Hearing Loss and Hearing Help: A Quick Guide for Consumers

by Richard Carmen, Au.D.

An estimated 34 million Americans experience hearing loss; worldwide, the disability afflicts 300 million people. Untreated hearing loss has been shown to lead to physical, social, emotional, and psychological problems significant enough to interfere with personal well-being, contentment in marriage, employment effectiveness, adaptability to new tasks, and overall enjoyment of life.

The High Cost of Not Treating Hearing Loss

The National Council on the Aging (NCOA) conducted a study, commissioned by the Hearing Industries Association, of more than 2000 hard-of-hearing adults and about 1700 of their family members. In its report, NCOA concluded that untreated hearing loss was associated with increased anger, frustration, paranoia, insecurity, instability, nervousness, tension, anxiety, irritability, discontentment, depression, and fear. The study also found that, in comparison with people who have sought help for their hearing loss, those with untreated loss were more likely to be self-critical, feel a sense of inferiority, suffer from social phobias, and be perceived by others as confused, disoriented, or unable to concentrate.
The physical implications of untreated hearing loss result from a phenomenon known as auditory deprivation. When a person has a hearing loss and goes only half-way--electing to use one hearing aid when two are recommended--the portion of the person’s brain that processes sound receives less stimulation on the unaided side, i.e., is auditorily deprived, than it would if the person wore two hearing aids. This reduced stimulation of the auditory portion of the brain can accelerate decline in speech recognition in the unaided ear. Researchers discovered auditory deprivation by studying a substantial number of subjects who had at least a moderate degree of hearing loss in both ears. In some cases, this diminished speech recognition was reversed when the person began wearing the second hearing aid.
The social implications of untreated hearing loss are numerous and often profound. These include more stressful marriages and damage to other important relationships; impaired job performance; misperceptions by others who mistake the effects of hearing loss for mental deterioration, confusion, aloofness, etc.; and social isolation when hearing loss makes normal conversation difficult or impossible.

Help is Available

Fortunately, there is help for hearing loss. Although in some cases there are medical or surgical solutions, usually the treatment of choice is amplification, i.e., hearing aids. In recent years, hearing aid technology has advanced to the point that nearly 90% of the instruments dispensed are digital and the formerly popular analog products have almost disappeared from the market. This is because digital technology is now so affordable and because, much like a stereo equalizer, it can manage almost any reasonable situation or challenge of sound. Therefore, the following information relates to state-of-the-art digital technology:
Digital Technology
Digital hearing instruments are available in various models that can fit almost every budget.
Because digital circuits offer tremendous flexibility, digital hearing aids are highly adaptable to the wearer’s environment. For example, they can make soft sounds automatically louder, make loud sounds softer, and cancel whistling feedback typically within 1 or 2 seconds.
They come with a wide range of options that may be appropriate for an individual consumer’s specific needs. For example, hearing aids (though not the very smallest models) may contain multiple microphones. These can help you appreciate your environment better, improve your ability to localize where sound originates, and, most important, provide you with better speech intelligibility in the presence of noise. Persons with impaired hearing may also be candidates for assistive technology, including FM and infrared systems that enable people to hear better in business meetings, conferences, or classrooms. There are also hearing aid telecoils that can improve the ability to hear on the telephone.
Many Styles
There are several choices when it comes to the size of hearing aids and how they are worn. The primary styles are:
  • completely-in-the-canal (CIC), the smallest model, which fits deep inside the ear canal and is almost invisible when worn;
  • in-the-canal (ITC), which fills a small part of the opening of the ear near the entrance to the ear canal;
  • in-the-ear (ITE), which fills part or all of the opening to the ear;
  • behind-the-ear (BTE), which is worn behind the ear and connected by inconspicuous tubing or wire to a plastic earmold in the ear canal.
The size of a hearing aid is very important to some people. Some of them are even willing to sacrifice better hearing for the sake of a less visible hearing aid. Frequently, though by no means always, a larger hearing aid with more room for optional features can offer the user greater benefit than a tiny instrument.
To learn more about your hearing, to have your hearing tested, or to find out if you are a candidate for hearing aids or other hearing help, you may wish to see an audiologist or hearing aid specialist in your area.
Both professions are licensed by states to dispense hearing aids and provide related services. Audiologists hold a graduate degree in audiology and are skilled in the diagnostic procedures required to differentiate among various pathologies of the auditory system. Hearing aid specialists, like audiologists, must meet state licensure requirements, and many specialists hold Board Certification in Hearing Instrument Sciences.
There are also physicians who specialize in the ear: otolaryngologists (also known as ear, nose, and throat doctors) and otologists.
If you are looking for a hearing healthcare provider in your area, several professional organizations offer referral suggestions on their web sites. These include the sites for:
If you have symptoms of a possible medical problem with your ears, such as drainage, impaction of earwax, pain, sudden hearing loss, or trauma to the ear, you are likely to be referred to a medical ear specialist (typically an otologist or otolaryngologist.
Some ear specialists are trained in the surgical procedure of cochlear implantation. Today, a typical candidate for a cochlear implant must have at least a severe to profound sensorineural hearing loss in both ears. A cochlear implant is not a hearing aid, but an electronic prosthetic device surgically placed in the inner ear, under the skin behind the ear to provide sound perception.

