your guide to better hearing. visit

7/29/2019 Your Guide to Better Hearing. Visit www.phonackenya.com

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BETTER HEARINGYour Guide o


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able o

Celebrities Who Overcame Hearing Loss

Financial Resources

Acknowledgements

Impact of Treated Hearing Loss on Quality of Life

Advances in the Diagnosis and Treatment of Hearing Loss

When a Loved One Resists Help

Hearing Aids

How Hearing Aids Work

Styles of Hearing Aids

Brief Guide to Modern Hearing Aid Technology

The Binaural Advantage (Two are better than one)

Medical Advances

Assistive Technology

Childhood Hearing Loss

Hearing in Children

Signs of Hearing Problems

Newborn Hearing Screening

Early Intervention for Children with Hearing Loss

Noise Exposure and Children

Consequences of Untreated Hearing Loss

Prevalence of Hearing LossHearing Loss

How We Hear

Signs of Hearing Loss

Types of Hearing Loss

Causes of Hearing Loss

Tinnitus

BHI Quick Hearing Check

Hearing Loss Prevention

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What Do These Famous People

Have in Common?

Tey all have hearing loss and they have all successullyovercome their hearing loss, the majority with hearingaids. Tese amous people have been so delighted withtheir improved hearing, that by serving as positive rolemodels, they hope to inspire other people to seek treat-ment early in their lie. Many people delay treatmentunnecessarily and as a result miss out on so much olie.

Visit our website at www.betterhearing.orgto read thepersonal success stories o the dozens o Better Hear-ing Institute celebrities who have overcome their ownhearing loss and...

Discover a World of Better Hearing!


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Many people are aware that their hearing has deteriorated but are reluctant to seek help. Perhaps they dont want to acknowl-edge the problem, are embarrassed by what they see as a weakness, or believe that they can get by without using a hearing

aid. And, unortunately, too many wait years, even decades, beore getting treatment.

But time and again, research demonstrates the considerable negative social, psychological, cognitive and health eects ountreated hearing loss with ar-reaching implications that go well beyond hearing alone. In act, those who have dicultyhearing can experience such distorted and incomplete communication that it seriously impacts their proessional and per-sonal lives, at times leading to isolation and withdrawal.

Studies have linked untreated hearing loss to:

n irritability, negativism and angern atigue, tension, stress and depressionn avoidance or withdrawal rom social situationsn social rejection and loneliness

Hearing loss is not just an ailment o old age. It can strike at any time and any age, even childhood. For the young, even a mildor moderate case o hearing loss could bring diculty learning, developing speech and building the important interpersonaskills necessary to oster sel-esteem and succeed in school and lie.

At the Better Hearing Institute, our mission is to help educate the public about hearing loss and promote the importance oprevention and treatment. In this guide, you will nd basic inormation about hearing loss, including advances in diagnosisand treatment, a review o dierent hearing aids, and resources or medical care and nancial assistance.

I you think you or a loved one suers rom hearing loss, dont delay another day. Visit a hearing healthcare proessional and

take the rst step toward a world o better hearing.

Sergei Kochkin, Ph.D.

Executive Director, Better Hearing Institute

IntroductionTe Consequences o Untreated Hearing Loss

HEARING LOSS

n reduced alertness and increased risk to personal saetyn impaired memory and ability to learn new tasksn reduced job perormance and earning powern diminished psychological and overall health


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The Prevalence of Hearing Loss in the U.S.Sergei Kochkin, Ph.D. Better Hearing Institute, Alexandria, VA

In order to gauge the number o people with hearing lossin the United States, 80,000 members o the National

Family Opinion (NFO) panel were surveyed. Tis survey,which has been unded by a sponsor o BHI since 1989, ispublished under the name Markerak. Te NFO panel isrepresentative o U.S. households.

People with hearing loss are oen embarrassed becausethey think that they are dierent or that they have a rarecondition. Te last Markerak survey (2004) estimated that31.5 million people report a hearing diculty; that is around10% o the U.S. population. So i you have a hearing loss,

understand that you are not alone. Te number o peoplewith hearing loss by age is provided in the graph above.

Here are some general guidelines regarding the incidence o hearing loss:

n 3 in 10 people over age 60 have hearing loss;

n 1 in 6 baby boomers (ages 41-59), or 14.6%, have a hearing problem;

n 1 in 14 Generation Xers (ages 29-40), or 7.4%, already have hearing loss;

n At least 1.4 million children (18 or younger) have hearing problems;

n It is estimated that 3 in 1,000 inants are born with serious to proound hearing loss.

Common Myths

Hearing loss affects only old people and is merely a sign of aging.

Actually it is the reverse o what most people think. Te majority (65%) o people with hearing loss areyounger than age 65. Tere are more than six million people in the U.S. between the ages o 18 and 44 withhearing loss, and nearly one and a hal million are school age. Hearing loss aects all age groups.

If I had a hearing loss, my family doctor would have told me.

Not true! Only 13% o physicians routinely screen or hearing loss during a physical. Since most peoplewith hearing impairments hear well in a quiet environment like a doctors oce, it can be virtually impos-sible or your physician to recognize the extent o your problem. Without special training, and an under-standing o the nature o hearing loss, it may be dicult or your doctor to even realize that you have ahearing problem.

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THE HEARING SYSTEM

Te anatomy o the hearing system can be divided into ourcomponents. Tese divisions are the:

1) outer ear

2) middle ear

3) inner ear

4) central auditory pathways

Hearing LossPatricia E. Connelly, Ph.D. CCC-A, FAAA New Jersey Medical School, Newark, NJ

1) THE OUTER EARTe outer ear is made up o the pinna or auricle and the external auditory canal. Te pinna col-lects and unnels sound down the ear canal. Te ear canal is curved, S shaped, and about 1inch long in adults. It has hairs and glands that produce wax called cerumen. Cerumen helps tolubricate the skin and keep it moist.

2) THE MIDDLE EAR

Te eardrum (tympanic membrane) is a membrane at the inner end o the ear canal. On thatinner side o the tympanic membrane is an air-lled space called the middle ear cavity. Tevibrations o the tympanic membrane are transmitted through the malleus (hammer) incus(anvil) and stapes (stirrup), also called the ossicles. Te stapes ootplate transmits the vibrationsinto the inner ear.

3) THE INNER EAR

Te inner ear has two divisions: one or hearing, the other or balance. Te hearing divisionconsists o the cochlea and the nerve o hearing. Te cochlea is snail-shaped, bony structurethat contains the sensory organ or hearing called the organ o Corti. Te organ o Corti releaseschemical messengers when the vibrations rom the stapes activate its tiny hair cells. Tese then

excite the nerves o hearing which carry sound to the brain.

4) CENTRAL AUDITORY PATHWAYS

Te central auditory system is a complex network o neural pathways in the brain that is re-sponsible or sound localization, speech understanding in noisy listening situations and othercomplex sounds, including music perception.

