Thursday 11 August 2011

Excellent rehabilitation Article Written in 2004.

This article provides some excellent ideas for dealing with patients and their experiences of hearing aid wear.

Becoming Friends with Your New Hearing Aids

© May 2004 by Neil Bauman, Ph.D.
Question: My audiologist did not adequately prepare me for the challenges I would face in adjusting to wearing my new hearing aids. What is the best way to adapt to wearing hearing aids?—V. O.
Answer: Good question. Let's go right back to the beginning. Far too often, people have unrealistic expectations as they anticipate hearing again with their new hearing aids. For many people, the scenario goes something like this.
The big day arrives. You are excited. You should be. Today you are going to hear again! Today you will receive brand new hearing aids.
Your audiologist carefully fits and adjusts them to meet your special hearing needs. She tests you with them to be sure you hear as well as possible. You are thrilled to hear her voice so clearly with your new aids.
You proudly walk out of her office. You are now on your own with your new "ears." You look forward to a hearing adventure.
You leave the building and step out into the street. Suddenly a horrible cacophony of sounds assaults your ears. You are shocked right out of your socks! You don't ever remember traffic being this noisy. You can't stand the awful racket. Quickly you reach up and yank your hearing aids out of your ears and stuff them into your pocket—and your dream of hearing again is shattered.

Please Don't Dump Me in Your Drawer

If this has been your experience, you are certainly not alone. Close to 200,000 hard of hearing people in the UK have done the same. In fact, one in every six to eight hearing aids sold today soon lie neglected and forgotten in dresser drawers.
To the above, add the enormous numbers of hard of hearing people who only drag their hearing aids out for certain special occasions. The rest of the time their hearing aids also languish in pockets and purses or get dumped back into dresser drawers.
This is a tragedy. Hearing aids designed to live in people's ears too often are denied the opportunity to help their owners hear better. Why do people pay good money—up to £3,000.00 for each hearing aid—and then not wear them? Even more to the point, what should people be doing so that they will become successful users of hearing aids? Here are some answers.

Have Realistic Expectations of What Your Hearing Aids Will Do for You

Before you are even fitted for new hearing aids, you need to have realistic expectations of what hearing aids will and will not do for you.

1. Hearing Aids Will Not Give You Normal Hearing

Hearing aids are aids to better hearing. They are not cures for hearing loss. Hearing aids will typically reduce your hearing loss to about half of what it was before. This means that for those of us with significant hearing losses, at best, we will still have mild to moderate hearing losses. Thus, if you expect normal hearing, you will be sadly disappointed. However, if you expect to hear better, you will be pleased with your new hearing aids—particularly in quiet situations.
If you set your expectations too high, you may be so disillusioned that you may toss your hearing aids in some dresser drawer and forget about them.
For example, one elderly lady was fitted with hearing aids that allowed her to hear and understand about 95% of what people were saying. After 4 weeks, she returned the hearing aids to her audiologist and asked for a refund. Why? Because she was upset that she was still missing 5%!
She consigned herself to a life of frustration and silence, because she focused on the 5% she missed rather than on the whopping 95% she now could hear.

2. It Takes Time to Adjust to Wearing Hearing Aids

It comes as a shock to many people that they need time to adjust to wearing hearing aids. They think that adjusting to wearing new hearing aids should be like putting on new glasses—instant clear sight.
The truth is, you need to give your brain time to relearn how to hear and process all the new sounds it is now hearing—especially if your hearing loss was gradual. You gradually lost certain sounds. Now, when you put on hearing aids, all of a sudden these sounds blast your ears and you are overwhelmed.
It takes time for you to get reacquainted with the sounds you haven't heard well for decades. This does not happen in a day or even a week. Your brain needs from 30 to 90 days or even longer to complete this process—so if you give up before this time, you will think hearing aids don't work for you and you could be very wrong.

