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CHAPTER 1: GENERAL INFORMATION

 

On this page:

Section 10 - Digital and analogue hearing aids

Section 11 - General tips on using hearing aids and listening

Click here to go to these sections on another page:

Section 5 - Is it worth getting a hearing aid?
Section 6 - One hearing aid or two hearing aids?
Section 7 - Hopes and expectations about hearing aids
Section 8 - On your first or follow up visits to the hospital
Section 9 -  Hearing aids and hearing aid moulds

Click on the links in the left hand column to see the other sections

Section 10 - Digital and analogue hearing aids

All hearing aids can amplify sound but some process sound digitally and some hearing aids process sound using analogue circuitry.

A hearing aid (either digital or analogue) has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.

The differences between analogue and digital hearing aids

Digital hearing aids are very similar to analogue hearing aids in appearance - they can be Behind-The-Ear models or the smaller In-The-Ear or In-The-Canal models, etc. (see Section 9.iv. Types of Hearing Aids). The main difference between analogue and digital hearing aids is the way that they process sound.  Digital hearing aids have a tiny computer which makes it possible to programme the hearing aid to fit an individual’s hearing loss as closely as possible.

What hearing aid users think about digital hearing aids

Opinions are divided: Some people prefer digital aids because they say that the sound is clearer than with digital hearing aids. Others like them because they say that they get less background noise.

Other people say they do not like them because some digital hearing aids have no volume control. This means that they cannot turn them up when they need or down when they need to.  However, some people find that they like not having a volume control as they found the controls too fiddly.

Some people find that the background noise is worse with their digital aids than when they had analogue aids.  Others with a directional microphone programme on their digital aids find that this can help reduce some of the background noise in some situations.

The following are what some people said about digital and analogue hearing aids:

1. I’ve found that since I’ve changed to digital hearing aids that speech is a little clearer than with my old analogue aids. 

2. It took me a long time to get used to my digital hearing aids, but now that my ears have got used to them, I find them just as helpful as my analogues were.

3. I’ve found these digital hearing aids a bit disappointing - a friend had some and she found them a big improvement, but I find that they don’t seem to work as well for me.  I sometimes wish I could go back to my analogue aids.

4. I’m really pleased with the digital aids I have at the moment, but the first ones that I was issued with I found very difficult to adjust to as they didn’t have a volume control.  I found that I was leaving them out more than I was wearing them as it was always too noisy.  I went back to my clinic and asked if I could have aids with a volume control.   I had to ask several times, but in the end, they gave me these ones, and they are so much better - I can wear them in most situations now - it does pay to be persistent sometimes.

Action on Hearing Loss has a selection of leaflets and factsheets about hearing aids including one on bone conduction hearing aids; click on this link to go to their page on Leaflets and Factsheets.

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Section 11 - General tips on using hearing aids and listening

1. Some people said that when they cannot follow people, their first step is to try to work out why they don’t understand them. If they manage to work out the cause of the problem they ask them to do whatever they feel is necessary. Sometimes they might need them to slow down and at other times they need them to speak up. Sometimes they need to ask them to do both. When possible they give an explanation. (See point 9 below.)

2. One person said “I try to ask nicely and not get annoyed with people who speak to me. I try to be polite and friendly and not snap through clenched teeth even if they do not speak in a helpful way. I also try not to get annoyed if I have asked them to be more helpful many times before and even if I’ve explained several times before.

It’s sad, but people forget. But I do find that if I manage not to get annoyed when I remind them, then some people often do try a bit harder even though some forget again in a few minutes.”

3. I ask people to slow down so that I can hear what they say: Why? I find that I hear better when people speak slower. Slower speech also helps me to lipread more effectively.

4. Noisy backgrounds: There were various strategies suggested for this. The strategies depend on people’s personal preferences and their type of hearing loss and the type of hearing aids people have. Some people said that they have used one strategy for years but now use a different strategy. Some people use different strategies depending on the situation they are in. For example, they might use one strategy in traffic and another strategy in a room full of speakers.