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THE PROCESS OF HEARING

Sound is transormed into mechanical energy by the tympanic membrane. It is then transmitted through the os-sicles to the inner ear where it is changed again into hydraulic energy or transmission through the uid-lled

cochlea. Te cochleas hair cells are stimulated by the uid waves and a neurochemical event takes place that excitesthe nerves o hearing. Te physical characteristics o the original sound are preserved at every energy change alongthe way until this code becomes one the brain can recognize and process.

Hearing loss misleads our brain with a loss o audibility and introduces distortion into the message that reaches thebrain. Changes in the eectiveness o the brain to process stimuli, rom head trauma, disease, or rom aging, canresult in symptoms that mimic hearing loss. Te ears and the brain combine in a remarkable way to process neuralevents into the sense o hearing. Perhaps its air to say that we hear with our brain, not with our ears!

SIGNS OF HEARING LOSS

Te signs o hearing loss can be subtle and emerge slowly, or they can be signifcant and come on suddenlyEither way, there are common indications. You should suspect hearing loss i you experience any o the signs

below.

You might have hearing loss i you . . .

SOCIALLY

n require requent repetition.n have diculty ollowing conversations involving more than 2 people.n think that other people sound mufed or like theyre mumbling.n have diculty hearing in noisy situations, like conerences, restaurants, malls, or crowded meeting rooms.n have trouble hearing children and women.n have your V or radio turned up to a high volume.n answer or respond inappropriately in conversations.n have ringing in your ears.n read lips or more intently watch peoples aces when they speak with you.

EMOTIONALLY

n eel stressed out rom straining to hear what others are saying.n eel annoyed at other people because you cant hear or understand them.n eel embarrassed to meet new people or rom misunderstanding what others are saying.n eel nervous about trying to hear and understand.n withdraw rom social situations that you once enjoyed because o diculty hearing.

MEDICALLY

n have a amily history o hearing loss.n take medications that can harm the hearing system (ototoxic drugs).n have diabetes, heart, circulation or thyroid problems.n have been exposed to very loud sounds over a long period or single exposure to explosive noise.

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Hearing LossPatricia E. Connelly, Ph.D. CCC-A, FAAA New Jersey Medical School, Newark, NJ

TYPES OF HEARING LOSS

In general terms, there are two types o hearing loss, conductive and sensorineural. A combination o both is alsoseen as a mixed hearing loss.

CONDUCTIVE HEARING LOSS

Conductive hearing loss is caused by any condition or disease that blocks or impedes the conveyance o soundthrough the outer or middle ear. Te result is a reduction in the sound intensity (loudness) that reaches the cochleaGenerally, the cause o conductive hearing loss can be treated with a complete or partial improvement in hearing.

SENSORINEURAL HEARING LOSS

Sensorineural hearing loss results rom inner ear or auditory nerve dysunction. Oen, the cause cannot be deter-

mined. It is typically irreversible and permanent. It, too, reduces the intensity o sound, but it might also result ina lack o clarity even when sounds, particularly speech, are loud enough. Te treatment or sensorineural hearingloss is amplication through hearing aids.

MIXED HEARING LOSS

A mixed hearing loss is a combination o a conductive and a sensorineural hearing loss. Hearing aids can be ben-ecial or persons with a mixed hearing loss, but caution should be exercised.

CAUSES OF HEARING LOSS

Te main causes o hearing loss are as ollows:

n Aging (presbycusis)

n Excessive noise (i.e. construction, rock music, gun shot, etc.)

n Sudden onset

n Inections (otitis media)

n Injury to the head or ear

n Birth deects or genetics (i.e. otosclerosis)

n Ototoxic reaction to drugs or cancer treatment (i.e. antibiotics, chemotherapy, radiation)

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Tinnitus, or Head NoisesRichard Carmen, Au.D. Auricle Ink Publishers, Sedona, AZ

Tinnitus oen simply reerred to as ringing-in-the-ears or head noises is a sound heard by one or both ears thatis described by dierent people in various ways. o some it is a high-pitched ringing, whining, or hissing sound

like listening to a conch shell. o others it may be a low roaring noise. innitus can be very mild, noticeable onlyin a quiet room, or it can become so loud and annoying the victim hears nothing else. It can be persistent, inter-mittent, or throbbing, depending on the cause. Some 50 million adults suer rom innitus. For 12 million, theproblem is so severe they are incapacitated. While innitus does not cause hearing disorders, it may accompanydecreased hearing and other ear symptoms such as pressure, unsteadiness, or dizziness. Oen, it occurs alone.

Some o the main causes are:

n wax buildup or obstructions in the outer ear canal

n peroration in the eardrum or uid accumulation behind

n

Otosclerosis - the stirrup bone (stapes) becomes xedn Otitis media (ear inections)

n exposure to a sudden loud noise or repeated exposure to noise without adequate protection

n trauma to the head or neck as in a concussion or whiplash injury

n some medications induce head noises

n high or low blood pressure or anemia

Treatment of Tinnitus

Correcting treatable causes o innitus (i.e. ear wax build-up, allergy, inection, syphilis) oen will improve the

condition. However, when the cause is unknown, or when head noises arise rom within the cochlea, auditorynerve, or brain, treatment becomes more dicult. Most medications and surgical procedures have not been suc-cessul in relieving innitus. Because o the direct association between the hearing mechanism and the nervoussystem, innitus suerers have been advised to avoid nervous tension, atigue, and stimulants. Sedatives, bioeed-back, and other relaxation techniques may oer some people temporary relie. Te only other approach that soar has achieved any success has been innitus Maskers to mask the ringing sound with other sounds as a meanso distracting the individuals concentration on innitus. Other worthwhile treatments to explore are cognitivetherapy and innitus Retraining Terapy (R).

Conclusion

Because innitus may be symptomatic o a more serious disorder, it is important to try and nd the cause beoretreating the head noises by any o these means.

I you or someone you know suers rom innitus, we urge you to contact an ear doctor (otologist or otolaryn-gologist) or audiologist as soon as possible.

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BHI Quick Hearing Check

I have a problem hearing over the telephone 0 1 2 3 4

I have trouble ollowing the conversation when

two or more people are talking at the same time

0 1 2 3 4

I have trouble understanding things on V 0 1 2 3 4

I have to strain to understand conversations 0 1 2 3 4

I have to worry about missing a telephone ring ordoorbell

0 1 2 3 4

I have trouble hearing conversations in a noisybackground such as a crowded room or restaurant

0 1 2 3 4

I get conused about where sounds come rom 0 1 2 3 4

I misunderstand some words in a sentence andneed to ask people to repeat themselves

0 1 2 3 4

I especially have trouble understanding thespeech o women and children

0 1 2 3 4

I have trouble understanding the speaker in a largeroom such as at a meeting or place o worship

0 1 2 3 4

Many people I talk to seem to mumble(or dont speak clearly)

0 1 2 3 4

People get annoyed because I misunderstand what they say 0 1 2 3 4

I misunderstand what others are saying andmake inappropriate responses

0 1 2 3 4

I avoid social activities because I cannot hearwell and ear I will reply improperly

0 1 2 3 4

Family members and riends have told me theythink I may have a hearing loss

0 1 2 3 4

StronglyDisagree

StronglyAgree

INSTRUCTIONS STEP #1

With respect to your hearing, please think about your experiences with each o the ollowing WIHOU the use o hearingor other devices designed to help you hear better. For each item, indicate the degree to which you agree or disagree (circlenumber or each item).

