Most people are surprised to learn how young the field of audiology really is, and just how recently its founding father established the profession. To put this in perspective, if you wanted to find the founding father of biology, for example, you’d have to go back in time by 2,300 years and read the The History of Animals, a natural history text written in the 4th century BCE by the Ancient Greek philosopher Aristotle.
In comparison, to find the founding father of audiology, we need go back only 70 years, to 1945 when Raymond Carhart popularized the word. But who was Raymond Carhart, and how did he come to establish a distinctive scientific discipline so recently? The narrative starts with World War II.
World War II and Hearing Loss
One of history’s famous lessons shows us that necessity is the mother of invention, meaning that challenging conditions prompt inventions focused on reducing the difficulty. Such was the story for audiology, as hearing loss was growing to be a bigger public health concern both during and after World War II.
Indeed, the primary driving force behind the advancement of audiology was World War II, which resulted in military personnel returning from combat with significant hearing damage due to direct exposure to loud sounds. While several speech pathologists had been calling for better hearing evaluation and treatment all along, the amount of people dealing with hearing loss from World War II made the request impossible to dismiss.
Among those calling for a new profession, Robert West, a well known speech pathologist, called for the development of the speech pathology field to include the correction of hearing in 1936 — the same year that Raymond Carhart would graduate with a Doctor of Philosophy degree in Speech Pathology, Experimental Phonetics and Psychology.
Raymond Carhart Establishes the New Science of Hearing
Raymond Carhart himself began his career in speech pathology. He received his Bachelor of Arts degree in Speech and Psychology from Dakota Wesleyan University in 1932 and his Master of Arts and Doctor of Philosophy degrees in Speech Pathology, Experimental Phonetics and Psychology at Northwestern University in 1934 and 1936. Carhart was in fact one of the department’s first two PhD graduates.
Right after graduation, Carhart became an instructor in Speech Re-education from 1936 to 1940. Then, in 1940 he was promoted to Assistant Professor and in 1943 to Associate Professor. It was what occurred next, however, that may have changed the course of history for audiology.
In 1944, Carhart was commissioned a captain in the Army to head the Deshon General Hospital aural rehabilitation program for war-deafened military personnel in Butler, Pennsylvania. It was here that Carhart, in the setting of helping more than 16,000 hearing-impaired military personnel, popularized the term audiology, designating it as the science of hearing. From that point forward, audiology would split from speech pathology as its own distinctive research specialization.
At the conclusion of the war, Carhart would go back to Northwestern University to develop the country’s first academic program in audiology. As a skillful professor, he guided 45 doctoral students to the completion of their work, students who would themselves become notable professors, scientists, and clinical specialists across the country. And as a researcher, among many contributions, Carhart developed and refined speech audiometry, in particular as it applied to calculating the effectiveness of hearing aid performance. He even identified a distinct pattern on the audiogram that indicates otosclerosis (hardening of the middle ear bones), eponymously named the “Carhart notch.”
Raymond Carhart’s Place in History
Of history’s founding fathers, the name Raymond Carhart may not be as familiar as Aristotle, Isaac Newton, Albert Einstein, or Charles Darwin. But if you wear hearing aids, and you know the degree to which the quality of life is increased as the result, you might place Raymond Carhart on the same level as history’s greats. His students probably would, and if you visit the Frances Searle Building at Northwestern University, you’ll still see a plaque that reads:
“Raymond Carhart, Teacher, Scholar, and Friend. From his students.”
When it’s time to shop for a car, the majority of us know exactly what to do. We do some research, compare options, and compose a list of questions to ask the dealership. We work on this so that by the time we’re ready to stop by the dealership, we have an idea of what we’re looking for and we know which questions to ask.
When it’s time to choose hearing aids, on the other hand, most people don’t know where to get started. Although the process is comparable to buying a car, it’s also in many ways more complicated (and probably not quite as fun). It’s more complicated because each person’s hearing loss is distinct and each pair of hearing aids requires customized programming. If purchasing a car was like this, it would be like you taking it home and having to install the transmission yourself.