  • Some people turn their hearing aids down when there is a lot of noise. Some scientists say that this is helpful because turning the hearing aid down improves the signal-to-noise ratio.
  • Some people turn their hearing aids off and take them off. People who do this are usually people who cannot hear any sound through a hearing aid which has been switched off. (There are a number of reasons for this. For some people this will because of the severity of their hearing loss. For others it will be because the mould in their ear is blocking off all the sound. For others it will be for both reasons.)
  • Some people switch their aids off and leave them in. (There are a number of reasons for this. For some people this will be because the mould in their ear does not block out all the sound and they can still hear something useful. Sometimes people may leave their aids in because there is so much noise that they want to block it out.)

Warning sounds: Please note that in some situations, people may not hear warning sounds if their aids are switched off.  This is something to think about. If you decide to switch off your hearing aids, if you can hear nothing when they are left in it might be advisable to take them out. On the other hand if you need to switch them on in a hurry, and you wear two rather then choose to leave them both in or out it might be better to have one in and one out. (A decision for you to make. Some experimentation would probably help before you make up your mind.)

Hearing aids without volume controls: Many digital aids are issued without a volume control. If you feel that you are having to switch your hearing aid off in noisy situations because you have no volume control and therefore cannot turn it down, we would recommend that you go back to your audiology clinic to get help. Tell them about your problems. They may be able to adjust your aid in some way. If you still have a problem after the aid has been adjusted go back and ask for further adjustment. There are many ways in which the aid can be adjusted so please do not give up.

However, if after adjustment you still have a problem then ask for an aid with a volume control. A volume control may solve at least some of your problems.

(See other chapters for example, Chapter 4: "Crowded Rooms" and Chapter 5 "Out of Doors")

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5. Keeping alert to noises going on around you: People have found that different strategies work for them. For example:

  • One person said: I try to keep alert all the time to people speaking or noises going on around me.
  • Another person said: I deliberately take rests from listening. I leave my hearing aids switched on and I get on with something wholeheartedly and in a concentrated way. At home and at work, they know I have a hearing loss and if people want to speak to me they make sure that they catch my attention. Indeed at home I like to read a book or get on with my other hobbies whenever I can. Sometimes I get on with household chores! I find that these periods of time when I don’t stay “on alert” give me a real chance to relax.

6. It can help if the speaker does not keep increasing and reducing the volume of their voice: Whenever possible, I ask the speaker to keep a level volume because it is hard if speakers raise and lower their voices as I have to keep adjusting my hearing aid.

7. It helps if people do not shout: I ask people not to shout and I explain why. When people shout it distorts the sound of their voice and so I cannot hear what they are shouting. It also distorts their mouth and this makes lipreading more difficult.

8. A lot of people need the speaker to talk louder:   If people do not speak loud enough you could try asking them to speak louder. This can be very helpful.

However it is useful to remember that when somebody raises their voice, some of the subtle nuances and inflections are sometimes lost and their voice may sound hard and unsympathetic when they do not mean to sound unpleasant. This can lead to misunderstandings. Looking at their expression may help; however, somebody talking louder than their usual volume may have a strained expression even though they are not feeling annoyed.

9. Some people are more helpful if they are given an explanation: Many people find that it is often really useful to give explanations.

The following comments sum up the issues in a useful way. One person said:

I find that explanations are very helpful with people I know and also with new people who seem to be friendly and cooperative types.

I give two sorts of explanation depending on the situation. Sometimes I explain what my problem is and sometimes I explain how they can help. Sometimes I do both.

For example:  I might say that “I have a high tone hearing loss and that means that I hear some sounds better than others. So please excuse me if I don't hear everything you are saying and ask for repeats."

Or I might explain that “I don’t hear so well so would you mind slowing down a little so that I can hear you better”.

I find that it’s worth practising what to say. I practise (rehearse) what to say in an empty room and in private.

10. Loop systems and other helpful additional equipment: For information about the loop system see for example, Chapter 6: "Environmental aids and strategies for TV, etc".

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11. Removing moisture from the hearing aid tubing and mould. The first thing to do is to see whether your audiology clinic has given you any advice about this. Some clinics provide handouts and booklets about this. They often have very useful diagrams.

Not everyone gathers a lot of moisture in their hearing aid tubing and mould. There are a number of different strategies for removing moisture from the hearing aid:

  • Some people remove the mould and push a pipe cleaner through
  • Some people remove the mould and blow the moisture out
  • Some people remove the mould and shake the moisture out
  • Some people remove the mould and use a puffer to puff the moisture out. Puffers can be bought from places like hearing aid shops. Some NHS clinics may also provide them
  • One person said: I always carry a piece of round elastic: I find that elastic is good for pushing through the hearing aid tube to remove the moisture in damp conditions.

