aids consists of two main things; 1) wearing your hearing aids regularly, and 2) informing your audiologist/dispenser of the problems you’re having. If you do those two simple things, then you will become a successful hearing aid user much more often than not.

In order to take full advantage of the technology in hearing aids, you must begin with the correct features in these products. Do you want a volume control? Would you like a special telephone program? Can you easily handle the battery that will go in the hearing aids? These and many other important details have to be addressed in order for you to be a successful user. Above and beyond those details, there are two things I believe are especially important to give you the best chance at success; 1) the use of two hearing aids, and 2) directional microphones. We were born with two ears for a reason, and in order for our brain to hear clearly in difficult situations we need sound input to both ears. If you are in a noisy environment, or a group with multiple people talking, you need both ears working together to give you the best chance to understand what is being said. I often have people who wear one hearing aid tell me that they struggle in background noise, and they will most likely continue to struggle if using only one hearing aid. Many of these people have since tried a second hearing aid and often see great improvement. However, if you are a new user, it is best to begin with two hearing aids because it is easier for your brain to become accustomed to hearing these “new” sounds. Hearing aids are expensive, but if you can afford to start with two at the same time you have a better likelihood of success. Remember, you have a trial period for a reason, and if you’re not satisfied with your products return them and try again, either at the same clinic or elsewhere.

My second point focuses on directional microphones, which is one of the most important technological advances in the hearing aids available for purchase today. Having directional microphones means that each hearing aid has two separate mics that work together to help you hear better in noise. They function to search out sources of noise and try to turn them down so that you can hear speech clearer. They allow the hearing aids to focus on the person in front of you, while decreasing the background noise behind and around you. With two hearing aids in your ears, and each of them with directional mics, you have the best chance of hearing in those difficult listening situations that hard of hearing people have always struggled with. What’s more is that directional mics are a no-charge option on the great majority of hearing aids, so it is something that should certainly be discussed when purchasing your products. If you consider as many details (e.g. directional mics, volume control, program button, phone program, etc.) as possible before completing the purchase, then you increase the likelihood of receiving satisfaction from the use of your hearing aids.

So, now we have the appropriate features in your hearing aids, we have an understanding that this is not a quick fix and requires patience, and we have established a comfortable interaction between audiologist/dispenser and the hearing aid user. These things get us off on the right foot, but there is still work to be done and this is where feedback from the user becomes most important. You should be scheduled for at least 2 appointments before your trial period (and the purchase) is complete, which is when you must tell your audiologist/dispenser what has improved and what has not. Your job is to wear the hearing aids regularly in as many different situations as possible, tell us how well you heard or did not hear in those environments, and then we can make adjustments to the hearing aid settings to improve your ability to understand speech. If there is a problem, the very first person who should know about it is your audiologist/dispenser. We do not want you to put the hearing aids in a drawer and give up on them. Today’s hearing aids can do a tremendous amount to help you hear. However, they can’t do their job if you don’t consistently wear them, and go back to the clinic where you purchased them to have programming changes made. These services are typically bundled into the up-front cost of the hearing aids, so before you complete the purchase you should find out what kind of follow-up is included in the price.

Patience is a Virtue

There are many interesting things you come across while working in the hearing health care industry. There are people factors from memory to dexterity to aging; there are environmental factors from weather patterns to a humid home to the voices of those we communicate with; and there are hearing aid factors such as product comfort, sound quality, and ease of use. All of these pieces are part of a very complex puzzle, but I personally consider the most important factor to be patience on the part of the hearing aid user themselves. However, being patient is often rather difficult for people, so I thought I would use this article to outline why it is so important.

