Hearing loss affects nearly half the people in the United States older than 65. In Vero Beach, with its 54,008 residents over 65, that’s more than 26,000 people statistically likely to have some level of hearing loss.
Hearing loss can be frustrating, embarrassing and even dangerous, so it is good news that hearing aids have gotten better in recent years, according to Aaron Liebman, a doctor of audiology (AuD) with more than 30 years’ experience who operates Aaron’s Hearing Care.
From the time when yelling was the only way to deal with hearing loss, to the 17th century when an “ear trumpet” placed in the ear concentrated incoming sound into a smaller area to make it louder, to non-digital hearing aids, to today’s high-tech devices, remedies for hearing loss have improved dramatically.
The most common cause of hearing loss, according to Mayoclinic.org, is sensorineural, which occurs when the inner ear, hearing nerves or hearing structures in the brain become damaged.
In adults, the aging process is the most common cause of this type of damage and hearing loss.
Another common form of hearing loss is conductive, caused by damage or blockage in the outer or middle ear, most commonly because of a build-up of ear wax, which muffles the sound.
“In the years just prior to computer digital and computer programmable hearing aids, differences between hearing aids made by different manufacturers were not significant,” said Liebman, discussing how hearing aid technology has advanced and how an audiologist works with patients to ensure they have the appropriate device for their needs, expectations and budget.
“In those days, as a way to adjust the sound quality, tiny electrical devices called potentiometers could be found on some hearing instruments. Usually, audiologists would try to fit hearing aids that had as many of these as possible. We could adjust volume, control over-amplification of loud sounds, low frequencies and high frequencies. The adjustments had to be made by hand using a tiny jeweler’s screwdriver.
“When these types of adjustments were made, we didn’t see the [corresponding] numerical data that, with today’s technology, we can now follow on a computer monitor.”
Computer advances that began in the 1980s continued into the digital age, giving audiologists the ability “to use a computer to adjust tone, volume and the maximum loudness aspect using a digital sound processing chip.
“Research discovered that a digital processing chip could automatically evaluate more aspects of incoming sounds, speech and noise, and make decisions on how to adjust itself to decrease noise and increase speech clarity,” said Liebman. “This more sophisticated computer software has provided us with the ability to adjust the hearing aids to provide an acceptable sound quality for our patients.”
Today an impressive array of hearing aid brands is available, with equally impressive high-tech features, which can vary from brand to brand and are often proprietary, designed for use with specific devices.
Bluetooth technology, for example, can be used to wirelessly connect hearing aids to such short-range devices as cellphones, TVs, computers and tablets. Another technology is T-Coil, which helps hearing aids perform better in challenging, noisy environments. They are also, according to the FDA, better for hearing over the telephone.
Also available is directional microphone technology that enables the device to optimally pick up sounds from in front of the wearer, while reducing noises from behind or next to the wearer.
Liebman explained that normal adult human hearing falls within a 20 to 140 decibel range.
Examples in the lowest volume range would be rustling leaves or normal breathing. Mid-range sounds include conversation (about 45 decibels), moderate rainfall (50-60 decibels) and hair dryer (90-100 decibels). Heavy metal concerts and jet planes taking off are in the high-to-painful range (about 140-150 ear-shattering decibels).
“We test different frequencies that cover the speech communication range,” Liebman said. “The low to mid-range sounds are mostly the ahh, ohs, bu, du, oooo, eee, mm sounds. Most permanent hearing loss is at the higher frequencies, with loss of the ‘voiceless’ consonant sounds: ss, f, t, k, p, which provide the clarity of speech.
“Because there is typically more hearing loss in the high frequencies where soft speech clarity sounds are found, just increasing the loudness doesn’t always make speech understandable,” Liebman added. Women’s voices typically have more speech information further out in the higher frequencies than men’s, which can make them more difficult to hear for someone with hearing loss.
“Most people are not aware when they need help. They’ll often blame it on other people mumbling, background noise, or say the TV or radio volume is too low,” said Liebman. “So they’re surprised when they get tested and realize what they can’t hear.”
To determine the various aspects of an individual patient’s hearing loss, Liebman typically asks questions and has the patient describe her or his hearing issues and the circumstances under which the loss is most noticeable and troublesome – whether inside, outdoors, watching TV, in conversation, in traffic or in large, noisy gatherings.
One of the most common hearing tests is “pure-tone testing,” in which the patient wears headphones and listens to a series of beeps while using a hand-held pushbutton device to indicate when a beep is heard, which helps pinpoint the frequencies at which hearing is lost.
Liebman uses this test and, he explained, also verbalizes at various volume levels and asks the patient to respond “yes” instead of pushing a button. This, he said, can make for a more spontaneous response, while the beep/push-button method could create an anticipation response, which might skew the data and alter the accuracy of the test.
He said he can tell more about how close they are to the softest level the patient can hear from the way in which the patient says “yes.”
A bone conduction test can help determine whether there is a conductive hearing loss. A bone vibrator headset sends sounds directly to the inner ear. If the patient hears better this way than with the pure-tone testing, they likely have conductive loss.
Once the extent and nature of the hearing loss is determined, the patient can choose from the available devices with the assistance of the audiologist.
Florida requires licensed audiologists to have a doctorate in audiology, requiring years of study concerning hearing, hearing rehabilitation, anatomy, and function of the hearing mechanism and hearing aid technology.
Dr. Liebman utilizes a range of manufacturers and technologies and does not believe one manufacturer is “the best.”
He recommends a patient’s hearing aid based on “the highest level of technology within what you can afford. We’ll try it, provide follow-up care, counseling and adjustments. If we determine that it is not the best for you, then we’ll change to a different style or manufacturer to fine with is best for you.”
Furthermore, he adds, in addition to providing the best technology possible, it is also vital that the “fitter” understands that technology, so the chosen hearing aid can benefit the patient at the highest possible level possible, in terms of comfort and sound quality.
Aaron’s Hearing Care is located at 925 37th Place in Vero Beach. The phone number is 772-562-5100.