STEP # 2Add up scores in each column scored 1-4-------

HEARING LOSS

+ + + =

Introduction

Te ollowing hearing loss check is based on the Revised American Academy o Otolaryngology-Head & NSurgery (AAO-HNS) ve-minute hearing test*. It is a means o quickly assessing i you possibly have a hearingrequiring reerral or an objective hearing test and possible hearing solution. Tis screener is related to objectiv


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STEP # 3

How Does Your Hearing Loss Score Compare to Adults with Hearing loss?

n adding up your responses to the 15 items you are now able to compare your scores to adults who have a hearing loss. TeNational Council on the Aging (NCOA) collected this inormation based on the responses rom a representative sample o 2,304people with hearing loss, ages 50 and above, using the National Family Opinion Panel in 1999.

First, locate your total score in column 1; Column 2 tells you how your hearing loss compares to adults with hearing loss; Columntells how your signicant other views the hearing loss; Column 4 tells you what hearing solution action is needed.

1 What is yourhearing loss score?

2 How does yourhearing loss compareto others?

3 How does your signifcantother describe your hearingloss?

4 Hearing Solution Action Needed

0-4 Lower 5% Very Mild None

5-9 Lower 10% V V

10-13 Lower 15% Majority mild withsome moderate

Hearing test may be necessaryto monitor your hearing.

14-17 Lower 20% | |

18-19 Lower 25% V V

20-21 Lower 30% Majority moderate withabout a third mild

Hearing test recommended; hearingsolution based on liestyle

22-23 Lower 35% | V

24-25 Lower 40% ||V

Hearing test recommended;hearing solution probablyneeded in many situations.

26-27 Lower 45% Majority moderatewith some mild

||

28-29 Middle- 50% | |

30-31 Upper 45% V V

32-33 Upper 40% Majority moderate

to severe

Extensive communication diculty

requiring testing and hearing solution34-35 Upper 35% | |

36-37 Upper 30% | |

38-39 Upper 25% | |

40-42 Upper 20% V |

43-45 Upper 15% Majority severe to proound |

46-50 Upper 10% | |

51-55 Upper 5% | |

56-60 Upper 1% V V

*Source: Koike, J.; Hurst, M.K.; and Wetmore, S. J. Correlation between the American

Academy o OtolaryngologyHead and Neck Surgery ve-minute hearing test and standardaudiological data, OtolaryngologyHead and Neck Surgery, Volume 111 (5), pp. 625-632

HEARING LOSS

measures o hearing loss using audiological equipment. In step #1 you are asked to respond to 15 items related toyour hearing. In step #2 you will score your hearing and in step #3 you will be able to compare yoursel to 2,304dults with hearing loss.


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Sergei Kochkin, Ph.D. Better Hearing Institute, Alexandria, VA

It would seem that hearing is a second-rate sense when compared to vision in our visually oriented modern soci-ety. People with hearing loss delay a decision to get hearing help because they are unaware o the act that receiving

early treatment or hearing loss has the potential to literally transorm their lives. Research by the National Coun-cil on the Aging on more than 2,000 people with hearing loss, as well as their signicant others, demonstratedthat hearing aids clearly are associated with impressive improvements in the social, emotional, psychological, andphysical well-being o people with hearing loss in all hearing loss categories rom mild to severe. Specically, hear-ing aid usage is positively related to the ollowing quality o lie issues.

Hearing loss treatment was shown to improve:

n Earning power

n Communication in relationships

n

Intimacy and warmth in amily relationshipsn Ease in communication

n Emotional stability

n Sense o control over lie events

n Perception o mental unctioning

n Physical health

n Group social participation

And, just as importantly, hearing loss treatment was shown to reduce:

n Discrimination toward the person with the hearing loss

n Hearing loss compensation behaviors (i.e. pretending you hear)

n Anger and rustration in relationships

n Depression and depressive symptoms

n Feelings o paranoia

n Anxiety

n Social phobias

n Sel-criticism

I you are one o those people with a mild, moderate or severe hearingloss, who is sitting on the ence, consider all the benets o hearingaids described above. Hearing aids hold such great potential to posi-tively change so many lives.

You Should Hear What You Are Missing!

The Impact of Treated Hearing Loss on Quality of Life

HEARING SOLUTIONS


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Advances in the Diagnosis and Treatment of Hearing LossRoss J. Roeser, Ph.D. University o exas-Dallas/Callier Center or Communication Disorders

New inormation about how we hear, as well as the explosion o new technology has made help available oralmost everyone with hearing loss.

Improved Identication of Hearing Loss

With recent advancements, it is now possible to perorm comprehensive testing to determine:

n I hearing loss exists, even or the youngest populations

n Te amount and nature o the hearing loss

n Te benets that are possible through available treatments

Breakthroughs in identication techniques include:

n Universal neonatal hearing screening to test the hearing o babies within the rst 48 hours o lie.

Such tests identiy hearing loss in inants so that treatments can begin as soon as possible.

n Auditory brainstem response (ABR) testing or use with dicult-to-test populations and or medicadiagnosis o auditory disorders. Te ABR test can be perormed on individuals o any age, even the youngestinant. Tere is no longer any reason to delay reerral o inants or hearing evaluation because they are tooyoung to test.

n Immitance testing or objective and complete evaluation o middle ear unction and assessments o thenerve unction o the ear.

n

Otoacoustic emissions testing that provide inormation regarding the hearing nerve in the inner earand help identiy the cause o hearing loss.

n Special auditory tests or identication o the exact location o the auditory impairment.

Improved Rehabilitation

Auditory rehabilitation is now available or individuals o all ages who have hearing loss. New and modernizedtechniques include:

n specialized educational programs or children with hearing loss

n individually tailored and computerized training in speech reading (lip reading), auditory training, and

counseling

n assistance in everyday listening through custom-designed personal hearing aids

n assistance in specic listening situations (telephone, television, and group listening devices) through the use oassistive listening devices

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Advances in the Diagnosis and Treatment of Hearing LossRoss J. Roeser, Ph.D. University o exas-Dallas/Callier Center or Communication Disorders

n Help or those with proound deaness through the use o cochlear implants, tactile hearing aids, and alertingdevices.

n Benet to those who suer rom tinnitus (ringing in the ears) through counseling and the use o speciallydesigned tinnitus maskers.

Help is now available or almost everyone with a hearing loss.

n I you HINK you have a hearing loss, diagnostic testing is available.

n I you KNOW you have a hearing loss, rehabilitation is available.

Hearing Healthcare Professionals

o nd the most comprehensive list o hearing healthcare proessionals near you, consult the yellow pages under

audiologist, audiology, hearing aids or Physicians Ear Nose Troat (Otolaryngology). Here is a brie de-scription o each hearing healthcare proession:

Audiologists identiy and assess disorders o the hearing and balance systems o children and adults. Audiologistsselect, t, and dispense amplication systems such as hearing aids and related devices; program cochlear implantsand provide instruction, rehabilitation, and counseling services to enhance human communication. A graduate(doctorate or master) degree is required or practice.

