03 5672 5598
Did you know that one in five Australians – over 3 million people – report that they cannot hear properly? A hearing loss may happen suddenly or gradually but it differs from most other disabilities in one important respect – it is invisible. This means that it often isn’t obvious, and it often isn’t understood.
What can stop us from hearing well?
A hearing loss can result if there is a problem at any point in the hearing pathway – in the outer, middle or inner ears, or in the complex auditory nerve pathway up to the brain. Hearing loss can be described as congenital or acquired. A congenital hearing loss is one that is present at, or soon after, birth. An acquired loss is one that occurs later on.
We can also describe hearing loss in terms of when it occurs in the process of the development of speech. A pre-lingual hearing loss is one where the hearing is lost before a child has completely developed speech and language. It may be congenital or acquired in the first few years of life, and can affect how well a child learns to speak. A post-lingual hearing impairment means the hearing loss is acquired after speech and language has developed, which is more common.
Depending on which part of the hearing system is affected, a hearing loss is categorised as conductive or sensorineural (pronounced sen-sorry-new-rol), or a mixture of both.
Conductive Hearing Loss
This is caused by blockage or damage in the outer and/or middle ear. A conductive hearing loss leads to a loss of loudness, and can often be helped by medical or surgical treatment. Some of the causes of conductive hearing losses are:
blockage of the ear canal by impacted wax or foreign objects.
outer ear infection (sometimes a result of swimming)
“glue ear” (middle ear infection), a common problem in young children
perforated ear drum, maybe from a bad middle ear infection or a loud explosion
ostosclerosis, which is an hereditary condition where bone grows around the tiny stirrup
bone (stapes) in the middle ear
partial or complete closure of the ear canal (known as atresia).
A conductive loss can be acquired (like an ear drum perforation) or congenital (like atresia). The degree of hearing loss caused by these different problems varies, but you cannot go completely deaf from a conductive hearing problem. In fact, it cannot cause any more than a moderately severe hearing impairment. This is because, at higher sound levels, sound waves travel through the skull. They “bypass” the conductive pathways of the hearing system and are picked up by the inner ear and hearing nerves. If there is a blockage to the conduction of sound in the outer or middle ear, the amount of sound that is carried to the cochlea (or inner ear) is reduced. This means that the quantity rather than the quality of sound is affected. If medical treatment is not possible, people with a conductive hearing loss generally find they benefit greatly from amplification provided by a hearing aid. Sensorineural hearing loss This is a result of damage to, or malfunction of, the cochlea (the sensory part) or the hearing nerve (the neural part). Again it can be acquired or congenital. Examples of causes of an acquired sensorineural hearing loss are:
The ageing process
Excessive noise exposure
Diseases such as meningitis and Meniere’s disease
Viruses, such as mumps and measles
Drugs which can damage the hearing system (called ototoxic drugs)
A congenital sensorineural hearing impairment may be the result of:
Inherited hearing loss
Prematurity, lack of oxygen at birth, or other birth traumas
damage to the unborn baby due to a virus, such as German measles (rubella) or CMV
jaundice, particularly when serious enough to require blood transfusion.
The best person to see about the possible cause of a hearing loss is an Ear, Nose and Throat specialist. He or she may arrange certain tests to eliminate some of the factors as the cause of a hearing loss. Parents who have a hearing impaired child may also wish to seek genetic counselling. This can be helpful in planning further children and also for finding out the chances of the child with hearing loss in turn having children with the same disability.
A sensorineural hearing loss usually leads not only to a loss of loudness but to a lack of clarity as well – the quantity and the quality of the sound is affected. This can sometimes limit the benefit that a hearing aid can offer as sounds may be loud enough but distorted. There is rarely any medical treatment of a sensorineural hearing loss and so it is permanent.
Mixed hearing loss
This is a hearing loss where there is a problem in both the conductive pathway (i.e. in the outer or middle ear) and in the nerve pathway (i.e. the inner ear). An example of a mixed hearing impairment is when there is a conductive loss due to a middle ear infection plus a sensorineural loss due to the ageing process.
Early warning signs of a hearing loss
You can hear but not understand.
You find it much harder to hear in noise and groups of people.
You have difficulty understanding people unless they are facing you.
You think people mumble or slur their words.
You have to ask for repetition a lot.
You need the TV up louder than others.
You find you have misunderstood the topic and are embarrassed when you say the wrong thing.
You avoid group meetings, social occasions, and even family gatherings because you have difficulty hearing.
You don’t hear the phone or door bell ring unless you are close to it.
You have head noises, such as buzzing or ringing sounds (tinnitus).
If I suspect a hearing loss what should I do?
1. See your Doctor to check there is no obvious blockage in your ears, such as impacted wax or ear infection, that can be treated.
2. See an Audiomitrist for an expert assessment and advice. Children, war veterans and most pensioners are eligible to be seen at an About Bass Coast Hearing For more information, just ring (03) 5672 5598
Annoying noise……does not damage our hearing, but it can disturb our sleep, irritate us, interrupt our concentration, interfere with the understanding of speech, and decrease work performance and efficiency. Sufficient noise annoyance can even cause mental and emotional disturbances.
What is ‘noise’?
Noise is often defined as unwanted sound. However, technically speaking, sound and noise do not differ. One person's sound is another person’s symphony.
What level of noise is annoying?
Annoyance is a difficult concept to quantify. It depends on the listener and the listening circumstances. Authorities attempt to place numbers on annoyance by examining the noise level in relation to either the typical background noise level, L A90% (the noise level that is exceeded for 90% of the time); or the average noise level, L Aeq .
The Standard that details the measure of annoying noise in the environment is Australian Standard AS 1055: 1997 Acoustics - Description and measurement of environmental noise. Some States have their own specific descriptions of noise.
Can it be controlled?
The general level of sound/noise in our community is tending to grow but at the same time individuals are becoming more aware of the noise pollution in our urban environment. For this reason there are many noise control laws in each State and Territory.
