Here at Advanced Hearing Care, I spend a lot of time counseling patients and their families and friends on realistic expectations for hearing treatment and rehabilitation. Some of the conversations can be quite passionate, especially when the family can’t understand why their loved one cannot seem to hear them, even though they’re wearing their hearing aids. After all, hearing aids are supposed to fix the problem, right?
Well, no, not really. Hearing aids are wonderful devices that supplement bad hearing. They help a person make the most of the hearing that they may have left. But they are not a substitute for good hearing. Nothing, no magic pill or surgery, can restore a person’s hearing to the way it was before the hearing loss occurred.
How Hearing Works
One of the biggest reasons why people have this misconception of hearing aids and hearing treatment is that they don’t really understand how hearing works or what is happening when someone has a hearing loss. After all, your ears just work, right? And you don’t have to think about it to make them work. So, most people just don’t have reason to think about it.
Like most of your senses, hearing requires a means of collecting stimuli and a method of delivering the data from those stimuli to the brain for processing. Your ears act as a funnel to collect sound waves in your environment and then both amplify and transform those sound waves into an electrical signal that can be processed by your brain. This process involves the outer ear, called the pinna; the ear canal; the middle ear, which is made of the ear drum and the ossicular bones; the inner ear, or cochlea; and the auditory nerve and brain. Along the way, the ear drum converts sound waves into mechanical energy, the stapes and cochlea convert the mechanical energy into hydraulic energy, and the cilia in the cochlea converts the hydraulic energy into electrical energy, which is finally processed by the auditory cortex in the brain.
A Matter of Physics
Sounds are formed anytime an object creates a vibration. These vibrations are called sound waves and they happen at a molecular level in every substance that has matter and mass. A good way to visualize this is to drop a pebble in a pond and watch the waves it creates. As mentioned above, the ear collects these sound waves in order to amplify and transform them into signals in the brain.
Generally speaking, the less complicated the sound environment, the easier it will be for the brain to sort through the sound waves available. In a small quiet room, there is very little interference from other sources of sound waves, there are fewer barriers to sound wave transmission, and the sound waves don’t have to travel very far to the ear. This is an ideal situation for hearing. The larger the space, the more sources of interfering background noise, the farther away you are from a reflective surface, the harder it will be to hear, even with normal hearing. Imagine again the pond and the pebble. The sound waves are a lot easier to “see” in a small pond with just a few pebbles than they are in an ocean during a rain storm.
Hearing aids cannot change the physics of environmental sound. There are certain properties to background noise, such as frequency ranges and harmonic patterns, that a hearing aid processor can be programmed to reduce, but it doesn’t work like a pair of noise-cancelling headphones. Those headphones have a distinct signal input from an audio device and a distinct sound pattern for the noise collected through a microphone. The headphones produce an inverse sound wave that cancels the noise. With hearing aids, the signal is mixed in with the noise and there’s no way to produce that inverse sound wave.
Mucking Up the Works
When hearing loss occurs, something happens to the anatomy of the ears and brain that causes the sound wave conversion and amplification process to not work the way it’s supposed to work. One of the most common problems is that the cilia in the cochlea, the part of the hearing that sends those electrical signals to your brain, begin to die. This is called sensorineural hearing loss. It is nerve damage and it is permanent.
This kind of hearing loss also often involves an issue with sound clarity in addition to the inability to detect certain sounds. In the case of someone who has those sound clarity issues, something is happening in the brain that causes the electrical signals that the brain receives to become garbled and distorted. When a person is experiencing this distortion, simple amplification of sound doesn’t help as much as you might think. After all, making a garbled sound louder does not improve its clarity. Since the distortion is actually happening in the brain, it is different for each person who experiences it and it cannot be easily measured or quantified, making compensation practically impossible.
So What Can I Do?
There are small things that you can do while you are speaking to make it easier for your loved one to understand you. Slow down and speak clearly; don’t shout! Shouting only distorts your speech. Rather than repeating a misunderstood word or phrase to the point of frustration, use different phrasing to avoid that misunderstanding. Make sure that you’re not speaking with your mouth full or obstructing your mouth with your hand or another object.
The best thing that can be done to help someone who has sound clarity and processing issues is to make the listening environment as simple as possible. First, turn off all potential sources of interfering noise. If it can’t be turned off, then turn it down or adjust its position to minimize the interference. Get on the same level as the person with the hearing loss and face them so you can speak directly to them. Move closer to them and stay within 4 to 6 feet. Never walk away from them while you’re talking or try to talk to them from another room in the house. Small environmental changes can do a lot to assist someone who is having trouble understanding speech.
It’s very important to remember that hearing loss is a permanent impairment and the goal of any hearing loss treatment process is to make the most of an individual’s remaining hearing. In even a best-case scenario, there are limitations to what hearing technology can do as far as speech enhancement and background noise reduction in very complex listening situations. No matter how much the technology advances, no matter how far it develops or how sophisticated it gets, it will never be a replacement for the hearing that you or your loved one enjoyed had before the hearing loss. For more tips and tricks, feel free to visit our Communication Tips page, or Contact Us with any questions you may have.