Luckily, you don’t need to know how to program your own hearing aids, but you do need to know the questions to ask to make sure that your hearing specialist covers all bases, correctly programming the most suitable hearing aids for your requirements and lifestyle. In this manner, producing a list of questions to talk about with your hearing specialist is the single most important thing you can do prior to your hearing test.
But which questions should you ask? Here are 35 to get you started, separated by category:
Specific kinds of hearing loss require specific types of treatment. The more you know about your own hearing loss, the better you’ll be able to sort through hearing aid options. You want to consider what form of hearing loss you have, if it will get worse, how soon you should treat it, and all of your treatment choices.
Questions to ask:
- What type of hearing loss do I have?
- Do I have unilateral or bilateral hearing loss?
- Can I have a copy of my audiogram?
- Will my hearing loss worsen as time goes by if left untreated?
- Will hearing aids enhance my hearing?
- How much of my hearing will hearing aids restore?
- What are my other choices besides hearing aids?
HEARING AID STYLES AND FEATURES
Hearing aids come in many styles, from multiple producers, loaded with numerous features. You need a organized way to narrow down your choices to ensure that you get the best hearing aid without wasting money on features you don’t need or want.
Questions to ask:
- How many different types of hearing aid styles do you offer?
- Which hearing aid style is most beneficial for my requirements and lifestyle?
- Which digital features would be valuable to me, and which could I do without?
- What are telecoils and directional microphones and do I need them?
- Do I need Bluetooth compatible hearing aids?
- Do my hearing aids need to be professionally programmed?
- Do I need one or two hearing aids, and why?
HEARING AID PRICES, FINANCING, WARRANTIES, AND TRIAL PERIODS
The total price of a pair of hearing aids commonly includes the professional fees associated with custom fitting and programming, along with several other services or accessories. You want to make sure that you fully grasp what you’re getting for the price, if financing is available, if insurance will help, what the warranty protects, the length of the trial period, and if any “restocking fees” apply to the end of the trial period.
Questions to ask:
- What is the total cost of the hearing aids, including professional services?
- Do you provide any financing plans?
- Will my insurance policy help pay for hearing aids?
- How much will my hearing aids cost me each year?
- Do the hearing aids come with warranty coverage?
- How much do hearing aid repairs cost after the warranty has concluded?
- Are repairs performed at the office or somewhere else?
- If my hearing aids have to be mailed out for repairs, are loaner hearing aids provided?
- Is there a trial period and how long is it?
- Is there a restocking fee if I return my hearing aids during or after the trial period?
HEARING AID OPERATION, CARE, AND MAINTENANCE
Your hearing specialist should explain to you how to care for, clean, and operate your hearing aids. To be sure that nothing is forgotten, make sure all of these questions are addressed:
Questions to ask:
- How do I operate my hearing aids?
- How do I use hearing aids with telephones and other electronics?
- Can you show me how to use all of the buttons, features, and settings for my hearing aids?
- What are environmental presets, and how do I access them?
- Do I need a remote control, or can I use my smart phone to operate the hearing aids?
- What batteries do I need, how long will they last, and how do I replace them?
- How should I clean and store my hearing aids?
- Do I need to come back for follow-up appointments?
- How long will my hearing aids keep working?
- Do I need to update the hearing aid software?
- Do I qualify for future hearing aid upgrades?
YOU’RE READY TO SCHEDULE YOUR HEARING TEST
Ok, so buying a pair of hearing aids may not be as enjoyable as picking out a new car. But the quality of life you’ll achieve from better hearing might very well make you happier, as you’ll reconnect with people and take pleasure in the subtleties of sound once again. So go ahead and schedule that hearing test — your new pair of hearing aids are waiting for a test drive.
You’ve without doubt heard that today’s hearing aids are “not your grandfather’s hearing aids,” or that hearing aid technology is light-years ahead of where it used to be, even as recently as 5 to 10 years ago. But what makes today’s technology so much better? And what exactly can modern hearing aids accomplish that couldn’t be achieved in the past?
The abbreviated answer is, like virtually all consumer electronics, hearing aids have benefited considerably from the digital revolution. Hearing aids have emerged as miniaturized computers, with all of the programming adaptability you would anticipate from a modern computer.
But before hearing aids became digital, they were analog. Let’s see if we can understand why the shift from analog to digital was such an enhancement.
