Getting used to your new hearing aid(s) or your replacement hearing aids

There are at least three situations where people may need to get used to unfamiliar hearing aids. These are:

• When you get a hearing aid(s) for the first time
• When you get a hearing aid for the other ear, for the first time
• When you get a replacement hearing aid(s)

Trying out new aids can prove to be exhilarating and exciting or very frustrating. However, most people say that it really is worth keeping on trying.

How long does it take to get used to new hearing aids? Some people put on their new hearing aid(s) and quickly find it to be a great help. However, others do not find the hearing aid at all useful at first. What you find usually depends on, for example, your type and degree of hearing loss and how long you have had hearing loss for or how long you have been wearing a different aid for.

Sometimes this is because sound produced by the aid is too loud or too soft and/or it produces a very unpleasant sound or even a distorted sound. Often the person will become used to the new sound in time and will find it extremely helpful and the reason it sounds strange at first is because they are not used to it. (However there are times when the sound is not helpful and when the hearing aid might be broken – see the section on the left “General tips on using hearing aids and listening “.)

Get as much advice from your NHS audiology clinic as possible: Some clinics may give a lot of advice about getting used to a hearing aid, others give little or none.

Before you leave the clinic make sure that they give you a chance to wear the aid in the clinic. Then you can get an idea what it feels like in your ear as well as an idea what it sounds like. It is to be hoped that they will let you try out the aid and also give you a chance to ask questions.

Also before you leave the clinic with your new hearing aid ask the person who gives it to you for information about using the new aid and on getting used to it. Ask for spoken instructions and also ask for written instructions. It is often easier to understand the instruction booklet if somebody has given you spoken information first.

While some hospitals give very little information on using your hearing aid, others hospitals provide a variety of information and are extremely helpful. For example:

• The hospital should normally give you the manufacturer’s leaflet(s). It is to be hoped that the leaflet will not only tell you how to care for your aid but also how to get the most out of using it.
• Some hospitals may give you their own or a general leaflet on hearing aids.
• Some hospitals even hold classes for new hearing aid users.

Just in case you are not given any advice, or cannot get hold of any other information here is a short introduction to using your new hearing aid (or new replacement) aid. The following information may be helpful for new hearing aid users, for people getting a replacement aid or people getting a second aid for the first time.

Advice about getting used to a new hearing aid usually includes the following type of information. The key point is to take it step by step at your own pace.

It may be a good idea not to wear the hearing aid on your way home from the clinic because it will probably be too noisy, as you are not used to it. In fact some people who have worn their new aid on their way home from the clinic have found using the new aid so noisy that they have given up trying with it before they reach home. That is a great pity.

When you get home put the hearing aid in your ear so that it fits comfortably. Make sure that you put it into the correct ear. Wear it for a short time. Start by wearing it in a quiet carpeted and curtained place somewhere in you in your home. This should prevent echoes and ‘sharp’ noises. Just listen – you may hear nothing at first. Also, make sure that you are sitting or standing comfortably as well.When you find that the aid fits comfortably in your ear, you may feel ready to start listening.  Listen to quiet sounds at first before you try out louder sounds. Only listen to sounds which are comfortable. For example, listen to your speech (e.g. read something out loud from a newspaper) and listen to non-speech sounds e.g. put a book down on a table. Listen for a short time at first – for example 10 or 20 minutes. (You may like to try this stage on your own or you may want to try it out with another person. It’s up to you.) At first you may not want to try the aid out for more than short periods of 10 or 20 minutes. Or you may wish to try it out for longer. It is entirely up to you, there is no wrong or right amount of time to spend. Just as there is no right or wrong way to learn how to use a hearing aid. It has to be a matter of personal preference – in other words it has to depend on what you find useful.

When you feel ready you may want to go round the house listening to sounds which were once familiar. You may not hear every sound, even with a hearing aid. However, you may experience some very strange sounds. Some people say that if you can recognise sounds then the recognition of sound may sometimes help you to ignore the sounds when they are forming background noise. Later on, if the sounds are very loud then ignoring them may be very difficult. However, the fact that you can recognise some household sounds may help you to ignore them when there is a conversation.

Examples of sounds to listen out for include all household sounds in your house, for example, running taps, the kettle, the washing machine, the dishwasher, the dryer, the boiler, the fridge, the clock, the toilet flushing, light switches, etc. You may even find that you can hear the softer sounds such as the gas hissing in the fire or on the hob, the clocks, footsteps, the radio, the TV and so on.

• The next step is to listen to speech. Try reading out to yourself quite a bit. Try listening to the TV – the news may be the best because there will usually be some occasions when you can see the speaker. If you have other people to talk to then, if they are patient chatting with them can be really very useful.
•  The next step is to try out other places but try and choose places where there is not too much background noise.