            First off, why is it that people tend to have very little patience with hearing aids? If you break your leg and wear a cast for 6-8 weeks, do you expect to take the cast off and have everything be perfect from Day 1? Most people would say no because they understand there is rehabilitation involved to strengthen the muscles before re-learning to walk using that weakened leg. In many cases there will always be a limp and, depending on your age and health, you may never be able to do all the things you previously did. If a person has macular degeneration and goes through numerous procedures to improve their sight, do they expect 20/20 vision at the start of treatment? How about at the end of treatment? Again, most people say no to both questions. You expect an improvement but nobody expects to get their normal vision back. So, why do many people think that using hearing aids will immediately fix their hearing, and that they’ll communicate just as easily as they did at 20 years of age? You will see improvements, but by no means should you expect artificial hearing devices to flawlessly fix your damaged hearing system.

Numerous studies have shown that the average person who knows they have hearing loss will wait 7-10 years before getting help. It takes a long time for a hearing loss to develop in the first place, and then they wait an additional 7-10 years on top of that before coming into my office. This means the average person likely has a hearing problem that’s been getting progressively worse for 15-20 years before we even start to address the issue. Does it really make sense to expect everything to sort itself out in three weeks? How about three months? We, as hearing health care professionals, expect to see a progressive improvement in your hearing ability for up to six months when properly using hearing aids. This can occur faster or slower, but the pace depends on you as an individual. You need to be patient and give your body the opportunity to get used to hearing again. There are many sounds around you that will be new (and annoying!), but you must expose yourself to sound in order to improve your ability to understand speech. Those of us lucky enough to have normal hearing are used to hearing the multitude of sound we are constantly surrounded by; but it will take time for your ears and your brain to become accustomed to hearing the sounds of the world through hearing aids. We will be patient in guiding you through this process; you need to be patient as well.

I assume that most people get frustrated with hearing aids when things don’t go smoothly from the start because of the money involved. Hearing aids are not covered by our provincial or federal health care, and they are rather expensive devices to purchase out of pocket. This is why it is critically important to be comfortable in dealing with your hearing aid provider right from the start. When you feel at ease about going to their office with your problems, it is much simpler for us to improve the sound of your hearing aids. If you are uncomfortable with your provider then you tend to put it off and your frustration increases. If you are not confident in their professional abilities to help your specific situation, then you’re definitely getting off on the wrong foot. You have options in most parts of NB, many towns have multiple locations where you can purchase hearing aids. If one isn’t the right fit then TRY ANOTHER. Furthermore, if you try hearing aids and aren’t happy with the performance, return them within your trial period and try another office. The key point in this is to ensure you have confidence and trust in the person you choose to deal with. This is a partnership that will last many years, so start off on the right foot. One thing to keep in mind, it’s never a bad idea to ask your friends or family who wear hearing aids about where they went and the quality of care they received.

So, what’s the underlying theme to all of this? Firstly, do not expect miracles. If you are being cared for by someone who knows their business, you will see improvements in many situations. It won’t be perfect, but it should be better. If your hearing hasn’t improved enough to justify the cost, RETURN THEM. Secondly, make the right decision of where to buy. Ask around, visit the different offices, meet the audiologists (or hearing instrument practitioners), and DON’T RUSH TO BUY. If you’re dealing with a salesman, then urgency and “buy now” is the name of the game. If you’re dealing with a hearing health care professional, then your ultimate success and complete care for your ears is at the forefront. Thirdly, and most importantly, BE PATIENT. Things do get better over time with hearing aids, but only if they are properly selected and fit by a knowledgeable professional. They are products you buy once every 5-7 years, please appreciate that we have a long term vision of improving your hearing ability that won’t be completely clear on Day 1. If you have concerns, be open and honest with your provider, it is their job to serve you, and they are paid through your purchases. You should expect enough success to warrant spending good money on these products; don’t be afraid to work side-by-side with your provider to achieve the greatest level of success possible. Best of luck and I wish you all continued improvements in your hearing world.

