MP3s 'to blame' for hearing loss

By Sima Kotecha a  BBC Newsbeat US reporter

Up to six and a half million teenagers in America struggle to hear whispered conversations or leaves rustling in the wind.

That's according to researchers in Boston, Massachusetts who say a growing number of 12 to 19 year olds have suffered slight hearing loss.

Doctors are putting the blame on MP3 players causing damage to the hearing of young people.
The study used data from a nationwide health survey.

It compared hearing loss in 3,000 teenagers from 1988-94 and then compared it with similar data from 2005-06.

The researchers say hearing loss has increased by 19% during that time, meaning one in five teenagers now has some sort of hearing damage.

Listen carefully

Some experts say it means teenagers should turn down the volume on their MP3 players and listen for less time.

But there's no absolute proof that the apparent hearing loss is a direct result of MP3 players or earphones.
"Our hope is we can encourage people to be careful", said the study's senior author, Dr. Gary Curhan of Brigham and Women's Hospital in Boston.
Most of the hearing loss was "slight", defined as inability to hear at 16 to 24 decibels.

A teenager with slight hearing loss might not be able to hear a tap dripping or their partner whispering "good night."

Those with slight hearing loss "will hear all of the vowel sounds clearly, but might miss some of the consonant sounds" such as t, k and s, according to Doctor Curhan.

He added: "I think the evidence is out there that prolonged exposure to loud noise is likely to be harmful to hearing, but that doesn't mean kids can't listen to MP3 players".

Each new generation of teenagers has found new ways to listen to loud music.

Brian Fligor, an audiologist at Children's Hospital Boston, said: "Today's young people are listening longer, more than twice as long as previous generations".

New Hearing Loss Forum

BHI Launches Discussion Forum July 23, 2010 The Better Hearing Institute (BHI) announced today that it has launched a discussion forum to help people and their families cope with hearing loss. This unique online forum covers a wide range of hearing health topics. It is designed as the go-to place for people with mild-to-severe hearing loss who are looking for a peer support community where they can chat and exchange information on hearing loss, treatments, tinnitus, hearing loss prevention, and other related topics. To participate in the discussion forum, visit www.betterhearing.org, click on “Discussion Forum,” and go to “Welcome!” to register. Moderated by BHI, the free discussion forum will have quick and convenient access to a wealth of accurate and valuable hearing health information found on the BHI web site. “Hearing loss is challenging for many people to deal with because it can be so isolating,” says Sergei Kochkin, PhD, BHI’s executive director.  “Unaddressed hearing loss can affect virtually every aspect of a person’s life. Even when someone with unaddressed hearing loss is surrounded by loved ones, the impaired ability to hear and actively participate in conversation can leave the individual feeling cut off.” Kochkin said that connecting with others with hearing loss grappling with the same issues can provide great comfort and support. The BHI discussion forum index includes topics such as Hearing Loss 101; Hearing Loss Treatment: Hearing Aids; Hearing Loss Treatment: Alternative/Supplementary Options; Tinnitus (Ringing in the Ears); Financial Assistance; Hearing Loss Prevention; Childhood Hearing Loss; Family and Relationships; and Hearing Loss Technology. According to a BHI study, the number of Americans with hearing loss has grown to more than 34 million—roughly 11 percent of the U.S. population. Over the past generation, hearing loss has increased at a rate of 160 percent of U.S. population growth and has remained one of the nation’s most commonly unaddressed health conditions. "Unaddressed hearing loss silently erodes one's quality of life, undermining family relationships, interfering with short-term memory, and creeping into virtually every aspect of daily living," says Kochkin. "But hearing loss can be easily diagnosed, and there are modern-day solutions that can help people hear better—so they don’t need to draw back in silence. “BHI is offering this forum so we can better help the large numbers of people with mild to severe hearing loss. We urge anyone with hearing loss—or anyone who cares about another with hearing loss—to join the online forum and share their questions and experiences. We want anyone with hearing loss or other hearing health issues, no matter how mild or severe, to find the support and help they need.”

Are You Aware of Your Hearing Loss?

