Hearing Level / Hearing Loss

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Taking Action - Introduction to Hearing Aids

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Introduction to Hearing Aids
Hearing Aid Categories
Styles of Hearing Aids
Assistive Listening Devices (ALDs)
Alerting Devices
Telecommunication Devices
Relay Services
Realistic Expectations
Frequently Asked Questions

INTRODUCTION TO HEARING AIDS

Hearing aids provide a way for sound to move through the ear and to the brain. It is important to begin using hearing aids with children as early as possible. In fact, the earlier your child has sound stimulation, the easier it will be to develop speech and and communication skills.

When thinking about hearing aids, it is important to remember hearing aids will not make your child's hearing normal. They do, however, make sound loud enough so that it can be interpreted by the brain. The brain is considered the most important part of the hearing system.

A hearing aid has three main parts.

Microphone: Picks up the sounds and changes it into an electrical signal
Signal Processor: Makes the sound louder and may strengthen or weaken parts of the signal
Speaker: Changes the signal back into sound that is delivered to the ear

“Listening devices” sold over the counter are not the same as a hearing aid because earing aids must be set so that they provide the correct amount of amplification for each frequency or pitch. The way that the hearing aid is programmed depends upon the type, degree, and shape of the hearing loss. They are programmed to make soft sounds louder at the same pitches the hearing loss occurs. Your audiologist will provide your child with the most appropriate amplification for their hearing loss.

Amplification or Processing with Analog or Digital Hearing Aids
Graphic is a representation of the difference between an analog and digital hearing aid. There are two ways to classify hearing aid types. The first is how the sound is amplified or processed (analog or digital). The other is how the hearing aid delivers the sound. Sound is delivered either by air conduction through the ear canal, or by bone conduction behind the ear.

Analog
An analog hearing aid has a simple circuit. The sound is picked up by a microphone and is changed into an electrical signal. The electrical signal is amplified and filtered. The electrical signal is then changed back into sound that is delivered to the ear. Many analog hearing aids have been replaced by digital hearing aids due to advances in technology.

Digital
A digital hearing aid has a circuit that is more complex. The sound is picked by the microphone and changed into a special digital code. The way the code is constructed determines the way that the sound is processed. After the sound has been processed, the signal is changed back into sound and delivered to the ear. Manufacturers have developed special codes to manipulate the sound in different ways. Their codes are based on models of the way the ear works.

Digital hearing aids are more flexible than analog hearing aids. They are also more expensive. However, as technology improves, the price of digital hearing aids will be reduced and more people will have access to them.

Air Conduction and Bone Conduction Hearing Aids
The second way to categorize hearing aids is by how the sound is delivered. Sound is delivered by air conduction through the ear canal or through the bone behind the ear.

Air Conduction
Most hearing aids deliver the sound to the ear by air conduction or through the ear canal. This type of hearing aid is appropriate for children with a sensorineural hearing loss. Some individuals with a mixed loss or a conductive hearing loss may also benefit from this type of hearing aid.

Bone Conduction
If a child has a conductive hearing loss, the audiologist might recommend a bone conduction hearing aid. These hearing aids deliver sound through the mastoid bone behind the ear. In a few cases, this is the most appropriate type of hearing aid.

Your child's audiologist determines the type of hearing aid that will be used. The audiologist bases decision on a number of factors. These factors may include the type, degree, and shape of the hearing loss, the age of the child, the activity level of the child, and the financial resources.

It is very important for you to understand why your child's audiologist recommends a particular type.

HEARING AID CATEGORIES

This graphic is a representation of an air conduction hearing aid. Most hearing aids deliver the sound to the ear by air conduction through the ear canal. This type of hearing aid is appropriate for persons with a sensorineural hearing loss. Some individuals with a mixed loss of a conductive hearing loss may also beneift from this type of hearing aid.

This graphic is a representation of an a bone conduction hearing aid. A bone conduction hearing aid works by conducting, or carrying, sound through the bone behind your ear. The vibrations of the sound are transmitted directly from the vibrating part of the bone conduction hearing aid through the skull to the cochlea. This avoids the outer and middle ears. If you wear ear plugs, you will notice that your own voice stills sounds fairly loud. This is because you are hearing your voice through bone conduction.