Digital vs analog hearing aids
At the most basic level, all hearing aids do the job the same way. Each hearing aid is made up of a microphone, amplifier, speaker, and battery. The microphone detects sound in the environment, the amplifier strengthens the signal, and the speaker supplies the louder sound to your ear.
Fundamentally, it’s not very complicated. Where is does get complex, though, is in the details of how the hearing aids process sound, which digital hearing aids accomplish far differently than their analog counterparts.
Analog hearing aids process sound in a fairly uncomplicated way. In three basic steps, sound is picked up by the microphone, amplified, and sent to the ear through the speaker. That is… ALL sound is made to be louder, including background noise and the sound frequencies you can already hear properly. Put differently, analog hearing aids amplify even the sounds you don’t want to hear — think of the scratching sound you hear from an analog recording on a vinyl record.
Digital hearing aids, alternatively, apply a fourth step to the processing of sound: conversion of sound waves to digital information. Sound by itself is an analog signal, but rather than just making this analog signal louder, digital hearing aids first convert the sound into digital form (saved as 0s and 1s) that can then be changed. Digital hearing aids, therefore, can CHANGE the sound before amplification by modifying the information saved as a series of 0s and 1s.
If this sounds like we’re talking about a computer, we are. Digital hearing aids are in essence miniature computers that run one specific application that manipulates and improves the quality of sound.
Advantages of digital hearing aids
A large number of modern hearing aids are digital, and for good reason. Because analog hearing aids can only amplify incoming sound, and cannot alter it, analog hearing aids very often amplify distracting background noise, making it hard to hear in noisy environments and nearly impossible to talk on the phone.
Digital hearing aids, however, have the versatility to amplify specific sound frequencies. When sound is converted into a digital signal, the computer chip can recognize, label, and store specific frequencies. For instance, the higher frequency speech sounds can be classified and stored separately from the lower frequency background noise. A hearing specialist can then program the computer chip to amplify only the high frequency speech sounds while suppressing the background noise — making it effortless to follow conversations even in noisy settings.
Here are some of the other advantages of digital hearing aids:
- Miniaturized computer technology means smaller sized, more discreet hearing aids, with some models that fit entirely in the ear canal, making them mostly invisible.
- Digital hearing aids tend to have more appealing designs and colors.
- Digital hearing aids can be programmed by a hearing specialist to process sound differently according to the setting. By changing settings, users can achieve ideal hearing for diverse situations, from a silent room to a noisy restaurant to talking on the phone.
- Digital hearing aids can be fine-tuned for each patient. Each person hears different sound frequencies at different decibel levels. Digital hearing aids permit the hearing specialist to adjust amplification for each sound frequency based on the attributes of each person’s unique hearing loss.
Try digital hearing aids out for yourself
Reading about digital hearing aids is one thing, trying them out is another. But bear in mind that, to get the most out of any set of hearing aids, you need both the technology and the programming proficiency from an experienced, licensed hearing specialist.
And that’s where we come in. We’ve programmed and fine-tuned countless hearing aids for individuals with all types of hearing loss, and are more than happy to do the same for you. Give us a call and experience the digital advantage for yourself!
Sometimes, it seems like we enjoy to deceive ourselves. Wikipedia has an entry titled “List of common misconceptions” that consists of hundreds of widely-held but false beliefs. Yes, I know it’s Wikipedia, but take a look at the bottom of the page and you’ll see approximately 385 credible sources cited.
As an example, did you know that Thomas Edison didn’t invent the lightbulb? Or that sugar does not actually make kids hyperactive? There are a multitude of examples of beliefs that we simply assume to be accurate, but from time to time, it’s a good idea to reassess what we think we know.
For some of us, it’s time to reexamine what we think we know about hearing aids. The majority of myths and misconceptions about hearing aids are based on the issues connected with the antiquated analog hearing aid models. But seeing as the majority of hearing aids are now digital, those concerns are a thing of the past.
So how current is your hearing aid knowledge? Read below to see if any of the top 5 myths are preventing you or someone you know from getting a hearing aid.
The Top 5 Myths About Hearing Aids
Myth # 1: Hearing aids are not effective because some people have had bad experiences.