For example, in NSW the following legislation all contain noise control laws:-
- Local Government Act 1993
- Environmental Planning and Assessment Act 1979
- Occupational Health and Safety Act 1983
- Liquor Act 1982
- Registered Clubs Act 1976
- Strata Titles Act 1973
- Motor Traffic Regulations 1935
- Mining Act 1992
It’s not possible to summarise the relevant legislation here. However, in most jurisdictions, if a “reasonable person” finds a noise annoying or offensive, usually people in authority will try to assist. If you have a recurring noise problem you will need to speak to an expert or local authority. Initially the best people to approach are your local Shire or Municipal Council. If it's a one-off event, then possibly your local police service can help. By far the best solution to any noise problem is one that is reached on a mutual understanding of everyone’s point of view and with the agreement of all involved.
Why we have two ears
Our two ears act as a type of receiving station for the brain. One ear is directed to the left the other to the right – like radar aerials that register signals coming from different directions. If the ears pick up the sound of a truck approaching, for example, the brain calculates the angle from which the sound has arrived. The brain has this capability since the nearest ear receives the sound a matter of microseconds earlier then the other one. With only one ear functioning properly, the exact origin of sounds is unclear. Even more important is the fact that quality of speech is better when it is heard with two ears. Speech received by only one ear sound flat and devoid of its rich nuances. That is why, in most cases, two hearing instruments are fitted to those with hearing loss in both ears.
The degree of hearing loss varies from person to person
Between the two extremes of hearing well and hearing nothing, there are many degrees of impairment. The terms used to describe the degree of hearing loss are mild, moderate, severe and profound. Most hearing losses are mild to moderate.
Mild hearing loss:
Unable to hear soft sounds, difficulty perceiving speech in noisy environments.
Moderate hearing loss:
Unable to hear soft and moderately loud sounds, considerable difficulty in perceiving speech
particularly with background noise.
Severe hearing loss:
Speakers must raise their voice. Group conversation is possible with considerable effort.
Profound hearing loss:
Some very loud sounds are audible but communication without a hearing instrument is impossible.
The impact of hearing loss to speech perception
Hearing loss in the inner ear is called (sensorineural hearing loss). The most common configuration of sensorineural hearing loss is a sloping high frequency loss. The inability to hear these high – pitched sounds such as “S”, “F”, “SH”, “T” affects our ability to understand speech clearly. This is why a person with this type of hearing loss will often say, “I can hear but I don’t understand what’s being said”.
The hearing test
Our hearing levels are measured with an audiometer, which precisely registers the extent and configuration of the hearing loss. The object of the assessment is to precisely register the extent and configuration of the hearing loss.
Since the extent of damage may be different in each ear they need to be tested separately. The resultant audiogram (hearing chart) enables us to establish the degree and type of your hearing loss. From the audiogram we can advise what hearing instrument/s would be suitable to your hearing loss and needs.
Things you need to know before your fitting appointment
Things you need to know before your Fitting Appointment
By now, you have had your hearing professionally assessed by our trained staff
and have been told the fact that you have a permanent hearing problem. Your
audiologist or audiometrist, after listening to your hearing needs has helped you
select the most appropriate hearing aid(s) to address those needs.
We would firstly like to congratulate you on your decision to do something about
your hearing loss.
This booklet has been provided as an educational tool. You will discover that
there is more to hearing rehabilitation than meets the eye.
The Human hearing system is extremely complex and hearing aids only serve
as the “tools” of the hearing rehabilitation programme. The success of this
programme depends on knowledge and perseverance.
Please take time to read the booklet before your fitting appointment. If you
have any questions, we are only a phone call away.
What to expect
Because you haven’t heard normal sounds and noises for a long time, wearing
hearing aid(s) seems a little strange at first. Your brain requires a bit of time to
re-adjust to the differences in sound quality and intensity that you are now
hearing. If you stick with your hearing aids so that you brain has had a chance
to catch up, sounds will eventually sound more natural to you.
As a result of a long standing hearing loss, your brain begins to “forget” many of
the speech sounds that you need to understand speech. Wearing hearing aids
will not necessarily mean you will regain speech understanding instantly. Just
as it takes a period of time before we learn a new language, research has
shown that it requires at least 60 – 90 days before the forgotten speech sounds
can be re-learnt and recognised again.
It takes time before we see results
Adjusting to Hearing Aids
Hearing aids are not magic, they will not bring you instant gratification. To
achieve better hearing, you need to wear the hearing aids for a period of time
every day. This allows time for your brain to re-adjust to the “new” sounds that
you are now hearing.
If you lost your hearing gradually over time, then your brain has been deprived
from stimulation in the sound pitches you no longer hear at normal volume.
Because of this, when you first put hearing aids in, your brain becomes quite
excited about all of the “new” sounds that it is now hearing – this may be a little
startling for you.
Here’s a list of what you may hear:
Familiar voices may sound a little odd
Your own voice may sound strange – as if you are talking into a bucket / tunnel
Your every-day environment may sound noisy – the hearing aids seem to pick
up every sound in the room
This will improve with time –
Because you haven’t heard normal sounds and noises for a long rime, wearing
hearing aids seems a little strange at first. But if you allow time for your brain to
re-adjust, this new sound quality will actually improve your speech
Although hearing aid technology has come a long way, it is still very important
to the outcome of the hearing rehabilitation programme that “Realistic
Expectations” are formed. Your audiologist or audiometrist would have briefly
discussed this with you at your initial consultation.
Take a moment to consider what you want your hearing aid to do for you. You
may like to write these down in the spaces provided. Next, consider for each
expectation whether it is realistic – that is, whether a normal hearing person in
this situation would be able to pick up every single word or not. Remembering
that hearing aids cannot give you back “normal” hearing.
At your fitting appointment, your clinician will explain the Hearing Aid
Adjustment Programme to you. This is a 2 week programme and basically
involves you wearing your hearing aids for a period of time each day. Two
hours on the first day and gradually increasing this by an hour or so each day.
We start you off in a quiet environment (e.g. at home, watching TV) then ounce
you are confident with this, we ask you to venture out into more noisy situations
(e.g. shopping centres, restaurants).
At the end of the two weeks, you come back for your review appointment where
we will address any problems you may have had during the programme. We
want to find out what worked and what didn’t work for you. We may need to do
further adjustments to the aids. As everyone’s ears are different, it may take us
a few gos to fine tune the aids to suit you. Hearing rehabilitation is an on-going
process and does not stop with the purchase of hearing aids. Once the review
process is over, we still encourage you to make further appointments should
you have any problems – problems are best solved as soon as they arise.
Please don’t hesitate to call us.
I am ready to get help and learn how to hear better!
As we mentioned before, hearing aids are only the “tools” of the rehabilitation
programme. The purchase of hearing aids alone will not help you hear better.
In order to overcome your hearing problems, you need a positive attitude, a
willingness to learn, commitment to your own hearing success, patience as your
brain takes time to re-adjust to “forgotten” sounds and practise handling the
Make this your personal choice to improve your communication with those close
to you. No-one else can hear through your ears but you. We’ll be there to
Now you are ready
We hope that we’ve been able to introduce you to some of the concepts
involved in hearing rehabilitation. Getting hearing aids for the first time may
seem a little daunting for many at first but we hope that we have provided you
with the essential knowledge to make the experience more reassuring for you.
If you have any questions or would like to find out more on any of the topics,
please contact us.
We look forward to seeing you at your fitting appointment and in assisting you to
better hearing in the future.
Hearing Impairment also affects those around you
Hearing impairment affects approximately 10% of the population. Although
people of all ages can be affected by a hearing loss, those over 60 years of age
have a significant hearing loss, making it one of the most common chronic
disorders. Hearing loss is invisible, it doesn’t hurt and the onset is typically
gradual. Yet, it has a profound affect on the people around you.
How should you communicate with people who have impaired hearing?
It is important to answer this question since hearing loss also impacts those
wishing to communicate with effected individuals. People often avoid contact
with those with impaired hearing since they don’t know how to react. This is
not only unfortunate but also unnecessary.
By following these 8 simple steps, communication between you and your loved
one will be made much easier.
1. Speak clearly and naturally:
It is not necessary to shout. Loud speech may overload the hearing
instrument causing voice distortion and even discomfort to the wearer.
Maintain a normal tone of voice, speak clearly and slowly
2. Move Closer:
Reducing the distance between the speaker and listener is helpful and
encourages improved speech understanding. This is particularly important if
there is background noise.
3. Face the listener:
Position yourself so that the listener can see your face and lips. Lip reading
is instinctive to all of us but it is particularly important for those with impaired
hearing to supplement the sound of speech
4. Attract the listener’s attention:
This can be done by either, using the person’s name, entering their field of
vision or tapping them lightly on the shoulder
5. Take the surroundings into account:
Avoid tyring to have conversations from one room to another or in rooms
with distracting noises e.g. washing machine, vacuum cleaner, loud music
6. Be aware of performance constraints:
Never put the hearing impaired listener and their instrument/s under too
much pressure. They both have limits.
7. Understand that using hearing instruments can be tiring:
When conversing with a novice hearing instrument user, be sensitive to signs of
fatigue. Don’t force or prolong conversations if the listener is tired
8. Be patient:
Respect the speed of progress and encourage the person with impaired
hearing when obvious progress is made. Be a good listener and help the
person to achieve the goal of participating in life again.
In many societies, using a hearing instrument has become as normal as
wearing glasses. Personalities from politics, business and film wear hearing
instruments. A hearing instrument may not be fashionable as designer
glasses but it is a masterpiece of technology that helps to overcome
For every instrument user, the role of family, friends and colleagues is
crucial, especially in the initial period of adjustment. The novice hearing
instrument user needs your support and encouragement.
Hearing impairment is as old as man-kind
Did you know Julius Caesar was hard of hearing?
Caeser to Casca: “Come on my right had, for this ear is deaf”
Julius Caeser, Shakespeare: Act 1, Scene 1
Take a short look through history. Did you know these historical greats had
a hearing loss?
Sir Joshua Reynolds, Dr. Samuel Johnson, Louis XV!!, Martin Luther,
Jonathan Swift, George Washington, John Greenleaf Whittier, Thomas A
Edison, Edward VII, William Stewart Gladstone, Winston Churchill, Eleanor
Roosevelt, Charles Algernon Swinburne, Ronald Reagan, Florence
- Are among many others who have been outspoken about their hearing
Ludwig Van Beethoven had a severe hearing loss and for most of his later
life could not even hear the masterpieces which poured from his tortured
soul. Once, conducting his own music, someone had to turn him around to
face his audience because he did not realize they were cheering for him.
The terrible burden of his hearing defect may be understood from these
words spoken before he died: “I shall hear in heaven.” Yet he did his best
to conquer his loss. He discovered that by fastening a sick of wood to his
piano and clenching the other end in his teeth, he could finely hear the
music as he played. In doing this, Beethoven was using the principle
already known to science – that bones conduct sound.
Your hearing and well being
The tragedy of a hearing loss is that without help, it robs the individual of
part of his / her effectiveness as a human being
Sound is one of the major channels by which we come in contact with the
world around us. Even more important, it is the basis for communication –
one of the ways we get in touch with other people. Sound couples us to our
environment and allows us to participate in life.
Hearing loss creates an invisible handicap which can have far reaching
social and psychological effects. Loss of hearing can cause serious
problems: threatening security, employment opportunities and social life.
Partially heard conversations, barely heard laughter and difficulty
understanding speech forces hearing-impaired persons inward closing down
the world around them. This is the real tragedy of hearing loss. It not only
cuts down on the richness of experience, it also robs the individual of part of
his / her effectiveness as a human being.
Unfortunately, most of us don’t realize how important hearing is until hearing
loss begins to affect our everyday lives. When this happens, the
detachment from our environment can leave a dark and lonely world.
Of all our 5 senses, hearing and sight – the two most important – fail more
frequently and more rapidly than do taste, touch or smell.
Hearing and hearing loss
Why we have two ears
Our two ears act as a type of receiving station for the brain. One ear is
directed to the left the other to the right like radar aerials that register signals
coming from different directions. If the ears pick up the sound of a truck
approaching, for example, the brain calculates the angle from which the
sound has arrived. The brain has this capability since the nearest ear
receives the sound a matter of microseconds earlier than the other one.
With only one ear functioning properly, the exact origin of sounds is unclear.
Even more important is the fact that quality of speech is better when it is
heard with two ears. Speech received by only one ear sound flat and devoid
of it’s rich nuances. That is why, in most cases, two hearing instruments are
fitted to those with hearing loss in both ears.
The degree of hearing loss varies from person to person
Between the two extremes of hearing well and hearing nothing, there are
many degrees of impairment. The terms used to describe the degree of
hearing loss are mild, moderate, severe and profound. Most hearing losses
are mild to moderate.
Mild hearing loss:
Unable to hear soft sound, difficulty perceiving speech in noisy environments
Moderate hearing loss:
Unable to hear soft and moderately loud sounds. Considerable difficulty in
perceiving speech particularly with background noise.
Severe hearing loss:
Speakers must raise their voice. Group conversation is possible with
Profound hearing loss:
Some very loud sounds are audible but communication without a hearing
instrument is impossible
The impact of hearing loss to speech perception
Hearing loss in the inner ear is called sensorineural hearing loss. The most
common configuration of sensorineural hearing loss is a sloping high
frequency loss. The inability to hear these high pitched sounds such as “S”,
“F”, “SH”, “T” affects our ability to understand speech clearly. This is why a
person with this type of hearing loss will often say, “I can hear but I don’t
understand what’s being said”.
The hearing test
Our hearing levels are measured with an audiometer which precisely
registers the extent and configuration of the hearing loss. The object of the
assessment is to precisely register the extent and configuration of the
hearing loss. Since the extent of damage may be different in each ear, they
need to be tested separately.
The resultant audiogram (hearing chart) enables us to establish the degree
and type of your hearing loss. From the audiogram, we can advise what
hearing instrument/s would be suitable to your hearing loss and needs.
Common causes of hearing loss
Perforation of the eardrum, infection or fluid in the middle ear and
otosclerosis (a calcification around the stapes limiting it’s ability to move) are
the most common causes. Many outer and middle ear problems can be
helped considerably by using hearing instruments. The audiologist will
advise you if further medical intervention is necessary.
The majority of hearing problems result from damaged inner ear structures.
Typical causes are the natural aging process, excessive exposure to noise,
medication that is toxic to the auditory system and head injuries. In such
cases the tiny hair cells in the cochlea are damaged, obstruction the transfer
of sound signals to the brain. As a rule, this damage cannot be reversed
medically but the adverse effects can be overcome to a large degree with
Q. Will hearing aid’s return me to “normal” hearing?
A. Unfortunately hearing aid/s will not return you to “normal”. The hearing
aid is just an “Aid”. It does not fix your hearing, it simply amplifies each
frequency so that you can hear and understand speech. Because of the
damage that is already there in your hearing organ, we cannot bring back
Q. How do I know what hearing aids are right for me?
A. The clinician will assess your hearing and advise you on what hearing
aids are appropriate for your loss and lifestyle. Because everyone’s ears
are different, it may take a few appointments to “finetune” the hearing
Q. Do I need two hearing aids?
A. In most cases we advise that binaural hearing aids would be of great
benefit to your specific needs. Two hearing aids will help to stimulate
both sides of the brain which is important for understanding speech. It
will help you hear better in background noise and tell you the direction of
How do you hear
With the possible exception of the brain, the ear may be the most complicated,
least understood organ in the body.
The outer ear:
The outer ear collects and channels sound waves from the air through the
external auditory canal. It ends at the tightly stretched eardrum 9tympanic
membrane) where the signal is changed from a sound wave into a mechanical
The vibrations of the eardrum are transferred through the middle ear by three
tiny, connected bones (ossicles) called the Malleus, Incus and Stapes. The
vibrations from the relatively large eardrum surface are directed to a much
smaller opening into the inner ear, with these bones acting as levers to move
the fluid in the next stage.
The inner ear:
The inner ear consists of two parts: the hearing mechanism and the balance
mechanism. The cochlea (snail-shaped structure) is involved with hearing and
the semicircular canals are involved with balance and motion.
The cochlea of the hearing mechanism contains thousands of tiny specialized
cells, each of which holds many microscopic hairs. These hairs are immersed
in fluid, which fills the cochlea. Movement of the fluid within the cochlea causes
the hairs immersed in the fluid to move, which in turn, stimulates the attached
cell to send a tiny electrical impulse along the fibres of the auditory to the brain.
Why you need to know about Phonemic Regression
As a result of a long standing hearing loss, your brain begins to “forget” many of
the speech sounds that you need to understand speech. Wearing a hearing aid
will not necessarily mean you will regain speech understanding instantly. Just
as it takes a period of time before we learn a new language, it will require at
least 60 – 90 days before the forgotten speech sounds can be learnt again.
Denial or Acceptance
It is normal for most people to go through a period of denial.
“I hear fine, it’s just that people mumble; they don’t speak clearly anymore”.
“It’s the noisy places where I have trouble hearing….I’ll just avoid those places
and I’ll be o.k”.
“I hear what I need to hear. I’ll just ask them to repeat.”
“I can cope with it. I’ll just concentrate a little harder.”
