UNIT 5 HEARING AIDS

Structure
5.1 Introduction
5.2 Need for Amplification
5.3 What is a Hearing Aid?
5.4 Parts and Functioning of Hearing Aids
5.4.1 Parts of the Hearing Aid
5.4.2 Functioning of the Hearing Aid

5.5 Types of Hearing Aid Fittings

5-6 Types of Individual Hearing Aids
5.6.1 Pocket-type Hearing Aids
5.6.2 Behind-the-Ear Hearing Aids
5.6.3 In-the-Ear Hearing Aids
5.6.4 Bone Conduction Hearing Aids

5.7 Ear Mould

5.8 Selection of a Hearing Aid
5.9 How to Help the Child get Accustomed to the Hearing Aids?
5.10 How to Take Care of the Hearing Aids?
5.11 Identifying Common Faults and RepairIMaintenance of the
Hearing Aids
5.12 Cochlear Implant

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5.1 INTRODUCTION
We have studied about types of hearing loss, importance of early
identification, and diagnosis of hearing loss. Once the hearing loss is
identified, the next stage is to consider remedial measures. If the hearing
impaired baby has only 20 per cent residual hearing, then we have to
think of how best we can mcke use of this 2Oper cent hearing. We are all
aware of the fact that normal hearing is a prerequisite for normal speech
and language development. We are also aware that every child with
hearing impairment has some residual hearing.'To make maximum
use of the residual hearing, the child needs to be fitted with proper hearing
aids. Once the appropriate hearing aids have been fitted, the child can be
trained to use his residual hearing to its maximum capacity. This will
Fostering Language facilitate his speech and language development, which will pave the way
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for his optimal overall development.
In this Unit, we will find out about what a hearing aid is and how ia ~ c t i ~
We will also get acquainted with the types of hearing aid fittings and the
variety of individual hearing aids .available. We will learn about the
importance of well-fitting ear moulds. This Unit will also familiarize us
with the process of selecting the appropriate hearing aid for an individual,
and inform us about how to look for common defects in hearing aids, and
do trouble-shooting. We will also be introduced to the procedure of
cochlear implants.
How Will This Unit Help You?
The information given in this Unit will help you to:
understand why your child needs amplification;
know what a hearing aid is and how it helps;
become aware of the essential parts of hearing aids and how the aid
functions;
learn about the different hearing aid fittings;
get familiar with the various types of hearing aids;
understand the importance of a well-fitting ear mould;
get acquaiiited with how an appropriate hearing aid is selected;
find out about how one may help the child to get used to wearing the
hearing aids;
learn about how to take care of the hearing aids;
get familiar with the common defects that may be encountered in the
fbnctioning of the hearing aids, and the likely causes of the same; and
become aware of what is a cochlear implant.

5.2 NEED FOR AMPLIFICATION

4 s you read in Unit 1, the intensity or loudness of sound is measured
in deciBels. A person with hearing loss is unable to hear sounds below
a certain deciBel (dB) level. As per the legal definition, "Hearing
impairment means loss of 60 dB or more in the better ear in the
conversational range of frequencies". In other words, a hearing impaired
person is unable to hear any words being spoken that are less than 60 dB in
intensity. This is the scenario in the absence of hearing aids. Unless
something is done to rectifjr the situation, the individual's language
development would obviously be affected. Therefore, it becomes
important to ensure that sounds that reach the hearing impaired child's
ears, are loud enough for him to hear them. Of course, children with a Hearing Aids
hearing loss of 40 to 50 dB also benefit from hearing aids, but generally,
the hearing loss of such children gets identified at a much later stage;
when they show poor academic performance, or when parentslteachers
notice from the behaviour that the child's hearing is not up to the mark.
Imagine a person giving a talk in a large hall. If no amplification device
(that is, a device that increases the volume of sound) is used, then it is
very likely that the persons at the end of the hall will not be able to hear
the speaker properly. But if the person delivering the lecture is provided
with a mike, then the situation changes! Now, what he is saying can be
heard by all!
In the case of hearing impairment, something similar is done. However,
you can't really provide a mike to every person speaking to the hearing
impaired individual, or to every source of sound. So what is done is
that the amplification device (the hearing aid) is fitted into the ear of
the person with hearing impairment. The hearing aid increases the
intensity or loudness of sound. The result is that even though the original
intensity of sounds may be much lower than what the hearing impaired
person is able to hear, because of the amplification provided by the
hearing aid, these sounds enter the person's ears at a higher intensity
level, so that the person is able to hear them.
However, in this context, it is important to ensure that the amplification
provided by the hearing aid is neither too low (or else, the person would
not be able to hear the sounds) nor too high (or the sounds would become
uncomfortably loud). For the right level of amplification, proper
assessment of hearing loss and careful selection of hearing aids are very
important. You have already read about assessment in Unit 3. In this
Unit, we will improve our understanding of hearing aids. So let us now
take a look at a hearing aid, the various parts of a hearing aid, and how it
acts as an amplification device.

WHAT IS A HEARING AID?

