Question: Can an ear that can barely hear a sound benefit from a hearing aid?

Michael: This depends on a number of things, but generally the answer is "yes." For one, the fact that the ear in this example can "barely" hear sound means that sound can (obviously) be heard if it is amplified enough.  Of course, it is possible that the amplified sound for some people will be perceived as garbled and unrecognizable.  However, for others it is conceivable that the amplified sound will be clear.  Factors such as word recognition ability, type of hearing loss (sensory versus conductive) and vision can play a large role in the amount of benefit a person with such a hearing loss will perceive sound.  But consider that even for those who continue to have difficulty recognizing amplified speech, hearing aids can amplify environmental sounds (such as alarms) that may help to provide cues to the person, resulting in important quality-of-life benefits.  Clearly, being able to detect the presence of a person nearby or to be able to hear a passing ambulance can be of great importance, and for those who otherwise "barely hear a sound," amplification may provide this.

Question: How do you feel about keeping an unaided ear, which is for all intents and purposes deaf and not benefited by an aid, stimulated for possible future CI implantation?  Does stimulating an ear with a hearing aid actually have any benefit?

Michael: I am a firm believer that it is important to stimulate one's auditory system, especially as noted in the case above.  I can refer to a number of studies over the past 15 years that have shown that lack of stimulation may lead to an auditory deprivation of sorts.  While we still have much to learn about the way the brain processes sound, data suggest that there may be adverse implications to the brain's wiring when the auditory system is deprived of sound.  The mechanism may be different, but I sometimes liken it to muscle atrophy in a person who has recently sustained injury.  Providing sound to an ear might be thought of as being comparable to rehabilitative exercises in this case. In recent years we've learned much about the "plasticity" of the brain, how it might "rewire" itself in certain ways in response to stimulation and/or injury.  While the otoneurological system may reorganize itself in response to cochlear implantation, there are implications and limitations based on age and prior auditory experience.  As such, it would seem that, generally speaking, auditory stimulation would be beneficial.

Question: Is there anything I can do to maintain my hearing aids' longevity?  If so, what should I be doing?

Michael: Well, by far the most common reason for hearing aids to come into disrepair is cerumen (earwax). Approximately 80% of all repairs are due to this industry-wide!  That being the case, I would suggest that those who do best to keep cerumen from the receiver (and the sensitive microphone) would be more likely to maintain the devices' longevity.  Having said that, though, it is important to note that some ears produce little cerumen, while others manufacture it like a factory.  Excess cerumen is often not an issue of hygiene; it is simply variable across individuals.  As such, those who produce more wax tend to have more hearing-aid repair issues. However, the person who takes care to routinely (and proactively) clean the hearing-aid openings (microphone and receiver) will tend to minimize such problems. Cerumen is not the only culprit, of course. Moisture, dust and heavy-handedness can cause damage.  I counsel people to "ritualize" the standard hearing-aid care techniques that they use.  For example, it should become habitual to not only clean the devices, but also to routinely place them in a specifically identified case when removing them (so as to minimize loss), and to take care to not be overly aggressive in cleaning, as it can sometimes actually cause unintended damage.  With proper care, the general lifespan of a hearing aid is approximately 3-5 years.

Question: When taking my aids off at night, is it necessary to leave the battery compartment open?

Michael: It's a great habit, and what I recommend but "necessary" is too strong a word.  The hearing aid will possibly work just as well whether you engage the door at night or not.  However, there are some known advantages to doing this.  In an increasing number of hearing aids, the battery door functions as an "on/off" switch.  As such, opening the door overnight will ensure that it is "off," thus preserving battery life.  Those who leave the door closed (i.e., the hearing aid "on") may wind up having a hearing aid that sits in a case unnecessarily whistling all night.  Ironically, the person who owns the hearing aid may not hear the whistling (as it is out of the ear), but others in the home (visitors, family members, etc.) may hear it.  Another potential advantage to closing the door at night is moisture-related.  Hearing aids in some ears can develop moisture when used. Opening the door can help provide some small amount of ventilation when not in use.

Question: Is there a difference in the maintenance of a behind-the-ear aid from an in-the-ear aid?

Michael: Yes.  A behind-the-ear (BTE) device has additional components that need tending.  A BTE has a portion that is physically behind the ear (containing the actual mechanical components), and a portion that sits in the ear (earmold).  The earmold must be cleaned as an in-the-ear (ITE) device might be cleaned, but tubing that runs through the BTE mold is more accessible than in an ITE, allowing for generally easier access to cerumen and other debris.  In all cases, however, the goal is to keep the devices clean and free of debris.

