Success with Hearing Aids:
Vision and Dexterity
Success with hearing aids depends on many things. Of great importance is the knowledge, skill, and availability of your provider. Provider time spent with you can have a major impact on your benefit. It is important to consider how much office time you may need and the provider’s willingness and ability to meet your needs when selecting a provider. Ask someone you know and trust for recommendations – the nicest, smartest, nearest, or cheapest provider may not be the best choice for you. This article is the first in a series focused on “How to Succeed with Hearing Aids.”
Ready access to your provider can get you comfortable with your hearing aids faster. And if the right devices are selected, they will improve your hearing, feel comfortable and allow you to independently use and maintain your devices. Even if your provider is readily available, you may have transportation limitations, or may live far from them, or you simply may not wish to visit them very often. All hearing aid users, even those without vision or dexterity limitations, would be best served by devices that are easy to use and maintain.
It is important for a provider to get to know your individual strengths and weaknesses in order to make a good recommendation, whether for new hearing instruments or a configuration change to existing hearing aids. The purpose of this article is to make you aware of the factors that can affect your ability to independently use and maintain your devices and your success with hearing aids. By discussing these factors with your provider, a wise decision at the outset can prevent many problems down the road.
Some consumers are experienced with hearing aids and/or have no physical limitations, and require little time at their provider’s office beyond the initial fit and follow-up. Other individuals require ongoing counseling while they are adapting to the hearing aids – to help them insert and remove the devices from their ears, change the batteries, clean the devices, use the telephone properly, and operate the various hearing aid controls.
How to Know your Limitations
Many consumers desire small, minimally visible hearing aids – unfortunately small devices can be more difficult to handle. An honest appraisal by thinking through use and maintenance details prior to selecting a hearing aid or accepting the recommendation of a provider can result in better outcomes and satisfaction, sooner. A straightforward appraisal of abilities can be accomplished by simply touching and handling different hearing aids. Typically, a prospective hearing aid user and their accompanying family members will intuitively know what will work best after a “hands-on” assessment. The provider should closely observe you performing tasks and suggest the configurations easiest for you to manage. The essential “tasks” related to using and maintaining hearing aids are listed below.
Everyday Hearing Aid Tasks
- Turn device off/on
- Insert device into ear
- Remove device from ear
- Use with telephone
- Change the volume
- Change the program
Hearing Aid Maintenance Tasks
- Change batteries
- Clean the ear mold/tip
- Change wax guards
Hearing aid owners with impairment of any of the following abilities may become frustrated with the amount of time and effort needed to complete the above tasks. Repeated difficulty with even one of these tasks can cause a hearing aid user to give up completely.
- visual acuity
- manual dexterity
- fingertip sensation
- cognitive ability
Some solutions that help with these problems include the following:
This solution can ease problems with the following tasks:
Turn device off/on
Placing the device in the charger turns it off and charges it up. Removing the device from the charger turns it on. The devices also come with two storage cases (one for each device) that turn the device off when it is placed inside the case and snapped shut.
Insert device into ear
ITE devices are usually easier to insert because there is only one piece to deal with and they are custom made – so they really only fit correctly when they are flush with the concha.
Remove device from ear
Removal is relatively easy and usually requires just a “tug” on the removal filament attached to the face plate of the device.
Use with telephone
It is often difficult for many individuals to remember to hold a telephone differently than they have most of their lives. When using BTE or RIC hearing aids, best telephone hearing occurs when the telephone speaker is held above the ear, either close to the hearing aid microphone, or parallel to the BTE body in the case of telecoil use with landline telephones. With ITE models hearing aid users get the best telephone clarity by holding the telephone up to their ear as they are used to.
Rechargeable batteries need to be changed every one to two years. Hansaton provides a 5-year warranty on their batteries that includes free replacements. The batteries are not replaceable by the user and must be sent to Hansaton for replacement.
A downside of ITE’s can be the need to replace plugged wax guards – see the section below regarding wax guards and alternatives. Hansaton is the only manufacturer currently marketing rechargeable ITE’s. The recharging station is shown below along with the two storage cases.
HANSATON RECHARGEABLE ITE HEARING AIDS
One drawback to this device is the depth limitations of the charger unit wells. This limitation limits how deep the devices can be made to go into the ear canal. For individuals with straight and tapered ear canals, the devices may not fit securely. This particular problem could be solved with a helix lock but may make insertion a little more difficult.
This solution has most of the advantages of the rechargeable ITE and is a better option for high frequency hearing loss as a substantially open fit is possible. It can also provide a more discreet option as the earmold can be made with a less visible material. However, telephone use may be more difficult since the telephone speaker must be held above the ear close to the device microphone, and hearing aid body in the case of telecoil use. Insertion can also be more cumbersome because there are two parts to contend with: the earmold, which goes in the ear canal, and the hearing aid body that goes behind the ear. However, there are many benefits of the rechargeable BTE/RIC including:
- less occlusion (open fit option)
- more discreteness
- greater product choice
- option to use rechargeable or standard batteries
- better retention, especially with straight and tapering ear canals
However, changing wax guards can be difficult see the section below regarding wax guards and alternatives. Both Signia and Hansaton manufacture rechargeable BTE/RIC devices that solve the same problems that rechargeable ITE’s do as shown below.
BTE and RIC RECHARGEABLE HEARING AIDS
In addition, ZPower, a relatively new company, manufactures recharger conversion kits that enable audiologists to modify many popular hearing aids into rechargeable devices without voiding the original manufacturer warranty. An example of a modified Resound hearing aids is shown below.