Once it has been confirmed that an individual has hearing loss and it has
also been confirmed that it cannot be treated through medicines and
surgery, the person should be fitted with the suitable hearing aid(s). Now,
what exactly is a hearing aid? Well, hearing aid is an electronic
instrument, which amplifies the sound; that is, increases the volume or
intensity of sound.
Hearing aid is an electronic device that amplifies the sound, that
is, makes it louder.
There is a wide range of hearing aids available. For instance, hearing aids
differ in their amplification (loudness) characteristics, meaning that some
hearing aids are high power aids (that is, they amplify the sound
 Fostering Language considerably, or make it much louder), while some are low power devices.
Development
In other words, some hearing aids increase the intensity of sound greatly,
whereas some increase the loudness to a lesser extent. Some hearing
aids focus on high frequency amplification (that is, the sounds of high
frequencies are amplified more than the low frequency sounds), while
others may provide the same amplification for all frequencies. But all
hearing aids have some common electronicparts. Let us find out about
these, and understand how the hearing aid functions.

5.4 PARTS AND FUNCTIONING OF

HEARING AIDS
The common essential parts of all hearing aids are the microphone, the
amplifier, and the receiver.
I

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5.4.1 Parts of the Hearing Aid
Microphone: Microphone is a very small-sized part of the hearing
aid. It collects all the sound waves and converts them into
electrical waves. These electrical waves are sent to the amplifier.
Amplifier: Amplifier increases the power of the electrical signals
- that b how the sound becomes louder. The loudness of this signal
depends upon the strength of the amplifier. The strength of
amplification is technically expressed in deciBels. In common
language, it is expressed as mild, moderate and high power
amplification. Depending upon the hearing loss, an amplifier of the
appropriate strength needs to be selected.
Receiver: The receiver, also known as the earphone, converts the
amplified electrical waves into sound waves. This receiver is
generally put in the external ear, and the sound waves are sent to the
ear drum through the external auditory canal. To fit the receiver in the
ear, there is a mould, which is made according to the ear size of the
individual with hearing impairment. We will learn more about the ear
mould in Section 5.7 of this Unit.
Telecoil: Some hearing aids have a special feature called telecoil. This
coil converts magnetic vibrations into electrical signals. These signals
are fed to the amplifier. In this case, the signals become audible without
any disturbances. This facility helps the hearing impaired person to listen
to the telephone.
In addition to these key components, hearing aids also have the following
?arts:
Volume Control: Every hearing aid has a volume control to increase or
decrease the volume of sound. It is similar to the knob on the radio or
tape recorder,
- which is used to make the sound loud or soft. In the same
manner, the volume control of the hearing aid is used to make the sound
louder or softer. There are numbers on the wheel. The volume control
can be adjusted according to the need of the child, and depending upon
whether the child is in a noisy environment or a quiet one. For younger
children, parents or caregivers need to adjust the volume control. Older
individuals can do the adjustment themselves. The hearing aid should not
be used at full volume or a high volume position, as it will distort the
sound and the child will not be able to hear clearly.
Tone Control: Some hearing aids have the facility to adjust the output of
the aid according to the hearing loss with respect to different frequencies.
The tone control has marlungs of H, N, and L on the knob. Setting the
hearing aid on 'H' means adjusting the aid for high frequency; that is,
providing greater amplification for high frequency sounds. Setting it on L
means adjusting the aid so that the low frequencies get more amplified
than the higher ones. The decision about tone control setting is based on
the audiogram. The controls on the hearing aid are usually set by the
audiologist, and should be used in the same position.
Battery Comnpartmnent: Every hearing aid needs power to amplify the
sounds. There are different batteries available for different types of hearing
aids. These are pencil type batteries and button cell batteries. The hearing
aid needs a 1.5 volt battery to operate. Since the hearing aid needs a lot of
power, the battery may last for the duration of only a fortnight to a month,
and then it needs to be replaced, depending on the number of hours of use.
The battery compartment varies from one hearing aid model to another.
Make sure that you learn how to change the battery, when you buy the
hearing aid.

'ibh #-Iit! r5'*i?lfc+

Parts of a pocket-type hearing aid

5.4.2 Functioning of the Hearing Aid

Once the hearing aid is switched 'on', the microphone of the hearing aid
starts collecting sound waves from the environment.,These sound waves
pertain to the sounds present in the immediate environment of the hearing
aid user. These could be speech sounds, music, traffic sounds, etc. These
sound waves are collected and are converted into electrical signals by the
microphone. These electrical signals get passed-on to the amplifier, which
increases the intensity of these signals, making them louder. These
amplified electrical waves are sent to the receiver, which converts the
electrical energy into sound energy. This way the amplified sound is fed
into the middle ear via the outer ear canal.

TYPES OF HEARING AID FITTINGS

When the eyesight is weak, the doctor examines both the eyes, and he may
say, "You have a mild defect in one eye, but the other eye has very poor
eyesight. You need to use eye glasses made according to the power
mentioned for each eye in this report." Similarly, the hearing aids need
to be selected according to the hearing loss. Depending upon the nature
and extent of hearing loss, and the financial resources available, the child
with hearing impairment is asked to use the aid in one ear or in both the
ears. Let us take a look at the hearing aid fittings that are commonly used.
Monaural Hearing Aid: Some hearing impaired children have better
hearing in one ear, while the other ear has almost no hearing capacity.
In that case, it may be recommended that the child wear the hearing
aid only in one ear, that is, the better ear (the ear which has better
residual hearing). When the hearing aid is fitted only in one ear,
it is called monaural hearing aid. Some families opt for fitting of'
a hearing aid only in one ear for financial reasons, but ideally, there
should be an individual hearing aid for each ear, unless advised
otherwise.
Binaural Hearing Aid: 'Binaural' refers to fitting two
independent hearing aids in the two ears. This type of fitting has
several advantages. This is the appropriate fitting to be given to all
hearing impaired individuals who have hearing loss in both the ears.
There can be the same type of hearing aid, with similar amplification,
in both the ears or there can be two different powers of amplification.
When the hearing loss in both the ears is different, that is, one ear
has better residual hearing than the other ear, then in such a situation,
both the ears need hearing aids with different levels of amplification.

