Hearing aid technology keeps evolving, which means there’s a growing variety of styles and features to consider.

“People who already use a hearing aid know that selecting one is not a simple decision,” says Eric Mann, M.D., Ph.D., chief medical officer in the federal Food and Drug Administration (FDA) office responsible for hearing aids. “Hearing loss affects people in different ways. So, it’s important to choose a hearing aid that’s appropriate for your condition and fits your lifestyle.”

The FDA regulates hearing aids to make sure they are safe and effective. If you’re considering hearing aids, the agency shares below, in a Consumer Update, some common technologies and terms you may encounter and notes a change that’s coming to how hearing aids are sold.

Hearing Aids and How They Work

People may be born with hearing loss. Or they may develop it later in life—often because the inner ear can wear out as we age or be damaged by years of exposure to loud noises.

In some cases, hearing loss is temporary and can be restored with medical help. In other cases, it’s permanent but can be improved with hearing aids.

Hearing aids are medical devices worn behind or in the ear. They can improve hearing by making sounds louder. However, hearing aids usually won’t restore your hearing to normal levels or quality in the way that eyeglasses can often restore vision to 20/20.

Air-conduction vs. bone-conduction hearing aids

Most hearing aids work through air conduction. They bring amplified sound into the ear canal. Sound then moves through the eardrum and three tiny bones in the middle ear to reach the inner ear, where it’s processed and sent to the brain.

For people who have problems with their outer or middle ear, those areas can be bypassed with bone-conduction hearing aids. They send sound through the skull to reach the inner ear.

Styles of Hearing Aids

Types of hearing aids include Behind the ear, Receiver in the canal or ear, In the ear, In the canal, and Completely in the canal

Behind-the-ear (BTE) aids: BTE hearing aids are generally the largest hearing aid style. A plastic case containing most of the electronics sits behind the ear and is connected to an earmold that fits in the ear canal. BTE hearing aids can be used by people of all ages. The style is often chosen for young children because it can be adapted as they grow.

Receiver-in-the-canal (RIC) aids: RIC (or mini receiver-in-the-ear; mini RITE) hearing aids sit behind the ear but are typically smaller than a BTE. The RIC hearing aid is attached to a tube housing a small wire with a dome-shaped tip at the end that rests in the ear canal (in some cases, earmolds are used). The RIC design allows more of the ear canal to remain open and is less visible than the BTE style.

In-the-ear (ITE) aids: This hearing aid sits completely in the outer ear (the “bowl” of the ear). All the hearing aid electronics are housed in a custom-fit shell.

In-the-canal (ITC) aids and completely-in-the-canal (CIC) aids: These are the smallest hearing aids currently available. The electronics are contained in a small custom-fit shell that fits partly or completely into the ear canal.  Some people may like them because they are less noticeable while other people may find them harder to handle.

Hearing Aid Features

Today’s hearing aids come with a variety of features. Here are some of the more common ones.

Directional microphones focus on sound from a specific direction. They could help you hear someone in a face-to-face conversation over the noise around you, for example.

Telecoils enable the hearing aid to pick up sound directly from compatible phones or compatible sound systems in public places, such as theaters and houses of worship.

Wireless connectivity such as Bluetooth allows hearing aids to interact with televisions, cellphones, computers or tablets.

Getting Hearing Aids

Medical evaluation is required for children younger than 18 years of age

While hearing loss in adults is often caused by aging or noise exposure, the reasons for hearing loss in children are more varied and may be associated with other medical conditions requiring medical evaluation and treatment. So, the FDA requires a statement of a doctor’s exam before the sale of hearing aids for children.

The FDA does not intend to enforce the requirement that people 18 years of age and older have a medical evaluation statement (or sign a waiver) before the sale of certain hearing aids.

Hearing aids typically are sold by audiologists; ear, nose and throat doctors; or sellers licensed to dispense hearing aids, such as instrument specialists.

Proposed Over-the-Counter (OTC) Hearing Aids

Some hearing aids can be legally sold directly to the user over the internet or through mail order if permitted in your state.

To broaden access to hearing aids, the FDA is proposing a new category of over-the-counter (OTC) hearing aids that you could buy in the store or online without seeing a physician for an exam or an audiologist for help with fitting. After the new FDA regulations are finalized, hearing aids could become more widely available nationwide.