Patricia B. Kricos, Ph.D. - University of Florida, Gainesville, Florida
“What? You think I have a hearing loss?” If you are like many people, you may be surprised when friends and family suggest that you have a hearing problem. You may think to yourself “I hear what people say. I don’t know why they think I have a hearing loss.” Many times, you probably do hear them when they are talking, but you may be missing some of their conversation with you, or you may not realize that what you think you heard is not exactly what they were saying. This can lead to your loved ones accusing you of not listening or of not paying attention. There may actually be times when you do not realize that someone is speaking. In this case, you may appear to be ignoring the person, or you may start talking, causing your communication partner to view you as quite rude. Faux pas such as this can lead to annoyance, resentment, and/or exasperation on the part of your communication partner.

You are not alone! Many people experience this, because hearing loss usually comes on very gradually. If you woke up one morning and suddenly could not hear your alarm clock, or the coffee brewing, or your neighbor’s lawnmower, you would probably know right away that you had a hearing problem. The hearing loss experienced by most people is not sudden, but instead comes on little by little. Even when people’s hearing losses have advanced to the point where they are missing the punch line during a joke, or failing to hear the tea pot whistle, they still are likely to know when someone is talking and to understand much of what is said, especially in an ideal listening situation where there is only one talker and no background noise.

Although your spouse, children, coworkers, and friends may nag you to do something about your hearing difficulties, you yourself may not realize how much you are missing in every day conversations. Even if a full hearing evaluation confirms that you have a significant hearing loss, you still may insist that even if you do, it is not causing any problems.

If this sounds like you, it may be helpful to start consciously monitoring situations in which you may be experiencing communication problems due to hearing loss. It is importance to realize that hearing loss not only affects your ability to understand what people are saying, it can also have other consequences. For example, you may not realize that lately you feel tense in social situations, that you become tired more easily, especially after a busy day at work or during a social situation, and that you want to bow out of previously enjoyed activities such as bowling. These changes may be occurring because, without realizing it fully, you may be straining to understand your communication partners and experiencing communication situations as stressful. Again, these experiences may happen so slowly over time that you do not even realize the connection between hearing difficulties and your emotional response to these difficulties.

Let’s say that your family and friends have suggested that you have a hearing loss, and a hearing health professional has confirmed that test results indicate a significant hearing loss. You, however, are still doubtful. Try monitoring your hearing for a few weeks so that you may become more aware of how your hearing loss may be affecting you, as well as your family and friends. When you realize not just that you have a hearing loss, but that it is affecting your family, social, and work place, you may be a better candidate for hearing assistive technology. When you monitor your conversational experiences, you will probably become more aware of everyday communication problems that you are experiencing. Your awareness of difficulties, such as hearing female voices, understanding in background noise, and participating in conversations when multiple speakers are talking, may help your hearing health care provider choose hearing assistive technology that would be most helpful for your particular problems.

To increase your awareness of how hearing loss might be affecting you, try periodically (e.g., every week) looking at the sample communication situations below and answering the question “How often does this happen to you?” using one of the following answers:

1. Never
2. Once or twice a week
3. Several times each week
4. Many times
5. All the time

Self-monitoring may help you realize that your family and friends are not just picking on you, but rather, that you do have hearing difficulties. These difficulties can cause problems not only for you, but also for family members, coworkers, and friends. If you scored 3 or more on these items you may have a hearing loss. For further information about your treatment options, go to the Edison Stanford Hearing Center web link titled Hearing Solutions or take the online hearing check by clicking here.

Is There Tinnitus Relief Through Herbal Treatments?

Richard E. Carmen, Au.D. – Auricle Ink Publishers, Sedona, AZ

In the past many years there have been a number of herbal remedies claiming benefit for tinnitus. As a clinical and research audiologist, I reviewed the literature on herbal treatments in 2004 and was unable to substantiate that any of the product manufacturers’ claims were backed by U.S. evidence-based research. As a former human studies researcher in the area of tinnitus during the 1980s, I’ve remained interested in this subject matter. In that it had been six years since I last looked at the literature, in June-July/2010 I ran a Medscape search that revealed 174 articles mentioning the word tinnitus. However, none of them were scientific studies on herbal treatments for tinnitus. On a Medline search for “tinnitus,” 7,078 articles were cited. But when I refined the search to “herbal treatment for tinnitus,” 24 articles were cited, almost all of which were useless because they only mentioned the word tinnitus or herbal treatment, but were not related to a study. Only one was an actual study (article in Chinese), and based on the abstract in English, there are serious flaws in the design of the study, not the least of which was the study lasted only 5 days.