STYLES OF HEARING AIDS

The style of a hearing aid refers how and where it is worn. There are three basic styles of hearing aids. The first is the body worn hearing aid. This style is rarely used today due to major advances in hearing aid technology. The most common hearing aid styles are the behind-the-ear hearing aid (BTE), and In-the-ear hearing aid (ITE). These two styles of hearing aids can accommodate most hearing losses.

ITEs can be broken down into additional styles. These are the in-the-canal (ITC) and completely-in-the-canal (CIC) hearing aids. These styles were created for adults who had already developed language skills before acquiring a hearing loss. Adults are often willing to compromise hearing ability for appearance. This is an unacceptable risk with children. Children need the best auditory signal that can be provided. ITEs may be an option for some children when they are older.

For young children who have not yet had the opportunity to learn speech and language, the BTE hearing aid is the most appropriate. BTEs offer a number of advantages over other styles of hearing aids for young children. The most important advantage is their flexibility in providing adequate access to sound stimulation for development of the hearing center in the brain.

Hearing Aid Styles

This graphic is a representation of hearing aid styles.

Benefits of Behind the Ear (BTE) Hearing Aids
BTE hearing aids can be use with the mildest hearing loss as well as the most severe. Even children with profound hearing loss may benefit from super power BTEs. Following are some of the reasons why BTEs are the best option for young children.

Safety - BTEs can have tamper proof battery doors to prevent children from swallowing the battery. Batteries are toxic and may cause burns.

Feedback - Feedback is the irritating "whistle" that a hearing aid makes when it is not fitting properly or when something, like a car seat, is too close to the hearing aid. Feedback is less of a problem with BTEs.

Earmolds - Earmolds may need to be changed 6 to 8 times each year because the baby's ear canal grows rapidly. The BTE earmold can be easily separated from the hearing aid.

Cleanliness - The earmold can be removed for regular cleaning.

FM Use - FM systems are used with hearing aids in the car, the house, or in school to improve the quality of the sound. BTE hearing aids can be ordered with FM system compatibility.

Consistent Use - BTE hearing aids are easier to handle, less likely to be misplaced or lost, more durable, have fewer repair problems, and have less feedback. This facilitates more consistent hearing aid use.

ASSISTIVE LISTENING DEVICES (ALDs)

Assistive listening devices (ALDs) are electronic devices used either with hearing aids and cochlear implants or instead of them. An ALD amplifies sound. A microphone picks up sound on an ALD system that is placed at or near a speaker’s mouth. A listener is able to adjust the volume on the ALD receiver to increase the loudness of the speaker’s voice over the background noise. There are several types of assistive listening devices.

To use an ALD with a hearing aid, the hearing aid must have a telecoil (or t-switch) or a direct audio input (DAI) jack. With the telecoil, the child must have a neckloop or silhouette to “patch” the hearing aid to the ALD. With the DAI jack, direct audio input “boots” or “shoes” are needed.

Personal Amplifier
This is a simple unit that has a microphone and amplifier. The speaker holds or wears the microphone which is connected to the unit with a wire. The listener keeps the receiver and controls the level of sound by adjusting the volume on the receiver and/or hearing aid. Personal amplifiers are good for one-on-one conversations when the speaker and listener are near one another (extension cords are available for the microphone). The microphone of a personal amplifier can be placed near the television or radio for easier listening. Personal amplifiers are portable and easily moved from one area to another.

FM System
A frequency modulation (FM) system uses radio frequencies to transmit sound. The Federal Communications Commission (FCC) allows FM systems to transmit on a small band of megahertz or frequency waves. An FM system is wireless. Sound is sent from a transmitter to a receiver by radio waves. The listener and speaker can be up to 500 feet apart, yet to the listener, the speaker's voice sounds as if they are standing next to one another. The voice signal from the speaker using the microphone is usually louder than surrounding background noises. FM systems are portable and easily moved from one area to another. Behind-the-ear hearing aids are available with an attachable FM radio-receiver for use with a compatible FM radio-microphone.

Even if children use an assistive listening device such as an FM system as their primary amplification, they should reserve time during the day to listen through environmental microphones rather than FM microphones so that they can develop sound localization skills.

