Question:  In July I am going to have a court date with my employer, which happens to be a large school district in the state of Wisconsin.  We have been trying to get accommodations but the school district is fighting us (my lawyer and I) tooth and nail.  This has been going on for two years.  I am an elementary Physical Education teacher and we are asking to have somebody in the gym with me to serve as a second pair of eyes, a possible FM system to try out and a special phone.  Plus an unbiased consultant to help me through this process and make recommendations to help me.

My question is this.  The meeting with the judge is going to be in a meeting room at the local university.  I told my lawyer I would like to be in close proximity to those speaking, I need to be able to lip read the speaker, the room should be free of outside noise such as air condition fans, road traffic, etc.

Is there anything else that would help me hear in this situation?  She asked about a microphone but I told her it depends on the acoustical sounds of the room.  Louder is not always better.

Michael: Without being familiar with your degree of hearing loss, visual pathology and other potential characteristics that may limit your communicative ability, I will answer more generally than I might otherwise do.  Typically, meetings with large numbers of people take place in rooms that are acoustically less-than-ideal.  In such cases, anything that can be done to improve the signal-to-noise ratio can help the listener.  An FM system is designed to provide such an improvement.  In fact, if the meeting room is equipped with a soundfield FM or other amplification system, and each speaker is provided with access to a microphone, all participants in the meeting can benefit.  You are correct… “louder is not always better”…the advantage from FM (or similar device) is in its ability to amplify the signal relative to undesirable noise.   My assumption is that if you have been advised to wear other amplification devices such as hearing aids, you will additionally use these in the meeting.  Also, although it probably goes without saying in such an important meeting, I would strongly advise you to request clarification or repetition of anything you are unsure of during the proceedings. 

Question:  I understand there's a new hearing aid that is implanted, called the BAHA.  Why would anyone want an implanted hearing aid when they can just wear one externally? Is there a difference in the aids that might create better sound for the person?

Michael: BAHA is a trademarked acronym for “Bone Anchored Hearing Aid”, and is made by Entific Medical Systems (www.entific.com).  This particular device has been on the market for several years, and early research describing similar devices dates back to the late 1940s.  Successful fitting requires the surgical implantation of a titanium mechanism which then integrates with bone of the ear.  Weeks after surgery, a speech processor is attached externally, allowing for collection, amplification and transmission of the sound to the ear.

The device does not purport to replace traditional hearing aids…it is mainly designed for people who meet one of three criteria: those with “Single-Sided Deafness (SSD)” (one otherwise unusable ear), those with chronic ear infections and those with congenital mixed hearing loss.  In the cases of those with SSD, the BAHA system can help provide information presented to the “dead ear” to be transmitted to the hearing mechanism of the better ear, via bone conduction.  Those with chronic ear infections and with congenital mixed hearing losses may sometimes not be candidates for traditional hearing aids, what with draining ears, cranial malformations and the like.  As such, the device can help by bypassing the air-conducted part of the auditory mechanism that may be further compromised in these patients.  There are other uses, and I have known of many patients who have had success with this system, but generally speaking it is not a substitute for the traditional hearing aids, but rather a choice for some populations for which a standard device may not be an option.    

Question:  Although I realize other patients go through this, I sometimes find it so embarrassing when my hearing aid is all sweaty and the tubing has air bubbles in them.  What is the quickest way to clean out the aid while at work or play without having to do this procedure overnight?

Michael: The two most common means of reducing moisture are by use of a dessicant, such as by using a “dry aid” kit (all types of hearing aids) and/or by using an earmold blower (BTEs…NOT for custom products). Neither one is something that can easily be done while at work or play, but tend to be used overnight or proactively.  Some patients produce enough moisture during the course of a day so as to adversely affect function.  In these cases, I have had my clients use an earmold blower when appropriate.  The blower is portable but a bit cumbersome for “during the day” use.  More aggressive cases might benefit from some of the electric dehumidifiers on the market, such as “Dry & Store”…however, these too are generally used overnight.

Question:  I have met many people in the saywhatclub who have lost their hearing rapidly within several months.   What can cause this progression?

Michael:  There are many reasons why sudden hearing loss can occur.  In all cases, medical work-up is indicated, as the rapid progression may be a sign of an undiagnosed medical condition or an inherited impairment. Noise exposure and head trauma can certainly cause hearing loss to progress rapidly, but in these cases the source is typically obvious to the patient.  The normal aging process, while consistent with progressive hearing loss, does not typically proceed rapidly.  There is a term for sudden hearing loss of unknown origins:  Idiopathic Sudden Sensorineural Hearing Loss.  It is a term for hearing loss of many origins, and may be viral in nature in many of the cases.   

Question:  How do you deal with parents who want a little hearing aid for their child's "little hearing problem"?   Are you finding parents of deaf/hearing impaired children becoming more difficult and less accepting of their childs hearing loss?

Michael: A majority of the people that I have fit in recent years are adults…however, as smaller devices have become available, I notice an equal proportion of adults and families of children who request these items.  Part of my job is to educate the parent as to the added benefits of a somewhat larger device that can accommodate FMs, telecoils, directional microphones without sacrificing power.  These features are critical to a youngster who might not have the same ability to seek help by requesting clarification, etc., that an adult may have.  When explained to most parents, this becomes a non-issue (or, less of an issue).  As children age, other (sometimes smaller) devices become more appropriate, and I can understand cosmetic concerns of kids as they enter their teen years.  However, the audiologist and the patient’s families must work together to best ensure that we do not sacrifice hearing, particularly in the educational setting.     

Question:  What is the most complicated and frustrating problem you find in attempting to fit a senior citizen?

Michael:  It is very difficult for me to generalize to any particular group.  I would say that the difficulties that I see in any group I see in all groups, albeit to lesser or greater degrees.  One such limiting factor, however, is a person’s resistance to obtain help.  When a patient denies help, but his/her hearing loss is not much of a burden on others (family members, etc.), this does not frustrate me as much.  However, when it is a clear case of a patient’s hearing loss causing him/her to limit social activities, interaction with family members, etc., and the person is certain that amplification will not help…it usually does not.  The lack of benefit in these cases is not likely due to the device, however, but to the patient’s predetermination that s/he cannot be helped.  It’s frustrating because it is difficult to help a person who wishes to not be helped, and ethical considerations would limit the audiologist’s ability to provide benefit.  It’s a situation that is complicated in that caring family members often wish the patient to follow-through against his/her will.  I try to take a very non-threatening approach, offering this type of patient information only, and try to encourage him/her to consider help in the future.  The patients who return often tell me they did so because of the fact that I did not pressure them into a decision when they were not ready.