The child should be fitted with suitable hearing aids. 1

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It is better that the child wears two hearing aids, one for 1
I
each ear. I
I
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Fitting hearing aids in both the ears makes sense-since both the ears
have hearing loss, it is important that they should both be helped with
hearing aids, so that whatever residual hearing is available in each ear,
gets stimulated. Providing the hearing impaired child with hearing aids
in both ears helps the child in identifying the direction of the source
 Hearing Aids
of sound. It also gives better sound quality and since the child is able
to hear better, he can develop clearer speech. Thus, a child with hearing
i impairment should be encouraged to use the binaural fitting.
The child with hearing impairment should wear two

. independent hearing aids in the two ears.

pseudo-binaural Hearing Aid: This type of hearing aid is available
only with the pocket-type model of hearing aid. As You would read
in the next Section, the main part of the pocket-type hearing aid is a
box, which can be kept in the pocket. The only part outside the box
is the receiver, which is connected to the hearing aid by a cord- The
term 'pseudo-binaural' is used when a single p ~ k e t - t hearing
~~e
aid, withtwo receivers, is fitted in the two ears. In this case the
sound reaches both the ears simultaneously, because of which the
child may find it difficult to identify the direction fKm which the
sound is coming. ~t is like wearing a "Walkman". In India, this is
the most commonly fitted instrument provided to hearing impaired
children. It is cost effective. However, p~e~do-binaural hearing aid
is appropriate only when the hearing 103s is of the same degree in
both the ears. If the child has uneven hearing loss, then a pseudo-
binaural hearing aid cannot be used since the single hearing aid will
provide the same amplification to both the ears; whereas what is
actually needed is two individual hearing aids (binaural fitting) so
that each ear gets the amplification it needs.

5.6 TYPES OF INDIVIDUAL HEARING AIDS

What we looked at just now were the various types of fittings. Let us
now take a look at the different types of hearing aids that are available.
5.6.1 Pocket-type Hearing Aids
The main part of the pocket-type hearing aid (also known as body-
worn hearing aid) is a rectangular box, which has all the components:
the microphone, amplifier, battery, volume control etc. The only part,
which is external, is the receiver. Since the box can be placed in the
pocket, this hearing aid is called the pocket-type aid. The receiver is
connected to the hearing aid by a wire. Some models have one wire
and receiver. These are used for monaural fitting. For binaural fitting,
two such hearing aids need to be used. Some models have two wires
and two receivers - these are used for pseudo-binaural fitting, Pocket-
hearing aids are available in all types of amplification, that is,
these are available in mild, moderate, and high amplification.

it "'"'cY~ 10 W e a r the hearing

a pocket
7 espeifia,ll
is
e hearing a b&ess
a
can be St1tchched
Fostering Language and worn by the child on hislher clotting (as shown in the Figure below).
Development
If the hearing aid is placed in the harness, it fits snugly, and reduces
distortions of sound which can be caused when the hearing aid rubs against
the child's clothing. The harness also helps to ensure that the hearing aid
does not fall. It can be worn on any type of dress. Remember the
microphone of the hearing aid should be always open to catch the sound
waves.

A "harness" should be used to wear the pocket-type hearing aids

I
Advantages: In India, most children with hearing impaimlent are fitted
with pocket-type hearing aids because of the cost factor - these are
comparatively cheaper and sturdier. The other types of hearing aids,
including behind-the-ear hearing aids (described next) are expensive,
and have recurring expenses of batteries. The pencil size batteries that
are used in the pocket-type hearing aids are much chea~er.making these
aids cost effective.

Pocket-type hearing aids are commonly used in our country

1
Disadvantages: To young children, these hearing aids feel very heavy.
The size of the hearing aid is relatively large, and the weight heavy,
particularly for young children, and as a result, they are likely to reject
the hearing aids. They are bulky especially for the infants. Further, the
pocket-type hearing aid has minimal cosmetic appeal. It is clearly visible
to all that the child is wearing a hearing aid. However, you need to help
the child overcome all these negative feelings. After all, hearing is more
important than anything else. And you are the only person who can
morivare -your child to wear the hearing aid. If you yourself are unhappy
about the of the hearing aid, and make the child wear it inside
+r A:& , ,A*,, than rilu,jt woll]dbe t ,theklgh frequency
 of sound. It also gives better sound quality and since the child is able Hearing Aids
to hear better, he can develop clearer speech. Thus, a child with hearing
impairment should be encouraged to use the binaural fitting.
The child with hearing impairment should wear two
independent hearing aids in the two ears.
Pseudo-binauralHearing Aid: This type of hearing aid is available
only with the pocket-type model of hearing aid. As you would read
in the next Section, the main part of the pocket-type hearing aid is a
box, which can be kept in the pocket. The only part outside the box
is the receiver, which is connected to the hearing aid by a cord. The
term 'pseudo-binaural'is used when a single pocket-typehearing
aid, with two receivers, is fitted in the two ears. In this case the
sound reaches both the ears simultaneously, because of which the
child may find it difficult to identify the direction from which the
sound is coming. It is like wearing a "Walkman". In India, thls is
the most commonly fitted instrument provided to hearing impaired
children. It is cost effective. However, pseudo-binaural hearing aid
is appropriate only when the hearing loss is of the same degree in .
both the ears. If the child has uneven hearing loss, then a pseudo-
binaural hearing aid cannot be used since the single hearing aid will
provide the same amplification to both the ears; whereas what is
actually needed is two individual hearing aids (binaural fitting) so
that each ear gets the amplification it needs.