Infra-red System
An infra-red system is wireless. Sound is sent from a transmitter to a receiver by light waves. The infra-red system produces a very clear signal, but since it is a light ray, the signal is susceptible to interference from incandescent and natural light. Infra-red systems are frequently used in theaters.

Induction Loop System
A loop system often encompasses an entire room or portion of a room. Loop systems are made of wire connected to an amplifier. A microphone is connected to the amplifier. The speaker holds or wears the microphone. The hearing aid wearer switches their hearing aid to the telecoil position and sits near the loop. The electro-magnetic energy from the loop is picked up by the telecoil in the person's hearing aid. For a hearing aid with a telecoil, a special receiver is not needed to access the induction loop system. Special receivers are available for people who do not wear hearing aids or do not have a telecoil in their hearing aid. Loop systems can be permanently installed in a room or remain portable. Loop systems are not very common in the United States.

Captioning
Captioning is text of spoken dialogue and sounds. Captioning gives deaf and hard-of-hearing persons equal access to information and enables them to participate in any process. Captioning also helps individuals who speak English as their second language and children learn to speak, read and write English. There are many types of captioning.

Closed Captioning (CC)
This is also known as stenographic captioning. It uses a court reporter's skills to capture spoken words and project them onto a television screen where they can be read. The court reporter's computer is connected to a TV station's encoder, which then transmits the captioned material via TV signal directly to any television, wherein a decoder chip decodes the signal and displays English text onto the television screen. The text display of spoken dialogue and sounds from TV programs, videotapes or DVD is visible only to those using a caption decoder or a TV with a built-in decoder chip. A decoder chip is required for televisions with a 12-inch or larger screen manufactured after July 1993.

Open Captioning
This is a text display of spoken dialogue and sounds from TV programs, videotapes or DVD and is visible to anyone. The captions are visible without a decoder or built-in decoder chip.

Real Time Captioning
Real time captioning is also called Communications Access Real-Time Translation (CART). Like closed captioning, it employs a court reporter's ability to capture the spoken word and visually project it onto a wall or a screen as text to read. Captioning is simultaneous with a live event. Real time captioning is most often used in classroom settings, meetings, seminars, and conferences.

Computer-Assisted Notetaking or Transcription
Computer-assisted notetaking or transcription (CAN) is a less precise and less sophisticated way of providing printed, real-time communication compared to Real-time captioning. With CAN, a skilled typist uses a laptop computer (with no special software) and sits next to the person who is deaf or hard of hearing. As they type what is being said, the "captions” appear on the computer screen. No special training is needed for CAN. It may be useful in certain situations, but is not recommended as a method to provide quality, real-time captioning.

Computer Software
Computer programs are available that translate abbreviations into words for a deaf or hard of hearing person to read. A typist can type faster by using abbreviations rather than complete words. The computer software programs translate or expand the abbreviations or "shorthand" into complete words. Trade names for these include C-Print, TypeWell, and others.

ALERTING DEVICES

Alerting devices use a flashing light, louder than normal sound, or vibrations to alert a deaf or hard of hearing person. Alerting devices include such things as a doorbell signaler, telephone signaler, smoke alarm signaler, wake-up alarm signaler, severe weather signaler, and baby cry signaler. Specialized equipment for people with a hearing loss must be purchased through vendors.

Alerting devices for clocks can emit very loud sounds, flash a lamp or strobe light, activate a pillow shaker/vibrator that plugs into the clock, or do all of these things.

Alerting devices work similar to alarm clocks and are available for smoke alarms, doorbells, and telephones. Alerting devices signal when a telephone rings by plugging a special cord into a telephone line that flashes a light or vibrates to alert the person of a call. Some vendors make all-in-one alerting systems that have wireless transmitters that can be easily placed next to existing fire alarms or doorbells. All of the alert systems have remote receivers, which can be placed throughout the house. National vendors who sell alerting devices are listed on the next page; contact them to get current information on products and prices.

TELECOMMUNICATION DEVICES

Amplified Telephone
Various telephones are available that amplify incoming voices by 20 to 55 decibels. Telephone amplifiers can be portable, battery operated, lightweight, and fit over a phone receiver.