I think Enrico and his research team in 2007¹ aptly sum things up regarding herbal treatments and tinnitus. It “ . . . lacks substantial scientific support, and . . . these substances are probably not clinically effective either.” Furthermore, they stated that, “. . . in view of the potential harm that may occur from inappropriate use of CAM products [complementary and alternative medicines, such as herbs], physicians need to be aware of their principal characteristics with particular emphasis on toxicity and possibilities of interaction with prescription drugs.”



In addition, in June-July/2010, I contacted two companies with over-the-counter tinnitus remedies using herbs, nutrients or a combination, for treatment of tinnitus. My inquiry to them was, “What U.S. evidence-based research is your claim based on?”



One company’s representative claiming tinnitus relief through their product (now seen all over television and print media) replied, “We’ve done extensive research over five years and the product works!”


I asked, “Where can I find this published study?”

She replied, “It’s not for public viewing.”



It defies common sense. If you have a proven relief for tinnitus, you’d want to be sharing this news with the world. Yet, they could provide nothing to me other than a claim and their word. The other company I contacted basically said the same thing – admitting there was no tinnitus research the company conducted to back the claim - BUT – I was told that the ingredients in the bottle were effective for a variety of things related to increasing blood flow, maintaining cognitive health, or relaxing the body.



On July 7, 2010, I ran an online search, “herbal treatment for tinnitus,” at The New England Journal of Medicine and the search turned up only one result, unrelated to the question. The same search at The Journal of the American Medical Association cited many articles isolating the word tinnitus in an article, but in the top 100 results, not a single article reported conducting such a study.



Here are the conclusions from an abstract that Morris and Avorn3 offer: “Consumers may be misled by vendors' claims that herbal products can treat, prevent, diagnose, or cure specific diseases, despite regulations prohibiting such statements. Physicians should be aware of this widespread and easily accessible information. More effective regulation is required to put this class of therapeutics on the same evidence-based footing as other medicinal products.”



It’s probably worth noting that the single most touted ingredient in some of these purported remedies is Ginkgo biloba. My general review of the literature in 2004, and again in June/2010, failed to uncover a single U.S. scientific study that supported the notion that any herbal treatment, including Ginkgo biloba, was of any more benefit for tinnitus than a placebo (sugar pill). Even company executives of tinnitus relief companies could not provide the data. What’s more, researchers can’t even agree that Ginkgo biloba is of benefit to health unrelated to tinnitus (see a December/2009 report on Medscape regarding a study on Ginkgo in Journal of the American Medical Association: www.medscape.com/viewarticle/714476).



Now then, in fairness as a reporter and quite in contrast to U.S. studies, some European research showed there was a link between herbal treatment and tinnitus. This is the basis for U.S. product claims. The problem is, as I said earlier, that results from these foreign studies have not been replicated in U.S. studies, so the methodologies in these foreign studies should be challenged. The reason there may be no studies conducted on herbal treatment for tinnitus is because there are far stricter guidelines in the U.S. than most other countries. We cannot know the flaws in research without knowing how the studies were designed, and exactly what the data showed. Here are only a few examples how tinnitus research can be so flawed and biased as to make the study itself worthless:

• scant case history details and “fact gathering” make for unreliable or biased results;
• not isolating and identifying variables (those things that could contaminate a study like having one patient privately taking a prescribed drug for stress or depression, for example, at the same time being assessed for the value of the test herb);
• not considering duration of tinnitus may be an influential factor (someone who just developed tinnitus last week versus a subject suffering for 20 years);
• not objectifying rating scale questions (how a researcher measures relief can influence outcome);
• not using standardized scales and measures in order to determine what comprises improvement or relief;
• failing to use randomized, blind or double-blind, placebo-controlled methodology;
• not taking into consideration the “unknowns,” for example, if most subjects report subjective tinnitus loudness about 1-4 (on a scale of 1–10 where 10 is loudest tinnitus), it may well be easier to shift tinnitus from 4 to 1 than from 8 to 5;
• failing to perform a physical exam at baseline to rule out potential factors that could influence the test result;
• failing to rule out obvious causes of tinnitus that could result in spontaneous recovery from tinnitus even after many months or years – and there are such known recoveries with cause and effect (for example, tinnitus caused by pressure or fluid in the middle ear can be resolved when the medical cause is treated; or something as simple as an ear canal hair touching the eardrum can set off a sound emission through conductance, with tinnitus immediately gone upon removal of the hair).