Hearing instrument specialists assess hearing and select, t, and dispense hearing aids and related devicesTey provide instruction, rehabilitation, and counseling in the use and care o hearing aids and related devices to

enhance human communication. Te nationally accepted credential or hearing instrument specials is certicationby the National Board or Certication in Hearing Aid Sciences.

Otolaryngologists (ear, nose, and throat physicians) perorm a complete medical history and physical examina-tion o the head and neck. Tey also perorm and supervise hearing and balance testing, which leads to the medicadiagnosis, treatment, and rehabilitation o diseases o the hearing and balance systems in children and adults. Tismay include prescribing medications; perorming surgery including implanting cochlear implants; and selecting,tting, and dispensing hearing aids and related devices. Te nationally accepted credential or otolaryngologists isboard certication by the American Board o Otolaryngology. A medical degree (MD or DO) is required.

HEARING SOLUTIONS


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Richard Carmen, Au.D. Auricle Ink Publishers, Sedona, AZ

When we think o helping a loved one with hearing loss who declines use o hearing aids, we oen think o howimportant it is to repeat ourselves, speak clearly, speak louder or interpret what others say i they cannot hear the

message. But when we do these good deeds or loved ones with a hearing loss, what we dont realize is that wereassisting in their ailure to seek help. Such well-intended eorts are counterproductive to the ultimate goal o themreceiving hearing aids. Heres why.

I a loved one with a hearing loss has come to rely on your good hearing, what is the great need or them towear hearing aids? Your co-dependent eorts must stop in order or them to grasp the magnitude o theirproblem. Many people with a hearing loss never realize how much communication they actually ail to understandor miss completely because you have become their ears. However, it takes only a short time or them to realize thatwithout your help, theyre in trouble. It is through this realization that one becomes inspired to take positive actionto solve their problem. Tereore, as a loving spouse or amily member you must create the need or your loved

one to seek treatment by no longer repeating messages and being their ears. Your ultimate goal is or them to hearindependent o you.

Here are some practical tips for you:

n Stop repeating yourself! Explain that you are on a Hearing Help Questone that involves your loved oneby allowing him or her the opportunity to realize the signicance o their hearing loss. Do not stop helpingthough. All you do is preace what you repeat by saying each time, Hearing Help! or some other identierIn a short amount o time, your loved ones will realize how oen you say this. In turn, they will come to realizehow oen they depend on you. (Tis suggestion is only or a loved one who resists the idea o getting anyhelp.)

n Stop raising your voice (then complaining youre hoarse). Tat results in stressing your throat and vocalchords.

n Stop being the messenger by carrying the communication load for the family. Do not tell yourloved one He said and She said when he or she needs to be responsible or getting this inormation directlyrom the source.

n Do not engage in conversation from another room as tempting as this is and as convenient asit appears. Tis sets up your communication process or ailure.

n Create a telephone need. Tis means or you to stop being the interpreter on the telephone. Allow yourloved one to struggle in order to recognize how much help he or she needs. Were looking or motivation (tohear) rom your loved onenot you.

HEARING SOLUTIONS

When a Loved One Resists Help


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Hearing AidsGus Mueller, Ph.D. Vanderbilt University, Nashville, NRuth Bentler, Ph.D. University o Iowa, Iowa City, IA

HOW HEARING AIDS WORK

While the processing o modern hearing aids is complex, and computer programming is required to make someo the adjustments, the basic components that make them work has not changed. Te basic unction o a hearingaid is as ollows:

n Sound waves enter through the microphone, which converts acoustic signals into electrical signals.

n Te amplier increases the strength o the electrical signal.

n From the amplier, the signal is then transormed back to an acoustic signal by the receiver (a miniatureloud speaker).

n From the receiver the signal is channeled into the ear canal, either through a small tube or through anear mold.

n A battery is required to power the hearing aid and enable the amplication process.

Many hearing aids also have user controls (e.g. toggle switch, volume control wheel, push button, orremote control) that enable the wearer to adjust a variety o hearing aid parameters, including:

n urning the hearing aid on or o

n Changing the volume

n Switching to the telecoil

n Switching between omni- and directional-microphone settings

n Switching to a dierent pre-programmed memory

Styles of Hearing Aids

Hearing aids have been available in our styles: body, eyeglass, behind-the-ear (BE), and in-the-ear (IE)Included in the category o IE hearing aids are in-the-canal (IC) and completely-in-the-canal (CIC) styles (allshown in the gures below). While body and eyeglass style hearing aids were regularly used 40-50 years ago, theycomprise only about 1% o all hearing aids marketed today. Instead, most individuals choose IE (approximately80%) or BE (approximately 20%) style hearing aids. Tis transition in style, use, and preerence is occurring ora number o reasons, including the reduction in the size o the components, durability, and cosmetic concerns onthe part o the consumer.

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TeITEstyle hearing aid ts directly into the external ear. Te circuitry is housedprimarily in the concha (external) portion o the ear. Due to the miniaturizationo the component parts (including the microphone, receiver and battery), it ispossible to make hearing aids small enough to ll only a portion o the concha

(IC) or t deeply into the ear canal (CIC). All three o these styles have typicallybeen considered to be more modern and cosmetically appealing. However, modernBE hearing aids have become smaller and at times are less noticeable than someIC hearing aids. Other eatures o in-the-ear aids are as ollows:

n More secure t, and easier insertion and removal than with BEs.

n Improved cosmetic benets with smaller styles (CIC, IC).

n Less wind noise in the smaller styles than with BEs.

n Directional microphone technology available or most styles, excludingCICs.

n Deep microphone and receiver placement with CICs may result in increasedbattery lie and high requency amplication compared with other styles.

n All components are integrated into a one-piece shell, which may be easier tohandle and operate than or BE styles.

Te BTE style hearing aid is housed in a small curved case which ts behind theear and is attached to a custom earpiece molded to the shape o your outer ear.Some BE models do not use a custom earpiece; instead the rubber tubing isinserted directly into the ear. Te case is typically esh colored, but can be obtainedin many colors and/or patterns. Other eatures include:

n BEs may be the most appropriate choice or young children, as only theearmold needs to be replaced periodically as the child grows and the earchanges in dimension.

n ypically, BEs are the most powerul hearing aid style available, and may bethe best option or persons with severe-to-proound hearing loss.

n FM and direct auditory input is routinely available as an optional or standardeature.

n elecoil circuitry is oen more powerul than with IEs.

n Non-occluding earmolds may be used with BE hearing aids, i a medical

condition exists or i the patient reports a plugged sensation when wearingother hearing aid styles.

n Directional microphone technology available with most BE styles andmodels.

n Larger battery sizes used in BEs may be easier to handle than smaller stylesor those with limited manual dexterity or vision decits.