The Role of the Communication Partner in Hard of Hearing Populations

Most people that live with a hard of hearing (HOH) person believe that 100% of the communication difficulties in their world come from the person who has a hearing problem. This leads to the prevalent belief that once a HOH person is fit with hearing aids (HAs), the problem will simply go away. They will be able to talk from another room, they will be able to communicate perfectly well in the car, while doing the dishes, with their back to the listener, or when they are surrounded by background noise. Unfortunately, this is simply not the case. A hearing loss is a very complex thing, and while HAs are part of the solution, they do not give back a person’s natural hearing. A major part of being a successful HA user is an improved approach to communication from BOTH the hard of hearing person AND the people who speak with them. This article will attempt to outline some common conversational pitfalls and shed light on the difficult world a HOH person lives in every day.

            When working with my clients and preparing them for the difficult journey that is hearing with HAs, I often hear the partner/spouse/family/friend say things like “I can’t wait until you get HAs so I don’t have to repeat myself anymore.” This can create a really troublesome starting point for all parties, as there are unrealistic expectations present even before we begin the process. Sure, the communication partner should definitely have to repeat less, conversation should be easier, the TV should be turned down lower, but HAs do not give a person back the hearing they had as a teenager. The vast majority of hearing loss comes from nerve damage, and HAs do not repair nerves. HAs function to amplify incoming sound, which gives your brain more volume to try and sort out what words and sounds mean. This improves a person’s hearing ability, but it does not correct all the problems that come from having a hearing system working with less than 100% sensitivity due to nerve damage. Here’s an analogy, if you lost three fingers on each hand you would be hard pressed to do many things that are simple right now. However, if you put on a pair of gloves, it would look like you have all 10 fingers, and people might assume you could do everything with your hands that they could. A person with hearing loss doesn’t have all their fingers (per se), so we can’t presume they’ll automatically revert to being a perfect communicator as soon as HAs are placed in their ears.

            If you’ve read my other Choices After 50 articles then you might remember an important topic I previously discussed, the learning process of hearing aid use. As we are dealing with a deficient system, we cannot expect it to perform at 100% capacity right from the start. We have to gradually introduce the sound and allow the HA user to adjust to hearing through artificial amplifiers. If we provided the user with too much sound all at once, then they would be overpowered by noises in the world around them and likely reject the HAs. This gradual process of acclimatization can take 6 months (sometimes even longer), and how appropriately we increase the sound typically goes hand-in-hand with how successful a HA user they will become. Thus, it is very important for those people communicating with the new HA user to be patient, and understand it takes time to become proficient with these unnatural devices. HAs work if they are fit properly, worn regularly, and if consistent follow-up appointments are made to gradually adjust the sound being directed into their ears.

            Perhaps the most important factor in being a successful user is wearing the HAs regularly in a variety of environments. Regularly wearing HAs is rarely something any man/woman wants to do, but it is the most critical element of success. Family/friends/ spouses often get on the HOH persons case to “go and get a pair of HAs,” so WE ALL want them to be used on a consistent basis. However, if things don’t immediately change to the liking of the communication partners, they sometimes badger the HA user to the point that the user gets frustrated and gives up, puts them in the drawer or returns them, and no one is any better off. I sometimes hear users tell me their wife/husband says “What’s the good of those HAs, you still can’t hear me.” Yet, many times they are speaking from another room, or with lots of background noise around. We (myself or the hearing instrument practitioner as well as the HA user) needs you to be patient, and not curtail the process by insisting upon immediately perfect results. We have a 90 day trial period to work out the kinks, but this is much more difficult if we don’t have the support of family and friends. If we can’t make them happy users then we will gladly take them back and refund your money. ALL hearing aids come with a trial period and you CAN return them if it’s done within the trial period. But, that assurance aside, the most important component of this paragraph is that we need those communicating with the HA user to support their use of the products and encourage them to keep using them. They WILL become better users if we work together, but if we aren’t all on the same page then no one is any better off.