Linde² and a group of researchers in 2003 reviewed clinical trials on herbal medicines including their effects on tinnitus, requiring what they felt were specific stringent methodology, and concluded, “From a total of 79 potentially relevant reviews pre-selected in the screening process, 58 met the inclusion criteria. Thirty of the reports reviewed Ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews.”



If you’re a person who regardless of the evidence seeks to try anything, then it should at least be done under medical supervision. It’s worth mentioning that in most people there are apparently few side effects using Ginkgo biloba (oral administration of Ginkgo special extract EGb 761, typically 24% ginkgo-flavonol glycosides, 6% terpene lactones). However, there can be side effects including gastrointestinal disturbances, headaches, dizziness, intracerebral hemorrhage, and allergic skin reactions. Most importantly perhaps is that it does function as a vasodilator (opens the blood vessels more). For people already on vasodilators it can increase the risk of bleeding; for example, when used in conjunction with histamines, anticoagulants (like Coumadin or Warfarin), vitamin B3 (variations of niacin), Alpha blockers (such as Phenoxybenzamine), antiplatelet agents (like aspirin), and even other herbs.



I would suggest to anyone searching for tinnitus relief no matter the treatment: be vigilant, discerning, demand to see the evidence that the product works, and don’t throw good money away on testimonials alone. That’s not science.

1. Enrico P, Sirca D, Mereu M., Antioxidants, minerals, vitamins, and herbal remedies in tinnitus therapy. Prog Brain Res. 2007;166:323-30.
2. Linde K, ter Riet G, Hondras M, Vickers A, Saller R, Melchart D; Systematic reviews of herbal medicines—an annotated bibliography. Forsch Komplementarmed Klass Naturheilkd 2003; Apr,10 Suppl. 1:17-27.
3. Morris CA and Avorn J. Internet marketing of herbal products. JAMA 2003;290:1505-1509.

Republished from www.EdisonStanfordHearing.com

Hearing Health and Alzheimer's Disease

by Max Stanley Chartrand, PhD

Today’s headlines are replete with warnings about the coming “tidal wave” of patients suffering from Alzheimer’s disease. Yet, little is currently being done to understand the correlation between presbycusis and the disease. This article looks at correlations between hearing loss and Alzheimer’s disease and suggests steps that need to be undertaken for these patients.

Almost like an orchestrated plan designed to scare the unwilling into submission, daily headlines scream about the coming “Tidal Wave of Alzheimer’s Cases.”¹ Indeed, reported incidences of this difficult-to-diagnose malady do seem to increase daily, and are expected to reach nearly 9 million in the United States by the year 2020.²

But the rest of the story is that much- needed hearing health care, along with its powerful cognitive, communicative and psychosocial implications, is virtually being ignored within the mental health/medical diagnostic battery.³ Meanwhile, a growing number of studies reveal a strong correlation between unmitigated hearing loss and dementia in older adults.^4,5,6

The signs of increasing dementia are not so much an increase in actual pathology as they are a demographic reflection of the rapid increase of people living longer than those generations before them. Furthermore, these larger numbers of seniors appear to be exhibiting far more serious hearing loss, yet are not as routinely referred for aural rehabilitation as they should be.⁷

Fig. 1 shows that there will soon be a virtual groundswell of those living past 65 years of age in the United States, the age group in which the vast majority of dementia cases occur.^8,9 This constitutes most of the so-called “tidal wave.” Here the largest demographic advance is in the 85 years and over group. The growth of both of these age groups (i.e., over 65 and over 85) correlates strongly with the increased incidence of Alzheimer’s disease (AD) and serious hearing loss, as shown in Figs. 2 and 3, revealing a logical statistical parallel.