Question: Is it okay to sleep with my hearing aids on?

Michael: It is generally advisable to remove the devices when sleeping.  For one, it helps to ventilate the ears, and keeps them from becoming irritated. Additionally, listening is generally not a high priority during these unwakeful hours, so one would not expect benefit from devices during that
time of the day.  Sleeping often involves some moving around, which will typically cause hearing aids to provide feedback (whistling).  However, I have had patients who live alone and have concern that they may not be able to hear a doorbell ring or a fire alarm sound without the hearing aid in and on.  In those cases, I ask the patient to consider some of the many vibrating assistive-living devices that can work with alarms and can generally address those concerns.  For the person who falls asleep in the armchair with hearing aids on, there is no real risk of anything other than having them fall out (I had this happen to a patient once. He searched throughout his home before finally finding it deeply embedded in a cushion of his recliner).

Question:  I wear 2 brand new Phonak Savia Art BTE aids. For the phone I use a ClearSounds Neckloop. I had my annual review at work and was told that the volume of my voice on the phone is loud. I was wondering if this is a normal occurrence for people with hearing losses who wear aids. Is there anything I can do to monitor the volume of my voice?

Michael: I have had a number of patients report this, although it is not generally reported to be a major concern.  We know that people will tend to speak at higher or lower intensity in response to how loud their own voice is perceived.  In other words, the person who has a significant hearing loss will tend to speak louder without a hearing aid than with one.  The reason is that without the hearing aid, the person perceives his/her own voice as being very soft, and therefore compensates by "yelling."  With the hearing aid in and functioning, one's own voice sounds more intense and is, therefore, lowered.  The fact that others continue to perceive you as speaking loud might suggest that the amplification is on the low side, although this is certainly not a definitive likelihood.  To be sure, you should have the device functionality (of both the hearing aid and the loop) checked.  If all appears to be functional, it is quite possible that you "just speak loud" (some people do this, and it may only be partially related to hearing loss).  However, as it appears that this may be undesirable to you and others, there are some things you may be able to do.  A simple thing would be to pop into your local electronics store and purchase the least-expensive sound-level meter (SLM), which should cost about $40-$50. Even better, see if your employer will obtain it.  When talking in various situations, note the intensity level (shown in deciBels) on the SLM.  Then, try to monitor your voice to a lower deciBel level; trying to hit a level that is more comfortable to others (an honest, trusted partner can be helpful for this task).  Then this small, non-intrusive device can be used at work. As you speak you can watch the level to be sure it does not exceed that deemed to be "loud" by your employer.  After some time, the SLM will become unnecessary, as you should have a better sense of what might be perceived as "loud" to others.  If the SLM method seems to be intimidating to you, a speech-language pathologist should be able to work with this issue over the course of a few sessions.

Question: I am looking to update my aids.  I have a profound loss in both ears and wear ITCs without telecoils.  I want a telecoil this time.  My question is about the best hearing aids on the market. I could say price is no object but that is not entirely true. Like anything else, the best on the market may not be for me or not help me that much.  A friend of mine swears by the Phonak and has a remote.  There are so many brands.  My hearing-aid tech experimented and tried an open-fit model on me. It was comfortable but I could not hear a thing.

Michael: Although technology has improved, allowing for very powerful circuitry in a smaller case than was possible a few years ago, I am still a proponent of BTE devices for profound hearing loss (with ITEs in some cases).  Digital devices have become much better at eliminating feedback but there are still limitations to the smaller ones when maximal power is required, as with profound hearing loss.  I do not feel strongly that any one particular manufacturer does a better job than any other.  Phonak is certainly a reputable company but, as you mention, "there are so many brands."  Remote controls are not generally items that will help you to hear better; rather, they may offer some convenience of use (and, they may not).  It may be possible to obtain benefit from an "entry-level" hearing-aid product. "Entry-level" does not refer to backward technology.  Simply put, it may be a digital or very advanced product that has some features stripped away or inaccessible to the user.  Still, it may be as beneficial to a person with a profound hearing loss as the highest-end products!  And, while "experiments" might be fun sometimes (like working with my fifth-grader on her recent science fair project), I cannot envision open-fit devices being very beneficial to someone with a profound hearing loss.  Perhaps there will be a day, what with technology rapidly advancing. However, to my knowledge, that day has not yet come.

Question: I store my aids in a dry desiccant container that you can refresh by heating. Is the Dry & Store better?

Michael: I have found standard, inexpensive desiccant cases to be suitable for most people.  Those with more aggressive moisture issues (one who excessively perspires or who works in a moist environment) will find the plug-in models are more efficient at moisture removal.