            In this paragraph, I would like to outline some of the things a communication partner can do to help a HOH person hear what’s being said much clearer. First off, it is very important to get the HA users attention before speaking to them. If you start talking and their focus is on something else, then they will likely miss the beginning of what you said and have to ask you to repeat it. It’s easier to say their name, get their attention, then start speaking, they should hear you much better. Another common example is in the living room when the television is turned on, perhaps the lights are turned down, and where you’re looking at the TV and not the HA user. The TV is a distracter, the lights make it hard for the HA user to see your face, and they aren’t paying complete attention to what you’re saying. Thus, get their attention, tap them on the leg or say their name, and then begin speaking. You can also mute the television or turn up the lights to give them an even better chance of hearing what’s being said. Most HOH people cannot hear people from another room, which is a factor of having hearing loss and not something HAs or surgery can typically correct. So, make it easy on both of you, go into the same room as the HA user before asking your question or saying what you intended to say, there’ll be fewer communication breakdowns and everyone will be happier. People regularly say that talking in the car is quite a challenge, so here’s what you can do. Turn down the radio and fan (removes extra noise), put up the windows (removes interference from the wind), and look straight ahead or towards the person when speaking. I often hear “I do OK in the car unless my wife/husband talks to me while looking out the window.” They will struggle to hear unless you take the steps to make it easier for them, and these examples will hopefully illustrate how you can improve that. In general for all environments, decrease the noise, decrease the distance between you and the HOH person, and get their attention before speaking, you’ll be less frustrated in the long run if you do.

            I hope this article helps you to appreciate some of the difficulties a HOH person has in our world. This world is LOUD, and people rarely follow all the best rules of communication (i.e. face the person, speak slowly and clearly, sitting in a quiet environment). This is an unfortunate fact of our world, but we can make subtle manipulations to help the HOH population hear more effectively. The HOH person has done their part by getting HAs, now it’s your turn to play ball and communicate more appropriately to afford them a better chance to hear. It is not easy to get used to HAs, it requires patience and commitment to a long process that most people are not excited to undertake. But, with hard work by the audiologist/dispenser, support from the family/friends, and consistent use by the HA user, we are successful much more often than not. I challenge you all to do your best to help the HA users in your life to hear better. After all, they got the HAs because everyone said they had a problem hearing, so now you need to take responsibility for speaking in a more appropriate fashion. Good luck and happy hearing!!

Bluffing

I’m not referring to your skills in playing cards here, rather a different form of bluffing when it comes to hearing and communication. We’ve all been there – we are sitting at a family dinner, in a crowded restaurant, or large social gathering. A joke is made, and everyone laughs, but you didn’t get the punch line. On the spot, you quickly put on a smile, and let out a small chuckle – not to bring attention to you. While it is true that these situations occur for most of the general population, they tend to be much more frequent for individuals with hearing loss. Many professionals in the hearing health care industry refer to this behavior as “bluffing”. In situations where a person cannot hear what is being said, but do not speak up about it, pretend to hear and comprehend, or try to “go with the flow”, they are doing themselves and their conversation partners a disservice. It may seem innocent, but bluffing gets you nowhere.

Bluffing with hearing loss can occur in several different forms. The first is as I mentioned above – when you pretend to hear what is being said in conversation so as not to bring attention to yourself or your hearing loss. This is detrimental to yourself as well as your conversation partners as you are not actively participating in the social environment. You may come across as being rude or as if you are ignoring someone, you may give inappropriate responses to questions, or make a comment that doesn’t apply. You may be present, but you are not actively engaged. Everyone misses parts of conversation from time to time, and in those circumstances, it is acceptable to ask for repetition. There are many different ways to ask for repetition as well; you may ask someone to rephrase their comment, or you may yourself repeat the part you heard and ask for clarification. If you happen to get to the point where you are asking every person to repeat, then it is time you seek assistance. Have your hearing tested, have your hearing devices adjusted, or consider making the leap and trying hearing aids for the first time.