BTE w/ small tubing

ITE

ITC

CIC

HEARING SOLUTIONS

BTE w/ earmold


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Hearing Aids

BRIEF GUIDE TO MODERN HEARING AID TECHNOLOGY

In addition to the basic eatures o hearing aids discussed earlier, there are many other eatures available in modernhearing aidssome o them are or convenience and ease o use, others are designed to improve speech under-standing or listening comort.

Adaptive Feedback Cancellation: Acoustic eedback (whistling rom the hearing aid) can be annoying, em-barrassing, and in some cases, prevent the hearing aid wearer rom using the correct amount o gain. Many otodays hearing aids have an automatic eature that quickly detects acoustic eedback and cancels it. Tis eature isdesigned to manage transitory eedback (e.g. caused by placing ones hand or a telephone next to the ear), and isnot a solution to a poorly tted ear mold or hearing aid.

Automatic Gain ControlOutput (AGCo): AGCo or output compression is used to put a ceiling on loudsounds. It handles the output aer the amplier, and can be adjusted to correspond to the patients threshold odiscomort (maintaining sounds below this level).

Automatic Gain ControlInput (AGCi): AGCi, or input compression, oen reerred to wide dynamicrange compression (WDRC) is used to repackage the speech signal (and other incoming sounds) to correspondto the reduced dynamic range o the hearing aid user. Tat is, i the incoming sounds have a 60 dB range, and thepatient only has a 30 dB range o useul hearing, the sounds might be compressed by 2:1 to t into the useul au-ditory region. Te notion is that most people with a hearing loss need more gain or so sounds than or average,and more gain or average sounds than or loud. WDRC accomplishes this automaticallyin act, i the WDRC isprogrammed correctly across requencies, many hearing aid users have little need or a volume control.

Digital Noise Reduction: With digital hearing aids, it is possible or the hearing aid to analyze an incomingsignal and dierentiate speech rom a broad-band noise signal. Tis can be accomplished simultaneously in sev-eral channels. I the dominant signal is believed to be noise in a given channel, there is a reduction in gain. Notehowever, that what a typical hearing aid user might consider to be noise, (background talkers at a party) mightnot be considered noise by the hearing aid. While this eature has the potential to improve speech understandingin typical dicult listening situations, this has yet to be veried by research.

Gus Mueller, Ph.D. Vanderbilt University, Nashville, NRuth Bentler, Ph.D. University o Iowa, Iowa City, IA

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Digital Signal Processing: Until recently, the majority o hearing aids utilized analog signal processing. Tishas changed rapidly over the past ew years, and today, nearly all hearing aids sold in the U.S. utilize digital signal

processing. Te advantage o digital processing is that less space is required, allowing manuacturers to includemany more programmable eatures in a small package. Trough the use o digital signal processing, the hearingaid can conduct an analysis o an incoming signal, and make a reasonable classication o the contentspeechversus broad-band noise versus acoustic eedback (whistling) versus music, or example. Tis classication canthen be used to trigger automatic activation o other special eatures.

Directional Microphone Technology: Using special microphones or phase cancellation signal processing, it ispossible to congure a hearing aid so that sounds rom the side, and especially the back o the hearing aid user areamplied less than sounds originating rom the ront. It can serve as a type o spatial noise reduction i the useris correctly positioned. Directional technology is available on all hearing aid styles except CICs (because o sizeconstraints). Importantly, directional technology does not improve localization o sounds. Research has shown

that many hearing aid users preer directional technology or listening in noise, usually when:

n the noise originates rom behind the listener,

n the talker is in ront o the listener,

n the listener is close to the talker,

n the room has low reverberation.

Some hearing aids automatically switch to a directional mode when the signal type and/or input intensity arematched to the characteristics o the algorithm. Adaptive directional hearing aids automatically track a dominantsingle noise source (e.g. a car passing by someone on a sidewalk), attempting to provide maximum reduction in

gain toward the location o the source.

Multiple Channels: Te majority o todays hearing aids have multiple channels. Each channel represents aportion o the requency range important or understanding speech. One advantage o multiple channels is thateatures such as gain and compression can be programmed dierently to reect changes in the patients hearingacross requencies. Multiple channels also are useul or implementing other eatures such as digital noise reduc-tion and eedback cancellation. Tere is no consensus regarding how many channels are enough (or how many aretoo many)to some extent, this depends on the eature utilized within the channels.

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Hearing AidsGus Mueller, Ph.D. Vanderbilt University, Nashville, NRuth Bentler, Ph.D. University o Iowa, Iowa City, IA

Multiple Memories: A memory is a location to store hearing aid settings that are designed or a particular

listening situation. It is common or hearing aids to have two or three memories. For example, in a hearing aidwith three memories, it is common that memory one will be or listening in quiet, memory two will be or lis-tening in noise, and memory three will be or telephone. On the other hand, many hearing aid users nd that asingle memory works in a variety o listening situations, and may only use one memory. Changing memories isaccomplished by using a button (or toggle switch) on the hearing aid, with a remote control device. In some digitahearing aids, it happens automatically.

Telecoils: With this special circuit, electromagnetic signals can be picked up rom the handset o the telephoneand amplied in a manner similar to the ampliying unction o the hearing aid. Although many hearing aid wear-ers report benet with this circuit, there is substantial variability across hearing aids. elecoils are not availablein some smaller custom-made models due to space limitations. Oen, hearing aids with multiple memories wil

devote one memory to the telecoil. In these aids, the telecoil can be accessed through a push button on the hearingaid or by the use o a remote control device.

The Binaural Advantage (Two are better than one)Sergei Kochkin, Ph.D. Better Hearing Institute, Alexandria, VA

I you have hearing loss in both ears (bilateral hearing loss), then most likely you are a candidate or two hearingaids. While a hearing healthcare proessional can determine best i you are a candidate or two hearing aids, the ul-

timate decision-maker concerning binaural aids is the person who will wear them. It is important that the personwith the hearing loss be given the chance to experience binaural (two hearing aids) amplication, beore a decisionon one or two hearing aids is made. Similar to the way reractory problems in both eyes are treated with a pair oglasses, it makes sense that bilateral hearing loss should be treated with binaural hearing aids.

Let me share with you why two hearing aids are better than one (visit www.betterhearing.org or more detailedexplanations o the binaural advantage):

n better understanding o speech

n better understanding in group and noisy situations

n better ability to tell the direction o sound

n better sound quality

n smoother tone quality

n wider hearing range

n better sound identication

n keeps both ears active resulting in potentiallyless hearing loss deterioration

n hearing is less tiring and listening more pleasant

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n eeling o balanced hearing

n greater comort when loud noises occur

n reduced eedback and whistling

n tinnitus (ringing in the ears) masking

n consumers preer two over onen customer satisaction is higher with two

Logically, just as you use both eyes to see clearly, you need two healthy ears to hear clearly. Beore you decide onone hearing aid, try two. Your hearing healthcare proessional can demonstrate to you the binaural advantageexperience either through headphones (during testing), probe microphones, master hearing aids, or during yourtrial tting. Decide or yoursel.