Getting used to background noise: Some people find that it doesn’t take too long to learn to ignore background noise. Others find that it can take a long time. Some people find that with practise they can ignore background noise enough to manage quite a few conversations and others find it very difficult.

If you have tried your aids out and you are really not happy then take your hearing aid(s) back and ask for it to be adjusted. Give your aids a good try out. Follow the instructions given to you by the clinic. Hearing aids can be adjusted in several ways (for example the quality of sound and also the mould can be changed to suit the wearer’s needs.). If the adjustments make no difference, and you are still unhappy with the aid, then ask for further advice or possible adjustments. The problem could be because you need more practice using it or it could be because the aid has not been set properly for you or the aid could be broken or it could be a combination of any of these.

Why are hearing aids difficult to fit? For a start hearing loss can be difficult to measure. Further, even though the modern equipment is very sophisticated, finding the most appropriate aid and adjusting it in the appropriate way to meet somebody’s individual hearing requirements can be difficult. However, please note that if you are finding that the sound really does continue to be strange then go back to the audiology clinic because it may not have been correctly set for you. The fact is that even if it has been issued to you with the help of a computer either the aid itself may be broken or the aid may not have been set to meet your actual requirements. The settings recommended by the computer may only be the starting point for meeting your particular type of hearing loss.

If the extra adjustments do not help then ask if you can try a different hearing aid. Many NHS clinics have a quite a good range of hearing aids so ask if you can try all the NHS aids which may be suitable for your hearing loss. Some audiology clinics are able to supply very complex aids free to patients who have been judged to need them.  So do not rush out and buy a private aid if the first NHS aid you try does not suit you.

A typical comment from a hearing aid user: “I took my hearing aid back several times and eventually, after many adjustments, there was an improvement in what I could hear.”  

Further, if you are ever unhappy with your hearing aid, it could be that you have the sort of hearing loss which means that you have wear a hearing aid for a long time before you get used to wearing it. However, don’t put up with an aid you are not happy with, go back and ask, because it may not be your hearing which is the problem, it may be that your aid needs to be adjusted in order to meet your hearing needs. Or it may be that you need a different hearing aid.

9.ii. Hearing aid moulds: What to do if you are not happy with your hearing aid or your hearing aid mould

Hearing aids can take a long time to get used to. Hearing aids for new users and new hearing aids for existing users can take a long time to get used to. Hours of practice may be needed.

However, it’s also worth bearing in mind that the problem may not be due to lack of practice or lack of familiarity with the aid or lack of determination to use the aid. The problem may lie with the aid itself. The following problems with aids are common:

• The hearing aid may simply be broken. Hearing aids are complex instruments so there are thus many ways in which they can break – even if they are new.
• The process of issuing an aid is complex. Matching a hearing aid to someone’s hearing loss and their individual hearing needs is not a simple process. Sometimes, for example, there is not enough time in the appointment to pick up the special needs that a user may have.
• The mould may not fit well. There are several points where there may be a breakdown in the process. The impression may have been incorrectly taken at the clinic. Or the person may have an ear canal which is difficult to take an impression of. Or the impression may break on its way to the factory or the mould may be broken on its way back. Or at some stage of the process there may even have been a switch of labels.

It is important to bear in mind that none of the problems with the aid or the mould may actually be anybody’s fault. The important thing is usually, not whose fault it is but what can be done to solve the problem. 

Uncomfortable moulds: If your mould is uncomfortable go back to the clinic to find out what is wrong and whether you need a new one. (If your mould is a new one, and uncomfortable, go back to the clinic immediately to have it checked. Keep going back until you have a comfortable mould. If the mould scratches your ear canal or rubs the skin off or causes an infection you could be in for a long period of pain and trouble. For example, you may be prevented from using the aid for a long time.)

It is useful to remember that moulds may not fit because:

• Your ears change slightly over time
• The material that the mould is made from may shrink
• Some materials that make moulds become hard over time

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9.iii. There are several good reasons for not rushing out to buy a private hearing aid:

• The NHS range of hearing aids is often very extensive and there may well be an NHS aid which suits your hearing loss very well.
• The NHS aids are manufactured by firms which also make private aids. The NHS is able to afford them because of bulk purchase
• It is possible to pay hundreds of pounds for exactly the same hearing aid that is supplied free by the NHS.
• It is possible that your hearing loss requires a very special aid which is not routinely supplied by the NHS. However before you rush out to buy the special aid, it is important to realise that the NHS has, in theory, the ability to supply free private aids for those who need them.
• Your hearing loss may be one of those which takes a long time to get used to. This means that it is not the NHS hearing aid which is at fault; merely that you need to spend a lot of time practising wearing the aid before you find it to be useful to you. However, remember that it is important to take the aid back to check whether you have been given the most appropriate aid for your hearing aid before you spend hours practising using an aid which is actually not suitable for your hearing loss. 
• It is possible that your hearing aid requires further adjustment.
• Cheap hearing aids that can be bought via mail order may be generic and not tailored/programmed to suit your personal and unique hearing loss.