Reality: To start with, hearing aids have been proven to be highly effective. A study reported in the Journal of the American Medical Association comparing the performance of three popular types of hearing aids determined that:
Each [hearing aid] circuit markedly improved speech recognition, with greater improvement observed for soft and conversationally loud speech….All 3 circuits significantly reduced the frequency of problems encountered in verbal communication….Each circuit provided significant benefit in quiet and noisy listening situations.
Additionally, since the publishing of this research, hearing aid technology has continued to get better. So the question is not whether hearing aids work — the question is whether you have the right hearing aid for your hearing loss, professionally programmed based on to your preferences by a qualified professional.
Negative experiences are probably the result of receiving the wrong hearing aid, buying hearing aids online, consulting the wrong individual, or not having the hearing aids customized and professionally programmed.
Myth # 2: Hearing aids are big, cumbersome, and unattractive.
Reality: This one is rather easy to disprove. Simply perform a quick Google image search for “attractive hearing aid designs” and you’ll discover a number of examples of sleek and colorful models from multiple manufacturers.
Also, “completely-in-the-canal” (CIC) hearing aids are available that are virtually or completely unseen when worn. The newer, stylish designs, however, compel some patients to choose the slightly larger hearing aid models to show-off the technology.
Myth # 3: Hearing aids are too expensive.
Reality: Today, some flat screen television sets with ultra-high definition curved glass retail for $8,000 or more. But this doesn’t make us say that “all TVs are too expensive.”
As with television sets, hearing aids range in cost according to functionality and features. While you may not want — or need — the top of the line hearing aids, you can without doubt find a pair that fits your needs, preferences, and finances. Also take into account that, as is the case with all consumer electronics, hearing aids are becoming more affordable every year, and that the value of healthier hearing and a better life is almost always well worth the cost.
Myth # 4: You can save time and money buying hearing aids online.
Reality: Remember myth # 1 that asserted that hearing aids are not effective? Well, it was very likely brought about by by this myth. Like we said before, hearing aids have been proven to be effective, but the one caution to that statement has always been that hearing aids have to be programmed by a professional to assure performance.
You wouldn’t dare purchase a pair of prescription glasses online without contacting your eye doctor because your glasses need to be individualized according to the unique attributes of your vision loss. Buying hearing aids is exactly the same.
Yes, visiting a hearing specialist is more expensive, but consider what you get for the price: you can be certain that you get the right hearing aid with the right fitting and settings, together with follow-up care, adjustments, cleanings, instructions, repair services, and more. It’s well worth it.
Myth # 5: Hearing aids are uncomfortable and confusing to operate.
Reality: If this makes reference to analog hearing aids, then yes, it is largely true. The thing is, almost all hearing aids are now digital.
Digital hearing aids dynamically process sound with a small computer chip so that you don’t have to be concerned about manual adjustments; in addition, some digital hearing aids can even be operated through your smartphone. The bottom line: digital hearing aids are being designed with optimum ease-of-use in mind.
Your hearing specialist can also produce a custom mold for your hearing aids, providing a comfortable and correct fit. While a one-size-fits all hearing aid will likely be uncomfortable, a custom-fit hearing aid conforms to the contours of your ear.
You have just concluded your hearing test. The hearing specialist is now coming into the room and presents you with a chart, like the one above, except that it has all of these signs, colors, and lines. This is designed to demonstrate to you the exact, mathematically precise properties of your hearing loss, but to you it may as well be written in Greek.
The audiogram contributes confusion and complexity at a time when you’re supposed to be focusing on how to enhance your hearing. But don’t let it fool you — just because the audiogram looks perplexing doesn’t mean that it’s difficult to grasp.
After reading through this article, and with a little vocabulary and a few basic concepts, you’ll be reading audiograms like a seasoned professional, so that you can focus on what really counts: better hearing.
Some advice: as you read the article, reference the above blank audiogram. This will make it much easier to comprehend, and we’ll tackle all of those cryptic markings the hearing specialist adds later.