The proposed OTC rules would apply to certain air-conduction hearing aids intended for people age 18 and older who have perceived mild to moderate hearing loss. A person with mild hearing loss may hear some speech sounds but not others. A person with moderate hearing loss may hear almost no speech when someone is talking at a normal level.

“We want hearing aids to be more readily available and accessible, especially as our population ages,” Mann explains. “It’s also important for people to recognize that hearing loss could be a sign of an easily treatable problem like built-up earwax or a more serious problem like a benign tumor on the hearing nerve. See a doctor when things don’t feel right, when your hearing loss is progressing, or if you are having associated symptoms like dizziness, ear pain, or drainage from the ear canal.”

Hearing Aids vs. Personal Sound Amplification Products

You may have seen products in stores or online that are known as personal sound amplification products (PSAPs). These are not alternatives to hearing aids.

While hearing aids and PSAPs both amplify sound for the user, the products have different intended uses. Hearing aids are intended to make up for impaired hearing. PSAPs, in contrast, are intended for people with normal hearing to amplify sounds in certain situations, such as recreational activities like birdwatching or hunting.

Because such PSAPs are regulated as consumer electronics and not medical devices, they may be more variable in terms of product quality compared to hearing aids. The FDA does not regulate such PSAPs for safety and effectiveness as it does for hearing aids.

For more information, click here to visit the National Institute on Deafness and Other Hearing Disorders, part of the National Institutes of Health (NIH).

Why is that? Well, like most animals, humans have two ears for a reason. Rather than receiving separate inputs of sound from each ear, both ears collect sound and send it to the brain, which processes the sound binaurally. Binaural hearing allows you to identify the direction from which sound is coming and hear it clearly. With single-sided hearing loss, you lose that ability.

Living with single-sided hearing loss

Relying on only one ear to hear means you may struggle to localize sounds and pinpoint the source of speech, especially in environments with loud background noise. Single-sided hearing loss also makes it challenging to understand higher-frequency sounds. While low-frequency sounds can bend around your head and still be heard when your good ear is facing away from the source, high-frequency sounds have shorter wavelengths, which get blocked by your head and can’t travel to the good ear. Since many consonant sounds fall in the high-frequency range, it can be challenging to comprehend speech and follow a conversation directed toward your “bad” side.

The longer you go without addressing single-sided hearing loss, the more it can affect your quality of life. For instance, you may have to ask people to speak toward your good side, reposition yourself, or constantly turn your head just to follow conversations, which can strain your neck and back. Listening fatigue is another potential issue due to the effort required to keep up with conversations while filling in the gaps from missing pieces of acoustic information. There is also the risk of depression. If struggling to understand others takes too much effort or if you are tired of having to contort your body to hear them, you might choose to avoid social situations altogether, which can make you feel isolated and lonely—known contributing factors to depression.

While hearing aids can help overcome the challenges of single-sided hearing loss, many people refuse to use them. Unfortunately, there is still a stigma around using hearing aids (i.e., they’ll make you seem old or out of touch). New technology can erase the stigma, offering a unique solution to single-sided hearing loss that is almost invisible so no one will know you’re wearing hearing devices.

CROS technology

To understand how this new technology transforms the way people address single-sided hearing loss, it’s important to understand previous methods. The most common was through contralateral routing of signals (CROS) hearing aid technology. This involves wearing a transmitter device, which looks like a normal hearing aid, on the ear with unaidable hearing loss, paired with a hearing aid on the better ear. Through this approach, the sound coming into your bad ear is picked up by the transmitter, processed, and transmitted to the hearing aid on your good ear. If you have a degree of hearing loss in your hearing ear, the paired hearing aids can also amplify sounds coming from both sides in the better ear (known as BiCROS).

Traditionally, such systems relied on bulky wires to connect the hearing aid and transmitter device. While technology has advanced to allow CROS hearing aids to connect to each other wirelessly, they have only been available in behind-the-ear devices, which don’t provide the high level of discretion many wearers desire.

A new approach to single-sided hearing loss

The newest technology to treat single-sided hearing loss builds upon previous solutions, while adding a new dimension of discretion. The result is a world’s first—CROS technology in a tiny hearing aid that sits in your ear canal almost invisibly. This solution provides people with single-sided hearing loss the right combination to meet their needs: advanced wireless technology to let them pick up sound from their unaidable side, and the confidence of having nearly invisible hearing aids so they don’t feel self-conscious.