If you do decide to buy a hearing aid make sure that you find out about the best dealers and about the hearing aids.

Don’t answer newspaper advertisements for firms which are not listed by The Register of Hearing Aid Dispensers.

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 9.iv  Types of hearing aids

There are several types of hearing aids available.  Which hearing aid is most suitable for you will depend on your type and degree of hearing loss.  The majority of NHS hearing aids are Behind-The-Ear aids. 

Behind-The-Ear hearing aids (BTE)

These, as the name suggests, sit behind the ear with a plastic tube from the aid into an open-fit dome (non-custom- made) or an earmould which is usually custom-made to fit the ear snugly and sits inside the ear.

Behind-the-ear aids can provide the most amplification, so are suitable for all losses, from mild to profound.

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In-The-Ear hearing aids (ITE)

These have the processing part of the hearing aid built into the mould, so everything is in the ear.  In-the-ear hearing aids are more likely to need repair than Behind-the-ear aids.  These are suitable for various hearing losses.

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Completely-In-the-Canal hearing aids (CIC)

These fit in the canal and like the in-the-ear hearing aids, they have the processor built into the mould.  Again, these types are more likely to need repairing than behind-the-ear aids. These hearing aids are not usually suitable for more severe hearing losses.

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CROS hearing aids

CROS stands for Contralateral Routing Of Sound (Contralateral means “on the other side”).
These are suitable for people with normal or near-normal hearing in one ear and no useful hearing in the other ear.  The CROS aid picks up sound from the side with no hearing and feeds it to the ear with normal hearing.

A CROS hearing aid has two parts:

• a microphone and transmitter on the side with no hearing
• a receiver and amplifier on the side with normal or near-normal hearing

CROS hearing aids can be either linked with a wire (as in the picture below), or they can be wireless, working as a radio system.

CROS ear moulds are often of an open fit design so they don’t block the sounds the good ear hears naturally.

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BiCROS aids

BiCROS aids are similar to the CROS aids, but are for people with no hearing in one ear and a hearing loss in the other ear.  Sound from the side with no hearing is fed into the ear with some hearing and amplified by a hearing aid. Again, the hearing aids can be linked by wire or use radio transmission.

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Spectacle aids

These are spectacles that have the hearing aid in the arm. They can be used either with a mould that fits into the ear in the normal way, or with a vibrator that rests on the bone behind the ear (see bone conduction hearing aids below). Spectacle aids can be expensive because both an optician and hearing aid dispenser are involved in making them.
Spectacle aids are suitable for people who wear glasses most of the time. A point to consider is that if your aid has to be repaired you will lose the use of your spectacles while it is being repaired (and vice versa). It is possible to have spectacles with hearing aids fitted for both ears, although this may increase the cost significantly.

It is also possible to obtain spectacle adaptors. With spectacle adaptors the hearing aid can be attached to your spectacles. Tubing connects it to an earmould in the same way as with a behind-the-ear aid. These are only suitable for some people, so discuss this with your audiologist if you are interested. 

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Bone-conduction hearing aids

A bone conduction aid may be suitable for someone who cannot wear/use an ordinary air conduction hearing aid, perhaps because they have eczema or a very small ear canal, or they have a conductive hearing loss.

A bone conduction hearing aid works differently to a conventional hearing aid. It still amplifies sounds but with a bone conduction hearing aid the sound is not passed into your ear canal via an earmould. With a bone conduction aid, the sound is conducted (carried) through the bone in your skull. This process is known as ‘bone conduction’.

The sound vibrations are then transmitted directly from the vibrating part of the bone conduction hearing aid through your skull to the cochlea.  This means sound does not have to go through the outer and middle ears.

A bone conduction hearing aid consists of a hearing aid that has been modified and a bone conductor or vibrator fitted to a headband. The headband holds the vibrator tightly to your head, usually behind the ear on the mastoid bone. The sound vibration is carried through the skull bone to both inner ears. (Some people may find these aids uncomfortable to wear and may give them headaches and sore skin because of the pressure of the headband).

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Bone-anchored hearing aids (BAHAs) (also called Bone-anchored hearing devices)

Bone anchored hearing aids also use bone conduction to transmit sound, but rather than wearing an oscillator on the outside of the skull, an implant is inserted directly into the bone of the skull.

