Like everything else in our micro-chip infused world, hearing aids have morphed dramatically over the last decade or so. My father’s hearing aids were relatively large and visible, even when he was in his early 40's and his hearing loss was not severe. It took a large battery and a lot of power to drive the transistors that connected to the amplifiers in his ears. His were hidden in the ear stem of his glasses, which meant he was stuck with ugly black frames with very large ear stems that were specially made for him. And the buds that were plugged into his ears were very large, like plastic mushrooms expanding out of his ear canals and filling in a good portion of his outer ear.
This was my memory of hearing aids, and the thought so depressed me that I delayed going to a dispenser to order a pair until long after the hearing test at the Boston Guild for the Hard of Hearing.
But when I finally went to the hearing aid dispenser in Belmont, Massachusetts who was recommended by the Guild, I found that the whole universe of hearing aids had changed. There were “in-the-canal” hearing aids (ITC) that were so small as to fit discretely into the canal and be almost invisible from the outside. For more power (and to offset more hearing loss) there were half-shells, and full-shells, and behind the ear hearing aids, each one allowing for larger batteries and therefore more power to offset more hearing loss.
(Note that this was in the early 1990's–today there are even more options, including completely in the canal hearing aids (CIC’s) that are so small as to fit totally inside the canal; as well as “open fit” hearing aids that fit behind the ear and connect to a small wire in the canal)
The most amazing change was digital hearing aids, as opposed to the old analog versions that my dad used. Like the compact disc revolution, digital hearing aids use a computer chip to digitize sound. The sound is then analyzed and adjusted based on your hearing loss profile. Missing a lot in the middle sound spectrum? The hearing aid will goose those frequencies up while holding the upper and lower frequencies level. That is what my profile dictated, reflecting my congenital hearing loss related to the otosclerosis in my stapes.
Digitization also allowed for miniaturization of components–hence the new ITC models.
The audiologist at the dispensary gave me yet another hearing test to confirm the results of the Guild test (measure twice, order once), and she suggested hearing aids from Siemens, then one of the leaders in digital technology. I liked the sound of Siemens–I knew that their HVAC and building management technology was among the best, and who can argue with German engineering? And so, sight unseen, I ordered a pair of ITCs from Siemens, with the guarantee that I could return them within 60 days if I did not like the way they sounded.
The price was $3,800 for the pair. Yes, that is correct, and amazingly to me, hearing aids were not and still are not covered by most medical plans. I did not have the cash available, but I needed these prosthetic devices to be able to hear, and so I did what any red-blooded American would do–I whipped out a credit card.
I often wonder why eyeglasses and dental implants, walkers and replacement limbs and even Viagra are covered by medical insurance but hearing aids are not. Is it because most folks with hearing aids are older, perhaps out of the workforce, and so there is less pressure on traditional corporate plans to include these items? The deaf community is fairly strong and can be militant to protect its interests, but it seems to be dominated by those with total hearing loss from birth–those whom hearing aids will not help. Perhaps this has reduced pressure for coverage in medical plans? Whatever the reason, hearing aids remain one of the prosthetic devices that you must pay for 100% on your own, which is an incredible burden for those of us who need them to be able to function in society.
My dad always had the latest hearing aid technology and personalized adaptations because as a disabled veteran he was treated at VA hospitals (paid for by the Canadian government). Every two or three years he would go in for a test and receive a new set of hearing aids. About the time I got my Siemens he received his first digital set also, and they came with a remote control to raise and lower the volume!
The audiologist injected warm wax into my ear, with a string in the middle to be able to pull it back out when it hardened. Trust me, having someone inject warm wax into your ear is not the most comfortable thing in the world. This became the mold of my ear that was sent to Siemens, who constructed a small shell and inserted the micro technology that would let me hear again.
Three weeks later, I was sitting in her office in Belmont as she opened up a small package and showed me my new ears. I started involuntarily shaking for some reason. She opened a small door on the side of each device and inserted a very small battery, snapped it shut, and gently slid them into my ears. For a second there was nothing, and then I was assaulted by huge booming echoes inside my head. What was that? Damn, it was my own breathing! And I also heard the air conditioning ducts swell and boom with air as the system cycled on above me. It was so loud that I was momentarily disoriented.
The audiologist smiled and asked me to remove them. She opened the battery doors and inserted small cables that were hooked up to her computer and then reinserted the hearing aids in my ears. Now came the really cool part–adjusting the digitization to best meet my personal tastes. By altering the amplification of different frequencies she could make the sounds I heard more acceptable to me. Even though Siemens had pre-set the hearing aids to meet my hearing test profile, they still needed customization.
I realized that I was greedy for sound. I told her I wanted these things pushed up so high that I could hear a mouse’s heartbeat in the walls. I wanted to be able to hear people whispering to each other across a room. But I settled for simply hearing more normal things. She warned me that it would take time to get used to hearing again, and that I should wear the hearing aids for a bit and then take them out until gradually my brain got re-accustomed to sound.
It was a muggy spring afternoon in Belmont. A light rain had fallen while I was getting fitted, and now the sun was breaking through the choppy gray clouds. Sitting in my car parked on the street outside the dispensary, I opened the windows and put the hearing aids back in my ears.
I was aware of the gentle hissing of car tires passing by on the wet road. And I heard a robin chirping in a nearby tree. And I suddenly, spontaneously, broke down sobbing as these sounds that I had not heard in many years washed into my brain and touched my soul. Hearing loss is an emotional as well as physical loss. I realized that my world had become much the poorer for not being to hear simple wonders like tires on a wet road, or the sound of my children sighing in their sleep. And now these amazing sounds were again in my brain. It felt like the world had instantaneously gone from monochromatic to being infused with a rainbow of colors. And it was in equal parts astonishing and disorienting.
At a hockey game at the Boston Garden a few nights later, I had to rip the hearing aids out of my ears. Not so much from the loud crowd noise as from the confusion of being able to hear conversations three rows ahead of me almost as well as I could hear the person sitting next to me. My head was spinning trying to filter out all the new sounds and focus on the ones that mattered. It takes time to retrain the brain.
Now, many years and a dozen sets of hearing aids later, I still have an emotional reaction every time I get a new set of hearing aids that have more power and let me hear well again. But clearly my hearing is declining at an inclining speed, and so I made the decision to have a stapedectomy, to replace the betraying stapes bones with titanium prosthetics, and hopefully stop the conductive bone loss decline (the nerve damage will remain forever). I will always have to wear hearing aids, but perhaps I will be able to stop the progression towards larger and more powerful ones every few years.
They are working now on implanted hearing aids that will let you swim and take showers with the devices installed, and perhaps that is in my future. But one thing I know for sure–I will always be a prosthetic man for the rest of my life.
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