5.6 TYPES OF INDIVIDUAL HEARING AIDS

What we looked at just now were the various types of fittings. Let us
now take a look at the different types of hearing aids that are available.
5.6.1 Pocket-type Hearing Aids
The main part of the pocket-type hearing aid (also known as body-
worn hearing aid) is a rectangular box, which has all the components:
the microphone, amplifier, battery, volume control etc. The only part,
which is external, is the receiver. Since the box can be placed in the
pocket, this hearing aid is called the pocket-type aid. The receiver is
connected to the hearing aid by a wire. Some models have one wire
and receiver. These are used for monaural fitting. For binaural fitting,
two such hearing aids need to be used. Some models have two wires
and two receivers - these are used for pseudo-binaural fitting. Pocket-
type hearing aids are available in all types of amplification, that is,
these are available in mild, moderate, and high amplification.
Sometimes, it is difficult to wear the hearing aid in the pocket, especially
for the girl child, as her dress may not have a pocket stitched. It is
recommended to make a "harness" to wear the hearing aid. A harness
Fostering Language and worn by the child on hisher clotting (as shown in the Figure below).
Development
If the hearing aid is placed in the harness, it fits snugly, and reduces
distortions of sound which can be caused when the hearing aid rubs against
the child's clothing. The harness also helps to ensure that the hearing aid
does not fall. It can be worn on any type of dress. Remember the
microphone of the hearing aid should be always open to catch the sound
waves.

A "harness" should be used to wear the pocket-type hearing aids

Advantages: In India, most children with hearing impairment are fitted

with pocket-type hearing aids because of the cost factor - these are
comparatively cheaper and sturdier. The other types of hearing aids,
including behind-the-ear hearing aids (described next) are expensive,
and have recurring expenses of batteries. The pencil size batteries that
are used in the pocket-type hearing aids are much cheaper, making these
aids cost effective.

Pocket-type hearing aids are commonly used in our country

Disadvantages: To young children, these hearing aids feel very heavy.

The size of the hearing aid is relatively large, and the weight heavy,
particularly for young children, and as a result, they are likely to reject
the hearing aids. They are bulky especially for the infants. Further, the
pocket-type hearing aid has minimal cosmetic appeal. It is clearly visible
to all that the child is wearing a hearing aid. However, you need to help
the child overcome all these negative feelings. After all, hearing is more
important than anything else. And you are the only person who call
motivate your child to wear the hearing aid. If you yourself are unhappy
about the visibility of the hearing aid, and make the child wear it inside
the shirt or dress, then the result would be that the high frequency sounds
would get absorbed while the low frequency would get emphasized, which Hearing Aids
would affect the sound quality. The sound will get muffled, andits clarity
will get affected. Remember, it is all right ifthe hearing aid is noticeable
to everybody - the child S hearing comes first; appearance is secondary.
Apart from being bigger and heavier, a major limitation of this type of
hearing aid is that since it is worn on the body, it is very difficult for the
person to make out the direction of the source of sound. Since it is worn
in the front, if someone calls the child frod behind, the child may not
hear it. Thus, the hearing impaired child wearing the pocket-type hearing
aid finds it difficult to identify the source of the sound, and would not
be able to respond to sound when it is presented from behind or from
the side. The hearing aid functions optimally when you talk to the
person from the front.
5.6.2 Behind-the-Ear Hearing Aids
The hearing aid is worn behind the ear, hence it is called behind-the-ear
aid (BTE). A thin plastic ear hook, attached to the body of the hearing
aid, is attached to the tube of the ear mould and the ear mould is fitted
to the ear. Sound is transmitted through this tube to the ear. It is always
recommended to have a custom-fit ear mould (you will read more about
ear moulds in Section 5.7) to give support to the hearing aid. There is
another external attachment called 'ear-lock', which is strongly
recommended in the case of children, since it prevents the hearing aid
from falling off. This hearing aid has variable amplification power: it can
have low power, moderate power or high power - depending upon the
requirement. Thus, these hearing aids can be used for different types of
hearing losses. Children as well as adults can wear them.

Behind-the-ear hearing aids have several advantages

Advantages: Behind-the-ear hearing aids are small and light. Since the
aid is minimally seen, it has an excellent cosmetic appeal. A major
advantage of these hearing aids is the use of modern technology. An
important benefit that children get with behind-the-ear aids is
directionality. When sound is presented from any direction, it reaches
13
Fostering Language the hearing aid at ear level. Hence, the child can understand from where
Development
the sound is coming. Two independent hearing aids with different
amplification levels are needed for uneven hearing loss; that is, when the
hearing loss for both the ears is different. However, learning to localize
sound and recognize different sounds needs to be taught to the child. Using
a good quality hearing aid doesn't mean that these things would happen
automatically. You will learn more about this in the Unit on auditory
training (Unit 6).