It’s not just the small size that makes these hearing aids unnoticeable. Like many modern hearing aids, the settings can be changed discreetly via a smartphone app. Rather than having to remove your hearing aids in public or push buttons to adjust settings, you can easily make any changes from your smartphone, without anyone knowing what you’re really doing.

Hear from both sides again

With single-sided hearing loss, you lose the crucial ability to pick up sounds coming toward both sides of your head. However, advanced CROS hearing aid technology solves this issue by enabling you to hear speech and localize sound from any direction. Such devices also solve another challenge for people with single-sided hearing loss: if you don’t want others to know you wear hearing aids, new nearly invisible devices can help you hear while providing the high level of discretion you prefer.

Lisa A. Perhacs, AuD, is a Clinical Education Specialist for Sivantos, Inc. She is responsible for training customers and sales staff on the company’s current technology and products. She conducts training sessions in customers’ offices, remotely, via webinars, and at regional and national events. Dr. Perhacs has more than 13 years of manufacturing experience including two years as the Training and Audiology Manager for Siemens Export Sales, based in Erlangen, Germany. Her six years of clinical experience includes private practice, a large medical setting, and Clinic Coordinator and Preceptor at Montclair State University. Dr. Perhacs earned her undergraduate degree from Seton Hall University, graduate degree from The College of New Jersey, and doctorate from Pennsylvania College of Optometry (now Salus University).

Deafening sound

A release from the university explains that to develop a treatment for noise-induced hearing loss, the researchers first had to understand its mechanisms. They built a tool using novel miniature optics to image inside the cochlea, the hearing portion of the inner ear, and exposed mice to a loud noise similar to that of a roadside bomb.

They discovered that two things happen after exposure to a loud noise: sensory hair cells, which are the cells that detect sound and convert it to neural signals, die, and the inner ear fills with excess fluid, leading to the death of neurons.

The release quotes corresponding author John Oghalai, MD as saying, “That buildup of fluid pressure in the inner ear is something you might notice if you go to a loud concert,” Dr. Oghalai is chair and professor of the USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery and holder of the Leon J. Tiber and David S. Alpert Chair in Medicine. “When you leave the concert, your ears might feel full and you might have ringing in your ears. We were able to see that this buildup of fluid correlates with neuron loss.”

Both neurons and sensory hair cells play critical roles in hearing.

“The death of sensory hair cells leads to hearing loss. But even if some sensory hair cells remain and still work, if they’re not connected to a neuron, then the brain won’t hear the sound,” Oghalai says.

The researchers found that sensory hair cell death occurred immediately after exposure to loud noise and was irreversible. Neuron damage, however, had a delayed onset, opening a window of opportunity for treatment.

A simple solution

The buildup of fluid in the inner ear occurred over a period of a few hours after loud noise exposure and contained high concentrations of potassium. To reverse the effects of the potassium and reduce the fluid buildup, salt- and sugar-based solutions were injected into the middle ear, just through the eardrum, three hours after noise exposure. The researchers found that treatment with these solutions prevented 45-64 percent of neuron loss, suggesting that the treatment may offer a way to preserve hearing function.

The treatment could have several potential applications, Oghalai explains.

“I can envision soldiers carrying a small bottle of this solution with them and using it to prevent hearing damage after exposure to blast pressure from a roadside bomb,” he says. “It might also have potential as a treatment for other diseases of the inner ear that are associated with fluid buildup, such as Meniere’s disease.”

Oghalai and his team plan to conduct further research on the exact sequence of steps between fluid buildup in the inner ear and neuron death, followed by clinical trials of their potential treatment for noise-induced hearing loss.

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About the Keck School of Medicine of USC

Founded in 1885, the Keck School of Medicine of USC is among the nation’s leaders in innovative patient care, scientific discovery, education and community service. It is part of Keck Medicine of USC, the University of Southern California’s medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes Keck Medical Center of USC, composed of Keck Hospital of USC and USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school has more than 1,750 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 800 medical students and 1,000 students pursuing graduate and postgraduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school’s faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals, Children’s Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, USC Cardiovascular Thoracic Institute, USC Institute of Urology, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, USC Norris Comprehensive Cancer Center, USC Roski Eye Institute and Zilkha Neurogenetic Institute.

In 2018, U.S. News & World Report ranked the Keck School among the top 35 medical schools in the country.

Previous studies have looked at how specific nutrients affect risk, but the relation of overall diet and risk of developing hearing loss was unclear. In a new study, researchers from Brigham and Women’s Hospital examined the relation between three different diets and risk of developing hearing loss: The Alternate Mediterranean diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010). They analyzed the results of 70,966 women in the Nurses’ Health Study II who were followed for 22 years. Results are published in the Journal of Nutrition on May 11.

“Interestingly, we observed that those following an overall healthy diet had a lower risk of moderate or worse hearing loss,” Sharon Curhan, MD, an epidemiologist in the Channing Division of Network Medicine at BWH, and first author of the study, said in a news release from Brigham and Women’s. “Eating well contributes to overall good health, and it may also be helpful in reducing the risk of hearing loss.”

In this longitudinal study, researchers collected detailed information on dietary intake every four years and found that women whose diets most closely resembled the AMED or DASH dietary patterns had an approximately 30 percent lower risk of moderate or worse hearing loss, compared with women whose diets resembled these dietary patterns the least. Moreover, findings in a sub-cohort of over 33,000 women for whom detailed hearing-related information had been collected suggest that the magnitude of the reduced risk may be even greater than 30 percent, and may also pertain to the AHEI-2010. The AMED diet includes extra virgin olive oil, grains, legumes, vegetables, fruits, nuts, fish and moderate intake of alcohol. The DASH diet is high in fruits and vegetables and low-fat dairy, and low in sodium. The AHEI-2010 diet has common components with AMED and DASH.

Assessment of hearing loss was based on self-report. Researchers say further research in additional populations is warranted.

To make matters worse, hearing loss is often progressive in nature. This means it can become gradually worse without the problem being immediately apparent to those suffering. Loved ones however, may notice a bit sooner.

Whether it’s loudly repeating yourself or noticing the TV volume up too high, all signs may be pointing to concerns of hearing loss. But how do you get aging parents to realize how much of a toll this is truly taking on their wellbeing?

Here are a few ways to convince your parents to consider hearing aids.

1. Discuss the sense of independence they’ll gain.

Not relying on others to repeat messages will allow your parents to play a more active role in discussions. While this can easily be taken for granted, being able to participate in the flow of information is essential to living an independent and productive life. This includes for example, being privy to important announcements when they are being made verbally.

2. Share how feelings of frustration may be reduced.

Older adults with hearing loss may hear noise but may not be able to discern what it is. This may be especially true with speech, making conversations extremely difficult. This is all dependent on the specific type of hearing loss, which may call for different kinds of communication needs.

3. Express your desire for their safety.

Whether it’s being able to hear the smoke detector when sleeping at night or a car honk while driving, talk about your desire for them to be as safe as possible at all times and how hearing well will help.

4. Discuss fatigue and how it can be reduced.

It’s easy to underestimate the amount of energy and effort it takes for someone who is hearing impaired to listen. In reality, it’s extremely exhausting and causes fatigue, which can impact the desire to partake in leisure activities and also impacts productivity. The brain has to work much harder to think and interpret sound and produce speech.

5. Offer to go with them to their first appointment.

Help reduce the fear of the unknown and increase the sense of urgency by offering to go with them to an appointment for a hearing test. An audiologist who will evaluate the sensitivity of their sense of hearing typically conducts this test. The test assesses a person’s ability to hear by measuring the ability of sound to reach the brain. Joining this appointment can help reduce any anxiety they may have been experiencing by just thinking about the visit.

While the growing number of people with hearing loss is certainly a concern, so is the fact that so few choose to do anything about it. It’s said that only about 20 percent of people who could benefit from hearing aids actually wear them, meaning there are millions of individuals choosing to ignore their hearing loss. While you might think hearing well isn’t a big deal or worth seeking treatment for, guess again.

