Hearing Assistive Devices
There are several types of hearing loss, which can lead to the need for a hearing assistive device. The types of hearing loss are as follows: Conductive hearing loss, Sensorineural hearing loss, Mixed hearing loss, Central and Functional hearing loss. Conductive hearing loss is when there is not enough sound getting thorough the outer and middle ear. Sensitivity to sound is diminished, but clarity is not changed as long as the sound is loud. Sensorineural hearing loss, sound is flowing normal through the outer and middle ear, but there is impairment in the inner ear auditory nerve (CN VIII) causing hearing loss. A problem with sensorineural lose is that sound is heard, but the person doesn’t understand speech. Mixed hearing loss is a combination of conductive and sensorineural. Central hearing loss is a problem in the central nervous system involving the inability to interpret sound. Functional hearing loss is caused by an emotional or psychological factor in which there is no physical finding of hearing loss (Lewis et al., 2011) Mosby and Elsevier (2009) (Crusse & Kent, 2013).
To determine the type of hearing loss, type of hearing device needed and proper fit, there are different doctors with different levels of education a person can see. Choosing a correct hearing specialist is important. An Audiologist can identify and access hearing disorders. They can also select and correctly fit hearing aids. Audiologists can also program cochlear implants and provide counseling services, rehab and instruction on device usage. An Audiologist is required to have a doctorate or masters degree. A Hearing Aid Specialist can access, select, fit and dispense hearing aids. The can also instruct rehabilitation and counsel in use and care of hearing aids. A certification by the National Board of Certification in Hearing Aid Sciences is needed. Otolaryngologist is an Ear, Nose Throat (ENT) physician. An ENT performs a complete medical history and physical exam of the head and neck. A hearing and balance test will be performed on supervised by this specialist leading to diagnosis, treatment and rehabilitation. This physician can prescribe medications and perform surgery, which can include cochlear implants, selecting, fitting and dispensing hearing aids. The credential for an ENT is board certification by the American Board of Otolaryngology. ENTs are required to have a medical degree (MD or DO) (Better Hearing Institute, 2014).
In order to determine the amount and types of hearing loss, there are many painless tests that can be performed. One basic test is the Whisper Test. An examiner will stand approximately one to two feet from the patient and speak using a low whisper. The patient is asked to repeat what has been said. Each ear is tested separately and the ear not being tested occluded. Another test is the Tuning Fork Test, which helps determine if the hearing loss is conductive or sensorineural. Then there is the Audiometer, an electric device to test a person’s hearing. This device consists of a head phone worn by the patient and an electronic device that produces sound. This device produces different tones ranging from high to low frequencies at different decibels. The patient signals which ear by raising the appropriate hand when they hear a tone. There are modified versions of this for young children or people who are disabled. The results from this test are put on an audiogram. An audiogram is a chart (Appendix A) that shows the lowest level that a person can detect sounds of different frequencies: which is recorded as a decibel. These are not all the tests that can be performed, there are more specialized tests that can be performed depending on the degree and cause of hearing loss(Berman & Snyder, 2012) (Lewis et al., 2011) (Mosby & Elsevier, 2009).
The most common hearing device used is the Hearing Aid. There are a wide variety of options to choose from depending on the persons’ activity level, finances, if you wear glasses, connection to a cell phone, the fit, cosmetic appeal, and type of hearing loss, amount of cerumen production or choice. They can be invisible, wireless, digital, have self adjusting volume, waterproof, and sweat resistant. Some models have rechargeable batteries. They come in many styles; behind the ear, in the ear, in the canal, and completely in the canal. There is also a middle ear implant; this type has an external part and an internal part. Some models can be color coded to determine which ear it is for or labeled left or right. Hearing aids require batteries, if they aren’t rechargeable, battery life can be approximately one week. Battery life will also depend on amount of usage and type or brand of hearing aid. Every time the batteries need replacement the cost can be around $6. There is care for hearing aids besides the battery changes. When removing hearing aids, they should be turned off to save battery life. If hearing aids will not be used for longer than one day the batteries should be removed to prevent corrosion from battery leakage. Always have a safe place to store your hearing aids, either in the box they came in or a labeled container. As with any electronic, they should be stored away from heat or moisture. For cleaning, manufacturer’s recommendations should be followed per device. Some models have datable parts that cannot get wet and other parts are to be cleaned with a mild soap and water. Some require only using a damp cloth for cleaning. Excess moisture or debris, such as cerumen should be removed from the ear mold opening either by blowing, a pipe cleaner or toothpick. Life expectancy for hearing aids, depending on models and proper care, can be approximately five years. Follow up doctor visits and regular hearing exams should still be done in part of maintaining your hearing for making or detecting any changes (American Speech-Language-Hearing Association, 2014) (Better Hearing Institute, 2014) (Berman & Snyder, 2012).