The main thing is not to blow, shake or push the moisture into the aid itself because that will probably damage the electronics of the aid.

People who are drying out their aid tubing and moulds at night time:

  • Some use one or more of the above strategies
  • Some people find that it is enough just to keep their aid in a warm dry place (but not on a radiator as this will probably damage the aid and the mould.)
  • Mail order companies such as Action on Hearing Loss Solutions (http://www.actiononhearingloss.org.uk/shop.aspx) and Connevans (www.deafequipment.co.uk) may be able to supply puffers, etc.
  • Some people buy drying crystals from the chemist or a hearing aid shop

(With regard to hearing shops. In some areas they are the only suppliers of puffers and drying crystals. But do not feel obliged to buy a private hearing aid because it is likely that you will be given as good, if not better hearing aids by the NHS. It may interest you to know that the NHS and private hearing aid shops usually use the same manufacturers because they are both looking for a high quality product.)

12. I always carry my hearing aid book: I always carry my hearing aid book so that I can get help (e.g. batteries, soft tubing and repairs) from any NHS hospital or clinic. Sometimes I have been on holiday when my hearing aid has broken down and having the book meant that I did not have to beg for help. Having the book also meant that the audiology clinic in the holiday town could see how the aid had been adjusted by my own clinic to suit my needs and so it meant that they could quickly adjust the aid to suit my needs.
 
13. I always ensure that my aid is in "tip top" condition: As soon as it starts breaking down (e.g. crackling, producing intermittent sound or inadequate volume) I take it back to the clinic for repair or exchange.

(Please note that if your aid does not seem to be producing enough sound it is possible that you need a different aid.)

14. Look after your aid and keep it dry: Do not allow your aid to be sprayed with water, shampoo, perfume or lacquer etc. If I do get spray onto my hearing aid I wipe it of quickly with a damp cloth. Also, if my aid gets wet I dry it near the radiator but I never put it on the radiator as this can destroy it.

15. A lot of people say that they always keep their aid in the same place: When they take their aid out, they always put it in the same safe place so that they can find it more easily in a hurry.

16. I always carry spare batteries and tubing: Carrying spare batteries has helped me on many occasions because batteries can suddenly need replacing – sometimes in the middle of a conversation. I have occasionally needed spare tubing – especially when on holiday.

17. Spares for holidays:  When I go on holiday abroad the NHS clinic lends me a spare hearing aid in case my aid breaks down. They also lend me extra batteries to take with me.

If they won’t lend you a spare digital aid then ask whether they have got any spare analogue aids. Some people who have had their analogue aids replaced by digital aids have been allowed to keep their old analogue aids either while they get used to digital aids or as spares in case their digital aids break down.

One person said: I wear two hearing aids. When the hearing aid on my better ear broke down I replaced it with the aid from my worse ear. The result was not wonderful, but it was far better for me than hearing nothing.

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18. Wax: Excessive wax can reduce the amount sound we hear as it may block the external auditory canal. Wax can also block the hearing aid mould.  (See point 19.)

One person said: I get my ears regularly checked for wax. I do make too much wax but I am never embarrassed about my wax because we need wax to keep our ears clean. Wax is anti-fungal and anti-bacterial. So, if a technician is rude enough to handle my mould as if “it is something the cat brought in” I tell myself I would rather have too much wax than too little.

19. It’s a good idea to keep the hearing aid mould clear of wax and other obstructions: You may want to ask whether your clinic has instructions for removing the wax from the earmould.

It’s also a good idea to wash the earmould every few days or more often if needed:

  • Detach the mould and soft tubing from the aid.
  • Only wash the mould (and not the aid itself) with soapy water
  • Rinse the earmould very well.
  • Never use detergent

(See point 11 above about removing moisture.)

In-the-ear hearing aids don’t have a mould that detaches from the aid and should only be cleaned with a dry cloth or according to the manufacturers’ or the dispenser’s instructions.

IMPORTANT: If you have two hearing aids make sure you know which earmould goes on which hearing aid.  Each hearing aid will be tuned to suit the hearing loss in one particular ear, so putting the wrong earmould on the aid might mean the aids don’t work as well. 