Harvey Patterson can attest to the challenges of living with hearing loss. A machine tool designer and NASCAR pit mechanic, Harvey has been exposed to loud noises for most of his life. This exposure has not only taken a toll on his hearing, but so many aspects of his life. If you continue to ignore your hearing loss, you may experience the same difficulties that he did, including:

Strained personal relationships

Hearing loss doesn’t just affect you, it can also be difficult for family and friends who struggle to communicate with you. Misunderstandings occur easily, which can strain those relationships. A defining moment for Harvey occurred when he didn’t hear an invitation from his grandson to watch him compete in a cross-country meet. After he failed to show up, his grandson asked why he didn’t love him anymore. If an innocent misunderstanding like that can make a child question his grandfather’s love, think about how damaging it can be to go years without treating your hearing loss and missing significant events in your family’s lives.

Career damage and safety risks

Aside from personal relationships, hearing loss can also put your career and job security at risk. Not hearing important directions from your boss or requests from clients can lead to work being done improperly. And employees with untreated hearing loss are more likely to earn less than their peers with normal hearing. For Harvey’s job, hearing is essential—if a machine isn’t working properly, sound is one of the first indicators. As Harvey’s hearing diminished, it became more difficult for him to hear those subtle cues.

Increased health risks

Since Harvey didn’t always respond when his grandsons spoke to him, they assumed he just wasn’t interested in them. Such fractured personal relationships can lead to social isolation, which can cause or exacerbate mental health conditions like depression or dementia. Hearing loss can also increase physical health risks, as people with hearing loss are three times as likely to experience dangerous falls.

Decreased quality of life

In addition to the potential damage to relationships with those important to you, your job stability, and your health, even the small things you miss out on can have a huge impact. Going to the park, walking around the neighborhood, or conversing in a restaurant—the world is full of sounds that make life more interesting and enjoyable. Missing out on them can be incredibly frustrating and diminish your quality of life.

Treating hearing loss improves lives

As devastating as it can be to miss out on these sounds, most people still put off addressing their hearing loss for an average of seven years after first noticing it. As you can imagine, a lot can happen in those seven years. But instead of just putting up with hearing poorly and shrugging off the negative effects, you can do something about it.

After he missed his grandson’s cross-country meet, Harvey decided he’d had enough and finally chose to do something about his hearing loss. He met with a hearing care professional to test his hearing and recommend the right hearing aids. And it changed his life completely.

Taking the steps to acknowledge you have hearing loss—and doing something about it—isn’t easy for everyone, and it certainly wasn’t for Harvey. But do you really want to continue missing out on the important things in life, or would you rather hear what you love again? It’s your choice.

A release from the publisher notes that currently, hearing aids can only be purchased in the United States through a licensed professional, with an average cost of $4,700 for two hearing aids (uncovered by Medicare). According to nationally representative estimates, fewer than 20 percent of adults with hearing loss report hearing aid use. Personal sound amplification products (PSAPs) are less-expensive, over-the-counter devices not specifically labeled for hearing loss treatment, but some are technologically comparable with hearing aids and may be appropriate for mild to moderate hearing loss.

Nicholas S. Reed, Au.D., of the Johns Hopkins School of Medicine, Baltimore, and colleagues compared five of these devices (costs, approximately $350 to $30) with a conventional hearing aid (cost, $1,910) among 42 adults (average age, 72 years) with mild to moderate hearing loss.

The researchers found that the change in accuracy in speech understanding from unaided to aided varied by device. Three of the PSAPs were associated with improvements in speech understanding that were similar to results obtained with the hearing aid; one demonstrated little improvement; and speech understanding was worse with one PSAP.

“Results lend support to current national initiatives from the National Academies, White House, and bipartisan legislation requesting that the U.S. Food and Drug Administration create a new regulatory classification for hearing devices meeting appropriate specifications to be available over the counter,” the authors write.

A limitation of the study was the modest number of participants.

Doctors believe that communication with their patients is important, but most studies of physician/elderly patient communication do not mention that hearing loss may affect this interaction. The findings come from a review led by two New York University professors published in April 2017 the Journal of the American Geriatrics Society.

A release from the university notes that many researchers have explored communication between doctors and their patients, but how many of them have considered the importance of hearing loss? To investigate this question, a team led by Dr. Joshua Chodosh of New York University School of Medicine and Dr. Jan Blustein, the NYU’s Robert F. Wagner School of Public Service and the School of Medicine, reviewed the published medical literature on doctor-patient communication, selecting research studies that involved patients aged 60 years and older.