Be an Educated Consumer

Consumer education is an integral component of adjusting successfully to hearing aids and overcoming hearing loss. You can find a great amount of information on the topic in books and magazines and on the Internet. Some hearing healthcare practitioners even offer classes where you and your family are welcome to discuss personal issues with other clients and their families.
However you educate yourself, it is essential that your expectations not exceed what hearing aids can provide. You need to understand that hearing aids do not restore lost hearing. And, while today’s advanced amplification can provide valuable help, no matter what hearing aids you wear, you will not hear the way you did when you were 18 years old and had normal hearing. Unrealistic expectations are the number one cause of dissatisfaction with and rejection of hearing aids. Here are some things to keep in mind:
  • While hearing aids may improve your ability to hear in noise, they cannot eliminate background noise.
  • No matter what hearing aids you wear, you will not hear and understand everything. Not even people with “normal” hearing can do that!
  • You should not purchase hearing aids based on the good experience of a friend, because what works well for one person may not for another. By the same token, because one person had a bad experience with hearing aids doesn’t mean you will.
  • Very few primary-care physicians refer their patients for hearing tests, so don’t expect your family doctor to be much help if you feel you have a hearing loss. If you are told “just live with it,” this is well-meant but misguided advice. You need to seek help from a professional trained to diagnose and treat hearing loss.
  • If you do get hearing aids, use them in as many environments as possible. That will help you understand their limitations as well as their benefits. Discuss these limitations with your hearing care professional.
  • Generally, instruments with more sophisticated technology such as analog programmable or digital circuitry will perform better in noise. But discuss your listening needs with your practitioner so you can be fitted with the technology most appropriate for you.
  • There is such a wide range of products now that almost any technology is available in an affordable price. For example, even 100% digital hearing aids come in low, middle, and high-range price categories.
Good luck in your search!
Richard Carmen, Au.D., is a clinical audiologist who has written extensively about hearing loss, its impact, and its treatment. Much of the material in this guide is derived from The Consumer Handbook on Hearing Loss & Hearing Aids: A Bridge to Healing, second edition, edited by Dr. Carmen. This Handbook was published in 2004 by Auricle Ink Publishers, Sedona, AZ. Dr. Carmen’s latest book, How Hearing Loss Impacts Relationships—Motivating Your Loved One (2005) is filled with helpful tips for families living with a loved one resistant to help. For further information, go to www.hearingproblems.com.
All rights reserved. Used by permission.

For More Information

There is a wealth of information on the web about hearing loss and its treatment. Many non-profit hearing healthcare and consumer advocacy and support organizations offer educational materials on their web sites for persons with hearing loss or related problems. These include:
Organizations of hearing healthcare professionals also offer information for consumers on their web sites. Here are several of these:
In the hearing industry, many companies have sections on their web sites designed specifically for consumers. Among these are: