Hearing Loss (6)
To understand hearing loss you need to understand what normal or average hearing means. If you have normal hearing you should have no difficulty hearing and understanding most of what other people in a conversation are able to hear, whether spoken by men, women or children. If you are experiencing a hearing loss, you may notice that you are unable to understand women or children, but can hear men more clearly. With the beginning of a hearing loss, the higher sounds such as those made by women and children are frequently the first sounds that we lose.
Hearing on the phone, at meetings, in large groups and with background noise may become challenging and frustrating for you. Generally, if you are having difficulty hearing the same things that others around you are hearing with no difficulty, you should discuss this with your doctor who can begin an assessment of your hearing and determine if there is a problem.
Hearing loss, once identified by a professional, will be described to you in terms of: a mild loss in which you experience some difficulty in ordinary conversation, a moderate loss where others must raise their voices and hearing devices are necessary for you to hear in most situations, a severe to profound loss where you would require hearing aids and/or other accommodations.
Hearing loss can be caused by many different factors and can occur at any age from birth through the senior years. One category of loss is called conductive loss and relates to problems with the transmission of sound waves through the outer and middle ear. Sounds that enter the ear can be disrupted by wax blocking the ear, a perforated ear drum, middle ear infections or fluid in the ears.
The other category of hearing loss is sensorineural loss and relates to problems with the reception of sound by the nerve cells within the ear. There can be many causes of this type of hearing loss including: congenital factors, illness, over-exposure to noise, and loud music, as well as age-related changes and use of some medications. Recent studies show a relationship between sensorineural loss and over-use of the cell-phone and in-the-ear audio devices which can damage the inner ear.
This depends on the type of loss your doctor identifies through a detailed assessment. Some hearing loses are treatable by medical procedures and medications. For other hearing losses there are assistive devices like hearing aids and implanted devices such as cochlear implants or bahas. Conductive losses such as those caused by some middle ear infections may clear up with medication if they are detected early; when left untreated they may cause more permanent damage to the eardrum and the middle ear. Hearing loss caused by head trauma, disease, congenital and genetic factors, and long-term noise exposure can often result in permanent nerve damage.
The key to successful treatment is to contact your doctor early to arrange for a referral to a specialist who will assess your hearing loss and discuss solutions. Early treatment can maximize your hearing abilities, put you on the road to peace of mind, and improve the quality of your life.
The hard of hearing are people of all ages who experience hearing loss but are able to acquire, or have already acquired, spoken language. Their primary means of communication is through speech. Those who call themselves deafened may choose to use some finger spelling or sign language to assist with their communication needs. Canadian statistics indicate that between 10 and 15 percent of our population is hard of hearing.
There is some confusion surrounding the terminology of hearing loss. In meeting people with hearing loss, you will hear terms such as hard of hearing, deafened or late-deafened, hearing impaired, hearing disabled, deaf and culturally deaf. The use of these terms is a matter of personal preference when referring to one’s own hearing loss. It is important to determine how a person with a hearing loss prefers to be identified and to respect individual preferences.
The acceptability and usage of terms related to hearing loss also change over time. The terms “hearing disabled” and “hearing impaired” have been used in the past but have become less acceptable to the hard of hearing as some feel the terms present a negative image of people with a hearing loss. Many people with hearing loss prefer to be identified as the hard of hearing.
The terms deafened and late-deafened are terms commonly used to describe people who have grown up communicating orally before experiencing severe to profound hearing loss. Oral language is their primary mode of communicating to others, supplemented by sign language, residual hearing, hearing aids and technical devices, speech reading, and implants.
The deaf and culturally deaf are terms used to describe those who were born deaf or became deaf before acquiring speech. The majority of deaf people use sign language instead of speech for communication. They participate primarily in the deaf community, language and culture of the deaf.
Tinnitus is abnormal noise perceived in one or both ears, or in the head. Tinnitus can be intermittent, or it can be constant. It can be experienced as a ringing, hissing, whistling, buzzing or clicking sound, and can vary in pitch and volume from a low murmer to a loud roar or squeal. Tinnitus is often associated with damage to the hearing system, but can also be associated with other events such as a head injury, some medications, nerve damage or vascular problems. Your doctor is the person to determine the cause of your tinnitus, and provide advice on treating or managing the symptoms
Although there are many sources of information about tinnitus on the internet, CHHA-MB has found information provided by the Center for Hearing Loss Help to be a good place to begin to learn more about this condition www.hearinglosshelp.com/articles/tinnitus.htm
Hearing Devices & Technologies (9)
Hard of hearing, the Deaf and those with other communication disorders in Manitoba can access emergency 911 service from their cell phones using text messaging. Users must register with MTS to access this service. Here are two important links:
To register for the service: T-911 registration
Where the service is available: T-911 service availability in Manitoba
In many cases hearing aids can significantly improve the hearing of a person with a hearing loss. Depending on the type and degree of loss experienced, hearing aids can approximate normal hearing for some people – usually those with a mild loss. However, hearing loss may range from mild to severe or profound, and can be caused by different factors. It may be due to the natural aging process, genetic factors, trauma to the ear, and a variety of medical conditions including chronic middle ear congestion due to colds or influenza.
This item includes a link a July 2009 report in Consumer Reports magazine on shopping for hearing aids. While the report is about hearing aid purchases in the US, the information can also be valuable to Canadian shoppers.
Once you have an audiogram created by an audiologist, you can find a list of hearing aid specialists in your area by checking the phone book or on-line. The audiologist you see may also be a hearing aid specialist, or your doctor may recommend a hearing aid centre. As well, people you know who have had positive experiences with a hearing centre may offer their recommendations.
Discuss with your hearing aid specialist the possibility of trying various types of devices so you can compare their effectiveness. hearing aid centres will offer a period of experimentation with your hearing aid. Ask your specialist how much time you have to decide on the best type and fit for you.
During the trial period try to experience a wide variety of listening situations such as watching TV, attending a movie, listening to music, visiting friends or going to a shopping mall to test the effectiveness of the hearing aid(s) in each setting. Note any problems you encounter, and report back to your specialist for adjustments or for the opportunity to try different types of hearing aids.
It is important to verify the warranty period for your hearing aids, and the type of coverage you have. It may require many visits to the specialist to find what is the best hearing device for you. It is worth the time invested!
Click the link below to read the July 2009 article in Consumer Reports magazine on how to shop for hearing aids.
You can also view this excellent report by the Mayo Clinic that explains how different hearing aids work and how they are fitted:
Additional details are available in the above FAQ – Thinking About Getting Hearing Hearing Aids? Things to keep in mind.
First Things First
• Visit your family doctor first to have your ears checked for possible ear wax build-up and other conditions that may affect your hearing. Your doctor may refer you to an ear-nose-throat (ENT) specialist for further evaluation, or may recommend an audiologist or hearing aid dispenser.
• See a properly licensed audiologist for a hearing test. There will probably be a fee for the test if you don’t purchase hearing aids from this business, but patients are entitled to receive a copy of their audiogram to take elsewhere. Some companies charge a fee even if you do purchase from them.
• Hearing loss related to employment or military service may be covered by Workers’ Compensation or Veterans’ Affairs. Find out the answer before proceeding with a hearing test and hearing aid purchase as these institutions may have special requirements or application processes
• If you have a private health insurance plan, find out if it covers testing and/or a portion of the purchase price of hearing aids, and if there are any referral letters/test results required in order to apply for coverage.
• Consider taking a support person along when you visit the hearing aid dispenser as it can be difficult to take in all the information they provide – especially if you have a significant hearing loss.
• People often find they have hearing loss in both ears, although one side may be worse than the other. This can lead people to think that one hearing aid in the bad ear is sufficient. Hearing aid dispensers will suggest instruments for both ears – and they are usually correct – it isn’t just some fancy sales pitch. While the ear is the organ that receives the sound, the brain is the organ that processes it, and the brain will perform this function better if it gets the best possible sounds from both ears.
• Insist on a decent trial period for new hearing aids – two or three weeks is not enough time for a person to get used to hearing better, especially if the loss is significant, and a lot of time has passed before purchasing hearing aids – six weeks (or even longer) is a more reasonable trial period.
• Find out if there is a re-stocking fee if you decide to return the aids during the trial period – some companies charge, some don’t; some companies will not take aids back but will work with you to find another brand that may work better.
• Be sure to understand what is and is not covered by any insurance the hearing aid dispenser provides – typically dealer-coverage is in effect for one year and covers one replacement of a lost or damaged hearing instrument. This can also vary depending on the hearing aid – some hearing aid manufacturers may have a longer warranty than the dispenser.
• You should be able to go back to your hearing aid dispenser as many times as you require to have your hearing aids adjusted to meet your needs – there should not be any additional fee for this – it should be part of the sales price. It’s important to understand this at the outset of the purchase process.
• Hearing aids are set according to a hearing test performed in a very quiet sound booth. This does not reflect the sounds one hears in the real world. You may need multiple visits back to explain what is too loud and what is too soft. Be sure to select a hearing aid dispenser that is easy to get to and that you feel comfortable about. This may mean visiting a few dealers before you decide which company to use.
• Hearing aids can have all kinds of bells and whistles – some important, some not so much. Be sure to understand what the basic hearing aid provides, and what features, if any, would be suitable for you. For example, some people benefit from having a special T-coil to hear better on the phone, but others may not need this feature.
• The hearing aid dispenser is responsible for teaching clients how to use and take care of their hearing aids – some people learn this quickly, others need more time.
• It is important to give the brain time to re-learn how to hear once hearing aids have been introduced. This means that you should wear your hearing aids every day all day to accustom your brain to new or forgotten sound sensations. The sounds that have been absent and suddenly return when a hearing aid is inserted can be confusing until the brain adjusts to them, recognizing that noises like a newspaper rustling or cutlery clattering can be ignored.
• Patience with your new hearing experience, and believing you have made the right decision further help with the adjustment.
• Ask your household insurance company if they will provide coverage for hearing aid loss or damage after the dealer’s insurance period is up: some insurance companies will not provide any coverage for hearing aids, and those that do usually charge an additional premium.
• The cost of hearing aids should be included as a medical expense when you file your income tax for the year in which you purchased them.
• In Manitoba, financial assistance to purchase hearing aids is available to members of the Society for Manitobans with Disabilities’ (SMD) through its Assistive Technology Program. To become a member of SMD you need to have received services from the society (e.g. parking permit, wheelchair) or be a member of CHHA or another organization affiliated with SMD. Details about the program are available at: http://smd.mb.ca/smd-services/assistive-technology
The Mayo Clinic web site includes helpful information on choosing hearing aids. Read their article at Mayo Clinic article on choosing hearing aids
Assistive listening devices include any mechanism used to help a hard of hearing person function in situations where hearing loss might otherwise prevent his/her full participation, enjoyment, or benefit. There’s a wide range of materials to help hard of hearing people to hear better at work, at home, and in social and public settings.
People with hearing loss may not be able to hear the doorbell or telephone; a flashing light or louder ringer for the doorbell, and volume control devices on the telephone may be sufficient for some to hear these sounds. Those with more severe hearing loss may require a special telephone that allows them to converse in written form. Since people remove their hearing aids at night, a regular alarm clock may not be loud enough to waken them. Vibrating alarms placed under the pillow or mattress will “shake one awake”.
Most TV channels now provide captioning for the hard of hearing and deaf. Hearing ear dogs are now used by some hard of hearing people both in the home and when outside the home to alert the person to dangers and to sounds they can’t hear.
Click on Access to learn more about the different types of equipment that’s available, as well as other useful devices and services to enhance hearing and participation.
TTY equipment enables teletypewriter communication between hard of hearing people, as well as between hard of hearing people and the hearing community. More information is available on the Access page.
A cochlear implant is an electronic device that can help some people to hear. The device has both internal and external components.
The internal components are surgically implanted in the mastoid area behind the ear. The implanted portion consists of a receiver and an electrode array in the inner ear to stimulate the cochlea.
The external part consists of a microphone, a programmed speech processor, and a transmitting coil.
Although cochlear implants do not restore “normal” hearing, they do provide a positive option for those with severe to profound hearing loss. Cochlear implants have been performed in a number of centres in Canada since the 1990’s, and are considered a safe and viable option for certain types of hearing loss.