The second is when you bluff that you have no hearing loss at all (aka denial). If you find yourself frequently missing parts of conversation, if your family members comment that you are not hearing them, or if you feel that “everyone mumbles these days”, chances are you may have some degree of hearing loss. In fact, you are certainly not alone in having hearing related difficulties. According to Statistics Canada (2002), more than one million Canadian adults have hearing loss, which in more than 50% greater than the number of adult Canadians with vision loss. When you consider these values, why is it that many people pretend to hear “fine”, however they have no issue admitting vision related problems and wearing glasses or bifocals? I think people have the perception that it’s “easy” to give the illusion that you are hearing – you smile, you nod, you laugh when everyone else laughs. If you are one of these “bluffers” however, you know that it is exhausting! You come home at the end of a social gathering very tired from the extra energy you used trying to appear as part of the group. You may find yourself leaving these social gathering early, or neglecting to attend altogether as you are simply to tired to put in the extra effort needed to fit in. If you are in this situation, please see an audiologist as soon as you can. We are here to help you, we want you to have a social lifestyle, to be connected to your family and friends, and we don’t want you to struggle to hear them. There is relief available, in the form of hearing aids and other devices. The first step is acceptance, then we can start to access your hearing abilities, and work with you individually.

The third is bluffing to your hearing health care provider or Audiologist. I have seen this many times during the fitting and follow up service of hearing aids. The patient is sitting in the chair, I ask how everything sounds, if they have had any trouble with the hearing aids, are the aids comfortable, are they happy with them. While many patients do offer their criticisms, which allow me to tweak the hearing aids appropriately, many others will simply say that “everything is fine” when in reality, they may be having trouble hearing on the phone, certain sounds may sound ‘off’, or the hearing aid may be uncomfortable. The reasons for bluffing in this situation may be that they do not want to be a difficult patient, they don’t think the problem is of big concern and feel they can get over it, or they have had poor success with hearing aids in the past and feel their problems cannot be solved. The truth is that you need to be candid with your audiologist. The successful use of hearing aids depends on proper programming and adjustment of the hearing aid, which often times take several adjustment sessions to get it right. If you’ve read any of the previous articles by audiologist Trevor, you should know by now to have selected a hearing health care provider that you trust and are comfortable talking with. In doing so, you should have no reason not to discuss problems you have been having with the fit, comfort or sound of the hearing aids. We want your feedback, you are not being difficult or causing trouble, and you are essentially making our job worthwhile as we enjoy the challenge and eventual success of the hearing aid fitting. Finally, while hearing aids of the past were often difficult to work with in terms of its capabilities, most of today’s hearing instruments are very sophisticated, and we very rarely run into a problem that cannot be solved. It is your hearing loss, your hearing aids, and your responsibility to tell your audiologist when something isn’t right – after all we are the only ones who can help solve the issue. We want you wearing the hearing device, happily and successfully.

Importance of a Proper Hearing Test

             In the run of a typical work week I hear multiple people tell me that they tried hearing aids (HAs) in the past, but have struggled a great deal with them. Sometimes people will say they found them uncomfortable, they made their ears itch, they were too loud, they felt they could hear better without them, or the most common report, they made background noise too loud. It can certainly be difficult to reach the success you want from HAs; but if we pay attention to all the little details and adjust the HAs properly, you stand a much better chance of success. Interestingly, one of the most important factors in a successful HA fitting, the hearing test, is commonly overlooked when purchasing HAs. This article will discuss some of the things to consider during your hearing test so that you give yourself the best chance of success when using HAs.

            When I began thinking about this topic, it kind of surprised me how often the quality of a hearing test is forgotten in the process of using HAs. All HAs purchased today are programmed using computers, and how they’re programmed is based 100% on information from the hearing test. So, if the hearing test isn’t accurately performed, how are the HAs supposed to work? It seems simple, and it really is, but most people don’t think about this when buying HAs. Furthermore, as you age or are exposed to more noise (either through work or recreation), your hearing loss tends to worsen, so we need to recheck your hearing at least once every two years.