Some audiology clinics mark the hearing aids with a small blue mark for the left ear and a red mark for the right ear.  Sometimes the marks are on the outside of the aid and sometimes in the battery compartment.  If you think having the aids marked in this way would help you, you could ask at your clinic if they could mark it for you.

Your clinic may be able to give you instructions for washing your earmoulds.

20. Replace the soft tubing on behind-the-ear hearing aids when needed: If the soft tubing goes hard or splits either replace it yourself or take the aid back to the clinic to be replaced. (When the soft tubing goes hard the acoustic properties of the tube change and this changes the sounds you hear.) Some people say that it needs changing at least every six months.

21. Replace the cord on body-worn hearing aids: If the cord goes hard or changes colour, get a new cord from the audiology clinic. (Cords should be soft and "pink". Older cords can become hard or blue or grey or gold coloured.) Either replace the cord yourself or ask the clinic to replace it. Some people say that it needs changing at least every six months.

22. Forward facing microphones and backward facing microphones: I find that hearing aids with forward facing microphones are the best for me than aids with backward facing microphones. I find that with backward facing microphones I can hear the conversation behind me better than I can hear the person speaking to me.

However some people prefer to have backward facing microphones. Some other people like to have hearing aids with both forward and backward facing microphones. There has been a lot of new work done on microphones and it really is worth trying out the aids your audiology clinic offers you.

Omni-directional microphones pick up sounds from all directions and are perhaps the most useful in most everyday situations where it is important to pick up sounds from all around.  People can then switch to their directional microphone when they find themselves in a noisy situation.

23. One person said, “I am always on the look out for a better hearing aid: The NHS brings out new ones periodically. When new aids are brought out I ask the clinic if they suit my type of hearing loss and if they do I ask whether I can try them.”

(NB Some audiology clinics may be quite helpful with regard to changing hearing aids. Some are not. Some are very helpful if a person has a hearing loss which is difficult to fit.)

24. Avoiding background noise: Whether you are indoors or outdoors, most people find it best to get as far away from background noise as possible.

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25. You may find it helpful to position yourself in the best place to hear if possible when there is background noise: Whether you are inside a room or building or outside, you may find that some places are better to hear from than others. It is often a matter of experimenting. It will depend on all sorts of things. For example it may depend on your type and degree (amount) of hearing loss. It may depend on whether you wear one hearing aid or two. (Some people say that two aids are better than one aid when there is a background noise.) It may depend on where the hearing aid microphones are placed – whether they are forward facing, backward facing or omni-directional.

For example:

  • If you are in the middle of a room there may be noise all around you.
  • If you are next to the wall, or in the corner of a room you may be surrounded by echoes. Or the wall may serve to enhance the sound for you. Responses are personal.
  • However, if you are next to a soft surface e.g. a curtain, a flock wall paper or your chair has a soft back they may absorb some of the echoes – even if you are next to a wall these may all be helpful.
  • It is usually a good idea you be away from sources of noise. For example, if you are at a restaurant it usually helps to be far away from the kitchen.

The best place for you to be may depend on the position of your microphone: You will need to experiment. For example, if someone has a forward facing microphone then they may not want to face the source of noise. However if the microphones are backward facing then you may not want to have your back to the noise. If your microphones are omni-directional then there will be other issues to think about and experiment with. For example, it will depend on whether you can control the direction of sound.

26. I have a good side for hearing and a bad side for hearing: I always ask people to be on my good side. If I don't feel up to asking I just try to "arrange things" so that the speaker is on my good side.

See Section 6 earlier in this chapter for information about two hearing aids rather than one hearing aid being useful for some people with a good and bad side.

27. I want clarity not volume: In general it is best not to turn the hearing aid up to full volume because if the aid is turned too high the sound gets distorted.

One person said: I am gradually losing my hearing, so when I get to the point where I need to turn the volume too high I go back to the clinic to ask for a more powerful aid.

Incidentally some people are finding that digital hearing aids are producing a clearer sound for them and so they do not need top have the volume as high as on their analogue aids. However, quite a few people do not find this to be so.

28. Hearing in bed: One person said, “In bed I choose the side of the bed whereby my good ear is uppermost so that I can hear my partner.”