Understanding Sound Frequencies and Decibels
The audiogram is really just a diagram that records sound volume on the vertical axis and sound frequency on the horizontal axis. (are you having flashbacks to high school geometry class yet?) Yes, there’s more to it, but at a fundamental level it’s just a chart graphing two variables, as follows:
The vertical axis records sound intensity or volume, measured in decibels (dB). As you move up the axis, the sound volume decreases. So the top line, at 0 decibels, is a very soft, faint sound. As you move down the line, the decibel levels increase, representing progressively louder sounds until you get to 100 dB.
The horizontal axis records sound frequency, measured in Hertz (Hz). Beginning at the top left of the graph, you will see a low frequency of 125 or 250 Hz. As you proceed along the horizontal axis to the right, the frequency will steadily increase until it gets to 8,000 Hz. Vowel sounds of speech are typically low frequency sounds, while consonant sounds of speech are high frequency sounds.
So, if you were to start at the top left corner of the graph and sketch a diagonal line to the bottom right corner, you would be increasing the frequency of sound (switching from vowel sounds to consonant sounds) while increasing the level of sound (moving from fainter to louder volume).
Testing Hearing and Marking Up the Audiogram
So, what’s with all the markings you normally see on this simple graph?
Simple. Start off at the top left corner of the graph, at the lowest frequency (125 Hz). Your hearing consultant will present you with a sound at this frequency through headsets, starting with the smallest volume decibel level. If you can hear it at the lowest level (0 decibels), a mark is created at the junction of 125 Hz and 0 decibels. If you can’t perceive the 125 Hz sound at 0 decibels, the sound will be provided again at the next loudest decibel level (10 decibels). If you can hear it at 10 decibels, a mark is made. If not, continue on to 15 decibels, and so on.
This equivalent procedure is done again for each frequency as the hearing specialist moves along the horizontal frequency axis. A mark is produced at the lowest perceivable decibel level you can perceive for each sound frequency.
In terms of the other symbols? If you see two lines, one is for the left ear (the blue line) and one is for the right ear (the red line: red is for right). An X is generally used to mark the points for the left ear; an O is used for the right ear. You may discover some other characters, but these are less critical for your basic understanding.
What Normal Hearing Looks Like
So what is considered to be normal hearing, and what would that look like on the audiogram?
Individuals with regular hearing should be able to perceive every sound frequency level (125 to 8000 Hz) at 0-25 decibels. What might this look like on the audiogram?
Just take the empty graph, locate 25 decibels on the vertical axis, and sketch a horizontal line completely across. Any mark made underneath this line may indicate hearing loss. If you can hear all frequencies below this line (25 decibels or higher), then you most likely have normal hearing.
If, on the other hand, you can’t perceive the sound of a specified frequency at 0-25 dB, you likely have some type of hearing loss. The smallest decibel level at which you can perceive sound at that frequency establishes the tier of your hearing loss.
As an example, consider the 1,000 Hertz frequency. If you can perceive this frequency at 0-25 decibels, you have normal hearing for this frequency. If the smallest decibel level at which you can perceive this frequency is 40 decibels, for example, then you have moderate hearing loss at this frequency.
As a summary, here are the decibel levels connected with normal hearing along with the levels linked with mild, moderate, severe, and profound hearing loss:
Normal hearing: 0-25 dB
Mild hearing loss: 20-40 dB
Moderate hearing loss: 40-70 dB
Severe hearing loss: 70-90 dB
Profound hearing loss: 90+ dB
What Hearing Loss Looks Like
So what might an audiogram with indications of hearing loss look like? Seeing that many instances of hearing loss are in the higher frequencies (referred to as — you guessed it — high-frequency hearing loss), the audiogram would have a downwards sloping line from the top left corner of the graph slanting downward horizontally to the right.
This signifies that at the higher-frequencies, it takes a increasingly louder decibel level for you to perceive the sound. And, since higher-frequency sounds are linked with the consonant sounds of speech, high-frequency hearing loss weakens your ability to comprehend and follow conversations.
There are a few other, less common patterns of hearing loss that can appear on the audiogram, but that’s probably too much detail for this article.
Testing Your New Knowledge
You now know the basics of how to read an audiogram. So go ahead, book that hearing test and surprise your hearing specialist with your newfound talents. And just imagine the look on their face when you tell them all about your high frequency hearing loss before they even say a word.