Hearing tests would ideally be performed only by audiologists, as they have the highest level of training for evaluating hearing, and can identify/assess medical problems with the ear other than hearing loss. There can sometimes be wait lists to see audiologists in private practice or the hospital, so it’s best to contact them to schedule an appointment. Your family doctor has to make the referral to a hospital audiology department, but you do not need a doctor’s referral to see an audiologist in private practice, you can just contact them directly. Most insurance companies and many other organizations (e.g. Worksafe NB, Health Services, Veterans Affairs Canada) require prescriptions and hearing tests performed by audiologists, so keep those details in mind when looking into the possibility of buying HAs. You may also have your hearing tested by a hearing instrument practitioner; they just don’t receive the medical management training instilled in all audiologists and are unable to write prescriptions for hearing aids.

It is common knowledge that if you wear glasses the lens prescription is periodically changed to accommodate a change in sight; when you have a hearing loss, you also need to have your ears properly tested and the HAs adjusted every so often. Don’t despair though, this does not mean you need to buy new HAs, in most cases they can be “tuned up” to sound the way they should. HAs are expensive devices, but they are very adjustable and can be reprogrammed to fit your new level of hearing loss in the majority of cases. Also, there is very rarely a charge for this if you go back to the location where you bought your hearing aids in the first place. Here’s one thing to keep in mind, hearing aids have an average lifespan of 5-7 years, so you will likely need to have them adjusted several times before they need to be replaced. This is one of the reasons I wrote in previous articles to make sure you trust and are comfortable with the person you buy your hearing aids from; you’ll be seeing them many times while you own your HAs.

Hearing tests should be performed in a sound proof booth by a qualified professional whenever possible. There are times when people are unable to come into the office or go to the hospital for a proper test because of sickness, injury, or lack of mobility; but if you can, it’s always better to be tested in a soundproof booth. Now, here’s why. The main problem with having hearing tests done in your kitchen or living room is that there are usually interfering noises, even if you don’t notice they’re there. Things like the fridge, traffic or wind outside, even distractions in the house can all affect the quality of your test. In most cases, this means the lower pitch sounds can’t be tested with 100% accuracy, making the HAs sound too loud and giving too much background noise when they’re placed in your ears. I’ve personally redone several dozen tests on people who have been tested in their living room by someone who came to their front door, and very rarely are the results the same. If your eyes weren’t tested properly and the prescription wasn’t accurate, then your glasses won’t make things look clear; this is also very true with your HAs. Keep this in mind when purchasing HAs, the sound quality you get starts from Day 1 with the hearing test, it should be done by a qualified hearing professional in a proper environment (preferably an audiologist in a soundproof booth). You owe it to yourself to get the best sound possible for the money you’re paying. One additional note, if you wish to have your hearing tested by an audiologist (the recognized hearing health care specialists in Canada), then you have every right to request to see their certification with either the New Brunswick or Canadian Audiology Associations.

It doesn’t typically cost a great amount for a hearing test. Most audiologists charge $40-$75 for a complete evaluation that lasts 45 minutes to an hour, and this usually includes the reprogramming of your HAs once the test is complete. These tests can also be performed at the audiology department in many hospitals (Fredericton, Saint John, Moncton, Sussex, Woodstock, and Bathurst among others have the proper testing facilities). As previously mentioned, hospital hearing tests are covered under Medicare but they typically have a long wait list, so book in advance if you take that route. If at all possible, see an audiologist to have a complete hearing evaluation performed in a soundproof booth before you buy hearing aids. You will get more accurate results because they have all the proper equipment at their disposal, meaning that your HAs should provide better sound when it’s all said and done. Having your hearing tested in your home should be done only as a last resort; the convenience factor for that one hour is not worth the long term frustrations and anger of having spent thousands of dollars on HAs that don’t sound the way they should. There are legitimate reasons why HAs sometimes do not work, so let’s make sure an inaccurate hearing test isn’t one of them.