29. Some children can be very helpful: It is worth encouraging children to help as they can become very helpful indeed as well as enjoy helping. Children are often very understanding if they are told why it is difficult to understand them. They also often appreciate an adult who will give them full attention because adults often don't listen to children. Children often do need to be told how to help e.g. speak more slowly, and to look at you when they speak. It can make a lot of difference if you get down to their level or get a bit closer to them. (But not frighteningly close). They may be interested in seeing your hearing aid and perhaps even being told a little about how it works.

For people with high tone losses many children’s voices can be very difficult to hear as they can be so high. However, if a child has a helpful approach they may well be more understandable if they are asked to slow down or speak louder etc. Incidentally, children’s voices do tend to drop as they get older (10 - 12), and for some hearing impaired people this will make them better to hear.

Some people said that they found that their grandchildren extremely helpful. Some also said that their grandchildren had enjoyed learning fingerspelling and had even taught it to their schoolfriends.

Quite a few people have said that they found that their grandchildren were much more helpful than their children.

30. Speakers who mumble: With speakers who mumble I turn up the volume of the hearing aid to see if that helps me. I also use lipreading and if neither helps me I ask the person to speak up.

Others have said that as soon they find that the speaker is mumbling they ask them to slow down a bit.

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31. Some people said that they look out for shops and banks displaying the international ear symbol (shown below) as this might mean there is somebody around who has been trained to communicate with deaf people and/or they might have a loop system.  (There is more information on the Ear Symbol in Chapter 1, Section 24)

dia_etsi_symbol      ?image_id=1398295

The international ear symbol on a glass window at a position in a bank or train station, etc, often indicates that the window may be looped (especially if there is a T in the bottom right hand corner). It would be worth trying the "T" switch on the hearing aid. Ask if the window loop is switched on. 

32. One person said, “I try to stay relaxed: I try not to panic if I can't hear. I try to keep calm. I find that these are helpful to me.”

Some people have reported doing regular relaxation exercises makes them more relaxed in general and enables them to deal more effectively with the effects of their hearing loss.

A relaxation exercise.  (There are other relaxation exercises in Chapter 1, Section 27: Tinnitus)

  1. Choose a quiet place where you won't be interrupted.
  2. Before you start, do a few gentle stretching exercises to relieve muscular tension.
  3. Make yourself comfortable, either sitting or lying down.
  4. Start to breathe slowly and deeply, in a calm and effortless way.
  5. Gently tense, then relax, each part of your body, starting with your feet and working your way up to your face and head.
  6. As you focus on each area, think of warmth, heaviness and relaxation.
  7. Push any distracting thoughts to the back of your mind; imagine them floating away.
  8. Don't try to relax; simply let go of the tension in your muscles and allow them to become relaxed.
  9. Let your mind go empty. Some people find it helpful to visualise a calm, beautiful place such as a garden or meadow.
  10. Stay like this for about 20 minutes, then take some deep breaths and open your eyes, but stay sitting or lying for a few moments before you get up.

(Source www.bbc.co.uk)

Another quick relaxation exercise is:

Quickie Relaxer

  1. Close your eyes and draw your attention and concentration inward.
  2. Smile inwardly with your mouth and eyes.
  3. Say to yourself "Alert mind, calm body."
  4. As you exhale, let your jaw, tongue, and shoulders go limp.
  5. Feel a wave of warmth and heaviness sweep down to your toes.
  6. Enjoy the feeling of peace and relaxation that this brings.
  7. Open your eyes and resume normal activities.

source: http://www.csupomona.edu/~jvgrizzell/kin370/extras/quickrelaxers.html


33. Understanding accents: Some people find that it helps them to hear and understand better if they can identify the accent. The problems with accents can include not just different sounds but also different stress patterns and rhythm. (Knowing the accent also helps me to lipread.) I also ask people with an unfamiliar accent to slow down, look at me, etc. Sometimes another person can help by relaying (repeating) what the speaker says. I usually find that I can follow the accent better as I get to know the person better. (If someone with an accent asks me for directions, I ask them to write place names down or spell them or point them out on the map. In some situations I also find it helpful to explain that I am hard of hearing. I never blame their accent but I do sometimes explain that as they have a different accent it may take me a little time to get used to their accent.

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