“It’s not really bad enough that I need hearing aids yet.”
“If my hearing gets any worse, then I’ll get help.”
You cannot hide your hearing loss….
It’s more obvious than any pair of hearing aids.
Your friends and loved ones already know that you have it. It is very difficult to
communicate with someone with a hearing impairment as it is difficult to
consistently change and maintain a different speaking manner. This eventually
leads to frustration on the part of the speaker and the listener. Because of this,
some people eventually stop asking for repeats…. Or they decide not to put
themselves into those “difficult” social situations where they may have to be a
burden to someone else.
Hearing Aids can help!!!
It is not about how well you can hear sounds…….
It’s about NOT missing out on life!
I love you
Ever heard these three little words shouted really loud?
No. Words of intimacy and affection are usually whispered.
A hearing loss makes you miss out on the subtext of what’s being said; the the
way it is being said; the tone of voice etc.
When we have a secret, we whisper it. Soft voices are more interesting, more
Hearing rehabilitation improves relationships… surely that’s a good enough
incentive to try.
Binaural Hearing…. As Nature intended.
Hearing with two ears helps us:
Tell the direction of sounds
Keep our balance of sounds
Hear better in background noise
Having two hearing aids also helps…
To stimulate both sides of our brain which is important for speech
Hearing aids do not give you back “normal” hearing
Focus on the improvements that your hearing aids have made and not
on the situations when they didn’t work so well
“If you still can’t her you friend speak from across the table at the restaurant, be
encouraged – a normal hearing person will have trouble under these
circumstances too”. –Thomas Jones
Your hearing aids job is to help you hear better, not perfectly. The
hearing aid is an aid
Background noise is normal. Normal hearing people hear it too. Don’t
give up because the noise bothers you. In time you will view it as part of
your “normal” world.
Listening tips for new users
1. Start wearing the aid in quiet situations
2. Listen to your own voice. You may notice a difference. Read aloud a
few paragraphs from the newspaper to get used to it
3. Begin wearing the aid for a few hours and gradually increase your
wearing time each day
4. Relearn the tricks of concentration. Pay attention. Listen
5. Avoid pretending that you have understood what was said. It will only
confuse things later
6. Don’t be afraid to ask people to repeat, speak louder or more slowly
7. Inform people that you have a hearing impairment and suggest what he
or she can do to help you hear better
8. Remind people to speak to you
9. Carefully watch the speaker. Attend to the lips, facial expressions,
gestures and body language
10. Position yourself to take advantage of good lighting. Make sure the light
source is behind you. Change you position if you find that there is a
glare to the speaker’s face
11. At informal gatherings, try to limit the number of people you speak with
at one time. One-to-one conversations are easier than group
12. You will hear a lot of loud noises in a noisy situation. Remember to
persevere with your hearing aids – it will improve with time
13. When watching T.V., turn the volume down
14. When listening over the telephone, place the receiver close to the
microphone of the hearing aid and angle the receiver
The fact is You have a hearing loss. Be proud of the fact that instead of being
stuck in denial about the hearing loss, you have done something about it!
You will need a combination of conversational tactics along with your hearing
instruments to help you communicate.
So, don’t be afraid to be assertive and let people know that you have a hearing
impairment and that they need to speak clearly and slowly to you. Have a look
at the previous handout to give you ideas on what to ask for. Hearing loss is
more common than you think. So, by letting people know what they can do to
help, you are also aiding community awareness of the “invisible” nature of the
impairment. After-all, there is a perfectly acceptable reason as to why you
didn’t pick up what they were saying – it’s not because you are not interested
and not paying attention on purpose.
Educate those around you!
It takes Two to Communicate!
Practical advice for family and friends:
The hearing aid alone is not enough to help a hearing impaired person hear
1. Speak clearly and naturally – It is not necessary to shout. A loud
voice may actually overload the hearing aid and cause distortion.
Maintain a normal tone of voice, speak clearly and slowly
2. Move Closer – This is especially important in noisy places
3. Face the listener – Make sure the listener can see your face and
lips. Lip-reading is instinctive to us all.
4. Attract the listener’s attention – make sure they know you are
talking to them before you start talking. Don’t try and have a
conversation from another room, they will not hear you
5. Take the surroundings into account – Is the TV, washing machine,
vacuum cleaner going in the background? Try and talk in a
6. Be aware of performance constraints – never put the hearing
impaired listener and their hearing instruments under too much
pressure. They both have their limits
Learning to use a hearing aid is hard work. Be patient and supportive of the
listener. Commend them for having the courage to help themselves.
Taking care of the Instruments
There are a few common issues that most people experience when they first
get hearing aids. It is often difficult to remember everything we tell you at the
fitting appointment as there is so much information.
Red = Right Blue = Left
Wipe you aids regularly with a dry cloth or tissue
Avoid getting your hearing aids wet
Hearing aids should never be exposed to extreme heat
Keep them in the case when you’re not wearing them
Make sure you give the hearing aid tubing a clean with the cleaning tool
regularly. It is often better to clean it in the morning when the wax has
Keep you hearing aids away from pets! They like to chew them!!
Make sure you turn the hearing aid off by opening the battery door when
you are not using it to save the battery
Batteries: The battery life will differ depending on the type of hearing aid, the
degree of your hearing loss and the amount of use. It’s a good idea to carry
extra batteries with you.
A hearing loss may be hereditary, occur suddenly or be an advancing process.
Millions of people worldwide are faced with hearing problems. Hearing aids can
be used successfully for almost all types of hearing losses.
Hearing aids are rather expensive, high precision electronic devices requiring
proper care. The hearing aid should be kept clean and free of earwax and must
not be exposed to extreme temperatures or humidity. When not in use, the
hearing aid should be kept in it’s pouch or case.
Hearing aids do not restore normal hearing but they do put the wearer’s
remaining hearing ability to very effective use. By amplifying sound and
speech, hearing aids help the wearer get the most out of each day.
The earmould: Until one gets used to the feeling, it can be annoying to have
something in the ear. If the ear canal is tender and the earmould is not formed
or placed correctly, it can be quite uncomfortable. In some cases, the earmould
can plug the ear, giving the sensation of talking in a barrel or having wqter in the
New sound impressions: In principle, a conventional hearing aid amplifies all
sounds, both wanted and unwanted ones. People with normal hearing are able
to subconsciously “filter out” some unnecessary sounds but this may prove
more difficult for the hearing aid user. With the help of the hearing aid, the user
may again be experiencing the “normal” noise levels that they lived with 20–30
years ago. This can take time to adjust to, especially since we all become more
sensitive to noise with age.
There are digital hearing aids today that can compensate to a great extent, for
the user’s inability to ignore noise.
These hearing aids enhance speech and speech sounds, while suppressing
background noise and other irritation sounds. Still, it takes time and effort to get
used to the new sound impressions. Most people get accustomed to wearing
hearing aids within a few months but the process can easily take longer.
Getting used to hearing aids: The problems we just named can cause the
users to give up wearing their hearing aids. Most hearing aid users hear
reasonably well in quiet surroundings, often even without their hearing aids.
Therefore, it may be tempting to only use the hearing aids in noisier
surroundings. To maximise the benefit of their hearing aids, it is however,
important that the users allow themselves to get used to wearing them in all
situations and here the assistance of family and care personnel could be very
It is generally a good idea for users to start wearing their hearing aids in quiet
surroundings. As they get accustomed to using their hearing aids, they can try
wearing them also in noisier surroundings and for an increasing amount of time.
Advantages: Active use of the hearing aids will make communication with
other people easier and this way contribute to increased quality of life. The user
can better hear what people are saying and can hold conversations with one
person, or even a group of people. They are better able to enjoy music, hear
the TV and radio, hear the telephone ring – experience all the sounds that make
up the day.
With the newer hearing aids, including the advanced digital instruments, users
can enjoy greater nuance and variety in their perception of sounds.
Hearing: The ear is an incredibly sophisticated and complex sensory
apparatus. Sensory cells in the inner ear convert the incoming sound to
hearing. Damaged sensory cells are the most common cause of hearing loss.
The damage reduces the ear’s sensitivity to sound so that the person is no
longer able to hear soft sounds whereas very loud sounds are heard almost
normally. In other words, soft sounds must be made louder or amplified to be
heard whereas loud sounds should only be amplified a little or not at all so they
do not become uncomfortably loud.
Communicating with a hearing impaired person: Hearing aids are a big
help but cannot, as mentioned previously, restore normal hearing. One of the
challenges facing a hearing impaired person is to determine from which
direction speech or sounds come and although advanced instruments are better
at “separating sounds”, it can still be difficult to distinguish and thereby
understand the various sounds.
Listening required energy and resources of the hearing impaired person.
Situations where many parts of the conversation must be repeated or where
misunderstandings obstruct sensible communication are strenuous for
everyone. Below are some guidelines that can help smooth away
1. Never speak with your back to the hearing impaired person
2. Make sure that you are not too far away from the person. The
sound intensity is reduced by 50% if the distance is doubled and
just a few metres may prevent the message from reaching the
3. Make sure that you have eye contact. If several people are
present, it is best to address the person by saying his or her name
4. In very noisy surroundings it is a big help if you touch the person
5. Speak slowly and clearly – but do not shout. Often it is not so
much a question of volume as of the articulation of each individual
6. Misinterpretation of just a single word can cause the meaning of a
comment or conversation to be lost. If the person does not
understand a sentence although you repeat it several times, then
try to rephrase it
Increased sensitivity: Many types of hearing losses give increased sensitivity
to loud sound and noise which means that the hearing impaired individual has
not just difficulty in hearing soft sounds but also loud sounds. Consequently,
loud speech may be just as unintelligible as soft speech and loud sounds can
sometimes even cause physical discomfort (e,g, screaming children, trucks,
scraping chairs etc).
Many modern hearing aids can be adjusted so that loud sounds are not
uncomfortably loud and soft sounds are audible. If is therefore important to
note whether the user often reacts negatively to loud sounds. If so, it would be
a good idea to discuss the option of trying another type of aid.
A general description of the hearing aid
A hearing aid consists of a microphone, an amplifier and a loud-speaker. The
hearing aid helps the ear pick up sound, makes it louder and sends it into the
ear. Both behind-the-ear and in-the-ear models are available.
A hearing aid consists of the following parts:
1. A microphone that picks up sound waves and converts them into
2. An amplifier that strengthens these signals
3. A loudspeaker (called a receiver in hearing aids) that reconverts
the amplified signals into sound.
4. An earmould that rests in the ear and through which sound travels
to the eardrum (behind-the-ear models)
5. A plastic tube that sends the sound from the hearing aid into the
earmould (behind-the-ear models)
To obtain maximum benefit of the hearing aid, the following functions (if
available) can be used:
1. Microphone and Telecoil(M-MT-T switch)
Most hearing aids are equipped with an M-MT-T switch
M = Microphone setting:
Set the switch to M for normal use
T= Telecoil setting: If the user is in a location where a loop system is
installed, switching to T (telecoil) allows clear reception of the desired
speech or music without background noise. The telecoil is also
recommended for telephone conversations, if the telephone receiver is fitted
with a sufficiently powerful magnetic field. Telephones that can be used with
a telecoil are available as audiological accessories. A telecoil can also
amplify sound from a radio or TV provided that these are connected to a
MT=Microphone and Telecoil setting: It is possible on many hearing aids to
listen through both the microphone and the telecoil simultaneously, by
switching to MT (middle position). When the user listens with both the
microphone and telecoil, he or she can converse with others while engaged
in other activities such as talking on the telephone or watching TV
2. Volume Control: It is recommended to turn off the hearing aid or turn
down the volume before inserting the hearing aid into the ear so the user
does not risk the discomfort of feedback whistling. When the hearing aid is
in place, adjust to the desired volume. Many modern hearing aids
automatically adjust the volume
Ménière’s disease is a condition that causes vertigo, tinnitus, and progressive deafness. There is no cure, but some treatments can ease the symptoms.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), approximately 615,000 people in the United States have Ménière’s disease. It can develop at any age, but it most commonly appears between 40 and 60 years of age. In most cases, it only affects one ear.
In this article, we explain the symptoms, causes, and triggers of Ménière’s disease, as well as natural and conventional treatments. We also recommend dietary changes that can help a person reduce the symptoms.
Although there is no cure, treatment can help manage some symptoms.
Ménière’s disease has links with stress and anxiety. However, it is unclear whether stress and anxiety cause symptoms of Ménière’s disease, or whether the disease leads to stress and anxiety.
Either way, stress and anxiety management can help reduce the intensity of symptoms. People may find that yoga, meditation, tai chi, or mindfulness helps them relax.
Research suggests that there is a link between smoking and tinnitus, so quitting may help reduce this symptom.
Medications for vertigo
Doctors may recommend different types of drugs for vertigo. The options include:
Motion sickness drugs: These medications include meclizine (Antivert) and diazepam (Valium). They can help with the spinning sensation that vertigo causes, as well as the nausea and vomiting.
Drugs for nausea: Prochlorperazine (Compazine) is an effective medication for treating nausea during an episode of vertigo.
Diuretics: These drugs reduce fluid retention in the body. For Ménière’s disease, doctors might prescribe a combination of triamterene and hydrochlorothiazide (Dyazide or Maxzide).
Reducing the amount of fluid that the body retains may improve the fluid volume and pressure in the inner ear. As a result, the severity and frequency of symptoms may decrease.
Middle ear injections
Doctors can inject some medications into the middle ear to improve symptoms of vertigo.
These drugs include the antibiotic gentamicin (Garamycin) and steroids, such as dexamethasone (Decadron).
Surgery may be an option for people with Ménière’s disease if other treatments have not been effective, or if symptoms are severe. Surgical options include:
Endolymphatic sac decompression: A surgeon removes a small portion of bone from around the endolymphatic sac. This membrane in the inner ear helps control water pressure in the ear. If it is not working correctly, this may contribute to vertigo.
Labyrinthectomy: A surgeon removes a portion of the inner ear.
Vestibular nerve section: A surgeon cuts the vestibular nerve.
Vestibular rehabilitation therapy: People may experience balance problems between episodes of vertigo. A healthcare professional can instruct them on exercises and activities that may help their body and brain regain the ability to process balance.
People with hearing loss may benefit from a hearing aid.
Aside from making adjustments to the diet and lifestyle, there are few natural options available to manage Ménière’s disease.
Some herbs, such as ginger root and ginkgo biloba, may provide relief from vertigo symptoms in some people.
However, according to the NIDCD, no evidence supports using herbal supplements, acupuncture, or acupressure to treat Ménière’s.
Herbal supplements may also interact with existing medications. People who wish to try these remedies should check with a doctor before taking them.
Positive pressure treatment
A few years ago, the Food and Drug Administration (FDA) approved a device that can help people who have Ménière’s disease.
This device releases small pulses of air pressure into the middle ear. These pulses seem to interact with the fluid inside the ear to reduce dizziness.
The symptoms of Ménière’s disease vary from person to person. They can occur suddenly, and their frequency and duration differ.
Doctors often refer to sudden symptoms as an attack. Ménière’s attacks vary in length but typically last for between 20 minutes and 24 hours.
Common symptoms that occur during an attack include:
Usually the most obvious symptom of Ménière’s disease, vertigo can involve:
a spinning sensation, even while a person is stationary
It is difficult to predict when a vertigo attack will occur. For this reason, it is important to have vertigo medication handy at all times.
Vertigo symptoms may interfere with several activities, including:
operating heavy machinery
climbing ladders or scaffolding
This persistent, disruptive noise in the ear may resemble the following sounds:
People are generally more aware of it during quiet times or when they are tired.
In a person with Méniére’s disease, levels of hearing loss may fluctuate, especially early on in the disease’s progression.
The person may also be more sensitive to loud sounds. Eventually, most people with Ménière’s develop some degree of long-term hearing loss.
Anxiety, stress, and depression
These psychological symptoms can also develop due to Ménière’s disease. The condition is unpredictable and can adversely affect the individual’s ability to work, especially if they have to climb ladders or operate machinery.
As hearing gets progressively worse, people might find social interaction more challenging.
Some people with Ménière’s lose the ability to drive, further limiting their independence, job prospects, freedom, and access to friends and family. It is important for people who experience stress, anxiety, or depression to tell their doctor.
Ménière’s can also have other effects throughout the body. We explore these in more detail in the section below.
Ménière’s disease develops in two stages. Between these stages, a person might not experience symptoms for extended periods.
In its early stages, Ménière’s disease causes sudden and unpredictable episodes of vertigo.
During these episodes, there will be some loss of hearing, which typically returns to normal once vertigo subsides. The ear may feel uncomfortable and blocked and have a sense of fullness or pressure. Tinnitus is also common in early stage Ménière’s disease.
After a vertigo attack due to Ménière’s disease, a person often has extreme exhaustion and feels the need to sleep for hours.
People may also experience the following during the early stages of the disease:
jerking eye movements
palpitations or a rapid pulse
Vertigo episodes become less frequent in the late stages of the disease and, in some cases, never come back.
However, balance, hearing, and vision problems can continue. Individuals will feel especially unsteady when it is dark. Hearing and tinnitus usually get steadily worse.
A person might also experience drop attacks. These involve spontaneously losing posture or suddenly falling down while remaining conscious.