Disadvantages: The only disadvantage of this type of hearing aid is that it

is costly, and the recurring expense of button cells used in the aid is very
high. Frequent failure of the hearing aid may occur due to sweating.
We sweat more at the ear level, and with the sweat going into the hearing
aid, the functioning of the hearing aid may get affected.

5.6.3 In-the-Ear Hearing Aids

This hearing aid fits in the ear, hence it is called in-the-ear aid. The whole
electronic circuit is fitted into a small plastic shell. This shell is specially
made for the person, after taking an ear impression of the person's pinna
and some part of the ear canal. There are different types of custom-
made in-the-ear hearing aids, as shown in the illustration below. These
hearing aids have appeal because they are not very visible. However,
these are not good for children. The ear size in the case of children is
too small for fitting the hearing aid in the ear. Also, as the ear size grows
bigger, the hearing aid needs to be changed. These types of hearing aids
are generally fitted to children above twelve years of age, and those who
have partial hearing loss. This type of hearing aid has less
amplification power, hence is not advisable in the case of severe or
profound hearing loss.

Buttery compartment

Volume cmtfd

In-the-ear hearing aids look aesthetic because they are not visible to
others, but they are not good for children
5.6.4 Bone Conduction Hearing Aids Hearing Aids

In the case of certain abnormalities such as absence of pinna or under

developed external ear structure, the person is unable to use a hearing aid.
In such conditions, certain modifications need to be made in the hearing
aid, so that the inner ear gets stimulated through bone conduction.
Hence, this type of hearing aid is called bone conduction type hearing aid.
Instead of the receiver, this hearing aid has a bone vibrator. To support the
vibrator, a headband is attached to the vibrator. Children with recurring ear
discharge may also be fitted with the bone conduction instrument.

Bone conduction hearing aids become essential if some

abnormalities are present

5.7 EARMOULD
The receiver of the hearing aid has to be put into the ear, and each child's
ear is unique in shape and size. As the solution to this problem, the
receiver of the hearing aid is put into an ear mould, which is specially
made for the child, and the mould is placed in the ear. A good fitting
mould enhances the quality of sound delivered in the ear, and is also
comfortable to wear. The proper fitting of the mould, and thus the
hearing aid, in the ear is a must. Unless the hearing aid (mould) fits
snugly in the external ear, the sound waves will not get sent effectively
to the ear drum. The poor fit of hearing aid will mean that the sound will
not get passed-on properly in the ear canal - on the contrary, the hearing
aid will give a continuous squeal, that is, a continuous whistling sound.
That means there is leakage of sound, indicating that because the hearing
aid has not fitted properly into the ear, the sound is getting out of the ear
and not into the ear. A continuous squeal is known as 'Feedback' of the
hearing aid. Whenever you hear a feedback, you need to worry about the
poor fit of the hearing aid, which in effect means the poor fit of the hearing
aid mould. There is no substitute for a custom-fit ear mould. Each ear
mould has to be made according to the size and shape of the external ear
Fostering Language of the person who has to wear it. It is like dentures. There are no standard
dentures; the same way, there are no universal ear moulds. Moulds for
the two ears are different. The right ear mould does not fit in the left ear
and vice-versa. The moulds are made of plastic or acrylic material. The
material may be hard or soft. Hard moulds are cheaper than the soft ear
moulds. As the child grows, the external ear will also grow and the ear
mould will become loose. Thus, in young children, the ear mould should
be replaced once in six months, and in the case of older children, once a
year. After ten years of age, it can be replaced less frequently.As the head
size grows to adult size, the need to change the mould due to change in
size is no longer required.

The ear mould should fit in the child's ear properly; otherwise the child
will not wear it. When the hearing aid specialist fits the ear mould made
for your child, it should be ensured that it is smooth and comfortable to
wear. Sometimes after wearing the mould for a few weeks, you may
notice that the edges of the ear mould are very sharp, or the canal is too
long - you must bring these details to the notice of the specialist. If the
somd bore (hole in the ear mould) is blocked by ear wax, it must be cleaned
or it will block the sound. If the ear mould is dirty, it should be detached
from the receiver and cleaned with lukewarm water and soap. After drying
in air, it should be fixed with the receiver. Most of the hearing aids are
rejected (not accepted) by the child because the ear moulds do not fit well
into the ear. Therefore, we should make sure that the ear mould is properly
fitted and is comfortable to wear.

Moulds have several advantages; let us take a look at them:

a Ear mould links the hearing aid and the ear canal of the person.

a A well-fitted mould transfers the amplified sound from the hearing

aid to the ear canal efficiently.

a It holds the receiver properly and gives comfort to the hearing aid
user.

a It prevents the aid from falling down.

Children can, and should, use the hearing aids in the course of all their
daily activities. They can wear hearing aids when they are playing,
studying, having food, going to the market or for a walk.

The child should not be wearing the aids while taking a bath, or while
sleeping. The rest of the time, the child can, and should, wear the hearing
aids all day. Remember, the more he uses the aids, the better his residual
hewing will get utilized; which in turn,will help in his language and speech
development.
 HELLO MURALI. LISTEN I
CALLED YOU. MURALI ...
WHERE I S MURALI? THERE YOU ARE.