TTY/TDD
A teletypewriter (TTY or sometimes TT) or telecommunication for the deaf (TDD) is a small device that looks like a typewriter. A keyboard and a visual display screen that hook up to a telephone line to allow people who are deaf or hard of hearing to communicate with each other over the telephone lines. Some TTY/TDDs are wireless and software is available that allows a computer to also function as a TTY.

Voice Carry Over (VCO) Telephone VCO telephones are for people who can read and use their voice to communicate with others, but who cannot hear over a telephone. VCO requires the use of a relay service. The relay service uses a communications assistant to type what a hearing person says and allows a deaf or hard of hearing person to speak directly to the hearing person. Wireless VCOs can be used with cordless and cellular telephones.

Wireless and Handheld Devices
Wireless technology allows people with hearing loss to communicate with both hearing, deaf and hard of hearing persons. From two-way pagers to cell phones to portable TTYs and VCOs, people with hearing loss can communicate quickly and effectively, from almost anywhere in the world.

Two-way pagers allow people to send and receive messages (where a standard pager only allows you to receive messages). Two-way pagers and other handheld devices can have text-messaging capabilities. These devices usually have other features that allow use of e-mail, instant messaging, Internet, and faxing. Some come ready to use with wireless IP-Relay (Internet Protocal-Relay). There are portable TTYs and VCO devices that directly connect to cell phones. They are also compatible with traditional phones, cordless phones, payphones, and accessible phones located in emergency call boxes.

Cell phone and hearing aid manufacturers are working together to ensure cell phones and hearing aids (particularly digital hearing aids) are compatible with each other. The volume control on cell phones often provides adequate amplification for hard of hearing callers. Cell phones may also come with accessories for people who are hard of hearing to use with and without their hearing aid(s). The Federal Communications Commission (FCC) requires all cell phones manufactured after 2003 to be TTY compatible.

RELAY SERVICES

Telecommunications Relay Service
Telecommunications relay service provides full telephone access to people who are deaf, hard of hearing or speech-disabled; they must have a TT/TTY which allows for text to voice and voice to text communication. Specially trained communication assistants complete all calls and stay on the telephone line to relay messages between hearing and deaf or hard of hearing people. Calls are private and there is no record of the conversation. Both TT/TTY and voice users can initiate calls through the Relay Service. It operates over standard phone lines or the Internet (called IP-Relay) and is available 24 hours a day, 365 days a year, with no restrictions on the length or number of calls placed. Users pay only for long distance calls.

Internet Relay
Internet relay services enable deaf and hard-of-hearing individuals to place text-based relay calls from their personal computer or mobile device to any standard telephone user in the US and its territories. The user needs an Internet connection (high- speed or dial-up) and a computer or mobile device enabled with an Internet provider that offers instant messaging. A user sends their message via instant messaging to the Internet relay service and a communications assistant contacts the standard telephone user and voices the text messages in real-time. Providers are listed below:

Video Relay Services
Video relay services (VRS) are available for those who prefer to communicate by sign. Video relay calls are placed through an easy-to-use videophone appliance connected to a TV or through a personal computer equipped with a Web camera and Net meeting software over a high speed or broadband Internet connection of at least 256K (i.e. DSL, cable, or T1 line). The “caller” signs to an American Sign Language (ASL) interpreter on their TV or computer screen via a video camera. The interpreter contacts the hearing user via a standard phone line and relays the conversation between the parties.

REALISTIC EXPECTATIONS

It is very important to understand what hearing aids can and cannot do. Hearing aids can compensate for the hearing loss across the frequency range. They do this by making softer sounds louder, medium sounds comfortable, and by making sure that the louder sounds are not too loud. Hearing aids cannot make the hearing normal. They can only make the sounds loud enough to be useful to the brain.

Even babies with a mild hearing loss are at risk for delayed communication development. The most important thing is to make sure that your baby wears his or her hearing aids for all of their waking hours.

Hearing aids alone will not ensure that your baby will develop speech and language skills. Babies need a wide variety of sounds for learning. It is very important to provide "auditory stimulation" so that the baby's brain can learn how to process the information. The most important kind of auditory stimulation is speech and language. The more you talk to your baby, the more experience your baby will have in listening. The more experience your baby has, the better chance he/she has to develop speech and language skills.