The most disruptive feature of Ménière’s disease is the sudden onset of vertigo attacks.
The individual may have to lie down and miss out on social, leisure, work, or family activities.
Vehicle licensing authorities in many countries state that people with a diagnosis of Ménière’s disease must not drive.
These authorities will not permit the individual to drive until they receive a doctor’s confirmation that their symptoms are under control.
Certain dietary changes can help reduce fluid retention. Generally, minimizing fluid retention will reduce the frequency and severity of the symptoms.
These measures may help:
Eating more frequent but smaller meals: Evenly distributing meals throughout the day helps regulate body fluids. Rather than eating three large meals a day, try six smaller ones.
Eating less salt: The less salt a person consumes, the less fluid their body will retain. People should avoid adding salt to meals and cut out most junk foods, as these are often high in added salt.
Reduce alcohol intake: Alcohol can adversely affect the volume and composition of the inner ear fluid.
Drink water regularly: Peoples with Ménière’s disease should take particular care to hydrate regularly during hot weather and intense exercise.
Avoid tyramine: This amino acid is in a range of foods, including chicken liver, smoked meats, red wine, ripe cheeses, nuts, and yogurts. It may trigger migraine, and people with Ménière’s disease should consider avoiding foods that contain it.
Ménière’s disease may occur due to an abnormality in the structure of the inner ear or the fluid levels in it.
However, the exact reason why these changes develop is unclear.
The inner ear contains a cluster of connected passages and cavities called the labyrinth.
The outer part of the inner ear is home to the bony labyrinth. Inside, there is a soft membrane structure, which is a smaller version of the labyrinth, with a similar shape.
The membranous labyrinth contains a fluid called endolymph. It also has hair-like sensors that respond to the fluid’s movement and send messages to the brain through nerve impulses.
Different parts of the inner ear play roles in various types of sensory perception, such as:
detecting acceleration in any direction
For all of the sensors in the inner ear to function fully, the pressure, volume, and chemical composition of the fluid have to be correct.
Certain features of Ménière’s disease alter the properties of the inner ear fluid, triggering the disorienting effects of the disease.
Certain stresses and emotional disturbances can trigger episodes of Ménière’s symptoms, including working for too long, underlying health conditions, and tiredness.
Salt in the diet is another trigger.
No single test or scan can allow a doctor to diagnose Ménière’s disease. The doctor will carry out an interview and physical examination, ask about the person’s medical and family history, and consider the signs and symptoms.
The doctor will ask about the following:
the severity of symptoms
how often symptoms occur
what medications the person has been taking
any previous problems with the ears
general health status
any history of infectious diseases or allergies
any family history of inner ear problems
Several other diseases and conditions have similar symptoms, which can make it challenging to diagnose Ménière’s disease.
To establish the extent of hearing loss, a doctor will perform an audiogram.
An audiometer produces tones of varying loudness and pitch. The individual listens with headphones and indicates when they hear a sound or when a sound is no longer present.
Many people with Ménière’s disease experience some degree of difficulty with balance. A person’s sense of balance may seem to resolve between episodes of vertigo.
A doctor introduces warm and cool water or air into the ear canal. They then measure involuntary eye movements in response to this simulation. Unusual responses may indicate an inner ear problem.
Rotary chair testing
The individual sits on a chair in a small, dark booth. The doctor places electrodes near the person’s eyes, and a computer-guided chair gently rotates back and forth at varying speeds.
The movement stimulates the inner balance system and causes nystagmus, or eye movements. A computer and monitor records these with an infrared camera.
Vestibular evoked myogenic potentials (VEMP) testing
This test measures the function of certain sensors in the inner ear that detect acceleration.
The individual wears a safety harness while standing barefoot on a special platform and trying to keep their balance under various conditions.
A doctor may wish to rule out other possible diseases and conditions, such as a brain tumor or multiple sclerosis (MS). They may request the following scans to help them do this:
Auditory brainstem response audiometry — which measures ear and brain function in response to sounds — to rule out tumors
Ménière’s disease has a complicated range of symptoms and is difficult to diagnose and treat.
Attacks may be frequent or infrequent and cause stress, anxiety, and hearing loss. Periods of remission occur between episodes.
A person with Ménière’s disease should seek medical support, as several methods are available to manage the symptoms.
Neurocognitive Function in Age-Related Hearing Loss
One of the most amazing abilities of the human brain is its capacity for change. The term neuroplasticity refers to the brain’s ability to adapt or change. While the brain is most amenable to change early in development (developmental neuroplasticity), neuroplastic changes may occur across the human lifespan as a result of disease, injury, dysfunction, and learning (adulthood neuroplasticity). Based on our findings, it appears that untreated hearing loss (even mild sensorineural hearing loss) is associated with neural reorganization and cognitive deficits.
Hearing loss linked to increased risk of dementia
Better relationships through better communication
Communication plays a significant role in a relationship.
To improve communication between people with hearing loss and their communication partners,
the Ida Institute in Denmark developed a free suite of tools.
As a consequence of their significant other having hearing loss, primary communication partners
sometimes experience third-party disability, which is defined by the WHO as the disability of family
members due to the health condition of their significant other. Of course, primary communication
partners can also be parents, children, siblings or even a best friend.
Third-party disability can impact social interactions, emotional wellbeing, and overall quality of life.
Communication partners report feelings of frustration and uncertainty and are prone to depression,
detachment, and marital discontent. But research shows that by involving communication partners
in the hearing care journey, both parties can experience improved quality of life and that
rehabilitation outcomes can be greatly improved.
That’s why it is crucial for hearing care professionals to involve clients’ key communication partners
in the rehabilitation process. Ida’s suite of Communication Partners tools guides people with hearing
loss, their communication partners, and hearing care professionals in managing hearing loss through
a more complete picture of the clients’ needs and greater support from communication partners.
See the Communication Partners tools on the Ida Institute website.
Diabetes and Hearing Loss
20 December 2022