Accordingly, in comparing symptoms of AD and unmitigated hearing loss in Table 1, striking correlations are observed—correlations which should make thinking persons sit up and take notice. Currently, there is an alarmingly low hearing instrument penetration rate among the 28-million strong hearing- impaired population in the U.S. at each level of impairment. Since 1992, this trend has continued downward relative to a rapidly growing market of those needing hearing help, but who are not seeking it.

Field reports show that too few older patients who present with complaints of possible AD are tested and treated for hearing loss. Many have been told that they were not candidates for hearing instruments without so much as a test of their hearing; others have been advised to seek hearing care “on a trial basis.” This may explain why only 10% of those within the most medically and clinically intensive portion of the older adult population—those reporting AD complaints—who need hearing correction actually use it, compared to a 60% usage rate among the hearing-impaired non-AD population.¹⁰

This is particularly striking when studies indicate that the rate of need for hearing instrument use among those with AD may actually be higher than the non-AD population. Of 52 elderly patients diagnosed with memory disorders in a 1996 University of South Florida study, for example, 49 (94%) were found to suffer from serious uncorrected hearing impairment.¹¹ Statistics like these have broad implications for hearing health care in general. For example, current pharmaceutical clinical trials under crash-program status need to look into the inclusion of hearing health status in their protocols, or risk losing objectivity in outcomes.

For the AD population there is persuasive evidence that hearing instrument use, combined with proper aural rehabilitation (in a multidisciplinary setting), can be a cost-effective approach to alleviating many AD-identified symptoms in patients who have AD and hearing loss.^12-14 In this case, such a program has been found to lessen many debilitating symptoms, including depression, passivity, negativism, disorientation, anxiety, social isolation, feelings of helplessness, loss of independence and general cognitive decline.¹¹

Removable Barriers

A research team at the University of Pittsburgh, in their composite review of studies on the subject of AD and hearing loss,¹⁰ concluded that there existed several professional and institutional barriers that prevent AD patients who suffer from hearing loss from receiving the hearing health care they need:

1. Lack of medical referral;
2. Difficult-to-test stereotype bias;
3. Lack of efficacy data;
4. Inappropriate diagnosis and technology;
5. Lack of access to ongoing care.

Each of these barriers can be overcome with an intensified education program on AD at every level of the physical and mental health care disciplines, especially in the front lines with primary care physicians. Medical and clinical higher education programs need to include principles of the interrelationship between cognition and aural rehabilitation. Mental health professionals and researchers (including those conducting pharmacology trials) need to require hearing evaluations as part of the early diagnostic battery. No diagnosis for AD should be rendered without ascertaining the auditory component of the patient’s health profile.
Obviously, the campaign needs to include hearing instrument specialists and dispensing and clinical audiologists. Dispensing programs should include comprehensive, multidisciplinary approaches to true aural rehabilitation. These would feature: Coping and communication repair strategies, assistive devices, cochlear implantation, and in-depth patient education, as well as hearing instrument use. Professionals can further ease the burden by counseling about the resources afforded under the Americans with Disabilities Act (ADA) of 1990. This will help raise the quality of life for all hearing-impaired patients, especially those with AD overlay who are in danger of losing their ability to be a part of larger society.

Most hearing aid patients need 90-120 days for neurological and physical acclimatization.^15,16 Certainly, dementia overlay cases require 6-12 month monitored programs to achieve appreciable goals of enhanced quality of life and personal independence.¹⁷ But as a result of 30-day trial policies, the industry has created an entire generation of hearing-impaired non-users today who think “hearing aids don’t work” for them, because they couldn’t achieve desired outcomes in the impossible space of 30 days. This also places the reasonable business expectations of professionals at odds with those they serve, causing a forfeiture of needed but uncompensated aftercare services.

Alzheimer’s Disease Untreated Hearing Loss Depression, anxiety, disorientation Depression, anxiety, feelings of isolation Reduced language comprehension Reduced communication ability Impaired memory (esp. short-term memory) Reduced cognitive input Inappropriate psychosocial responses Inappropriate psychosocial responses Loss of ability to recognize (agnosia) Reduced mental scores Denial, defensiveness, negativity Denial, heightened defensiveness, negativity Distrust and suspicion regarding other’s motives Distrust and paranoia (e.g., belief that others may be talking about them)

Table 1. Symptomatic similarities of Alzheimer’s disease and untreated hearing loss.