Medical AdvancesPatricia E. Connelly, PhD, CCC-A, FAAA New Jersey Medical School, Newark, NJ

Between 5% and 10% o people with hearing loss are not candidates or hearing aids. When conventional ampli-cation does not help, there may be alternative approaches to the treatment o hearing loss as illustrated by theollowing examples. A medical consultation is necessary, preerably by a physician who is Board Certied in Otolaryngology Head and Neck Surgery.

n Severe hearing loss or deafness. When hearing aids cannot eectively ampliy conversational speecha cochlear implant evaluation should be considered.

n Otosclerosis. Fixation o the hearing bones or Otosclerosis and the hearing loss it causes may respondavorably to a surgical procedure called a stapedectomy.

n Impacted cerumen. Removal o ear wax may result in reversal o the hearing loss. Some audiologists aretrained in the procedure.

n Ear infections. Te treatment o ear inections is important or the restoration o good health to the ears andmay restore hearing. reatment usually is with antibiotics or by draining uid behind the eardrum.

n Acoustic neuroma. Tis is a tumor that grows on the nerve o hearing and balance. Surgery may benecessary.

n Atresia and Microtia. A bone-conduction hearing aid or a surgically implanted bone-anchored hearing aidmay improve hearing.

n Unilateral deafness. Several options may be helpul including: trans-cranial tting, bone-anchored hearingaid, CROS hearing system, or assistive listening devices. A comprehensive audiological evaluation is essential

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Assistive TechnologyCynthia Compton-Conley, Ph.D. Gallaudet University, Washington, DC

Due to technological advancements in recent years, todays hearing aids do an excellent job o helping people meetmany o their communication needs. However, sometimes there are situations where additional technologies may

be needed. For example, some hearing aid users may continue to experience diculty understanding speech innoisy environments, rom a distance, as when watching V or attending a movie or play, or while listening on thetelephone. At bedtime, a person with even a mild to moderate hearing loss may not hear the smoke alarm locateddown the hall. Tis same person might miss a doorbell chime while listening to the V a room away. Further, achild with normal hearing, who suers rom recurrent middle ear inections or who has a central auditory process-ing disorder, is at a denite educational disadvantage when seated in a typical classroom with poor room acousticsand excessive noise.

How Assistive Technology Can Help

Many auditory and non-auditory devicescollectively known as Assistive echnology, Assistive Listening Devices

(ALDs), or Hearing Assistance echnology (HA) are available to help people with all degrees o hearing lossTese devices can help acilitate improved ace-to-ace communication, reception o electronic media, telephonereception, and reception o important warning sounds and situations.

Devices to Facilitate Face-to-Face Communication and the Reception of Electronic Media

Auditory assistive listening devices can be thought o (roughly) as binoculars or the ears. By placing a remotemicrophone next to the talker (or loudspeaker) or by connecting directly into the sound source (V, VCR, MP3player, etc.), these devices bring the desired sound closer to ones ear(s) beore it has a chance o being mixed withnoise and reverberation. Te captured sound is then sent to the listener via a hardwired or wireless linkTree wireless systems can be used: FM (see below), inrared or inductive (audio loop). In order to use these sys-

tems, the hearing aid must be equipped with either a telecoil or a eature called direct audio input (DAI). DAIallows very tiny FM receivers to be plugged into the bottom o the hearing aid. DAI or a telecoil also allow bodyworn FM and inrared receivers to be used with more styles o hearing aids. Finally, a telecoil allows the hearingaid itsel to unction as the receiver when listening to a room-sized inductor (room loop) installed in a building(e.g. church, movie house). For greatest listening exibility ask or hearing aids with telecoils built into them. Andi you want to have the opportunity to use the latest tiny FM receivers, think about purchasing behind-the-ear(BE) hearing aids equipped with DAI.wo types o visual systems are available to help people understand speech at a meeting or other live event: Com-puter-Assisted Note taking (CAN) and Communication Access Real ime ranslation (CAR), also known asReal ime Captioning.

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Devices to Facilitate Telephone Reception

Special telephone ampliers are available that replace the telephone handset, attach to the phone between thehandset and the phone (in-line ampliers) or attach to the handset and are powered by a battery (portable ampli-ers). Each o these ampliers can be used with or without a hearing aid. Tese standard telephone ampliers can

be coupled to a hearing aid either acoustically or inductively. With acoustic coupling, the amplier is held up tothe hearing aids microphone. While this tends to work well with a CIC hearing aid, it usually results in an annoy-ing whistling sound (eedback) with the larger hearing aid models. However, i the larger models are equippedwith a telecoil, then the hearing aid can be set to and held next to the amplier, with no eedback.

Special telephones with built-in amplication are also available in both standard and wireless handset modelsAlso available are devices that enable you to use your hearing aid(s) with a digital cell phone or distortion- andnoise-ree reception.

For those who cannot understand over the voice telephone, even with amplication, there are other options such

as the Voice Carry Over (VCO) or read and talk telephone. Used with the telephone relay service, VCO allowsyou to talk directly to the other party while an operator translates what the other party says to you into print thatis displayed on a small LCD screen.

Alerting Devices

Alerting devices allow hard o hearing and dea people to be aware o many environmental sounds and situationsin the home, in school or in the workplace, as well as or travel and recreation. Such systems use either micro-phones or electrical connections to pick up the desired signal and hardwired or wireless transmission to send thesignal to you in a orm to which you can respond. For example, when someone presses the doorbell button, whenthe phone rings or the re alarm is activated, these events can trigger a ashing incandescent or uorescent light,

a loud horn, a vibrational device (pager, bed shaker), or a an.

WHICH SYSTEM IS BEST?

A broad assortment o auditory and non-auditory technology is available to assist in removing the communicationbarriers o everyday lie. Your hearing healthcare proessional should be able to help you select the best system, orcombination o systems, based on your own unique communication needs and liestyle.

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Childhood Hearing LossJudith Gravel, Ph.D. Childrens Hospital o Philadelphia, Philadelphia, PA

Childrens quality o lie and development vitally depend on hearing. Children learn to speak because they hearothers and themselves communicate. Hearing helps your child learn to read, appreciate music, and receive warn

ings o approaching harm. Your child will have diculty coping with many o lies challenges and opportunitiesat home and in school without good hearing.

Age Communication Behavior

5 months urn to source o moderate and so sounds

6 months Recognize amiliar voices and engage in vocal play with parents

9 months Demonstrate understanding o simple words

10 months Babbles by stringing multiple, single-syllable speech sounds together

12 months One or more real, recognizable spoken words emerge

18 months Understands simple phrases, retrieves, places or manipulates amiliar objects on spo-ken request; points to body parts on request; spoken vocabulary o 20-50 words andshort phrases

24 months Spoken vocabulary 200-300 words; speaks in simple sentences; most speech is under-standable to adults not with the toddler on a daily basis; sits and listens to read-aloudstory books

3 5 years Uses spoken language constantly to express wants, reect emotions, convey inorma-tion and ask questions. Understands nearly all that is said. Vocabulary grows rapidly:1000-2000 words; produces complex and meaningul sentences. All speech sounds areclear and understandable by 5 years.