A bone anchored hearing aid (BAHA) consists of a permanent titanium fixture or implant (instead of a removable headband), which is surgically inserted into the part of the skull bone that is behind your ear. The vibrating part (called a ‘percutaneous abutment’) is fitted into the implanted fixture. A small detachable sound processor clips onto the abutment.

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Cochlear implants

A cochlear implant is a small electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. A cochlear implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.

The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see the diagram below).

A cochlear implant has the following parts:

• A microphone, which picks up sound from the environment
• A speech processor, which selects and arranges sounds picked up by the microphone
• A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses
• An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.

The following explanation of how a cochlear implant works is from the website:
http://www.nidcd.nih.gov/health/hearing/coch.asp

“A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognises the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognise warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone.”  

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Bluetooth enabled hearing aids

Some hearing aids are Bluetooth enabled – this means they can connect to other devices via Bluetooth. For example, you may be able to download an app to your phone that allows you to alter the volume and change the programme. If you feel this might be useful to you, speak to your audiologist to see if your aid is compatible.

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9.v. Register of Hearing Aid Dispensers held by the Health Professions Council

(Formerly held by The Hearing Aid Council)

All private hearing aid dispensers should be registered with the Health Professions Council. It is a criminal offence for anyone to dispense a hearing aid unless that person is registered with the Health Professions Council (this only applies to private dispensers and not the NHS).

The Health Professions Council offers a search facility on their website to enable you to check whether an individual is registered with the Health Professions Council: click here to go to the HPC website.

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9.vi. Looking after hearing aids

One good strategy if you wear hearing aids is to keep them in good condition.  Hearing aids are like any other piece of machinery – they need to be looked after to keep them working properly.

You may have received some advice about looking after your hearing aids from your audiology clinic. 

There are some golden rules for hearing aids:

• Don’t get them wet
• Don’t let them get too hot – by leaving them in the car glove box on a hot day, for example; or near a radiator
• Don’t let them get too cold. This can cause the battery to run down
• Keep them out of reach of children and pets – one gentleman said his hearing aid was never in the same place in the morning as he left it the night before.  This meant he often had to spend time searching for his hearing aid, often finding it under the table or one of the chairs.  One day he came down early and found his cat using his hearing aid as a toy and chasing it around the living room!
• It is important to get the tubing changed regularly as hard tubing will affect what you hear (about every 6 to 12 months is usual, though some people will need it changing more often than others)
• Avoid wearing your hearing aids whilst putting on hairspray – the tiny droplets can get in the aid and cause damage
• Don’t carry them in your pocket – if you like to take them out to give your ears a break you could put them in the box they came in or find a suitable container that will protect them from bumps and knocks (and being sat upon!)
• If you are having a problem with your hearing aid, take it back to your audiologist.

1.  One person said, “I take my hearing aid for a “check-up” every year to make sure everything’s working as it should.  It puts my mind at rest as I would hate to be without my hearing aid even for a day.”

2.  One person said that when they are wash their earmould or change the battery, they do it over a tray so that if they drop it, it doesn’t disappear under the furniture or get damaged on the hard floor.

3.  A tip from a hearing aid user who likes doing sports, but found that her hearing aids sometimes came out and on one occasion got damaged: “I use a piece of toupee tape to attach my hearing aid to my head.  It might sound silly, but it works – I can go jogging with my hearing aids in now without having to worry about them coming out.”  (You can get toupee tape from places which sell wigs and also Connevans.)

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9.vii. Why do hearing aids whistle/trill?

Hearing aids sometimes whistle (the whistling is also known as acoustic feedback).  This occurs because some of the sound amplified by the hearing aid is escaping outwards from the ear mould and this is being picked up again by the hearing aid microphone. This sound is then re-amplified, escapes from the ear mould once more, and is again picked up by the microphone. This is what causes the hearing aid to whistle.

There are several reasons why a hearing aid might whistle:

• The ear mould may have shrunk with age, so it does not make a good seal in the ear.  This allows the sound to escape to be picked up by the microphone.
• The hearing aid mould may not have been put in the ear correctly.
• There may be wax or a foreign object in the ear canal which reflects sound back out of the ear.
• The tubing on Behind-The-Ear hearing aids may be brittle and cracked with age.  (Most people find they need the tubing changed every 6 months or so, but some need it changing more often, others not so often.
• The hearing aid volume may be set too high.  (If you feel you only benefit from the the hearing aid when it is on full volume it may be worth going back to your audiologist for a re-assessment.)
• There is something close to the hearing aid reflecting sound back towards the microphone – such as a hat, hood, turned-up collar or your hand as you adjust the controls on the hearing aid.
• The hearing aid itself may be faulty.

If your hearing aid whistles regularly, you may want to get it checked at the audiology clinic.  You might also want to have your ears checked by your GP in case there is a build-up of wax.