We also need to develop and implement better hearing care evaluation and rehabilitation models for those who also suffer from dementia. This would include educational materials to share with allied professionals with whom we might work in meeting the needs of hearing aid patients. Doing so will effectively bring several other professionals into the circle of care, including occupational therapists, geriatricians and eldercare professionals.¹⁷

Hearing Help and Alzheimer's

The literature is replete with conclusive evidence that unmitigated hearing loss increases the risk for depression, hypertension, heart conditions, dementia, long-term convalescence, income loss and the breaking of familial bonds. Yet far too many of those needing hearing care to assist in the prevention and/or amelioration of accompanying dementia are not receiving it. A steady, coordinated drumbeat of professional and consumer education can significantly pierce through the wall of public, professional and governmental misconceptions.

Over the years the author has had the opportunity to visit numerous long-term nursing facilities. Invariably, the question “How many of your patients suffer from dementia?” is asked. Almost without variation the answer comes back, “Well, most of them, actually. That’s why they’re here.”

The caregivers are then asked, “How many suffer from serious hearing loss?”, to which a typical reply might be: “Well, let’s see, Mr. Jones has a hearing aid, and Mrs. Smith has two…that’s all I can think of…the rest of our residents seem to hear fine.” However, hearing screening tests, when administered to the entire residential population, generally reveal that every resident there suffers from a bilateral loss greater than 30 dB PTA, with many in excess of 65 dB PTA. And what about the two patients who already have hearing aids? Mr. Jones’ hearing aid was lost in the wash six months ago, and Mrs. Smith’s aids were plugged solidly with cerumen, each sporting a dead, crusted-over zinc-air battery requiring a pocket knife to remove. In essence, Mrs. Smith has been wearing ear plugs for several weeks.

Obviously, the distance between informed mental/hearing health management and today’s current standards of care appear to be far apart. Closing the gap will require ongoing research and education, motivational marketing and unyielding commitment by all healthcare professionals. Hopefully, appropriate measures can be implemented in time to help stem and appropriately administer to the anticipated “tidal wave” of Alzheimer’s patients.

Max Chartrand, PhD, serves as director of research for DigiCare® Hearing Research & Rehabilitation, Rye, CO, and is a faculty member of the International Institute for Hearing Instruments Studies and the American Conference of Audioprosthology.
Correspondence can be addressed to HR or Max Chartrand, DigiCare Hearing Research & Rehabilitation, P.O. Box 706, Rye, CO 81069; email: Mchartran@aol.com.

References
1. The coming tidal wave of Alzheimer’s. USA Today: March 22, 2000.
2. Aural Rehab Concepts: A survey of the literature on the prevalence of Alzheimer’s. Rye, CO, 2000.
3. Chartrand MS: Alzheimer’s & hearing loss. Professional education course, International Institute for Hearing Instruments Studies, Livonia, MI, 2000.
4. Ulmann R, Larson E, Rees T, Koepsell T & Duckert L: Relationship of hearing impairment to dementia and cognitive function in older adults. JAMA 1989; 261: 1916-1919.
5. Peters C Potter J & Scholer S: Hearing impairment as a predictor of cognitive decline in dementia. J Am Geriatric Soc 1988; 36: 981-986.
6. Ventry I & Weinstein B: The hearing handicap for the elderly: A new tool. Ear & Hearing 1982; 3: 128-133.
7. Chartrand MS: Demographics in hearing healthcare. Continuing education course, Livonia, MI: International Institute for Hearing Instruments Studies, 1999.
8. U. S. Bureau of the Census: U.S. Bureau of the Census Report, 1998.
9. Aural Rehab Concepts: Statistical projection for Alzheimer’s in the U.S. Population 2000-2020. Rye, CO, 2001.
10. Palmer C, Adams S, Durrant J, Bourgeouis M & Ross M: Managing hearing loss in patient with Alzheimer’s disease. J Am Acad Audiol 1998; 9 : 275-284.
11. Gold M: Hearing loss in a memory disorders clinic: A specially vulnerable population. Archives of Neurology 1996; 53: 922.
12. Durrant J, Gilmartin J, Holland A, Kamerer D & Newall P: Hearing disorders management in Alzheimer’s disease patients. Hear Instrum 1990; 42: 32-35.
13. Hardick E: Aural rehabilitation programs for the aged can be successful. J Acad Rehab Audiol 1977; 10: 51-67.
14. Ratcliffe D: (Citation) Task Force on the National Strategic Research Plan of the National Institute on Deafness and Other Communication Disorders: Costs, benefits, and quality of life. Hear Jour 1992; 45 (9):11-18.
15. Palmer C: Deprivation, acclimatization, adaptation: What do they mean for your hearing aid fittings? Hear Jour 1995; 47(5):10, 41-45.
16. Chartrand M & Chartrand G: Sherlock & Watson on solving the mysteries of aural rehabilitation. Continuing education course. Livonia, MI: International Institute for Hearing Instruments Studies, 2001.
17. Gatehouse S & Killion M: HABRAT: Hearing Aid Brain Rewiring Accommodation Time. Hear Instrum 1993; 44 (10): 29-32.