Signs of Hearing Problems

Te single most important sign o hearing loss in children is the ailure to develop, or the delayed development ospoken language.

I children have severe or proound hearing loss, it is usually obvious that they do not respond to sound. Some-times it is dicult to detect mild orms o hearing loss, including hearing loss in only one ear. Even the morecommon orms o mild hearing loss, however, can negatively impact communication development and schoolperormance.

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Common warning signs or hearing loss include:

n Family member or teacher concern regarding: n hearing acuity n delays or dierences in speech and language development n attention or behavioral diculties

n academic perormancen Inappropriate, delayed, or lack o response to so and moderate-level sounds: speech or environmental when

distractions are minimal

n Use o what? or huh? requently

n Intently watching the aces o speakers

n Diculty understanding speech in background noise

n Sitting close to the V set when the volume is adequate or others; increasing the V or stereo/tape/CD playervolume to unreasonably loud levels

n Not responding to voices over the telephone or switching ears continually when the phone is utilized

n Not startled by intense sounds

n Unable to locate the source o a sound accurately

Newborn Hearing Screening

oday, the vast majority o newborns receive a hearing screening beore discharge rom the hospital. wo types oobjective test technologies are used to screen or hearing loss in newborns: otoacoustic emissions and the auditorybrainstem response (sometimes called ABR test or BAER test). Tese screening tests can detect 80-90% o inantswith moderate degrees o hearing loss and greater. However, no screening test is perect. Children with mildhearing loss may pass newborn hearing screening. Newborn hearing screening cannot identiy children with late

onset or progressive types o hearing loss.

Even when an inant passes a hearing screening test in the hospital, it is important to monitor developmentalmilestones or hearing, language and speech. I your child was born with visual, cognitive or motor disabilities, acomprehensive audiological evaluation would be important to ensure your childs hearing is completely normal.

HEARING CAN BE EVALUATED AT ANY AGE

Hearing assessment can be completed in children o any age using objective and subjective audiologic testtechnologies. Tereore, hearing testing should not be delayed. Conrmation o hearing loss is made ollowingaudiologic and medical assessment.

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Childhood Hearing LossJudith Gravel, Ph.D. Childrens Hospital o Philadelphia, Philadelphia, PA

EARLY INTERVENTION FOR CHILDREN WITH HEARING LOSS

All newborns should be screened or hearing loss beore 1 month, hearing loss should be confrmed by 3 monthsand children with diagnosed hearing loss should receive intervention, which means enrollment in early interven-tion programs by 6 months o age. (Maternal and Child Health Bureau, Centers or Disease Control and Prevention, JointCommittee on Inant Hearing (JCIH, 2000))

It is important to remember that inants may be t with amplication soon aer the conrmation o the hearingloss. As such inants may begin to use hearing aids and assistive devices beore 6 months o age.

Inants age 12 months with proound hearing loss, who have not made sucient progress with conventional hear-ing aids are considered candidates or cochlear implants. In some cases (as when meningitis is the cause o dea-ness), younger inants may be candidates or a cochlear implant.

Risk Conditions for Childhood Hearing Loss(Joint Committee on Inant Hearing, 2000)

Neonates from Birth Through 28 Days

n An illness or condition requiring admission o 48 hours or greater to an inant care unit

n Stigmata or other ndings associated with a syndrome known to include a sensorineural and or conductivehearing loss

n Family history o permanent hereditary childhood sensorineural hearing loss

n Cranioacial anomalies, including those with morphological abnormalities o the pinna and ear canaln In-utero inection such as cytomegalovirus, herpes, toxoplasmosis, or rubella

Infants 29 Days Through 2 Years

n Parental or caregiver concern regarding hearing, speech, language, and or developmental delay

n Family history o permanent hereditary childhood hearing loss

n Stigmata or other ndings associated with a syndrome known to include a sensorineural or conductive hearingloss or Eustachian tube dysunction

n Post-natal inections associated with sensorineural hearing loss including bacterial meningitis

n In-utero inections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis

n Neonatal indicators, specically hyperbilirubinemia at a serum level requiring exchange transusion, persistentpulmonary hypertension o the newborn associated with mechanical ventilation, and conditions requiring theuse o extracorporeal membrane oxygenation (ECMO).

n Syndromes associated with progressive hearing loss such as neurobromatosis, osteopetrosis, and Usherssyndrome

n Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as FriedreichsAataxia and Charcot-Marie-ooth syndrome

n Head trauma

n Recurrent or persistent otitis media with eusion or at least three 3 months

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NOISE EXPOSURE AND CHILDREN

I speech must be raised (shouted) to communicate, it is very likely that the noise is excessive and possibly dam-aging. Ringing in the ears (tinnitus) aer noise exposure also indicates excessive sound levels. Children should

be told about the dangers o noise exposure and the use o ear protection (ear plugs, ear mus, etc.). When earprotection is unavailable, simply block the ear canal opening with your ngers. Tis serves as to reduce the leveo sound going to the eardrum. Obviously children should be protected rom excessive noise exposure wheneverpossible.

FEDERAL LEGISLATION AND CHILDREN WITH HEARING LOSS

Trough the Individuals with Disabilities Education Act (IDEA, 1997), the Federal Department o Education pro-vides unds to states or children birth to 21 years who have disabilities. A child with a hearing loss is covered bythe provisions o IDEA i, by reason o the childs hearing loss the child is deemed to require special education andrelated services. Related services includes transportation, speech-language pathology, audiology and other such

services as may be required to assist the child in beneting rom special education. Services provided can howevervary by state and even school district.

Preparing Your Child for Better Hearing

You are your childs role model or attitudes on hearing loss and hearing conservation. I hearing and the use ohearing protection are important to you, it will be important to your child as well. With your understanding, en-couragement, and support, your child will enjoy a world o better hearing.

Remember:

n You childs hearing is the means through which communication will develop and ourish.

n Guard your childs hearing careully and seek proessional help i you are concerned at any time.

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Hearing Loss PreventionRichard W. Danielson, Ph.D. National Space Biomedical Research Instituteand Baylor College o Medicine, Houston, X

Noise is one o the most common causes o hearing loss, and one o the most common occupational illnesses in theUnited States. A single shot rom a shotgun, experienced at close range, may permanently damage your hearing inan instant. Repeated exposures to loud machinery may, over an extended period o time, present serious risks tohuman hearing.

n 10 million Americans have already suered irreversible hearing damage rom noise.

n 30 million are exposed to dangerous noise levels each day.

n Te eects o noise on hearing are oen underestimated because the damage takes place so gradually.

Excessive noise damages the delicate hair cells in the inner ear. Tis damage results in sensorineural hearing lossand oen tinnitus (ringing o the ears). Dangerous levels o noise can come rom working in noisy occupations orin engaging in dangerous recreational activities:

n Beware o dangerous recreational activities: video arcades, re crackers, discos, music concerts, shootinga gun, movie theatres, sporting events, motor boards, motorcycles, snowmobiles, boom cars.

n Occupations particularly under risk or hearing loss due to exposure to noise are as ollows: reghterspolice ocers, actory workers, armers, construction workers, military personnel, heavy industry workersmusicians, entertainment industry proessionals.