The child should wear the hearing aids all the time. It would enable him to
hear more, and help in his language development

5.8 SELECTION OF A'HEARING AID

We have seen that there are different types of hearing aids. They are of
different shapes and styles, and use different amplifiers. It is the expert's
job to determine the appropriate hearing aid for the child with hearing
impairment. The audiogram is the basis for selection of the hearing
aid. You would recall reading about assessment, audiometry, and
audiograms in Unit 3. The audiogram gives information about whether
the hearing aid should be fitted in one ear (in case the parents mention
financial constraints) or in both the ears. It also gives information about
the desired power required for that particular child. However, in order to
find out which aid is suitable for the child, one needs to test how well the
child is able to hear with the help of the hearing aid. Hearing aid trial is
critical for ensuring that the aid would help the child hear the spoken
language around him to the maximum extent, with least distortion
or noise. A child who has some language can be asked questions to
assess his ability to follow conversational speech with and without the
hearing aid. However, whereas children who have some language can
respond to questions asked, the assessment and evaluation, including
hearing aid trial, is more difficult in the case of very young children. In
the course of hearing aid trial, the audiologist tries out different hearing
aids and prescribes the suitable one for the child after observing the
child's behaviour with different hearing aids, asking him questions (if
the child is able to respond to questions), and through objective tests.
Through these methods, the audiologist determines how much better the
I Fostering Language
fivelo~ment
child is able to hear because of the hearing aid, using different formulae
as per the audiogram of the child. The Aided Graph helps in the selection
of the hearing aid.
Aided Graph: The test to assess the suitability of the hearing aid, that
is the hearing aid trial, is done in a sound field room. As you read in
Section 3.5 of Unit 3, a sound field room is a very quiet room with
minimal noise. You may wish to go through that Section again to refresh
your memory about how hearing of an individual is assessed, and how
with modifications like conditioning and free field audiometry, the
assessment of hearing may be done even with respect to very young
children.
For selection of a suitable hearing aid, the child's hearing level is
assessed with and without the hearing aids. The hearing levels with
the hearing aid and without the hearing aid are compared and the
difference between the two readings gives information about the benefit
being provided by the hearing aid. This information is plotted on the
graph shown below. The objective is to get a hearing response at close
to 60 dB with the hearing aid. Our normal conversation level is
considered to be around 40 dB to 60 dB, and if the child with hearing
impairment responds to all the sounds around 60 dB, it means that he
would be able to access most of the speech and language sounds. He
would also get oriented to environmental sounds. Such a child would
not have much difficulty in learning language. Thus, if the response
is seen around 60 dB, it means that the child will hear well with the
hearing aid, and the expert recommends that particular hearing aid model
for the child with hearing impairment. But in practice, it is very difficult
to get the response at around 60 dB level for every child with hearing
impairment. In that case, the hearing aid which helps the child to respond
best is selected and fitted.

The speech banana' graph

The hearing aid response should be in the shaded portion. That indicates
that the child's residual hearing can respond to speech sounds such as
vowels and consonants. It would be easy to teach speech and language to
this child. If the child is in a position to identify most of the vowels, and
consonants, we would be able to plan and predict the sounds to which he
would be able to respond well; the sounds that he may not be able to hear;
and the sounds for which the child may need a lot of training and practice.
This shaded portion of the graph is called "Speech Banana", since it
looks like a banana, and since our primary concern is about audibility of
speech (in other words, our concern is that the child should be able to hear
what is being said). The objective is always to find the hearing aid, which
will show the responses in the "speech banana". However, children
with severe to profound hearing loss may not give a very promising
response. Nevertheless, this aided graph (that is, the graph indicating the
responses of the child with the use of hearing aid), helps the experts to
give guidelines to the other professionals, and the parents, about what are
the speech sounds that the child would be able to hear, and which ones he
would not.
After the hearing aid selection
Once the hearing aid is selected, ear moulds are made according to the
ear size of the child. As you know, in order to make the hearing aid fit
well in the child's ear, we use a custom-made ear mould. This is made
from a synthetic material. These moulds are fitted to the hearing aids,
and the hearing aids are ready to wear. But this is not an easy task.
Young babies do not like anything being put into their ears. Children find
it uncomfortable to have something artificial in their ears and so there is
always a lot of resistance to the hearing aid from the child. This is one
major issue that has to be handled. Another issue is the expectations of
parents and other family members. With spectacles, one is able to start
seeing clearly right away, without any additional inputs. In the same way,
everyone expects that the child should be able to "hear" and respond to
sounds as soon as the hearing aids have been fitted. They find it difficult
to understand that it is not the same. The parents and family members
are very anxious to see the child respond to sounds. They want to see the
child respond to his name, the doorbell and many more things - but it is
not very easy. The child has never heard any sound before, so it is very
difficult for him to identi@ various sounds like a car starting, the clang
of kitchen vessels and so on. We all know that any person with normal
hearing learns language by listening. We associate the name heard with
the object every time, and that is how our concepts develop. Since
children with hearing impairment find it very difficult or sometimes even
impossible to hear speech sounds, they are unable to form associations
between words and objects. ~ h ' need e ~ to be taught to develop these
associations. We have to teach them to detect, identify and associate
sounds with objects and meanings. You will be reading more about these
aspects in later Units.
 Fostering Language Getting the child the appropriatehearing aid, and helping him accept it and
use it is a wise decision indeed. You may get suggestions of not putting on
the hearing aid, or waiting and watching with the assumption that the child
may outgrow his hearing loss, or looking around for some treatment. But
remember,if you postpone the hearing aid fitting even for a few
months, you are losing out on the vital period of language learning.
The more the tiwe lost, the greater would be the chances that the child
may not be able toacquire age-appropriate language. Teaching language to
children with hearing loss can be hard, but-your consistent efforts wilI
make the difference in your child.4
And as a parent you are the best teacher
for your child. ,

First and foremost, we need to follow certain steps to ensure that the child
is comfortable with his hearing aids. Let us now take a look at how this
may be done.

5.9 HOW TO HELP THE CHILD GET

ACCUSTOMED TO THE HEARING
AIDS?
You have taken the right decision of fitting the child with the appropriate
hearing aids. Now, you would need to make some effort to ensure that the
child will wear the aids all day long, every day. And that's not an easy task.
Most children will not accept the aids immediately. No child likes to put
any object in the ear. The immediate reaction of a child is to reject the
foreign body which is put in his ear. Just think of the time when your child
refused to wear a scarf or a cap, and how hard you had to struggle to put it
on! The same way, he is going to refuse to use the hearing aids. You will
need to help the child get used to, and accept the aids.
Let us see how one can start working on getting the child to accept the
hearing aids.
a When the child has worn the hearing aids, start playing with
him, If you try to keep him occupied, his attention will get diverted
from the hearing aids. Make the game a joyful event.
a Be affectionate and show the child that you like him with his
hearing aids on. This is very important for the child.
a Make joyful sounds, and speak in a pleasant voice. The sounds
should be loud and clear. Every time, try to draw his attention to the
sounds. Speak in a regular voice; not in a whisper, and also speak slowly
- that makes the sounds clearer to the child. Put your finger on your
ear and say, "I heard it."
When the child has worn the hearing aids for 10 to 15 minutes, remove!

I
them. Try this kind of a session three to four times in a day. It has been
observed that in a couple of months, the child will start accepting the aids
and kill ask t6 keep them on for a longer duration. Once the child starts
using the aids for two to three hours, it is a strong indication that he has

20
accepted the hearing aids, and that he is trying to listen to the sounds in his Hearing Aids
environment. The next step will be making these listening activities more
meaningful. You will learn about this in the next few Units.
Some children do reject hearing aids very strongly. In that case, initially,
acclimatize the child with ear moulds only. Once the child starts wearing
ear mould for half an hour, attach the receiver of the hearing aid to the ear
mould. Remember, never bribe the child to use the hearing aids. "If
you wear the aids, I shall give you a chocolate", or "If you wear the hearing
aids, I shall take you to the garden" - such statements give very wrong
messages to the child. He gets more interested in the tangible benefits
like chocolates, toys or going out, and may not get focused on the hearing
aids or listening, which is our ultimate goal. However, you should reward
the child with approval and praise when he keeps his hearing aids on.
Once listening becomes an enjoyable experience, the child would
like to use the hearing aids for extended hours.

The parents and family members should not be a&=d of the

aids are still not eonunon and
hearing aids of the child. ~ e a r i n g
they attract the attention of people. The parents may face
embarrassing questions from relatives and friends. Tlw parents
have to develop the strength to face such questions and h e m w
-
that the child wears the hearing aids even when they ga out to
attend social events.

Y W A T IS YOUR SON

The family members should not feel embarrassed about the fact that
the child wears hearing aids. They should handle questions about it
confidently, without feeling awkward.
. 21
I Fostering Language
Development 5.10 HO'W TO TAKE CARE OF THE
HEAFUNG AIDS?
As the hearing aid is worn on the body, its wear and tear is frequent. The
dust, body heat, and sweat affect the performance of the aid since it is an
electronic instrument. Thus, you need to take good care of it. Given
below are some ways oftaking care of hearing aids:
The hearing aid should not be exposed to water/heat/excessive dust.
It should be handled carefully and should be kept in a cool dry place.
Use hearing aid harness to secure the pocket-type hearing aid.
Use ear-lock for behind-the-ear aid.
Use hearing aid protector (a plastic cover for the hearing aid, to prevent
young children from changing the hearing aid settings).
Place the hearing aid and the ear mould in a box with silica gel. Silica
gel absorbs the moisture, and helps to keep the hearing aid dry.
Ear moulds should be cleaned regularly, by wiping them first with a
damp cloth or tissue, and then with dry cloth.
Do not use discharged or weak batteries. Change the battery regularly.
Look at the positive and negative ends of the battery, and place the
battery appropriately. If the aid is not going to be used for a long
time, remove the battery from the instrument.
Keep the hearing aid at a safe place when it is not being used.
Check the hole of the ear mould. If it is blocked with wax, then
make sure to clean it gently with a pin.
Some children have a tendency of forming excessive wax in the ear.
If the mould gets clogged with wax frequently, then it is advisable
to get the child's ear cleaned by an ENT doctor.
A visit to an ENT doctor or an audiologist once a year is a good
practice.
Do not use a hearing aid cord that has wrinkles.
Always keep a spare battery and cord.
Get your hearing aid serviced regularly.
In case of a major problem, contact a qualified professional.
4 DOnot force the ear mould into the child's ear if it doesn't fit gently.
Get a well-fitting and comfortable ear mould made for the child.
Fostering Language Change the cord. It is easy to replace. Remove the cordfiom
Development
the hearing aid and the receiver. It is a plug-socket fitting.
Replace the damaged cord with a new cord.
5) The receiver may be damaged.
Ifyou have put the new battery and changed the cord, and still
you do not get enough amplification or you do not get
ampliJication at all, then it is likely that the receiver may have
got damaged. In that case, replace the receiver. The receiver of
the pocket model cannot be repaired, but receiver of the BTE
model is inside the hearing a i d , which needs to be repaired
by the hearing aid expert.
If the amplification is weak:
1) The battery may be weak.
Change the battery.
2) The hearing loss of the person may have changed. It may have
got worsened.
Get the hearing level assessed again. In case the hearing aid
needs to be changed, do so.
3) Ear tip may have got clogged with wax.
Clean the ear tip, and remove the wax with a pin.
4) There may be dust on the microphone cover.
Remove the dust.
5) The volume control may be on reduced settings.
Adjust the volume control setting.
If the hearing aid is giving feedback while being worn, .then it
could be due to the following reasons:
1) The ear mould may not have fitted correctly. It may not be of
correct size or may not have been worn properly.
2). The ear tip may be too large or too small for the size of the ear
canal.
3) The volume control may have been turned to its maximum level.
4) (In the case of thepocket-type hearing aid) The hearing aid may
be close to the receiver. The distance between the hearing aid
and the receiver should be more than eight inches. Stitch a pocket
to the child's shirt or dress in such a way that the hearing aid can
be tucked into it.
 5 ) (In the case of behind-the-ear hearing aid) Check the tubing
connection. This connection is between the ear mould, and the
hook of the hearing aid; and this tube may have got clogged. If
the problem continues, then it needs attention from the service
engineer.
Sometimes the sound is present and sometimes it is not:
There may be a loose connection. Check all the connections.
Distorted output or unclear sound:
Check all the switches and connections. If you are unable to rectify
the problem, then it should be sent to the dealerlmanufacturer or a
trained person who can repair it.
The life of a hearing aid is considered to be around five to six years. If
the hearing aid is more than six years old, then it is better to change the
instrument.