Of the 67 papers included in their study, only 16 (23.9%) included any mention of hearing loss. In some cases (4 out of the 67), people with hearing loss were excluded from the study. Three of the studies reported on an association between hearing loss and quality of care. In only one study did the researchers offer patients some kind of hearing assistance to see whether it would improve communication. (It found that offering hearing assistance improved patients’ understanding.)

The release quotes Chodosh as saying, “Hearing loss has long been neglected in the medical community. As a geriatrician, I see many patients who struggle to hear what I’m saying to them. That makes me less certain that they are getting what they need.”

The findings suggest that research on physician-elderly patient communication has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.

The release quotes Blustein as saying, “Patients are often older people, for whom hearing loss is a daily issue. It’s also an issue that’s ripe for research: how can we attend to and improve hearing and understanding so that patients get the best quality care possible?”

In an accompanying editorial, Frank Lin, MD, PhD of the Johns Hopkins School of Medicine and Heather Whitson, MD, MHS of the Duke University School of Medicine noted that the review offers a major opportunity for practice improvement. “Common sense, low (or no) cost strategies can be employed to mitigate the negative impact of both hearing and vision loss in patient communication,” they wrote. “And some accommodations (e.g., minimizing ambient noise, speaking face to face, creating patient education materials with large-print font) are so simple and potentially beneficial that they could be implemented universally.”

       Full disclosure

       Delayed disclosure

       Nondisclosure

Before you decide which option you want to pursue, make sure you understand your rights to reasonable accommodations and know what assistive devices are available to help you succeed on the job.

Seeking employment and hard of hearing

The following are typical concerns expressed by people looking for jobs who have hearing loss significant enough to raise concerns:

Q       Do I have to tell a potential employer I’ll need an accommodation during the application/interview process?

A        No, you don’t. According to the Equal Employment Opportunity Commission (EEOC), you aren’t required to disclose any medical procedures, use of hearing aids, or related health conditions as a job applicant.

Q       If I need an accommodation during my interview, should I ask for it?

A        Yes. If you need help to hold a successful interview, then you should request a sign language interpreter or whatever else you might need, within reason. However, at the point of disclosure, a potential employer is then free to ask if you will require further accommodation to perform the job.

Q       What questions can an employer ask me during the application/interview process with regards to hearing loss and my ability to do a job?

A        An employer might be limited in what they can ask you regarding how you’re treating your hearing loss, but there are questions regarding your ability to perform “essential functions” they’re allowed to ask, such as:

  Can you respond quickly to instructions in a noisy, fast-paced environment?

  Do you have good communication skills?

  Are you able to meet legally required safety standards to perform these duties?

You should answer these questions honestly, keeping in mind that a perfectly valid response is, “Yes, with reasonable accommodation.” It might help to familiarize yourself with available accommodations for the job you’re applying to by visiting the EEOC website, keeping in mind under the Americans with Disabilities Act (ADA) a potential employer must enable you to participate in the application process on an equal footing with hearing candidates.

Q       If after I’m hired I disclose my hearing loss (with or without a need for accommodations) for the first time, can my employer change their mind about hiring me?

A        No, but a caveat applies: an employer can’t just withdraw their offer because you disclose your hearing difficulties if you can perform the necessary functions of the job with or without accommodation unless your hearing loss directly threatens the safety of yourself or others, and the risk cannot be mitigated by reasonable accommodations.

Employed and lost your hearing

People who are already employed typically express the following concerns:

Q       If I didn’t let my employer know about my hearing loss and need for accommodations during the interview process, when should I inform them?

A        You’ll ultimately have to determine this for yourself, but should ask as soon as you perceive you’re having difficulty performing a job function. Whether that’s immediately or years have passed since hiring doesn’t matter, but it’s advisable to do so before you receive a negative performance review.

Q       What constitutes a “reasonable” accommodation for hearing loss under the ADA?