I you have to raise your voice to shout over the noise to be heard by someone within an arms length away, thenoise is probably in the dangerous range.

Some o the warning signs o the presence o or exposure to hazardous noise are as ollows:

n You cant hear someone three eet away.

n You have pain in your ears aer leaving a noisy area.

n You hear ringing or buzzing (tinnitus) in your ears immediately aer exposure to noise.

n You suddenly have diculty understanding speech aer exposure to noise.

n You can hear people talking but you cannot understand them.

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WHAT YOU CAN DO TO PROTECT YOUR HEARING

n I you work in an at-riskoccupation, check with youremployer to make sure youhave adequately protected your

hearing according to OSHAregulations.

n Limit exposure time to noisyactivities.

n Wear hearing protection, such asoam or silicone plugs or mus.Foam plugs are available atyour pharmacy while mus andspecialized ear protection canbe purchased at sporting good

stores or saety equipment stores.n At home, turn down the volume

on the television, radio, stereosand walkmans.

n Wear ear plugs or mus whenusing loud equipment (i.e. lawnmowers, power saw, lea blower).

n Buy quieter products (comparedB ratings the smaller thebetter).

n Reduce the number o noisy

appliances running at thesame time in your personalenvironment.

n Avoid medications that can bedangerous to your hearing. Besure to ask your physician aboutpossible eects on your hearing.

An Ounce of PreventionBe alert to hazardous noise. Since prevention is so critical, make sure that your amily (especially children)riends, and colleagues are aware o the hazards o noise.

Remember: One-third of hearing loss is preventable with proper hearing protection.

PROTECT THE HEARING THAT YOU HAVE NOW!

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Financial Resources

Financial assistance or hearing help is oen available to beneciaries o public assistance programs and to otherson a limited budget. First ask your local hearing center, ear doctor, or hearing healthcare proessional. He or she

may be aware o local assistance programs. Possible sources o nancial help are as ollows:

LOCAL

n Department o Social Services, Human Services (listed in the telephone directory under city and state government). In many states, Medicaid oers assistance to those with speech, hearing and language disorders whoqualiy. Medicare may provide unds or testing and medical treatment, but does not und hearing aids at thistime.

n Mayors oce (Community services listed under city governments).

n Chamber o Commerce (listed in the white pages).

SOCIAL SERVICE AND CHARITABLE ORGANIZATIONS

Local chapters o many social service organizations have special programs or people with hearing loss. Contaclocal social service organizations in your area, or local chapters o the ollowing service organizations:

Lions Clubs International KiwanisNational Easter Seals Society Sertoma InternationalUnited Way March o DimesRotary Club Optimist Club

Tere are also a number o charitable organizations specializing in hearing healthcare which at times will providegrants or hearing aids. Visit the BHI website or up-to-date inormation.

STATE

n Contact your State Department o Rehabilitation Services (or Department o Vocational Rehabilitation).

n For aid to children, try the Maternal and Child Health Service and the Youth Projects divisions o your StateDepartment o Human Services.

FEDERAL

n Te Veterans Administration provides hearing aids to eligible veterans. Veterans should contact their nearesVA oce or hospital or inormation.

CORPORATEn Your health insurance provider, union or employer may oer nancial assistance or hearing aids or audio-

logical services either through reimbursement or as part o a hearing healthcare agreement entitling you to adiscount on hearing aids.

n Many employers have exible spending accounts in eect enabling you to purchase hearing aids on a pre-in-come tax basis.

n Under the American with Disabilities Act (ADA) you may be eligible or hearing aids or other assistive tech-nology i it is needed to perorm your job.

For more specifc inormation on sources or fnancial assistance please visit us on the web

at www.betterhearing.org.


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Acknowledgements

Brian BenderDirector o Sales and Marketing

Interton, Plymouth, MN

Ruth Bentler, Ph.D.Proessor, University o IowaIowa City, IA

Richard Carmen, AuDPublisher, Auricle Ink PublishersSedona, AZ

Cynthia Compton-Conley, Ph.D.Associate Proessor & Director, Assistive DevicesCenter/Department o Hearing, Speech & Language

Sciences, Gallaudet University, Washington, DC

Patricia E. Connelly, Ph.D., CCC-A, FAAANew Jersey Medical School, Division o Otolaryngology Head & Neck Surgery, Newark, NJ

Richard W. Danielson, Ph.D.Manager or Audiology and Hearing ConservationNational Space Biomedical Research Instituteand Baylor College o Medicine, Houston, X

Dave Fabry, Ph.D.Director o Clinical ResearchPhonak LLC, Warrenville, IL

odd Fortune, Ph.D.Director o AudiologyInterton, Plymouth, MN

Judith Gravel, Ph.D.Director o the Center or Childhood Communication

Te Childrens Hospital o PhiladelphiaPhiladelphia, PA

Kathy J. Harvey, MsEd, CCC-A, BC-HISBeach Hearing Healthcare CentersVirginia Beach, VA

Patricia McCarthy, Ph.D.Proessor, Rush University Medical CenterChicago, IL

H. Gustav Mueller, Ph.D.Proessor, Vanderbilt University

Nashville, N

om Powers, Ph.D.Director o Audiology and Strategic DevelopmentSiemens Hearing Instruments, Piscataway, NJ

Ross J. Roeser, Ph.D.Proessor and Executive DirectorUniversity o exas-Dallas/Callier Center orCommunication Disorders, Dallas, X

Don Schum, Ph.D.Vice President AudiologyOticon Inc., Somerset, NJ

im rine, Ph.D.VP Hearing Research & echnologyStarkey Laboratories, Eden Prairie, MN

Laura Voll, M.S., CCC-ABusiness Manager, Grason-StadlerViasys Healthcare, Madison, WI

Te Better Hearing Institute would like to thank the ollowing sources or permission to use or extract material previously published andor or the rights to use photos and gures:

Te Hearing Journal, New York, NY.Te Hearing Review, Los Angeles, CA (www.hearingreview.com)Audiology Online, San Antonio, X (www.audiologyonline.com and www.healthyhearing.com)Sight and Hearing Association, St. Paul, MN (www.sightandhearing.com)

Auricle Ink Publishers:Te Consumer Handbook on Hearing Loss & Hearing Aids: A Bridge to Healing. 2nd Edition (2004), Richard Carmen, AuD. EditorHow Hearing Loss Impacts RelationshipsMotivating Your Loved One, Richard Carmen, AuD. (2005).

Bernaon LLC, Somerset, NJGallaudet University, Washington, DCInterton, Plymouth, MN

Oticon Inc, Somerset, NJPhonak LLC , Warrenville, ILSiemens Hearing Instruments, Piscataway, NJ

Better Hearing Institute echnical Advisory Council


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WWW.BETTERHEARING.ORG

515 KING STREET y SUITE 420 y ALEXANDRIA, VA 22314 y TEL : 703.684.3391 y FAX: 703.684.6048

your guide to better hearing. visit

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