For more information, visit the Canadian Academy of Audiology web site http://www.canadianaudiology.ca/consumers/cochlear/
A Baha is a bone-anchored hearing aid that is placed in position through surgery. It has both internal and external parts. A Baha may be appropriate for someone who has one-sided deafness, has had many ear infections, or who may not have a normal outer ear.
It helps people with a different type of hearing loss from those who would benefit from a cochlear implant.
Baha placement is available in some centres in Canada.
For more information on Baha technology, visit www.cochlear.com
Different hearing devices may be worn differently – for example, behind the ear, or in the ear. You will need to make an appointment with your hearing aid specialist for assistance.
Vertigo and Balance Problems (2)
Dizziness can indicate that you have an inner ear problem, are reacting to prescription or non-prescription medications, or that you have some other medical condition. You should consult your primary care physician for help in identifying the cause of your dizziness. Your doctor may also refer you to a specialist for detailed testing.
Meniere’s Disease is an inner-ear balance disorder that causes attacks of vertigo (a sense you or your environment is spinning), along with other symptoms, including tinnitus (noise in the ear), aural fullness (a feeling of pressure or pain in the ear), and fluctuating hearing loss. CHHA Manitoba Chapter holds support group meetings for people with Meniere’s disease. Click here for information on support group meetings. To find out more about Meniere’s disease and other balance disorders, you may wish to visit the Vestibular Disorders Association web site at www.vestibular.org.
Finding Help (5)
CHHA Manitoba does not recommend any specific audiologist or hearing centre.
However, your personal physician will be able to recommend the right hearing specialist for you to see, and will likely refer you to an ear nose throat (ENT) specialist first to identify any possible physical cause of your hearing problem.
Your doctor may also recommend an audiologist, or you can see an audiologist recommended by a friend or family member. You can also contact any hearing centre in your area to request testing by an audiologist. You do not require a doctor’s referral to book an appointment with an audiologist.
My audiologist says I need a very expensive hearing aid. Where can I go to get an unbiased second opinion?
An audiologist is a specialist at assessing hearing, and will provide you with a copy of your audiogram at your request. The audiogram gives a complete picture of your hearing levels, and should also include a written summary of the results of your hearing test.
You can take your audiogram and written report to any approved hearing instrument specialist to discuss the type of hearing device best suited to your needs. If you are not satisfied with the recommendations and costs, you can seek a second opinion from any other hearing centre or audiologist who is qualified to dispense hearing aids.
Hearing aids are not covered by Manitoba Health, except for children under the age of 18. Information on coverage is available at http://www.gov.mb.ca/health/mhsip/hearingaid.html
You may be covered for the purchase hearing aids through your private medical insurance plan. Check with your insurance company’s plan administrator prior to making a purchase so you will know exactly what is covered and what documentation is required to submit a claim.
If your hearing loss is the result of a work injury, you may be eligible for assistance through Workers’ Compensation. You must check with your Workers’ Compensation case manager to find out if you are covered and what process you must follow to receive support.
In Manitoba, financial assistance may be available through the Society for Manitobans with Disabilities’ (SMD) Assistive Technology Program. To benefit from this program you must be a member of CHHA or another organization affiliated with SMD in order to qualify. Information about the program is available at: http://smd.mb.ca/smd-services/assistive-technology
In 1999 CHHA National developed the following definition of speechreading as part of the Working & Coping with a Hearing Loss project:
“Speechreading is a skill, learned through study and practice, requiring patience, perseverance, and a sense of humour. Speechreading is more than reading lips! It involves interpreting the sounds that you can hear, watching the movement of the lips, jaws and tongue, and the facial expressions and body language. It’s about using every means possible to understand our fellow human beings!”
Hearing loss support groups help people with reduced hearing learn to speech-read and also provide an opportunity to meet with others with hearing loss for mutual support. Meeting leaders teach speech reading techniques and share practical tips and tricks for coping effectively. Meeting leaders are all trained speech-reading instructors.
If you would like more information please use the contact button at the top of the page to email our office, or telephone 204-975-3037 and leave a message for a call-back.