3. Everything Is Too Loud Now

One of the biggest shocks people experience when wearing new hearing aids is how loud everyday sounds now seem. The toilet flushing thunders like Niagara Falls! Clinking cutlery sounds like jackhammers. Initially, you may find you cannot stand rustling papers, running water and other everyday sounds.
However, with time, your brain will learn to turn down its internal volume control so these sounds become bearable. This is another reason you need to persevere during those first 90 days. Unfortunately, many people give up before this happens. If they had kept using their hearing aids a little longer, they would have succeeded.
People with sensorineural hearing losses also often suffer from recruitment. Recruitment is the perception that sounds increase in volume faster than they really do. Thus, if you ask a person to speak up and they raise their voice, it may seem like they are now shouting at you.
Recruitment is the result of a reduced dynamic range—that area between the softest sound you can hear and the loudest sound you can stand. Hearing aids need to amplify all sounds so that you can hear them, yet must not amplify them so much that you perceive the louder sounds as painful.
Typically, the greater your hearing loss, the worse your recruitment. Thus, you need to get hearing aids that have good wide dynamic range compression circuitry built in. This compression needs to be set properly for your hearing loss, or loud sounds will "blow the top of your head off." At least that is the way it feels.
Sounds that recruit may seem far too loud, but in reality, this is only your perception of them. In truth, they are not so loud that they are damaging your ears.

4. Hearing Aids Cannot Fix Fuzzy or Distorted Hearing

When you lose your hearing, you not only hear sounds softer, but also speech now sounds fuzzy or distorted. This is because typically you lose most of your hearing in the high frequencies. It is these higher frequencies that give speech much of its intelligence. If your ears can no longer hear these frequencies no matter how much these sounds are amplified, hearing aids will not bring clarity to your fuzzy hearing world.
However, if you still have some high frequency hearing, digital aids can be adjusted to specifically amplify these higher frequencies much more than the lower frequencies you typically hear reasonably well. This will help you hear clearer speech once again. It will not be perfect—so don't expect that—but it will be better.

5. Hearing Aids Do Not Let You Hear Well in Noise

Hearing aids work best in quiet situations when you are only 3 to 8 feet from the speaker. In noise, or at greater distances, hearing aids alone typically do not work well. In fact, not being able to hear in noise is one of the most common complaints of hearing aid users. The truth is, you may hear worse in noise than you do without wearing your hearing aids. For this you just spent £4,000.00?
If you live or work in noisy environments, make sure your hearing aids have good noise suppression circuitry. You will also find that to hear effectively in noise, you will likely need to couple your hearing aids with various assistive listening devices.
Unfortunately, few people even know that assistive technology exists, so they don't insist on having the specific features they need built into their hearing aids in order to couple to this technology.

6. You May Not be Ready Psychologically

Wearing hearing aids before you are ready psychologically is a sure way to fail. You first have to grieve for your hearing loss (i.e. work through the stages of denial, anger, bargaining, and depression before reaching the acceptance stage). It is only when you reach the acceptance stage that you are finally ready to do all you can to help yourself hear better—which includes wearing hearing aids. If you are still in the denial or depression stages, you will not give hearing aids a fair trial before relegating them to the dresser drawer.

Get the Right Hearing Aids and Features

In order to become friends with your new hearing aids, you need hearing aids that are friendly to you and your lifestyle in the first place. "Friendly" hearing aids have the features you need to hear the best you can with your particular hearing loss.
I recommend getting behind the ear (BTE) hearing aids because they are big enough to contain all the "goodies" you need, have the power you may need, last longer, need fewer repairs and are cheaper. In addition, they are easier to put on, easier to manipulate the controls and easier to find when you put them down.
What "goodies" do you need in your hearing aids? In my opinion, you should never buy a hearing aid that does not have a built-in telecoil (sometimes called a T-switch, t-coil or audiocoil). With a telecoil, you can couple effectively to personal amplifiers, FM systems or infrared system via neckloops or silhouettes and to telephones and room loops just via the telecoil. If you have a severe or profound hearing loss, you may also want direct audio input (DAI) capability and/or built-in FM receivers.
If you have to listen to people from a distance or listen when several others are talking, directional microphones can make a big difference. Better yet, get noise-canceling capability combined with directional microphones.

