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TWO HEARING AIDS? I WANT A DIGITAL ONE!
A QUICK LOOK AT MODERN MYTHS
"Why would I want two? No I'm sorry I couldn't wear two. Besides I've never seen anyone wearing two. "I just want one of those invisible digital aids."
This reaction is very common in my practice and at many other similar establishments across the country. Yet the wearing (and usage!) of two hearing aids is, for the vast majority of hearing impaired people, widely recommended by audiologists, manufacturers and researchers. However, we should not ignore the reactions recounted above. They are given with genuine feeling; none more so than when someone has been provided with the standard NHS analogue monaural BTE issue; frequently their first reason for visiting a private practice is to enquire if there is anything that they could obtain privately that is better. The simple answer has to be "Yes", and the first course of action to be advised would often be "Put another NHS one in the other ear"- this initial advice is usually declined.
The effect of wearing of what is usually referred to as a binaural [or bilateral] fitting is particularly noticeable and beneficial where the two ears' threshold loss is within 20dBHL of each other. There are many benefits for the user including: Better understanding in noisy places; Improved sound and tone quality; Gives a wider hearing range; Keeps both ears active; Less tiring making listening a more pleasant experience and creates a feeling of balance; Better identification of the direction of sound and of the actual sound; More comfort when dealing with loud noises. And the sheer practicality that should one need to be sent away for service, the user still has one to prevent being cut off!
There are of course many people whose motivating force is for the cosmetic aspect initially and do expect a tiny invisible one. Obviously there can't be a truly invisible aid, however it is extremely important to extract exactly what is required and why from the prospective client. Is their hearing worse in certain situations; is it just vanity; can their ears, both physically and medically, accommodate a fully in-the-ear aid; are their hands sufficiently dextrous and sensitive to insert, control, change batteries and clean a tiny aid?
And why does it have to be digital? "Well they cut out all the background noise don't they?" Well no, not exactly. The adverts often seem to imply that, but digital aids do, amongst other things, improve the signal-to-noise ratio - unfortunately it doesn't sound so catchy. The digital processing of sound certainly allows a greater ability to make the sound clearer [compare your old LPs with CDs] and the ability to provide a greater amplification of high frequency signals, which a vast number of hearing-impaired people are missing. However there is a vast amount of digital aids of varying complexity and ability.
The basic "entry level" ones are not necessarily any better than the advanced programmable analogue aids, especially when two of the analogue variety are compared with just one digital. This then leads to the answer to the "just selling two" accusation, it is generally always better use of limited financial resources to get the most for your money. Split whatever you can afford between two ears.
Unfortunately, together with the propensity of the NHS to traditionally fit monaurally which leads people to presume that is all they need, some clients then demand that dispensers provide what they think is best rather than accept the hearing aid audiologist's "best advice" [which they are bound so to do by their Code of Practice]. The NHS is making a lot of news now from their digital initiative but it is costing an awful lot and benefiting just a few so far, with waiting lists across the country increasing rapidly and sufferers still have minimal choice and it's generally still one behind the ear. They have also been conservative with their suggestions of costs; the supply of a "free" hearing aid comprises many factors, not just the actual mass produced unit itself - consultancy, admin, electricity, telephone, buildings, insurance, training etc.
The NHS could have followed the Irish model to provide faster access to hearing aids and wider choice by providing a voucher for the standard issue, which could also be put towards the cost of better ones.
So I hope I have addressed some of the current myths and misinformation about digital hearing systems and as to just not being able to wear two? Well just think of all the things that you do wear in pairs!
Ian Croft is a Registered Hearing Aid Dispenser.
He is a Council Member & Fellow of the British Society of Hearing Aid Audiologists. He has his own private practice in Pinner.
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