Cochlear Implants are used with people that have profound hearing loss in both ears, when hearing aids cannot be used. Cochlear implants work by electrical stimulation to the auditory nerve (CN VIII). There is an electrical microphone placed behind the ear, a transmitter, speech processor are under the skin. There are electrodes that are near the cochlea (tiny hair cells) which then stimulates the auditory nerves in the ear. These implants can provide sounds to individuals who one heard none. Cochlear implants may not restore hearing, but can provide a sensation of sounds which can aid in the training or improvement of speech, or improve lip reading. Not all people are candidates for this device, it depends if the hearing loss happened before or after language skills were learned and motivation of the person. If the patient is a candidate more tests are performed to be sure in the success in the cochlear implant performance. The implant surgery can be performed as an outpatient surgery or a one night stay in the hospital. Approximately 4-6 weeks after the surgery the external parts will be fitted on the patient and this process can take several days to several months. Then there are additional visits when the implant is ready for activation, adjusting and programming. After the Cochlear implant is working there is rehabilitation from Audiologists, speech-language pathologists, teachers, and counselors. Basic care and maintenance of cochlear implants requires removing the external components before bed, wiping the external components with a clean dry cloth and placing in a specialized container to remove moisture. Once a week the external parts need to be taken apart, and cleaned with a soft dry cloth. Regular checking and cleaning battery contacts, also checking and replacing microphone covers need to be done to maintain clarity of sound. The external components cannot be worn swimming or in a shower. The cost of cochlear implant surgery can exceed $40,000.00. Some health insurance companies will cover some level of coverage for cochlear implants. Medicare, Maternal and children’s health services and other federal health plans provide benefits for cochlear implants. Medicaid provides coverage for cochlear implants for children under 21 and also provides benefits for adults as well (American Speech-Language-Hearing Association, 2014) (National Institute on Deafness and Other Communication Disorders (NIDCD), 2013) Lewis, Dirksen, Heitkemper, Bucher, and Camera (2011) (National Institute on Deafness and Other Communication Disorders (NIDCD), 2013) (Mosby & Elsevier, 2009).
Whether a person isn’t wearing their hearing aids or they don’t have them, there are ways to approaching and communicating with people who are hard of hearing: When walking into a room to a person who is hard of hearing you don’t want to startle them. Draw attention to yourself by waving your hand so they take notice you are there. Touch the person before speaking. If they have the television or radio on turn it off or mute it. Don’t walk up to them chewing or anything in your mouth. Make sure the room is well lit so they can see your face clearly or if they wear glasses make sure they have them or hand them their glasses so they can see you. When you speak to them face them and use eye contact, don’t turn your head away. Pointing to visual clues can help. Speak in short simple words/sentences and don’t over annunciate your words. Don’t talk to them like they are a child. Don’t yell at them; speak normally as if they can hear you, unless they ask you to speak louder. When talking, stand close to the person. If the person has an ear that hears better, stand on that side to talk. Don’t make faces or strange and unusual gestures. A few basic and inexpensive ways to communicate are pen and paper, or a white board (Lewis et al., 2011) (Ackley & Ladwig, 2011) (Shuler, Mistler, Torrey, & Depukat, 2013) (McKinney, James, Murray, & Ashwill, 2009).
Sometimes people may not want to wear a hearing aid because they don’t want people to know or see because of appearance. There may be many reasons why a person isn’t using a hearing device. They may not have the dexterity to insert, clean or maintain their hearing aids. Some people may need assistance, personal or financial for hearing aids to be used and maintained. Hearing aids can take some time for the person to adjust to them and the person just didn’t give it enough time or go back to the doctor with their issues. Sounds that a person hasn’t heard for sometime can sound different at first, which can be a deterrent to the use of the hearing aid (Lewis et al., 2011).

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