A        Employers are expected to provide accommodations that allow you to match the same performance levels as hearing co-workers in equal positions and enjoy the benefits/perks of employment available to all other employees. For example, management has to enable you to receive informal information communicated to the workplace, make it possible for you to fully participate in meetings, social gatherings, and other employer-sponsored events, and advance professionally. On the other hand, employers can deny any request for an accommodation that would be significantly difficult or expensive to implement. And it’s ultimately your employer, not you, who gets to decide whether your requested accommodation is approved — they can also elect to utilize a cheaper, simpler alternative. The following aren’t considered “reasonable” accommodations legally:

  Eliminating a fundamental job function

  Lowering production standards

  Overlooking code of conduct and other rules violations

  Providing personal use devices, like hearing aids

Q       What should I do if my co-workers or boss make jokes or hassle me because of my hearing difficulties?

A        The ADA prohibits harassing behavior based on disability if and when the jokes, name calling, and similar bad behaviors become so frequent or serious that they create a hostile environment. If this occurs, or if you are demoted or lose your position and can prove that it was based on your hearing loss, you can file an employment discrimination charge against your employer.

While your employer cannot require you to address your hearing loss, wearing hearing aids sends a positive message. It says you’re willing to do whatever it takes to succeed by taking proactive action. Hearing better prevents misunderstandings during critical exchanges with customers, co-workers, and managers. Studies have found that most hard of hearing employees experienced significant improvements in their ability to communicate effectively in most job situations by wearing hearing aids. And if you’re concerned that wearing hearing aids will signal to potential or current employers that you’re “old” or “infirm” please remember that many of the hearing aids available today are so small, they can be nearly invisible to others. Wearing hearing aids is also less noticeable than constantly asking for things to be repeated!  So, whether you’re searching for a job or concerned about keeping the one you have, wearing hearing aids can provide significant advantages.

Lisa Klop AU.D. is an Educational Specialist for Signia brand hearing aids. She is responsible for training customers and sales staff on the brand’s current technology and products. She conducts training sessions in customers’ offices, remotely, via webinars, and at regional and national events.  Areas of particular expertise include hearing assistive technology and the fitting of kids and teens. Prior to joining Signia (then Siemens Hearing Instruments) in 2012, she operated a private dispensing practice for six years.  Other clinical experience includes hospital, ENT, and non-profit clinics. Lisa obtained her doctorate degree in Audiology from Central Michigan University in 2005. 

In an interdisciplinary study published by the Journal of Neurophysiology, researchers Samira Anderson, Jonathan Z. Simon, and Alessandro Presacco found that adults aged 61–73 with normal hearing scored significantly worse on speech understanding in noisy environments than adults aged 18–30 with normal hearing. The researchers are all associated with the UMD’s Brain and Behavior Initiative.

“Evidence of degraded representation of speech in noise, in the aging midbrain and cortex” is part of ongoing research into the so-called cocktail party problem, or the brain’s ability to focus on and process a particular stream of speech in the middle of a noisy environment. This research brings together the fields of hearing and speech science, neuroscience and cognitive science, electrical engineering, biology, and systems science.

The study subjects underwent two different kinds of scans to measure their brains’ electrical activity while they listened to people talk. The researchers were able to see what the subjects’ brains were up to when asked what someone was saying, both in a quiet environment and amidst a level of noise.

The researchers studied two areas of the brain. They looked at the more ‘ancestral’ midbrain area, which most vertebrate animals—all the way down to fish—have, and which does basic processing of all sounds.  They also looked at the cortex, which is particularly large in humans and part of which specializes in speech processing.

In the younger subject group, the midbrain generated a signal that matched its task in each case—looking like speech in the quiet environment, and speech clearly discernable against a noisy background in the noise environment.

But in the older subject group, the quality of the response to the speech signal was degraded even when in the quiet environment, and the response was even worse in the noisy environment.

“For older listeners, even when there isn’t any noise, the brain is already having trouble processing the speech,” said Simon.

Neural signals recorded from cortex showed that younger adults could process speech well in a relatively short amount of time. But the auditory cortex of older test subjects took longer to represent the same amount of information.

Why is this the case? “Part of the comprehension problems experienced by older adults in both quiet and noise conditions could be linked to age-related imbalance between excitatory and inhibitory neural processes in the brain,” Presacco said. “This imbalance could impair the brain’s ability to correctly process auditory stimuli and could be the main cause of the abnormally high cortical response observed in our study.”

“Older people need more time to figure out what a speaker is saying,” Simon noted. “They are dedicating more of their resources and exerting more effort than younger adults when they are listening to speech.”