Realistic Expectations for Young Children
As children get older, they are faced with more difficult listening situations. Hearing aids do not work as well in noisy situations as they do in quiet situations. There are three situations that will be the most difficult. These are across distance, when the speaker's face is not visible, and when there is background noise. In these situations, speech is much more difficult to understand - even with the best hearing aids. People without a hearing loss may also have difficulty understanding in these situations.

You can help your child by using "communication courtesy principles". Encourage your child to look at your face when you are talking. Minimize the background noise whenever possible. Don't expect your child to hear and understand the message if you are more than three to six feet away.

FM systems can be helpful in difficult listening situations. Using radio waves, FM systems can transmit sound up to 300 feet. For infants, they are very useful while riding in the car, when you are busy around the house, and anytime you want the child to focus on what you are saying in a noisy situation. They become even more useful as your child enters preschool. Most children use FM systems with their hearing aids in the classroom.

Sources of Funding
There are several ways to obtain funding for hearing aids. Medicaid or through Minnesota Department of Human Services Deaf and Hear of Hearing Services (DHHS) are the most common sources of funding. A few health insurance companies have hearing aid benefits. Some private national programs also provide support. Your audiologist will be able to provide you with this information.

Service organizations are another funding alternative. Some of these organizations are the Lion's Club's Loaner Bank, Sertoma, Scottish Rite, Rotary Club, and the Optimist Club. Talk with your audiologist about the options available in your community.

FREQUENTLY ASKED QUESTIONS

Why can't my baby wear smaller hearing aids?
Behind-the-ear hearing aids are the best hearing aids for young children. Depending on your baby's hearing loss, it may be appropriate to change hearing aids styles when your child becomes a teenager.

How long will my baby have to wear hearing aids?
Hearing aids are not a cure for hearing loss. If your child has a hearing loss and the hearing loss cannot be improved by surgery, hearing aids may be recommended. If hearing aids are recommend, your child will need to wear hearing aids for the rest of their life.

Does my baby need to wear his/her hearing aids all day every day?
If you want your child to develop speech and language skills, your baby will need to have consistent exposure to sound. Your baby should wear the hearing aids for the time he/she wakes up until going to bed at night. Some babies prefer to wear their hearing aids even at nap time.

How do I get my baby to leave the hearing aids in his/her ears?
There are many techniques that can help keep them in place or from getting lost. These include the use of hypoallergenic two-sided tape, huggie hearing aids, and critter clips. If your baby takes his/her hearing aids out, firmly place them back in his/her ears. If your baby gets upset, wait a few minutes before trying again. The goal is to teach your baby to listen and learn new sounds wearing the hearing aids.

What if my child swallows a battery?
This is an emergency. If your baby accidentally swallows a hearing aid battery, call the Minnesota Poison Control Hotline number at 800-222-1222.

How often does my baby need new earmolds?
When babies are very young, the size of their ear changes quickly. Earmolds may need to be replaced every month or every few months. As your baby gets older, the time that each earmold will last becomes longer and longer. Older children may only need new earmolds every year or so.

How do I clean the hearing aids?
You should look at the earmold every day to see if it needs to be cleaned. The basic steps include removing the earmold from the hearing aid and cleaning and drying the earmold before reattaching to the hearing aid. It should be removed from the hearing aid and thoroughly cleaned every week or every two weeks. On a daily basis, the hearing aid and earmold should be wiped down. It is important not to get the hearing aid part wet because it may damage the hearing aid.

Go to> About First Hearing Aids

Information on this web site was obtained from the Infant Hearing Guide developed in a cooperative project between the University of Arkansas for Medical Science, Arkansas Children's Hospital and the University of Arkansas RRTC and we would like to acknowledge their work.

THIS INFORMATION DOES NOT PROVIDE MEDICAL ADVICE. All content, including text, graphics, images and information are for general informational purposes only. You are encouraged to talk with your doctor or other health care professional with regard to information contained on this web site. After reading this information, you are encouraged to review the information carefully with your doctor or other healthcare provider. The Content is not intended to be a substitute for professional medical advice, diagnosis or treatment. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE, OR DELAY IN SEEKING IT, BECAUSE OF SOMETHING YOU HAVE READ ON THIS web site.