CHAPTER FIVE
Hearing Aid Technology and Rehabilitation
Robert W. Sweetow, Ph.D.

There are many myths and misconceptions regarding hearing aids. The objective of this chapter is to prepare you with accurate up-to-date information to help in your decision to upgrade or try new hearing aids. Keeping up to date is very important, and sometimes difficult to do because technology is changing so rapidly. But in today’s world, consumers need to be educated so that they can work together with their professional to make the best decisions possible. This chapter addresses questions you may ask yourself before and even during your test drive of hearing aids.

“Am I a candidate for hearing aids?”

Forty years ago, many hearing healthcare professionals believed that only people with hearing loss due to outer or middle ear problems (conductive hearing loss) could be helped by hearing aids. Patients were often told that hearing aids could make sounds louder (like turning up the volume on a radio), but would not necessarily make sounds clearer. This thinking was reinforced by reports of unfavorable results from those hard of hearing patients who did try hearing aids and who still couldn’t understand speech clearly—particularly in noisy places. Of course, it’s now recognized that early attempts to fit hearing aids on people with nerve damage (sensorineural hearing loss) were seriously hindered by the limited sound quality produced by these early devices; by the limited choice of electronic variations; and by inadequate fitting strategies used in trying to determine the best manner to amplify speech without making it too loud or too noisy.

In the early days of fitting hearing aids, professionals often tried to determine who was a candidate on the basis of the degree of hearing loss shown on the hearing test. Simply considering the degree of hearing loss, however isn’t adequate to describe the impact hearing loss has on your life. Indeed, it oversimplifies the complexities of hearing impairment. By using a more “holistic” approach to identifying and correcting communication difficulties, not just hearing loss, we realize that candidacy is based more on your communicative needs rather than purely on test results obtained in a soundproof room. That is, your own personal, subjective needs. A good litmus test is to ask yourself whether you feel stressed or fatigued after a day of straining to hear. Hearing aids may simply relieve this strain, rather than making sounds louder or allowing you to understand all speech in all listening environments. Reducing strain alone can be very important, not only to you, but to those trying to talk to you. Therefore, properly fitted hearing aids can provide benefit even if you have a relatively mild hearing loss.

It was also incorrectly believed that you couldn’t use hearing aids if you had normal hearing for low-pitched sounds (up to 1500 or 2000 Hz); if you had a hearing loss in only one ear; if your speech understanding abilities were reduced; or if you had difficulty tolerating loud sounds (for example, a crying baby). Advances in technology now allow for good fittings for most patients these experiencing these problems. . .

Unfortunately, despite need, many people resist trying hearing aids. There are three main reasons for this resistance.

First is hearsay. A lot of us have friends or relatives who have purchased hearing aids that currently reside in their dresser drawers. These unsuccessful wearers of amplification are more than happy to spread the gospel on the limitations (some accurate, some not) of hearing aids. Often, unsuccessful experiences occurred in extremely difficult listening environments in which even people with normal hearing had trouble understanding speech.

Second, despite the fact that people of all ages have hearing impairment and use amplification, there has been an undeniable social stigma attached to wearing hearing aids. The problem of vanity has been eased, in large part, by the continuing trend toward hearing devices that can barely be seen. However, not all listeners with hearing loss are candidates for these devices. . .

On the other hand, keep in mind that it’s very possible you’ll be pleasantly surprised. Remember that, as will be discussed later in this chapter, there have been more changes in hearing aids during the last few years than in the previous forty.