5.12 COCHLEAR IMPLANT

Sometimes, despite giving consistent listening training, the child does not
benefit from hearing aids. In some cases, particularly when the degree of
hearing loss is very high, the hearing aid may help the child to detect some
sounds, but not all. Hence scientists have been looking for a better solution.
Cochlear implant is a newer option that is available.

Cochlear implant (instead of regular hearing aids) is a newer and more

advanced option for children with profound hearing loss

Cochlear implant is an electronic instrument. The doctors need to perform

a special surgery, and fix it in the inner ear. We have seen earlier that the
inner ear of the person with hearing impairment does not function well,
due to which the ear cannot send the message to the brain. The cochlear
implant bypasses the inner ear and sends the information directly to the
Fostering Language auditory nerve. One needs to wear the external device as well. This device
communicates with the inner ear device through a magnet. The external
device picks up sound and converts the same to electrical impulses that
are sent to the implant. This way, the auditory nerve gets direct stimulation.
Implant is recommended for children with a hearing loss of 80 dB
and above. It is advisable to do implant surgery between one and five years
of age, as this is the age when language is learnt. Children up to the age of
fifteen years may also benefit from the surgery, but tkbenefits will be
limited and they need to be discussed with the doctor or the audiologist.
This is a surgical procedure, and it is not done in all the hospitals or centres.
At this stage, implant is very expensive, but it is important for us to know
that such advanced technology is available in India and is useful for children
with a high degree of hearing loss.

As is true in the case of fitting of hearing aids, after the implant surgery,
language training is a must. Children have to be taught how to perceive
sounds, and associate them with objects and meanings. Hearing aids (and
cochlear implant) help the children to come closer to the hearing world,
but they still need to be helped to hear; to perceive and respond to different
sounds. The next Unit will explain to us about listening training, which is
called auditory training.

5.13 LET US SUM UP

Once the hearing loss is identified, remedial measures should be taken as
soon as possible. Some residual hearing exists in every child with hearing
impairment. To facilitate age appropriate development of language and
communication skills, the child's residual hearing needs to be assessed
and the child fitted with the appropriate hearing aids.
Hearing aids are of different shapes, styles and colours, but every hearing
aid has some basic components: a microphone, an amplifier, and a receiver.
A hearing aid basically functions as follows:

The microphone collects the sound from the environment;

the sound is converted into electrical signals; these are sent to;

the amplifier; the amplifier makes the signal louder; these amplified
waves'are sent to the receiver; and

the receiver converts the electrical energy into sound energy.

The hearing aid fitting may be monaural (that is, the hearing impaired child
uses only one hearing aid), binaural (that is, the child wears two independent
hearing aids in the two ears) or pseudo-binaural (when two receivers of a
single hearing aid are fitted in the two ears). The pseudo-binaural fitting is
available with respect only to the pocket-type hearing aid.
 Hearing Aids
The different types of hearing aids are as follows:
I a) Pocket model
b) Behind-the-ear (BTE)

The proper fitting of the hearing aid in the ear is a must. Ear moulds link
the hearing aid and the ear canal of the individual.A custom-made ear mould
is essential. Mould sends the sounds effectively to the ear canal.
Audiogram is the base for selection of a hearing aid. It tells us the desired
power of the hearing aid. The hearing aid trial is carried out to determine
which hearing aid will hefpthe child to hear better. If the child's hearing
level is 60 dB or less with the hearing aid, this means that the child would
be able to access most of the speech and language.
Young children often refuse to wear hearing aids. Initially, put them on
while the child is playing. Proper care ofthe aid needs to be taken. You can
deal with minor faults very easily.
For children with hearing loss of 80 dB or above, the new technique of
'Cochlear Implant' is available. This is a surgical procedure. However, after
the surgery, language training will nevertheless have to be given to the