ZPOWER RETROFIT OPTION
Other kits are available for the following devices and this list continues to grow.
- Audio Service: Mood G3
- Beltone: Legend, First, Promise, True
- Phonak: Audeo V, Audeo VT, CROS II
- Resound: LiNX 2, LiNX, LiNX TS, Alera, Verso, Verso TS
- Rexton: Emerald
- Siemens: Pure Micon, Pure Binax, Pure Primax, Orion2, Orion
Lastly, Phonak will be launching rechargeable BTE hearing aids, reportedly in late August 2016. The product is called Audeo B-R. The devices will reportedly have the two different charger options as shown below.
PHONAK RECHARGEABLE HEARING AIDS
Full size hearing aids tend to be large, and although designed especially for severe to profound hearing losses, may be used for any degree of hearing loss. They typically are called Super Power (SP) or Ultra Power (UP) hearing aids. The advantage of these devices is that they have the large form factor necessary to accommodate a size 675 battery. These batteries are the largest standard hearing aid batteries available and are easy to grasp and place into the device, even with fingers that are arthritic or have neuropathy. Unfortunately, these devices are quite large, may not fit comfortably or securely behind smaller or floppy ears, and may interfere with glasses. Generally, they also are more visible than smaller devices. Other full size BTE’s are available with size 13 batteries, and while not as easy to manipulate as size 675 batteries, may be suitable for some dexterity-limited individuals. The benefits of these larger devices are described below.
Turn device off/on
The battery doors are quite large on these devices and compared with smaller devices are more easy to see, feel, and operate.
Insert device into ear
Having a conventional earmold permitted by standard tubing provides more to grasp during insertion. The proportions of the device are more identifiable during placement behind the ear.
Remove device from ear
Again, the larger size provides more tactile feedback to an individual with finger dexterity and sensation difficulties.
The larger size of the 675 battery makes them easier to grasp and manipulate into the battery compartment. Also larger 675 batteries will last longer, and so battery changes are less frequently necessary.
The vent and sound bore of a conventional earmold is more visible with limited visual acuity and appropriate cleaning tools more easily used. A shortcoming is that if tubing must be removed from the ear hook to allow cleaning of the tube and bore with a blower or floss, it might be best to have a family member perform this task or bring the device in to your provider for service.
FULL-SIZE BTE HEARING AIDS
Remote controls can be helpful with any style of hearing aid as they can supplant the buttons and switches on the hearing aids, which can be small and difficult to find, distinguish, and operate. A remote control utilizes two senses – vision and touch – so they can be easier to operate as long as they are simple and the buttons are large and clearly labeled. Below are photos of various remote controls. One downside of a remote control is that it is an extra piece of equipment that can be forgotten, misplaced or lost. Many remote controls can be worn around the neck or attached to a key chain, however.
COMMON REMOTE CONTROLS
Summary of use and maintenance problems and possible solutions
The chart below summarizes the potential solutions for a given task with which a hearing aid user experiences difficulty. For a given impairment (Visual Acuity, Manual Dexterity, Fingertip Sensation, Cognitive Ability) a “P” indicates which task(s) may be a Problem and which technology may offer a Solution. Note that “S-“ indicates a solution alternative that may not be as effective as an “S” solution alternative.
The Good and the Bad of Wax Guards and Stock Domes
Cerumen (ear wax) is common and can cause a hearing aid to stop working. Earwax can plug up the opening where sound exits from the device or earmold into the ear canal. When plugging blocks the sound, many users will think the cause is a dead battery, and so they will change batteries unnecessarily to no avail. Or, they may think the hearing aid stopped working and will call their audiologist to schedule a visit. Worse yet they may be unaware of the lack of sound and simply walk around with non-functioning hearing aids, which is worse than not wearing hearing aids at all.
Before RIC hearing aids became widely available, wax filters were present primarily in custom (ITE/ITC/CIC) hearing aids. Conventional earmolds are more resistant to plugging as the sound bore is larger and it takes longer to fill up with cerumen. Also, conventional earmolds are larger and it is just easier for somebody with visual acuity or finger dexterity impairments to clean them.
Typical wax guard systems for custom devices are shown below. The idea of a wax guards is to prevent serious damage to the hearing aid as they prevent ear wax from fouling up the speaker, which may require potentially costly repairs. Choosing the right system is complex and warrants serious thinking on the part of your provider to enhance your success with hearing aids. The best choice depends on your specific ear anatomy, the location and degree of your cerumen production, and your dexterity/visual status.
Each option has its pros and cons. The wax filter can be difficult to change by individuals with dexterity/visual limitations but may be easily and conveniently changed by a family member. The receiver tube extension option must be cleaned periodically but not likely as often as a wax filter needs to be changed. The wax spring requires replacement by your audiologist but required servicing is typically less frequent than the other two options. Individuals who have the tube extensions and cannot clean it themselves may need to visit their provider if no one else is available.
CUSTOM DEVICE CERUMEN MANAGEMENT OPTIONS
TYPICAL WAX FILTER SYSTEM FOR RIC WITH STOCK EAR TIPS
CUSTOM EARMOLD OPTIONS – EASIER TO SEE, CLEAN,
AND MANIPULATE INTO THE EAR
Because there are so many use and maintenance factors that affect your success with hearing aids. It is wise to ask your provider a lot of questions. Try to bring a trusted friend or family member with you, especially if that person will be helping you to use and maintain your hearing aids. Finally, being honest with yourself about your abilities and limitations, and discussing any limitations with your provider will go a long way toward ensuring you end up with hearing aids that do not become a burden.