Use Assistive Technology with Your Hearing Aids

Noise and distance are two enemies of hearing aid users. Under these conditions, you need to combine your hearing aids with assistive listening devices such as personal amplifiers, room loops, FM systems and infrared systems. Used together, these devices can turn your hearing aids into super aids.
This is because with these devices, you are effectively moving the microphone from your ears up to the speaker. As a result, you will hear beautiful clear sound in both ears at the same time straight from the speaker's mouth. At the same time, most of the room noise is blocked out—a definite win-win situation.

Good-bye World of Silence! Successfully Adapting to Wearing Hearing Aids

If you have followed the suggestions outlined above, you now have hearing aids that will best fit your needs. You realize that hearing with them won't be perfect, but you'll hear much better than you do now. What you need to do now is learn how to effectively adjust to wearing your new hearing aids so you won't rip them out of your ears in disgust and throw them in a drawer.
In contrast to the opening scenario where the person attempted to wear his hearing aids home from the Audiologists' office, here is a better way to adjust to wearing them.
Sit down and relax in a quiet place in your home. Put your hearing aids in your ears and turn them on. Talk to yourself while you adjust the volume to a comfortable level.
Listen to the sounds around you. Do you hear the hum of the refrigerator? the creaking of your house? the sounds of a car driving by outside? the rustle of your clothes? Get used to them for they will again be a part of your life.
Learn to feel comfortable with your hearing aids. It's normal that your ears will feel full, (and probably hot and sweaty too) like you have something stuffed in them—because you do. If your earmolds hurt, go back to your audiologist to have them ground down a bit. Wearing hearing aids may feel uncomfortable to some degree, but they should never hurt.
On the first day, wear your hearing aids for only one hour. The second day: two hours, the third day: three hours. After that, add another hour a day until you are comfortable wearing them all the time. If this is too fast for you, just increase the time by a smaller amount, say 30 minutes a day.
To begin with, do not wear your hearing aids in noisy places. You need to be comfortable in quiet places first. Treat yourself to easy listening situations during your first few weeks of adjusting to wearing your hearing aids. Try not to listen to too much too soon. If sounds are too loud, turn your hearing aids down slightly. If your hearing aids begin to bother you, take them off and give yourself a rest. Put them on again later. You need time to get used to wearing them and to hearing sounds again. The key to success is to make haste slowly.
Read aloud to yourself. You may be horrified how loud or different your voice sounds. This is normal. Get used to it. This is how you really sound. Slowly you will come to like your "new" voice.
The sound of your phone ringing or the sudden ding-dong of your door bell may startle you. You may jump when doors slam, dogs bark or people cough. This too, is normal.
When you are comfortable hearing your own voice, talk to one other person in a quiet place. Have them sit between 3 and 6 feet from you.
When you are ready, wear your hearing aids outside and listen to the sounds around you. Try to identify birds singing, traffic sounds, rustling leaves, the sounds of your shoes scrunching on the sidewalk. Begin on relatively quiet streets and slowly build up to busy downtown streets.
Finally, but only after you are comfortable wearing your hearing aids in all other situations, are you ready to tackle difficult and noisy listening situations. In crowds and at parties, talk to one person at a time. Don't try to follow everyone at once. If the noise gets to you after a while, seek a quiet place. In restaurants, start with quiet, well-lighted ones. Gradually work up to noisier restaurants as you feel comfortable.
Adjust slowly and consistently to wearing your new hearing aids. You must be patient for it will take time. Remember, it takes from 30 to 90 days for your brain to adjust to the new sounds it is now hearing.
How well and how fast you adapt to your new electronic ears depends on several factors. These include: how bad your hearing loss is, the type of loss you have, how long you have had the loss, whether it happened gradually over many years or whether it was sudden, and how well your ears can discriminate different sounds.
Adapting to your new hearing aids may take a week or a month or a year—everyone is different. The important thing is to keep at it. Don't compare your progress with others.
If you only have a mild loss, you may adapt to your new aids the first day—it may be love at first sound. If your hearing loss is severe you likely will take much longer to adapt. The same is true if you have had a hearing loss for many years before doing anything about it.
However, when you finally adapt to wearing your hearing aids, something surprising happens. The day will come when you will actually feel undressed unless you are wearing your hearing aids. You realize just how much your hearing aids help you successfully cope in the hearing world. Without realising it, you and your hearing aids have become close friends indeed!

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