Selecting a Hearing Instrument

Before purchasing a hearing aid, check to see if you have done the following:

• Consulted with your physician or had your hearing problem evaluated by a medical doctor
• Evaluated the qualifications and services provided by your licensed Hearing Instrument Specialist®
• Carefully read the user instruction brochure and terms of your hearing aid contract
• Made sure the instrument comes with a warranty and that you understand its terms
• Selected a model that fits comfortably, suits your individual needs and operates with ease.

Hearing instruments come in many types, designs and styles. Some provide a variety of special features such as programmability, telephone pickups, adjustable tone controls and microprocessors for noise filtration.

Therefore, hearing instrument prices vary greatly, depending on the type of instrument, the number of special features and the services provided by your specialist.

Price should not be the primary concern, except for the limitations of your budget, when selecting hearing instruments. The objective is to select hearing instruments that will meet your needs by providing the most effective assistance for your hearing impairment.

Extensive laboratory and field research has scientifically proven that people benefit most from wearing a hearing instrument in each ear. This is commonly referred to as a binaural fitting.

Benefits of binaural hearing include an improved overall sound quality, clearer speech perception in normal listening environments, increased understanding in groups and noisy background situations, more relaxed hearing, no longer straining to use the best ear and a feeling of more balanced hearing.

Members of IHS have the experience and expertise needed to assist you in selecting the hearing instrument that will provide optimal amplification for your individual hearing loss.

The proper selection of a hearing instrument encompasses not only a person's hearing loss, but other factors, as well. Occupation, lifestyle, environment and physical limitations (because of the dexterity needed to adjust the hearing instrument's volume, change batteries, etc.) must be considered before proper selection of the hearing instrument can take place.

It is emphatically recommended that you purchase a hearing instrument in person, rather than through mail order or the Internet. Expert, personal assistance is required in the evaluation of your hearing, the selection and fitting of the hearing instrument and the follow-up services needed for the successful use of your hearing system. This can only be accomplished through a professional relationship between you and your Hearing Instrument Specialist®. Hearing instruments today come in different styles and different circuit-types for improved hearing for individual hearing needs.

Digital and microprocessor technology are part of the newer hearing aid designs. The cost of hearing aids reflects differences in size, advanced technology and professional services. As a result, the range of prices will vary for each aid. Allow your Hearing Instrument Specialist ® to advise you of your options. They will combine their expertise of fitting hearing instruments with your personal needs for hearing.

How Our Hearing Works

The improved ability to hear has a tremendous impact on the quality of life for both those with hearing loss and their families. Having a good understanding of how your hearing works and then knowing your options for the best help available through today's advanced hearing aid technology will help you make the right choice in amplification - and to use your new hearing instruments to their fullest potential.

As sound passes through each ear, it sets off a chain reaction that could be compared to the toppling of a row of dominoes. First, the outer ear collects pressure (or sound) waves and funnels them through the ear canal. These vibrations strike the eardrum, then the delicate bones of the middle ear conduct the vibrations to the fluid in the inner ear. This stimulates the tiny nerve endings, called hair cells, which transform the vibrations into electro-chemical impulses. The impulses travel to the brain where they are understood as sounds you recognize.